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111 Cards in this Set

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Tanner 1
pre-puberty
Tanner 2
Male: testes enlarge; scrotal skin changes in texture, pigment; scant pubic hair

Female: breast budes; downy pigmented pubic hair
Tanner stage 3
Both: Growth spurt

Male: penis lengthens "pencil penis", scrotum becomes larger; pubic hair increases, darkens, becomes coarse.

Female: breast mound becomes larger; pubic hair increases, darkens, becomes coarse spreads to mons.
Tanner stage 4
Male: increase length and width of penis, darkening of scrotal skin; adult-like pubic hair, not yet spread to medial thighs.

Female: Menarche; areola elevated as second mound above level of breast; adult-like pubic hair not yet spread to medial thigh.
Tanner stage 5
Adult genitalia with pubic hair spread to medial thigh.
Tanner stage 3
Both: Growth spurt

Male: penis lengthens "pencil penis", scrotum becomes larger; pubic hair increases, darkens, becomes coarse.

Female: breast mound becomes larger; pubic hair increases, darkens, becomes coarse spreads to mons.
Tanner stage 4
Male: increase length and width of penis, darkening of scrotal skin; adult-like pubic hair, not yet spread to medial thighs.

Female: Menarche; areola elevated as second mound above level of breast; adult-like pubic hair not yet spread to medial thigh.
Tanner stage 5
Adult genitalia with pubic hair spread to medial thigh.
Tanner stage 3
Both: Growth spurt

Male: penis lengthens "pencil penis", scrotum becomes larger; pubic hair increases, darkens, becomes coarse.

Female: breast mound becomes larger; pubic hair increases, darkens, becomes coarse spreads to mons.
Tanner stage 4
Male: increase length and width of penis, darkening of scrotal skin; adult-like pubic hair, not yet spread to medial thighs.

Female: Menarche; areola elevated as second mound above level of breast; adult-like pubic hair not yet spread to medial thigh.
Tanner stage 5
Adult genitalia with pubic hair spread to medial thigh.
List characteristics of candida vulvovaginitis. What is the antibiotic of choice?
s
Rx:
List characteristics of bacterial vaginosis. What is the antibiotic of choice?
s
Rx:
List characteristics of atrophic vaginitis. What is the antibiotic of choice?
s
Rx:
List characteristics of HSV-2. What is the antibiotic of choice?
s
Rx:
List characteristics of nongonococcal urethritis/ cervicitis. What is the antibiotic of choice?
s
Rx:
List characteristics of gonococcal urethritis / vaginitis. What is the antibiotic of choice?
s
Rx:
List characteristics of trichomoniasis. What is the antibiotic of choice?
s
Rx:
List characteristics of syphilis. What is the antibiotic of choice?
s
Rx:
List characteristics of genital warts. What is the antibiotic of choice?
s
Rx:
What are characteristics of normal/healthy vaginal discharge or vaginal environment?
s
Rx:
What are characteristics of PID? What are the treatments of choice?
s
Rx:
What are pathogens and treatment for acute, uncomplicated UTI?
s
Rx:
What is treatment of acute uncomplicated pyelonephritis (outpatient therapy)?
s
Rx:
Compare pathogens and treatment for epididymitis / epididymoorchitis in men <35y.o. and men >35y.o.
<35y.o. -

>35y.o. -
Rx:
Complaints & clinical findings in acute bacterial prostatitis. What is treatment of choice?
<35y.o. -

>35y.o. -
Rx:
Treatable causes of urinary incontinence:
"diappers"
Rx:
When would you initiate HIV antiretrovial therapy? (i.e. CD4 count, clinical situations)
s
s
Highest rate of HIV transmission is through ___________?
Receptive anal intercourse.

(then insertive anal intercourse, needle stick, receptive vaginal intercourse)
s
Incidence of BPH in men.
50% in men 51-60 y.o.

80% in men 80+ y.o.
s
Drug classes for treatment of BPH. MOA of these drugs.
Alpha-1 receptor blockers

5-Alpha reductase inhibitors
s
At what age do you start screening for Prostate cancer? What is the screening?
50. Start at 45 for men at high risk. PSA and DRE annually.
At what age do you start screening for cervical cancer?
21
Which HPV types are associated with high cervical and colorectal malignancy?
16, 18, 31, 33, 35, 39 have high malignancy rates
Which cause genital warts?
6 and 11 cause warts.
Who would you screen for HIV?
Offer to all patients ages 13-64 regardless of risk factors and all pregnant women.
What is phimosis?
s
What is paraphimosis?
s
Exam findings of hydrocele . . .
s
Exam findings of varicocele. . .
s
Define chyptorchidism. . .
s
Condition characterized by scrotal pain, loss of cremasteric reflex.
testicular torsion
Define menopause.
12 months s/p last menses.
Average age of menopause.
51 y.o.
Pros/Cons of HRT for menopause.
Pros: best treatment for vasomotor sx (i.e. hot flashes), conserves bone density.

Cons: Risks of CVD. Contraindicated in h/o breast, ovarian cancer, stroke, CVD or high risk factors for CVD.
Treatment options for menopausal vasomotor symptoms, emotional lability. . .
HRT; SNRI venlafaxine (Effexor); SSRIs sertraline (Zoloft) and paroxetine (Paxil); Gabapentin (Neurontin); high dose vitamin E, phytoestrogens may help.
Most common etiology of dementia
Alzheimers Disease (50-80%)
Labs for work up of patient with new onset mental status change. . .
CMP
glucose
calcium
LFTs
Vitamin B12, folate
TSH
RPR
CBC with diff
UA, Urine C&S
ECG

maybe: Tox screen, HIV, CT/MRI, PET scan, CXR, ESR
List Alzheimer-Type Dementia pharm treatment.
Vitamin E
Cholinesterase inhibitors (donepezil/Aricept)
N-methyl-D-aspartate receptor antagonist (memantine/Namenda)
Treat depression with SSRIs, MAOIs,
Treat other sx such as pain or infection.
Antipsychotics for agitation, psychosis.
DSM IV criteria for GAD
At least 3 Sx on most days x 6 months:
Excessive anxiety, worry.
Difficulty controlling worry.
Irritabily.
Difficulty concentrating
Sleep disturbance
Physical symptoms - restlessness or feeling on edge, fatigue, muscle tension.
SSRI with longest 1/2 life:
Fluoxetine (Prozac)
SSRI with shortest 1/2 life:
Paroxetine (Paxil)
Why might you avoid prescribing Paxil in the elderly patient?
Side effect of sedation
Which SSRIs are CYP 450 isoenzyme inhibitors?
Fluoxetine (Prozac) and paroxetine (Paxil). Sertraline (Zoloft), but less so.
DXA scan normal result
within 1 SD of "young normal" adult
DXA scan = osteopenia
BMD between 1.0 and 2.5 SD of "young normal" adult
DXA scan = osteoporosis
2.5 SD or more below "young normal" adult
Risk factors for osteoporosis:
s
Who would you treat for osteoporosis?
s
What are treatment options for osteoporosis?
s
What is recommended daily dose of Calcium and Vitamin D for adults >50 y.o.?
s
Clinical features of Rheumatoid arthritis?
s
Clinical features of Osteoarthritis?
s
What labs would you order if you suspect a patient has RA?
s
Indications for imaging in back pain are:
s
First line therapy for prepatellar bursitis is _________.
Joint aspiration.
Chief complaint in diagnosis of lateral epicondylitis?
Decreased grip strength.
Chief complaint in diagnosis of medial epicondylitis?
Decreased grip strength.
Activity that causes medial epicondylitis?
Golf
Activities that causes lateral epicondylitis?
Tennis, hammering, repetitive lifting.
Treatments for acute gout attack are:
Naproxen sodium
colchicine or PO corticosteroid
local steroid injection for those with contraindications to NSAIDs
Where to tophi form in gout?
Areas of cooler body temp: auricles, extensor surface of hands, elbows.
Most problematic joints affected by OA are ____ and ____.
Hips and knees.
Peak age of onset of RA?
20-40 y.o.
Most common site for a cervical disc lesion is:
C5-C6
Most common causes of neck pain are soft tissue abnormalities caused by injury or wear and tear; rarely infection and tumors.
The most common diagnosis for complaint of acute low back pain is:
lumbosacral strain
- Erector spinae muscle often implicated.
- Rarely a precipitating incident; usually the culmination of many events, often in individuals who have poor conditioning or poor posture/scoliosis
-PE will show straightening of lumbosacral curve, normal neuro exam
When is imaging indicated for a patient who complains of back pain?
If suspicious for or to rule out:
cancer/malignancy (i.e. systemic symptoms)
paget's disease
spondylolithesis
scoliosis
trauma
old age (or other risk factors for compression fracture)
osteoporosis
CT or MRI if radiculopathy
Management of lumbosacral strain includes:
ice/heat therapy
gentle stretching and activity
NSAIDs
muscle relaxants (beware of abuse potential)
aerobic and toning exercise
instruction for proper body mechanics
early mobilization leads to better outcomes.
What is reactive arthritis? What are its causes?
Acute nonpurulent arthritis complicating an infection elsewhere in the body. AKA Reiter's Syndrome.
"can't pee, can't see, can't climb a tree"
(asymmetrical oligoarthritis, sausage-shaped finger, cervicitis or acute diarrhea within 1 month of onset of arthritis; conjunctivitis/iritis, genital ulceration or urethritis.
S/P acute bacterial diarrhea (Shigella, salmonella, campylobacter); STDs (chlamydia trachomatis, ureaplasma urealyticum)
T or F:
CCBs may cause increase in GERD symptoms.
True
What may be a clinical presentation in multiple myeloma?
Older age (average 66 yo)
pain in long bones, especially spine
anemia (normocytic, normochromic)
hypercalcemia
renal insufficiency

MM is a neoplastic proliferation in the bone marrow which results in skeletal destruction.
What does AV nicking indicate?
Long standing hypertension.
What is pyrosis?
heartburn
Is a pink-red TM in a screaming child a normal or abnormal finding?
May be normal - hyperemia and flushing of the face that occurs with crying.
A distorted or erythematous TM is suggestive of OM.
Where do direct inguinal hernias occur?
Hesselbach's triangle
Where do indirect inguinal hernias occur?
Internal inguinal ring
What is a common complaint of a man with an inguinal hernia?
scrotal heaviness at the end of the day
What is the MMSE commonly used to assess?
Evaluation for dementia.
What enzymes are elevated with alcoholism?
AST, ALT, GGT

AST will be higher than ALT

GGT may be elevated if AST, ALT are normal - indicates liver damage.
What medications can be used to treat anorexia and bulemia?
SSRIs. Usually in high doses.
What is the rapid HIV test? (i.e. screening test first performed)
ELISA test
What is the confirmatory test for HIV positive result in rapid HIV test?
Western Blot.
A patieint was exposed to HIV through sexual intercourse. He should be followed with screening tests to identify seroconversion for how long?
1 year
Why would lotions (versus creams or ointments) be discouraged in treating atopic dermatitis?
High water content and low oil content of lotions lead to water evaporation on the skin and further skin drying.
What is the drug 5-fluoraouracil (topically) used to treat?
basal cell carcinoma
Which BPH medication provides immediate relief of symptoms?
alpha blockers
What effect do 5-alpha reductase inhibitors have on PSA results?
this drug will reduce PSA levels by 50% or greater within the first 3 months and will sustain this reduction as long as the medication is taken due to MOA of interference with prostatic intracellular androgen response mechanism.
Definition of TIA.
A sudden onset of focal neurological symptoms that lasts less than 24 hours. Not benign. . . Even brief ischemia (infarction begins once an area has been ischemic for 1 hour), can produce irreversible brain damage.
Dietary triggers of gout. . .
High purine foods. Meat, fish, alcohol.
What is the incubation period for a primary scabies infection?
3-4 weeks
Pharm treatment for shingles within 72 hours of onset?
antiviral (acyclovir)
pain meds
What age do you start screening women for osteoporosis?
65 y.o.
What is the minimum time between Hep B vaccines? (also applies to DTaP, IPV and MMR)
1 month
What is the minimum time between varicella vaccines?
3 months
What is normal pressure hydrocephalus?
Symptoms include gait difficulty, cognitive disturbance and urinary incontinence.

CT will show enlarged ventricles.
What are the three most common causes of bacterial diarrhea in the US?
salmonella
campylobacter
shigella
Primary headache red flags:
S
N
O
O
P
normal vaginal pH
3.8-4.2
When evaluating serum creatinine in the elder, the NP considers that:
This value is influenced by glomerular filtration rate.
What would liver enzymes show in a patient with alcoholism?
Elevation of AST and ALT, ratio 2:1. Within 3 x ULN.
Most common 2 causes of acute pancreatitis?
gallstones and alcoholism