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1160 Cards in this Set
- Front
- Back
- 3rd side (hint)
Where are growth hormones secreted
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Anterior pituitary gland
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Give s+s of acromegaly
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excessive acral growth, facial features, sweating, HA, peripheral neuropathy, decrase energy osteoarthitis, depression, galactorrhea
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Give physical exam of acromegaly
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earliest most common: facial puffiness, broad nose, furrow brow, skin thickening
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What is the Diagnostic for acromegaly
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Definitive test is the oral glucose tolerance test: GH secretion should be suppressed by oral glucose load
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What is the management of acromegaly
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Co-mange with endocrinologist, cure is reduction in IGF-I to age adjust normal and suppressed GH after oral glucose testing to less than 1ng/ml. Somatostatin (octreotide) and dopamine agnonist (bromocriptine)
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Agromegaly and patient education
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life long chronic progressive disease, physical changes don't remit w/ therapy. But may slow down or stop just cant reverse.
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Addisons (adrenal gland disorder): define
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destruction or reduction in adrenal gland
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S+S of Addison disease
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N/V, hypotension, acute shock (trauma or illness). Chronic: n/v, dizzy, chronic abd pain, hyperpigment, lethargy weakness
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PE how do patients with addison look
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chronically ill, dehydrated
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What diagnostic test are needed for Addison disease
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Elevated ACTH and suppressed cortisol, hyponatremia, hypercalemia (CMP), CXray (exclude TB)
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Management of Addison disease (chronic)
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oral hydrocortisone 20-30mg/d (restore diurnal pattern) and fludrocortisone (0.05-0.2mg/d) correct renal and hypotension.
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What is the management of acute adrenal insufficiency
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IV hydrocortisone 100mg q 6hr for 24hr then taper. hypotension, hypovolemia, hypoglycemia ICU
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What is patient education of Addison Disease
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med adjust w/ fever and common illness (hydrocortison doubled quickly) never stop steroids quickly
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Define Cushings (basic)
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Over production of cortisol (adrenal disease)
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What are S+S of chronic changes of Cushings disease
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weight loss, loss of menses, libido, depression ,insomnia, bruising
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What do you find on PE of Cushings disease
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exogenous/central obesity, moon face, thickening facial fat, buffalo hump
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What diagnostic do you perform for Cushings
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24hr urine cortisol levels repeated 2-3x
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What is the management of Cushings
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Depends on source of hypercortisolism: pituitary resection, Chemo,
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What do you find on PE of pheochromocytoma:
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HTN >170systolic, arrhymias, tachy or brady
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Initial eval of alcoholic would include what
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CAGE
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What part of an alcoholics life is usually affect last between family, health, realtionships, work.
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Work is affected last
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What are the 5 stages of Prochaska's change framework
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1. Precontemplation: not interested in change
2. contemplation: consider change & pos/neg aspects 3. Preparation: makes some change to behaviors or thoughts but feeling of no tools to proceed 4. action: ready to make change 5. maintenance/relaps: learns to continue the change and deal w/ backsliding |
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What are the 3 steps for alcohol screening according to NIH
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1. ask about use
2 assess for alcohol problems 3. advise appropriate action 4. monitor patient progress |
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How soon after stopping due alcohol w/ drawals begin, and peak.
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begin in 12 hrs after last drink and peak 24-48hrs w/ abatement over few days.
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What are sx of alcohol w/drawal
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agitation, hallucination , disorientation, seizures
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What medication is useful for alcohol w/drawals:
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benzodiazepines: ativan.
also tx dehydration, malnourishment, infection |
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What are some inpatient detox criteria for the alcoholic?
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other acute illness (infection, cardiac), alcohol related sx prior to detox, prior w/drawal sx of delirium tremors or seizures, coexisting mental health like depression
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What benzodazapine should be used on an alcoholic w/ hepatic dysfunction
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lorazepam (or other short acting)
if no hepatic deficiency then valium |
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What role do antipsychotic play in managing w/drawal of alcohol
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no role, they are not used in alcohol w/drawals
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What medication is used for the physical sx of alcohol w/drawal such as tachycardia or tremors?
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beta blocker (propanolol, atenolol)
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What do you use for nutritional deficencies in alcoholics
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high dose B vitamin and supplement of thiamine, pyridoxine, folic acid and vit C
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Which is more specific for hepatic damage: ALT or AST
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ALT: more specific to liver due to limited concentration in other organs. U should ID the ration of AST/ALT in alcoholics
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How many criteria must be met diagnose substance abuse?
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three of the following:
-tolerance (need for increase intake to produce same result) -Withdrawal (substance needed to stop w/drawal sx) -use amount or duration of use greater than intended -repeat attempts to stop w/o success -to much time spent using, recovering or trying to obtain -reducing or abandoning social, occupation, rec activities due to use -cont use despite knowing it causes problems |
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Who have higher rates of misuse of prescription medication? men or women
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women: thought to be due to higher use of health system
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Which benzodiazapine has a higher abuse potential: short or long acting
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rapid-onset or as needed basis increase abuse potential.
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Name on benzodiazapine that has long half life and slow onset...which also decreases risk of dependence
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clonazepam
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What is the first dosing step to discontinue benzodiapine in a patient that is psycholigically dependent
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reduce dose by 25% per week.
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How quickly does the onset of w/drawals begin with benzos
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a few days w/ shorter half life (lorazepam) and up to 3 wks w. longer half life (clonazepam)
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What are physical sx of benzo w/drawals?
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HTN, tachycardia, diarrhea, nausea, hyperthermia, restlessness, myalgia, lacrimation , rhinorrhea
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What alpha-adrenergic antagonist help minimize opiod w/drawal
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clonidine (also works on HTN)
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What is a medication that is used in the tx of w/drawal of heroin but also has addictive qualities
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methadone
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What are risk associated w/ chronic marijuana use
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COPD, driving impairment
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What drug class is Rohypnol
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benzodiazapines
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What is the DSM-IV criteria for anorexia nervosa:
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inability or refusal to maintain body weight
-85% normal weight for height -intense fear of gaining weight and becoming fat, -perception of body weight and shape |
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what r the 2 types of anorexia demonstrated:
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restricting (intake) and no binge and binge-purge in cycles (not secretive like bulimia nervousa
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Treating anorexia nervosa includes both
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cognitive-behavioral and pharm
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What medication can be used to increase appetite and reduce anxiety in anorexia
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Cyproheptadine (Periactin)
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DSM-IV criteria for bulimia nervosa
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eating excessive for a discrete period w/ lack of control then binge, laxative, diuretic or fasting
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Sx of bulimia
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hypokalemia, dental enamel erosion, parotid gland enlargement
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Sx of anorexia
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lanugo, dysrhythmias, hepatomegaly, cheilosis, gum disease, dry skin, hypotension w/ bradycardia, hypothermia
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What r the pharm tx of bulimia
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antidepressants: SSRI
Wellbutrin should not be used may increase bingeing or seizure |
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What are the characteristics of binge eating and how does it differ from bulimia nervosa
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lack of control over amount and type of food, at least 6 months, distress, self anger sham over amount eaten. There is no purging with this type they are usually obese
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Depression diagnosis typically includes:
a. early morning wakening b. unable to fall asleep c. hyper state d. none |
early morning wakening
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DSM-IV criteria for depression
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5 or more sx for 2 wks:
-mood, diurnal variation (morning worse than later in day) -interest: lack of former pleasure -eating: increase or decrease w/ weight change -sleep: waking at 3-4am w/ inability to fall back asleep -motor activiy: agitated or retarted -fatigue: lack of energy -self-worth: inappropriate guilt -concentration: difficulty, indecisiveness -repeated thoughts about death or suicide -depressed mood or decrease interest must be one of them |
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What are the difference between depression and dementia
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dementia: cognitive changes slowly over years w/ depression much shorter
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What would u consider the dx in a person taking benzo for anxiety but feeling worse
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depression
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psychomotor agitation w/ fidgeting and irritabilty found in patients w/ depression: what age group is this found
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kids and adolescents and Type A adults
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What are the combined approach for depression tx:
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interpersonal therapy and pharm: interpersonal alone has 60% relapse
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Dysthmia: define
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low -level daily depression w/ at least two previously ID depressive sx in 2 years (adults) 1yr (child)
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A change in feeling such as "feelig good to be alive for the first time" would be found in what dx
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dysthmic
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What is the dx of major depression (criteria)
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depressed mood >3m after death or loss
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What is the tx for adjustment disorder
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interpersonal therapy
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SSRI: Paxil what are the indications, A/Rxn,
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: panic disorder, depression, OCD
A/Rx: sedating (HS best), constipation, antihistamine increase appetite, comments: good if hepatic dysfunction, good in elderly due to short T1/2 life. use slow tapering to decrease w/drawal effect |
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SSRI: Zoloft: indication, adverse rxn
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depression, panic, OCD:
Adverse: GI upset, sleep disturbance comment: take w/ food to enhance absorption |
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SSRI: Celexa and Lexapro: indication, Adverse rxn
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Depression,
Rxn: somnolence and insomnia, agitation and anorexia comment: lexapro has better adverse rxn profile vs celexa |
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SSRI: Prozac: indication, rxn
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depression, OCD, bulimia
rxn: energizing, anorexia common comment: am dosing, long 1/2 life bad for elderly, weight loss not sustained |
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What is the mechanism of action of antidepressants
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increase availability of selected neurotransmitter (serotonin, norepinephrine, dopamine)
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How long do SSRI S/E usually last.
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2-6wks,
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Tricyclics: Effexor: indication, rxn
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depression
stimulant in larger amounts, need trazodone to help w/ sleep, Nausea at high dose, increase dystolic by 5 comment: SSRI in low doses, dopamine effect at high dose |
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What antidepressant is useful in those with substance abuse too
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wellbutrin (dont use in anorexia)
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What are some tricyclic antidepressants
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nortriptyline, desipramine
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Sx of SSRI w/drawal syndrome
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dizziness, paresthesia, anxiety, nausea, sleep disturbance, insomnia
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Serontonin activity on 5-HT1A receptor sites is used to Tx:
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antidepressant, OCD, antipanic, antisocial
comment: action site basis of most antidepressant, antipanic |
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Which antidepressants should be used in place of tricyclics if there is risk of suicide
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SSRI and atypcial antideperssants due to their increase safety profile
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Required length of pharm intervention in depression per AHCPR guidelines
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6-9m:
-acute phase tx to bring sx under control may last 3m -cont med for minimum of 6m after depression remission -relapse highest in first 2 m after discontinuation of therapy consider maintenance as w/ any chronic illness |
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What are some risks in depression relapse
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dysthmia preceding episode
-poor recovery between episodes -current episodes >2yrs -onset depression <20yrs or >50yrs -FHx of depresssion -severe sx such as suicide or psychosis |
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Seotonin receptor site: 5-HT1C, 5-HT2C: activity when stimulated
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influence CSF production, cerebral circulation, regualtion fo sleep. perception of pain, cardio function
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comment: reason tachycardia, dizziness, alteration of sleep pattern and change in pain perception occurs w/ SSRI
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Serotonin receptor site: 5-HT1D activity when stimulted (triptans)
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antimigraine activity; triptan preparation works by stimulating receptor site, TCA works at this site
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Serotonin receptor site: 5-Ht2 activty when stimulated
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agitation, akathisia, anxiety, panic, insomnia, sexual dysfunction, excessive upregulated in those w/ depression
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receptor site highly stimulated in activating SSRI such as fluoxetine. causes sexual dysfunctioni n SSRI,
-nefazodone and trazodone antagonize action at this site and tx of anxious depression and have more favorable sexual profile |
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Serotonin receptor site: 5-HT3 activity when stimulated
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nausea, GI distress, diarrhea, HA
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stimulated w/ antidepressant w/ poor GI side effect profile. Zofran blocks activity at site (5-HT3 antagonist)
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Which class has more side-effects: TCA or SSRI
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TCA but are superior to SSRI when depresion is moderat to severe also w/ patients w/ pain
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Depression w/ episodes of mania is dx w/:
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bipolar I disorder
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Mania:
-grandiosity or exaggerates selft esteem -reduced need for sleep -increased talkativeness -flight of ideas or racing thoughts -easy distractibility -psychomotor agitation -poor judgement for at least 1 wk |
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Bipolar 1 disorder is most common in: Men or women
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Women: onset around puberty
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Dx of Bipolar 2 is made if
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depression has episodes of mania lasting less than 4 days w/ little social incapacitation (remain productive)
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Cyclothymic disorder includes:
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mood disorder present 2yrs w/ episodes of mania lasting less than 4 days
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If a TCA is given to a person with bipolar disord what do 15% develop?
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mania
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What is a classic sx of anxiety as it relates to sleep
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difficulty initiating sleep (depression is waking early)
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What is the onset rate of benzodiazepine:
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rapid onset
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Buspiorn (BuSpar) has: high, moderate or low abuse potential?
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low abuse potential
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New onset of panic disorder findings would include:
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peak sx 10min, hx of agoraphobia, chest pain during attack
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What med is used for panic disorder
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Paxil (SSRI antidepressant)
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Diagnostic criteria for generalized anxiety include
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difficulty concentrating apprehension, irritability
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According to the AHCPR tx guidelines pharm tx for anxiety should be continued for how long
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6m AFTER remission is achieved
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Which medication may mimic anxiety disorder:
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sympathomimetic
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Rapid w/drawal of lorazapam will result in what side effect
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tremors and hallucinations
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Risk of benzodiazepine misuse minimized if a: longer, shorter or rescue (PRN) dose is perscribed
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longer duration of action
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PTSD may report having:
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agoraphobia (panic attack), feeling of detachment, hyperarousal
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Pharm tx for PTSD include
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Buspirone (BuSpar)
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Pharm Tx for irritability and impulsiveness in PTSD
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carbamazepine: Tegratol (anticonvulsant)
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OTC herbal used for sx of depression
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St. John Wart
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Tx resistant panic disorder may respond to
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monoamin oxidase inhibitor
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Tx of pt w/ panic disorder using SSRI w/ the goal being?
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reduction in number and severity of panic attacks is the goal
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DSM-IV criteria GAD (generalized anxiety disorder)
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-excessive anxiety or worry most days for 6m
-difficulty controlling worry, physical or mental distress -problems cannot be attributed to med or alcohol, disease or other condition -3 of the following: muscle tension, restlessness, fatigue, difficulty concentrating, irritability, difficulty initiating sleep |
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Depression w/ anxiety reports: which first
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nervous feeling after onset of depressed mood
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Cardinal presenting signs of anxiety disorder:
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tachycardia, hyperventilation, palpitation, tremors, sweating, difficulty falling asleep
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What mechanism of action do benzo have for anxiety disorders
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enhance GABA function and products that enhance availablity of serotonin
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Which benzo are more lipophilic and why is this important in tx of anxiety
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valium or clonazepam: enter brain more rapidly and igniting effect promptly (may feel intoxicating)
note: longer half life left in fat. |
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Which benzo are more hydrophilic and why is that important
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slower onset of action less intoxicating same therapeutic effect
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Which benz may be better for tx anxiety in the elderly
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Serax: short half life
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When working to reduce amount of benzo used how much should you decrease it:
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25% per wk
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What are sx of w/drawal of benzo w/ rapid removal of med
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tremors, hallucination, seizures, delirium tremors
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What is the average onset age of panic disorders
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27 years rare after 45 more common in women if also agoraphobia
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What is the tx of choice for panic disorders
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SSRI: low side effects better than TCA
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What is the saying when starting SSRI treatment for panic attach
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start low and go slow: Paxil is a good starting w/ low side effect
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What medication is used in PTSD w/ hyperarousal:
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clonidine and propanolol: trazadone for sleep
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OTC Herb: St. Johns wort: Are similar to what medications
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like MAOI/SSRI, TCA:
less anticholinergic effect, wieght gain than TCA -similar potential for energizing such as fluoxeting (SSRI) -TId or QID dosing needed; avoid concurrent use w/ SSRI, TCA or MAO |
I
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What does the BATHE Model stand for (used in emotionally distressed)
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B: background
A: affect, anxiety T:trouble H: handling E: empathy |
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What are the progestatinal effects when taking oral contraceptives
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inhibit ovulation by suppressing lutenizing hormone (LH), thickening endocervical mucus and hampering implantation by endometrial atrophy
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What are the estrogenic effects when taking oral contraceptives
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ovulation inhibited by suppression of follicle stimulating hormone (FSH) and LH by alteration of endometrial cellular structure
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How long after discontinuing oral contraception should you wait to conceive.
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you do not have to wait
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what are non-contraceptive benfits of oral contraceptives
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1. lower rates of benign breast tumors and dysmenorrhea,
2. menstral volume reduced 60%, 3. decreased rates of Fe deficiency anemia, 4. decrease endometrail , ovarian, breast cancer if used >5yrs, 6. less PID due to increase endocervical lining, 7. acne, hirsutism, ovarian cyst, PMS, rheumatoid arthritis sx |
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What should you do if you vomit w/in 2hrs of taking oral contraceptive
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retake dose
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If you miss taking an oral contraceptive of 30-35ug, what should you do to ensure continued prevention of pregnancy?
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if using 30-35ug
-1 or 2 active pill then: tak as soon as possible and continue taking daily (no additional protection needed. -Missed >3d ro start a pack 3 day late: take active hormonal pill ASAP an dcontineu pills daily and use condoms or abstain until 7 days of active pills |
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If missed oral contraceptiv of 20ug or less ethinyl estrodiol
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missed 1 active pill then:
take active pill ASAP and continue pills daily (no other protection) Missed >2d or start 2d late then: take hormonal pill ASAP use condom for 7 d |
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A women with seizures would do better on what type of contraception
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depo-provera: due to progestin protection against seizures.
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What class of contraception have potassium sparing qualities
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drospirenone in yasmin (progestin) use w/ caution in hepatic or renal dysfunction
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What additional medication can reduce breakthrough bleeding when using depo
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ibuprofen, naproxen BID for 3-5 days
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what supplement should be encouraged when taking depo:
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calcium at 1000-1500mg/day
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What is the soonest that a diaphragm may be removed after sex
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6hrs should use a spermacide with the diaphragm
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A woman w/ recurrent UTI would or would not be a good candidate for a diaphrahm:
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would not due to the need for spermacide
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WHO precaution for OC
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DVT, CHD, CVA, heart disease, breast cancer, prego, laction <6wk pp, hepatitis, HA w/ neuro sx, >35, smoker>20cig day known thromboic mutation factor V Leiden
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What percentage of women experience hot flashes during menopause
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80% have hot flashes and night sweat
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Estrogen deficient vaginitis: what lab finding would u find
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vaginal pH >5
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53y/o on hormone therapy w/ conjugated euqine estrogen having vaginitis sx should also take what topical and where
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topical estrogen to the vagina
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relative contraindication to postmenopausal HT include:
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seizure disorder, dyslipidemia, migraine headache
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Absolute contraindication to postmenopausal HT
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endometrial cancer
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When advising perimenopausal women about HT you consider a benefit to include:
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HT helps preserve bone density and reduce risk of osteoporosis
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post menopausal HT effects on bones include:
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reduction in frequency of spinal and hip fx
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Progestin component of HT is given to:
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minimize endometrial hyperplasia
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Selective estrogen receptor modulator therapy (Evista) helps:
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in the reduction of osteoporosis and breast cancer risk
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during perimenopause sx will most likely:
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be in the week before the onse to menses
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What is noted in short=term <1-2yrs HRT use in post menoausal
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HRT can minimize menopausal sx
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What body area has highest estrogen receptor sights
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vulva
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What sx are tx when using black cohosh use in menopause?
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decreased frequency and severity of hot flashes
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Adding androgen to HT may well be suited for woman w/
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sever hot flashes in spite of maximized estrogen therapy
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typical HT regimen containts---of estrogen dose of oral contracetpive
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1/4th
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Black cohosh during perimenopause will likely do what physiologically:
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bind to estrogen receptors decreasing side effects of premenopause
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Why do menopausal women get hot flashes
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Lutinizing Hormone surge/flucuations in estrogen in 80% of women. surgical menopausal women have more sever sx
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What deficiency during menopause increase risk of osteoporosis
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estrogen
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Why do you use progestin during HT versus just estorgen:
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endometrial cancer risk and breast cancer (contraindicated in hx of breast cancer)
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Which of the following are absolute contraindication to postmenopausal estrogen therapy?
a. unexplained vag bleed b. breast cancer c. acute liver disease d. all of the above |
-unexplained vag bleed
-acute liver disease -thrombotic disease -endometrial cancer -neuro-opthalmologic vascular -breast cancer |
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What are relative contraindication to postmenopausal estrogen therapy
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seizure disorder, dyslipidemia, migraine, thromobophlebitis, gallbladder disease. absolute: vag bleed, coagulation disorder until corrected
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Tamoxifin is a SERM that locks out estrogen effects on what body part
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breast
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urge incontinence define and intervention
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involuntary loss of urine: behavioral, voiding schedule
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What medication is used for urge incontinence
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terodiline (selective muscarinic receptor antagonist) relaxes smooth muscle and bladder pressure
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urge incontinence: most common in elderly: what is the Sx, Tx
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sensation need to empty bladder cant be controlled, involuntary loss
Tx: avoid stimulants, gental bladder stretch by delay void, reduce bladder contration w/ detrol or ditropan |
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What Sx, Tx of stress incontinence:
path: weak pelvic floor and urethral muscle. Found in women rare in men: |
Sx: sneeze, exercise, cough results in urine loss.
Tx: kegel, support w/ vag tampon, urethral stent, pessary use. Topical estorgen, phenylpropanolamin (alpha agonist) |
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Urethral obstruciton: of outflow (prostatic, stricture, tumor. Older men: sx tx
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dribbling post-void and urge incontinence on presentation
Tx: treat urethral obstruction |
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transient incontinence results from what underlying process:
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delirium, UTI, medication, restricted activity (bed ridden). tx underlying process, discontinue offending medication
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What is common in women during reproductive years:
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vag pH of 4.5 or less
-lactobacillus predominant vag organism -thick, white vag secretion during luteal phase |
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What does vag discharge appear during ovulation?
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stingy and clear
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Vaginal itch w/ perineal excoriation, erythema, white, clumping discharge: microscope would reveal
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hyphae (yeast in budding form)
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Bacterial vag presents w/
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malodorous discharge
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tx of vulvovaginitis by Candida albicans:
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clotrimazole cream (lotrimin) antifungal : tx thrush, ringworm, athletes foot
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1wk thin, green-yellow vag discharge w/ perivag irritation; vag eryth, petechial hem on cervix, WBC, motile organ what is the dx
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trichomoniasis
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Tx of trichomoniasis
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metronidazole (flagyl) antibiotic: Tx also C. diff, H. pylori other parasitic infection
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Tx for bacterial vaginosis:
|
oral metronidazole (flagyl), clindamycin cream, oral clindamycin (Cleocin)
|
|
|
w/o sx but partner has dysuria w/o discharge, she has friable cervix covered in thick yellow discharge what is the infection
|
chlamydia trachomoatis
|
|
|
Tx for N. gonorrhoeae
|
Ceftriaxone (Rocephin), or cefixime (suprax): used also in ear and throat infections
|
|
|
Gonococal infections are symptomatic in most males: true or false
|
false: most are asymptomatic
|
|
|
Complications of Gonococcal and chlamydial GU infection in women include:
|
PID, tubal scarring, peritonitis
|
|
|
Initial complaints in women w/ HPV-2
|
painful ulcer, inguinal lymphadenopathy, thin vaginal discharge
|
|
|
Tx for HHV-2 genital infection
|
famciclovir: also used to tx herpes zoster (shingles)
|
|
|
What would you prescribe for chlamydia infection
|
doxycycline, erythtromycin, azithromycin (best) efficacy
|
|
|
What is the incubation of Gonnorrhea: how do women infected present
|
1-5days: dysuria, milky purulent blood tinged discharge
|
|
|
Lymphogranuloma venerum: clinical presentation and tx
|
vesicular or ulcerative leasion on external genitalia w/ inguinal lymphadenitis or buboes
Tx: doxycycline 100mg BID x 21d or E-mycin 500mg QID x 21d |
|
|
nongonococcal urethritis and cervicitis (not pregnant): PE and Tx
|
-PE: cervicitis, irritative void sx, mucopurulent discharge
-Tx: Azithromycin 1 g PO single dose or doxy 100mg BID x7d alt: E-mycin 500mg QIDx7d or levofloxacin 500mg QD x7d |
|
|
Gonococcal urethritis (not pregnant): PE and Tx
|
irritative void sx, purulent discharge
single dose for uncomplicated: -cefixime 400mg po, cetriaxone 125mg IM or cipro concurrently tx w/ Azithro 1g x1, doxy 100mg bid if chlamydial infection not ruled out. may consider spectinomycin |
|
|
Pelvic inflammatory disease: PE and Tx
|
irritative void, fever, Cervical motion tenderness
TX: a: ofloxacin 400mg bid or levo 500mg QD w/ or w/o metronidazole 500mg BID x 14d B: ceftriaxone 250mg IM plus doxy100mg BID x 14d w/ or w/o metronidazole 500mg bid x 14 |
|
|
trichomoniasis: PE and Tx
|
dysuria, itching, vulvovaginal irritation, dyspareunia, yellow-greeen vag discharge, cervical petechial hemorrhage (strawberry spots), motile organism and WBC on microscope
TX: metronidazole 2 g x1, metronidazole 500mg BID x 7 d |
|
|
Bacterial vaginosis PE and Tx
|
clue cells, pos whiff test,increase volume discharge: thin, gray, buring, pruritis: pH >4.5, few WBC
-CDC: metronidazole (flagyl) 500mg Bid x 7d, 1 applicator 5g intravaginally QD x 5d or clindamycin cream 2%, 1 applicator intravag at HS x 7d |
|
|
candidiasis: PE and tx
|
PE: itching, burning, thick white to yellow discharge, vulvovaginal excoriation, erythema: HYphae, pH<5
Tx: miconazole (antifungal), fluconazole, terconazole |
|
|
chancroid: PE and tx
|
painless genital ulcer
Azithro (macrolide) 1g oral x1 or ceftriaxone (cephlasporin/Rocephin) 250mg IM x1, or cipro 500 BIDx3d or Emycin (Macrolide) 500tidx7d |
|
|
Genital Herpes: PE and tx
|
PE: painful ulcerated lesion, lymphadenopathy, thin vag discharge if lesion near vagina or introitus.
- Tx: inital: acyclovir 400tidx7-10d or famciclovir 250tidx7-10d or valacyclovir 1g bidx7-10d |
|
|
genital warts (condyloma acuminata): PE and tx
|
verruca-form lesions or may subclincial unrecognized
|
tx: podofilox 0.5% solution or imiquimod 5%:
cryotherapy, tricholroacetic acid, surgical |
|
Pelvic inflammaotry disease presents w/
|
dysuria, cervical motion tenderness, diffuse abd pain abnormal vag bleed, GI, fever
|
|
|
Most common pathogen in pelvic inflammatory disease
|
c. trachomatits
|
|
|
Tx for Pelvic inflammatory allergic to PNC:
|
ofloxacin w/ metronidazole
|
|
|
What labs should be obtained w/ Pelvic inflammatory
|
elevated ESR or C-reactive protein, leukocytosis w/ neutrophilia
|
|
|
Tx of pelvic inflammatory may include
|
ceftriaxone 250mg IM x 1, followed by doxy 100bidx2wks
|
|
|
sequelae to genital condyloma may include
|
cervical carcinoma
|
|
|
Describe condyloma lesions
|
verruciform: Shaped like a wart or warts
|
|
|
tx for condyloma acuminatum
|
imiquimod (Aldara)
|
|
|
What HPV type cause condyloma
|
HSV 6 and 11
|
|
|
What strain of HPV most often in cervical cancer
|
HPV 16 and 18
|
|
|
% of anogenital and cervical cancer caused by HPV
|
95%
|
|
|
Mechanism of action of imiquimod (aldara)
|
immune modulator condyloma acuminatum
|
|
|
Sx usually present after how many weeks upon contact w/ syphilis
|
2-4 wks after contact
|
|
|
HPV type cause condyloma
|
HSV 6 and 11
|
|
|
what is present w/ primary syphilis
|
painless ulcer, palpable inguinal nodes, spontaneously healing lesion
|
|
|
HPV most often in cervical cancer
|
HPV 16 and 18
|
|
|
% of anogenital and cervical cancer caused by HPV
|
95%
|
|
|
What is present in secondary syphilis
|
generalized rash, arthraligia, lymphadenopathy
|
|
|
What is imiquimod (aldara) used for?
a. actinic keratosis b. superficial basal cell carcinoma c. genital and anal warts d. all of the above |
D. actinic keratosis, basal cell carcinoma, genital warts:
It is an immune response modifier |
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
Sx usually present after how many weeks upon contact w/ syphilis
|
2-4 wks after contact
|
|
|
what is first line tx of syphilis
|
penicillin
|
|
|
HPV type cause condyloma
|
HSV 6 and 11
|
|
|
what is present w/ primary syphilis
|
painless ulcer, palpable inguinal nodes, spontaneously healing lesion
|
|
|
HPV most often in cervical cancer
|
HPV 16 and 18
|
|
|
What is present in secondary syphilis
|
generalized rash, arthraligia, lymphadenopathy
|
|
|
% of anogenital and cervical cancer caused by HPV
|
95%
|
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
Mechanism of action of imiquimod (aldara)
|
immune modulator condyloma acuminatum
|
|
|
what is first line tx of syphilis
|
penicillin
|
|
|
Sx usually present after how many weeks upon contact w/ syphilis
|
2-4 wks after contact
|
|
|
what is present w/ primary syphilis
|
painless ulcer, palpable inguinal nodes, spontaneously healing lesion
|
|
|
What is present in secondary syphilis
|
generalized rash, arthraligia, lymphadenopathy
|
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
what is first line tx of syphilis
|
penicillin
|
|
|
What is the name of a fertilized ovum?
|
Zygote
|
|
|
What is the "baby" called up to 2 weeks postconception?
|
blastocyst: stage prior to embryo forming, lots of cell division
|
|
|
Stage: 8-12wks post conception is called
|
Embryo
|
|
|
A nongravida uterus would be the size of a
|
large lemon
|
|
|
An 8 weeks uterus woudl be the size of a
|
tennis ball/ orange
|
|
|
At 10 wks uterus would be the size of a
|
baseball
|
|
|
At 16wks the fundus of the uterus would be in what location
|
halfway between the symphysis pubis and umbilicus
|
|
|
At 20 wks the fundus should be at what land mark
|
the umbilicus
|
|
|
What % of babies are in the vertex position by 36th wk of preg
|
95%
|
|
|
What is recommended weight gain durign pregnancy w/ normal BMI
|
25-35lbs
|
|
|
Normal BMI: what is the average daily intake ontop of normal calories during pregnancy
|
300 kcal
|
|
|
Normal BMI: waht is daily calorie requirement on top of normal diet when lactating:
|
500 kcal
|
|
|
Waht is the recommended Ca intake during pregnancy
|
1200-1500
|
|
|
Maternal Fe is greatest in what part of pregnancy
|
second and third trimester
|
|
|
What is the most common acquired anemia during pregnancy:
|
iron deficiency
|
|
|
Give an example of neural tube defect:
|
anencephaly, spina bifida, encephalocele
|
|
|
What is the leading causes of preventable fetal mental retardation
|
fetal alcohol syndrome
|
|
|
risk associated with Pica intake:
|
constipation, bowel obstruction, nutritional deficiency
|
|
|
How much does blood volume increase at 42 wks. 25%, 50%, 75%
|
50%
|
|
|
Drop in diastolic BP is most notable in what trimester
|
second
|
|
|
S1 heart sound become louder or quieter during pregnancy
|
Louder
|
|
|
What type of murmur becomes evident during pregnancy
|
physiologic systolic ejection
|
|
|
What happens to the renal collecting system during pregancy:
|
it dialates
|
|
|
Is it common to find physiologic glucosuria and proteinuria during pregnancy
|
Yess: it is common to find glucosuria and proteinuria
|
|
|
What happens to the transvers thoracid diameter and diaphragmatic contraction
|
it increases in size
|
|
|
What happens to the lower esophageal sphincter during pregnancy
|
the lower sphinchter relaxes
|
|
|
What happens to the intestines regarding motility during pregnancy
|
the intestine slows down
|
|
|
What happens to the gallbladder during pregancy
|
the gallbladder doubles in size
|
|
|
What happens to insulin levels during pregnancy
|
they increase 2-10 fold
|
|
|
What happens to fasting plasma glucose during pregnancy
|
It should remain the same, test for gestational diabetes
|
|
|
What is Hegars Sign in pregnancy
|
uterine isthmus become soft and compressible
|
|
|
What is Chadwicks sign
|
Cervix color and texture change becoming cyanotic
|
|
|
What is Goodwells sign
|
Cervix becomes less firm
|
|
|
What happens to the breast during pregnancy
|
nipples, areolae darken and increase in size. Venous congestion
|
|
|
What happens to breast tissue during pregnancy
|
increase nodules due to proliferation of lactiferous glands
|
|
|
What happens to the blood during pregnancy
|
volume increases by 40-50% peak at 32 wks, RBC production increase by 33%
|
|
|
Why does dilutional physiologic anemia occur during pregnancy
|
the RBC increase by 33%
|
|
|
What happens to the renal system during pregnancy
|
increased blood flow and GFR, dilation of renal collecting
|
|
|
Why does the physiologic glucosuria and proteinuria occur during pregnancy
|
The GFR increases so renal cant reabsorb glucose and protein
|
|
|
What happens to tidal volume and residual volume late in pregnancy
|
Tidal volume increases and residual volume is reduced
|
|
|
What happens to the digestive system during pregnancy
|
lower esophageal sphincter relaxes due to pressure, intestine and stomach slow to allow absorption on nutrients
|
|
|
What happens to the gallbaldder during pregnancy
|
it doubles in siz, dilute bile and increase risk of stones
|
|
|
What account for weight gain in a health pregnancy
|
first half: maternal weight change
Second half: components of pregnancy |
|
|
When should the triple screen be done: wks
|
16-20 wks
|
|
|
How often are visits during 28-32 wks
|
every 2 wks
|
|
|
List the appropriate weight gain during pregnancy at
<19wks, 19-26, 26-29, >29wks |
a. 28-40lbs
b. 25-36lb c. 15-25lb d:15+lbs |
|
|
What prenatal care: first visit:
|
pap smear, rubella titer, PPD, VDRL, RPR, HIV, Blood type, antibody screen, GC/chlamydia, Hg electrophoresis (african, asian), UA urin C&s
|
|
|
Fetal loss occurs in 1 in ____ amniocentesis
|
1:200 deaths
|
|
|
What may be causes of an elevated Alpha-fetoprotein (AFP)?
|
underestimated gestational age, open neural tube defect, meningomyelocele
|
|
|
What are some pregnancy test from 16-20 wks
24-28wks 28-32 wks |
16-20: triple marker/screen US
24-28: 1-hr glucose load; if Rh neg, T&Screen 28-32: Hg, STI testing as indicated (HIV, HBsAg, GC, chamydia) RhoGram |
|
|
What are the pregnancy care test: 32-36wks, 35-37 wks, 40-42wks, 41+wks
|
32-36 fetal presntation, kick count (fetal movements ?4 in 1 hr;>10 in 2 hr)
35-37: grp B stretpococcus culture (rectal and vag) 40-42: vag exam to assess cervical ripness, fetal station 41+ Nonstress test, biophysical profile |
|
|
Edwards syndrome is from trisomy:
|
18
|
|
|
Edward syndrome most kids live a full life: true or false
|
false: most affected infants die during first year of life
|
|
|
what is a major risk factor for being born w/ down's syndrome
|
born to women older than 35yrs
|
|
|
Downs syndrome is from trisomy
|
21
|
|
|
What are the components of the triple screen test in pregnancy
|
AFP, hCG, unconjugated estriol
|
|
|
What are two test to assess for congenital defects in utero
|
amniocentesis or chorionic vilus sampling
|
|
|
What are the physical findings of edward syndrome
|
low birth weight, mental retartation, cranial, cardiac renal malformation
|
|
|
What are examples of neural tube defects:
|
meningomyelocele, anencephaly, spina bifida
|
|
|
Where is alph-fetoprotein synthesized in fetus
|
yolk sac, GI tract, liver
|
|
|
What can lead to misinterpreted AFP test: it can be higher in earlier pregnancy
|
underestimate gestational age
|
|
|
What is the most sensitive marker for detecting trisomy 21
|
increase hCG level: Low hCG indicates trisomy 18
|
|
|
Triple screen is not diagnostic they are used in pregnacy to...
|
assess for risk of nural tube defect
|
|
|
Medication most commonly pass through placenta via:
|
passive diffusion
|
|
|
What is the category for safe for use in pregnancy:
|
cat: a
|
|
|
Med that cause teratogenic in humans but benefit outweights risk of use in life threat assigned cat
|
cat: D
|
|
|
Which of medication is pregnacy risk D: Misoprostol, Captopril, Cefuroxime, regular insulin
|
Captopril (ACE-I) HTN HF med (capoten)
|
|
|
Drugs cause teratogenic in animals but not in human assign preg risk:
|
Cat: C
|
|
|
Preg at 38wks w/ UTI may tx w/
|
Amoxicillin w/ clavulanate
|
|
|
Preg w/ asthma; when may bronchospasm worsen?
|
29-36wks
|
|
|
Preg w/ acute bacterial rhinosinusistis may tx w/
|
amoxicillin, cefuroxime, azithromycine but NOT levofloxacin
|
|
|
according to IDSA duration for antibiotics for tx of UTI during preg is:
|
7 days
|
|
|
SSRI w/ drawal syndreom best characterized as
|
bothersome but not life threatening
|
|
|
The placenta is best able to transport what type of substance
|
Lipophilic
|
|
|
2nd trimester w/ migraine Ha best tx would be
|
Ibuprofen
|
|
|
SSRI during preg: study has shown the affects on infants later in life
|
had no observable difference
|
|
|
SSRI w/ longest half-life:
|
Fluoxetine (Prozac)
|
|
|
Most commonly used medication during 1st trimester in pregnancy
|
antibiotics
|
|
|
Benzodiazipine w/ drawal risk includes
|
Seizures
|
|
|
Tx of chronic asthma in patients that are preg is:
|
short-acting beta agonist
|
|
|
24wks preg w/ acute asthma flare should be given:
|
montelukast (singulair): a leukotriene receptor antagonist (LTRA)
|
|
|
Drug know to be harmful to fetus given cat
|
X
|
|
|
Sertraline is preg risk cat;
|
cat: D (pos evidence of fetal risk) may is specific cases still be used. Doxy, ARB, ACE-I
|
|
|
Clonazepam in preg is cat: B,C,D,X
|
cat: D (pos evidence of fetal risk)
|
|
|
Bupripion (wellbutrin, zyban) during preg is cat:
|
cat: B (none in animal but no study in humans (PNC, cephalosporins, Acetaminophen)
|
|
|
Tricyclic antidepressants during preg are cat risk:
|
cat: D
|
|
|
Antimicrobial that is Cat B used in preg infection is:
|
erythromycin
|
|
|
PNC are preg cat risk:
|
Cat: B
|
|
|
What uropahtogens are capable of reducing urinary nitrates to nitrites
|
E. Coli, Proteus spp., Klebsiella pneumonia
|
|
|
In Preg asymptomatic bacteruria should be:
|
Tx to avoid complicated UTI
|
|
|
Common UTI organism in preg
|
E. Coli
|
|
|
Length of antimicrobial for preg w/ asymptomatic bacteria
|
3-7d
|
|
|
What does teratogenic?
|
substance that has potential to create a characteristic set of malformation in fetus
|
|
|
When is the teratogenic period:
|
between day 31 and 81 following last menstral period: organanogenis is taking place
|
|
|
What are three factors in drugs passing through the placenta
|
lipohilicity (higher the easier)
Molecular weight <500g/mol maternal drug levels |
|
|
Can a preg receive insulin or heparin?
|
Yes because they have higher molecular weight that can not pass through the placenta
|
|
|
Which is better during preg: benadryl or claritin (loratadine)
|
Claritin: more hydrophilic so causes less S/E to fetus
|
|
|
Define Preg Cat B, C, D, X
|
B is best , C w/ caution, D for danger, X (cross the drugs off the list)
|
|
|
Why is bronchospasm worse between 29-36 wks in preg?
|
increase esophageal irritation from GERD: esophageal sphincter loosens due to increase pressure
|
|
|
What cat are inhaled (and oral) corticosteroids and Beta agonist in preg: B, C, D, X
|
cat: C no proof human injury but some in animals
|
|
|
What is the preventative tx for N/V in preg
|
tx H. pylori, ginger, Ca antacid q2hr for 2-3d. B6 is preventative
|
|
|
What is the tx for migraines in preg
|
tylenol and nsaid (except term due to risk of antiplatelet effect)
|
|
|
What can be used for migraine during preg to attenuate HA sx
|
lidocaine 4% to affected nostril
|
|
|
What meds can be given to preg w/ major depression?
|
serotonin and dopamine receptor modulators, tricyclic and benzo
|
|
|
Bupropion (dopamine receptor modulator) is a cat B , SSRIs are cat C. Should you switch to bupropion during preg.
|
No. switching can increase depression
|
|
|
How do you taper down SSRI to prevent w/drawal syndrome
|
taper 25% of total dose over a week
|
|
|
What are the S/E of SSRI w/drawal:
|
jitteriness, nausea, sleep disturbance: worse w/ fluoxetine (longer half life)
|
|
|
How long can effects of SSRI last in fetus
|
30days may cause w/drawal such as irritability protracted crying shivering
|
|
|
Tricyclics and benz are what cat for preg
|
Cat D rarely prescribed during preg
|
|
|
Taper dose down all benzo prior to preg by 25% week to prevent
|
w/drawals of tremors, hallucination, seizures, delirium termens
|
|
|
What are sequela events that can occur from asymptomatic bacteriuria, in preg
|
acute cystitis, pyelonephritis, UTI
|
|
|
Why should a urine culture be obtain in all women early in preg?
|
Risk of UTI from asymptomatic bacteriuria.
|
|
|
Define Hales lactation risk cat:
L1 and L2 |
L1: safest (cromolyn, APAP, depo (1m post birth)
L2: safer, limited study: nitrofuratoin, cephalosporins, 2nd gen antihistamines, prednisone, SSRI |
|
|
Define Hales lactation risk cat:
L3 and L4 |
L3: mod safe, no controlled studies or limited: TMP-SMX, Fq antibiotics, 1st gen antihistamines
|
|
|
Define hales lactation risk cat: L5
|
contraindiated: radioactive isotopes, cocaine
|
|
|
What wk in preg is preeclampsia noted?
|
20th
|
|
|
What are risk factors for preeclampsia?
|
age <16->40, first preg or first pre w/ new partner, pregestational diabetes, presense of collagen vascular, HTN, Renal, FHx,
|
|
|
What are sx of severe preeclampsia?
|
BP >160/110, proteinuria (>5), hepatic, renal or CNS damage
|
|
|
What are the components of HELLP in preeclampsia?
|
Hemolysis, elevated liver, low platelet and eclampsia
|
|
|
What is the most important intervention of preeclampsia?
|
High suspicion w/ high risk: the OB consult: rest,monitor, antiHTN, anticonvulsant
|
|
|
what is the definitive tx of eclampsia?
|
Birth
|
|
|
When does grp B streptococcus colonize typically in preg and when does it trnsfer to fetus?
|
during 1st wk of preg, and when water breaks or onset of labor
|
|
|
When should Group Beta Testing in preg occur?
|
35-37wks: trnsf to baby when labor begins
|
|
|
Define Chronic HTN vs Gestational HTN:
|
chronic: HTN prior preg, prior to 20th wk, persist >6wks post
gestational: HTN after 20 wk but resolving w/in 6wks post |
|
|
Define:
Preeclampsia, Eclampsia |
- PreEclampsia: HTN after 20wk w/ protein uria >300mg/24hr and edema
- Eclampsia: PreEclampsia sx w/ tonic-clonic seizures or alt mental status |
|
|
HTN Cat in Preg:
HELLP |
PreE w/ elevated hepatic enzyme levels and low platelets
|
|
|
What does the acronym BATHE stand for in domestic violence?
|
B:background: home work
A: affect, anxiety: feel T: trouble: worries H: handling: support, intervention E: empathy: |
|
|
define inevitable abortion?
|
US w/ viable preg but +vag bleed
|
|
|
define threatened abortion?
|
uterine contents process being expelled
|
|
|
Define incomplete abortion?
|
some portion of product remain in uterus but no longer viable
|
|
|
Quantitative serum HcG doubles every ___hrs the 1st wk of pregnancy?
|
48 hours
|
|
|
Where are 95% of ectopics located?
|
fallopian tubes
|
|
|
What is the classic triad of ectopic pregnancy?
|
abd pain, vag bleed, adnexal mass: but in only 50% of women w/ ectopic
|
|
|
What are the diagnostic for ectopic?
|
Urine, serum (neg r/o ectopic), see a decrease in expected quant number for age, also US.
|
|
|
What is salpingectomy (in ectopic preg)
|
opening of tube and removal of content
|
|
|
What is definition of spontaneous abortion
|
ending prior to 20 wks: 60% due to chromosomal defect
|
|
|
What is the longest part of labor?
|
latent phase (2-3days)
|
|
|
When does the first stage of active labor start?
|
at 3-4 cm cervix
|
|
|
When should a preg women be instructed to go the hospital?
|
when contractions r occuring q 5min.
|
|
|
What is the second stage of labor?
|
the actual birth
|
|
|
What is the third stage of birth
|
when placenta is delivered
|
|
|
How long is avg labor for first mother?
|
9hrs, 6 for 2nd and beyond.
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
What characteristic apply to Type 2 DM: think main risk factors
|
heredity and obesity
|
|
|
What characteristic apply to Type 2 DM: think primary risk factors
|
heredity and obesity
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
How often does ADA guideline for testing type 2 in asymptomatic >45yrs old
|
every 3 years
|
|
|
What characteristic apply to Type 2 DM: think main risk factors
|
heredity and obesity
|
|
|
How often does ADA guideline for testing type 2 in asymptomatic >45yrs old
|
every 3 years
|
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin
|
hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)
|
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
What characteristic apply to Type 2 DM: think main risk factors
|
heredity and obesity
|
|
|
Rosiglitazones (TZD) thiazolidinedione mech of action
|
insulin sensitizer making cells more responsive to insulin: Avandia
|
|
|
Rosiglitazones mech of action
|
insulin sensitizer
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
insulin G (Lantus) has a short or extended duration of action?
|
extended duration of action
|
|
|
Lispro (humalog) onset of action occurs in what time:
|
less than 15min
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
What diabetic med should be used w/ caution in sulfa allergy
|
glyburied (sulfonylureas)
|
|
|
How often does ADA guideline for testing type 2 in asymptomatic >45yrs old
|
every 3 years
|
|
|
What is metformins (glucophage) Mech of action
|
increases insulin action in peripheral tissue reduces hepatic glucose production
|
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
How often does ADA guideline for testing type 2 in asymptomatic >45yrs old
|
every 3 years
|
|
|
Rosiglitazones mech of action
|
insulin sensitizer
|
|
|
how often does ADA guideline for testing type 2 in <45 years?
|
only if hx of high-density lipoprotein <35mg or other risk factors
|
|
|
What is a criteria for dx of type 2 DM:
|
plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5
|
|
|
Rosiglitazones (avandia) (thiazolidinedione) mech of action
|
insulin sensitizer
|
|
|
Insulin: onset, peak duration of action:
Lispro, Humalog |
O: 15min, P: 30-90min, D: <5hr
|
short-acting, rapid onset
|
|
Insulin: onset, peak, duration of action: Regular; Humulin R
|
O: 1/2-1hr, P: 2-3hr, D: 4-6hr
|
short-acting
|
|
Insulin: onset, peak, duration of action: Humulin N, NPH
|
O: 2-4hr, P: 4-10hr, D: 14-18hr
|
Intermediate acting
|
|
Insulin: onset, peak, duration of action: Humulin L, Lente
|
O: 3-4, P: 4-12 hr, D: 16-20: intermediate acting (medicinet.com)
|
|
|
Insulin: onset, peak, duratation of action: Lantus
|
O: hours, P: none, D: >24hrs
|
Insulin glargine
|
|
What medication can you consider when tx a HTN and DM:
|
ACE-I: like fosinopril : nephroprotective features
|
|
|
What should be monitored when prescribing biguanide; ie, metformin (glucophage)
|
creatinine
|
|
|
what percent of the body's insuline mediated glucose uptake takes place in the muscle
|
80%
|
|
|
Exercise reduces Insulin Resistance by _____% w/ effects lasting _____Hrs
|
40% and 48hrs
|
|
|
What amount of cholesterol does the ADA recommend
|
300mg or less
|
|
|
What is the Somogyi effect
|
when insulin induces hypoglycemia and triggers excess secretion of glucagon and cortisol which leads to hyperglycemia
|
|
|
What is the dawn phenomenon as it relates to diabetes?
|
reduced insulin sensitivity 5am-8am due to earlier spikes in growth hormone.
|
|
|
sulfonylureas act on what in diabetes
|
stimulate insulin release from functioning beta cells and enhance insulin sesitivity
|
|
|
What amount of weight loss is expected w/ metformin
|
3-5kg in first months of use
|
|
|
What is another advantage of metformin besides DM
|
It can help improve lipid profile (decrease LDL and triglycerids while increasing HDL)
|
|
|
What is the major adverse effect of metformin
|
GI upset: increase dose slowly
|
|
|
What indicated nephropathy in DM patients
|
Proteinuria: microalbumin (obtain in the morning due to false positive later in the day)
|
|
|
What is the goal of A1C and BP in DM, per 7th JNC report of joint national committe.
|
<7% and <130/<80
|
|
|
Sulfonylurea: M of action and caution
|
insulin secretagogue
|
sulfa allergy, renal dysfunction
|
|
Thiazolidinedion (TZD): M of Action and caution
|
insulin sensitizer
|
monitor ALT; hypoglycemia when used w/ sulfonyl or insulin but not solo
|
|
Biguanides (metformin): M of Action, caution
|
Insulin sensitizer and decrease live glucose production
Caution: Monitor creatinine lactic acidosis risk w/ eleveated CR, hypoglycemia when used w/ sulfony, GI side effect |
|
|
A-gulucosidase inhibitors: M of action, caution (Precose, glyset)
|
delay intestinal carb absorption:
|
Taken w/ meals, help manage postprandial hyperglycemia, GI S/E
|
|
meglitinides: action caution
|
Short acting insulin secretagogue
|
Quick insulin burst, before meals, helps postparanal
|
|
Dipeptidyl peptidase -4 (DPP-4) inhibitor: Januvia, Onglyza: MoA?
|
increase level of insulin, increase sythesis and release of insulin from pancreatic beta cells and decrease release of glucagon from alpha cells.
Dose adjust for renal impair, little hypo risk, use w/ metformin |
|
|
What are risk factors of lactic acidosis when using metformin?
|
renal insufficiency, dehydration, radiographic contrast dye
|
|
|
What are medications that causes secondary hyperglycemia
|
Niacin, corticosteroids, thiazide diuretics
|
|
|
How do meglitinide anaologs help w/ DM2:
|
prevent postprandial hyperglycemia
|
|
|
What is the most common adverse effect of alpha-glucosidase inhibitor?
|
flatulance
|
|
|
Intervention in microalbumin for DM include:
|
improved glycemic control, strict dyslipidemia control, use of ACE-I or angiotensin receptor blocker.
ACE-I have some nephroprotection |
|
|
Drugs whose names end in "-pril" and reduce efferent arteriolar pressure are from what class:
|
ACE-I:
|
|
|
What class of meds end in "sartan" and help preserve renal function in DM
|
Angiotensin receptor blockers
|
|
|
What medications increase your risk of heat stoke?
|
Med: tricyclic antidepressants (triptylines), beta blockers (lol), vasoconstrictors like decongestants.
Note: meds change the bodies ability to regulate core temp by negating increase CO and vasodilaiton |
|
|
What lab should be gotten in a patinet w/ heat stroke
|
CK to assess muscle damage --> release of electrolyte tissue damage, hyperkalemia
|
|
|
What can heat stroke lead to..before death?
|
polycythemia due to volume constriction and hyponatremia w/ Na <120 and stress induced leukocytosis
|
|
|
Tx of Heat Stroke
|
cooling w/ tepid spray and fan vs ice (may cause vasoconstriction decrease ability to lose heat from core), Rhabdomyolysis-->acute renal failure, Ck, creatinine
|
|
|
62y/o HTN, smoke, Trigly:280, HDL:38, LDL:135 what med is best (class)
|
multi drug therapy is needed
|
|
|
46y/o HTN smoke, Trig: 110, HDL: 48, LDL: 192, on low-cholest diet what is next best step?
|
HMG-CoA (coenzyme A reductase inhibitor) (lipitor, zocor, pravistatin) statins
|
|
|
64y/o HTN DM2, Trig: 180, HDL 38, LDL: 135. Meds: sulfonylurea, TZD, biguanide, ACE-I, thiazide diuretic what next?
|
lipid-lowering drug therapy initiated.
|
|
|
What lab should be check w/ taking HMG-CoA reductase inhibitor (Statin) ?
|
aspartate aminotransferase (liver function), CK
|
|
|
What changes are expected when taking fibrates?
|
increase in HDL: only medication that actually document increase in HDL
|
|
|
What changes are expected when taking Niacin?
|
Increase in HDL
|
|
|
When prescribing Zetia what should you expect to see?
|
reduction in LDL
|
|
|
What are risk factors for statin induced myostitis?
|
advanced age, low body weight, high statin dose
|
|
|
What is the average LDL reduction when only diet is modified in lowering cholesteral tx?
|
5-10%
|
|
|
When taking atorvastatin and cholestyramine advise the patient to take the medicaiton?
|
separeate cholestyramine from other meds by 2hrs (affect absorption)
|
|
|
What medication is most effective against lipoprotein?
|
niacin
|
|
|
What are secondary causes of hypertriglyceridemia?
|
hypothyroidism, poorly controlled DM or excessive alcohol
|
|
|
HMG CoA reductase inhibitor (statin)? Effect, comments
|
lower LDL by 18-55%
Increase: HDL by 5-15% lower Trig by 7-20% |
check AST prior to initiation, & periodically
check CK initiation. not needed further unless sx A/E: rhabdo, myositis, increase when combined w/ fibrate, reanal impairment |
|
Resin (cholestyramine, colestipol, colesevelam): benefits and adverse rxn
|
low LDL:15-30%
increase HDL: 3-5% nonsystemic w/ no hepatic monitoring required, minimal effect on Trig (may increase if trig >400) A/E: GI, constipation, decrease of other meds absorption take >2hrs after |
|
|
Niacin (class: antihyperlipidemia): benifits, Use, adverse effects,
|
increase HDL: 15-35%
decrease Trig: 20-50% decrease LDL: 5-25% Highly effective against atherogenic lipoprotein A/E: flushing (take ASA 1hr prior to reduce), hyperlgycemia, hyperuricemia, GI, hepatotoxicity Contra: active liver disease, gout, peptic ulcer |
|
|
Fibric acid derivatives: gemfibrozil (lopid), fenobribrate (tricor): what should you expect to see w/ tx and A/E
|
increase HDL
decrease Trig: 20-50% decrease LDL 5-20% (if normal Trig) May raise LDL w/ high Trig A/E: dyspepsia, gallstones, myopathy if taken w/ statin Contra: sever renal or hepatic disease |
|
|
What does Ezetimibe (Zetia) do and what are A/Rxn
|
decrease LDL-C
increase HDL-C -minimal effect on Trig, prescribe w/ another lipid lowering agent to enhance LDL A/E: few due to no limited systemic absorption |
|
|
Sedondary hyperlipidemia:
What does inactivity result in |
decrase HDL
|
|
|
Sedondary hyperlipidemia:
What does Alcohol abuse result in |
increase triglycerides, increase HDL increase LDL
|
|
|
Sedondary hyperlipidemia:
What does DM result in |
increase Trig, decrease HDL, increase total cholesterol
|
|
|
Sedondary hyperlipidemia:
What does Hypothyroidism result in |
increase Trig increase Total TC
|
|
|
Secondary hyperlipidemia:
What does High dose thiazide diuretics result in |
increase TC, LDL, Trig
|
|
|
Sedondary hyperlipidemia:
What does Chronic renal result in |
increase TC and Trig
|
|
|
Metabolic syndrome dx includes:
|
abd obesity, trig levels higher than 150, HDL less than 40 in men and 50 in women
|
|
|
What is characteristic of Metabolic Syndrome related to insulin?
|
Insulin resistance is present
|
|
|
Describe plasminogen activator inhibitor:
|
increased levels in atherosclerotic lesion
-inhibits fibrin degradation by plasmin -enhances clot formation |
|
|
Define metabolic syndrome:
|
3 or more: obesity, blood pressure, dyslipidemia, glucose intolerance
|
|
|
What is insulin resistance:
|
a reduced sensitivity in the tissue to insulins action at given concentration -->subnormal effect on glucose metabolism
|
|
|
Metabolic syndrome Guidelines:
|
abd men >40 inches, W >35
-Trig >150, HDL<40 BP: >130/85 Fasting glucose >110 |
|
|
Insulin resistance is inversely related to decrease urine clearanc of what
|
Uric acid (gout)
|
|
|
Tx of insulin sensitizing medication for pt w/ polycystic ovary syndrome can lead to
|
resumption fo ovulation, fertility, reduced hirsutism
|
|
|
What are some disadvantages to apple shaped (central abd fat)
|
metabolically active fat, high insulin levels, IR, free fatty acids and high insulin (increase hunger)
|
|
|
IR contribute to prothromotic and proatherogenic state because
|
Plasminogen activator inhibitor: inhibits fibrin degradation enhancing clot formation
|
|
|
Seeing a gradual climb in glucose level over years you should consider risk for
|
metabolic syndrome and DM2
|
|
|
Insulin resistance leads to HTN by increase in:
|
renal sodium resabsorption-->expand cir volume and incrase vascular resistance
|
|
|
Insulin resistance leads to cardiovascular effects of:
|
Hypertension through an increase vascular smooth muscle, greater response to angiotensin II and greater sympathetic activation
|
|
|
Aerobic exercise can reduce IR by what percent
|
40% and last 48hrs, reduces BP and improves lipids
|
|
|
What medication improves insulin sensitivity and metablic parameters like lipids and BP
|
TZD (pioglitazone, rosiglitazone)
|
|
|
What does daily ASA do for BP, lipids
|
counter act proinflammatory and prothrombotic effects of IR
|
|
|
What does the WHO define as obesity ___kg/M2 or more
|
30 Kg/M2
|
|
|
What does orlistat do for weight loss
|
reduc dietary fat absorption by 30%. Results in diarrhea if you eat fats
|
|
|
What does Meridia due for weight loss
|
acts on brain control for mood an dwell being and appetite
|
|
|
When can someone consider Bariatric surgical:
|
100lbs or more over ideal or >40BMI
|
|
|
What are risk factors for pancreatitis:
|
hyperlipidemia, abd trauma, thiazid diuretic use, alcoholism, gallbladder stones,
|
|
|
What lab is obtained to determine acute pancreatitis
|
serum lipase level w/ amylase
|
|
|
What is the most reliable test for pancreatic cancer
|
MRI is the most reliable diagnostic.
|
|
|
What is care of pancreatitis
|
parenteral hydration , analgesia, gut rest, tx underlying cause
|
|
|
How does a pancreatic cancer present:
|
abd pain , weight loss, anorexia, N/v, jaundices
|
|
|
Amylase in Acute Pancreatitis will appear ______ and return back to normal ______. What % are due to cholelithiasis vs % due to alcoholic pancreas
|
* appears 2-12h after sx onset
* back to normal w/in 7d of pancreatitis resolution * Amylase level >1000 U/L *80%=Dx cholelithiasis *6% = Dx alcoholic pancreatitis |
|
|
Amylase: What effects amylase levels
Nonpancreatic amylase: |
*salivary glands
* ovarian cysts * ovarian tumors * tubo-ovarian abscess * ruptured ectopic preg * lung cancer |
|
|
Lipase in Acute Pancreatitis:
Lipase appear how soon after onset and peaks at what time frame |
* appears 4-8h after sx onset
* Peaks at 24h, decreases 8-14d of pancreatitis resolution |
|
|
What non pancreatic reasons would result in elevated Lipase?
|
* renal failure
* perforated duodenal ulcer * bowel obstruction * bowel infarction |
|
|
Hyperthyroidism: signs and sx
Characteristics (patho) |
excessive energy release, rapid cell turnover
|
|
|
Hperthyroidism: signs and sx
Causes (disease names) |
Graves, thyroiditis, metabolically active thyroid nodule
|
|
|
Hperthyroidism: signs and sx
Neurologic: sx |
Nervousness, irritability, memory problems
|
|
|
Hperthyroidism: signs and sx
Weight |
weight loss (modest only in 50%)
|
|
|
Hperthyroidism: signs and sx
Enviornmental response |
Heat intolerance
|
|
|
Hperthyroidism: signs and sx
Skin |
Smooth, silky skin
|
|
|
Hyperthyroidism: signs and sx
Hair |
fine hair w/ freq loss
|
|
|
Hyperthyroidism: signs and sx
Nails |
thin nails that break w/ ease
|
|
|
Hyperthyroidism: signs and sx
GI |
frequent, low-volume, loose stools
|
|
|
Hyperthyroidism: signs and sx
Menstrual |
Amenorrhea or low-volume menstral flow
|
|
|
Hyperthyroidism: signs and sx
Reflexes |
Hyperreflexia w/ "quick out-quick back" action
|
|
|
Hyperthyroidism: signs and sx
Muscle strength |
Proximal muscle weakness
|
|
|
Hyperthyroidism: signs and sx
Cardiac |
Tachycardia
|
|
|
Hyorthyroidism: signs and sx
Characteristics: physiological |
Reduced energy release, slow cell turnover
|
|
|
Hypothyroidism: signs and sx
Causes (disease state) |
Post thyroididits >90%, primary pitutuary failure (rare), thyroid removal
|
|
|
Hypothyroidism: signs and sx
Neurologica |
lethargy, disinterest, memory problems
|
|
|
Hypothyroidism: signs and sx:
Weight |
Weight gain (5-10lbs)
|
|
|
Hypothyroidism: signs and sx
Environmental response: |
chilling easily, cold intolerance
|
|
|
Hypothyroidism: signs and sx
Skin |
Coarse, dry skin
|
|
|
Hypothyroidism: signs and sx
Hair |
thick, coarse hair w/ tendency to break
|
|
|
Hypothyroidism: signs and sx
nails |
thick, dry nails
|
|
|
Hypothyroidism: signs and sx
GI |
constipation (slow down everything)
|
|
|
Hypothyroidism: signs and sx
Menstrual |
Menorrhagia
|
|
|
Hypothyroidism: signs and sx
Reflexes |
hyporeflexia: Slow relaxation phase, "hung up" reflex
|
|
|
Hypothyroidism: signs and sx
Muscle strength |
no change
|
|
|
Hypothyroidism: signs and sx
Cardiac |
bradycardia (in severe cases
|
|
|
Hyperthyroidism: signs and sx
Hair |
fine hair w/ freq loss
|
|
|
Hyperthyroidism: signs and sx
Nails |
thin nails that break w/ ease
|
|
|
Hyperthyroidism: signs and sx
GI |
frequent, low-volume, loose stools
|
|
|
Hyperthyroidism: signs and sx
Menstrual |
Amenorrhea or low-volume menstral flow
|
|
|
Hyperthyroidism: signs and sx
Reflexes |
Hyperreflexia w/ "quick out-quick back" action
|
|
|
Hyperthyroidism: signs and sx
Muscle strength |
Proximal muscle weakness
|
|
|
Hyperthyroidism: signs and sx
Cardiac |
Tachycardia
|
|
|
Hyorthyroidism: signs and sx
Characteristics: physiological |
Reduced energy release, slow cell turnover
|
|
|
Hypothyroidism: signs and sx
Causes (disease state) |
Post thyroididits >90%, primary pitutuary failure (rare), thyroid removal
|
|
|
Hypothyroidism: signs and sx
Neurologica |
lethargy, disinterest, memory problems
|
|
|
Increased thyroid disorder risk increase in what age grp
|
elderly
|
|
|
What lab value for TSH fT4 is most consistent w/ hypothyroidism
|
normal fT4 and elevated TSH Levels (somthing is wrong w/ the thryoid and the pituitary is trying to compensate by giving more TSH)
|
|
|
what is Hashimoto's disease
|
hypothyroidism from an autoimmune response (most common) resulting in thyroidistis destroying large amounts of thyroid
|
|
|
What is the most common causes of hypothyroidism
|
autoimmune thyroiditis next is surgical
|
|
|
What lab value do you expect to find in Graves disease
|
Low TSH level (thyroid overproduction makes pituitary slow down in production of TSH w/ feed back mechanism)
|
|
|
What is a physical finding in graves related to the eyes
|
Eye LID retraction (appears eye are bulging)
|
|
|
What is the mechanism of action for radioactive iodine in tx of Graves
|
destroy overactive thyroid
|
|
|
What is useful in tx tremor in hyperthyroidism?
|
propanolol (beta blocker)
|
|
|
T4 for elderly dose should be what compared to middle age adult
|
75% or less
|
|
|
What do you suspect on thyroid scan that reveals thyroid mass (cold spot):
|
thyroid cyst
|
|
|
What lipid value do you find in untreated hypothyroidism
|
hypertriglyceridemia
|
|
|
U find painless thyroid mass and TSH level less than 0.1 (low) what is the causes
|
autonomously functioning adenoma
|
|
|
Fixed, painless thyroid mass w/ s of hoarsness and dysphagia what should you consider:
|
thyroid malignancy
|
|
|
What is cost effective to determine malignancy from benign thyroid nodules
|
fine-needle aspiration biopsy
|
|
|
What is a side effect of excessive levothyroxine (synthroid)
|
Bone thinning
|
|
|
When should TSH be reassessed when tx w/ synthroid (levothyroxine) is altered
|
6-8wks
|
|
|
U find 3cm round mobile thyroid mass, US reveals fluid filled structure dx is
|
thyroid cyst
|
|
|
A patient w/ downs syndrome should periodically be monitored for what endocrine disorder
|
hypothyroidism
|
|
|
What do you expect to find in elderly w/ hyper or hypothyroidism
|
atypical presentation: typically lab values identify disease
|
|
|
What is the purpose of thyroid hormone physiologically (basic)
|
assist cell in energy releasing activities
|
|
|
What medication can causes a alteration in iodine metabolism=hypothyroidism
|
lithium, amiodarone
|
|
|
What is the most sensitive and specific thyroid test
|
TSH (produced by anterior pituitary)
|
|
|
What is the negative feedback loop in thyroid pituitary function
|
TSH output is determined by amount of circulating T4
|
|
|
What is the most helpful test in confirmation of an abnormal TSH level
|
fT4- it reflects the function of the thyroid gland. So TSH first the T4 (usually obtained together) but too many things cause variation in T4 to for it to be significant by itself
|
|
|
Is TSH increase or decreased in hypothyroidism
|
Increased (it is trying to compensate due to decrease feedback of T4)
|
|
|
Is TSH increased or decreased in hyperthyroidism
|
Decreased (thyroid is putting off extra T4 so pituitary decreases amount of TSH)
|
|
|
How do you confirm hyperthyroidism if TSH is low or undetectable?
|
obtain fT4:
(if it is high then the feedback is decreased) |
|
|
What medication is given w/ low T4 (hypothyroidism)
|
synthroid (levothyroxine)
|
|
|
What is the age of onset of Graves
|
20-40 years
(may have underlying like pernicious anemai, myasthenia gravis, DM) |
|
|
What is the clinical presentation of graves?
|
diffuse thyroid enlargement, exophthalmos, nervousness, tachycardia, heat intolerance
|
|
|
What does a thyroid scan reveal in Graves?
|
Large (hot) gland w/ heterogeneous uptake
|
|
|
What are tx of graves:
|
Methimazole, propylthiiouracil or radioactive iodine or removal of thyroid
(then tx hypothyroidism) |
|
|
What do you expect the lab values to be in hypothyroidism
|
Elevated TSH and normal fT4 (subclinical)
|
|
|
When should u initiate tx of hypothyroidism?
|
When TSH rise above 10mU/L (normal 0.5-4) even in presence fo normal fT4
|
|
|
What is the initial dose of synthroid in tx of hypothyroid
|
75-125 ug (75% or less in elderly)
|
|
|
What do you do if you find a palpable thyroid nodule:
|
watch and wait if no changes to TSH (may obtain fine-needle biopsy to determine malignancy)
|
|
|
BPH affects approx ___% of men by age of 60
|
50 (90% by 85y/o)
|
|
|
What are sx of BPH
|
increase frequency decrease force of output, nocturia, sensation incomplete bladder
|
|
|
What medication cause urinary retention in men complicating BPH
|
tricyclic, first gen antihistamines (anticholinergic effect)
|
|
|
What non pharm causes bladder irritation after intake of:
|
caffeine and artifical sweetners: do not use if incontence or bladder disorders
|
|
|
What class of med can be helpful in BPH:
|
alpha1 receptor antagonist (alpha blockers) (note: if HTN too then only added to existing therapy
|
|
|
What medication helps reduce the size of the prostate by blocking conversion of testosterone to dihydrtestosterone.
|
Finasteride
|
|
|
When should surgical intervention be considered in BPH.
|
recurrent UTI, recurent or persistent gross hematuria, bladder stones, renal insufficiency
|
|
|
Chancoid is a
|
(soft chanker) STI: from bacteria H. Ducreyi
|
|
|
Treatement of Chancoid is:
|
Azithromycin (macrolide)
ciprofloxacin (2nd gen fluorquinolone) ceftriaxone (cephalosporin) |
|
|
What other disease do you expect to find when testing for chancroid (STD)
|
herpes simplex
|
|
|
What does Chancroid look like?
|
vesicular pustular lesion painful, soft ulcer w/ necrotic base at point of inoculation.
|
|
|
What is the causative organism in lymphogranuloma venereum
|
C. trachomatis 1&3
|
|
|
What are the physical findings w/ lymphogranuloma venereum
|
lesions fuse and create multiple draining sinuses mainly in the groin
|
|
|
What is the tx for lymphogranuloma venereum
|
tetracycline
|
|
|
Chancroid: causative organism
presentation |
H. ducreyi
painful genital ulcer, mult lesion, inguinal lymphadenitis |
|
|
Chancroid Tx
|
Azith 1g oral or
Ceftriaxone 250 IM or Cirpo 500 BID x 3d |
|
|
Genital Herpes: organism, presentation
|
HSV2
Painful ulcerated lesion (w/ primary |
|
|
Genital Herpes: Tx
|
Initial: acyclovir 400 Tidx7-10 or
famciclovir 250 tid x7-10, episodic: acyclovir 400 tid x 5d famciclovir 125 bid x 5d Suppression acyclovir 400 bid |
|
|
Lymphogranuloma venereum: oragnism presentation
|
C. Trachomatis:
vesicular ulcer lesion, external genitalia w/ inguinal lymphadenitis or buboes |
|
|
Lymphogranuloma venereum: tx
|
Doxy 100 Bid x 21d
|
|
|
Nongonococcal urethritis and cervicitis: organism presentation
|
C. trachomatis
cervitiss, irritative void, mucopurelent discharge |
|
|
nongonococcal urethritis and cervicitis: tx
|
azith 1g PO or dox 100 bid x7d
|
|
|
Gonococcal urethritis: organism presentation
|
N. gonorroeae
irritative void, purulent discharge |
|
|
Gonococcal urethritis: Tx
|
Single dose uncomplicated of Cefixime 400mg PO or ceftriaxone (rocephin) 125mg IM, tx w/ azith 1g single or doxy 100 bid x 7 in chlaymida not ruled out
|
|
|
What do you treat concurrently w/ gonococcal urethrits (GC)
|
Chlamydia (azith 1g or doxy x 7d)
|
|
|
Epididymitis (epidimymoorchitis) organism and presentation
|
N. gonorrhoeae, C. trachomatis
irritative void, fever painful swell epidiymis and scrotum |
|
|
epididymitis: tx
|
ceftriaxone (rocephin) 250mg IM PLus doxy 100mg bid x 10d
|
|
|
Trichomoniasis: organism presentation
|
T. vaginalis:
none or dysuria, strawberry cervix (punctate hemorrhages) |
|
|
trichomoniasis: tx
|
Metronidazole (flagyl) 2g onetime
|
|
|
Genital warts (condyloma acuminata): orgnanism presentation
|
HPV
verruca form lesions or subclincial |
|
|
Genital warts (condyloma acuminata): tx
|
patient applied: polofilox 0.5% or imiquimod 5% cream:
Provider: liquid nitrogen, tricholoacetic acid, surgical or podophyllin resin |
|
|
Acute bacterial prostatitis <35y: organism presentation
|
N. gonorrhoeae, C. trachomatis
irritative void, suprapubic, perinal pain, fever, tender boggy prostate |
|
|
acute bacterial prostatitis: Tx
|
Ofloxacin 400mg x1 then 300BIDx10d or
Ceftriaxone (rocephin) 250mg IM then doxy 100mg bid x 10 |
|
|
Acute bacterial prostatits: organism and presentation >35y
|
Enterobacteriaceae (coliforms)
void, suprapubic perinaeal pain, boggy prostate, leukocytosis |
|
|
acute bacterial prostatis: tx >35
|
Ciprofloxacin 500mg bid or ofloxacin 200mg PO qD x 14
|
|
|
Chronic bacterial prostatis: organism presentation
|
enterobacteriaceae
void, dull,poorly localized suprapubic perineal pain |
|
|
What is the difference in epididymitis in younger vs older men
|
older men: secondary to prostatitis
younger: STI: C. trachomatis or N. gonorrhoeae |
|
|
What is Prehn sign in epididymitis?
|
reduction in pain when scrotum is elevated above symphysis pubis
|
|
|
What is epidiymoorchitis:
|
both testicles involved swelling so two cannot be distinguished
|
|
|
epidiymoorchitis: mainly caused by UTI: What is the diagnostic test to determine tx?
|
urine culture
|
|
|
37y/o w/ gram neg cocci, dysuria, urethral discharge what is likely organism:
|
N. gonorrhoeae
|
|
|
Tx option for gonococcal proactitis is
|
ceftriaxone, 125 IM
|
|
|
CDC recommends what single dose for uncomplicated urethritis by N. gonorhoeae?
|
cefixime (cephlasorin )suprax
|
|
|
Risk of transmission from infected woman to male is what percent if single coital act?
|
20-30%: 60-80% chance man to women
|
|
|
What is the incubation period of N. Gonorrhoeae
|
1-5d
|
|
|
Because gonorrhoeae produces beta-lactamase what is the best antibiotic
|
cephalosporin: ceftriaxone and cefixime
|
|
|
Tx of chronic bacterial prostatitis should consider treating a gram ____ _____ organism
|
gram negative rods (e. coli or pseudomonas)
|
|
|
What are sx of acute bacterial prostatitis:
|
perineal pain, irritative void, fever
Low back pain in chronic BP |
|
|
What does the prostate feel like on exam w/ acute bacterial prostatitis
|
boggy
|
|
|
How long should the tx of chronic bacterial prostatitis last and what med is best:
|
ciprofloxacin for 4wks may need 12 wks.
|
|
|
What is the best diagnostic test to ID offending organism in bacterial prostatitis
|
urine culture
|
|
|
What does a digital rectal exam of prosate cancer find
|
prostatic induration
|
|
|
A PSA will ____ w/ prostate cancer
|
double in serial annual test w/ normal prostatic exam
|
|
|
Risk factors for prostate cancer
|
African, FHx, high fat diet
|
|
|
Average American __% life time risk of prostate cancer
|
40 %
|
|
|
What are the findings on testicular torsion?
|
scrotal pain unilateral loss of cremasteric reflex, swollen tender
|
|
|
What diagnostic test is used in assessing testicular torsion
|
doppler to determine blood flow: (will be decreased if severe)
|
|
|
What is orchiopexy and when is it used
|
Tacking the testicles low in the scrotum to prevent re-occurrence of testicular torsion
|
|
|
Variocele presents w/
|
"bag of worms" mass in scrotum dissappears when lying down
|
|
|
What is a lab finding w/ variocele
|
decreased sperm count w/ increase abnormal forms (similar to varicose veins in the legs...weak valves result in increase swelling of veins)
|
|
|
What is tx of variocele ( like varicose veins in scrotum)
|
scrotal support
|
|
|
Primary syphilis: presentation, tx
|
painless ulcer, indurated: lymphadenopathy.
PNC G 2.4m IM if allergy then Doxy 100mg Bid x 2w |
also tx for secondary syphilis or latent syphilis of <1yr
|
|
Secondary syphilis: presentation, Tx
|
diffuse maculopapular rash palms and soles, lymphadenopathy. fever, malaise
Tx: PNC G 2.4M IM allergey to PNC Doxy 100mg BID or Tetra 500 QID x2wk |
|
|
Later or tertiary: presentation, slide 3 tx
|
Gumma (granulomatous lesions involveing skin, mucous membranes, bone) aortic insufficiency, aortic aneurysm, Argly Roberttson pupil seizures
|
PNC G 2.4 M IM weekly x 3 wk or if allergic like secondary:
doxy 100mg BID x 2 wks |
|
When do lesions present in syphilis
|
2-4 wks after sexual contact.
|
|
|
What is a sequelae of HPV
|
anorectoal carcinoma
|
|
|
What best describes a condyloma acuminatum lesion
|
verruciform
|
|
|
Tx w/ condyloma acuminatum:
|
imiquimod (aldara) or podofilox
|
|
|
What age should you receive HPV for colorectoal carcinoma prevention
|
13-18
|
|
|
What are common risk factors for ED
|
HTN, DM, smoking (anything): testosterone deficiency is NOT a risk factor
|
|
|
What is the result of using sildenafil (what is it)
|
Erection: although sexual stimulation will still be needed to achieve erection: (viagra)
|
|
|
What is the most probable cause of ED in 70y/o
|
some underlying cause
|
|
|
What medications can causes ED
|
anti HTN, antidepressants, cimetidine (tagament)
|
|
|
How does sildenafil or vardenafil work?
|
enhance effects of nitric oxide: chemical relaxes smooth muscle in penis and allows increase blood flow (take 1hr prior to sex)
|
|
|
What should not be taken w/ sildenifil (viagra)
|
a nitrate (NTG)
|
|
|
What drug can be injected into the penis for erection or what drug can be inserted in the urethra (ouch)
|
alprostadial (caverject) or Muse
|
|
|
Describe the effects of asthma on the airway
|
chronic airway inflammation w/ superimposed bronchospasm
|
|
|
What do you expect to find in an acute asthma flared managed in a primary care (physical exam not lung sounds)
|
hyperresonance on thoracic percussion
|
|
|
44y/o being tx w/ fluticasone w/ salmeteral (advair) 1puff bid and albuteral 1-2 x wk prn wheeze. Now w/ URI and wheeze what diagnostic should you obtain to assess air flow?
|
peak expiratory flow (PEF): maximum speed of expired air
|
|
|
24y/o asthma flare, using pulmicort and albuterol but cont to have wheeze. PEF 55% baseline you should adjust meds to include
|
adding a prednisone. For long term control a long acting beta 2 agonist can also be used
|
|
|
What do you expect to find on CXR during acute asthma attack?
|
Hyperinflation (think of wheeze trying to escape)
|
|
|
36y/o w/ asthma and HTN what med should you avoid when tx his HTN
|
beta blocker (propanolol)
|
|
|
Which sx is consistent w/ asthma
|
nocturnal cough, cough or wheeze after exercise, cold that "got to the chest" or tak >10d to clear
|
|
|
What is a corner stone tx of moderate persistent asthma
|
inhaled corticosteroid
|
|
|
29y/o female moderate intermittent asthma, not using inhaled corticosteroid but is using albuterol PRN to relieve her cough and wheeze> now using 2 puffs per day you should
|
discuss excessive albuterol use may increase risk of asthma death
|
|
|
In tx of asthma what should leukotriene inhibitors be used for:
|
inflammatory inhibitors
|
|
|
How long after inhaled corticosteroids or leukotriene do you expect to see results
|
1-2 weeks
|
|
|
Xopenex has what improved benefit over albuterol
|
greater bronchodilation w/ lower dose
|
|
|
What are the goals of of asthma care:
|
minimal or no sx like cough and wheeze especially at night
|
|
|
What is the normal circadian variation of PEF
|
10-15% from waking to night: w/ asthma it is >15% at night =nocturnal bronchospasm
|
|
|
What is the backbone of mild, moderate or severe persistent asthma therapy (3 slides)
|
use of inflammatory control drug: inhaled corticosteroids (symbicort, fluticasone), mast cell stabilizers (cromyln) and leukotriene modifiers (singulair)
note: Inhaled corticosteroids are the most effective and preferred |
|
|
What are the rescue inhaler and why are they used
|
short acting-beta 2 agnoist (albuterol, levalbuterol) used to relieve acute superimposed bronchospasm
|
|
|
In asthma control what is the next treatment when giving a corticosteroid when sx control is not being met:
|
Add a long acting beta 2 agonist: salmetrol, formoterol
|
|
|
beta2 agonist have a "-terol" suffix what are some meds and what are their actions
|
albuterol short acting, and salmetrol long acting: Stimulate beta 2 site causing bronchodilation
|
|
|
Why should beta-adrenergic antagonist "lol" not be used in asthma?
|
They can precipitate bronchospasm ie propanolol
|
|
|
Corticosteroids have an "-one" or "-ide" suffix: examples
|
fluticasone (flovent), prednisone, budesnide (pulmicort)
|
|
|
Leukotriene receptor agonist (leukotriene modifiers) have "-lukast" sufix: examples:
|
montelukast (singulair)
|
|
|
Why is do you hear hyperresonance on percussion and hyperinflation in asthma
|
because of air trapping, decreased PEF
|
|
|
Asthma:
Inhaled Corticosteroids: MoA, indication (three slides) |
inhibit eosinophilc action, potentate effects of beta2 agonist
controller drug, prevention of inflammation: must be used consistently to help |
|
|
Asthma tx:
Cromolyn (intal): MoA and indications (3 slides) |
halts degradation of mast cells and release of histamine (MAST cell stabilizer)
|
Controler drug, prevents inflammation:
need consistent use but less effect than corticosteriods |
|
Leukotrien modifier: (montelukast) singulair: MoA, indications
|
M of A: Inhibit action of inflammatory mediator by blocking receptor sites
Indications: controller drug, prevent inflam less effective than corticosteroids best when added on as 2nd tx w/ allergic rhinitis |
|
|
Oral corticosteroids: MoA, indictations (3 slides)
|
inhibit eosinophili and other inflammatory actions
-tx of acute inflamation in asthma and COPD >2wks tx adrenal suppression |
|
|
Albuterol (ventolin, proventil,xopenex): MoA, indications
|
Beta2 agonist; bronchodilation via stimulation of beta2 receptors
-Rescue drug: acute bronchospasm: onset: 15min, duration 4-6hrs |
|
|
Long acting beta2 agonist: salmeterol: MoA and indications
|
Beta2 agonist; broncholiation, through stimualation of beta2 receptors
Prevent broncho spasms: Salmetrol: onset 1hr, druation 12hr. |
|
|
Ipratropium (atrovent)
tiotropium bromide (spiriva): MofA and indications |
anticholinergic and muscarinic antagonist, yielding broncholdiation
|
tx and prevent bronchospasm:
onset >30min best use to avoid rather than tx bronchospasm |
|
Theophylline: MoA and indications
|
mild bronchodilation, helps diaphram contract
prevent bronchospasm Narrow theraputic not used often |
|
|
what is the therapeutic action of inhaled corticosteroids when tx COPD
|
reduction in airway inflammation
|
|
|
What is consistent w/ dx of COPD
|
FEV1/FVC ratio of less than 0.70
|
|
|
What is found in the airway early stages of chronic bronchitis
|
excessive mucus production
|
|
|
What is found in the airway of emphysema patients
|
enlargement of air spaces distal to terminal bronchioles
|
|
|
What is the GOLD tx for COPD guidelines for stages II-Iv COPD
|
short-acting inhaled bronchodilators
|
|
|
What is the goal of using inhaled corticosteriods in stage III COPD
|
minimize risk of repeated exacerbations
|
|
|
Which cortiocsteriod is most potent:
methylprednisolone, 8mg triamcinolone, 10g prednisone 15mg hydrocortisone 18mg |
Prednisone
|
|
|
What is the typical organism in acute chronic bronchitis
|
H. influenzae...also Mycoplasma pneumoniae, Chlamydia pneumoniae, and Streptococcus pneumonia.
|
|
|
What is an appropriate antibiotic for a 72y/o HF, acute bacterial COPD who has failed amoxicillin
|
levofloxacin
|
|
|
What is the appropriate antibiotic for 52y/o w/ acute bacterial COPD exacerbation
|
azithromycin
|
|
|
What is the definition of chronic bronchitis:
|
report of excessive mucus for >3m per year fro 2 years absence of other causes 80% causes by smoking
|
|
|
What is considered the backbone of COPD therapy
|
Bronchodilators: Tioptropium bromide (Spiriva) and ipratropium bromide (atrovent) anticholinergic w/ stage II-IV COPD
|
|
|
What should you advise all COPD patients to avoid
|
noxious agents, smoking, irritants, obtain annual influenza and antipneumococcal vaccine
|
|
|
COPD: Stage Characteristic, treatment
Stage 0 |
cough, sputum production, no spirometric abnormalities
tx: COPD risk reduction |
|
|
COPD: Stage Characteristic, treatment
Stage I Mild |
FEV: FVC ratio <0.70
>FEV >80% of predicted w/w/o sx |
hort acting bronchodilator PRN
-albuterol, pirbuterol, levalbuterol |
|
COPD: Stage Characteristic, treatment
|
FEV:FVC ration >0.70
-50%>FEV <80% of predicted W or w/o sx REg us of >1 long acting bronchodilator: tiotropium,salmeterol -short acting bronchodilator PRN -inhaled corticosteroids if repeated exacerbation -pulmonary rehabilitation |
|
|
COPD: Stage Characteristic, treatment:
Stage III |
FEV:FVC ratio<0.70
-30%>FEV <50% of predicted |
Reg us of >1 bronchodilator
-Tiotropium/salmeterol short acting: albuterol Corticoid if repeated Pulmonary rehabilitation |
|
COPD: Stage Characteristic, treatment
Stage IV |
FEV:FVC ratio <0.70
-FEV<30% of predicted or resp failure or HF >1 long acting broncho: triotriopium - short acting: albuteral -cortico if repeat exacerbation -tx of complications -long term o2 therapy -surgical |
|
|
Potency of corticosteroids:
Higher potency (equipotent doese): Which is highe potency: Dexamethasone 0.75mg Betamethasone 0.6-.75mg |
Betamethasone 0.6-.75mg
Dexamethasone 0.75mg |
|
|
Potency of corticosteroids:
Medium potency (equipotent dose) |
Methylprednisolone 4mg
Triamcinolone, 4mg prednisolone 5mg prednisone 5mg |
|
|
Potency of corticosteroids
Lower patency (equipotent dose) |
Hydrocortisone 20mg
cortison 25mg |
|
|
acute bacterial: COPD: etiology and tx:
|
Gram-pos and neg respiratory pathogen, atypical
amoxicillin or doxy or cephalo, if failure then fluoroquinolone or HD augmentin |
|
|
Acute bacterial: Chronic bronchitis: what is the organism: what is the tx
|
Psuedomonas aeruginosa
Tx: Ciprofloxacin, levofloxacin |
|
|
5MM or larger w/ HIV or other immunosuppression or organ transplant or taking 15mg prednisone = pos or neg TB
|
positive TB
|
|
|
What is the dx after PPD: 10mm in high risk: immagrants, IV drug, health care, resident housing, correction, homeless, health:
|
Positive TB
|
|
|
15mm or larger in all others including those that appear to have no TB
|
Positive TB
|
|
|
Anergy testing in TB
|
giving skin test of substances other than TB determines weakened immune system
|
|
|
Bacille Calmette Guerin in TB
|
given in many countries: low risk of causing false-pos
|
|
|
Booster phenomenon in TB:
|
seen in elderly. first TB is neg but next year positive because previous infection long ago boost the immune response
|
|
|
Two step testing TB is used to:
|
distinguish booster rxn (caused by TB infection that occured years ago) from rxn caused by recent infection
|
|
|
What is chemoprophylaxis therapy for pos TB but no sx
|
isonizide therapy and periodic chest xray
|
|
|
Antibiotic for community acquired pneumonia: No comorbidity
|
azithromycin 5-7d
|
|
|
antibiotic for CAP pt cant take macrolide:
|
doxycycline
|
|
|
Antibiotic for CAP in 78y/o w/ COPD
|
amoxicillin w/ a macrolide
|
|
|
Antibiotic for CAP in 69y/o w/ HF and DM2:
|
respiratory fluoroquinolone
|
|
|
Antibiotic for CAP in 58y/o w/ dry cough, HA malaise no recent antibiotic:
|
clarithromycin (biaxin) macrolide, doxy
|
|
|
What is a quality of respiratory fluoroquinolone:
|
activty against drug resistant S. pneumonia (DRSP)
|
|
|
Drug resistant S. Pneumonia (DRSP) mechanism of resistance:
|
alteration in protein-binding sites
|
|
|
H. influenzae mechanism of resistance:
|
beta lactamase production
|
|
|
What is a characteristic of macrolide:
|
effective against atypical pathogen also beta lactamase (PNC is not effective against beta lactamase)
|
|
|
CAP should be tx w/ antimicrobial for how long according to american thoracic society
|
5-7days outpatient
|
|
|
What are modifying factors for P. aeruginosa
|
corticosteroid use, strucural lung disease, malnutrition
|
|
|
What is mechanism of transmission in atypical pneuomonia?
|
cough
|
|
|
Risk factors for pneuomina death:
|
renal insufficency, elderly, comorbidity, immunosupressed
|
|
|
What is an acceptable sputum specimen for gram staining?
|
few squamous epithelial cells and many WBC
|
|
|
52y/o smoker w/ CAP, 3rd day therapy w/o fever, hydrated, feeling better when do you get chest xray
|
7-12 weeks from now
|
|
|
62y/o hosp w/ CAP considers what about vaccination
|
influenza and antipneumococcal should be given now
|
|
|
Why is it labeled community acquired pneumonia?
|
pt resides in comunity not recently hosp and not nursing home
|
|
|
What is typical presentation of pneumonia?
|
Cough, dyspnea, sputum production, pleuritic chest pain,
|
|
|
What may CXR reveal in pneumonia pt
|
infiltrate patterns and areas of consolidation w/ S. pneuonia
|
|
|
If a smoker w/ pneumonia take CXR 7-12 wks after therapy to assess for ?
|
lung cancer
|
|
|
What is the main organism of smokers w/ pneumonia?
|
H. influenzae (tracheobronchial tree conlonized
|
|
|
How are mycoplasma pneumoniae and C. pneumonia transmited
|
via cough, in closed community
|
|
|
Tx of CAP:
no comorbidity: |
macrolide: azithro or clarithro
Alt: doxy if macro intolerant |
|
|
Tx of CAP:
w/ comorbidy : HF, COPD |
Beta-lactam: cepodoxime, augmenten, ceftriaxone+cefpodoxime PLUS
macrolide or doxy or resp fluoroquinolone |
|
|
What increases risk of death from pneumonia?
|
>65yrs, electrolyte or hem disorder (Na<130, absolute neutrophil <1000) other illness.
|
|
|
What organism is seen mostly in alocholics w/ pneumonia
|
Klebseilla. pneumonia
|
|
|
What increases Risk of CAP by P. aeruginos:
|
structual lung, corticosteroid, broad spectrum antibiotic in previous month, malnutrition
|
|
|
What increase risk of resistant microbes:
|
repeat exposure to given agent, underdosing, unecessary prolonged tx period
|
|
|
H. influenzae produces beta-lactamase: what antimicrobial is ineffective against this
|
penicillin
|
|
|
what antimicrobials are useful when beta-lactams are ineffective (atypical pathogens)
|
macrolides, tetracyclines, respiratory fluoroquinolones
|
|
|
What is the best preventative measure to prevent the most fatal form of pneumonia:
|
obtaining a pneumococcal vaccine
|
|
|
CNS: I, II, III: control or responsible for ?
|
Olfactory, Optic, Occulomotor (eye movement)
|
|
|
CNS: IV, V, VI
|
Trochlear (ear), Trigeminal (temp, pain, tactile), abducens (eye)
|
|
|
CNS: VII, VIII, IX
|
Facial (Bells palsy), auditory (vestibulocochlear, rinne test), glossopharyngeal (swallowing)
|
|
|
CNS: X, XI, XII
|
Vagus, Accessory (shoulder shrug), Hypoglossal: protrusion of tongue
|
|
|
What can be a complication of Lyme disease:
|
bells palsy (need to obtain a titer to verify)
|
|
|
What lab test should be obtained w/ bells palsy:
|
RPR, veneral disease test, HIV
|
|
|
Is Neuroimaging needed w/ bells palsy?
|
no due to unilateral CN dysfunction on typical of intracranial neoplasm
|
|
|
What is tx of Bells palsy:
|
may give corticosteroid if w/in 10days of sx
|
|
|
40y/o 5wk hx recurrent HA at night, last 1hr severe behind left eye w/ lacrimation, nasal discharge what is HA dx:
|
cluster HA
|
|
|
Prophylactic tx for migraines HA:
|
Propanolol (beta blocker)
|
|
|
55y/o woman hx of angina and migraine: best choice of acute HA tx (called abortive migraine therapy)
|
ibuprofen
|
|
|
Migraine HA typically presents as a _____ Pain
|
pulsating pain
|
|
|
Tension HA typically described as _____ type pain
|
pressing type pain
|
|
|
Tx options in cluster HA include:
|
NSAID, oxygen, triptans (imatrex, maxalt)
|
|
|
What has the most rapid analgesic onset?
naproxen, liquid ibuprofen, diclofenac, celecoxib (all nsaids) |
liquid ibuprofen
|
|
|
What are limitations to Fioricet (butalbital w/ APAP and caffeine?
|
high rate of rebound HA
|
|
|
Why should neuroleptic meds in migraines be limited to 3x per week?
|
Their extrapyramidal movement risk:
|
|
|
What should the expectation be w/ prophylactic HA tx long term:
|
approx 50% reduction in number
|
|
|
48y/o monthly 4d premenstrual migraine, poor response to triptans (serotonin receptor agonist) and analgesic w/ hot flashes what next:
|
-use continuous monophasic oral contraceptive
-estrogen patch -triptan prophylaxis |
|
|
Prophylactic tx for prevention of tension type HA include
|
desipramine (Norpramin) tricylic antidepressant
|
|
|
68y/o w/ new HA, bilateral frontal to occipital worse on rising in am and coughing, better mid day. What is causing HA?
|
increased ICP
|
|
|
Clinical presentation:
Tension Ha |
30min-7d w/ >2 of following
-press, nonpulsating -mild to moderate -bilateral - >1 of following then migriane Nausea, photophob,phonophob |
|
|
clinical presentation : migraine w/o aura:
|
5 attacks w/:
B. last 4-72hrs C.two: unilateral, pulsating, mod-severe, activity aggravates -during HA >1 of following N/V photophob and phonophob |
|
|
Clinical presentation:
Migraine w/ aura |
HA w/ or after aura
-focal dysfunction of cerebral cortex or brianstem =>aura sx develop over 4min, =>2sx occur in succession: -no aura sx last >1hr. then consider alternative dx |
|
|
Clinical presentation:
Cluster HA |
occur daily in grps (clusters):
-last wks-months, then dissappear m-yrs -occur same time of year equinox, 1-8 episode/d. Mostly 1hr into sleep, (alarm clock) HA -behind one eye w/ steady intense, crescedo pattern 15-3h: Suicide HA w/ lacrimation, conjunctival injection, ptosis, nasal stuffiness |
|
|
In the absence of neurological exam MRI or CT is usually not indicated?
|
Yield little additional information compared to cost
|
|
|
Are Migrain w/ or W/o aura more common?
|
without an aura (effects 80% of migraine) assess for warning of agitation, jitteriness
|
|
|
What does SNOOP stand for in HA RED flags
|
S-systemic sx: fever, weight loss, HIV cancer
N-neuro sx: confusion, LOC O- onset: sudden, abrupt O- Old: new onset progressive, >50y/o P- Previous: FHx, different, change in attack and freq, severity, presentation |
|
|
Cluster HA are more common in what age
|
middle age men w/ heavy alcohol and tobacco (suicide HA) over several weeks w/ lacrimation, rhinorrhea
|
|
|
What is tx of cluster HA
|
remove trigger: smoking, alcohol, triptans, NSAID, oxygen
|
|
|
What form of migraine tx has rapid onset but more expensive
|
injectable: sumatriptona, dihydroergotamine: 15-30min. best if GI upset
|
|
|
What are triptans and why are they used in HA (migraine): Preventative therapy used daily: Imitrex
|
selective serotonin receptor agonist: increase uptake of serotonin which vasoconstrics blood vessels decrease inflammation. (CONTRindicated in Prinzmetal angina or CAD or pregnant, or recent use of ergots)
|
|
|
What are ergotamines and why are they used in HA (migraine but NOT tenstion)
|
vasoconstrictor effects: avoid in hx of CAD
|
|
|
NSAIDS are useful for what type of HA
|
tension and migrain: inhibit prostaglanding and leukotriene synthesis (use first sx of Ha)
|
|
|
Which has best relief w/ HA: NSAID or APAP/ ASA
|
NSAID due to improved analgesic effect
|
|
|
Fioricet w/ caffeine, butalbital and APAP: use and type of HA
|
enhances neurotransmitter action, dependency risk and rebound
|
|
|
Midrin (isomethepetene, APAP, dichloralphenzone: used in and caution
|
migraine and tension HA: Contraindicated if vasoconstriction concern
|
|
|
Excedrin Migraine: ASA, APAP, caffeine: OTC: type HA
|
migraine and tension: excessive use may causes rebound
|
|
|
Neuroleptics: adjuct therapy to what type HA
|
migraine: control N/V, sedating
|
|
|
What are some examples of neuroleptics used in migraine tx:
|
Compazine, phenergan: used >3xwk increase risk of extrapyramidal effects
|
|
|
What are the risks of Opiod use?
|
dependency (habit), sedating use sparingly, respiratory distress if OD
|
|
|
What receptor do most HA medication work on?
|
5HT2 receptor: 1-2m use is required to be effective prophylactic
|
|
|
What are some HA inducing medications:
|
estrogen, progesterone, vasodilators
|
|
|
HA due to ICP presents w/ c/o
|
worst on awaking but decreases throughout day.
|
|
|
Tension Ha present w/ c/o
|
worsen as the day progresses
|
|
|
18y/o c/o HA fever, + kernig and Brudzinski signs: Dx
|
meningitis
|
|
|
19y/o dx meningococcal meningitis: who should receive prophylactic tx
|
those w/ household type exposure: >4hr/wk exposure
|
|
|
Bacterial meningitis w/ show ____ on CSF
|
glucose at 30% of serum level
|
|
|
Viral or aseptic meningitis expect to find CSF___
|
predominance of lymphocytes
|
|
|
Describe Kernig sx
|
pt lying supine - hip flexed 90 degree; knee extension = resistance or pain to lower back or posterior thigh
|
|
|
Papilledema is what:
|
optic disk bulging caused by elevated ICP bilateral
|
|
|
Who should the NP obtain a CSF on as part of eval for Fever
|
younger child w/ altered neurologic findings
|
|
|
What do you expect to find in CSF (WBC) of meningitis:
|
Pleocytosis: WBC >5cells/mm whether: bacterial, viral, tubercular, fungal or protozoan
|
|
|
What do you expect to find regarding glucose and protein of CSF in bacterial meningitis
|
decrease normal glucose (<60%), elevated protein levels
|
|
|
What do you expect to find in glucose and protein of CSF in viral meningitis
|
normal glucose, normal protein but +lymphocytosis
|
|
|
What diagnostic should be performed prior to Lumbar puncture on suspected meningitis
|
MRI or CT scan
|
|
|
What are common pathogens in bacterial meningitis adult:
|
S. pneumonia, N. meningitis, staph and H.influenzae
|
|
|
Clinical presentation of bacterial meningitis:
|
classic triad: fever, HA, nuchal rigidity
|
|
|
What is brudzinski sign
|
Passive neck flexion in supine => flexion of knees and hips (meningitis)
|
|
|
What does absence of venous pulsation during eye exam indicated?
|
increased ICP
|
|
|
How many hr of exposure increase risk of passing meningitis:
|
> 4 hours, wk prior to sx
|
|
|
What is antimicrobial options in bacterial meningitis
|
rifampin (antituberculin), ciprofloxacin, ceftriaxone
|
|
|
34y/o dx w/ MS what is the typical pattern
|
variable exacerbations and remissions
|
|
|
Tx options in MS to attenuate disease progression:
|
interferon B-1B
|
|
|
What is consistent presentation of parkinson
|
tremor at rest and bradykinesia
|
|
|
What are tx options (pharm) w/ parkinsons
|
levodopa, ropinirole, pramipexole
|
|
|
Pallidotomy is helpful in managment of parkinsion disease associated w/ refactory ______
|
dyskinesia
|
|
|
What are common sx of MS:
|
numbness of limb, monocular visual loss, dipolia, vertigo, facial weakness o rnumbness, sphincter disturbance, ataxia, nystagmus
|
|
|
How is MS classified, what are the stages?
|
1. relapsing remitting MS: no neuro effects after remission
2. chronic progressive: episodes do not fully recover and accumulative defest |
|
|
MS typical progression:
|
relapsing-remitting for years later develop chronic progressive
|
|
|
Why is MS difficulty to dx:
|
sx of recurrent fatigue, muscle weakness and other nonspecific sx occur w/ mult illness
|
|
|
What are then name of maintenace therapy for MS: interferon B-1b
|
Betaseron: reduces exacerbations
|
|
|
What immunosuppresive therapy is used in MS
|
methotrexate or mitoxantrone
|
|
|
What are the six cardinal signs of Parkinson:
|
tremor at rest, rigidity, bradykinesia, flexed posture, loss of postural reflexes, mask like facies (tremor at rest or bradykinesia must be present)
|
|
|
What is typical in Parkinson gait:
|
rapid small steps, turning takes several steps move forward/back
|
|
|
What is the tx of choice in parkinsons and why
|
ropinirole (Requip) and pramipexole (Mirapex) dopamine agonist
|
|
|
What develops after taking levodopa for 5-10 yrs for parkinson
|
dyskinesia (tics of hands, face)
|
|
|
What is used to reduce dyskinesia
|
Symmetrel: may only be used 1yr.
|
|
|
Why is pallidotomy used:
|
surgical therapy management of dykinesia in parkinsons: removal of gladius pallidum
|
|
|
Describe absence seizure (petit mal)
|
blank staring 3-50 sec w/ impaired LOC
|
|
|
Describe simple partial seizure?
|
awake state w/ abnormal motor lasting seconds
|
|
|
Describe tonic-clonic (grand mal)
|
rigid extension of arms and legs then sudden jerking w/ LOC
|
|
|
Describe myoclonic seizure
|
brief, jerking contraction of arms legs or trunk
|
|
|
Tx for seizure include:
|
carbamazepine (tegratol) phenytoin (dilantin), gabapentin (neurotin), clonazepam, valproic acid (AED)
|
|
|
When taking phenytoin w/ ____ may exhibit toxicity
|
theophylline
|
|
|
What is the risk of giving phenytoin w/ other high protein bound properties:
|
may result in displacement from protein binding site => increased free phenytoin => toxicity
|
|
|
What are risk factors for TIA
|
Afib, CAD, oral contraceptive
|
|
|
Delirium has acute or insidious onset?
|
acute: usually w/ change to medication w/ anticholinergic
|
|
|
Pneumonic for delirium: DELIRIUMS
|
D: drugs
E: emotion L: low oxygen I:infection R: retention urine or feces Ictal or postictal state U- Undernurished: b12, folate, dehydration M: metabolic (DM, thyroid S: subdural hematoma |
|
|
What is the tx of demintia/alzhiemers
|
Cholinesterase inhibitor (Aricept)
|
|
|
Define Primary HA
|
not associated w/ other disease, Migraine, tension type
|
|
|
Define Secondary HA
|
Associated w/ or caused by other conditions, does not resolve until cause resolved: ICP, brain tumor, bleed, inflammation
|
|
|
When does the evidence suggest to obtain Neuroimaging w/ nonacute HA
|
Hx: dizzy, numbness, HA awakens from sleep, worse w/ valsalva, accelerating, new onset
|
|
|
What might be suggested if patients says "worst HA of my life"
|
Consider hemmorhage.
|
|
|
What are some lifestyle triggers for migrianes
|
Menses, ovulation, preg, BC, illness, intense activity, sleep to much to little, missing meal, bright light, odors, weather, altitude ,meds, stress
|
|
|
What dieatary triggers infleuence migraine
|
ripened cheese, liver, herring, MSG, chocolate, alsohol, caffeine ect
|
|
|
What strategy is used to slow decline of the Alzheimer type dementia patient?
|
Vit E 10000 IU Bid or selegiline 5mg BID
|
|
|
AAN: Alz dementia: strategy:
mild to mod, use of cholinesterase inhibit mainstay of tx: what r they |
Donepezil (aricept), rivastigmine (Exelon), time limited benefit 6-12m. Increase acetylcholine in brain. Aricept only tx approved for all stages of alzheimers.
|
|
|
What are diff dx of dementia in older adults w/ similar sx:
|
depression, pain, infection
|
|
|
Physical finding in COPD include
|
decrease tactile fremitus, wheeze, prolonged expiratory phase of forced exhalation, low diaphram, increased AP diameter, reduced forced expiratory volume at 1 sec, reduction in Sats.
|
|
|
NAEPP-EPR-3 Goals of asthma care
|
1. minimal/no chronic sx of cough/wheeze
2. few/no ER visit/hospitalization 3. Minimize air remodeling(inflame) 4. Minimal/no prn short acting beta 2 agonist (<2d/wk w/ beta2 except for sprots 5. no limitation to activity |
|
|
What is the most common reason for protracted asthma exacerbation
|
viral URI
|
|
|
Long term O2 therapy in COPD:
Goal |
- increase baseline PaO2 at rest to >60mm/hg or SaO2 >90% or both
- Indication to intiate long term: PaO2 <55mm or SaO2 <88% w/ or w/o hypercapnia, HF, cor pulmonale, polycythemia |
|
|
What is a risk specific to females of developing DM?
|
Hx of gestational diabetes
|
|
|
Dx of DM2 can be made by:
|
glucose of 126 and 136:, glucose >200mg and confirmed or glucose tolerance w/ 2 abnormals
|
|
|
Screening for DM2 should be while:
|
fasting
|
|
|
Undiagnosed DM may present as what in females
|
vaginal candidiasis (elevated glucose feed yeast)
|
|
|
What is most important screen for diabetic nephropathy
|
Microalbumin: earliest indicate of kidney damage. if + reassess 3-6m
Screen in all DM >12y/o |
|
|
What is the earliest glycemic abnormality?
|
postprandial glucose elevation
|
|
|
What is the typical presentation of DM2?
|
Insidious onset w/ weight gain. found on screening for fasting glucose
DM1 typical acute onset |
|
|
ADA: what is tx of DM2 after oral meds have failed?
|
intermediate or long acting insulin at bedtime or morning 1xd 10U or0.2/kg. Cont oral unless sulfon or meglit (d/c)
|
|
|
Elevated glucose evening meal indicates what in a DM
|
not enough AM intermediate insulin, increase dose to 2-3U at a time, check sugars 3 d after change. Cont increase 2-3 until at goal
|
|
|
sx that may present as DM2 inlcude:
|
fatigue, athletes foot (glucose), infected mosquito bites
|
|
|
Acanthosis nigricans due to:
|
obese insulin resistance
|
|
|
What should target HR be in new DM
|
120s to 70s, the lower the better (w/in reason)
|
|
|
When do you screen a new DM2 for renal nephropathy
|
at diagnosis
|
|
|
How soon can you determine anti-proteinuric effect of ACE-I
|
6-8wks
|
|
|
What is the next lab if a pos albumin screen?
|
spot albumin w/ creatinine ratio
|
|
|
what is the definition of renal neropathy?
|
>300mg/d of albuminauria on 2 occasion seperated by 3-6m
|
|
|
What are the target lipids for DM according to ADA
|
HDL >50
LDL <100 Trig <150 |
|
|
what increases A1C
|
glucose and alcohol
|
|
|
What is the relationship w/ triglycerides and A1C:
|
Triglycerides w/ increase w/ A1C
|
|
|
How does hyperthyroidism affect blood pressure?
|
increase systolic and diastolic, HR is typically >100
|
|
|
What are some endocrine causes of secondary HTN?
|
pheochromocytoma, Cushings, neuroblastoma,
|
|
|
What is the normal value of TSH?
|
5.0
|
|
|
What lab abnormality is common w/ hypothyroidism? not involving the thyroid or pituitary
|
hypercholesterolema
|
|
|
What is the most sensitive test for majority of hypthyroidism?
|
TSH only
|
|
|
45y/o female TSH 13 then 1m later 15 what is the dx:
|
hypothyroidism
|
|
|
Hx of tx for hyperthyroidism will now likely have?
|
hypothyroidism
|
|
|
Serum free T4 falls TSH will?
|
TSH will rise
|
|
|
Hypercholesterolemia is common when TSH is >than ____
|
10 mU/L: dont tx hyperlipidemia until TSH <10
|
|
|
What are common lab findings in hypothyroidism not associated w/ thyroid or pituitary?
|
hyponatremia, hyperprolactinemia, hyperhomocysteinemia, anemia, elevated creatinine
|
|
|
What are medication and disorders that can increase TSH
|
metoclopramide (reglan), amiodarone, adrenal insufficiency, pituitary, generalized thyroid hormone resistance
|
|
|
what are common sx of hypothyroidism?
|
fatigue, weight gain, dry skin, hair nails that break easily, cold intolerance, constipation, menstrual irregularities
|
|
|
Tx of hyperthyroid has an inverse result of?
|
destroying the gland ability to produce thyroid hormone T3 and T4
|
|
|
What may happen to TSH if synthroid is substitued by a generic med?
|
TSH will vary due to the different bioavailablities of generic meds
|
|
|
How do you determine amount of T4 to replace (synthroid) in a patient?
|
replacement based on weight in Kg and multiply by 1.6 for 1 day.
|
|
|
What do you expect to FSH to do in a menopausal women w/ hot flashes and no period for 12m
|
increase (follicle stimulating hormone) best diagnostic is PE: bleed change, hot flash, sleep disturbance, GU sx
|
|
|
How long before PAP smear should women not have sex, douch, or use tampon
|
48hrs prior to PAP
|
|
|
60y/o w/ small amount vag bleed, postmenopausal x 2 yrs dx would be?
|
atrophic vaginal mucosa (endometrial carcinoma is a concern but rare)
|
|
|
28y/o w/ primary dysmenorrhea OTC motrin, naproxen what next tx?
|
oral contraceptives
|
|
|
Dx of osteoporosis is made when what diagnostic test?
|
BMD bone mineral density 2.5 more from standard or T-score of -2.5 or less
|
|
|
What is the usual age recommendation for HPV test?
|
21yrs or 3years after first sexual intercourse
|
|
|
Primary risk factor for breast cancer is?
|
age
|
|
|
A localized tumor in prostate gland will have what sx?
|
none: but will be indurated on exam
|
|
|
Hematuria is uncommon clinical manifestation in what early male cancer?
|
prostate cancer
|
|
|
30y/o w/ lump to breast during menses what is the next step?
|
advise to return 3-20 days after menstation to reasses, if any concern then mammogram and US
|
|
|
DRE (digital rectal exam): it is not acceptable to perform while: standing, kneeling, lying on side, in lithotomy position
|
kneeling: best way is supine and legs in stirrups
|
|
|
A radical prostatectomy 6 m ago now urinary incontinence what is going on?
|
a common complication, subsides in 2yrs and/or develop ED
|
|
|
What med should be avoided in benign prostatic hypertrophy (BPH)?
|
nasal decongestant: may increase urge to urinate
|
|
|
What age should digital rectal exam be perfromed for prostate cancer, what age should PSA and dRE
|
40 for DRE and 50 for both
|
|
|
When should PSA and DRE be perfromed on blacks?
|
before the age of 50yrs, five yrs prior to other races
|
|
|
What is the most common cause of epididymitis in <35y/o.
|
Chlamydia trachomatois, in older men >35 UTI is most common
|
|
|
Why are truck drivers predisposed to noninfectious epididymitis:
|
reflux of urine into epidimyis from ejaculatory ducts and vas
|
|
|
Inguinal hernia is hernation of what
|
bowel or omentum into scrotum
|
|
|
How does an inguinal hernia present?
|
scrotal pain and a scrotal mass or scrotal swell (abd pain) bowel sounds in scrotum (w/ a stethascope??)
|
|
|
What is Hesselbach triangle?
|
inguinal ligament, rectus muscle and epigastric vessel: Inguinal hernia
|
|
|
patient dx w/ cluster HA should eliminate what?
|
triggers like nicotine and alcohol
|
|
|
Audible carotid bruits indicate?
|
Atherosclerosis: increase probability of death from CVA or CAD
|
|
|
Mini mental status exam assess?
|
mild alzheimers
|
|
|
Differential dx of suspected alzheimers also includes?
|
tumor, cerebral hemmorage, cerebral infarct
|
|
|
what is included in the mini mental exam?
|
orientation, short-term memory-retention, short-term recall, language, attention (does NOT dx alzheimers)
|
|
|
How long after initiating acetylcholinesterase inhibitor should you eval for efficacy
|
6-12m: assess caregiver feedback, repeat mental status, ADL, S/E cost
|
|
|
What increases the risk of and elder being abused?
|
decrease cognative due to caregiver strain, stress depression
|
|
|
What does the snell chart test?
|
distant vision and CNII
|
|
|
Giant cell arteritis: temporal arteritis is best dx by?
|
temporal artery biopsy
|
|
|
What is the typical complaint of temporal arteritis:
|
new onset HA, abrupt visual change, jaw claudication, fever or anemia elevated sed rate 72y/o
|
|
|
Where is carpal tunnel usually felt on the fingers?
|
thumb, index finger middle finger and radial side of ring finger
|
|
|
What structures are directly affected by carpal tunnel?
|
Medial nerve: inflammation of wrist tendeons, transverse carpal ligament
|
|
|
What are 4 prominent features of Parkinson?
|
bradykinesia, muscular rigitdity, resting tremor, postural instability
|
|
|
What is anosmia?
|
inability to smell, CN 1 olfactory nerve (peppermint or coffee)
|
|
|
What CN is responsible for hearing
|
CN 8
|
|
|
What CN is responsible for eye movement
|
III, IV, VI
|
|
|
What CN is responsible for facial sensation?
|
CN V (light touch test)
|
|
|
What may be an indicator of hemorrhagic stroke?
|
headache w/ stroke
|
|
|
What diagnostics does a pt w/ new onset TIA
|
CT and/or MRI, ECG, CBC, PTT< lytes, creatinine, glucose, lipids transcranial doppler US
|
|
|
What should you do w/ a new onset TIA?
|
immediate ER referal
|
|
|
Why is ASA used as an antiplatelet therapy?
|
ASA inhibits enzyme cyclooxygenase adn reduces thromboxane A2 production
|
|
|
Define Secondary prevention?
|
intervention to help prevent second occurrence of deleterious event. ex: ASA after a stroke
|
|
|
What is the criteria for migraine?
|
1. 4-72hrs
2. HA has 2 of following: unilateral, pulsating mod to severe, aggravated routine activity 3. photophobia, phono 4. 5 attacks which fulfill these criteria 5. no underlying illness |
|
|
Which are most likely triggered by food: migraine or tension
|
migraine: sx nausea, worse w/ activity
|
|
|
Does Bell palsy present w/ pain.
|
NO: sx of sagging eyebrow, impaired blink, mouth drawn up
|
|
|
How long after a rubella should a pt avoid pregnancy
|
1 month (though no documented injury of offspring) safe when breastfeeding
|
|
|
What immunizations can be given in 1st trimester?
|
influenza, tetanus, diptheria
|
|
|
When should varicella be given in pregnancy?
|
Never, no live viruses should be given during pregnancy
|
|
|
What are classic sx fo ectopic pregnancy?
|
amenorrhea, vag bleed, abdominal pain
|
|
|
Due dates are used to:
|
Assess fetal growth provide accurate data for screen test if LMP cant be determined do an US to determine fetal age.
|
|
|
What does pregnancy test assess the prescence of...
|
beta hCG: best 1st void in am or anytime if serum
|
|
|
Tx of asymptomatic bacteriuria in pregnancy?
|
nitrofurantoin (Macrobid): prevents pyelonephritis, Ciprofloxacin (quinolone should be avoided in preg), Amoxicillin is poor coverage of E.coli.
|
|
|
17y/o pregnant should be assessed for
|
STD and HIV:
|
|
|
Should all pregnant pt be screened for hypothyroidism?
|
No: only if hx of or FHx or symptomatic
|
|
|
What are risk associated with intercourse during pregnancy?
|
STD, preterm labor due to lower uterine stimuli, Oxytocin released
|
|
|
Routine screen of gestation diabetes should occur?
|
at 24 weeks
|
|
|
When should a 1st trimester pt w/ chlamydia and Gonorrhea be tx and rescreened
|
Tx immediately rescreened later even if no sx
|
|
|
what are increased risk of ectopic preg?
|
prior hx of ectopic, IUD use, Hx of PID, abortion
|
|
|
What medication should be used for UTI in pregnancy?
|
Macrodantin safe and most efficacious?
|
|
|
What medication is associated with fetal tooth discoloration? ....really?
|
Doxycycline
|
|
|
Why is ciprofloxacin not recommended during pregnancy?
|
potential problems w/ bone and cartilage formation
|
|
|
What is myperemesis gravidarum
|
persistent vomit results in weight loss of >5% (morning sickness is milder)
|
|
|
What is Anhedonia
|
loss of pleasure in things that use to bring interest, screen for depression
|
|
|
What is the most common S/E of lithium:
|
nephrogenic diabetes insipidus, plyuria and polydyspia
|
|
|
What is searching behavior after the death of a loved one?
|
Imagined hearing or seeing deceased...should resolve in 6m no meds needed
|
|
|
CAGE used for
|
screen for alcohol abuse
|
|
|
CAGE stands for:
|
C" need to cut down
A: Annoyed by criticism G: guilty about amount E: need eye opener. Usually 2 or more |
|
|
What are physcial sx of alcohol abuse?
|
Macrocytosis, due to B12 deficienttremors, HTN, rhinophyma, peripheral neuropahty, telangiectasias, hepatosplenomegaly
|
|
|
What labs are elevated in alcoholics?
|
Liver enzymes: ALT and AST usually 2x higher than ALT
|
|
|
Which of the following is bulimia nervosa?
bing w/o purge pruge must be present loss of control refusal to eat |
loss of control: may involve purge and nonpurge
|
|
|
What are typical S/E of SSRI
|
Nausea, Ha daily
|
|
|
Elderly tx for depression w/ TCA exhibit?
|
cognitive changes and urinary retention
|
|
|
Bipolar disorder is associated with high rates of >>.
|
suicide
|
|
|
What med is indicated for acute mania?
|
Lithium
|
|
|
What should be monitored when taking valproate for manic sx
|
Valporic Acid, platelets, LFT. Assess for thrombocytopenia,
Target valproate levels: 50-125 |
|
|
Tx for depression w/ fluoxetine finds out shes pregnant what should the next step be>
|
Continue w/ medication, let OB and patient make this decision; it does cross placenta
|
|
|
What drugs are associated with a dry cough?
|
ACE-I
|
|
|
What would be part of the differential in cough?
|
CHF, GERD, Asthma, URI, ACE-I
|
|
|
How is M. and C. pneumonia respiratory pathogens spread?
|
via cough
|
|
|
Which patient needs a peak flow?
chronic bronchitis, emphysema, pneumonia, asthma |
Asthma: measures peak expiratory flow; sensitive to resp tube changes.
|
|
|
What does FEV1 stand for:
|
forced expiratory volume in 1 sec. Used w/ emphysema; aveoli are stretched and contain trapped air.
|
|
|
What medications are use to tx COPD? clsasses
|
long acting bronchodilators (salmeterol), anti-cholinergic (tiotropium), steroids.
|
|
|
Which of the following is most important to assess w/ new onset asthma?
-smoker? -how severe r sx? -How often do sx occur -do you wheeze? |
How often do sx occur? Determines pharm management and frequency.
|
|
|
A 45 yr smoker will most likely have what respiratory disorder?
|
COPD
|
|
|
Why are narcotic contraindicated in COPD patients?
|
decrease respiratory drive and worsen hypercapnia
|
|
|
What is the most common pathogen in atypical pneumonia?
|
mycoplasma pneumonia
|
|
|
What is the most common pathogen in community acquired pneumonia?
|
Streptococcus pneumonia: usually post influenza in the very young and old
|
|
|
How many metered doses are in an metered dose inhaler?
|
200 doses
|
|
|
What is the next step for a pt that is using MDI >2x wks and needs a refill w/ daily maintenance steroid.
|
Increase the steroid and refill the albuterol. the pt is not well controlled and needs better maintenance
|
|
|
Which of the following is not common in acute bronchitis?
cough, pharyngitis, nasal discharge, fever |
Fever.
Cough is the most common lasting >5d. If fever w/ cough then consider pneumonia. |
|
|
What is the tx for acute bronchitis w/ purulent sputum?
|
anti-tussive only. Only antibiotics if pertussis. Purulent sputum is epithelial cells sloughing which results in colored sputum.
|
|
|
Which of the following meds are needed in acute bronchitis?
-steroids oral -antibiotic -decongestant and antitussive -antibiotic and steroids |
-decongestant and anti-tussive
tx the sx rarely bacterial |
|
|
What is the recommended max amount rescue inhaler should be used w/ proper asthma maintenance
|
2xwk day or 2x month at night
|
|
|
Why should you NOT use Timolol (eye medication) in an Asthma patient?
|
It is a beta-blocker which may precipitate asthma exacerbation
|
|
|
what is essential in dx of COPD
|
PFT = FEV and FVC (forced vital capacity)
|
|
|
Why should ipratropium (atovent) not be used w/ beta blockers unless short of breath?
|
Beta agonist increase side effects like tachycardia and treemors w/o improved efficacy
|
|
|
Why is asthma not listed under COPD diseases?
|
Asthma is reversible COPD is not.
|
|
|
Which organism in pneumonia has rust colored sputum?
|
Strept pneumonia
|
|
|
What major lab is found in pneumonia?
|
leukocytosis: gram stain can be pos or neg: leukopenia is an omnious sign in elderly
|
|
|
What is a typical finding on xray w/ pneumonia?
|
inflitrates: w/ fever, CP, dyspnea, sputum
|
|
|
Mycroplasma pneumoniais present as what type of pneumonia and what are the sx and what does the xray reveal?
|
atypical pneumonia
varied sx xray has: thickened bronchial shadow, streaks of interstitial infiltration and atelectasis |
|
|
What antibiotic can be used empirically w/ pneumonia in otherwise healthy pt
|
azithromycin or augmentin
|
|
|
What are sx of trichomonas in males
|
no sx in males:
Females: itching and discharge Tx w/ metronidazole (flagyl) |
|
|
Chancroid is an STD from H. Ducreyi what is it a co-factor STD w/:
|
HIV and heals slower:
males have pain females dont |
|
|
21y/o w/ HPV lesions on vulva what is the tx:
|
trichloroacetic acid: warts will slough off after 1 or more tx
|
|
|
What test are ordered after + HIV results?
|
CD4 and HIV RNA (viral load): norm CD4 500-1500, at 200 dx w/ AIDS
|
|
|
How often should viral counts (CD4) be monitored?
|
every 3-4 months (2-8 wks when changing therapy) Sx do not affect CD4 counts
|
|
|
What medications are used for trichomoniasis
|
metronidazole
|
|
|
Which risk factor has greatest impact on HIV transmission?
viral load -type of sex -presence of STD -patient gender |
Viral load
|
|
|
How long after a needle stick will seroconversion occure?
|
4-10wks
|
|
|
Pt neg for HIV but exposed 4m ago. When should she be retested?
|
no recommendation for futher testing. Window period is w/in 3 mnths of exposure if neg after then neg
|
|
|
What is the primary reservoir for HIV?
|
lymphatic tissue
|
|
|
If someone has persistent generalized lymphadenopathy what should be tested?
|
HIV
|
|
|
What clincal syndrome is from replacement of normal vaginal flora?
|
bacterial vaginosis
|
|
|
Male patients presents w/ dsyuria what is the likely STD?
|
Chalmydia and gonorrhea
|
|
|
Dx w/ genital herpes, what will be prescribed?
|
valacyclovir
|
|
|
Suspected of syphilis needs a _____ screening
|
serum assessmetn RPR
|
|
|
72y/o early renal insufficiency: what lab do you expect
|
serum creatinine is sligtly elevated: protein would not be specific for renal disease
|
|
|
A pt w/ a long hx of HTN dx w/ chronic renal insufficiency: What would dx test reveal?
|
clear urine & elevated creatinine: clear because kidney cant filter content.
|
|
|
What organ is responsible for erythropoietin production:
|
kidney
|
|
|
When is the only time asymptomatic bacteria treated?
|
During pregnancy to prevent UTI, or other immunosuppressive state
|
|
|
What diagnostic diagnosis a UTI
|
urine bacteria >100,000, midstream, clean catch
|
|
|
What is murphys sign
|
inspiratory arrest w/ deep palpation of upper right quadrant (cholecystitis)
|
|
|
Are males or females more likely to suffer from urolithiasis?
|
males: sx of fever, chills, RBC casts are mucoprotein complexes
|
|
|
24y/o female patient dx w/ uncomplicated UTI. What is important and is least important assessment?
Body temp, abd exam, CVA tenderness, vag exam |
body temp, abd exam, CVA tenderness: Vag exam would not be indication unless vag discharge
|
|
|
How long should a UTI be tx w/ septra?
|
3 days
|
|
|
Male w/ sx of burning w/ urination. what assessment is least important?
|
abd exam would be least important: diff dx: urethritis, epididymitis, prostatitis, STD
|
|
|
Acute Mnt Sickness:
Onset, sx, PE: |
1-6hrs-several days, rapid
Sx: Ha, cough, anorexia, nausea, weakness, insomnia |
PE: increased HR, decreased BP, fluid retention
|
|
Acute Mnt sickness:
Tx, Prevention |
Tx: descend >500m, acclimatize, acetazolamide (diamox), emetics, analgesics
Prevention: Ascend slowly, avoid strenuous exertion and rapid ascent, consider acetazolamide 1 day prior and 2 days after ascent, spend night intermediate altitude |
|
|
High-altitude pulmonary edema:
tx |
descent, rest evacuation, nifedipine (CCB), oxygen, hyperbaric bag
|
|
|
High altitude cerebral edema:
Tx |
descent evacuaiton, dexamthasone, hyperbaric bag, BLS, seizure control
|
|
|
What immune response results in anaphylaxis?
|
immunoglobulin E (IgE): bronchospasm, hypoxemia, hypotension. basophil and Mast cells
|
|
|
What immune response indicates severe rxn?
|
facial angioedema, resp distress, vascular collapse
|
|
|
What is a biphasic reaction?
|
Primary rxn 1-45 min after exposure then sec rxn hrs after exposure.
|
|
|
What medication is used for anaphylaxis?
|
IM Epi (0.3-0.5 of 1:1000) q 15min
-0.01mg/kg children (vastus lateralis) -diphenhydramine: 50-100mg Po or IM if severe, -Ranitidine 50mg IV -Hydrocortisone for delayed relief: 100mg q6hr for relapse prevention |
|
|
What test can ID allergens:
|
RAST: radioallergosorbent
|
|
|
Mosquitoes, flies: presentation
|
pruritic, painful papule, secondary infection common
|
|
|
Bedbug, kissing bug: presentation
|
clustered, erythematous, purutic nodules
|
|
|
Fleas: presentation
|
pruritic grouped welts, papules, vesicles, secondary infection common
|
|
|
Lice: presentation
|
pruritus, nits in scalp, body or pubic hair
|
|
|
Centipedes: presenation
|
pain an ditching w. local necrosisi
|
|
|
millipedes: bite presentation
|
brown stain w/ blistering
|
|
|
Scabies: Presentation
|
burrow lesion w/ pruritus, secondary infection, usually in webs of fingers and hands
|
|
|
Chiggers: presentation
|
pruritic papules or vesicles, secondary infection
|
|
|
Ticks: presentation
|
pruritic papules w/ tick present
|
|
|
Tx of lice and scabies includes:
|
1% lindane lotion or Kwell, scbene shampoo 2 consecutive nights, consider permethrin for scabies also
|
|
|
What is a good repellent to prevent outdoor insect bites?
|
diethyltoluamide (DEET) or Indalone
|
|
|
Describe a Brown Recluse and tx:
|
length 5x width, yellow, brwn or black, thin legs, violin shaped marking, supportive tx, or surgical if >2cm
|
|
|
Describe a Black widow and tx
|
female most venmous, black, brwn, tan, may or may not have hour glass, tx: supportive, tetanus, pain relief (calcium gluconate)
|
|
|
What are presentation of coral snake bite sx?
|
salivation, dysarthria, diplopia, dysphagia, dyspnea, seizures- 6hr after bite.
|
|
|
What is the tx for snake bites and scorpion stings?
|
calm, immobilze, minimize physical activity, wipe bite, BLS, tetanus, antivenom for snakes. Observe for 12 hrs
|
|
|
What is the mainstay of GI decontamination in overdose or chemical ingestion?
|
activated charcoal 1-2 g/kg: DONT use in caustic acids, alkalis, alcohols, lithium or heavy metals
|
|
|
What is the tx for ethylene glycol
|
Ethanol 10% in D5W, over 30min, then maintain blood alcohol at 100-150mg/dl
|
|
|
Electric injury: Which is more dangerous AC or DC
|
AC alternating current = tetanic skeletal muscle contraction prevents letting go of engergized source
|
|
|
Acids (toilet cleaner, drain, hydrocholric, sufuric, batter acid)
Sx, Tx |
Sx: burns of oral mucosa, drooling, odynophagia, abd pain
Tx: Sucralfate 1g PO -copiously wash mouth. DO NOT induce vomiting, lavage or administer charcoal |
|
|
Alkalis: Sx, Tx
|
Sx: caustic-burns
Tx: dilution w/ water, DO NOT induce vomit, lavage. Ingest large amounts of waster or milk, avoid emesis |
|
|
Anticholinergic exposure: Sx, Tx
|
Sx: flushing skin, vlurred vision or mydriasis, tachy mucous membrane
Tx: physostigmine, 0.5-2.0 IV or IM |
|
|
Carbon Monoxide: Sx, Tx
|
Sx: HA, cherry lips, altered consciousness, coma
Tx: Oxygen, 100% hyperbaric chamber |
|
|
Ethylene glycol: Sx, Tx
|
Sx: cough, dizziness, HA, abd pain, dullness, N/V
Tx: Ethanol, 10ml/kg of 10% ethanol solution over 30min |
|
|
Isopropyl alcohol: Sx, Tx
|
Sx: Ethyl alcohol-like (ETOH-like) (altered consciouness, stupor, slurred speech) dizzy, GI, coma
Tx: lavage charcoal, no not vomit, lavage w/in 30min ingestion: may require dialysis |
|
|
Methanol: Sx, Tx
|
Sx; cough, dizzy, HA, nausea, dry skin, redness
Tx: Ethanol: same as E. glycol |
|
|
Petroleum products: Sx, Tx of ingestion
|
Sx: vomiting, chest or abd pain, cough, dyspnea, fever, arrhythmia, seizures, LOC
Tx: Prompt lavage, O2, ipecac in alert, intubate |
|
|
Head Trauma: Glasgow coma:
Eye opening scoring |
spontaneous 4
verbal: 3 pain: 2 no response: 1 |
|
|
Head trauma: Glasgow com:
Best motor response |
obeys verbal: 6
localizes pain: 5 movement or w/drawl to pain: 4 flexion to pain (decort): 3 extension to pain (decerb) 2 no response: 1 |
|
|
Head Trauma: Glasgow Coma
Best Verbal: |
A&O: 5
Converse but confused: 4 Nosense/inappropriate words: 3 nonspecific sounds: 2 No response: 1 |
|
|
What is the cascade effect of cerebral edema?
|
increased ICP=> decreased cerebral blood flow => cerebral ischemia
|
|
|
What diagnostics should be used on Head Injuries:
|
xray for cervical, CT for depressed or deteriorating LOC, LOC <5min, amnesia, GCS 12-14, depressed skull
|
|
|
What is the most important time after a head trauma?
|
following the initial stabilization: 24hrs after are the most important for cerebral swelling
|
|
|
What are steps would require a head injury to return to the hospital?
|
drowsiness difficult to awake, continuous nausea, vomiting more than twice, seizures, pupillary changes, weakness, severe HA, dizziness.
|
|
|
What is postparandial hypotension?
|
hypotension after meals (mostly in elderly due to rush of blood to abdomen)
|
|
|
What fluid challenge should you give someone w/ hypovomlemia
|
250-500ml of NS IV
|
|
|
What head elevation should there be in a person sleeping w/ hypotension?
|
10-20 degrees for sleep
|
|
|
Does cocaine interfere w/ reactivity of pupils?
|
no but antichoinergics causes unreactive pupils
|
|
|
What medications cause nystagmus?
|
alcohol, lithium, tergretol, meprobmate, primidone
|
|
|
What medication is given for APAP overdose?
|
N-acetylcysteine: 140mg/kg.
|
|
|
What medication is given for benzo overdose?
|
Flumazenil (0.2mg q 1min)
|
|
|
Sexual assault: definition
|
sexual act that is forced or coerced w/o consent of victim
|
|
|
What should you do if a patient has been sexually assaulted w/in the last 5 days?
|
defer physical exam and refer to ER if the patient wants to pursue legal action. If > 5d or no legal then manage in the office
|
|
|
What is the time limit to offer pregnancy or STD prophylactics:
|
72 hrs
|
|
|
What STD test should be performed on a sexual assault?
|
gonorrhea, chlamydia most prevelant. Test for HIV/AIDs cannot be doen until 3-6months due to seroconversion
|
|
|
What percent of sexual assault victims will have PTSD?
|
1/3rd
|
|
|
How are tilts performed:
|
lie, sit stand for 5 min each w/ BP and pulse: drop systolic by 20 , diastolic by 10 and increase pulse 20.
|
|
|
What is passive external rewarming:
|
placing patient i warm environment
|
|
|
What is active external rewarming:
|
hot blankets, hot packs, warm bodies, forced air rewarming
|
|
|
What medication is given or APAP overdose?
|
N-acetylcysteine: 140mg/kg.
|
|
|
What medication is given for benzo overdose?
|
Flumazenil (0.2mg q 1min)
|
|
|
Sexual assault: definition
|
sexual act that is forced or coerced w/o consent of victim
|
|
|
What should you do if a patient has been sexually assaulted w/in the last 5 days?
|
defer physical exam and refer to ER if the patient wants to pursue legal action. If > 5d or no legal then manage in the office
|
|
|
What is the time limit to offer pregnancy or STD prophylactics:
|
72 hrs
|
|
|
What STD test should be performed on a sexual assault?
|
gonorrhea, chlamydia most prevelant. Test for HIV/AIDs cannot be doen until 3-6months due to seroconversion
|
|
|
What percent of sexual assault victims will have PTSD?
|
1/3rd
|
|
|
How are tilts performed:
|
lie, sit stand for 5 min each w/ BP and pulse: drop systolic by 20 , diastolic by 10 and increase pulse 20.
|
|
|
What is passive external rewarming:
|
placing patient i warm environment
|
|
|
What is active external rewarming:
|
hot blankets, hot packs, warm bodies, forced air rewarming
|
|
|
What is core rewarming?
|
warem IV fluids, heated and humidified oxygen, body cavity lavage
|
|
|
What temperature of water should frostbite extremities be warmed?
|
98.6-104F: also give motrin, topical alovera to decrease inflammation, Tetanus, IV PNC: at 500kU
|
|
|
How long does it take to acclimate to warm climates:
|
7-14 days
|
|
|
How does Cushings develop?
|
ACTH-secreting tumors of the pituitary or small cell lung carcinomas which elevate Cortisol and ACTH levels.
|
|
|
What is a pheochromocytoma?
|
tumor of chromaffin cells, unilateral --> abnormal production of epi and norepi-->Na retention, reduced hydrostatic..
|
|
|
What is the exception to Addisons presentation of slow onset?
|
inadequate supplement of corticosteroids (chronic users of corticosteroids --> addisons)
|
|
|
Sx of Cushings:
|
sudden weight gain, loss of menses, decreased libido, depression bruising.
|
|
|
What diagnostic is critical upon the dx of Addision to r/o another disease?
|
chest xray to rule out TB
|
|
|
How is Cushings syndrome most accurately dx?
|
24hr excretion of cortisol in urine
|
|
|
What diagnostic confirms pheochromocytoma?
|
elevated catecholamines in 24hr urine
|
|
|
What sequal events may occur w/ Addisions?
|
eating disorders, alcoholism, malnutrition, HYPERTHYROID, diabtes, apathy, depression
|
|
|
What is the tx of chronic adrenal insufficiency (Addisions)?
|
oral hydrocortisone 20-30mg/d (consider mineralocorticoid replacement to correct renal and hypotension.
|
|
|
What is the first choice in managment of Cushings?
|
Pituitary tumor resection w/ chemo
|
|
|
What are complications of Cushings?
|
osteoporosis, hypertension, diabetes
|
|
|
DM 1 what is the the problem?
|
beta cell destruction and requires exogenous insulin
|
|
|
What is the Problem w/ DM2?
|
beta cell dysfunction and/or insulin defect
|
|
|
What causes fasting hyperglycemia?
|
increased hepatic glucose production in the impaired early stage of insulin secretion
|
|
|
What causes Postprandial hyperglycemia?
|
Decreased uptake of glucose from skeletal muscles
|
|
|
How often should a new or uncontrolled DM1 or DM2 be seen?
|
every 3 months, extended to 6 if well controlled
|
|
|
How often should a diabetic get an A1C?
|
ADA: twice a year at a minumum or every 3 months if glucose not controlled
|
|
|
How often should microalbumin be obtained in DM?
|
yearly after 5 yrs of DM1
Yearly after onset DM2 |
|
|
What is the definitive test to assess kidney function?
|
24hr creatinine clearance
|
|
|
What does the basal phase do in glycemic control?
|
Inhibits glycolisis and gluconeogenesis and maintains insulin steady state
|
|
|
What is morning hyperglycemia controlled by? basal or prandial insulin
|
Basal insulin
|
|
|
Why is Symlin used in diabetes?
|
it reduces amount of food consumed and slows gastric emptying. Injected before the meal
|
|
|
What are the recommended before meal glucose readings in DM?
|
70-120mg/dl
|
|
|
What are the postprandially glucose goals in diabetes?
|
<140mg/dl 2hr after meal
|
|
|
What is the recommended begining dose of insulin for DM1?
|
20u in morning before breakfast, if fasting of 250 then 5U before bedtime snack.
|
|
|
What medication mimics the effects of basal insulin?
|
Glargine 24hr long acting no peak
|
|
|
How often should insulin dose be adjusted and when can adjustment stop?
|
adjust every 3-4 days until fasting glucose is <110mg/dl; only increase by 2-8U if obese and 1-4 if thin
|
|
|
What is professional scope of practice?
|
Address role, function, population, practice setting. Serve as the initial source to define individual scope of practice (TBON)
|
|
|
What is the wording used when an APRN directs another nurse to a specific task? Delegating or assigning
|
APRN are only allowed to delegate assitive personnel they may assign another nurse
|
|
|
What is the process of receivign prescriptive authority for controlled substance?
|
TBON authority, TDPS registration, DEA registration number.
|
|
|
What level of controlled substance may an APRN provide?
|
schedule III, IV, V
|
|
|
What is the maximum period that a controlled substance may be prescribed for by an APRN?
|
30 days
|
|
|
Can an APRN refill a prescription?
|
Yes but only after consultation and documentation w/ a delegating physician. (TBON)
|
|
|
What is the minimum age a controlled substance may be prescribed by an APRN?
|
2y/o if younger then consultation is required w/ documentation
|
|
|
If tx migraines w/ abortive therapy what is the max time to use tylenol, NSAIDs?
|
2d/wk to prevent analgesic rebound: can make HA daily condition
|
|
|
What is the tx of urge incontinent (pharm)
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Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
These are the most commonly used medications for urge incontinence. They are available in a once-a-day formula that makes dosing easy and effective. The most common side effects of these medicines are dry mouth and constipation. People with narrow-angle glaucoma cannot use these medications. Flavoxate (Urispas) is a drug that calms muscle spasms. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence. Tricyclic antidepressants (imipramine, doxepin) have also been used to treat urge incontinence because of their ability to "paralyze" the bladder smooth muscle |
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Addisons, Cushings, and Pheochromocytoma are disorders of what?
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Adrenal Gland
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What is Addison's disease?
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chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids
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What is the tx of addison's?
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Life long replacement of steroids...hydrocortisone and fludrocortisone
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What is found in Addison's Crisis?
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snycope, hypoglycemia, leg pain, low B/P, lethargy, hypokalemia, fever, convulsion
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Why and how long should you avoid alcohol when taking metronidazole (flagyl)?
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24hrs: avoid disulfiram-type rxn (severe n/v)
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What do you do if a pt fails tx on flagyl for trichomoniasis?
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Retreat w/ flagyl 500mg
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What antibiotics are used for acute prostatitis?
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Septra and fluoroquinolones
(PNC and Cephlosporins can not be used because they cant penetrate the prostatic epithelium) |
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What is the most common cause of hyperthyroidism
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Graves disease: abnormal immune response -->thryoid produces too much thyroid hormone T4, T3
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What are sx of B. pertussi?
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paroxysmal cough lasting >2wks
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What population is considered + TB at >5 induration?
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HIV, Recent TB contact, CXR w/ fibrotic change, organ transplant, Immunosuppressed
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What population is + TB w/ >10mm induration?
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<5yr immigrant, IV drug, congregate setting, lab personnel, peds<4y/o, peds exposed to high risk
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What population is + TB w/ >15mm induration?
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Everyone
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Tx of CAP w/ no comorbidity?
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Macrolide: azithromycin, clarithromycin, erythromycin
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Tx of CAP w/ comorbidity?
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Respiratory fluoroquinolone (levofloxacin)
OR advanced macrolide plus beta-lactam: Augmentin, Rocephin, Alternative to macrolide: Doxy |
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How is Legionella for pneumonia spread?
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inhalation of contaminated water
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The most common pneumonia is Streptococcus pneum. What is it resistant too?
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beta-lactams (PNC), Macrolides (emycin, clarithro, azithro), tetracyclines (doxy).
Known as drug-resistant S. pneum (DRSP) |
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What antibiotic should be used against DRSP (drug resistant S. Pneumonia)?
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respiratory fluoroquinolones (levoflaxacine [levaquin])
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What type of pneumonia organism is seen in alcoholics?
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Klebsiella pneumonia
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How do you know if a sputum sample is adequate for testing?
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Few Epithelial cells w/ many WBC (epithelial will come from throat not lungs)
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What medication may be given to latent TB if isoniazid is not tolerated? How long?
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Rifampin (6-9m)
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What is meant by long-term oxygen therapy in COPD?
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>15hrs day w/ oxygen
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If a person has a persistant cough that is controlled by a bronchodilator what is the dx?
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asthma
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Which environment is more likely to induce asthma sx. A warm humid space or a cold dry space?
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Cold dry space
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What are the three components of asthma dx?
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1. episodic sx of airflow obstruction (wheeze)
2. evidence of at least partial reversible (improves w/ med) 3. excusion of other condistions |
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What diagnostic tool is essential in the dx of astham?
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spirometry: Should be 80-100% expected:
Volume or speed/flow of air that can be inhaled and exhaled |
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How often should microalbuminuria be obtained in DM w/ neg protein?
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Annually
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When giving biguanide what should you monitor? CK, ALP, ALT, Cr
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Cr-creatinine:
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Secondary causes of hyperglycemia include all except?
niacine, corticosertoids, thiazide, angiotensin receptor blocker |
Angiotensin receptor blocker
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A1C provides info on glucose control over what period of time?
21-47d, 48-63d, 64-90d, 90-120d |
90-120 d...or 3 months
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If taking the following insulin at 8am what time would you expect the peak to occur?
1. Lispor, 2. Reg Insulin 3. NPH insulin, 4. Lantus |
1. Lispor: 30m-1hr
2. Reg Insulin: 2-3hr 3. NPH Insulin: 4-6hr 4. Lantus: no peak (24hr coverage) |
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What do meglitinide minimize in type 2 DM
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Pstparandial hyperglycemia
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What is a common adverse effect of alpha-glucosidase inhibitor:
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Gastrointestinal upset
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What are steps to improve microalbuminuria?
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1. improve glycemic control
2. strict dyslipidemia control 3. use ACE-I or ARBS |
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How often should A1C be checked in those w/ stable glycemic control?
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twice a year (every 6m)
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What is the mechanism of action of sitagliptin (Januvia)?
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Increase incretin -->increase synthesis and release fo insulin from pancreatic beta cells.
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What is the mechanism of action of sitagliptin (Januvia)?
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Increase incretin -->increase synthesis and release fo insulin from pancreatic beta cells.
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What is the mechanism of action for Byetta?
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Stimulates insulin production in response to increase plasma glucose
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What DM med should be avoided if hx fo gastroparesis?
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exentaide (Byetta): mainly due to its S/E of n/v/d with regular use
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What are recomended tx of HTN w/ type 2 dM?
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Beta blockers, ACE-I, ARBS; NOT alpha blocker
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What do expect to find when giving a fibrate?
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increase HDL
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What do you expect to find when giving niacin for lipids?
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increase HDL
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What do you expect to find when giving Zetia for lipids?
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reduction in LDL
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With Zetia (ezetimibe) what should routinely be monitored?
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No need to monitor labs...little impact on liver or kidney
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Which of the following man not causes statin-induced myositis?
advanced age, use of statin w/ resin, low body weight, high statin dose |
Us of statin w/ resin is not a risk for myositis
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Which of the following is most effective against lipidprotein?
1. HMG-CoA reductase inhibitors 2. Niacin 3. bile acid 4. fibrates |
2. Niacin
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What can untx hypothyroid lead to in lipid profile?
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increased LDL, TC, and Trig
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What should rigorous physical exercise do to lipid values?
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increase HDL, Lower VLDL, Lower Triglycerides
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What should you expect to see when giving fish oil?
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decrease triglycerides
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What should you expect to see when giving Plant stanol and sterold on lipid profile?
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decrease LDL
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How much eicosapentaenoic acid and doccosahexaenoic acid (omega-3) per day should you prescribe?
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1G (preferably from fish oil)
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Obestity is defined as BMI >
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30kg/m2
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When using orilstat (Alli) when should you take the medication?
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w/in one hour of each meal w/ fat
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What is responsible for satiety?
1. norepi 2. epi 3. dopamine 4. serotonin |
Serotonin
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What are adverse effects of sibutramine (Meridia)?
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somnolence
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Which med is associated w/ weight gain?
1. risperidone (Risperdal) 2. topiramate (topamax) 3. metformin 4. phentermine |
Risperidone: tx schizo
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If walking 8000-10000 steps/day what is the milage?
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4-5miles
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What medication is used to reduce craving for alcohol?
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acamproste (Campral)
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What medication is used to modify intoxicating effects of alcohol?
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naltrexone (ReVia)
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What medication results in unplesant adverse effects of alcohol?
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anabuse
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What happens to RBC in alcoholics and why?
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become macrocytic due to reduction in folate
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Define Acromegaly
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Excessive growth hormone: excessive bone and soft tissue growth
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