Thomas Day 3 Dit

Front 1

study where you look at people with disease, people without disease, and look for risk factor(s)?

how measure?

Back 1

case-contol study (retrospective)

Odds ratio

Front 2

study where you take group of people with risk factor and see if they develop a disease

Back 2

cohort study (prospective, confirms risk factors/risk factor reduction)

Front 3

sensitivity rules in or out for a disease?

Back 3

SNOUT

sensitivity rules out

Front 4

to increase positive predictive value, do what?

Back 4

increase prevalence in the population you are screening (so screen those with other symptoms that have higher pre-test probability of having disease, like abdominal pain in ovarian cancer screening)

Front 5

prevalence equation

Back 5

incidence X disease duration

Front 6

what is equation for Relative Risk, and in what circumstance does Odds Ratio approximate relative risk?

Back 6

Relative Risk (cohort studies)
(a/a+b)/(c/c+d)

Odds ratio (case control) approximates when PREVALENCE LOW, so a and c become miniscule, which becomes (a/b)/(c/d) = ad/bc

Front 7

what is equation for Number Needed to Treat? Number Needed to Harm?

Back 7

NNT - 1/Absolute risk reduction

NNH - 1/Attributable risk

Front 8

Berkson's bias

Back 8

studies performed on hospitalized patients (bias of symptoms, more severe)

Front 9

sampling bias is

Back 9

generalizability

Front 10

late-look bias

Back 10

collecting data at inappropriate time, like late in chronic disease when only those with less severe disease would be around

Front 11

procedure bias

Back 11

more attention and better compliance seen in treatment group

Front 12

lead-time bias

Back 12

earlier detection of disease (PSA) makes it look like people are living with disease longer (makes it look like longer survival) (but natural history the same, seen in screening tests)

Front 13

Pygmalion effect

Back 13

researcher's belief in efficacy of rx changes outcome

Front 14

Hawthorne Effect

Back 14

study participants change behavior because they know they are being studied

Front 15

in positive skew distribution, what is order of bigger to smaller?
Mode, Mean, Median

Back 15

skewing of a few scores to upper portion (tail to right)

Mean>Median>Mode

Front 16

type I error

Back 16

alpha error = False Positive

finding difference when there is not one (1 vertical line in P, false positive)

Front 17

type II error

Back 17

beta error = False Negative

finding a difference when in reality there is none (2 vertical lines in Negative, type II)

Front 18

power calculated by

Back 18

1-beta error (type II, False Negative)

Front 19

what measurement is likelihood of alpha error?

Back 19

p value (chance that findings of study are not real)

Front 20

an alpha (type 1 error) male more likely will mistakenly claim he found a difference or that he didn't find a difference?

Back 20

he will claim he found a difference when one doesn't exist (to show his friends)

alpha error - type I --> False Positive

Front 21

1 SD contains?
2 SD?
3 SD?

SD of 1.65?

Back 21

1 SD - 68%

2 SD - 95%

3 SD - 99.7%

1.65 SD - 90%

Front 22

Standard Error of Mean is related to SD how?

Back 22

SD/ square root of n (number of participants)

Front 23

how calculate Confidence Interval at 95%?

Back 23

take mean

add Z* Std. Error of Mean to each side

Z= 2 for 95%

Front 24

2 vaccinations recommended for diabetics? smokers? (same)

Back 24

influenza, pneumococcal

Front 25

avoid what vitamin supplement in smokers? check for what in smokers age 65-75?

Back 25

vitamin A (increases lung cancer risk)

abdominal US to rule out AAA

Front 26

what diarrheal illnesses are reportable in US? (2)

Back 26

salmonella, shigella

Front 27

top 3 leading causes of death in infants

Back 27

congenital anomalies, short gestation, SIDS

Front 28

top 3 leading causes of death ages 1-14

Back 28

injuries, cancer, congenital anomalies

Front 29

top 3 leading causes of death 15-24

Back 29

injuries, homicide, suicide

Front 30

top 3 leading causes of death 25-65

Back 30

cancer, heart disease, injuries

Front 31

top 4 leading causes of death >65

Back 31

heart disease, cancer, stroke, COPD

Front 32

Medicare:
part A covers
part B covers
part C covers
part D covers

what specific condition qualifies someone for Medicare?

Back 32

A- inpatient care (and home health, hospice, nursing home)
B- outpatient
C- A&B
D- prescription only

End Stage Renal Disease

Front 33

What is capitation reimbursement?

Back 33

fixed payment for a period of time (like an ER shift) or number of patients

HMOs an example

Front 34

usually need parental consent to treat minors, except for what conditions (4)?

Back 34

-STDs and other infections
-pre-natal care
-contraception
-drug abuse treatment

Front 35

in premie baby started on formula too early may get what?

Back 35

necrotizing enterocolitis

Front 36

Car seat guidelines:
car seat in back facing backward?
car seat in back facing forward?
booster seat in back?
regular seat in back?

Back 36

less than 1 year and less than 20 lbs - carseat facing backwards
between 1-4 years and more than 20 lbs - carseat facing forwards
over 4 years and over 40 pounds - booster seat back
when over 4'9'' and 8-12 - normal seat in back (lap and shoulder)

Front 37

boy genital changes in tanner stages
1
2
3
4
5

Back 37

1- prepubescent
2- testis enlargement (think Dr. Cross talk)
3- penis gets longer
4- penis gets wider, glans develop, testis darken
5- adult

Front 38

Tanner stage girl breast development
1
2
3
4
5

Back 38

1- prepubescent
2- bud with papilla and aereola enlargement
3- more enlargement
4- aerola and papilla form secondary mound on breast
5- mature

Front 39

Quiz yourself on developmental milestones!

Back 39

They suck! important!

Front 40

Tanner pubic hair stages
1
2
3
4
5

Back 40

1- prepubescent
2- sparse hair
3- becomes dark, curly
4- adult hair but less
5- adult hair

Front 41

when do girls usually start getting:
breast development
growth spurt
menarch

Back 41

breasts- 11
growth spurt- 12
menarch- 13

Front 42

when do boys get:
stage 2 genital growth
growth spurt

Back 42

stage 2- 12
growth spurt- 14-15

Front 43

Elderly sleep patterns:
-slow wave sleep?
-REM sleep?
-REM latency?
-awakenings?

Back 43

increased REM latency (time to get to REM) and awakenings

decrease in both slow wave sleep AND REM sleep

Front 44

Depressed sleep patterns?
-REM sleep?
-REM Latency?
-slow wave sleep?
-awakenings?

Back 44

increased REM sleep and faster onset (dec. REM latency)
less slow wave sleep
more awakenings

Front 45

1 sexual problem for male, female
elderly? what doesn't decrease?

Back 45

male- slower erection
female- vaginal atrophy/dryness

sexual interest stays same

Front 46

grief can be pathological if patients have clinical depression longer than ___ months or inability to re-engage in life by ____ months

Back 46

2 months

inability to reengage after 6 months

Front 47

3 classes of substances increased in stress?

what happens to muscle tone, GI, water absorption

Back 47

free fatty acids/cholesterol/lipids

17-OH corticosteroids (immunosuppression)

catecholamines increase

muscle tone decreases, increased defecation (gastrocolic reflex), decreased water absorption

Front 48

4 diseases that can cause sexual dysfunction

Back 48

diabetes, depression, hyperprolactinemia, low testosterone

Front 49

4 drugs that can cause sexual dysfxn

Back 49

Beta-blockers, Neuroleptics, SSRIs, ethanol

Front 50

NTs in sleep:
what brain part key in initiating
what NT decreases REM
what NT associtated with REM

Back 50

going to sleep- Raphe nucleus (serotonin)
NE- decreases REM
ACh- associated with REM

Front 51

what are associated EEG waveforms with:
awake
eyes closed
stage 1
stage 2
stage 3-4
REM

Back 51

beta- awake
alpha- eyes closed
theta- stage 1 sleep
sleep spindles and K complexes- stage 2 (have bruxism)
Delta- Stage 3 and 4 (sleep-walking, bedwetting)

Front 52

alcohol, benzos, barbiturates decrease what part of sleep (2)

Back 52

REM and delta sleep

Front 53

Enuresis:
most effective long term therapy?

drug therapy (2)

Back 53

enuresis alarm (classical conditioning)

imipramine (decreases phase 4 sleep, where bedwetting occurs)
indomethacin (constricts afferent arteriole)

drugs have righ recurrance rate upon continuation, behavioral best

Front 54

eye movement during sleep from what area of brain

Back 54

PPRF (all fast horizontal eye movements)

Front 55

primary drugs in Restless Leg Syndrome are also used in what other condition

Back 55

Parkinson's

carbidopa/levadopa

Front 56

Modafinil used for what?

Back 56

Narcolepsy

SSRIs for cataplexy

Front 57

circadian rhythm= what nucleus, stimulated by what, releases what

Back 57

suprachiasmic nucleus stimulated by retina to release NE to pineal gland (releases melatonin)

Front 58

Penicillin

3 mechs

Back 58

binds PBPs
blocks PABA (transpeptisase cross linking of cell wall)
activates autolytic enzymes

Front 59

Penicillin use, 2 toxicities

Back 59

gram positives (strep pneumo, strep pyogenes, actinomyces), spirochetes

hypersensitivity, hemolytic anemia

Front 60

2 bugs that can alter PBPs

Back 60

staph aureus, strep pneumo

Front 61

are ampicillin and amoxicillin penicillianase resistant like methicillin, naficillin, and dicloxacillin?

Back 61

NO!
amino penicillins are penicillinase SENSITIVE, but can use B-lactamase inhibitors to increase efficacy

meth, naf, dicloxacillin only ones that are inherintly penicillinase resistant penicillins

Front 62

in what condition is ampicillin rash seen in (not hypersensitivity)

Back 62

mononucleosis

Front 63

use ticarcillin, carbenacillin, piperacillin for

Back 63

pseudomonas

Front 64

Ceftazidime used for

Back 64

pseudomonas (3rd gen)

Front 65

cefuroxime generation?

Back 65

2nd (PEcK)

Front 66

Cefazolin generation

Back 66

1st generation

Front 67

Cefoprozil

Back 67

2nd generation

Front 68

Cefdinir

Back 68

2nd generation cephalosporin

Front 69

Cefepime

Back 69

4th generation

Front 70

what antibiotic drug class can give you a vitamin K deficiency?

Back 70

cephalosporins

Front 71

cephalosporins and aminoglycosides can cause what?

Back 71

nephrotoxicity when used together

Front 72

4 drugs that can cause disulfiram-liike rxn

Back 72

procarbazine
sulfonylureas
metronidazole
cephalosporins

antabuse is disulfiram

Front 73

2 situations aztreonam used, what is its coverage?

Back 73

in renal insufficiency (instead of aminoglycosides)

those with penicillin allergy (still binds PBP, but is a monobactam)

GRAM NEG ONLY (PEcKS)

Front 74

Meropenem used when? toxicities

Back 74

like Imipenam/Cilastatin

broad spectrum (but will not cover MRSA)

Gi distress, skin rash, seizures

Front 75

Diffuse flushing of whole body after antibiotic administration is what? avoid how?

Back 75

Vanc (red man syndrome)

give with antihistimine, slow infusion rate

Front 76

cephalosporins and aminoglycosides can cause what?

Back 76

nephrotoxicity when used together

Front 77

4 drugs that can cause disulfiram-liike rxn

Back 77

procarbazine
sulfonylureas
metronidazole
cephalosporins

antabuse is disulfiram

Front 78

2 situations aztreonam used, what is its coverage?

Back 78

in renal insufficiency (instead of aminoglycosides)

those with penicillin allergy (still binds PBP, but is a monobactam)

GRAM NEG ONLY (PEcKS)

Front 79

Meropenem used when? toxicities

Back 79

like Imipenam/Cilastatin

broad spectrum (but will not cover MRSA)

Gi distress, skin rash, seizures

Front 80

Diffuse flushing of whole body after antibiotic administration is what? avoid how?

other side effects?

Back 80

Vanc (red man syndrome)

give with antihistimine, slow infusion rate

nephrotoxicity, ototoxicity, thrombophlebitis

Front 81

use what to prophylax against bacerial endocarditis

Back 81

penicillin V/ cefalexin

Front 82

first part of gram negatives in micro section, go over that

Back 82

I know u don't wanna, but u needa

Front 83

Epiglottitis caused by?
rx
what else can be cause by this bacteria

Back 83

H. Flu type B
will be "cherry red", "thumb" sign on x-ray

ceftriaxone

haEMOPhilus
epiglotitis
meningitis
otitis media
pneumonia

Front 84

when suspect epiglotitis, what is next step?

Back 84

keep child comfortable and calm (so don't lose airway)

-have intubation equipment close

Front 85

3 causes of intersititial pneumonia, tx

Back 85

mycoplasma, H. flu, chlamydia pneumonia)

erythromycin, azithromycin

Front 86

2 bacteria associated with Drug use bacterial endocarditis

Back 86

pseudomonas
staph epidermidis

Front 87

Enterobacteriaceae species (7), virulence factors

Back 87

gut bacteria
E. Coli
Shigella
Salmonella
enterobacter
serratia
proetus

have capsular K antigen
flagellar H antigen
somatic O antigen

ferment glucose, oxidase negative

Front 88

2 most common causes of gram - sepsis

Back 88

1. E coli
2. klebsiella

Front 89

what causes proteus to produce staghorn calculi?

Back 89

has Urease--> urea- NH3 and C02, causes ammonia phosphate magnesium kidney stones

Front 90

diarrhea afte egg salad, chicken salad, etc is probably?

tx?

Back 90

salmonella

AVOID ANTIBIOTICs, will lengthen duration of illness

Front 91

what bug can remain in gallbladder chronically

Back 91

salmonella typhi (Typhoid Fever strain)

Front 92

What bug associated with Reiter's syndrome?

Back 92

Shigella

Front 93

how is campy spread

Back 93

fecal-oral

(and likes "hot campfires," grows at 42 celcius)

Front 94

necessary treatment in cholera

Back 94

prompt rehydration therapy

Front 95

outbreak in diarrhea in daycare center, think of?

what is common way of spreading?

Back 95

Yersinia entercolitica

by pet feces (think puppies in a daycare)

Front 96

what bug can mimic apendicitis?

Back 96

Yersinia enterocolitica

causes mesenteric adenitis

Front 97

current triple therapy for H. pylori

Back 97

PPI
clarithromycin
Amoxicillin or metronidazole

Front 98

what bug found in cat feces?
puppy feces?
animal urine?

Back 98

cat feces- toxoplasma
puppy feces- yersinia enterocolitica
animal urine- leptospira

Front 99

Borrelia Burgdoferi carried by what tick type

Back 99

Ixodes

Front 100

borrelia recurrentis causes recurrent fever, carried by

Back 100

louse

Front 101

undulant fever caused by what from doing what?

Back 101

brucellosis, from UNpastuerized milk

Front 102

black bulbous plaques and fever in person in SW

Back 102

yersinia pestis

Front 103

fever from rabbit

Back 103

Francisella tularensis

Tularemia

"think rabbit eating tulip"

Front 104

2 conditions caused by pasteurella multocida

Back 104

osteomyelitis, cellulits

Front 105

bug in sepsis from peritoneal fistula/rupture

Back 105

bacterioides (most common bacteria in gut)

Front 106

motile organism that causes UTI

Back 106

proteus

Front 107

Amikacin is what

Back 107

an aminoglycoside

Front 108

which drug class will not work if you take milk, antacids, iron-containing preps?

Back 108

tetracyclines

(fecally excreted, get pulled out)

Front 109

2 problems tetracyclines have in kids, fetus

2 other problems

Back 109

teeth discoloaration, bone growth problems
teratogen

GI distress, photosensitivity

Front 110

photosensitivity rxns (3)

Back 110

sulfonamides, amiodarone, tetracycline

Front 111

which antiobiotic can prolong QT interval?

Back 111

erythromycin

Front 112

URIs in pregnancy, commonly use

Back 112

macrolides (azithromax,eryythromycin)

Front 113

what antibiotic can cause gray baby syndome?

Back 113

chloramphenicol

(also used for eye infections)

Front 114

bacteriocidal antibiotic that is used for cystitis and is safe in pregnancy, makes oxidative radicals from bacterial enzymes

Back 114

Nitrofurantoin

Front 115

what drug inhibits dihydropteroate synthetase

Back 115

sulfonamides

together with trimethoprim (inhibits dihydrofolate reductase) to inhibit THF and dTMP

Front 116

name 3 classes of drugs that can cause steven-johnsons

Back 116

the anti-epileptics

penicillin

sulfa drugs

Front 117

TMP-SMX used for (5)

Back 117

UTI
MRSA
PCP
SS (salmonella and shigella)

think shortenings

Front 118

TMP-SMX toxicities, treatment

Back 118

anemia, leukopenia, granulocytopenia

but can reverse by giving folinic acid

Front 119

2 antibiotics not to take with antacids

Back 119

tetracylcines, floroquinolones

Front 120

why usually avoid floroquinolones in kids/fetuses, exception

what is its mechanism of action?

Back 120

tendon/cartilege problems

cystic fibrosis

inhibits DNA gyrase (topoisomerase II)

Front 121

Metronidazole mech?
bugs affected

Back 121

makes reactive radicals that damage bugs

GET GAP on the metro
giardia
entamoeba
trichamonis
gardenella
anaerobes
h Pylori

Front 122

2 drug regimen for neonatal meningitis/sepsis

Back 122

ampicillin and gentamycin

Front 123

macrolide uses?

can use instead of another antiobiotic class in what situaiton?

what is most common cause of non compliance

Back 123

atypical pneumonias
STDs
URI
gram (+)

use if penicillin allergy

GI distress

Front 124

3 toxicities for chloramphenicol

Back 124

anemia, aplastic anemia, gray baby syndrome

Front 125

most common cause of noncompliance with tetracyclines

Back 125

GI distress

Front 126

Sulfa drugs (that don't have sulfa in name)

Back 126

celecoxib
TMP-SMX
furosemide
probenacid
-mustines (sufolnylureas)
thiazides
acetazolamide
sumatripan