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179 Cards in this Set
- Front
- Back
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How much does type II Dm effect CV disease?
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2-4X increased risk
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What three things does type II DM the leading cause of?
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end stage renal disease
adult onset blindness non-traumatic amputation |
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What is the fasting blood glucose levels for type 2 DM?
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above 126
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What is the random blood glucose for type 2 DM?
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+200
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What is the normal HgA1c level ?
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5%
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What are the perdiabetes HgA1c level?
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5.7-6.4%
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What is the diabetes level for HgA1c?
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6.5%
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What are the MACROvascular diseases associated with DMII?
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myocardial infarction, most common cause of death
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How do you prevent macrovascular DMII events?
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weight loss, BP control, and lipid lowering
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What are the microvascular diseases associated with type II DM?
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retinopathy
directly correlated with blood sugar levels |
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What are the hallmarks of microvascular nephropathy from DM?
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microalbuminuira
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What three things must be managed with type II DM?
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HgA1c
BP Cholesterol |
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How do you treat HgA1c >9% with no symptoms?
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start triple therapy
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How do you treat HgA1c >9% with symptoms?
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treat with insulin
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What drug is the cornerstone of dual therapy for DMII?**
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Metformin
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What is thyrotoxicosis?
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excess thyroid hormone action
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What are the clinical features of a hyperthyroid disorder?
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hypermetabolic state
overactive sympathetic nervous system |
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What is the best screen test for hyperthroidisim?
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TSH levels
Low= hyperthyroid |
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What is used to confirm the diagnosis of hyperthyroidism?
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free T4 is HIGH
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What is the triad of graves disease?
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hyperthroidism
exopthalmos pretibial myxedema |
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What is graves disease?
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thyroid stimulating immunoglobulin mimics normal TSH, causing the thyroid to pump out hormones (t3/t4) making an overactive metabolic state
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What are the labs for graves disease?
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low TSH
high free T4 |
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What are the two anti thyroid drugs?
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methimazole
propylthiouracil |
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Which antithyroid drug is perferred during pregnancy?
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propylthiouracil
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What is hashimotos disease?
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under secretion of thyroid hormone
due to autoimmune destruction of the thyroid |
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what antibodies are present in hashimotos disease?
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anti-thyroperoxidase antibodies
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What is the treatment for hashimotos disease (hypothyroidism)
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Levothyroxine- which is dose titrated every 6 weeks until stable dose is achieved
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What causes cushings syndrome?
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most commonly caused by exogenous glucocorticoids*
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What is the most common endogenous cause of cushing syndrome?
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hypersecretion of POMC (pro-opiomelanocortin) by a pituitary adenoma
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What are the symptoms of cushings syndrome?
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HTN
weight gain red/purple striae moon face buffalo hump hirsuitism depression weakness |
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What is the two step diagnosis process for cushing syndrome?
(first step only) |
24hr urinary free cortisol
dexamethason suppression test (used to tell what root cause of the disease is) |
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What is the second step in the two step diagnosis of cushing syndrome?
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identify the cause of the cushings based upon the ACTH level
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What is conn syndrome?
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this is hyperaldosteronism
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What are the symptoms of hyperaldosteronism?
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HTN
hypokalemia Hypernatermia metabolic alkalosis (low K, and high Na+- this is essentially the opposite of spirolactone, an aldosterone antagnosist K+ sparing diuretic) |
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What is the most common cause of secondary HTN?
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hyperaldosteronism
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What are the lab values for hyperaldosteronism?
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elevated ratios of plasma aldosterone concentration vs. plasmin renin activity
high PAC: PRA |
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What is addisons disease?
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inadequate production of glucocorticoids/mineralcorticoids/and androgens
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What is the most common cause of addisons disease?
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autoimmune
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What are the clinical signs of addisons disease?
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chronic fatigue
salt craving hypotension pigmented skin and mucous membranes hyponatremia hypoglycemia hyperkalemia hypercalcemia |
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What is waterhouse-friderichsen syndrome?
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adrenal failure
this is a catastrophic syndrome of overwhelming bacterial infection typically nisseria meningitidis septicemia leads to hypotension, DIC, adrenal hemorrhage |
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How do you diagnose Addisons disease?
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morning serum cortisol levels below 6mg/dL is sugestive of addisons disease
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What is the root cause of non-classical adrenal hyperplasia?
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defect in 21-hydroylase enzyme activity
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What is presentation of nonclassical andrenal hyperplasia?
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decreased cortisol levels
increased ACTH levels-> which increase androgen production |
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What is a pheochromocytoma?
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a catecholamine secreting tumor of the adrenal glands
(puts out NE, epi, Dopa) |
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What are the typical clinical sings of a pheochromacytoma?
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Palpatation, perspiration, headache, temor, pallor, and hypertension thats resistant to treatment
Self limited episodes! |
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How do you diagnose a pheochromacytoma?
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free metanephrines and catecholamines in a 24 hours urine collection
very sensitive and specific |
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What is the pharm treatment for a pheochromacytoma?
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alpha blockers (-osin's)
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When is HCG detectable in pregnancy?
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8-10d post fertilization
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What should the fundal height before for 12 weeks?
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barely above pubix symphysis
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What should the fundal height be for 20 weeks pregnant?
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umbilicus
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What are the diagnostic levels for gastational diabetes?
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1h GTT >130
3 hr OGTT >140 @ 3 hours |
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What are the major problems with gestational diabetes for the fetus?
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increased glucose= increased fetal insulin.
so macrosomnia, and shoulder dystocia |
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What is hyperemesis gravidarum?
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frequent vomiting during early pregnancy
weight loss dehydration acidosis alkalosis hypokalemia |
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What are diamniotic/monochroironic twins at risk for?
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twin/twin transfusion syndrome
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What are the normal respiratory changes during pregnancy?
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increased tidal volume
increased O2, decreased CO2 respiratory Alkalosis (low co2) |
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What are the normal EKG changes during pregnancy?
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ST, T, Q waves, inverted T's
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What are the CXR changes that occur during pregnancy?
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cardiomegaly, heart rotated toward L
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How does insulin sensitivity change in the first 20 weeks of pregnancy?
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insulin sensitivity increases
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What are the risk factors for macrosomia?
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diabetes
obesity post term pregnancy multiparity |
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What are macrosomia babies at risk for?
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birth trauma
shoulder dystocia jaundice hypoglycemia |
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What is the presentation of Erb's palsy?
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weak detoid, infraspinatus, and biceps
waiter's tip! |
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What nerves are damaged in Erb's palsy, and how?
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C5-C6, due to torquing the head away from the arm during birth
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What nerves are injured in klumpkes palsy?
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C8- T1
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What are the physical findings in klumpkes palsy?
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claw hand, forearm is supinated, and the fingers are flexed
(caused by trying to catch yourself, so your hand stays that way) |
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What is teratogenesis like in weeks 1-2?
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this is all or nothing, either aborts, or doesnt affect
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When is treatogenesis most likely?
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weeks 5-10, due to organogenesis
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What are the teratogenic effects of alcohol?
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growth restriction, MR, microcephaly, midfacial hypoplasia, renal/cardiac defects
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What are the teratogenic effects of cocaine?
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bowel atretisa, heart limb facial and GU malformations, IUGR, cerebral infarction, placental abruption
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What is the definition of preeclampsia?
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systolic BP >140, diastolic >90
proteinuria >300mg/24h or 1+ urine dipstick |
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What are the signs a placental abrutption?
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painful
bleeding fetal distress |
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What is the first stage of labor?
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interveal between onset and full dilation.
has two phases, latent and active |
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What is the second stage of labor?
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interval between complete dilation and fetal delivery
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What is the 3rd stage of labor
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the interval after delivery of baby, till delivery of placenta
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what are the 3 P's of succesfful vaginal delivery?
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power
passage passenger |
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What are the two best types of maternal pelvis shapes?
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gynecoid
anthropoid |
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What is the obstetrical conjugate?
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this is the AP diameter between the sacral promontory and the pubic symphysis
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What are the 7 cardinal movements of labor?
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engagement
descent flexion internal rotation extension external rotation restitiution |
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In what types of patients and in what areas of the body should you avoid using a local anesthetic with epinephrine?
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dont use epi- in nose, toes, fingers, penis, and ears.
Also beware in peripheral vascular disease |
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In a patient who is allergic to Novocaine, can you use Xylocaine? Should you use the multidose vial or the single dose vial?
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xylocaine is an amide
while novocaine is an ester there is no cross reactivity between the two types better to use single vials with allergies* |
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Does epinephrine extend or shorten the duration of a local anesthetic?
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this extends the duration of local blocks by preventing wash out
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Which causes less pain: SubQ or intradermal injection?
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subQ injection is less painful
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What can you do to reduce the pain of an injection?
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cooling agent
injecting bacteriostatic saline w/ benzyl alcohol inject benadryl |
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How long does it take EMLA to work and can you use it on broken & unbroken
skin? |
Used only on intact skin*
takes about 1-2 hours to work |
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How long does it take for a digital nerve block to work?
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No epi*
5-10 |
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Describe the direction of pressure used to loosen and lift an ingrown nail. Then
describe the way that the nail is split and removed. |
Pull the nail up against the nail, and away from the nail bed
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What is Phenol used for and what complication can occur with it?
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this is being used to cauterize the germinal tissue with phenol for 3 min.
can have post procedure infection- typically staph |
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How do you differentiate a subungual hematoma from a subungual melanoma,
splinter hemorrhages, and green nail syndrome? |
hematoma is from trauma, and is typically are horizonal
melanoma are longitudinal linear, and may extend into the oft tissue |
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Describe the difference between the procedure for removing a 1-barb versus a 2-
barb fish hook. |
to remove a single barb hook- anestitize its way out, push it through, clip off the tip, then back it out
to remove a double barb, twist hook until sharp end is visible, cut off eye of hook, and pull on sharp end to remove |
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How do you pull out a tick and what should you avoid doing?
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pull perpendicular
dont break off the mouth parts |
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Know how to perform a punch biopsy and how you know if you are through to
the subQ tissue. |
there is a major drop in resistance once the dermis is punched through.
push down next to punch, if it depresses with the skin, you didnt punch deep enough |
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How many mm beyond the margin of the lesion must you freeze for a benign
lesion? |
1-3mm ring of ice around the lesion
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What are the disadvantages and contraindications to cryotherapy?
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cant use with blacks
destorys hair follicles poor ciculation melanomas |
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What type of suture is best for skin and what size is used on the body?
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nylon unbraided is th best, 4-0,5-0 on the body
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What is the preferred technique for biopsy for pigmented lesions?
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excisional biopsy is the best
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Why is a cervical polyp removed?
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these are removed due to symptomology
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When do you need to give tetanus immune globulin?
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if you suspect ?
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what is hutchinsons sign?
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this is subungal melanoma spreading out from under the nail into the surrounding tissue
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What are the two main conditions to think about with pelvic pain (the two worst case scenerios)
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hemorrhagic shock from ectopic pregnancy
septic shock from PID |
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How do recurrent episodes of PID effect fertility?
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these all decrease fertility
1=11% 2=34% 3=54% |
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What is the pain for PID or torsions?
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dull ache
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What is the pain of ectopic pregnancy?
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severe sharp pain
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What does pelvic pain with exercise or coitus suggest?
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ruptured ovarian cyst
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What does pain with/just before menses suggest?
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endometriosis
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What does mid cycle pain suggest?
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mittelscmerz
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What does pelvic pain during or shortly after menses suggest?
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salpingitis
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What age group gets extopic pregnancies?
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20-30 years old
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What age group gets PID?
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15-19 years old
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what test should all women of child bearing age with pelvic pain be given?
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pregnancy test!
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Why should you do a CBC with pelvic pain?
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look for left shifts due to infection
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What is the classical picture of ectopic pregnancy?
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delayed menses, abdominal pain, vaginal bleeding
sudden onset of pain |
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What is the classic picture of PID in women?
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sudden or gradual, colicky pain usually bilateral in lower pelvis.
associated with fever, chills, malaise, vomiting, tenderness, leukocytosis |
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what are the signs of endometriosis?
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constant pain 2-7 days before menses, may radiate to back, thighs, recutum, bladder
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What are the signs of a ruptured corpus luteum cyst?
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sudden onset, severe, intermittent, localized to one adnexa
distended, leukocytosis, cystic adnexal mass |
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What are the signs of uterine fibroids?
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old black females
bleeding mobile non tender smooth masses |
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What are the signs of mittelschmerz?
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sudden onset sharp pain, can be severe, localized to one adnexa. may radiate to ipsilateral shoulder.
has hx of smilar episodes |
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What is the presentation of threatened abortion?
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this is commonly mistaken for ectopic pregnancy
-HCG+, abdominal pain, vaginal bleeding |
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What is a Macule?
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an alteration in skin color that cannot be felt, smaller than .5cm
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What is a patch?
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an alteration in skin color that cannot be felt, bigger than .5cm
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What is a papule?
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palpable solid lesion smaller than .5cm
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what is a plaque?
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palpable solid lesion greater than .5 cm, elevated lesion greater in diameter than in height
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what is a nodule?
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a firm lesion that is thicker or deeper than the average papule or plaque
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What is a tumor?
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this is the same thing as a nodule, only even bigger
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What is a vescicle?
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this is raised, clear fluid filled lesion less than .5 cm in diameter
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What is a bullae?
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a raised clear fluid filled lesion larger than .5 com
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what is a pustule?
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raised lesions that contain pustular material
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What are wheals?
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flat topped palpable lesions of variable size and configuration that represent dermal edema
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What is a cyst?
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enclosed cavity with a lining that can contain a liquid or semisolid material located deep within the skin
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What is a crust?
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remains of blood and pus dried on- this is a 2ndary lesion
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What is an erosion?
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a moist slightly depressed area representing a blister base -this is a 2ndary lesion
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What is an ulcer?
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this is a moist slightly depressed area that represents loss of epidermis AND dermis- this is a 2ndary lesion
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What are scales?
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excess dried epidermal cells -this is a 2ndary lesion
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what is desquamation?
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this is peeling sheets of skin after acute injury - this is a 2ndary lesion
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What is atrophy?
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skin surface is depressed due to thinning- this is a 2ndary lesion
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What is excoriation?
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traumatized area of skin caused by scratching or rubbing - this is a 2ndary lesion
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What are fissures?
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linear wedged shaped cracks -this is a 2ndary lesion
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What is petechiae?
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a deposit of blood less than .5cm -this is a 2ndary lesion
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What is purpura?
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a deposit of blood greater than .5 cm-this is a 2ndary lesion
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What is Lichenification?
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thickening of the skin -this is a 2ndary lesion
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What is dermoscopy?
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using a microscope to look at this skin, used to help figure out where to biopsy- helps diagnose melanoma
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What id Diascopy? what does it differentiate?
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test for blanching by pressing a clear glass slide over something.
hermorrhagic lesions dont blanch while inflammation does |
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What is the inital bite due to a brown recluse spider like?
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painless- and asymptomatic at time of bite
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What is the progression of a brown recluse spider bite?
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hours later it becomes painful, develops ischemia and a necrotic ulcer
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what is the toxin in brown recluse spider bites?
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sphingomyelinase D
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What time of the year do brown recluse spider bites occur?
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summer time usually
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What is the home treatment for brown recluse spider bites?
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rest, cold packs, elevation, and tylenol
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What is a black widow spider bite like?
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this is noticed as a sharp pin prick pain
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What are the symptoms that occur within one hour of a black widow spider bite?
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abdominal pain**
localized or generalized cramping, muscle rigiditiy |
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What is the toxin in a black widow spider bite?
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alpha-Latrotoxin
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What does a-Latrotoxin do?
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this binds nerves and causes NT release
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How do flea bites present?
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groups of 3 (breakfast lunch and dinner) typically on lower legs above sock line
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What do chigger bites look like?
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sylostomes in the dermis.
itchy red papules |
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How long does it take for chigger bites to show up?
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these can delay several hours before they produce intense itching
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What is the classic history with chiggers?
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exposure to grass, itching along waistline and ankles- itching can persist for weeks
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What does the lesion of a lyme disease bite look like?
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this produces erythema migrans, which is an expanding erythematous annular lesion with central clearing
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how long does the erythema migrans take to appear?
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about 3-30days after the bite
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What are the stage 1 effects of lyme disease?
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flu like symptoms, and the bullseye rash
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what are the stage 2 effects of lyme disease?
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cardiac problems, nerological problems like bells palsy
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What are the stage 3 effects of lyme disease?
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arthritis and neruo problems
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What the treatment for lyme disease?
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doxycycline
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What is the agent that casues lyme disease?
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borrelia burgdorferi
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What is the vector for lyme disease?
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ixodes scapularis (deer tick)
ixodes pacificus |
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What is the presentation of scabies infection?
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debilitating tiching, often worse at night
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Where on the body do scabies usually infect?
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finger webs, and flexor creases
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What is the Tx for scabies?
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Permethrin cream all over body.
no need to treat pets |
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What is Impetigo?
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this is transient papules with thin roofed vesicles or pustles that erode and produce honey crusted lesions
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what are the causative agents of impetigo?
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staph aures, or GABHS
bullous is typically GABHS |
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What is the treatment for impetigo?
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mupirocin- nonbullous (staph a)
dicloaxacillin/cephalexin - bullous (GABHS) |
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What is the typical cause of folliculitis?
|
staph A
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What causes hottub folliculitis?
|
pseudomonas aeruginoas
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What is the important prodrome of herpes zoster?
|
pain precedes the rash, following a dermatome patter
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What is the presentation of herpes zoster?
|
rash doesnt cross midline
rule of 7's, 7days of vesciles 7 days of crust 7 days till rash is gone |
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What bad about the tip of the nose being involved in herpes zoster?
|
puts them at risk for ocular complications
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Who gets zostavax?
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all adults over 60 years old regardless of hx of shingles
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what is the treatment for shingles?
|
acyclovir or valacyclovir- given within 72 hours of onset of symptoms
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what is a common presentation of herpes simplex in kids?
|
ginigvostomaitis
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What is herpetic whitlow?
|
herpes of the distal fingers
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What causes molluscum contagiosum?
|
DNA pox virus
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What causes hand foot mouth disease?
|
coxsackie A16
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What is the presentation of hand foot mouth disease
|
a self limited exanthem-enathem
lesions on the bottocks, and hand, foot, and mouth rash involves palms and soles** |
