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137 Cards in this Set
- Front
- Back
- 3rd side (hint)
In 1999 what percent of the US population was 65 or older?
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13% or 34.5 mllion
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What age group will increase the fastest?
A. 50 and over B. 65 and over C. 75 and over D. 85 and over |
D. 85 and over
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Increased Mortality of older adults is due to
A. Widowhood B. Death of family, especially siblings. C. Recognizing declining function. D. None of the above E. All the above. |
E. All the above.
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What percentage of elderly live in poverty? Consider an apartment complex with six apartments. How many of the residents are poor who live there?
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17% or 1/6
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Atchley has identified 5 stages of retirement. What are they?
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Remote phase - anticipation but no preparation.
Near phase - Reality is evident, beginning to prepare. Honeymoon phase - immed after retirement. Epheuoria. Trying to do all they didn't do while working Financial limitations. Disenchantment phase - "let-down" Reorientation - more realstic choices and alternate souces of satisfaction |
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In what culture is old age a triumph. HTN is their major issue.
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African Amercans
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What culture expects their family to care for the elderly. Old age is considered a blessing.
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Asian
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In what culture is youth valued and elderly are instutionalized?
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Caucasian
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What culture believe their states of health and illness are actions of God. Older relatives are held in high esteem.
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Hispanics
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The people of this culture have a strong sense of identity and shared beliefs. Their religious traditions are of great importance.
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Jewish American
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HTN Pharm Choice for Heart Failure.
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No CCB See Hint card
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Give Thiazide, BB, ACEI, ARB, Aldosterone Antagonist
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HTN Pharm choice for Post MI
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No thiazide, no ARB, no CCB
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Give BB, ACEI, aldosterone antagonist
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HTN Pharm Choice for high CVD risk. See hint card.
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No aldosterone antagoinst
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Give thiazide, BB, ACEI, CCB
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HTN Pharm Choice for Chronic Kidney disease
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No thiazide, beta blocker, CCB. See hint card.
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Give ACEI and ARB
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HTN Pharm Choice for Diabetes
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No aldosterone antagonist, See hint card.
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Give thiazide, BB, ACEI, ARB, CCB
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HTN for stroke prevention
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No ARB, CCB, BB, Aldosterone antagonist. See hint card.
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Give Thiazide, ACEI
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What condtion do you not give ARB?
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Stroke preventon and Heart Failure
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What condition do you not give a thiazide?
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Kidney disease and post MI
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What condition do you not give ACEI?
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It is OK for all conditions
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What condition do you not give CCB?
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Heart Failure, Post MI, Chronic kidney disease, recurrent stroke prevention
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What condition do you not give a BB? Can't PP, then no BB.
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Chronic kidney disease, Recurrent kidney disease
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What condion do you not give Aldosterone Antagonist?
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Diabetes, Chronic kidney disease, Recurrent stroke prevention.
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A list of Loop Diuretics
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Furosemde, Bumetanide (Bumex), Torsemide (demedex)
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A list of Potassium-sparing diuretics
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Amiloride, spironolactone, triamterene
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A list of Beta Blockers
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Propanolol, nadolol (corgard), penbutolol, atenolol (tenormin), metoprolol (lopressor), among many others
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Name some beta-blockers with some alpha-1 blocking activity
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labetolol (trandate), carvediol (coreg)
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A list of ACEI
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Benzapril (lotensin), Catopril (capoten), Enalapril (vasotec), lisinopril (zestril), Ramipril (altace). Notice the ****Pril's
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A list of ARBs
You can get a tan on ARB beach. |
Notice the "tans." Losartan (cozaar), valsartan (diovan), irbesartan (avapro), Olmesartan (benicar), among others
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A list of Calcium Channel Blockers
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Diltiazem (cardizem), amlodipine (norvasc), verapamil (calan), amont others. Note the "pines."
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A list of Alpha 1 antagonists
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Doxazosn (cardura), Prazosin (minipress), Terazosin (hytrin)
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A list of centrally acting alpha agonists. Consider the Child psychiatric CENTER.
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Clonidine, Gunafacine (tenex), methydopa (aldomet).
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A list of vasodilators. That means you get more blood to places, like your scalp.
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Minoxidil (loniten), Hydralazine (apresoline).
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Skin: Morphology
Abscess |
Localized collection of purulent fluid in a cavity formed by disintegration or necrosis of tissues >1cm
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Skin: Morphology
Bulla (blister) |
Circumscrised elevation of skin >=1 cm in diam. containing liquid membranous lining and containing fluid or semisolid material. Blister on the foot.
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Skin: Morphology
Cyst |
Closed cavity or sac (norm or abnorm) with an epithelial, endothelial or membranous lining and containing fluid or semisolid material.
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Skin: Morphology
Macule |
Circumscribed flat area of skin, different in color or texture from its surrounding tissue <1cm diam. with a patch being larger
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Skin: Morphology
Nodule |
Solid mass of the skin with can be observed as an elevation or can be palpated, usually 1 cm in diam or more
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Skin: Morphology
Papule |
Small solid elevation of the skin, <1cm in diam.
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Skin: Morphology
Patch |
Large macule >1 cm in diam
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Skin: Morphology
Plaque |
Elevated area of skin >1cm with relatively broad flat surface which appears like a plateau in cross-section; may have the same subdivision as mentioned under papule: Classic is psoriasis
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Skin: Morphology
Pustule |
A visiblue accumulation of purulent fluid in the skin <1cm
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Skin: Morphology
Tumor |
Enlargement of the tissues by normal or pathological material or cells that form a mass; may be inflammatory or a begign or a malignant new growth of cells or tissue.
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Skin: Morphology
Vesicle |
A curcumstribed elevation of the skin <1cm in diameter and containing a serous fluid.
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Skin: Morphology
Wheal |
Elevated white or pink compressible, evanescent papule or plaque produced by dermal edema; a red, axon-mediated flare often surrounds it: associated commonly with allergic reactions.
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Skin: Configuration
Annular |
Circular, begins in center and spreads to periphery
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Skin: Morphology
Confluent |
Lesions run together
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Skin: Morphology
Grouped |
lesion cluster
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Skin: Morphology
Gyrate |
twisted, streak, line, stripe
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Skin: Morphology
Linear |
Scratch, streak, line, stripe
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Skin: Morphology
Polycyclic |
annular lesions merge
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Skin: Morphology
Solitary or discrete |
Individual and distinct lesions that remain separate
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Skin: Morphology
Target |
Iris, resembles iris of eye, lesions with concentric rings of color.
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Skin: Morphology
Zosteriform |
Liner arrangement along a nerve route.
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Skin
Impetigo. |
Skin infection caused by staph, primary lesion is a thin walled vesicle that breaks easily. There is lateral extension of the superficial leasion with HONEY COLORED CRUST at the edge.
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Skin
Carbuncle |
Necrotizng infection of skin and subcutaneous tissue composed of a grou of furnucles (boils) - staph - much larger than furucle, may heal with significant scarring.
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Skin
cellulitis |
Inflamation of cellular tissue, particularly purulent inflamation of dermis, subcutaneus tissue and soft tissue.
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Skin: Fungal infections
Candida Balanitis |
inflamation of superficial tissues of penile head caused by candid albicans
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Skin: Fungal infections
Candida Intertrigo |
irritation of the folds of the skin, common in warm moist body areas like underarms, groin, under breasts, under folds of skin of abdomen of persons who are obese.
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Skin: Fungal infections
Tinea capitus |
scalp (trichophyton 80% or microsporum) tx with selsun blue (NEVER head and shoulders)
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Skin: Fungal infections
Tinea corporis |
Ringworm (trichophyton or microsporum)
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Skin: Fungal infections
Tinea crusis |
Jock itch
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Skin: Fungal infections
Tinea pedis or mannum |
pedis, athletes foot and mannum hand. Tx. Aluminum subacetate sol. soaks (if dry, use miconozole, etc.; powder if wet)
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Skin: Fungal infections
Tinea unquim |
onchomycosis, toe nails T. rubrum 80% of all cases
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Skin: Fungal infections
Tinea Versicolor |
Hypo/hyperpigmentaton macules on limbs. fungual infection of the skin caused by the yeast Pityrosprum orbiculare). Tx with selsun blue (on at night, bathes in am.)
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Keratoses and Skin Cancers:
Actinic Keratoses |
small patches that occur on sun exposed parts of the body. Asymptomatic and consicered premalignant although 1:1000 leasions per year grogress to squamous cell carcinoma. Rough in texture. May be tender.
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Keratoses and Skin Cancers:
Squamous cell cancer. No treatment needed. |
Arise out of actinic keratoses and develop in the course of a few months. Has 3-7% potential for mets. Occurs subsequent to prolonged sun exposure on exposed parts in fair skinned individuals who sunburn easily. Friable (bleeds easily). Surgical excision
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Keratoses and Skin Cancers:
Seborrheic Keratosis |
Benign skin lesions, common in elderly. Appears "stuck on" and is 3-20 mm in dm.
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Keratoses and Skin Cancers:
Basal Cell Carcinoma |
THE MOST COMMON SKIN CANCER. Found mostly in 60-70 Y/O. Papule or nodule that may have a central scab or erosion. Most common on face. Little risk of mets, but cosmetic deformity f untreated for prolonged period. Surgical excision.
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Keratoses and Skin Cancers:
Malignant Melanoma |
Highest mortality rate of all skin ca with median age of 40 at dx. May metastasize to any organ. Rapid or indolent (slow) growth. Asymmetry Border irregularity Color variation D>6 mm Elevation Enlargement
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Keratoses and Skin Cancers:
Atopic Dermatitis (eczema) |
intense itching along a typical pattern of distribution with remission and and exacerbation. Sensitive to low humidity, winter, triggered by sweating, ointments, hot baths and animal dander.
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Keratoses and Skin Cancers:
Allergic Contact Dermatitis |
Acute or chronic condition characterized by skin inflammation at the site of contact with chemicals or allergens.
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Keratoses and Skin Cancers:
Psoriasis |
Benign hyperproliferative inflammation of the skin that can be acute or chronic; Koebners phenomenon: Injury or irritation tends to induce lesions of psoriasis. Has pitting of the nails strongly suggests psoriasis, Auspitz sign - droplets of blood when scales removed.
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Keratoses and Skin Cancers:
Pityriasis Rosea |
Mild, acute inflammatory disorder, more common in females (50% more than males) 1-30 age group, sprin and fall seasons; self limiting. Initial lesion 2-10 cm "herald patch". Christmas tree pattern - follows cleavage lines on the trunk.
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Keratoses and Skin Cancers:
Lyme Disease |
Most common vector born disease in the us. Multisystem inflammatory disorder caused by spirochete transmission. Distinctive "bulls-eye" macular or popular rash. Flu like, sick, fever,chills.
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Keratoses and Skin Cancers:
Warts |
Common: Children and young adult
Filiform: found near moth, beard, periorbital and paranasal. Flat: forhead, back of hands, mouth and beard area Plantar: point of maximum pressure. Genital: HPV most common viral STD. |
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Pyelonephritis is a bacterial infection in the kidney and renal pelvis. What are the two F's that are the hallmark symptoms?
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Fever and Flank pain
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What is the key symptom of a lower UTI?
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Dysuria
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What is the treatment of choice for geriatric UTI's?
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Trimethprim/Suflamethoxazole DS BID x 7-10 days and ciprofloxacin 250 mg BID X 7-10 days.
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What are the instructions for taking Boniva (Ibandronate)?
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Take 1 hr. before eating and sit up 1 hr. after.
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What are the instructions for taking Foxamax (alendronate)?
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Take 30 min. before eating and sit up for 30 min. after.
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What is the daily requirement for a woman over 65 for calcium?
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1500 mg
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What is the main reason for osteoporosis?
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Hypoestrogen.
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What are the risks of HRT?
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MI, DVT, Breast Ca.
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A woman has a breast lump that is firm, fixed, and non-tender. What is it likely to be?
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Cancer
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A lump palpated that is mobile, tender, and squishy, what is it likely to be?
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Fibrocystic or a lipoma.
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Regarding the symptoms of PDD (premenstrual dysphoric disorder), what is the time element.
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It occurs 7-10 days prior to menses and ends when the menses begins.
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The difference between the symptoms of a UTI and epididymitis is what?
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Scrotal edema.
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What tests are done for epididymitis?
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STD, Urine Culture, and scrotal ultrasonography if condition worses or febrile episodes unresponsive to antibiotics.
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Regarding ipididymitis, there is a positive phrens. What is that?
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Lift the scrotum and it feels better. If there is torsion there is a negative phrens.
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Acute Bacterial Prostatitis. What are the symptoms?
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Fever/chills, low back pain, dysuria, urgency/frequency, nocturia. The PE: fever. prostate on palpation is very painful, it is swollen, may be warm and tender, may be firm or boggy.
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Treatment for prostatits is what?
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Over 35 years old, Bacrim DS BID for 2-4 weeks.
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BPH is the most common cause of bladder obstruction in men over 50 years old. What treats it?
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Terazocin or Prazocin.
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PSA tests for prostatic specific antigens. What is the lowest normal to be concerned about?
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4 ng/ml. If it is 10 there is almost surely prostate cancer.
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What percent of patients have a normal PSA, yet are diagnosed with prostate cancer.
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40%
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Which should come first; PSA or DRE?
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PSA. A DRE can increase the PSA.
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Who definitely should be on a medication for BPH?
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Men over 50 with BPH.
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Regarding AIDS, the killer pneumonia is no longer PCP, but now Pneumocystis jirovecii (PJP). What is the prophylactic treatment?
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Bactrim DS.
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What is the most common allergic reaction?
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Allergic drug eruption.
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What is the treatment for an allergy to a drug.
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Stop the drug and use an antihistamine for itching.
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What is the most common dermatological problem among elderly?
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Itching, or senile pruritis.
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What are some symptoms of frost bite?
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numbness, pain, tingling, burning sensation. 1st through 4 degree issues like a burn.
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Treatment for frost bite.
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Don't touch, rub, or use pressure.
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Causes of Cellulitis
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Prior trauma, underlying skin lesion, diabetes, pedal edema, and venous and lymphatic compromise.
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What does cellulitis look like?
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It is tender, pain, swelling, red and warm. sounds like infection to me.
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Proten is measured by?
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Albumin. Below 3.5% indicated protein malnutrition and retards healing
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B12 deficiency may result in what?
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Anemia, depression, anorexia, fatigue
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Vitamin C. What happens with too much or too little?
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Too much can cause anorexia and gastric irritation. Too little can cause scurvy. No evidence it helps wound healing.
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What is Vitamin E good for?
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Cardiovascular, memory, antioxidant, immunity. Caution - may act as anticoagulant.
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Iron supplements can cause what?
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Anorexia, diarrhea, constipation.
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What are some causes of dysphagia?
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Myasthenia gravis, Parkinson's disease,CVA, Amyotrophic lateral sclerosis, MS, Bulbar poliomyelitis, Polyneuropathies, Muscular dystrophies, endocrine myopathy/structural lesions, CA, Cricoid Webs, Anterior cervical osteophytes, postsurgical scarring, inflammatory lesions.
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What is Odynophagia?
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Painful swallowing.
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Workup for dysphagia.
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R/O metabolic, endocrine pathology, barium swallow, endoscopy, esophageal manometry (motility disorders), CXR for aspiration, Refer to SLP, GI, Dentist, neurologist.
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Cachexia
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Increased protein breakdown, metabolic demands, changed protein synthesis, increased cytokinin producion.
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Cachexia is a syndrome manifested by?
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anorexia, weight loss, metabolic alterations and weakness.
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Cachexia is associated with?
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Cancer, pulmonary disease, end-stage cardiac, RA, end stage dementia. Cardiac disease associated cachexia / incr BMR, protein synthesis, enteropathy and early satiety resulting in protein losses.
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Management of cachexia.
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Treat underlying pathology, control pain, manage depression, manage early satiety, deal with fatigue, control GI upset/N/V, address xerostoma.
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Labs for workup
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CBC with diff, B12, folate, lipids, liver panel, lytes, ca, Phosophorous,BUN, Creat, thyroid profile, Glucose.
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Pharmacokinetic changes and the elderly.
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Absorption: No change
Distribution: less lean body mass can cause increased plasma concentration. Metab: decreased liver metab, blood flow and body mass leads to prolonged drug effects. Excretion: Decreased GFR, tubular secretion, and renal mass reduces renal clearance on most drugs. |
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Receptor changes in elderly.
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May up or down regulate with age.
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Common Adverse Reactions in elderly.
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CNS: sedation, memory loss, dizziness, depression, confusion.
Anticholinergic: Blurred vision, urinary retention, constipation dry mouth. Effects on movement and balance Effects on bone and supporting structures. |
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Most common Drugs to cause CNS S/E
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Benzo's, antipsychotics, beta-blockers, steroids, cimetidine, reserpine, narcotics, diuretics.
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Most common drugs to cause anticholinergic S/E
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Cholinergic agonists, tricyclic antidepressants, antipsychotics
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Most common drugs to cause S/E on balance and movement.
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Neuroleptics, metronidazole, phenytoin, ASA, aminoglycosides, furosemide, beta-blockers, vasodilators, metoclopramide.
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Most common drugs to cause S/E on bone and supporting structures.
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Steroids, heparin, Li.
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Issues related to safe drug use.
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45% are reported for nonadherence, multiple medication: over age 65 medicaid pts take over 13 drugs per year.
More OTC. Often use medications belonging to someone else and often herbs |
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Risks associated with polypharmacy.
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Increased morbidity,medical expense, AE, incidence of depression,nursing home admission.
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OTC offenders to polypharmacy.
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Cimetidine, Niacin, antacids, laxatives, CA (may decrease absorbance of thyroid hormones), tetracyclines.
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Herbal agents that complicate polypharmacy.
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Aloe (PO): incr. cardiac glycosides and thiazides.
Feverfew: potentiates anticoagulants. Garlic: potentiates oral antidiabetics. Gingko: potentiates anticoagulants. Ginseng: decreases effect of furosemide and has estrogen effects. Hawthorn: interacts with antihypertensives and cardiac medicines. St. John's Wort: incr. s/e of SSRI's. Kava-kava: increases effects of benzo's, etoh. and other cns depressants. Licorice: conraindicated in pts taking cardiac glycosides and thiazides. Green tea: potentiates anticoags. |
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How much acetaminophen is toxic?
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over 4G/day
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If patient is allergic to PCN what are they likely allergic to?
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Cephalosporins
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Antibiotics with renal clearance:
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PCN, Cephalosporins, Aminoglycosides, Quinolones, tetracyclines, vancomycin.
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Antibiotics with hepatic clearance:
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Macrolides (azithromycin, clarithromycin, erythromycin), Clindamycin, Flagyl (also renal), Linezolid [(Zyvox) also cleared by renal.]
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Antifungals cleared by renal
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Amphotericin, Flucytosine, Fluconazole, Ketoconazole (also hepatic), Miconazole (also hepatic).
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Antifungals cleared by liver.
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Griseofulvin, Itraconazole.
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Warfarin monitoring, used for systemic embolism.
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To prevent embolism INR should be 2.0-3.0 (target 2.5). If INR is elevated above 5 the next doses are held until it is back in range. May use VITK to reverse effects within 24 hours.
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Heparin IV used for venous thrombosis and PE; monitoring.
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CBC with platelets Q 3 days.
PTT 6 hours after bolus and 6 hours after each dosage result. Monitor PTT Q 24 hours and readjust heparin drip prn. |
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Antidote to heparin?
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Protamine Sulfate. DO NOT USE IN PATIENTS ALLERGIC TO FISH.
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