Nurse Practitioner Test 2

Front 1

Where are growth hormones secreted

Back 1

Anterior pituitary gland

Front 2

Give s+s of acromegaly

Back 2

excessive acral growth, facial features, sweating, HA, peripheral neuropathy, decrase energy osteoarthitis, depression, galactorrhea

Front 3

Give physical exam of acromegaly

Back 3

earliest most common: facial puffiness, broad nose, furrow brow, skin thickening

Front 4

What is the Diagnostic for acromegaly

Back 4

Definitive test is the oral glucose tolerance test: GH secretion should be suppressed by oral glucose load

Front 5

What is the management of acromegaly

Back 5

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)

Front 6

Agromegaly and patient education

Back 6

life long chronic progressive disease, physical changes don't remit w/ therapy. But may slow down or stop just cant reverse.

Front 7

Addisons (adrenal gland disorder): define

Back 7

destruction or reduction in adrenal gland

Front 8

S+S of Addison disease

Back 8

N/V, hypotension, acute shock (trauma or illness). Chronic: n/v, dizzy, chronic abd pain, hyperpigment, lethargy weakness

Front 9

PE how do patients with addison look

Back 9

chronically ill, dehydrated

Front 10

What diagnostic test are needed for Addison disease

Back 10

Elevated ACTH and suppressed cortisol, hyponatremia, hypercalemia (CMP), CXray (exclude TB)

Front 11

Management of Addison disease (chronic)

Back 11

oral hydrocortisone 20-30mg/d (restore diurnal pattern) and fludrocortisone (0.05-0.2mg/d) correct renal and hypotension.

Front 12

What is the management of acute adrenal insufficiency

Back 12

IV hydrocortisone 100mg q 6hr for 24hr then taper. hypotension, hypovolemia, hypoglycemia ICU

Front 13

What is patient education of Addison Disease

Back 13

med adjust w/ fever and common illness (hydrocortison doubled quickly) never stop steroids quickly

Front 14

Define Cushings (basic)

Back 14

Over production of cortisol (adrenal disease)

Front 15

What are S+S of chronic changes of Cushings disease

Back 15

weight loss, loss of menses, libido, depression ,insomnia, bruising

Front 16

What do you find on PE of Cushings disease

Back 16

exogenous/central obesity, moon face, thickening facial fat, buffalo hump

Front 17

What diagnostic do you perform for Cushings

Back 17

24hr urine cortisol levels repeated 2-3x

Front 18

What is the management of Cushings

Back 18

Depends on source of hypercortisolism: pituitary resection, Chemo,

Front 19

What do you find on PE of pheochromocytoma:

Back 19

HTN >170systolic, arrhymias, tachy or brady

Front 20

Initial eval of alcoholic would include what

Back 20

CAGE

Front 21

What part of an alcoholics life is usually affect last between family, health, realtionships, work.

Back 21

Work is affected last

Front 22

What are the 5 stages of Prochaska's change framework

Back 22

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

Front 23

What are the 3 steps for alcohol screening according to NIH

Back 23

1. ask about use
2 assess for alcohol problems
3. advise appropriate action
4. monitor patient progress

Front 24

How soon after stopping due alcohol w/ drawals begin, and peak.

Back 24

begin in 12 hrs after last drink and peak 24-48hrs w/ abatement over few days.

Front 25

What are sx of alcohol w/drawal

Back 25

agitation, hallucination , disorientation, seizures

Front 26

What medication is useful for alcohol w/drawals:

Back 26

benzodiazepines: ativan.
also tx dehydration, malnourishment, infection

Front 27

What are some inpatient detox criteria for the alcoholic?

Back 27

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

Front 28

What benzodazapine should be used on an alcoholic w/ hepatic dysfunction

Back 28

lorazepam (or other short acting)
if no hepatic deficiency then valium

Front 29

What role do antipsychotic play in managing w/drawal of alcohol

Back 29

no role, they are not used in alcohol w/drawals

Front 30

What medication is used for the physical sx of alcohol w/drawal such as tachycardia or tremors?

Back 30

beta blocker (propanolol, atenolol)

Front 31

What do you use for nutritional deficencies in alcoholics

Back 31

high dose B vitamin and supplement of thiamine, pyridoxine, folic acid and vit C

Front 32

Which is more specific for hepatic damage: ALT or AST

Back 32

ALT: more specific to liver due to limited concentration in other organs. U should ID the ration of AST/ALT in alcoholics

Front 33

How many criteria must be met diagnose substance abuse?

Back 33

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

Front 34

Who have higher rates of misuse of prescription medication? men or women

Back 34

women: thought to be due to higher use of health system

Front 35

Which benzodiazapine has a higher abuse potential: short or long acting

Back 35

rapid-onset or as needed basis increase abuse potential.

Front 36

Name on benzodiazapine that has long half life and slow onset...which also decreases risk of dependence

Back 36

clonazepam

Front 37

What is the first dosing step to discontinue benzodiapine in a patient that is psycholigically dependent

Back 37

reduce dose by 25% per week.

Front 38

How quickly does the onset of w/drawals begin with benzos

Back 38

a few days w/ shorter half life (lorazepam) and up to 3 wks w. longer half life (clonazepam)

Front 39

What are physical sx of benzo w/drawals?

Back 39

HTN, tachycardia, diarrhea, nausea, hyperthermia, restlessness, myalgia, lacrimation , rhinorrhea

Front 40

What alpha-adrenergic antagonist help minimize opiod w/drawal

Back 40

clonidine (also works on HTN)

Front 41

What is a medication that is used in the tx of w/drawal of heroin but also has addictive qualities

Back 41

methadone

Front 42

What are risk associated w/ chronic marijuana use

Back 42

COPD, driving impairment

Front 43

What drug class is Rohypnol

Back 43

benzodiazapines

Front 44

What is the DSM-IV criteria for anorexia nervosa:

Back 44

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

Front 45

what r the 2 types of anorexia demonstrated:

Back 45

restricting (intake) and no binge and binge-purge in cycles (not secretive like bulimia nervousa

Front 46

Treating anorexia nervosa includes both

Back 46

cognitive-behavioral and pharm

Front 47

What medication can be used to increase appetite and reduce anxiety in anorexia

Back 47

Cyproheptadine (Periactin)

Front 48

DSM-IV criteria for bulimia nervosa

Back 48

eating excessive for a discrete period w/ lack of control then binge, laxative, diuretic or fasting

Front 49

Sx of bulimia

Back 49

hypokalemia, dental enamel erosion, parotid gland enlargement

Front 50

Sx of anorexia

Back 50

lanugo, dysrhythmias, hepatomegaly, cheilosis, gum disease, dry skin, hypotension w/ bradycardia, hypothermia

Front 51

What r the pharm tx of bulimia

Back 51

antidepressants: SSRI
Wellbutrin should not be used may increase bingeing or seizure

Front 52

What are the characteristics of binge eating and how does it differ from bulimia nervosa

Back 52

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

Front 53

Depression diagnosis typically includes:
a. early morning wakening
b. unable to fall asleep
c. hyper state
d. none

Back 53

early morning wakening

Front 54

DSM-IV criteria for depression

Back 54

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

Front 55

What are the difference between depression and dementia

Back 55

dementia: cognitive changes slowly over years w/ depression much shorter

Front 56

What would u consider the dx in a person taking benzo for anxiety but feeling worse

Back 56

depression

Front 57

psychomotor agitation w/ fidgeting and irritabilty found in patients w/ depression: what age group is this found

Back 57

kids and adolescents and Type A adults

Front 58

What are the combined approach for depression tx:

Back 58

interpersonal therapy and pharm: interpersonal alone has 60% relapse

Front 59

Dysthmia: define

Back 59

low -level daily depression w/ at least two previously ID depressive sx in 2 years (adults) 1yr (child)

Front 60

A change in feeling such as "feelig good to be alive for the first time" would be found in what dx

Back 60

dysthmic

Front 61

What is the dx of major depression (criteria)

Back 61

depressed mood >3m after death or loss

Front 62

What is the tx for adjustment disorder

Back 62

interpersonal therapy

Front 63

SSRI: Paxil what are the indications, A/Rxn,

Back 63

: 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

Front 64

SSRI: Zoloft: indication, adverse rxn

Back 64

depression, panic, OCD:
Adverse: GI upset, sleep disturbance
comment: take w/ food to enhance absorption

Front 65

SSRI: Celexa and Lexapro: indication, Adverse rxn

Back 65

Depression,
Rxn: somnolence and insomnia, agitation and anorexia
comment: lexapro has better adverse rxn profile vs celexa

Front 66

SSRI: Prozac: indication, rxn

Back 66

depression, OCD, bulimia
rxn: energizing, anorexia common
comment: am dosing, long 1/2 life bad for elderly, weight loss not sustained

Front 67

What is the mechanism of action of antidepressants

Back 67

increase availability of selected neurotransmitter (serotonin, norepinephrine, dopamine)

Front 68

How long do SSRI S/E usually last.

Back 68

2-6wks,

Front 69

Tricyclics: Effexor: indication, rxn

Back 69

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

Front 70

What antidepressant is useful in those with substance abuse too

Back 70

wellbutrin (dont use in anorexia)

Front 71

What are some tricyclic antidepressants

Back 71

nortriptyline, desipramine

Front 72

Sx of SSRI w/drawal syndrome

Back 72

dizziness, paresthesia, anxiety, nausea, sleep disturbance, insomnia

Front 73

Serontonin activity on 5-HT1A receptor sites is used to Tx:

Back 73

antidepressant, OCD, antipanic, antisocial
comment: action site basis of most antidepressant, antipanic

Front 74

Which antidepressants should be used in place of tricyclics if there is risk of suicide

Back 74

SSRI and atypcial antideperssants due to their increase safety profile

Front 75

Required length of pharm intervention in depression per AHCPR guidelines

Back 75

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

Front 76

What are some risks in depression relapse

Back 76

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

Front 77

Seotonin receptor site: 5-HT1C, 5-HT2C: activity when stimulated

Back 77

influence CSF production, cerebral circulation, regualtion fo sleep. perception of pain, cardio function

Hint 77

comment: reason tachycardia, dizziness, alteration of sleep pattern and change in pain perception occurs w/ SSRI

Front 78

Serotonin receptor site: 5-HT1D activity when stimulted (triptans)

Back 78

antimigraine activity; triptan preparation works by stimulating receptor site, TCA works at this site

Front 79

Serotonin receptor site: 5-Ht2 activty when stimulated

Back 79

agitation, akathisia, anxiety, panic, insomnia, sexual dysfunction, excessive upregulated in those w/ depression

Hint 79

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

Front 80

Serotonin receptor site: 5-HT3 activity when stimulated

Back 80

nausea, GI distress, diarrhea, HA

Hint 80

stimulated w/ antidepressant w/ poor GI side effect profile. Zofran blocks activity at site (5-HT3 antagonist)

Front 81

Which class has more side-effects: TCA or SSRI

Back 81

TCA but are superior to SSRI when depresion is moderat to severe also w/ patients w/ pain

Front 82

Depression w/ episodes of mania is dx w/:

Back 82

bipolar I disorder

Hint 82

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

Front 83

Bipolar 1 disorder is most common in: Men or women

Back 83

Women: onset around puberty

Front 84

Dx of Bipolar 2 is made if

Back 84

depression has episodes of mania lasting less than 4 days w/ little social incapacitation (remain productive)

Front 85

Cyclothymic disorder includes:

Back 85

mood disorder present 2yrs w/ episodes of mania lasting less than 4 days

Front 86

If a TCA is given to a person with bipolar disord what do 15% develop?

Back 86

mania

Front 87

What is a classic sx of anxiety as it relates to sleep

Back 87

difficulty initiating sleep (depression is waking early)

Front 88

What is the onset rate of benzodiazepine:

Back 88

rapid onset

Front 89

Buspiorn (BuSpar) has: high, moderate or low abuse potential?

Back 89

low abuse potential

Front 90

New onset of panic disorder findings would include:

Back 90

peak sx 10min, hx of agoraphobia, chest pain during attack

Front 91

What med is used for panic disorder

Back 91

Paxil (SSRI antidepressant)

Front 92

Diagnostic criteria for generalized anxiety include

Back 92

difficulty concentrating apprehension, irritability

Front 93

According to the AHCPR tx guidelines pharm tx for anxiety should be continued for how long

Back 93

6m AFTER remission is achieved

Front 94

Which medication may mimic anxiety disorder:

Back 94

sympathomimetic

Front 95

Rapid w/drawal of lorazapam will result in what side effect

Back 95

tremors and hallucinations

Front 96

Risk of benzodiazepine misuse minimized if a: longer, shorter or rescue (PRN) dose is perscribed

Back 96

longer duration of action

Front 97

PTSD may report having:

Back 97

agoraphobia (panic attack), feeling of detachment, hyperarousal

Front 98

Pharm tx for PTSD include

Back 98

Buspirone (BuSpar)

Front 99

Pharm Tx for irritability and impulsiveness in PTSD

Back 99

carbamazepine: Tegratol (anticonvulsant)

Front 100

OTC herbal used for sx of depression

Back 100

St. John Wart

Front 101

Tx resistant panic disorder may respond to

Back 101

monoamin oxidase inhibitor

Front 102

Tx of pt w/ panic disorder using SSRI w/ the goal being?

Back 102

reduction in number and severity of panic attacks is the goal

Front 103

DSM-IV criteria GAD (generalized anxiety disorder)

Back 103

-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

Front 104

Depression w/ anxiety reports: which first

Back 104

nervous feeling after onset of depressed mood

Front 105

Cardinal presenting signs of anxiety disorder:

Back 105

tachycardia, hyperventilation, palpitation, tremors, sweating, difficulty falling asleep

Front 106

What mechanism of action do benzo have for anxiety disorders

Back 106

enhance GABA function and products that enhance availablity of serotonin

Front 107

Which benzo are more lipophilic and why is this important in tx of anxiety

Back 107

valium or clonazepam: enter brain more rapidly and igniting effect promptly (may feel intoxicating)
note: longer half life left in fat.

Front 108

Which benzo are more hydrophilic and why is that important

Back 108

slower onset of action less intoxicating same therapeutic effect

Front 109

Which benz may be better for tx anxiety in the elderly

Back 109

Serax: short half life

Front 110

When working to reduce amount of benzo used how much should you decrease it:

Back 110

25% per wk

Front 111

What are sx of w/drawal of benzo w/ rapid removal of med

Back 111

tremors, hallucination, seizures, delirium tremors

Front 112

What is the average onset age of panic disorders

Back 112

27 years rare after 45 more common in women if also agoraphobia

Front 113

What is the tx of choice for panic disorders

Back 113

SSRI: low side effects better than TCA

Front 114

What is the saying when starting SSRI treatment for panic attach

Back 114

start low and go slow: Paxil is a good starting w/ low side effect

Front 115

What medication is used in PTSD w/ hyperarousal:

Back 115

clonidine and propanolol: trazadone for sleep

Front 116

OTC Herb: St. Johns wort: Are similar to what medications

Back 116

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

Hint 116

I

Front 117

What does the BATHE Model stand for (used in emotionally distressed)

Back 117

B: background
A: affect, anxiety
T:trouble
H: handling
E: empathy

Front 118

What are the progestatinal effects when taking oral contraceptives

Back 118

inhibit ovulation by suppressing lutenizing hormone (LH), thickening endocervical mucus and hampering implantation by endometrial atrophy

Front 119

What are the estrogenic effects when taking oral contraceptives

Back 119

ovulation inhibited by suppression of follicle stimulating hormone (FSH) and LH by alteration of endometrial cellular structure

Front 120

How long after discontinuing oral contraception should you wait to conceive.

Back 120

you do not have to wait

Front 121

what are non-contraceptive benfits of oral contraceptives

Back 121

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

Front 122

What should you do if you vomit w/in 2hrs of taking oral contraceptive

Back 122

retake dose

Front 123

If you miss taking an oral contraceptive of 30-35ug, what should you do to ensure continued prevention of pregnancy?

Back 123

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

Front 124

If missed oral contraceptiv of 20ug or less ethinyl estrodiol

Back 124

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

Front 125

A women with seizures would do better on what type of contraception

Back 125

depo-provera: due to progestin protection against seizures.

Front 126

What class of contraception have potassium sparing qualities

Back 126

drospirenone in yasmin (progestin) use w/ caution in hepatic or renal dysfunction

Front 127

What additional medication can reduce breakthrough bleeding when using depo

Back 127

ibuprofen, naproxen BID for 3-5 days

Front 128

what supplement should be encouraged when taking depo:

Back 128

calcium at 1000-1500mg/day

Front 129

What is the soonest that a diaphragm may be removed after sex

Back 129

6hrs should use a spermacide with the diaphragm

Front 130

A woman w/ recurrent UTI would or would not be a good candidate for a diaphrahm:

Back 130

would not due to the need for spermacide

Front 131

WHO precaution for OC

Back 131

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

Front 132

What percentage of women experience hot flashes during menopause

Back 132

80% have hot flashes and night sweat

Front 133

Estrogen deficient vaginitis: what lab finding would u find

Back 133

vaginal pH >5

Front 134

53y/o on hormone therapy w/ conjugated euqine estrogen having vaginitis sx should also take what topical and where

Back 134

topical estrogen to the vagina

Front 135

relative contraindication to postmenopausal HT include:

Back 135

seizure disorder, dyslipidemia, migraine headache

Front 136

Absolute contraindication to postmenopausal HT

Back 136

endometrial cancer

Front 137

When advising perimenopausal women about HT you consider a benefit to include:

Back 137

HT helps preserve bone density and reduce risk of osteoporosis

Front 138

post menopausal HT effects on bones include:

Back 138

reduction in frequency of spinal and hip fx

Front 139

Progestin component of HT is given to:

Back 139

minimize endometrial hyperplasia

Front 140

Selective estrogen receptor modulator therapy (Evista) helps:

Back 140

in the reduction of osteoporosis and breast cancer risk

Front 141

during perimenopause sx will most likely:

Back 141

be in the week before the onse to menses

Front 142

What is noted in short=term <1-2yrs HRT use in post menoausal

Back 142

HRT can minimize menopausal sx

Front 143

What body area has highest estrogen receptor sights

Back 143

vulva

Front 144

What sx are tx when using black cohosh use in menopause?

Back 144

decreased frequency and severity of hot flashes

Front 145

Adding androgen to HT may well be suited for woman w/

Back 145

sever hot flashes in spite of maximized estrogen therapy

Front 146

typical HT regimen containts---of estrogen dose of oral contracetpive

Back 146

1/4th

Front 147

Black cohosh during perimenopause will likely do what physiologically:

Back 147

bind to estrogen receptors decreasing side effects of premenopause

Front 148

Why do menopausal women get hot flashes

Back 148

Lutinizing Hormone surge/flucuations in estrogen in 80% of women. surgical menopausal women have more sever sx

Front 149

What deficiency during menopause increase risk of osteoporosis

Back 149

estrogen

Front 150

Why do you use progestin during HT versus just estorgen:

Back 150

endometrial cancer risk and breast cancer (contraindicated in hx of breast cancer)

Front 151

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

Back 151

-unexplained vag bleed
-acute liver disease
-thrombotic disease
-endometrial cancer
-neuro-opthalmologic vascular
-breast cancer

Front 152

What are relative contraindication to postmenopausal estrogen therapy

Back 152

seizure disorder, dyslipidemia, migraine, thromobophlebitis, gallbladder disease. absolute: vag bleed, coagulation disorder until corrected

Front 153

Tamoxifin is a SERM that locks out estrogen effects on what body part

Back 153

breast

Front 154

urge incontinence define and intervention

Back 154

involuntary loss of urine: behavioral, voiding schedule

Front 155

What medication is used for urge incontinence

Back 155

terodiline (selective muscarinic receptor antagonist) relaxes smooth muscle and bladder pressure

Front 156

urge incontinence: most common in elderly: what is the Sx, Tx

Back 156

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

Front 157

What Sx, Tx of stress incontinence:
path: weak pelvic floor and urethral muscle.
Found in women rare in men:

Back 157

Sx: sneeze, exercise, cough results in urine loss.
Tx: kegel, support w/ vag tampon, urethral stent, pessary use. Topical estorgen, phenylpropanolamin (alpha agonist)

Front 158

Urethral obstruciton: of outflow (prostatic, stricture, tumor. Older men: sx tx

Back 158

dribbling post-void and urge incontinence on presentation
Tx: treat urethral obstruction

Front 159

transient incontinence results from what underlying process:

Back 159

delirium, UTI, medication, restricted activity (bed ridden). tx underlying process, discontinue offending medication

Front 160

What is common in women during reproductive years:

Back 160

vag pH of 4.5 or less
-lactobacillus predominant vag organism
-thick, white vag secretion during luteal phase

Front 161

What does vag discharge appear during ovulation?

Back 161

stingy and clear

Front 162

Vaginal itch w/ perineal excoriation, erythema, white, clumping discharge: microscope would reveal

Back 162

hyphae (yeast in budding form)

Front 163

Bacterial vag presents w/

Back 163

malodorous discharge

Front 164

tx of vulvovaginitis by Candida albicans:

Back 164

clotrimazole cream (lotrimin) antifungal : tx thrush, ringworm, athletes foot

Front 165

1wk thin, green-yellow vag discharge w/ perivag irritation; vag eryth, petechial hem on cervix, WBC, motile organ what is the dx

Back 165

trichomoniasis

Front 166

Tx of trichomoniasis

Back 166

metronidazole (flagyl) antibiotic: Tx also C. diff, H. pylori other parasitic infection

Front 167

Tx for bacterial vaginosis:

Back 167

oral metronidazole (flagyl), clindamycin cream, oral clindamycin (Cleocin)

Front 168

w/o sx but partner has dysuria w/o discharge, she has friable cervix covered in thick yellow discharge what is the infection

Back 168

chlamydia trachomoatis

Front 169

Tx for N. gonorrhoeae

Back 169

Ceftriaxone (Rocephin), or cefixime (suprax): used also in ear and throat infections

Front 170

Gonococal infections are symptomatic in most males: true or false

Back 170

false: most are asymptomatic

Front 171

Complications of Gonococcal and chlamydial GU infection in women include:

Back 171

PID, tubal scarring, peritonitis

Front 172

Initial complaints in women w/ HPV-2

Back 172

painful ulcer, inguinal lymphadenopathy, thin vaginal discharge

Front 173

Tx for HHV-2 genital infection

Back 173

famciclovir: also used to tx herpes zoster (shingles)

Front 174

What would you prescribe for chlamydia infection

Back 174

doxycycline, erythtromycin, azithromycin (best) efficacy

Front 175

What is the incubation of Gonnorrhea: how do women infected present

Back 175

1-5days: dysuria, milky purulent blood tinged discharge

Front 176

Lymphogranuloma venerum: clinical presentation and tx

Back 176

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

Front 177

nongonococcal urethritis and cervicitis (not pregnant): PE and Tx

Back 177

-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

Front 178

Gonococcal urethritis (not pregnant): PE and Tx

Back 178

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

Front 179

Pelvic inflammatory disease: PE and Tx

Back 179

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

Front 180

trichomoniasis: PE and Tx

Back 180

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

Front 181

Bacterial vaginosis PE and Tx

Back 181

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

Front 182

candidiasis: PE and tx

Back 182

PE: itching, burning, thick white to yellow discharge, vulvovaginal excoriation, erythema: HYphae, pH<5
Tx: miconazole (antifungal), fluconazole, terconazole

Front 183

chancroid: PE and tx

Back 183

painless genital ulcer
Azithro (macrolide) 1g oral x1 or ceftriaxone (cephlasporin/Rocephin) 250mg IM x1, or cipro 500 BIDx3d or Emycin (Macrolide) 500tidx7d

Front 184

Genital Herpes: PE and tx

Back 184

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

Front 185

genital warts (condyloma acuminata): PE and tx

Back 185

verruca-form lesions or may subclincial unrecognized

Hint 185

tx: podofilox 0.5% solution or imiquimod 5%:
cryotherapy, tricholroacetic acid, surgical

Front 186

Pelvic inflammaotry disease presents w/

Back 186

dysuria, cervical motion tenderness, diffuse abd pain abnormal vag bleed, GI, fever

Front 187

Most common pathogen in pelvic inflammatory disease

Back 187

c. trachomatits

Front 188

Tx for Pelvic inflammatory allergic to PNC:

Back 188

ofloxacin w/ metronidazole

Front 189

What labs should be obtained w/ Pelvic inflammatory

Back 189

elevated ESR or C-reactive protein, leukocytosis w/ neutrophilia

Front 190

Tx of pelvic inflammatory may include

Back 190

ceftriaxone 250mg IM x 1, followed by doxy 100bidx2wks

Front 191

sequelae to genital condyloma may include

Back 191

cervical carcinoma

Front 192

Describe condyloma lesions

Back 192

verruciform: Shaped like a wart or warts

Front 193

tx for condyloma acuminatum

Back 193

imiquimod (Aldara)

Front 194

What HPV type cause condyloma

Back 194

HSV 6 and 11

Front 195

What strain of HPV most often in cervical cancer

Back 195

HPV 16 and 18

Front 196

% of anogenital and cervical cancer caused by HPV

Back 196

95%

Front 197

Mechanism of action of imiquimod (aldara)

Back 197

immune modulator condyloma acuminatum

Front 198

Sx usually present after how many weeks upon contact w/ syphilis

Back 198

2-4 wks after contact

Front 199

HPV type cause condyloma

Back 199

HSV 6 and 11

Front 200

what is present w/ primary syphilis

Back 200

painless ulcer, palpable inguinal nodes, spontaneously healing lesion

Front 201

HPV most often in cervical cancer

Back 201

HPV 16 and 18

Front 202

% of anogenital and cervical cancer caused by HPV

Back 202

95%

Front 203

What is present in secondary syphilis

Back 203

generalized rash, arthraligia, lymphadenopathy

Front 204

What is imiquimod (aldara) used for?
a. actinic keratosis
b. superficial basal cell carcinoma
c. genital and anal warts
d. all of the above

Back 204

D. actinic keratosis, basal cell carcinoma, genital warts:
It is an immune response modifier

Front 205

What is present in tertiary syphilis

Back 205

Gumma (lesions found on liver, heart, brain, skin)

Front 206

Sx usually present after how many weeks upon contact w/ syphilis

Back 206

2-4 wks after contact

Front 207

what is first line tx of syphilis

Back 207

penicillin

Front 208

HPV type cause condyloma

Back 208

HSV 6 and 11

Front 209

what is present w/ primary syphilis

Back 209

painless ulcer, palpable inguinal nodes, spontaneously healing lesion

Front 210

HPV most often in cervical cancer

Back 210

HPV 16 and 18

Front 211

What is present in secondary syphilis

Back 211

generalized rash, arthraligia, lymphadenopathy

Front 212

% of anogenital and cervical cancer caused by HPV

Back 212

95%

Front 213

What is present in tertiary syphilis

Back 213

Gumma (lesions found on liver, heart, brain, skin)

Front 214

Mechanism of action of imiquimod (aldara)

Back 214

immune modulator condyloma acuminatum

Front 215

what is first line tx of syphilis

Back 215

penicillin

Front 216

Sx usually present after how many weeks upon contact w/ syphilis

Back 216

2-4 wks after contact

Front 217

what is present w/ primary syphilis

Back 217

painless ulcer, palpable inguinal nodes, spontaneously healing lesion

Front 218

What is present in secondary syphilis

Back 218

generalized rash, arthraligia, lymphadenopathy

Front 219

What is present in tertiary syphilis

Back 219

Gumma (lesions found on liver, heart, brain, skin)

Front 220

what is first line tx of syphilis

Back 220

penicillin

Front 221

What is the name of a fertilized ovum?

Back 221

Zygote

Front 222

What is the "baby" called up to 2 weeks postconception?

Back 222

blastocyst: stage prior to embryo forming, lots of cell division

Front 223

Stage: 8-12wks post conception is called

Back 223

Embryo

Front 224

A nongravida uterus would be the size of a

Back 224

large lemon

Front 225

An 8 weeks uterus woudl be the size of a

Back 225

tennis ball/ orange

Front 226

At 10 wks uterus would be the size of a

Back 226

baseball

Front 227

At 16wks the fundus of the uterus would be in what location

Back 227

halfway between the symphysis pubis and umbilicus

Front 228

At 20 wks the fundus should be at what land mark

Back 228

the umbilicus

Front 229

What % of babies are in the vertex position by 36th wk of preg

Back 229

95%

Front 230

What is recommended weight gain durign pregnancy w/ normal BMI

Back 230

25-35lbs

Front 231

Normal BMI: what is the average daily intake ontop of normal calories during pregnancy

Back 231

300 kcal

Front 232

Normal BMI: waht is daily calorie requirement on top of normal diet when lactating:

Back 232

500 kcal

Front 233

Waht is the recommended Ca intake during pregnancy

Back 233

1200-1500

Front 234

Maternal Fe is greatest in what part of pregnancy

Back 234

second and third trimester

Front 235

What is the most common acquired anemia during pregnancy:

Back 235

iron deficiency

Front 236

Give an example of neural tube defect:

Back 236

anencephaly, spina bifida, encephalocele

Front 237

What is the leading causes of preventable fetal mental retardation

Back 237

fetal alcohol syndrome

Front 238

risk associated with Pica intake:

Back 238

constipation, bowel obstruction, nutritional deficiency

Front 239

How much does blood volume increase at 42 wks. 25%, 50%, 75%

Back 239

50%

Front 240

Drop in diastolic BP is most notable in what trimester

Back 240

second

Front 241

S1 heart sound become louder or quieter during pregnancy

Back 241

Louder

Front 242

What type of murmur becomes evident during pregnancy

Back 242

physiologic systolic ejection

Front 243

What happens to the renal collecting system during pregancy:

Back 243

it dialates

Front 244

Is it common to find physiologic glucosuria and proteinuria during pregnancy

Back 244

Yess: it is common to find glucosuria and proteinuria

Front 245

What happens to the transvers thoracid diameter and diaphragmatic contraction

Back 245

it increases in size

Front 246

What happens to the lower esophageal sphincter during pregnancy

Back 246

the lower sphinchter relaxes

Front 247

What happens to the intestines regarding motility during pregnancy

Back 247

the intestine slows down

Front 248

What happens to the gallbladder during pregancy

Back 248

the gallbladder doubles in size

Front 249

What happens to insulin levels during pregnancy

Back 249

they increase 2-10 fold

Front 250

What happens to fasting plasma glucose during pregnancy

Back 250

It should remain the same, test for gestational diabetes

Front 251

What is Hegars Sign in pregnancy

Back 251

uterine isthmus become soft and compressible

Front 252

What is Chadwicks sign

Back 252

Cervix color and texture change becoming cyanotic

Front 253

What is Goodwells sign

Back 253

Cervix becomes less firm

Front 254

What happens to the breast during pregnancy

Back 254

nipples, areolae darken and increase in size. Venous congestion

Front 255

What happens to breast tissue during pregnancy

Back 255

increase nodules due to proliferation of lactiferous glands

Front 256

What happens to the blood during pregnancy

Back 256

volume increases by 40-50% peak at 32 wks, RBC production increase by 33%

Front 257

Why does dilutional physiologic anemia occur during pregnancy

Back 257

the RBC increase by 33%

Front 258

What happens to the renal system during pregnancy

Back 258

increased blood flow and GFR, dilation of renal collecting

Front 259

Why does the physiologic glucosuria and proteinuria occur during pregnancy

Back 259

The GFR increases so renal cant reabsorb glucose and protein

Front 260

What happens to tidal volume and residual volume late in pregnancy

Back 260

Tidal volume increases and residual volume is reduced

Front 261

What happens to the digestive system during pregnancy

Back 261

lower esophageal sphincter relaxes due to pressure, intestine and stomach slow to allow absorption on nutrients

Front 262

What happens to the gallbaldder during pregnancy

Back 262

it doubles in siz, dilute bile and increase risk of stones

Front 263

What account for weight gain in a health pregnancy

Back 263

first half: maternal weight change
Second half: components of pregnancy

Front 264

When should the triple screen be done: wks

Back 264

16-20 wks

Front 265

How often are visits during 28-32 wks

Back 265

every 2 wks

Front 266

List the appropriate weight gain during pregnancy at
<19wks, 19-26, 26-29, >29wks

Back 266

a. 28-40lbs
b. 25-36lb
c. 15-25lb
d:15+lbs

Front 267

What prenatal care: first visit:

Back 267

pap smear, rubella titer, PPD, VDRL, RPR, HIV, Blood type, antibody screen, GC/chlamydia, Hg electrophoresis (african, asian), UA urin C&s

Front 268

Fetal loss occurs in 1 in ____ amniocentesis

Back 268

1:200 deaths

Front 269

What may be causes of an elevated Alpha-fetoprotein (AFP)?

Back 269

underestimated gestational age, open neural tube defect, meningomyelocele

Front 270

What are some pregnancy test from 16-20 wks
24-28wks
28-32 wks

Back 270

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

Front 271

What are the pregnancy care test: 32-36wks, 35-37 wks, 40-42wks, 41+wks

Back 271

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

Front 272

Edwards syndrome is from trisomy:

Back 272

18

Front 273

Edward syndrome most kids live a full life: true or false

Back 273

false: most affected infants die during first year of life

Front 274

what is a major risk factor for being born w/ down's syndrome

Back 274

born to women older than 35yrs

Front 275

Downs syndrome is from trisomy

Back 275

21

Front 276

What are the components of the triple screen test in pregnancy

Back 276

AFP, hCG, unconjugated estriol

Front 277

What are two test to assess for congenital defects in utero

Back 277

amniocentesis or chorionic vilus sampling

Front 278

What are the physical findings of edward syndrome

Back 278

low birth weight, mental retartation, cranial, cardiac renal malformation

Front 279

What are examples of neural tube defects:

Back 279

meningomyelocele, anencephaly, spina bifida

Front 280

Where is alph-fetoprotein synthesized in fetus

Back 280

yolk sac, GI tract, liver

Front 281

What can lead to misinterpreted AFP test: it can be higher in earlier pregnancy

Back 281

underestimate gestational age

Front 282

What is the most sensitive marker for detecting trisomy 21

Back 282

increase hCG level: Low hCG indicates trisomy 18

Front 283

Triple screen is not diagnostic they are used in pregnacy to...

Back 283

assess for risk of nural tube defect

Front 284

Medication most commonly pass through placenta via:

Back 284

passive diffusion

Front 285

What is the category for safe for use in pregnancy:

Back 285

cat: a

Front 286

Med that cause teratogenic in humans but benefit outweights risk of use in life threat assigned cat

Back 286

cat: D

Front 287

Which of medication is pregnacy risk D: Misoprostol, Captopril, Cefuroxime, regular insulin

Back 287

Captopril (ACE-I) HTN HF med (capoten)

Front 288

Drugs cause teratogenic in animals but not in human assign preg risk:

Back 288

Cat: C

Front 289

Preg at 38wks w/ UTI may tx w/

Back 289

Amoxicillin w/ clavulanate

Front 290

Preg w/ asthma; when may bronchospasm worsen?

Back 290

29-36wks

Front 291

Preg w/ acute bacterial rhinosinusistis may tx w/

Back 291

amoxicillin, cefuroxime, azithromycine but NOT levofloxacin

Front 292

according to IDSA duration for antibiotics for tx of UTI during preg is:

Back 292

7 days

Front 293

SSRI w/ drawal syndreom best characterized as

Back 293

bothersome but not life threatening

Front 294

The placenta is best able to transport what type of substance

Back 294

Lipophilic

Front 295

2nd trimester w/ migraine Ha best tx would be

Back 295

Ibuprofen

Front 296

SSRI during preg: study has shown the affects on infants later in life

Back 296

had no observable difference

Front 297

SSRI w/ longest half-life:

Back 297

Fluoxetine (Prozac)

Front 298

Most commonly used medication during 1st trimester in pregnancy

Back 298

antibiotics

Front 299

Benzodiazipine w/ drawal risk includes

Back 299

Seizures

Front 300

Tx of chronic asthma in patients that are preg is:

Back 300

short-acting beta agonist

Front 301

24wks preg w/ acute asthma flare should be given:

Back 301

montelukast (singulair): a leukotriene receptor antagonist (LTRA)

Front 302

Drug know to be harmful to fetus given cat

Back 302

X

Front 303

Sertraline is preg risk cat;

Back 303

cat: D (pos evidence of fetal risk) may is specific cases still be used. Doxy, ARB, ACE-I

Front 304

Clonazepam in preg is cat: B,C,D,X

Back 304

cat: D (pos evidence of fetal risk)

Front 305

Bupripion (wellbutrin, zyban) during preg is cat:

Back 305

cat: B (none in animal but no study in humans (PNC, cephalosporins, Acetaminophen)

Front 306

Tricyclic antidepressants during preg are cat risk:

Back 306

cat: D

Front 307

Antimicrobial that is Cat B used in preg infection is:

Back 307

erythromycin

Front 308

PNC are preg cat risk:

Back 308

Cat: B

Front 309

What uropahtogens are capable of reducing urinary nitrates to nitrites

Back 309

E. Coli, Proteus spp., Klebsiella pneumonia

Front 310

In Preg asymptomatic bacteruria should be:

Back 310

Tx to avoid complicated UTI

Front 311

Common UTI organism in preg

Back 311

E. Coli

Front 312

Length of antimicrobial for preg w/ asymptomatic bacteria

Back 312

3-7d

Front 313

What does teratogenic?

Back 313

substance that has potential to create a characteristic set of malformation in fetus

Front 314

When is the teratogenic period:

Back 314

between day 31 and 81 following last menstral period: organanogenis is taking place

Front 315

What are three factors in drugs passing through the placenta

Back 315

lipohilicity (higher the easier)
Molecular weight <500g/mol
maternal drug levels

Front 316

Can a preg receive insulin or heparin?

Back 316

Yes because they have higher molecular weight that can not pass through the placenta

Front 317

Which is better during preg: benadryl or claritin (loratadine)

Back 317

Claritin: more hydrophilic so causes less S/E to fetus

Front 318

Define Preg Cat B, C, D, X

Back 318

B is best , C w/ caution, D for danger, X (cross the drugs off the list)

Front 319

Why is bronchospasm worse between 29-36 wks in preg?

Back 319

increase esophageal irritation from GERD: esophageal sphincter loosens due to increase pressure

Front 320

What cat are inhaled (and oral) corticosteroids and Beta agonist in preg: B, C, D, X

Back 320

cat: C no proof human injury but some in animals

Front 321

What is the preventative tx for N/V in preg

Back 321

tx H. pylori, ginger, Ca antacid q2hr for 2-3d. B6 is preventative

Front 322

What is the tx for migraines in preg

Back 322

tylenol and nsaid (except term due to risk of antiplatelet effect)

Front 323

What can be used for migraine during preg to attenuate HA sx

Back 323

lidocaine 4% to affected nostril

Front 324

What meds can be given to preg w/ major depression?

Back 324

serotonin and dopamine receptor modulators, tricyclic and benzo

Front 325

Bupropion (dopamine receptor modulator) is a cat B , SSRIs are cat C. Should you switch to bupropion during preg.

Back 325

No. switching can increase depression

Front 326

How do you taper down SSRI to prevent w/drawal syndrome

Back 326

taper 25% of total dose over a week

Front 327

What are the S/E of SSRI w/drawal:

Back 327

jitteriness, nausea, sleep disturbance: worse w/ fluoxetine (longer half life)

Front 328

How long can effects of SSRI last in fetus

Back 328

30days may cause w/drawal such as irritability protracted crying shivering

Front 329

Tricyclics and benz are what cat for preg

Back 329

Cat D rarely prescribed during preg

Front 330

Taper dose down all benzo prior to preg by 25% week to prevent

Back 330

w/drawals of tremors, hallucination, seizures, delirium termens

Front 331

What are sequela events that can occur from asymptomatic bacteriuria, in preg

Back 331

acute cystitis, pyelonephritis, UTI

Front 332

Why should a urine culture be obtain in all women early in preg?

Back 332

Risk of UTI from asymptomatic bacteriuria.

Front 333

Define Hales lactation risk cat:
L1 and L2

Back 333

L1: safest (cromolyn, APAP, depo (1m post birth)
L2: safer, limited study: nitrofuratoin, cephalosporins, 2nd gen antihistamines, prednisone, SSRI

Front 334

Define Hales lactation risk cat:
L3 and L4

Back 334

L3: mod safe, no controlled studies or limited: TMP-SMX, Fq antibiotics, 1st gen antihistamines

Front 335

Define hales lactation risk cat: L5

Back 335

contraindiated: radioactive isotopes, cocaine

Front 336

What wk in preg is preeclampsia noted?

Back 336

20th

Front 337

What are risk factors for preeclampsia?

Back 337

age <16->40, first preg or first pre w/ new partner, pregestational diabetes, presense of collagen vascular, HTN, Renal, FHx,

Front 338

What are sx of severe preeclampsia?

Back 338

BP >160/110, proteinuria (>5), hepatic, renal or CNS damage

Front 339

What are the components of HELLP in preeclampsia?

Back 339

Hemolysis, elevated liver, low platelet and eclampsia

Front 340

What is the most important intervention of preeclampsia?

Back 340

High suspicion w/ high risk: the OB consult: rest,monitor, antiHTN, anticonvulsant

Front 341

what is the definitive tx of eclampsia?

Back 341

Birth

Front 342

When does grp B streptococcus colonize typically in preg and when does it trnsfer to fetus?

Back 342

during 1st wk of preg, and when water breaks or onset of labor

Front 343

When should Group Beta Testing in preg occur?

Back 343

35-37wks: trnsf to baby when labor begins

Front 344

Define Chronic HTN vs Gestational HTN:

Back 344

chronic: HTN prior preg, prior to 20th wk, persist >6wks post
gestational: HTN after 20 wk but resolving w/in 6wks post

Front 345

Define:
Preeclampsia, Eclampsia

Back 345

- PreEclampsia: HTN after 20wk w/ protein uria >300mg/24hr and edema
- Eclampsia: PreEclampsia sx w/ tonic-clonic seizures or alt mental status

Front 346

HTN Cat in Preg:
HELLP

Back 346

PreE w/ elevated hepatic enzyme levels and low platelets

Front 347

What does the acronym BATHE stand for in domestic violence?

Back 347

B:background: home work
A: affect, anxiety: feel
T: trouble: worries
H: handling: support, intervention
E: empathy:

Front 348

define inevitable abortion?

Back 348

US w/ viable preg but +vag bleed

Front 349

define threatened abortion?

Back 349

uterine contents process being expelled

Front 350

Define incomplete abortion?

Back 350

some portion of product remain in uterus but no longer viable

Front 351

Quantitative serum HcG doubles every ___hrs the 1st wk of pregnancy?

Back 351

48 hours

Front 352

Where are 95% of ectopics located?

Back 352

fallopian tubes

Front 353

What is the classic triad of ectopic pregnancy?

Back 353

abd pain, vag bleed, adnexal mass: but in only 50% of women w/ ectopic

Front 354

What are the diagnostic for ectopic?

Back 354

Urine, serum (neg r/o ectopic), see a decrease in expected quant number for age, also US.

Front 355

What is salpingectomy (in ectopic preg)

Back 355

opening of tube and removal of content

Front 356

What is definition of spontaneous abortion

Back 356

ending prior to 20 wks: 60% due to chromosomal defect

Front 357

What is the longest part of labor?

Back 357

latent phase (2-3days)

Front 358

When does the first stage of active labor start?

Back 358

at 3-4 cm cervix

Front 359

When should a preg women be instructed to go the hospital?

Back 359

when contractions r occuring q 5min.

Front 360

What is the second stage of labor?

Back 360

the actual birth

Front 361

What is the third stage of birth

Back 361

when placenta is delivered

Front 362

How long is avg labor for first mother?

Back 362

9hrs, 6 for 2nd and beyond.

Front 363

What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin

Back 363

hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)

Front 364

What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin

Back 364

hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)

Front 365

What characteristic apply to Type 2 DM: think main risk factors

Back 365

heredity and obesity

Front 366

What characteristic apply to Type 2 DM: think primary risk factors

Back 366

heredity and obesity

Front 367

insulin G (Lantus) has a short or extended duration of action?

Back 367

extended duration of action

Front 368

insulin G (Lantus) has a short or extended duration of action?

Back 368

extended duration of action

Front 369

Lispro (humalog) onset of action occurs in what time:

Back 369

less than 15min

Front 370

Lispro (humalog) onset of action occurs in what time:

Back 370

less than 15min

Front 371

What diabetic med should be used w/ caution in sulfa allergy

Back 371

glyburied (sulfonylureas)

Front 372

What diabetic med should be used w/ caution in sulfa allergy

Back 372

glyburied (sulfonylureas)

Front 373

What is metformins (glucophage) Mech of action

Back 373

increases insulin action in peripheral tissue reduces hepatic glucose production

Front 374

What is metformins (glucophage) Mech of action

Back 374

increases insulin action in peripheral tissue reduces hepatic glucose production

Front 375

What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin

Back 375

hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)

Front 376

How often does ADA guideline for testing type 2 in asymptomatic >45yrs old

Back 376

every 3 years

Front 377

What characteristic apply to Type 2 DM: think main risk factors

Back 377

heredity and obesity

Front 378

How often does ADA guideline for testing type 2 in asymptomatic >45yrs old

Back 378

every 3 years

Front 379

how often does ADA guideline for testing type 2 in <45 years?

Back 379

only if hx of high-density lipoprotein <35mg or other risk factors

Front 380

What is a characteristic of type 1 DM: ie what is the blood glucose level and insulin

Back 380

hyperglycemia and ketoacidosis from lack of insulin (pancreas isnt makin it or enuff)

Front 381

how often does ADA guideline for testing type 2 in <45 years?

Back 381

only if hx of high-density lipoprotein <35mg or other risk factors

Front 382

insulin G (Lantus) has a short or extended duration of action?

Back 382

extended duration of action

Front 383

What is a criteria for dx of type 2 DM:

Back 383

plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5

Front 384

What is a criteria for dx of type 2 DM:

Back 384

plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5

Front 385

Lispro (humalog) onset of action occurs in what time:

Back 385

less than 15min

Front 386

What characteristic apply to Type 2 DM: think main risk factors

Back 386

heredity and obesity

Front 387

Rosiglitazones (TZD) thiazolidinedione mech of action

Back 387

insulin sensitizer making cells more responsive to insulin: Avandia

Front 388

Rosiglitazones mech of action

Back 388

insulin sensitizer

Front 389

What diabetic med should be used w/ caution in sulfa allergy

Back 389

glyburied (sulfonylureas)

Front 390

insulin G (Lantus) has a short or extended duration of action?

Back 390

extended duration of action

Front 391

Lispro (humalog) onset of action occurs in what time:

Back 391

less than 15min

Front 392

What is metformins (glucophage) Mech of action

Back 392

increases insulin action in peripheral tissue reduces hepatic glucose production

Front 393

What diabetic med should be used w/ caution in sulfa allergy

Back 393

glyburied (sulfonylureas)

Front 394

How often does ADA guideline for testing type 2 in asymptomatic >45yrs old

Back 394

every 3 years

Front 395

What is metformins (glucophage) Mech of action

Back 395

increases insulin action in peripheral tissue reduces hepatic glucose production

Front 396

how often does ADA guideline for testing type 2 in <45 years?

Back 396

only if hx of high-density lipoprotein <35mg or other risk factors

Front 397

What is a criteria for dx of type 2 DM:

Back 397

plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5

Front 398

How often does ADA guideline for testing type 2 in asymptomatic >45yrs old

Back 398

every 3 years

Front 399

Rosiglitazones mech of action

Back 399

insulin sensitizer

Front 400

how often does ADA guideline for testing type 2 in <45 years?

Back 400

only if hx of high-density lipoprotein <35mg or other risk factors

Front 401

What is a criteria for dx of type 2 DM:

Back 401

plasma glucose level 126mg or higher after 8hr fast on more than one occasion...also now A1C>6.5

Front 402

Rosiglitazones (avandia) (thiazolidinedione) mech of action

Back 402

insulin sensitizer

Front 403

Insulin: onset, peak duration of action:
Lispro, Humalog

Back 403

O: 15min, P: 30-90min, D: <5hr

Hint 403

short-acting, rapid onset

Front 404

Insulin: onset, peak, duration of action: Regular; Humulin R

Back 404

O: 1/2-1hr, P: 2-3hr, D: 4-6hr

Hint 404

short-acting

Front 405

Insulin: onset, peak, duration of action: Humulin N, NPH

Back 405

O: 2-4hr, P: 4-10hr, D: 14-18hr

Hint 405

Intermediate acting

Front 406

Insulin: onset, peak, duration of action: Humulin L, Lente

Back 406

O: 3-4, P: 4-12 hr, D: 16-20: intermediate acting (medicinet.com)

Front 407

Insulin: onset, peak, duratation of action: Lantus

Back 407

O: hours, P: none, D: >24hrs

Hint 407

Insulin glargine

Front 408

What medication can you consider when tx a HTN and DM:

Back 408

ACE-I: like fosinopril : nephroprotective features

Front 409

What should be monitored when prescribing biguanide; ie, metformin (glucophage)

Back 409

creatinine

Front 410

what percent of the body's insuline mediated glucose uptake takes place in the muscle

Back 410

80%

Front 411

Exercise reduces Insulin Resistance by _____% w/ effects lasting _____Hrs

Back 411

40% and 48hrs

Front 412

What amount of cholesterol does the ADA recommend

Back 412

300mg or less

Front 413

What is the Somogyi effect

Back 413

when insulin induces hypoglycemia and triggers excess secretion of glucagon and cortisol which leads to hyperglycemia

Front 414

What is the dawn phenomenon as it relates to diabetes?

Back 414

reduced insulin sensitivity 5am-8am due to earlier spikes in growth hormone.

Front 415

sulfonylureas act on what in diabetes

Back 415

stimulate insulin release from functioning beta cells and enhance insulin sesitivity

Front 416

What amount of weight loss is expected w/ metformin

Back 416

3-5kg in first months of use

Front 417

What is another advantage of metformin besides DM

Back 417

It can help improve lipid profile (decrease LDL and triglycerids while increasing HDL)

Front 418

What is the major adverse effect of metformin

Back 418

GI upset: increase dose slowly

Front 419

What indicated nephropathy in DM patients

Back 419

Proteinuria: microalbumin (obtain in the morning due to false positive later in the day)

Front 420

What is the goal of A1C and BP in DM, per 7th JNC report of joint national committe.

Back 420

<7% and <130/<80

Front 421

Sulfonylurea: M of action and caution

Back 421

insulin secretagogue

Hint 421

sulfa allergy, renal dysfunction

Front 422

Thiazolidinedion (TZD): M of Action and caution

Back 422

insulin sensitizer

Hint 422

monitor ALT; hypoglycemia when used w/ sulfonyl or insulin but not solo

Front 423

Biguanides (metformin): M of Action, caution

Back 423

Insulin sensitizer and decrease live glucose production
Caution: Monitor creatinine lactic acidosis risk w/ eleveated CR, hypoglycemia when used w/ sulfony, GI side effect

Front 424

A-gulucosidase inhibitors: M of action, caution (Precose, glyset)

Back 424

delay intestinal carb absorption:

Hint 424

Taken w/ meals, help manage postprandial hyperglycemia, GI S/E

Front 425

meglitinides: action caution

Back 425

Short acting insulin secretagogue

Hint 425

Quick insulin burst, before meals, helps postparanal

Front 426

Dipeptidyl peptidase -4 (DPP-4) inhibitor: Januvia, Onglyza: MoA?

Back 426

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

Front 427

What are risk factors of lactic acidosis when using metformin?

Back 427

renal insufficiency, dehydration, radiographic contrast dye

Front 428

What are medications that causes secondary hyperglycemia

Back 428

Niacin, corticosteroids, thiazide diuretics

Front 429

How do meglitinide anaologs help w/ DM2:

Back 429

prevent postprandial hyperglycemia

Front 430

What is the most common adverse effect of alpha-glucosidase inhibitor?

Back 430

flatulance

Front 431

Intervention in microalbumin for DM include:

Back 431

improved glycemic control, strict dyslipidemia control, use of ACE-I or angiotensin receptor blocker.
ACE-I have some nephroprotection

Front 432

Drugs whose names end in "-pril" and reduce efferent arteriolar pressure are from what class:

Back 432

ACE-I:

Front 433

What class of meds end in "sartan" and help preserve renal function in DM

Back 433

Angiotensin receptor blockers

Front 434

What medications increase your risk of heat stoke?

Back 434

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

Front 435

What lab should be gotten in a patinet w/ heat stroke

Back 435

CK to assess muscle damage --> release of electrolyte tissue damage, hyperkalemia

Front 436

What can heat stroke lead to..before death?

Back 436

polycythemia due to volume constriction and hyponatremia w/ Na <120 and stress induced leukocytosis

Front 437

Tx of Heat Stroke

Back 437

cooling w/ tepid spray and fan vs ice (may cause vasoconstriction decrease ability to lose heat from core), Rhabdomyolysis-->acute renal failure, Ck, creatinine

Front 438

62y/o HTN, smoke, Trigly:280, HDL:38, LDL:135 what med is best (class)

Back 438

multi drug therapy is needed

Front 439

46y/o HTN smoke, Trig: 110, HDL: 48, LDL: 192, on low-cholest diet what is next best step?

Back 439

HMG-CoA (coenzyme A reductase inhibitor) (lipitor, zocor, pravistatin) statins

Front 440

64y/o HTN DM2, Trig: 180, HDL 38, LDL: 135. Meds: sulfonylurea, TZD, biguanide, ACE-I, thiazide diuretic what next?

Back 440

lipid-lowering drug therapy initiated.

Front 441

What lab should be check w/ taking HMG-CoA reductase inhibitor (Statin) ?

Back 441

aspartate aminotransferase (liver function), CK

Front 442

What changes are expected when taking fibrates?

Back 442

increase in HDL: only medication that actually document increase in HDL

Front 443

What changes are expected when taking Niacin?

Back 443

Increase in HDL

Front 444

When prescribing Zetia what should you expect to see?

Back 444

reduction in LDL

Front 445

What are risk factors for statin induced myostitis?

Back 445

advanced age, low body weight, high statin dose

Front 446

What is the average LDL reduction when only diet is modified in lowering cholesteral tx?

Back 446

5-10%

Front 447

When taking atorvastatin and cholestyramine advise the patient to take the medicaiton?

Back 447

separeate cholestyramine from other meds by 2hrs (affect absorption)

Front 448

What medication is most effective against lipoprotein?

Back 448

niacin

Front 449

What are secondary causes of hypertriglyceridemia?

Back 449

hypothyroidism, poorly controlled DM or excessive alcohol

Front 450

HMG CoA reductase inhibitor (statin)? Effect, comments

Back 450

lower LDL by 18-55%
Increase: HDL by 5-15%
lower Trig by 7-20%

Hint 450

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

Front 451

Resin (cholestyramine, colestipol, colesevelam): benefits and adverse rxn

Back 451

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

Front 452

Niacin (class: antihyperlipidemia): benifits, Use, adverse effects,

Back 452

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

Front 453

Fibric acid derivatives: gemfibrozil (lopid), fenobribrate (tricor): what should you expect to see w/ tx and A/E

Back 453

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

Front 454

What does Ezetimibe (Zetia) do and what are A/Rxn

Back 454

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

Front 455

Sedondary hyperlipidemia:
What does inactivity result in

Back 455

decrase HDL

Front 456

Sedondary hyperlipidemia:
What does Alcohol abuse result in

Back 456

increase triglycerides, increase HDL increase LDL

Front 457

Sedondary hyperlipidemia:
What does DM result in

Back 457

increase Trig, decrease HDL, increase total cholesterol

Front 458

Sedondary hyperlipidemia:
What does Hypothyroidism result in

Back 458

increase Trig increase Total TC

Front 459

Secondary hyperlipidemia:
What does High dose thiazide diuretics result in

Back 459

increase TC, LDL, Trig

Front 460

Sedondary hyperlipidemia:
What does Chronic renal result in

Back 460

increase TC and Trig

Front 461

Metabolic syndrome dx includes:

Back 461

abd obesity, trig levels higher than 150, HDL less than 40 in men and 50 in women

Front 462

What is characteristic of Metabolic Syndrome related to insulin?

Back 462

Insulin resistance is present

Front 463

Describe plasminogen activator inhibitor:

Back 463

increased levels in atherosclerotic lesion
-inhibits fibrin degradation by plasmin
-enhances clot formation

Front 464

Define metabolic syndrome:

Back 464

3 or more: obesity, blood pressure, dyslipidemia, glucose intolerance

Front 465

What is insulin resistance:

Back 465

a reduced sensitivity in the tissue to insulins action at given concentration -->subnormal effect on glucose metabolism

Front 466

Metabolic syndrome Guidelines:

Back 466

abd men >40 inches, W >35
-Trig >150, HDL<40
BP: >130/85
Fasting glucose >110

Front 467

Insulin resistance is inversely related to decrease urine clearanc of what

Back 467

Uric acid (gout)

Front 468

Tx of insulin sensitizing medication for pt w/ polycystic ovary syndrome can lead to

Back 468

resumption fo ovulation, fertility, reduced hirsutism

Front 469

What are some disadvantages to apple shaped (central abd fat)

Back 469

metabolically active fat, high insulin levels, IR, free fatty acids and high insulin (increase hunger)

Front 470

IR contribute to prothromotic and proatherogenic state because

Back 470

Plasminogen activator inhibitor: inhibits fibrin degradation enhancing clot formation

Front 471

Seeing a gradual climb in glucose level over years you should consider risk for

Back 471

metabolic syndrome and DM2

Front 472

Insulin resistance leads to HTN by increase in:

Back 472

renal sodium resabsorption-->expand cir volume and incrase vascular resistance

Front 473

Insulin resistance leads to cardiovascular effects of:

Back 473

Hypertension through an increase vascular smooth muscle, greater response to angiotensin II and greater sympathetic activation

Front 474

Aerobic exercise can reduce IR by what percent

Back 474

40% and last 48hrs, reduces BP and improves lipids

Front 475

What medication improves insulin sensitivity and metablic parameters like lipids and BP

Back 475

TZD (pioglitazone, rosiglitazone)

Front 476

What does daily ASA do for BP, lipids

Back 476

counter act proinflammatory and prothrombotic effects of IR

Front 477

What does the WHO define as obesity ___kg/M2 or more

Back 477

30 Kg/M2

Front 478

What does orlistat do for weight loss

Back 478

reduc dietary fat absorption by 30%. Results in diarrhea if you eat fats

Front 479

What does Meridia due for weight loss

Back 479

acts on brain control for mood an dwell being and appetite

Front 480

When can someone consider Bariatric surgical:

Back 480

100lbs or more over ideal or >40BMI

Front 481

What are risk factors for pancreatitis:

Back 481

hyperlipidemia, abd trauma, thiazid diuretic use, alcoholism, gallbladder stones,

Front 482

What lab is obtained to determine acute pancreatitis

Back 482

serum lipase level w/ amylase

Front 483

What is the most reliable test for pancreatic cancer

Back 483

MRI is the most reliable diagnostic.

Front 484

What is care of pancreatitis

Back 484

parenteral hydration , analgesia, gut rest, tx underlying cause

Front 485

How does a pancreatic cancer present:

Back 485

abd pain , weight loss, anorexia, N/v, jaundices

Front 486

Amylase in Acute Pancreatitis will appear ______ and return back to normal ______. What % are due to cholelithiasis vs % due to alcoholic pancreas

Back 486

* 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

Front 487

Amylase: What effects amylase levels
Nonpancreatic amylase:

Back 487

*salivary glands
* ovarian cysts
* ovarian tumors
* tubo-ovarian abscess
* ruptured ectopic preg
* lung cancer

Front 488

Lipase in Acute Pancreatitis:
Lipase appear how soon after onset and peaks at what time frame

Back 488

* appears 4-8h after sx onset
* Peaks at 24h, decreases 8-14d of pancreatitis resolution

Front 489

What non pancreatic reasons would result in elevated Lipase?

Back 489

* renal failure
* perforated duodenal ulcer
* bowel obstruction
* bowel infarction

Front 490

Hyperthyroidism: signs and sx
Characteristics (patho)

Back 490

excessive energy release, rapid cell turnover

Front 491

Hperthyroidism: signs and sx
Causes (disease names)

Back 491

Graves, thyroiditis, metabolically active thyroid nodule

Front 492

Hperthyroidism: signs and sx
Neurologic: sx

Back 492

Nervousness, irritability, memory problems

Front 493

Hperthyroidism: signs and sx
Weight

Back 493

weight loss (modest only in 50%)

Front 494

Hperthyroidism: signs and sx
Enviornmental response

Back 494

Heat intolerance

Front 495

Hperthyroidism: signs and sx
Skin

Back 495

Smooth, silky skin

Front 496

Hyperthyroidism: signs and sx
Hair

Back 496

fine hair w/ freq loss

Front 497

Hyperthyroidism: signs and sx
Nails

Back 497

thin nails that break w/ ease

Front 498

Hyperthyroidism: signs and sx
GI

Back 498

frequent, low-volume, loose stools

Front 499

Hyperthyroidism: signs and sx
Menstrual

Back 499

Amenorrhea or low-volume menstral flow

Front 500

Hyperthyroidism: signs and sx
Reflexes

Back 500

Hyperreflexia w/ "quick out-quick back" action

Front 501

Hyperthyroidism: signs and sx
Muscle strength

Back 501

Proximal muscle weakness

Front 502

Hyperthyroidism: signs and sx
Cardiac

Back 502

Tachycardia

Front 503

Hyorthyroidism: signs and sx
Characteristics: physiological

Back 503

Reduced energy release, slow cell turnover

Front 504

Hypothyroidism: signs and sx
Causes (disease state)

Back 504

Post thyroididits >90%, primary pitutuary failure (rare), thyroid removal

Front 505

Hypothyroidism: signs and sx
Neurologica

Back 505

lethargy, disinterest, memory problems

Front 506

Hypothyroidism: signs and sx:
Weight

Back 506

Weight gain (5-10lbs)

Front 507

Hypothyroidism: signs and sx
Environmental response:

Back 507

chilling easily, cold intolerance

Front 508

Hypothyroidism: signs and sx
Skin

Back 508

Coarse, dry skin

Front 509

Hypothyroidism: signs and sx
Hair

Back 509

thick, coarse hair w/ tendency to break

Front 510

Hypothyroidism: signs and sx
nails

Back 510

thick, dry nails

Front 511

Hypothyroidism: signs and sx
GI

Back 511

constipation (slow down everything)

Front 512

Hypothyroidism: signs and sx
Menstrual

Back 512

Menorrhagia

Front 513

Hypothyroidism: signs and sx
Reflexes

Back 513

hyporeflexia: Slow relaxation phase, "hung up" reflex

Front 514

Hypothyroidism: signs and sx
Muscle strength

Back 514

no change

Front 515

Hypothyroidism: signs and sx
Cardiac

Back 515

bradycardia (in severe cases

Front 516

Hyperthyroidism: signs and sx
Hair

Back 516

fine hair w/ freq loss

Front 517

Hyperthyroidism: signs and sx
Nails

Back 517

thin nails that break w/ ease

Front 518

Hyperthyroidism: signs and sx
GI

Back 518

frequent, low-volume, loose stools

Front 519

Hyperthyroidism: signs and sx
Menstrual

Back 519

Amenorrhea or low-volume menstral flow

Front 520

Hyperthyroidism: signs and sx
Reflexes

Back 520

Hyperreflexia w/ "quick out-quick back" action

Front 521

Hyperthyroidism: signs and sx
Muscle strength

Back 521

Proximal muscle weakness

Front 522

Hyperthyroidism: signs and sx
Cardiac

Back 522

Tachycardia

Front 523

Hyorthyroidism: signs and sx
Characteristics: physiological

Back 523

Reduced energy release, slow cell turnover

Front 524

Hypothyroidism: signs and sx
Causes (disease state)

Back 524

Post thyroididits >90%, primary pitutuary failure (rare), thyroid removal

Front 525

Hypothyroidism: signs and sx
Neurologica

Back 525

lethargy, disinterest, memory problems

Front 526

Increased thyroid disorder risk increase in what age grp

Back 526

elderly

Front 527

What lab value for TSH fT4 is most consistent w/ hypothyroidism

Back 527

normal fT4 and elevated TSH Levels (somthing is wrong w/ the thryoid and the pituitary is trying to compensate by giving more TSH)

Front 528

what is Hashimoto's disease

Back 528

hypothyroidism from an autoimmune response (most common) resulting in thyroidistis destroying large amounts of thyroid

Front 529

What is the most common causes of hypothyroidism

Back 529

autoimmune thyroiditis next is surgical

Front 530

What lab value do you expect to find in Graves disease

Back 530

Low TSH level (thyroid overproduction makes pituitary slow down in production of TSH w/ feed back mechanism)

Front 531

What is a physical finding in graves related to the eyes

Back 531

Eye LID retraction (appears eye are bulging)

Front 532

What is the mechanism of action for radioactive iodine in tx of Graves

Back 532

destroy overactive thyroid

Front 533

What is useful in tx tremor in hyperthyroidism?

Back 533

propanolol (beta blocker)

Front 534

T4 for elderly dose should be what compared to middle age adult

Back 534

75% or less

Front 535

What do you suspect on thyroid scan that reveals thyroid mass (cold spot):

Back 535

thyroid cyst

Front 536

What lipid value do you find in untreated hypothyroidism

Back 536

hypertriglyceridemia

Front 537

U find painless thyroid mass and TSH level less than 0.1 (low) what is the causes

Back 537

autonomously functioning adenoma

Front 538

Fixed, painless thyroid mass w/ s of hoarsness and dysphagia what should you consider:

Back 538

thyroid malignancy

Front 539

What is cost effective to determine malignancy from benign thyroid nodules

Back 539

fine-needle aspiration biopsy

Front 540

What is a side effect of excessive levothyroxine (synthroid)

Back 540

Bone thinning

Front 541

When should TSH be reassessed when tx w/ synthroid (levothyroxine) is altered

Back 541

6-8wks

Front 542

U find 3cm round mobile thyroid mass, US reveals fluid filled structure dx is

Back 542

thyroid cyst

Front 543

A patient w/ downs syndrome should periodically be monitored for what endocrine disorder

Back 543

hypothyroidism

Front 544

What do you expect to find in elderly w/ hyper or hypothyroidism

Back 544

atypical presentation: typically lab values identify disease

Front 545

What is the purpose of thyroid hormone physiologically (basic)

Back 545

assist cell in energy releasing activities

Front 546

What medication can causes a alteration in iodine metabolism=hypothyroidism

Back 546

lithium, amiodarone

Front 547

What is the most sensitive and specific thyroid test

Back 547

TSH (produced by anterior pituitary)

Front 548

What is the negative feedback loop in thyroid pituitary function

Back 548

TSH output is determined by amount of circulating T4

Front 549

What is the most helpful test in confirmation of an abnormal TSH level

Back 549

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

Front 550

Is TSH increase or decreased in hypothyroidism

Back 550

Increased (it is trying to compensate due to decrease feedback of T4)

Front 551

Is TSH increased or decreased in hyperthyroidism

Back 551

Decreased (thyroid is putting off extra T4 so pituitary decreases amount of TSH)

Front 552

How do you confirm hyperthyroidism if TSH is low or undetectable?

Back 552

obtain fT4:
(if it is high then the feedback is decreased)

Front 553

What medication is given w/ low T4 (hypothyroidism)

Back 553

synthroid (levothyroxine)

Front 554

What is the age of onset of Graves

Back 554

20-40 years
(may have underlying like pernicious anemai, myasthenia gravis, DM)

Front 555

What is the clinical presentation of graves?

Back 555

diffuse thyroid enlargement, exophthalmos, nervousness, tachycardia, heat intolerance

Front 556

What does a thyroid scan reveal in Graves?

Back 556

Large (hot) gland w/ heterogeneous uptake

Front 557

What are tx of graves:

Back 557

Methimazole, propylthiiouracil or radioactive iodine or removal of thyroid
(then tx hypothyroidism)

Front 558

What do you expect the lab values to be in hypothyroidism

Back 558

Elevated TSH and normal fT4 (subclinical)

Front 559

When should u initiate tx of hypothyroidism?

Back 559

When TSH rise above 10mU/L (normal 0.5-4) even in presence fo normal fT4

Front 560

What is the initial dose of synthroid in tx of hypothyroid

Back 560

75-125 ug (75% or less in elderly)

Front 561

What do you do if you find a palpable thyroid nodule:

Back 561

watch and wait if no changes to TSH (may obtain fine-needle biopsy to determine malignancy)

Front 562

BPH affects approx ___% of men by age of 60

Back 562

50 (90% by 85y/o)

Front 563

What are sx of BPH

Back 563

increase frequency decrease force of output, nocturia, sensation incomplete bladder

Front 564

What medication cause urinary retention in men complicating BPH

Back 564

tricyclic, first gen antihistamines (anticholinergic effect)

Front 565

What non pharm causes bladder irritation after intake of:

Back 565

caffeine and artifical sweetners: do not use if incontence or bladder disorders

Front 566

What class of med can be helpful in BPH:

Back 566

alpha1 receptor antagonist (alpha blockers) (note: if HTN too then only added to existing therapy

Front 567

What medication helps reduce the size of the prostate by blocking conversion of testosterone to dihydrtestosterone.

Back 567

Finasteride

Front 568

When should surgical intervention be considered in BPH.

Back 568

recurrent UTI, recurent or persistent gross hematuria, bladder stones, renal insufficiency

Front 569

Chancoid is a

Back 569

(soft chanker) STI: from bacteria H. Ducreyi

Front 570

Treatement of Chancoid is:

Back 570

Azithromycin (macrolide)
ciprofloxacin (2nd gen fluorquinolone)
ceftriaxone (cephalosporin)

Front 571

What other disease do you expect to find when testing for chancroid (STD)

Back 571

herpes simplex

Front 572

What does Chancroid look like?

Back 572

vesicular pustular lesion painful, soft ulcer w/ necrotic base at point of inoculation.

Front 573

What is the causative organism in lymphogranuloma venereum

Back 573

C. trachomatis 1&3

Front 574

What are the physical findings w/ lymphogranuloma venereum

Back 574

lesions fuse and create multiple draining sinuses mainly in the groin

Front 575

What is the tx for lymphogranuloma venereum

Back 575

tetracycline

Front 576

Chancroid: causative organism
presentation

Back 576

H. ducreyi
painful genital ulcer, mult lesion, inguinal lymphadenitis

Front 577

Chancroid Tx

Back 577

Azith 1g oral or
Ceftriaxone 250 IM or
Cirpo 500 BID x 3d

Front 578

Genital Herpes: organism, presentation

Back 578

HSV2
Painful ulcerated lesion (w/ primary

Front 579

Genital Herpes: Tx

Back 579

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

Front 580

Lymphogranuloma venereum: oragnism presentation

Back 580

C. Trachomatis:
vesicular ulcer lesion, external genitalia w/ inguinal lymphadenitis or buboes

Front 581

Lymphogranuloma venereum: tx

Back 581

Doxy 100 Bid x 21d

Front 582

Nongonococcal urethritis and cervicitis: organism presentation

Back 582

C. trachomatis
cervitiss, irritative void, mucopurelent discharge

Front 583

nongonococcal urethritis and cervicitis: tx

Back 583

azith 1g PO or dox 100 bid x7d

Front 584

Gonococcal urethritis: organism presentation

Back 584

N. gonorroeae
irritative void, purulent discharge

Front 585

Gonococcal urethritis: Tx

Back 585

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

Front 586

What do you treat concurrently w/ gonococcal urethrits (GC)

Back 586

Chlamydia (azith 1g or doxy x 7d)

Front 587

Epididymitis (epidimymoorchitis) organism and presentation

Back 587

N. gonorrhoeae, C. trachomatis
irritative void, fever painful swell epidiymis and scrotum

Front 588

epididymitis: tx

Back 588

ceftriaxone (rocephin) 250mg IM PLus doxy 100mg bid x 10d

Front 589

Trichomoniasis: organism presentation

Back 589

T. vaginalis:
none or dysuria, strawberry cervix (punctate hemorrhages)

Front 590

trichomoniasis: tx

Back 590

Metronidazole (flagyl) 2g onetime

Front 591

Genital warts (condyloma acuminata): orgnanism presentation

Back 591

HPV
verruca form lesions or subclincial

Front 592

Genital warts (condyloma acuminata): tx

Back 592

patient applied: polofilox 0.5% or imiquimod 5% cream:
Provider: liquid nitrogen, tricholoacetic acid, surgical or podophyllin resin

Front 593

Acute bacterial prostatitis <35y: organism presentation

Back 593

N. gonorrhoeae, C. trachomatis
irritative void, suprapubic, perinal pain, fever, tender boggy prostate

Front 594

acute bacterial prostatitis: Tx

Back 594

Ofloxacin 400mg x1 then 300BIDx10d or
Ceftriaxone (rocephin) 250mg IM then doxy 100mg bid x 10

Front 595

Acute bacterial prostatits: organism and presentation >35y

Back 595

Enterobacteriaceae (coliforms)
void, suprapubic perinaeal pain, boggy prostate, leukocytosis

Front 596

acute bacterial prostatis: tx >35

Back 596

Ciprofloxacin 500mg bid or ofloxacin 200mg PO qD x 14

Front 597

Chronic bacterial prostatis: organism presentation

Back 597

enterobacteriaceae
void, dull,poorly localized suprapubic perineal pain

Front 598

What is the difference in epididymitis in younger vs older men

Back 598

older men: secondary to prostatitis
younger: STI: C. trachomatis or N. gonorrhoeae

Front 599

What is Prehn sign in epididymitis?

Back 599

reduction in pain when scrotum is elevated above symphysis pubis

Front 600

What is epidiymoorchitis:

Back 600

both testicles involved swelling so two cannot be distinguished

Front 601

epidiymoorchitis: mainly caused by UTI: What is the diagnostic test to determine tx?

Back 601

urine culture

Front 602

37y/o w/ gram neg cocci, dysuria, urethral discharge what is likely organism:

Back 602

N. gonorrhoeae

Front 603

Tx option for gonococcal proactitis is

Back 603

ceftriaxone, 125 IM

Front 604

CDC recommends what single dose for uncomplicated urethritis by N. gonorhoeae?

Back 604

cefixime (cephlasorin )suprax

Front 605

Risk of transmission from infected woman to male is what percent if single coital act?

Back 605

20-30%: 60-80% chance man to women

Front 606

What is the incubation period of N. Gonorrhoeae

Back 606

1-5d

Front 607

Because gonorrhoeae produces beta-lactamase what is the best antibiotic

Back 607

cephalosporin: ceftriaxone and cefixime

Front 608

Tx of chronic bacterial prostatitis should consider treating a gram ____ _____ organism

Back 608

gram negative rods (e. coli or pseudomonas)

Front 609

What are sx of acute bacterial prostatitis:

Back 609

perineal pain, irritative void, fever

Low back pain in chronic BP

Front 610

What does the prostate feel like on exam w/ acute bacterial prostatitis

Back 610

boggy

Front 611

How long should the tx of chronic bacterial prostatitis last and what med is best:

Back 611

ciprofloxacin for 4wks may need 12 wks.

Front 612

What is the best diagnostic test to ID offending organism in bacterial prostatitis

Back 612

urine culture

Front 613

What does a digital rectal exam of prosate cancer find

Back 613

prostatic induration

Front 614

A PSA will ____ w/ prostate cancer

Back 614

double in serial annual test w/ normal prostatic exam

Front 615

Risk factors for prostate cancer

Back 615

African, FHx, high fat diet

Front 616

Average American __% life time risk of prostate cancer

Back 616

40 %

Front 617

What are the findings on testicular torsion?

Back 617

scrotal pain unilateral loss of cremasteric reflex, swollen tender

Front 618

What diagnostic test is used in assessing testicular torsion

Back 618

doppler to determine blood flow: (will be decreased if severe)

Front 619

What is orchiopexy and when is it used

Back 619

Tacking the testicles low in the scrotum to prevent re-occurrence of testicular torsion

Front 620

Variocele presents w/

Back 620

"bag of worms" mass in scrotum dissappears when lying down

Front 621

What is a lab finding w/ variocele

Back 621

decreased sperm count w/ increase abnormal forms (similar to varicose veins in the legs...weak valves result in increase swelling of veins)

Front 622

What is tx of variocele ( like varicose veins in scrotum)

Back 622

scrotal support

Front 623

Primary syphilis: presentation, tx

Back 623

painless ulcer, indurated: lymphadenopathy.
PNC G 2.4m IM if allergy then
Doxy 100mg Bid x 2w

Hint 623

also tx for secondary syphilis or latent syphilis of <1yr

Front 624

Secondary syphilis: presentation, Tx

Back 624

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

Front 625

Later or tertiary: presentation, slide 3 tx

Back 625

Gumma (granulomatous lesions involveing skin, mucous membranes, bone) aortic insufficiency, aortic aneurysm, Argly Roberttson pupil seizures

Hint 625

PNC G 2.4 M IM weekly x 3 wk or if allergic like secondary:
doxy 100mg BID x 2 wks

Front 626

When do lesions present in syphilis

Back 626

2-4 wks after sexual contact.

Front 627

What is a sequelae of HPV

Back 627

anorectoal carcinoma

Front 628

What best describes a condyloma acuminatum lesion

Back 628

verruciform

Front 629

Tx w/ condyloma acuminatum:

Back 629

imiquimod (aldara) or podofilox

Front 630

What age should you receive HPV for colorectoal carcinoma prevention

Back 630

13-18

Front 631

What are common risk factors for ED

Back 631

HTN, DM, smoking (anything): testosterone deficiency is NOT a risk factor

Front 632

What is the result of using sildenafil (what is it)

Back 632

Erection: although sexual stimulation will still be needed to achieve erection: (viagra)

Front 633

What is the most probable cause of ED in 70y/o

Back 633

some underlying cause

Front 634

What medications can causes ED

Back 634

anti HTN, antidepressants, cimetidine (tagament)

Front 635

How does sildenafil or vardenafil work?

Back 635

enhance effects of nitric oxide: chemical relaxes smooth muscle in penis and allows increase blood flow (take 1hr prior to sex)

Front 636

What should not be taken w/ sildenifil (viagra)

Back 636

a nitrate (NTG)

Front 637

What drug can be injected into the penis for erection or what drug can be inserted in the urethra (ouch)

Back 637

alprostadial (caverject) or Muse

Front 638

Describe the effects of asthma on the airway

Back 638

chronic airway inflammation w/ superimposed bronchospasm

Front 639

What do you expect to find in an acute asthma flared managed in a primary care (physical exam not lung sounds)

Back 639

hyperresonance on thoracic percussion

Front 640

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?

Back 640

peak expiratory flow (PEF): maximum speed of expired air

Front 641

24y/o asthma flare, using pulmicort and albuterol but cont to have wheeze. PEF 55% baseline you should adjust meds to include

Back 641

adding a prednisone. For long term control a long acting beta 2 agonist can also be used

Front 642

What do you expect to find on CXR during acute asthma attack?

Back 642

Hyperinflation (think of wheeze trying to escape)

Front 643

36y/o w/ asthma and HTN what med should you avoid when tx his HTN

Back 643

beta blocker (propanolol)

Front 644

Which sx is consistent w/ asthma

Back 644

nocturnal cough, cough or wheeze after exercise, cold that "got to the chest" or tak >10d to clear

Front 645

What is a corner stone tx of moderate persistent asthma

Back 645

inhaled corticosteroid

Front 646

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

Back 646

discuss excessive albuterol use may increase risk of asthma death

Front 647

In tx of asthma what should leukotriene inhibitors be used for:

Back 647

inflammatory inhibitors

Front 648

How long after inhaled corticosteroids or leukotriene do you expect to see results

Back 648

1-2 weeks

Front 649

Xopenex has what improved benefit over albuterol

Back 649

greater bronchodilation w/ lower dose

Front 650

What are the goals of of asthma care:

Back 650

minimal or no sx like cough and wheeze especially at night

Front 651

What is the normal circadian variation of PEF

Back 651

10-15% from waking to night: w/ asthma it is >15% at night =nocturnal bronchospasm

Front 652

What is the backbone of mild, moderate or severe persistent asthma therapy (3 slides)

Back 652

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

Front 653

What are the rescue inhaler and why are they used

Back 653

short acting-beta 2 agnoist (albuterol, levalbuterol) used to relieve acute superimposed bronchospasm

Front 654

In asthma control what is the next treatment when giving a corticosteroid when sx control is not being met:

Back 654

Add a long acting beta 2 agonist: salmetrol, formoterol

Front 655

beta2 agonist have a "-terol" suffix what are some meds and what are their actions

Back 655

albuterol short acting, and salmetrol long acting: Stimulate beta 2 site causing bronchodilation

Front 656

Why should beta-adrenergic antagonist "lol" not be used in asthma?

Back 656

They can precipitate bronchospasm ie propanolol

Front 657

Corticosteroids have an "-one" or "-ide" suffix: examples

Back 657

fluticasone (flovent), prednisone, budesnide (pulmicort)

Front 658

Leukotriene receptor agonist (leukotriene modifiers) have "-lukast" sufix: examples:

Back 658

montelukast (singulair)

Front 659

Why is do you hear hyperresonance on percussion and hyperinflation in asthma

Back 659

because of air trapping, decreased PEF

Front 660

Asthma:
Inhaled Corticosteroids: MoA, indication (three slides)

Back 660

inhibit eosinophilc action, potentate effects of beta2 agonist
controller drug, prevention of inflammation:
must be used consistently to help

Front 661

Asthma tx:
Cromolyn (intal): MoA and indications (3 slides)

Back 661

halts degradation of mast cells and release of histamine (MAST cell stabilizer)

Hint 661

Controler drug, prevents inflammation:
need consistent use but less effect than corticosteriods

Front 662

Leukotrien modifier: (montelukast) singulair: MoA, indications

Back 662

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

Front 663

Oral corticosteroids: MoA, indictations (3 slides)

Back 663

inhibit eosinophili and other inflammatory actions
-tx of acute inflamation in asthma and COPD
>2wks tx adrenal suppression

Front 664

Albuterol (ventolin, proventil,xopenex): MoA, indications

Back 664

Beta2 agonist; bronchodilation via stimulation of beta2 receptors
-Rescue drug: acute bronchospasm: onset: 15min, duration 4-6hrs

Front 665

Long acting beta2 agonist: salmeterol: MoA and indications

Back 665

Beta2 agonist; broncholiation, through stimualation of beta2 receptors
Prevent broncho spasms:
Salmetrol: onset 1hr, druation 12hr.

Front 666

Ipratropium (atrovent)
tiotropium bromide (spiriva): MofA and indications

Back 666

anticholinergic and muscarinic antagonist, yielding broncholdiation

Hint 666

tx and prevent bronchospasm:
onset >30min
best use to avoid rather than tx bronchospasm

Front 667

Theophylline: MoA and indications

Back 667

mild bronchodilation, helps diaphram contract
prevent bronchospasm
Narrow theraputic not used often

Front 668

what is the therapeutic action of inhaled corticosteroids when tx COPD

Back 668

reduction in airway inflammation

Front 669

What is consistent w/ dx of COPD

Back 669

FEV1/FVC ratio of less than 0.70

Front 670

What is found in the airway early stages of chronic bronchitis

Back 670

excessive mucus production

Front 671

What is found in the airway of emphysema patients

Back 671

enlargement of air spaces distal to terminal bronchioles

Front 672

What is the GOLD tx for COPD guidelines for stages II-Iv COPD

Back 672

short-acting inhaled bronchodilators

Front 673

What is the goal of using inhaled corticosteriods in stage III COPD

Back 673

minimize risk of repeated exacerbations

Front 674

Which cortiocsteriod is most potent:
methylprednisolone, 8mg
triamcinolone, 10g
prednisone 15mg
hydrocortisone 18mg

Back 674

Prednisone

Front 675

What is the typical organism in acute chronic bronchitis

Back 675

H. influenzae...also Mycoplasma pneumoniae, Chlamydia pneumoniae, and Streptococcus pneumonia.

Front 676

What is an appropriate antibiotic for a 72y/o HF, acute bacterial COPD who has failed amoxicillin

Back 676

levofloxacin

Front 677

What is the appropriate antibiotic for 52y/o w/ acute bacterial COPD exacerbation

Back 677

azithromycin

Front 678

What is the definition of chronic bronchitis:

Back 678

report of excessive mucus for >3m per year fro 2 years absence of other causes 80% causes by smoking

Front 679

What is considered the backbone of COPD therapy

Back 679

Bronchodilators: Tioptropium bromide (Spiriva) and ipratropium bromide (atrovent) anticholinergic w/ stage II-IV COPD

Front 680

What should you advise all COPD patients to avoid

Back 680

noxious agents, smoking, irritants, obtain annual influenza and antipneumococcal vaccine

Front 681

COPD: Stage Characteristic, treatment
Stage 0

Back 681

cough, sputum production, no spirometric abnormalities
tx: COPD risk reduction

Front 682

COPD: Stage Characteristic, treatment
Stage I Mild

Back 682

FEV: FVC ratio <0.70
>FEV >80% of predicted
w/w/o sx

Hint 682

hort acting bronchodilator PRN
-albuterol, pirbuterol, levalbuterol

Front 683

COPD: Stage Characteristic, treatment

Back 683

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

Front 684

COPD: Stage Characteristic, treatment:
Stage III

Back 684

FEV:FVC ratio<0.70
-30%>FEV <50% of predicted

Hint 684

Reg us of >1 bronchodilator
-Tiotropium/salmeterol
short acting: albuterol
Corticoid if repeated
Pulmonary rehabilitation

Front 685

COPD: Stage Characteristic, treatment
Stage IV

Back 685

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

Front 686

Potency of corticosteroids:
Higher potency (equipotent doese):
Which is highe potency:
Dexamethasone 0.75mg
Betamethasone 0.6-.75mg

Back 686

Betamethasone 0.6-.75mg
Dexamethasone 0.75mg

Front 687

Potency of corticosteroids:
Medium potency (equipotent dose)

Back 687

Methylprednisolone 4mg
Triamcinolone, 4mg
prednisolone 5mg
prednisone 5mg

Front 688

Potency of corticosteroids
Lower patency (equipotent dose)

Back 688

Hydrocortisone 20mg
cortison 25mg

Front 689

acute bacterial: COPD: etiology and tx:

Back 689

Gram-pos and neg respiratory pathogen, atypical
amoxicillin or doxy or cephalo, if failure then
fluoroquinolone or HD augmentin

Front 690

Acute bacterial: Chronic bronchitis: what is the organism: what is the tx

Back 690

Psuedomonas aeruginosa
Tx: Ciprofloxacin, levofloxacin

Front 691

5MM or larger w/ HIV or other immunosuppression or organ transplant or taking 15mg prednisone = pos or neg TB

Back 691

positive TB

Front 692

What is the dx after PPD: 10mm in high risk: immagrants, IV drug, health care, resident housing, correction, homeless, health:

Back 692

Positive TB

Front 693

15mm or larger in all others including those that appear to have no TB

Back 693

Positive TB

Front 694

Anergy testing in TB

Back 694

giving skin test of substances other than TB determines weakened immune system

Front 695

Bacille Calmette Guerin in TB

Back 695

given in many countries: low risk of causing false-pos

Front 696

Booster phenomenon in TB:

Back 696

seen in elderly. first TB is neg but next year positive because previous infection long ago boost the immune response

Front 697

Two step testing TB is used to:

Back 697

distinguish booster rxn (caused by TB infection that occured years ago) from rxn caused by recent infection

Front 698

What is chemoprophylaxis therapy for pos TB but no sx

Back 698

isonizide therapy and periodic chest xray

Front 699

Antibiotic for community acquired pneumonia: No comorbidity

Back 699

azithromycin 5-7d

Front 700

antibiotic for CAP pt cant take macrolide:

Back 700

doxycycline

Front 701

Antibiotic for CAP in 78y/o w/ COPD

Back 701

amoxicillin w/ a macrolide

Front 702

Antibiotic for CAP in 69y/o w/ HF and DM2:

Back 702

respiratory fluoroquinolone

Front 703

Antibiotic for CAP in 58y/o w/ dry cough, HA malaise no recent antibiotic:

Back 703

clarithromycin (biaxin) macrolide, doxy

Front 704

What is a quality of respiratory fluoroquinolone:

Back 704

activty against drug resistant S. pneumonia (DRSP)

Front 705

Drug resistant S. Pneumonia (DRSP) mechanism of resistance:

Back 705

alteration in protein-binding sites

Front 706

H. influenzae mechanism of resistance:

Back 706

beta lactamase production

Front 707

What is a characteristic of macrolide:

Back 707

effective against atypical pathogen also beta lactamase (PNC is not effective against beta lactamase)

Front 708

CAP should be tx w/ antimicrobial for how long according to american thoracic society

Back 708

5-7days outpatient

Front 709

What are modifying factors for P. aeruginosa

Back 709

corticosteroid use, strucural lung disease, malnutrition

Front 710

What is mechanism of transmission in atypical pneuomonia?

Back 710

cough

Front 711

Risk factors for pneuomina death:

Back 711

renal insufficency, elderly, comorbidity, immunosupressed

Front 712

What is an acceptable sputum specimen for gram staining?

Back 712

few squamous epithelial cells and many WBC

Front 713

52y/o smoker w/ CAP, 3rd day therapy w/o fever, hydrated, feeling better when do you get chest xray

Back 713

7-12 weeks from now

Front 714

62y/o hosp w/ CAP considers what about vaccination

Back 714

influenza and antipneumococcal should be given now

Front 715

Why is it labeled community acquired pneumonia?

Back 715

pt resides in comunity not recently hosp and not nursing home

Front 716

What is typical presentation of pneumonia?

Back 716

Cough, dyspnea, sputum production, pleuritic chest pain,

Front 717

What may CXR reveal in pneumonia pt

Back 717

infiltrate patterns and areas of consolidation w/ S. pneuonia

Front 718

If a smoker w/ pneumonia take CXR 7-12 wks after therapy to assess for ?

Back 718

lung cancer

Front 719

What is the main organism of smokers w/ pneumonia?

Back 719

H. influenzae (tracheobronchial tree conlonized

Front 720

How are mycoplasma pneumoniae and C. pneumonia transmited

Back 720

via cough, in closed community

Front 721

Tx of CAP:
no comorbidity:

Back 721

macrolide: azithro or clarithro
Alt: doxy if macro intolerant

Front 722

Tx of CAP:
w/ comorbidy : HF, COPD

Back 722

Beta-lactam: cepodoxime, augmenten, ceftriaxone+cefpodoxime PLUS
macrolide or doxy or resp fluoroquinolone

Front 723

What increases risk of death from pneumonia?

Back 723

>65yrs, electrolyte or hem disorder (Na<130, absolute neutrophil <1000) other illness.

Front 724

What organism is seen mostly in alocholics w/ pneumonia

Back 724

Klebseilla. pneumonia

Front 725

What increases Risk of CAP by P. aeruginos:

Back 725

structual lung, corticosteroid, broad spectrum antibiotic in previous month, malnutrition

Front 726

What increase risk of resistant microbes:

Back 726

repeat exposure to given agent, underdosing, unecessary prolonged tx period

Front 727

H. influenzae produces beta-lactamase: what antimicrobial is ineffective against this

Back 727

penicillin

Front 728

what antimicrobials are useful when beta-lactams are ineffective (atypical pathogens)

Back 728

macrolides, tetracyclines, respiratory fluoroquinolones

Front 729

What is the best preventative measure to prevent the most fatal form of pneumonia:

Back 729

obtaining a pneumococcal vaccine

Front 730

CNS: I, II, III: control or responsible for ?

Back 730

Olfactory, Optic, Occulomotor (eye movement)

Front 731

CNS: IV, V, VI

Back 731

Trochlear (ear), Trigeminal (temp, pain, tactile), abducens (eye)

Front 732

CNS: VII, VIII, IX

Back 732

Facial (Bells palsy), auditory (vestibulocochlear, rinne test), glossopharyngeal (swallowing)

Front 733

CNS: X, XI, XII

Back 733

Vagus, Accessory (shoulder shrug), Hypoglossal: protrusion of tongue

Front 734

What can be a complication of Lyme disease:

Back 734

bells palsy (need to obtain a titer to verify)

Front 735

What lab test should be obtained w/ bells palsy:

Back 735

RPR, veneral disease test, HIV

Front 736

Is Neuroimaging needed w/ bells palsy?

Back 736

no due to unilateral CN dysfunction on typical of intracranial neoplasm

Front 737

What is tx of Bells palsy:

Back 737

may give corticosteroid if w/in 10days of sx

Front 738

40y/o 5wk hx recurrent HA at night, last 1hr severe behind left eye w/ lacrimation, nasal discharge what is HA dx:

Back 738

cluster HA

Front 739

Prophylactic tx for migraines HA:

Back 739

Propanolol (beta blocker)

Front 740

55y/o woman hx of angina and migraine: best choice of acute HA tx (called abortive migraine therapy)

Back 740

ibuprofen

Front 741

Migraine HA typically presents as a _____ Pain

Back 741

pulsating pain

Front 742

Tension HA typically described as _____ type pain

Back 742

pressing type pain

Front 743

Tx options in cluster HA include:

Back 743

NSAID, oxygen, triptans (imatrex, maxalt)

Front 744

What has the most rapid analgesic onset?
naproxen, liquid ibuprofen, diclofenac, celecoxib (all nsaids)

Back 744

liquid ibuprofen

Front 745

What are limitations to Fioricet (butalbital w/ APAP and caffeine?

Back 745

high rate of rebound HA

Front 746

Why should neuroleptic meds in migraines be limited to 3x per week?

Back 746

Their extrapyramidal movement risk:

Front 747

What should the expectation be w/ prophylactic HA tx long term:

Back 747

approx 50% reduction in number

Front 748

48y/o monthly 4d premenstrual migraine, poor response to triptans (serotonin receptor agonist) and analgesic w/ hot flashes what next:

Back 748

-use continuous monophasic oral contraceptive
-estrogen patch
-triptan prophylaxis

Front 749

Prophylactic tx for prevention of tension type HA include

Back 749

desipramine (Norpramin) tricylic antidepressant

Front 750

68y/o w/ new HA, bilateral frontal to occipital worse on rising in am and coughing, better mid day. What is causing HA?

Back 750

increased ICP

Front 751

Clinical presentation:
Tension Ha

Back 751

30min-7d w/ >2 of following
-press, nonpulsating
-mild to moderate
-bilateral
- >1 of following then migriane
Nausea, photophob,phonophob

Front 752

clinical presentation : migraine w/o aura:

Back 752

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

Front 753

Clinical presentation:
Migraine w/ aura

Back 753

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

Front 754

Clinical presentation:
Cluster HA

Back 754

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

Front 755

In the absence of neurological exam MRI or CT is usually not indicated?

Back 755

Yield little additional information compared to cost

Front 756

Are Migrain w/ or W/o aura more common?

Back 756

without an aura (effects 80% of migraine) assess for warning of agitation, jitteriness

Front 757

What does SNOOP stand for in HA RED flags

Back 757

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

Front 758

Cluster HA are more common in what age

Back 758

middle age men w/ heavy alcohol and tobacco (suicide HA) over several weeks w/ lacrimation, rhinorrhea

Front 759

What is tx of cluster HA

Back 759

remove trigger: smoking, alcohol, triptans, NSAID, oxygen

Front 760

What form of migraine tx has rapid onset but more expensive

Back 760

injectable: sumatriptona, dihydroergotamine: 15-30min. best if GI upset

Front 761

What are triptans and why are they used in HA (migraine): Preventative therapy used daily: Imitrex

Back 761

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)

Front 762

What are ergotamines and why are they used in HA (migraine but NOT tenstion)

Back 762

vasoconstrictor effects: avoid in hx of CAD

Front 763

NSAIDS are useful for what type of HA

Back 763

tension and migrain: inhibit prostaglanding and leukotriene synthesis (use first sx of Ha)

Front 764

Which has best relief w/ HA: NSAID or APAP/ ASA

Back 764

NSAID due to improved analgesic effect

Front 765

Fioricet w/ caffeine, butalbital and APAP: use and type of HA

Back 765

enhances neurotransmitter action, dependency risk and rebound

Front 766

Midrin (isomethepetene, APAP, dichloralphenzone: used in and caution

Back 766

migraine and tension HA: Contraindicated if vasoconstriction concern

Front 767

Excedrin Migraine: ASA, APAP, caffeine: OTC: type HA

Back 767

migraine and tension: excessive use may causes rebound

Front 768

Neuroleptics: adjuct therapy to what type HA

Back 768

migraine: control N/V, sedating

Front 769

What are some examples of neuroleptics used in migraine tx:

Back 769

Compazine, phenergan: used >3xwk increase risk of extrapyramidal effects

Front 770

What are the risks of Opiod use?

Back 770

dependency (habit), sedating use sparingly, respiratory distress if OD

Front 771

What receptor do most HA medication work on?

Back 771

5HT2 receptor: 1-2m use is required to be effective prophylactic

Front 772

What are some HA inducing medications:

Back 772

estrogen, progesterone, vasodilators

Front 773

HA due to ICP presents w/ c/o

Back 773

worst on awaking but decreases throughout day.

Front 774

Tension Ha present w/ c/o

Back 774

worsen as the day progresses

Front 775

18y/o c/o HA fever, + kernig and Brudzinski signs: Dx

Back 775

meningitis

Front 776

19y/o dx meningococcal meningitis: who should receive prophylactic tx

Back 776

those w/ household type exposure: >4hr/wk exposure

Front 777

Bacterial meningitis w/ show ____ on CSF

Back 777

glucose at 30% of serum level

Front 778

Viral or aseptic meningitis expect to find CSF___

Back 778

predominance of lymphocytes

Front 779

Describe Kernig sx

Back 779

pt lying supine - hip flexed 90 degree; knee extension = resistance or pain to lower back or posterior thigh

Front 780

Papilledema is what:

Back 780

optic disk bulging caused by elevated ICP bilateral

Front 781

Who should the NP obtain a CSF on as part of eval for Fever

Back 781

younger child w/ altered neurologic findings

Front 782

What do you expect to find in CSF (WBC) of meningitis:

Back 782

Pleocytosis: WBC >5cells/mm whether: bacterial, viral, tubercular, fungal or protozoan

Front 783

What do you expect to find regarding glucose and protein of CSF in bacterial meningitis

Back 783

decrease normal glucose (<60%), elevated protein levels

Front 784

What do you expect to find in glucose and protein of CSF in viral meningitis

Back 784

normal glucose, normal protein but +lymphocytosis

Front 785

What diagnostic should be performed prior to Lumbar puncture on suspected meningitis

Back 785

MRI or CT scan

Front 786

What are common pathogens in bacterial meningitis adult:

Back 786

S. pneumonia, N. meningitis, staph and H.influenzae

Front 787

Clinical presentation of bacterial meningitis:

Back 787

classic triad: fever, HA, nuchal rigidity

Front 788

What is brudzinski sign

Back 788

Passive neck flexion in supine => flexion of knees and hips (meningitis)

Front 789

What does absence of venous pulsation during eye exam indicated?

Back 789

increased ICP

Front 790

How many hr of exposure increase risk of passing meningitis:

Back 790

> 4 hours, wk prior to sx

Front 791

What is antimicrobial options in bacterial meningitis

Back 791

rifampin (antituberculin), ciprofloxacin, ceftriaxone

Front 792

34y/o dx w/ MS what is the typical pattern

Back 792

variable exacerbations and remissions

Front 793

Tx options in MS to attenuate disease progression:

Back 793

interferon B-1B

Front 794

What is consistent presentation of parkinson

Back 794

tremor at rest and bradykinesia

Front 795

What are tx options (pharm) w/ parkinsons

Back 795

levodopa, ropinirole, pramipexole

Front 796

Pallidotomy is helpful in managment of parkinsion disease associated w/ refactory ______

Back 796

dyskinesia

Front 797

What are common sx of MS:

Back 797

numbness of limb, monocular visual loss, dipolia, vertigo, facial weakness o rnumbness, sphincter disturbance, ataxia, nystagmus

Front 798

How is MS classified, what are the stages?

Back 798

1. relapsing remitting MS: no neuro effects after remission
2. chronic progressive: episodes do not fully recover and accumulative defest

Front 799

MS typical progression:

Back 799

relapsing-remitting for years later develop chronic progressive

Front 800

Why is MS difficulty to dx:

Back 800

sx of recurrent fatigue, muscle weakness and other nonspecific sx occur w/ mult illness

Front 801

What are then name of maintenace therapy for MS: interferon B-1b

Back 801

Betaseron: reduces exacerbations

Front 802

What immunosuppresive therapy is used in MS

Back 802

methotrexate or mitoxantrone

Front 803

What are the six cardinal signs of Parkinson:

Back 803

tremor at rest, rigidity, bradykinesia, flexed posture, loss of postural reflexes, mask like facies (tremor at rest or bradykinesia must be present)

Front 804

What is typical in Parkinson gait:

Back 804

rapid small steps, turning takes several steps move forward/back

Front 805

What is the tx of choice in parkinsons and why

Back 805

ropinirole (Requip) and pramipexole (Mirapex) dopamine agonist

Front 806

What develops after taking levodopa for 5-10 yrs for parkinson

Back 806

dyskinesia (tics of hands, face)

Front 807

What is used to reduce dyskinesia

Back 807

Symmetrel: may only be used 1yr.

Front 808

Why is pallidotomy used:

Back 808

surgical therapy management of dykinesia in parkinsons: removal of gladius pallidum

Front 809

Describe absence seizure (petit mal)

Back 809

blank staring 3-50 sec w/ impaired LOC

Front 810

Describe simple partial seizure?

Back 810

awake state w/ abnormal motor lasting seconds

Front 811

Describe tonic-clonic (grand mal)

Back 811

rigid extension of arms and legs then sudden jerking w/ LOC

Front 812

Describe myoclonic seizure

Back 812

brief, jerking contraction of arms legs or trunk

Front 813

Tx for seizure include:

Back 813

carbamazepine (tegratol) phenytoin (dilantin), gabapentin (neurotin), clonazepam, valproic acid (AED)

Front 814

When taking phenytoin w/ ____ may exhibit toxicity

Back 814

theophylline

Front 815

What is the risk of giving phenytoin w/ other high protein bound properties:

Back 815

may result in displacement from protein binding site => increased free phenytoin => toxicity

Front 816

What are risk factors for TIA

Back 816

Afib, CAD, oral contraceptive

Front 817

Delirium has acute or insidious onset?

Back 817

acute: usually w/ change to medication w/ anticholinergic

Front 818

Pneumonic for delirium: DELIRIUMS

Back 818

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

Front 819

What is the tx of demintia/alzhiemers

Back 819

Cholinesterase inhibitor (Aricept)

Front 820

Define Primary HA

Back 820

not associated w/ other disease, Migraine, tension type

Front 821

Define Secondary HA

Back 821

Associated w/ or caused by other conditions, does not resolve until cause resolved: ICP, brain tumor, bleed, inflammation

Front 822

When does the evidence suggest to obtain Neuroimaging w/ nonacute HA

Back 822

Hx: dizzy, numbness, HA awakens from sleep, worse w/ valsalva, accelerating, new onset

Front 823

What might be suggested if patients says "worst HA of my life"

Back 823

Consider hemmorhage.

Front 824

What are some lifestyle triggers for migrianes

Back 824

Menses, ovulation, preg, BC, illness, intense activity, sleep to much to little, missing meal, bright light, odors, weather, altitude ,meds, stress

Front 825

What dieatary triggers infleuence migraine

Back 825

ripened cheese, liver, herring, MSG, chocolate, alsohol, caffeine ect

Front 826

What strategy is used to slow decline of the Alzheimer type dementia patient?

Back 826

Vit E 10000 IU Bid or selegiline 5mg BID

Front 827

AAN: Alz dementia: strategy:
mild to mod, use of cholinesterase inhibit mainstay of tx: what r they

Back 827

Donepezil (aricept), rivastigmine (Exelon), time limited benefit 6-12m. Increase acetylcholine in brain. Aricept only tx approved for all stages of alzheimers.

Front 828

What are diff dx of dementia in older adults w/ similar sx:

Back 828

depression, pain, infection

Front 829

Physical finding in COPD include

Back 829

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.

Front 830

NAEPP-EPR-3 Goals of asthma care

Back 830

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

Front 831

What is the most common reason for protracted asthma exacerbation

Back 831

viral URI

Front 832

Long term O2 therapy in COPD:
Goal

Back 832

- 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

Front 833

What is a risk specific to females of developing DM?

Back 833

Hx of gestational diabetes

Front 834

Dx of DM2 can be made by:

Back 834

glucose of 126 and 136:, glucose >200mg and confirmed or glucose tolerance w/ 2 abnormals

Front 835

Screening for DM2 should be while:

Back 835

fasting

Front 836

Undiagnosed DM may present as what in females

Back 836

vaginal candidiasis (elevated glucose feed yeast)

Front 837

What is most important screen for diabetic nephropathy

Back 837

Microalbumin: earliest indicate of kidney damage. if + reassess 3-6m
Screen in all DM >12y/o

Front 838

What is the earliest glycemic abnormality?

Back 838

postprandial glucose elevation

Front 839

What is the typical presentation of DM2?

Back 839

Insidious onset w/ weight gain. found on screening for fasting glucose
DM1 typical acute onset

Front 840

ADA: what is tx of DM2 after oral meds have failed?

Back 840

intermediate or long acting insulin at bedtime or morning 1xd 10U or0.2/kg. Cont oral unless sulfon or meglit (d/c)

Front 841

Elevated glucose evening meal indicates what in a DM

Back 841

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

Front 842

sx that may present as DM2 inlcude:

Back 842

fatigue, athletes foot (glucose), infected mosquito bites

Front 843

Acanthosis nigricans due to:

Back 843

obese insulin resistance

Front 844

What should target HR be in new DM

Back 844

120s to 70s, the lower the better (w/in reason)

Front 845

When do you screen a new DM2 for renal nephropathy

Back 845

at diagnosis

Front 846

How soon can you determine anti-proteinuric effect of ACE-I

Back 846

6-8wks

Front 847

What is the next lab if a pos albumin screen?

Back 847

spot albumin w/ creatinine ratio

Front 848

what is the definition of renal neropathy?

Back 848

>300mg/d of albuminauria on 2 occasion seperated by 3-6m

Front 849

What are the target lipids for DM according to ADA

Back 849

HDL >50
LDL <100
Trig <150

Front 850

what increases A1C

Back 850

glucose and alcohol

Front 851

What is the relationship w/ triglycerides and A1C:

Back 851

Triglycerides w/ increase w/ A1C

Front 852

How does hyperthyroidism affect blood pressure?

Back 852

increase systolic and diastolic, HR is typically >100

Front 853

What are some endocrine causes of secondary HTN?

Back 853

pheochromocytoma, Cushings, neuroblastoma,

Front 854

What is the normal value of TSH?

Back 854

5.0

Front 855

What lab abnormality is common w/ hypothyroidism? not involving the thyroid or pituitary

Back 855

hypercholesterolema

Front 856

What is the most sensitive test for majority of hypthyroidism?

Back 856

TSH only

Front 857

45y/o female TSH 13 then 1m later 15 what is the dx:

Back 857

hypothyroidism

Front 858

Hx of tx for hyperthyroidism will now likely have?

Back 858

hypothyroidism

Front 859

Serum free T4 falls TSH will?

Back 859

TSH will rise

Front 860

Hypercholesterolemia is common when TSH is >than ____

Back 860

10 mU/L: dont tx hyperlipidemia until TSH <10

Front 861

What are common lab findings in hypothyroidism not associated w/ thyroid or pituitary?

Back 861

hyponatremia, hyperprolactinemia, hyperhomocysteinemia, anemia, elevated creatinine

Front 862

What are medication and disorders that can increase TSH

Back 862

metoclopramide (reglan), amiodarone, adrenal insufficiency, pituitary, generalized thyroid hormone resistance

Front 863

what are common sx of hypothyroidism?

Back 863

fatigue, weight gain, dry skin, hair nails that break easily, cold intolerance, constipation, menstrual irregularities

Front 864

Tx of hyperthyroid has an inverse result of?

Back 864

destroying the gland ability to produce thyroid hormone T3 and T4

Front 865

What may happen to TSH if synthroid is substitued by a generic med?

Back 865

TSH will vary due to the different bioavailablities of generic meds

Front 866

How do you determine amount of T4 to replace (synthroid) in a patient?

Back 866

replacement based on weight in Kg and multiply by 1.6 for 1 day.

Front 867

What do you expect to FSH to do in a menopausal women w/ hot flashes and no period for 12m

Back 867

increase (follicle stimulating hormone) best diagnostic is PE: bleed change, hot flash, sleep disturbance, GU sx

Front 868

How long before PAP smear should women not have sex, douch, or use tampon

Back 868

48hrs prior to PAP

Front 869

60y/o w/ small amount vag bleed, postmenopausal x 2 yrs dx would be?

Back 869

atrophic vaginal mucosa (endometrial carcinoma is a concern but rare)

Front 870

28y/o w/ primary dysmenorrhea OTC motrin, naproxen what next tx?

Back 870

oral contraceptives

Front 871

Dx of osteoporosis is made when what diagnostic test?

Back 871

BMD bone mineral density 2.5 more from standard or T-score of -2.5 or less

Front 872

What is the usual age recommendation for HPV test?

Back 872

21yrs or 3years after first sexual intercourse

Front 873

Primary risk factor for breast cancer is?

Back 873

age

Front 874

A localized tumor in prostate gland will have what sx?

Back 874

none: but will be indurated on exam

Front 875

Hematuria is uncommon clinical manifestation in what early male cancer?

Back 875

prostate cancer

Front 876

30y/o w/ lump to breast during menses what is the next step?

Back 876

advise to return 3-20 days after menstation to reasses, if any concern then mammogram and US

Front 877

DRE (digital rectal exam): it is not acceptable to perform while: standing, kneeling, lying on side, in lithotomy position

Back 877

kneeling: best way is supine and legs in stirrups

Front 878

A radical prostatectomy 6 m ago now urinary incontinence what is going on?

Back 878

a common complication, subsides in 2yrs and/or develop ED

Front 879

What med should be avoided in benign prostatic hypertrophy (BPH)?

Back 879

nasal decongestant: may increase urge to urinate

Front 880

What age should digital rectal exam be perfromed for prostate cancer, what age should PSA and dRE

Back 880

40 for DRE and 50 for both

Front 881

When should PSA and DRE be perfromed on blacks?

Back 881

before the age of 50yrs, five yrs prior to other races

Front 882

What is the most common cause of epididymitis in <35y/o.

Back 882

Chlamydia trachomatois, in older men >35 UTI is most common

Front 883

Why are truck drivers predisposed to noninfectious epididymitis:

Back 883

reflux of urine into epidimyis from ejaculatory ducts and vas

Front 884

Inguinal hernia is hernation of what

Back 884

bowel or omentum into scrotum

Front 885

How does an inguinal hernia present?

Back 885

scrotal pain and a scrotal mass or scrotal swell (abd pain) bowel sounds in scrotum (w/ a stethascope??)

Front 886

What is Hesselbach triangle?

Back 886

inguinal ligament, rectus muscle and epigastric vessel: Inguinal hernia

Front 887

patient dx w/ cluster HA should eliminate what?

Back 887

triggers like nicotine and alcohol

Front 888

Audible carotid bruits indicate?

Back 888

Atherosclerosis: increase probability of death from CVA or CAD

Front 889

Mini mental status exam assess?

Back 889

mild alzheimers

Front 890

Differential dx of suspected alzheimers also includes?

Back 890

tumor, cerebral hemmorage, cerebral infarct

Front 891

what is included in the mini mental exam?

Back 891

orientation, short-term memory-retention, short-term recall, language, attention (does NOT dx alzheimers)

Front 892

How long after initiating acetylcholinesterase inhibitor should you eval for efficacy

Back 892

6-12m: assess caregiver feedback, repeat mental status, ADL, S/E cost

Front 893

What increases the risk of and elder being abused?

Back 893

decrease cognative due to caregiver strain, stress depression

Front 894

What does the snell chart test?

Back 894

distant vision and CNII

Front 895

Giant cell arteritis: temporal arteritis is best dx by?

Back 895

temporal artery biopsy

Front 896

What is the typical complaint of temporal arteritis:

Back 896

new onset HA, abrupt visual change, jaw claudication, fever or anemia elevated sed rate 72y/o

Front 897

Where is carpal tunnel usually felt on the fingers?

Back 897

thumb, index finger middle finger and radial side of ring finger

Front 898

What structures are directly affected by carpal tunnel?

Back 898

Medial nerve: inflammation of wrist tendeons, transverse carpal ligament

Front 899

What are 4 prominent features of Parkinson?

Back 899

bradykinesia, muscular rigitdity, resting tremor, postural instability

Front 900

What is anosmia?

Back 900

inability to smell, CN 1 olfactory nerve (peppermint or coffee)

Front 901

What CN is responsible for hearing

Back 901

CN 8

Front 902

What CN is responsible for eye movement

Back 902

III, IV, VI

Front 903

What CN is responsible for facial sensation?

Back 903

CN V (light touch test)

Front 904

What may be an indicator of hemorrhagic stroke?

Back 904

headache w/ stroke

Front 905

What diagnostics does a pt w/ new onset TIA

Back 905

CT and/or MRI, ECG, CBC, PTT< lytes, creatinine, glucose, lipids transcranial doppler US

Front 906

What should you do w/ a new onset TIA?

Back 906

immediate ER referal

Front 907

Why is ASA used as an antiplatelet therapy?

Back 907

ASA inhibits enzyme cyclooxygenase adn reduces thromboxane A2 production

Front 908

Define Secondary prevention?

Back 908

intervention to help prevent second occurrence of deleterious event. ex: ASA after a stroke

Front 909

What is the criteria for migraine?

Back 909

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

Front 910

Which are most likely triggered by food: migraine or tension

Back 910

migraine: sx nausea, worse w/ activity

Front 911

Does Bell palsy present w/ pain.

Back 911

NO: sx of sagging eyebrow, impaired blink, mouth drawn up

Front 912

How long after a rubella should a pt avoid pregnancy

Back 912

1 month (though no documented injury of offspring) safe when breastfeeding

Front 913

What immunizations can be given in 1st trimester?

Back 913

influenza, tetanus, diptheria

Front 914

When should varicella be given in pregnancy?

Back 914

Never, no live viruses should be given during pregnancy

Front 915

What are classic sx fo ectopic pregnancy?

Back 915

amenorrhea, vag bleed, abdominal pain

Front 916

Due dates are used to:

Back 916

Assess fetal growth provide accurate data for screen test if LMP cant be determined do an US to determine fetal age.

Front 917

What does pregnancy test assess the prescence of...

Back 917

beta hCG: best 1st void in am or anytime if serum

Front 918

Tx of asymptomatic bacteriuria in pregnancy?

Back 918

nitrofurantoin (Macrobid): prevents pyelonephritis, Ciprofloxacin (quinolone should be avoided in preg), Amoxicillin is poor coverage of E.coli.

Front 919

17y/o pregnant should be assessed for

Back 919

STD and HIV:

Front 920

Should all pregnant pt be screened for hypothyroidism?

Back 920

No: only if hx of or FHx or symptomatic

Front 921

What are risk associated with intercourse during pregnancy?

Back 921

STD, preterm labor due to lower uterine stimuli, Oxytocin released

Front 922

Routine screen of gestation diabetes should occur?

Back 922

at 24 weeks

Front 923

When should a 1st trimester pt w/ chlamydia and Gonorrhea be tx and rescreened

Back 923

Tx immediately rescreened later even if no sx

Front 924

what are increased risk of ectopic preg?

Back 924

prior hx of ectopic, IUD use, Hx of PID, abortion

Front 925

What medication should be used for UTI in pregnancy?

Back 925

Macrodantin safe and most efficacious?

Front 926

What medication is associated with fetal tooth discoloration? ....really?

Back 926

Doxycycline

Front 927

Why is ciprofloxacin not recommended during pregnancy?

Back 927

potential problems w/ bone and cartilage formation

Front 928

What is myperemesis gravidarum

Back 928

persistent vomit results in weight loss of >5% (morning sickness is milder)

Front 929

What is Anhedonia

Back 929

loss of pleasure in things that use to bring interest, screen for depression

Front 930

What is the most common S/E of lithium:

Back 930

nephrogenic diabetes insipidus, plyuria and polydyspia

Front 931

What is searching behavior after the death of a loved one?

Back 931

Imagined hearing or seeing deceased...should resolve in 6m no meds needed

Front 932

CAGE used for

Back 932

screen for alcohol abuse

Front 933

CAGE stands for:

Back 933

C" need to cut down
A: Annoyed by criticism
G: guilty about amount
E: need eye opener.
Usually 2 or more

Front 934

What are physcial sx of alcohol abuse?

Back 934

Macrocytosis, due to B12 deficienttremors, HTN, rhinophyma, peripheral neuropahty, telangiectasias, hepatosplenomegaly

Front 935

What labs are elevated in alcoholics?

Back 935

Liver enzymes: ALT and AST usually 2x higher than ALT

Front 936

Which of the following is bulimia nervosa?
bing w/o purge
pruge must be present
loss of control
refusal to eat

Back 936

loss of control: may involve purge and nonpurge

Front 937

What are typical S/E of SSRI

Back 937

Nausea, Ha daily

Front 938

Elderly tx for depression w/ TCA exhibit?

Back 938

cognitive changes and urinary retention

Front 939

Bipolar disorder is associated with high rates of >>.

Back 939

suicide

Front 940

What med is indicated for acute mania?

Back 940

Lithium

Front 941

What should be monitored when taking valproate for manic sx

Back 941

Valporic Acid, platelets, LFT. Assess for thrombocytopenia,
Target valproate levels: 50-125

Front 942

Tx for depression w/ fluoxetine finds out shes pregnant what should the next step be>

Back 942

Continue w/ medication, let OB and patient make this decision; it does cross placenta

Front 943

What drugs are associated with a dry cough?

Back 943

ACE-I

Front 944

What would be part of the differential in cough?

Back 944

CHF, GERD, Asthma, URI, ACE-I

Front 945

How is M. and C. pneumonia respiratory pathogens spread?

Back 945

via cough

Front 946

Which patient needs a peak flow?
chronic bronchitis, emphysema, pneumonia, asthma

Back 946

Asthma: measures peak expiratory flow; sensitive to resp tube changes.

Front 947

What does FEV1 stand for:

Back 947

forced expiratory volume in 1 sec. Used w/ emphysema; aveoli are stretched and contain trapped air.

Front 948

What medications are use to tx COPD? clsasses

Back 948

long acting bronchodilators (salmeterol), anti-cholinergic (tiotropium), steroids.

Front 949

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?

Back 949

How often do sx occur? Determines pharm management and frequency.

Front 950

A 45 yr smoker will most likely have what respiratory disorder?

Back 950

COPD

Front 951

Why are narcotic contraindicated in COPD patients?

Back 951

decrease respiratory drive and worsen hypercapnia

Front 952

What is the most common pathogen in atypical pneumonia?

Back 952

mycoplasma pneumonia

Front 953

What is the most common pathogen in community acquired pneumonia?

Back 953

Streptococcus pneumonia: usually post influenza in the very young and old

Front 954

How many metered doses are in an metered dose inhaler?

Back 954

200 doses

Front 955

What is the next step for a pt that is using MDI >2x wks and needs a refill w/ daily maintenance steroid.

Back 955

Increase the steroid and refill the albuterol. the pt is not well controlled and needs better maintenance

Front 956

Which of the following is not common in acute bronchitis?
cough, pharyngitis, nasal discharge, fever

Back 956

Fever.
Cough is the most common lasting >5d. If fever w/ cough then consider pneumonia.

Front 957

What is the tx for acute bronchitis w/ purulent sputum?

Back 957

anti-tussive only. Only antibiotics if pertussis. Purulent sputum is epithelial cells sloughing which results in colored sputum.

Front 958

Which of the following meds are needed in acute bronchitis?
-steroids oral
-antibiotic
-decongestant and antitussive
-antibiotic and steroids

Back 958

-decongestant and anti-tussive
tx the sx rarely bacterial

Front 959

What is the recommended max amount rescue inhaler should be used w/ proper asthma maintenance

Back 959

2xwk day or 2x month at night

Front 960

Why should you NOT use Timolol (eye medication) in an Asthma patient?

Back 960

It is a beta-blocker which may precipitate asthma exacerbation

Front 961

what is essential in dx of COPD

Back 961

PFT = FEV and FVC (forced vital capacity)

Front 962

Why should ipratropium (atovent) not be used w/ beta blockers unless short of breath?

Back 962

Beta agonist increase side effects like tachycardia and treemors w/o improved efficacy

Front 963

Why is asthma not listed under COPD diseases?

Back 963

Asthma is reversible COPD is not.

Front 964

Which organism in pneumonia has rust colored sputum?

Back 964

Strept pneumonia

Front 965

What major lab is found in pneumonia?

Back 965

leukocytosis: gram stain can be pos or neg: leukopenia is an omnious sign in elderly

Front 966

What is a typical finding on xray w/ pneumonia?

Back 966

inflitrates: w/ fever, CP, dyspnea, sputum

Front 967

Mycroplasma pneumoniais present as what type of pneumonia and what are the sx and what does the xray reveal?

Back 967

atypical pneumonia
varied sx
xray has: thickened bronchial shadow, streaks of interstitial infiltration and atelectasis

Front 968

What antibiotic can be used empirically w/ pneumonia in otherwise healthy pt

Back 968

azithromycin or augmentin

Front 969

What are sx of trichomonas in males

Back 969

no sx in males:
Females: itching and discharge
Tx w/ metronidazole (flagyl)

Front 970

Chancroid is an STD from H. Ducreyi what is it a co-factor STD w/:

Back 970

HIV and heals slower:
males have pain females dont

Front 971

21y/o w/ HPV lesions on vulva what is the tx:

Back 971

trichloroacetic acid: warts will slough off after 1 or more tx

Front 972

What test are ordered after + HIV results?

Back 972

CD4 and HIV RNA (viral load): norm CD4 500-1500, at 200 dx w/ AIDS

Front 973

How often should viral counts (CD4) be monitored?

Back 973

every 3-4 months (2-8 wks when changing therapy) Sx do not affect CD4 counts

Front 974

What medications are used for trichomoniasis

Back 974

metronidazole

Front 975

Which risk factor has greatest impact on HIV transmission?
viral load
-type of sex
-presence of STD
-patient gender

Back 975

Viral load

Front 976

How long after a needle stick will seroconversion occure?

Back 976

4-10wks

Front 977

Pt neg for HIV but exposed 4m ago. When should she be retested?

Back 977

no recommendation for futher testing. Window period is w/in 3 mnths of exposure if neg after then neg

Front 978

What is the primary reservoir for HIV?

Back 978

lymphatic tissue

Front 979

If someone has persistent generalized lymphadenopathy what should be tested?

Back 979

HIV

Front 980

What clincal syndrome is from replacement of normal vaginal flora?

Back 980

bacterial vaginosis

Front 981

Male patients presents w/ dsyuria what is the likely STD?

Back 981

Chalmydia and gonorrhea

Front 982

Dx w/ genital herpes, what will be prescribed?

Back 982

valacyclovir

Front 983

Suspected of syphilis needs a _____ screening

Back 983

serum assessmetn RPR

Front 984

72y/o early renal insufficiency: what lab do you expect

Back 984

serum creatinine is sligtly elevated: protein would not be specific for renal disease

Front 985

A pt w/ a long hx of HTN dx w/ chronic renal insufficiency: What would dx test reveal?

Back 985

clear urine & elevated creatinine: clear because kidney cant filter content.

Front 986

What organ is responsible for erythropoietin production:

Back 986

kidney

Front 987

When is the only time asymptomatic bacteria treated?

Back 987

During pregnancy to prevent UTI, or other immunosuppressive state

Front 988

What diagnostic diagnosis a UTI

Back 988

urine bacteria >100,000, midstream, clean catch

Front 989

What is murphys sign

Back 989

inspiratory arrest w/ deep palpation of upper right quadrant (cholecystitis)

Front 990

Are males or females more likely to suffer from urolithiasis?

Back 990

males: sx of fever, chills, RBC casts are mucoprotein complexes

Front 991

24y/o female patient dx w/ uncomplicated UTI. What is important and is least important assessment?
Body temp, abd exam, CVA tenderness, vag exam

Back 991

body temp, abd exam, CVA tenderness: Vag exam would not be indication unless vag discharge

Front 992

How long should a UTI be tx w/ septra?

Back 992

3 days

Front 993

Male w/ sx of burning w/ urination. what assessment is least important?

Back 993

abd exam would be least important: diff dx: urethritis, epididymitis, prostatitis, STD

Front 994

Acute Mnt Sickness:
Onset, sx, PE:

Back 994

1-6hrs-several days, rapid
Sx: Ha, cough, anorexia, nausea, weakness, insomnia

Hint 994

PE: increased HR, decreased BP, fluid retention

Front 995

Acute Mnt sickness:
Tx, Prevention

Back 995

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

Front 996

High-altitude pulmonary edema:
tx

Back 996

descent, rest evacuation, nifedipine (CCB), oxygen, hyperbaric bag

Front 997

High altitude cerebral edema:
Tx

Back 997

descent evacuaiton, dexamthasone, hyperbaric bag, BLS, seizure control

Front 998

What immune response results in anaphylaxis?

Back 998

immunoglobulin E (IgE): bronchospasm, hypoxemia, hypotension. basophil and Mast cells

Front 999

What immune response indicates severe rxn?

Back 999

facial angioedema, resp distress, vascular collapse

Front 1000

What is a biphasic reaction?

Back 1000

Primary rxn 1-45 min after exposure then sec rxn hrs after exposure.

Front 1001

What medication is used for anaphylaxis?

Back 1001

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

Front 1002

What test can ID allergens:

Back 1002

RAST: radioallergosorbent

Front 1003

Mosquitoes, flies: presentation

Back 1003

pruritic, painful papule, secondary infection common

Front 1004

Bedbug, kissing bug: presentation

Back 1004

clustered, erythematous, purutic nodules

Front 1005

Fleas: presentation

Back 1005

pruritic grouped welts, papules, vesicles, secondary infection common

Front 1006

Lice: presentation

Back 1006

pruritus, nits in scalp, body or pubic hair

Front 1007

Centipedes: presenation

Back 1007

pain an ditching w. local necrosisi

Front 1008

millipedes: bite presentation

Back 1008

brown stain w/ blistering

Front 1009

Scabies: Presentation

Back 1009

burrow lesion w/ pruritus, secondary infection, usually in webs of fingers and hands

Front 1010

Chiggers: presentation

Back 1010

pruritic papules or vesicles, secondary infection

Front 1011

Ticks: presentation

Back 1011

pruritic papules w/ tick present

Front 1012

Tx of lice and scabies includes:

Back 1012

1% lindane lotion or Kwell, scbene shampoo 2 consecutive nights, consider permethrin for scabies also

Front 1013

What is a good repellent to prevent outdoor insect bites?

Back 1013

diethyltoluamide (DEET) or Indalone

Front 1014

Describe a Brown Recluse and tx:

Back 1014

length 5x width, yellow, brwn or black, thin legs, violin shaped marking, supportive tx, or surgical if >2cm

Front 1015

Describe a Black widow and tx

Back 1015

female most venmous, black, brwn, tan, may or may not have hour glass, tx: supportive, tetanus, pain relief (calcium gluconate)

Front 1016

What are presentation of coral snake bite sx?

Back 1016

salivation, dysarthria, diplopia, dysphagia, dyspnea, seizures- 6hr after bite.

Front 1017

What is the tx for snake bites and scorpion stings?

Back 1017

calm, immobilze, minimize physical activity, wipe bite, BLS, tetanus, antivenom for snakes. Observe for 12 hrs

Front 1018

What is the mainstay of GI decontamination in overdose or chemical ingestion?

Back 1018

activated charcoal 1-2 g/kg: DONT use in caustic acids, alkalis, alcohols, lithium or heavy metals

Front 1019

What is the tx for ethylene glycol

Back 1019

Ethanol 10% in D5W, over 30min, then maintain blood alcohol at 100-150mg/dl

Front 1020

Electric injury: Which is more dangerous AC or DC

Back 1020

AC alternating current = tetanic skeletal muscle contraction prevents letting go of engergized source

Front 1021

Acids (toilet cleaner, drain, hydrocholric, sufuric, batter acid)
Sx, Tx

Back 1021

Sx: burns of oral mucosa, drooling, odynophagia, abd pain
Tx: Sucralfate 1g PO
-copiously wash mouth. DO NOT induce vomiting, lavage or administer charcoal

Front 1022

Alkalis: Sx, Tx

Back 1022

Sx: caustic-burns
Tx: dilution w/ water, DO NOT induce vomit, lavage. Ingest large amounts of waster or milk, avoid emesis

Front 1023

Anticholinergic exposure: Sx, Tx

Back 1023

Sx: flushing skin, vlurred vision or mydriasis, tachy mucous membrane
Tx: physostigmine, 0.5-2.0 IV or IM

Front 1024

Carbon Monoxide: Sx, Tx

Back 1024

Sx: HA, cherry lips, altered consciousness, coma
Tx: Oxygen, 100% hyperbaric chamber

Front 1025

Ethylene glycol: Sx, Tx

Back 1025

Sx: cough, dizziness, HA, abd pain, dullness, N/V
Tx: Ethanol, 10ml/kg of 10% ethanol solution over 30min

Front 1026

Isopropyl alcohol: Sx, Tx

Back 1026

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

Front 1027

Methanol: Sx, Tx

Back 1027

Sx; cough, dizzy, HA, nausea, dry skin, redness
Tx: Ethanol: same as E. glycol

Front 1028

Petroleum products: Sx, Tx of ingestion

Back 1028

Sx: vomiting, chest or abd pain, cough, dyspnea, fever, arrhythmia, seizures, LOC
Tx: Prompt lavage, O2, ipecac in alert, intubate

Front 1029

Head Trauma: Glasgow coma:
Eye opening scoring

Back 1029

spontaneous 4
verbal: 3
pain: 2
no response: 1

Front 1030

Head trauma: Glasgow com:
Best motor response

Back 1030

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

Front 1031

Head Trauma: Glasgow Coma
Best Verbal:

Back 1031

A&O: 5
Converse but confused: 4
Nosense/inappropriate words: 3
nonspecific sounds: 2
No response: 1

Front 1032

What is the cascade effect of cerebral edema?

Back 1032

increased ICP=> decreased cerebral blood flow => cerebral ischemia

Front 1033

What diagnostics should be used on Head Injuries:

Back 1033

xray for cervical, CT for depressed or deteriorating LOC, LOC <5min, amnesia, GCS 12-14, depressed skull

Front 1034

What is the most important time after a head trauma?

Back 1034

following the initial stabilization: 24hrs after are the most important for cerebral swelling

Front 1035

What are steps would require a head injury to return to the hospital?

Back 1035

drowsiness difficult to awake, continuous nausea, vomiting more than twice, seizures, pupillary changes, weakness, severe HA, dizziness.

Front 1036

What is postparandial hypotension?

Back 1036

hypotension after meals (mostly in elderly due to rush of blood to abdomen)

Front 1037

What fluid challenge should you give someone w/ hypovomlemia

Back 1037

250-500ml of NS IV

Front 1038

What head elevation should there be in a person sleeping w/ hypotension?

Back 1038

10-20 degrees for sleep

Front 1039

Does cocaine interfere w/ reactivity of pupils?

Back 1039

no but antichoinergics causes unreactive pupils

Front 1040

What medications cause nystagmus?

Back 1040

alcohol, lithium, tergretol, meprobmate, primidone

Front 1041

What medication is given for APAP overdose?

Back 1041

N-acetylcysteine: 140mg/kg.

Front 1042

What medication is given for benzo overdose?

Back 1042

Flumazenil (0.2mg q 1min)

Front 1043

Sexual assault: definition

Back 1043

sexual act that is forced or coerced w/o consent of victim

Front 1044

What should you do if a patient has been sexually assaulted w/in the last 5 days?

Back 1044

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

Front 1045

What is the time limit to offer pregnancy or STD prophylactics:

Back 1045

72 hrs

Front 1046

What STD test should be performed on a sexual assault?

Back 1046

gonorrhea, chlamydia most prevelant. Test for HIV/AIDs cannot be doen until 3-6months due to seroconversion

Front 1047

What percent of sexual assault victims will have PTSD?

Back 1047

1/3rd

Front 1048

How are tilts performed:

Back 1048

lie, sit stand for 5 min each w/ BP and pulse: drop systolic by 20 , diastolic by 10 and increase pulse 20.

Front 1049

What is passive external rewarming:

Back 1049

placing patient i warm environment

Front 1050

What is active external rewarming:

Back 1050

hot blankets, hot packs, warm bodies, forced air rewarming

Front 1051

What medication is given or APAP overdose?

Back 1051

N-acetylcysteine: 140mg/kg.

Front 1052

What medication is given for benzo overdose?

Back 1052

Flumazenil (0.2mg q 1min)

Front 1053

Sexual assault: definition

Back 1053

sexual act that is forced or coerced w/o consent of victim

Front 1054

What should you do if a patient has been sexually assaulted w/in the last 5 days?

Back 1054

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

Front 1055

What is the time limit to offer pregnancy or STD prophylactics:

Back 1055

72 hrs

Front 1056

What STD test should be performed on a sexual assault?

Back 1056

gonorrhea, chlamydia most prevelant. Test for HIV/AIDs cannot be doen until 3-6months due to seroconversion

Front 1057

What percent of sexual assault victims will have PTSD?

Back 1057

1/3rd

Front 1058

How are tilts performed:

Back 1058

lie, sit stand for 5 min each w/ BP and pulse: drop systolic by 20 , diastolic by 10 and increase pulse 20.

Front 1059

What is passive external rewarming:

Back 1059

placing patient i warm environment

Front 1060

What is active external rewarming:

Back 1060

hot blankets, hot packs, warm bodies, forced air rewarming

Front 1061

What is core rewarming?

Back 1061

warem IV fluids, heated and humidified oxygen, body cavity lavage

Front 1062

What temperature of water should frostbite extremities be warmed?

Back 1062

98.6-104F: also give motrin, topical alovera to decrease inflammation, Tetanus, IV PNC: at 500kU

Front 1063

How long does it take to acclimate to warm climates:

Back 1063

7-14 days

Front 1064

How does Cushings develop?

Back 1064

ACTH-secreting tumors of the pituitary or small cell lung carcinomas which elevate Cortisol and ACTH levels.

Front 1065

What is a pheochromocytoma?

Back 1065

tumor of chromaffin cells, unilateral --> abnormal production of epi and norepi-->Na retention, reduced hydrostatic..

Front 1066

What is the exception to Addisons presentation of slow onset?

Back 1066

inadequate supplement of corticosteroids (chronic users of corticosteroids --> addisons)

Front 1067

Sx of Cushings:

Back 1067

sudden weight gain, loss of menses, decreased libido, depression bruising.

Front 1068

What diagnostic is critical upon the dx of Addision to r/o another disease?

Back 1068

chest xray to rule out TB

Front 1069

How is Cushings syndrome most accurately dx?

Back 1069

24hr excretion of cortisol in urine

Front 1070

What diagnostic confirms pheochromocytoma?

Back 1070

elevated catecholamines in 24hr urine

Front 1071

What sequal events may occur w/ Addisions?

Back 1071

eating disorders, alcoholism, malnutrition, HYPERTHYROID, diabtes, apathy, depression

Front 1072

What is the tx of chronic adrenal insufficiency (Addisions)?

Back 1072

oral hydrocortisone 20-30mg/d (consider mineralocorticoid replacement to correct renal and hypotension.

Front 1073

What is the first choice in managment of Cushings?

Back 1073

Pituitary tumor resection w/ chemo

Front 1074

What are complications of Cushings?

Back 1074

osteoporosis, hypertension, diabetes

Front 1075

DM 1 what is the the problem?

Back 1075

beta cell destruction and requires exogenous insulin

Front 1076

What is the Problem w/ DM2?

Back 1076

beta cell dysfunction and/or insulin defect

Front 1077

What causes fasting hyperglycemia?

Back 1077

increased hepatic glucose production in the impaired early stage of insulin secretion

Front 1078

What causes Postprandial hyperglycemia?

Back 1078

Decreased uptake of glucose from skeletal muscles

Front 1079

How often should a new or uncontrolled DM1 or DM2 be seen?

Back 1079

every 3 months, extended to 6 if well controlled

Front 1080

How often should a diabetic get an A1C?

Back 1080

ADA: twice a year at a minumum or every 3 months if glucose not controlled

Front 1081

How often should microalbumin be obtained in DM?

Back 1081

yearly after 5 yrs of DM1
Yearly after onset DM2

Front 1082

What is the definitive test to assess kidney function?

Back 1082

24hr creatinine clearance

Front 1083

What does the basal phase do in glycemic control?

Back 1083

Inhibits glycolisis and gluconeogenesis and maintains insulin steady state

Front 1084

What is morning hyperglycemia controlled by? basal or prandial insulin

Back 1084

Basal insulin

Front 1085

Why is Symlin used in diabetes?

Back 1085

it reduces amount of food consumed and slows gastric emptying. Injected before the meal

Front 1086

What are the recommended before meal glucose readings in DM?

Back 1086

70-120mg/dl

Front 1087

What are the postprandially glucose goals in diabetes?

Back 1087

<140mg/dl 2hr after meal

Front 1088

What is the recommended begining dose of insulin for DM1?

Back 1088

20u in morning before breakfast, if fasting of 250 then 5U before bedtime snack.

Front 1089

What medication mimics the effects of basal insulin?

Back 1089

Glargine 24hr long acting no peak

Front 1090

How often should insulin dose be adjusted and when can adjustment stop?

Back 1090

adjust every 3-4 days until fasting glucose is <110mg/dl; only increase by 2-8U if obese and 1-4 if thin

Front 1091

What is professional scope of practice?

Back 1091

Address role, function, population, practice setting. Serve as the initial source to define individual scope of practice (TBON)

Front 1092

What is the wording used when an APRN directs another nurse to a specific task? Delegating or assigning

Back 1092

APRN are only allowed to delegate assitive personnel they may assign another nurse

Front 1093

What is the process of receivign prescriptive authority for controlled substance?

Back 1093

TBON authority, TDPS registration, DEA registration number.

Front 1094

What level of controlled substance may an APRN provide?

Back 1094

schedule III, IV, V

Front 1095

What is the maximum period that a controlled substance may be prescribed for by an APRN?

Back 1095

30 days

Front 1096

Can an APRN refill a prescription?

Back 1096

Yes but only after consultation and documentation w/ a delegating physician. (TBON)

Front 1097

What is the minimum age a controlled substance may be prescribed by an APRN?

Back 1097

2y/o if younger then consultation is required w/ documentation

Front 1098

If tx migraines w/ abortive therapy what is the max time to use tylenol, NSAIDs?

Back 1098

2d/wk to prevent analgesic rebound: can make HA daily condition

Front 1099

What is the tx of urge incontinent (pharm)

Back 1099

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

Front 1100

Addisons, Cushings, and Pheochromocytoma are disorders of what?

Back 1100

Adrenal Gland

Front 1101

What is Addison's disease?

Back 1101

chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones (glucocorticoids and often mineralocorticoids

Front 1102

What is the tx of addison's?

Back 1102

Life long replacement of steroids...hydrocortisone and fludrocortisone

Front 1103

What is found in Addison's Crisis?

Back 1103

snycope, hypoglycemia, leg pain, low B/P, lethargy, hypokalemia, fever, convulsion

Front 1104

Why and how long should you avoid alcohol when taking metronidazole (flagyl)?

Back 1104

24hrs: avoid disulfiram-type rxn (severe n/v)

Front 1105

What do you do if a pt fails tx on flagyl for trichomoniasis?

Back 1105

Retreat w/ flagyl 500mg

Front 1106

What antibiotics are used for acute prostatitis?

Back 1106

Septra and fluoroquinolones
(PNC and Cephlosporins can not be used because they cant penetrate the prostatic epithelium)

Front 1107

What is the most common cause of hyperthyroidism

Back 1107

Graves disease: abnormal immune response -->thryoid produces too much thyroid hormone T4, T3

Front 1108

What are sx of B. pertussi?

Back 1108

paroxysmal cough lasting >2wks

Front 1109

What population is considered + TB at >5 induration?

Back 1109

HIV, Recent TB contact, CXR w/ fibrotic change, organ transplant, Immunosuppressed

Front 1110

What population is + TB w/ >10mm induration?

Back 1110

<5yr immigrant, IV drug, congregate setting, lab personnel, peds<4y/o, peds exposed to high risk

Front 1111

What population is + TB w/ >15mm induration?

Back 1111

Everyone

Front 1112

Tx of CAP w/ no comorbidity?

Back 1112

Macrolide: azithromycin, clarithromycin, erythromycin

Front 1113

Tx of CAP w/ comorbidity?

Back 1113

Respiratory fluoroquinolone (levofloxacin)
OR
advanced macrolide plus beta-lactam: Augmentin, Rocephin,
Alternative to macrolide: Doxy

Front 1114

How is Legionella for pneumonia spread?

Back 1114

inhalation of contaminated water

Front 1115

The most common pneumonia is Streptococcus pneum. What is it resistant too?

Back 1115

beta-lactams (PNC), Macrolides (emycin, clarithro, azithro), tetracyclines (doxy).
Known as drug-resistant S. pneum (DRSP)

Front 1116

What antibiotic should be used against DRSP (drug resistant S. Pneumonia)?

Back 1116

respiratory fluoroquinolones (levoflaxacine [levaquin])

Front 1117

What type of pneumonia organism is seen in alcoholics?

Back 1117

Klebsiella pneumonia

Front 1118

How do you know if a sputum sample is adequate for testing?

Back 1118

Few Epithelial cells w/ many WBC (epithelial will come from throat not lungs)

Front 1119

What medication may be given to latent TB if isoniazid is not tolerated? How long?

Back 1119

Rifampin (6-9m)

Front 1120

What is meant by long-term oxygen therapy in COPD?

Back 1120

>15hrs day w/ oxygen

Front 1121

If a person has a persistant cough that is controlled by a bronchodilator what is the dx?

Back 1121

asthma

Front 1122

Which environment is more likely to induce asthma sx. A warm humid space or a cold dry space?

Back 1122

Cold dry space

Front 1123

What are the three components of asthma dx?

Back 1123

1. episodic sx of airflow obstruction (wheeze)
2. evidence of at least partial reversible (improves w/ med)
3. excusion of other condistions

Front 1124

What diagnostic tool is essential in the dx of astham?

Back 1124

spirometry: Should be 80-100% expected:
Volume or speed/flow of air that can be inhaled and exhaled

Front 1125

How often should microalbuminuria be obtained in DM w/ neg protein?

Back 1125

Annually

Front 1126

When giving biguanide what should you monitor? CK, ALP, ALT, Cr

Back 1126

Cr-creatinine:

Front 1127

Secondary causes of hyperglycemia include all except?
niacine, corticosertoids, thiazide, angiotensin receptor blocker

Back 1127

Angiotensin receptor blocker

Front 1128

A1C provides info on glucose control over what period of time?
21-47d, 48-63d, 64-90d, 90-120d

Back 1128

90-120 d...or 3 months

Front 1129

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

Back 1129

1. Lispor: 30m-1hr
2. Reg Insulin: 2-3hr
3. NPH Insulin: 4-6hr
4. Lantus: no peak (24hr coverage)

Front 1130

What do meglitinide minimize in type 2 DM

Back 1130

Pstparandial hyperglycemia

Front 1131

What is a common adverse effect of alpha-glucosidase inhibitor:

Back 1131

Gastrointestinal upset

Front 1132

What are steps to improve microalbuminuria?

Back 1132

1. improve glycemic control
2. strict dyslipidemia control
3. use ACE-I or ARBS

Front 1133

How often should A1C be checked in those w/ stable glycemic control?

Back 1133

twice a year (every 6m)

Front 1134

What is the mechanism of action of sitagliptin (Januvia)?

Back 1134

Increase incretin -->increase synthesis and release fo insulin from pancreatic beta cells.

Front 1135

What is the mechanism of action of sitagliptin (Januvia)?

Back 1135

Increase incretin -->increase synthesis and release fo insulin from pancreatic beta cells.

Front 1136

What is the mechanism of action for Byetta?

Back 1136

Stimulates insulin production in response to increase plasma glucose

Front 1137

What DM med should be avoided if hx fo gastroparesis?

Back 1137

exentaide (Byetta): mainly due to its S/E of n/v/d with regular use

Front 1138

What are recomended tx of HTN w/ type 2 dM?

Back 1138

Beta blockers, ACE-I, ARBS; NOT alpha blocker

Front 1139

What do expect to find when giving a fibrate?

Back 1139

increase HDL

Front 1140

What do you expect to find when giving niacin for lipids?

Back 1140

increase HDL

Front 1141

What do you expect to find when giving Zetia for lipids?

Back 1141

reduction in LDL

Front 1142

With Zetia (ezetimibe) what should routinely be monitored?

Back 1142

No need to monitor labs...little impact on liver or kidney

Front 1143

Which of the following man not causes statin-induced myositis?
advanced age, use of statin w/ resin, low body weight, high statin dose

Back 1143

Us of statin w/ resin is not a risk for myositis

Front 1144

Which of the following is most effective against lipidprotein?
1. HMG-CoA reductase inhibitors
2. Niacin
3. bile acid
4. fibrates

Back 1144

2. Niacin

Front 1145

What can untx hypothyroid lead to in lipid profile?

Back 1145

increased LDL, TC, and Trig

Front 1146

What should rigorous physical exercise do to lipid values?

Back 1146

increase HDL, Lower VLDL, Lower Triglycerides

Front 1147

What should you expect to see when giving fish oil?

Back 1147

decrease triglycerides

Front 1148

What should you expect to see when giving Plant stanol and sterold on lipid profile?

Back 1148

decrease LDL

Front 1149

How much eicosapentaenoic acid and doccosahexaenoic acid (omega-3) per day should you prescribe?

Back 1149

1G (preferably from fish oil)

Front 1150

Obestity is defined as BMI >

Back 1150

30kg/m2

Front 1151

When using orilstat (Alli) when should you take the medication?

Back 1151

w/in one hour of each meal w/ fat

Front 1152

What is responsible for satiety?
1. norepi
2. epi
3. dopamine
4. serotonin

Back 1152

Serotonin

Front 1153

What are adverse effects of sibutramine (Meridia)?

Back 1153

somnolence

Front 1154

Which med is associated w/ weight gain?
1. risperidone (Risperdal)
2. topiramate (topamax)
3. metformin
4. phentermine

Back 1154

Risperidone: tx schizo

Front 1155

If walking 8000-10000 steps/day what is the milage?

Back 1155

4-5miles

Front 1156

What medication is used to reduce craving for alcohol?

Back 1156

acamproste (Campral)

Front 1157

What medication is used to modify intoxicating effects of alcohol?

Back 1157

naltrexone (ReVia)

Front 1158

What medication results in unplesant adverse effects of alcohol?

Back 1158

anabuse

Front 1159

What happens to RBC in alcoholics and why?

Back 1159

become macrocytic due to reduction in folate

Front 1160

Define Acromegaly

Back 1160

Excessive growth hormone: excessive bone and soft tissue growth