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379 Cards in this Set

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What is Mirena?
A levonorgestrel IDU. Do not use with PID, STD or + anitphospholipids. The levonorgestrel released from Mirena prevents pregnancy by increasing the thickness of the natural mucus at the neck of the womb.
What are the non-contraception benefits of oral contraceptives, patches and rings?
Predictable cycles, treat dysmenorrhea & menorrhagia, reduce ovarian cysts, decreased risk of ovarian, endometrial and colon cancers, prevents bone loss and PID and ectopic, treats acne, hirsutism and perimenopause.
After one single act of unprotected pregnancy, what is the risk of becoming pregnant?
7.2 %
What time frame should emergency contracpetion be taken in?
As soon as possible or within 72-120 hours.
Does emergency contraception have abortive properties?
Unlikely. Works by inhibiting ovulation, inhinbiting sperm and interferes with fertilization.
Why does BC help with ectopc pregnancies?
Progesterone increases endocerivcal mucus which in turn decreases the risk of ascending infection. Less PID equals less tubal scarring and therefore less risk for ectopic pregnancies.
At what age does it become risky to prescribe combined hormonal contraceptives to a smoker?
Unacceptable health risk at age 35 when smokes >15 cig. per day.
Caution at age 35 with <15 cig per day.
When can birth control be started in a mother who is breastfeeding?
After the child is 6 months old.
If the mother is not breastfeeding, can start at > 21 days postpartum.
What is the "quick start" method of initiating birth control?
First pill on the day of her visit to the office as long as pregnancy can safely be excluded. Pt should be advised to use back up for 7 days.
Can you give oral contraceptives to a 45 year old with tension type headaches?
Yes. But not in migraine with aura (it may increased headaches in these patients). At age 40 you also start considering if the advantages are worth the risk of prescribing the medication.
What hormone does the emergency contraception pill contain?
Progesterone only. Equivalent to taking the progesterone component of 40 birth control pills.
What time frame is considered the neontal period?
0-28 days
What time frame is considered the infancy period?
first year of life
What time frame is considered the toddler period?
1-2 years
What time frame is considered the preschool period?
3-4 years
What time frame is considered the school age period?
5-12 years
What percent of birth weight will the infant lose in the first week?
10%
At what age (weeks) should the infant be back at initial birth weight?
2 weeks
How much weight does a baby gain in the first three months?
30 g/day or 2 lbs/month
What is the vision range of a newborn?
8-12 inches
Erikson's Stages: What is infancy?
0-18 months. Trust vs. mistrust. Children develop a sense of trust when caregivers provide reliabilty, care, and affection. A lack of this will lead to mistrust. Priority is feeding.
Erikson's Stages: What is early childhood?
2-3 years. Autonomy vs. shame. Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt. Priority toilet training.
Erikson's Stages: What is preschool?
3-5 years. Inititive vs. guilt. Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. Priorty is exploration.
Erikson's Stages: What is school age?
6-11 years. Inudstry vs.inferiority. Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority. Priority is school.
Erikson's Stages: What is adolescence?
12-18 years. Idenitity vs. role confusion. Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. Priority is social relationships.
Erikson's Stages: What is young adulthood?
18-40 years. Initmacy vs. isolation. Young adults need to form intimate, loving relationships with other people. Success leads to strong relationships, while failure results in loneliness and isolation. Priority is relationships.
Erikson's Stages: What is middle adulthood?
40-65 years. Generativity vs stagnation. Adults need to create or nurture things that will outlast them, often by having children or creating a positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in shallow involvement in the world. Priority is work and children.
Erikson's Stages: What is maturity?
65- death. Ego vs.dispair. Older adults need to look back on life and feel a sense of fulfillment. Success at this stage leads to feelings of wisdom, while failure results in regret, bitterness, and despair. Priority is reflect on life.
What are some normal findings for a two week old (term) baby?
Visual preference for the human face. Hears high pitched voices best. Reacts to cry of other neonates. Well developed sense of smell.
When will a child exhibit seperation anxiety?
6-8 months
When will a child be able to sit up on their own?
6-7 months
What are some behaviors that should be expected in a 3-5 month old?
Recognizes food by sight, reaches for objects and makes raspberry sound.
If you are doing a development assessment on a child thati s 5.5 months old and they were born at 32 weeks, what age would you expect to assess their development at?
3.5 months. Subtract the 8 weeks premature. The adjusted age calculation should be used until 24 months.
At what age does the child sit with support?
5-6 months
At what age does a child laugh?
3-4 months
At what age should a child rolll from back to stomach?
6-8 months
At what age does is a child able to preform a hand to hand transfer?
6-8 months
In a 2 month old boy you notice that the foreskin is not easily retractable. When should it be?
3 years old.
When should the posterior fontanelle close?
4 months
When should the anterior fontanelle close?
9-18 months
What does a clicking sound during breast feeding mean?
Poor latch. There should not be a clicking sound. Baby's lips should be flared and nipple and areola should be in baby's mouth.
When do you see physiologic hyperbillirubinemia in a baby?
After 24 hours. If you see it before it is going to be pathological.
At birth what is being treated when administering eye ointment?
Gonococcal infection (conjunctivits). Treated with erythromycin opthalmic preparation. This does not prevent chlamydia.
What is the incubation period for chlamydial conjuntivitis?
10 days to 2 weeks
How long is a woman in a hypercoagulable state post partum?
3 weeks
When can a child walk solo?
12-14 months
When can a child play pee-a-boo?
9-11 months
When does a child imitate bye-bye?
6-8 months
At what age should 100% of the the child's speech be understood by someone NOT in daily contact with the child?
3.5 years old (3-4)
At what age can a child walk down stairs alternating steps?
3 y/o
At what age can a child peddle a tricycle?
3 y/o
At what age can a child tie a shoe?
6-7 y/o first graders
At what age can a child verbalize what to do when cold, hungry or tired?
4 y/o (abstract problem solving)
At what age can a child name their best friend?
5-6 years old
At what age can a child draw a person with 12 + parts?
6-7 y/o, can also voice an intended career
At what age can a child use plurals?
3-4 y/o
A mild fever of 1-2 days long is most liekly to occur after a 6 month old recieves which vaccine?
Pneumococcal conjugate 13-valent vaccine PCV 13. Not really high fever. Also will be cranky.
Is MMR a live vaccine?
Yes. But not transferrable from child to pregnant mother because it does not shed.
When do you delay immunizations?
In the presence of life threatening illness only.
Can you give Flumist to an asthmatic?
No. This is intranasal and is contraindicated in airway disease. Can start @ 24 months otherwise. Airway disease gets IM injection.
What is the best way to protect infants < 6 months old from influenza?
Have close contacts and members of the family vaccinated.
The American Academy of Pediatrics recommends screening for autism at which times in early childhood?
18 months and 24 months
What are red flag developmental signs in a 6 month old?
No smiles or joyful expressions
What are reg flag developmental signs in a 9 month old?
No back and fourth sharing of sounds, smiles or facial expressions
What are reg flag developmental signs in a 12 month old?
Lack fo response to name. No back and fourth gestures such as pointing, reaching, or waving. No babbling or baby talk.
What are red flag developmental signs in a 16 month old?
No spoken words.
What are reg flad developmental signs in a 24 month old?
No meaningful 2 work phrases that don't involve imitating or repeating.
For which type of Hepatitis is there not a vaccine for?
Hepatitis C. Blood to blood contact and associated with IV drug use.
What displays flat facial profile, hypotonia, hyperflexible joints, a single palmar crease in both hands and Brushfield spots?
Down Syndrome. Trisomy 21. Extra chromosome, 47 instead of 46. Also see palpebral fissures and epincanthial folds. Screened with quad screen and nuchal translucency.
What are Brushfield spots?
Small white grayish brown spots noted on the periphery of the iris, due to aggregation or connective tissue. Seen with Down's Syndrome.
What provides immediate passive immunity?
Immune globulin.
What does it mean when HBsAG is positive?
Infection with Hep B.
If a child is born to a mother positive for Hep B what should be administered to the child?
Hep B vaccin and Hep B immune globulin. **** (This baby will need a special dose of Hep B)
What are the rules for puttting a child in a forward facing car seat?
1 year old and 20 lbs.
How old should a child be to sit in the front passenger seat?
13 years old (or ideally taller that 4'9")
What symptoms would you see with tricyclic antidepressant overdose?
Anticholinergic effects, confusion, flushed face, prolonged QT interval, and convulsion.
What do you see with anticholergic overdose?
Blind as a bat, mad as a hatter, red as a beet, hot as hell, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone.
Seen with antihistamines, antiparkinsons. antidepressants, scopolamine, atropine, etc.
When is the onset of puberty in females?
8-13 years
At what Tanner Stage to breast buds appear?
Tanner 2. And generally menarche will be two years later.
What is Turner's?
Female disorder of missing sex chromosome. There are characteristic physical abnormalities, such as short stature, swelling, broad chest, low hairline, low-set ears, and webbed necks. Ammenorrhea.
What is Klinefelter's
Males have an extra chromosome. XXY. Principal effects include hypogonadism and reduced fertility. A variety of other physical and behavioural differences and problems are common, though severity varies and many boys and men with the condition have few detectable symptoms (gynecomastia).
When will a female reach puberty?
8-13
When will a male reach puberty?
9-14
At what Tanner stage does the growth spurt occur?
Tanner 3 (picture your middle finger as being the longest)
What do you see in a male in Tanner stage 3?
Long thin penis and breast. Provide reassurance during this time. Also is the growth spurt.
What is fragile X syndrome?
Seen in males, they have lg testes after the onset of puberty, large body habitus, learning differences, lg forehead ears, prominent jaw and tendency to aviod eye contact. Less common in females. Most commo cause of autism.
What is the leading cause of childhood meningitis?
Haemophilus influenzae type B
no risk @ age 4
low risk @ age 2
First line therapy for acne vulgaris?
Benzoyl peroxide
What is a major side effect of Retin A
sensitive to sun
How long does it take to see improvement in acne when treating with oral antibiotics?
6-8 weeks. Needs new layer of skin (entire dermal turnover cycle)
What part of medicare covers NP services as opposed to RN services?
Part B. Part A is RN services.
When is accutane indicated?
Cystic lesions that have shown minimal to no improvement with other treatment modalities.
What precautions need to be taken with female patients when prescribing accutane?
Regularly monthly visits, pregnancy testing, 2 forms of birth control, and informed consent.
What is a serious concerning side effect of Accutane?
Risk for sucicide. Must carefully monitor mood with this medication as per FDA.
What is the leading cause of death in adolescents?
accidents
What is the CRAFFT screening test for?
Adolescent susbtance abuse. Car, relax, alone, forget, family and trouble. Yes to 2 answeres is a problem.
When does the American Cancer Society recommend to initiate cervical cancer screening?
3 years after onset of vaginal intercourse.
With what condition do you see a sandpaper like rash with exudative pharyngitis, fever, headache, anterior cervical lymphadenopathy?
Scarlet fever, Strep pyogenes. Beta hemolytic.
When does the rash with Scarlet fever appear?
Day 2 of pharyngitis adn then often peels days later.
What do you treat scarlet fever with?
PCN. Macrolide if allergic.
What causes Roseola?
HHV-6 Herpes virus 6
What presents as a rosy pink or maculopapular rash lasting hours to 3 days that follows a 3-7 day period of high fever?
Roseola
How do you treat Roseola?
Supportive treatment. Monitor for 10% of febrile seizure.
What causes fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting about 3 days and also present with posterior cervial lymphadenopathy 5-10 days prior to onset of the rash?
Rubella virus
What is the major concern with Rubella?
Tertatogenic. Keep away from pregnany women! Esp. during 1st trimester, 80% rate of congenital rubella syndrome.
Which disease usually presents with acute fever, nasal discharge, cough, generalized lymphadenopathy, conjunctivitis, photophobia, Koplik spots, pharyngitis, and maculopapular rash 3-4 days after onset?
Measles, Rubeola virus.
What is the incubation period for Rubella?
14-21 days
What is the incubation period for Rubeola?
10-14 days. It is tranmissible 1 week prior to rash to 2-3 weeks after rash disappears.
What is the major concern with Rubeola
CNS and respiratory impairment is common. Permanent neurological impairment is possible and death.
What are Koplik spots?
Seen with Rubeola or measles. They appears 2 days prior to onset of rash. Presents on oral mucosa as white spots with blue rings within red spots. Happens in 1/3 of cases.
When do you give the MMR?
At 12-15 months and again at 4-6 years.
What presents with fever, malaise, sore mouth, anorexia, conjuntivitis, pharyngitis and 1-3 days after onset lesions present?
Hand foot and mouth disease. Coxscakie virus
What are the symptoms of 5ths disease?
3-4 days of mild ful like illness foloowed by 710 days of red rash that beings on the face with slapped cheek appearance that spreads to trunk and extremities. No longer contagious after onset of rash. Leukopenia is common. Careful around pregnany women, risk for hydrops
What is Kawasaki's disease?
Durine acute phase of illness have high fever that lasts about 11 days, polymorphus exanthem on trunk, flexor regions, perineum, erythema of the oral cavity (strawberry tongue). Chapped lips, bilateral conjunctivitis without eye discharge, cervical lymphadenopathy, edema and erythema of the hands and feet with peeling skin. Treat with IV immunoglobulin and ASA
What is the most common childhood anemia?
Iron deficiency anemia
What does the hemogram look like in iron deficiency anemia?
Microcytic and hypochromic.
Small due to lack of hemoglobin and pale from the same.
What age are children at the greatest risk for anemia?
12 mo - 2.5 years
What would be the recommended amount of vitamin D for 13 month old?
400 IU daily
How much calcium should toddlers, preschool and older children get?
Toddler = 500mg daily
Preschool = 800mg
Older = 1300 mg
1 cup milk = 250mg
An inncocent murmur will become softer when going from supine to standing position... true or false?
True. Heard in early systolic, heard all over precordium
What is a still's murmur?
Bengin childhood murmur that has a humming or vibratory quality.
What type of murmur becomes louder with position change from supine to standing?
Hypertrophic cardiomyopathy. pathological.
What are the most common causitive organisms for acute otitis media?
1- S. pneumoniae
2- H. influenzae
3- M. catarrhalis
What is the ratio of Hemoglobin to Hematocrit?
1:3
What should you suspect when you see (sudden) confusion and incontinence in an elder?
UTI or urosepsis
What are examples of primary prevention?
Immuniziations, couseling about safety, injury and disease prevention
What is secondary prevention?
Screening, symptomatic/preclinical state to minimize impact of disease.
Ex.) screening blood pressure, mammograms, colonoscopy and skin survery for lesions.
What is tertiary prevention?
Minimizing disease outcomes and adjusts therapy to avoid further target organ damage.
Ex.) Adjust insulin for glucose control.
What should the maximum water temperature be set at in the home to avoid burns?
120 F
Checking stool for occult blood is an example of what type of prevention?
secondary
With what infectious disease do you see pseudomembrane with?
Diptheria
What is active immunity?
Resistance developed in response to an antigen (infecting or vaccine) and usually characterized by the presence of an antibody produced by the host.
Ex) contract the disease or vaccine
What is passive immunity?
Immunity conferred by an antibody produced in another host, acquired naturally by an infant from mother or artificially by administration of an anitbody-contiang preparation (antiserum or immune globulin)
Ex) mother to baby or IgG
What is the onset and duration of active immunity?
Onset- within 1 month
Duration - years to lifelong
What is the onset and duration of passive immunity?
onset- within hours of dose
duration - limited, usually 6-9 months
What vaccines are contraindicated with a allergy to neomycin?
IPV, MMR, varicella, smallpox
What vaccines are contraindicated with a allergy to streptomycin, polymyxin B?
IPV, vaccinia (small pox)
What vaccines are contraindicated with a allergy to baker's yeast?
Hepatitis B
What vaccines are contraindicated with a allergy to baker's yeast?
Hepatitis B
What vaccines are contraindicated with a allergy to Egg?
Influenza - nasal spray and injected
What vaccines are contraindicated with a allergy to Egg?
Influenza - nasal spray and injected
What vaccines are contraindicated with a allergy to Gelatin?
Varicella Zoster
What vaccines are contraindicated with a allergy to Gelatin
MMR and varicella
When should epinephrine be given for an anaphylactic reaction?
SC or IM every 5 minutes if symptoms persist or increase. Anaphylaxis often has a biphasic response.
The greatest risk for tetanus infection is when?
When coming from soil, deep dark areas where anaerobic conditions exist.

It's the length of the nail that was in anaerobic condition not the nail or rust.
Can you give flu mist to an asthmatic?
No. Active live virus and is contraindicated in asthmatics. They can and should receive the IM injection.
What are some characteristics of the antipneumococcal vaccine (pneumovax)?
Protects only against S.pneumoniae.
Indicated in the immunosuppressed.
Does not cause significant adverse reactions, only localized at injection site.
It is able to be given during antimicrobial therapy.
What precautions do you take with live viruses?
Caution in those with immunosuppresion.
Pregnancy.
>49 y/o
children or adolescents on ASA therapy
Hx of guilian-barre syndrome after vaccine
reactive airway disease or asthma
Which is the conjugate... pneumovax or prevnar?
Prevnar- conjugate, commonly causes achiness (has protein attached to polysaccharide)
Pneumovax- is the poly. less reactions
What is immune globulin?
A concentrated solution of antibodies from pooled and donated blood.
Advise Jehovas witness of this because it is a blood product!
What is Gardasil?
Quadrivalent vaccine against HPV types 6,11,16, and 18. Warts and malignancy.
You can recieved this with a hx of gential warts.
What is cervarix?
Bivalent vaccine against HPV types 16,18. Only for malignancy, NOT warts.
Can you do a PPD test after MMR has been given the day before?
No. Can not give the same day. Otherwise it should be delayed for one month. Not doing so can alter test results.
Which vaccines are live attenuated?
MMR, Varicella, Flumist, and Varicella Zoster.
Caution in pregnancy, immunosupressions, and HIV infection when CD4 is less than 200.

Attentuated- is live organism put under adverse conditions leading to the loss of virulence but retention of their ability to induce protective immunity :)
What age range can receive the live attenuated viruses?
2-49 years old.
What age range can receive the live attenuated viruses?
2-49 years old.
When is the flu vaccine recommended?
Ages 6 months or older.
Who gets 2 doses of the flu vaccine?
children 6months old - 8 years old who are receiving the vaccine for the first time.
When is the hep B vaccine given?
Birth
1-2 months
6-18 months
When is the rotavirus vaccine given?
2mo
4 mo
6mo
When is DTP given?
2mo
4mo
6mo
15-18 mo
4-6 yrs
When is HIB given?
2mo
4 mo
6 mo
12-15 months
When is pneumococcal vaccine given
2mo
4mo
6mo
12-15mo
When is the polio vaccine given?
2mo
4mo
6-18 mo
4-6 yrs
When is influenza vaccine given?
Annually starting at 6 months old
When is MMR given?
12-15 months
4-6 years
When is varicella given?
12-15 months
4-6 years
When is Hep A given?
2 doses between 12 months -23 months
When is meningococcal given?
in high risk groups over 2 years old
When is HPV given?
after 9 years old.
usually...11-12 in 3-dose series.
May also be given to male for prevention of gential warts.
Give 1st does, 2nd dose 1-2 months after 1st, and then give 3rd dose 6 months after the first dose.
When is tetanus updated?
Every 10 years
When is mammography recommended?
•Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
How often should a clinic breast exam be preformed?
•Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s, and every year for women 40 and over
What is the CAGE questionaire?
Alcohol screening.
Cut down. Anooyed by your drinking. Guilty. Eye-opener.

Positive reponse to 3 items + problem
What is causes AST elevation?
Alcohol, statins, tylenol
What causes ALT elevation?
Avandia/Actos, liver and toxins
When you see elevated AST and macrocytosis, what should you suspect?
When AST level is elevated with normal ALT level, coupled with mild macrocytosis (MCV > 100 fL, seen in about 30% to 60% of men who drink five or more drinks per day and in women at a threshold of three or more drinks per day), long-standing alcohol abuse is the likely cause.
How do you calculate a pack year history?
number of packs per day multiplied by the number of years smoked
Who has more completed acts of suicide, males or females?
males
Who attempts suicide most often?
females
Completed suicide is most common in elder or youth?
Elder
How should you begin a sentace when using theraputic communication techniques?
"I"
I am here to help you
I am concerned
How to we screen for colorectal cancer?
colonoscopy q10 years and annual FOB after age 50.
Depending on risk factors may need to start before age 50 and screen more often depending on disease entitity and degree of history.
When should a pap test be done and how often?
•All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
After 30 years old, may completed q 2-3 years.
Stop at age 70.
When should an endometrial biposy be preformed?
post menopausal bleeding
When should DRE exam routinely be preformed?
Not currently supported by ACS.
Otherwise routinely done in med starting at age 50 years annually.
What is Prochaska's Change Stage Theory?
In the Transtheoretical Model, change is a "process involving progress through a series of stages:"
Precontemplation (Not Ready)-"People are not intending to take action in the foreseeable future, and can be unaware that their behaviour is problematic"
Contemplation (Getting Ready)-"People are beginning to recognize that their behaviour is problematic, and start to look at the pros and cons of their continued actions"
Preparation (Ready)-"People are intending to take action in the immediate future, and may begin taking small steps toward behaviour change"
Action – "People have made specific overt modifications in modifying their problem behaviour or in acquiring new healthy behaviours"
Maintenance – "People have been able to sustain action for awhile and are working to prevent relapse"
Termination – "Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping"
Recommended treatment for TB, latent or active.
latent: 6-9 months with INH.
Active: Combo of three medications, bearing in mind resistance patterns ( INH, rifampin, ethambutol, pyrazinamide, and streptomycin).

NO pyrazinamide given in pregnancy.
What is erythropoiesis?
Is the process by which red blood cells (erythrocytes) are produced. It is stimulated by decreased O2 in circulation, which is detected by the kidneys, which then secrete the hormone erythropoietin, which further stimulates the production of RBC's.
Where does erythropoetin come from ?
90% renal 10% hepatic
Decreased in advanced renal failure when GFR<49
What is a reticulocyte?
Immature red blood cell.
See elevated in reponse to anemia.
Absence of this response = inadequate bone marrow.
What remains unaffected by hydration status... Hemoglobin or hematocrit?
Hemoglobin
What is the ratio of hemoglobin to hematocrit?
1:3
What are the causes of anemia?
1- blood loss (acute-hemorrhage & chronic- erosive gastritis, menorrhagia)
2- decreased RBC production (lack of b12, folic acid, iron, bone marrow suppression, or anemia of chronic disease)
3- premature destruction of RBC's (hemolysis, decreased life span)
What is the normal blood volume in an average human being?
5L
What is the average life span of an RBC?
90-120 days
What is MCV?
Mean corpuscle volume. Normal value is 80-96. It describes the average size of the red blood cell
What is MCH?
Mean cell hemoglobin.
Normal 31-37.
Describes the color of the RBC (aka the hemoglobin because that's what gives it it's color)
What is RDW?
RBC distribution width.
If high means that the new cells are different from the old cells.
Abnormal at > 15%.
Earliest sign of evolving anemia.
What is the reticulocyte count?
A normal response to anemia in an attempt to correct the loss by increase the amount of new RBC's.
What are the most common causes of erosive gastritis?
ASA, steriods, ETOH & Stress
What ethnic groups are at risk for ALPHA Thalassemia minor?
African and Asian
What ethnic groups area at risk for BETA thalaseemia minor?
Afreican , Mediterranean and Middle Eastern
What is Thalassemia?
Anemia of genetic origin that results in reduced rate of synthesis or no synthesis of one of the globin chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the thalassemias.
PROBLEM IN THE PRODUCTION OF HEMOGLOBIN!
Sometimes treated with Chelation or blood transfusion.
What is Thalassemia?
Anemia of genetic origin that results in reduced rate of synthesis or no synthesis of one of the globin chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the thalassemias.
PROBLEM IN THE PRODUCTION OF HEMOGLOBIN!
Sometimes treated with Chelation or blood transfusion.
What is Thalassemia?
Anemia of genetic origin that results in reduced rate of synthesis or no synthesis of one of the globin chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the thalassemias.
PROBLEM IN THE PRODUCTION OF HEMOGLOBIN!
Sometimes treated with Chelation or blood transfusion.
Which type of anemia is nomocytic, normochromic and normal RDW?
Blood loss. Most commonly hemorrhage, or anemia of chronic disease.
Which type of anemia is nomocytic, normochromic and normal RDW?
Blood loss. Most commonly hemorrhage, or anemia of chronic disease.
Which type of anemia is nomocytic, normochromic and normal RDW?
Blood loss. Most commonly hemorrhage, or anemia of chronic disease.
What type of anemia is microcytic, normochromic with elevated RDW?
Iron deficiency. Cells are small and pale, and new cells are smaller that the old. Chronic blood loss as well- b/c no hemoglogin available as it is not being recycled. Therefore, new cells are small because being created withinsufficient hemoglobin.
What type of anemia is microcytic, hypochromic, with and normal RDW.?
Thalassemia. Small pale cells that are the same size to due genetics (all the cells are being produced the same way)
What is pernicious anemia?
lack of intrinsic factor which leads to impaired intestinal absoprtion of b12 and therefore anemia. Macrocytic, normochromic, with increased RDW.
What type of anemia is macrocytic, normochromic with and increased RDW?
B12, folic acid (folate or b9) or pernicious anemia. Really big cells are seen because DNA syntheisis goes unchecked and develops really large cells.
What is the most likely cause of an elevated MCV, in absence of anemia?
Drug induced. Tegretol, Dilantin, Depakote, ETOH or AZT. Reversible upon stopping medication but it is not an idication to do so.
What is Epoetin (EPO, Procrit)?
Treatment for anemia, particularly in advanced kidney disease.
What is the most common type of anemia in childhood?
Iron deficiency
What is the most common type of anemia during pregnancy?
Iron deificiency
What is the most common type of anemia in childbearing years?
Iron deficiency
What is the most common type of anemia in elderly?
Anemia of chronic disease and then iron deficiency is #2.
What is the most important source of the body's iron supply?
Recycled iron contents from aged red blood cells. 80%
You advise a person who is a vegan to supplement their diet with what?
Vitamin b12.
Plenty of A and folic acid in fruits and veggies.
A 78 year old woman presents with fatigue, spoon shaped nails, and the following labs:
hg-9 rbc-2.4 mcv-70 rdw-19%. A critical diagnosis to consider is.....
Gastrointestinal blood loss.
Signs of pernicous anemia?
Triad of paraesthesias, sore tongue and weakness, this is not the chief symptom complex. The patient may complain of fatigue, depression, forgetfulness, difficulty concentrating, low-grade fevers, nausea and gastrointestinal symptoms (heartburn), weight loss. Because PA may affect the spinal cord, the patient may also complain of impaired urination, loss of sensation in the feet, unsteady gait, weakness, and clumsiness. Anemia may cause tachycardia (rapid heartbeat) and cardiac murmurs, along with a waxy pallor. In severe cases, the anemia may cause evidence of congestive heart failure.
In evaluating a person with a microcytic anemia, the next step in the lab testing includes a serum _______.
Ferritin level. This will reflect the iron stores.
What test is run when suspecting hemolytic anemia?
Haptoglobin.
Binds to hemoglobin in recycle process so doesn't send hemoglobin to kidney. The hemolysis shows an elevation in this.
When are the signs and symptoms of anemia very profound?
When HgB is less than 8
Name a macrocytic anemia?
B12
What is a hemic murmur?
Cause by disturbances from anemia. Resolves with treatmemt of anemia. May also be caused by thyroids, fever, and 3rd trimester pregnancy (hemodilution).
What is Cooley anemia?
Thalassemia MAJOR. Don't often survive childhood with this. requires transfusions.
What is an important aspect to remember about a pt with alpha thalassemia minor?
Genetic couseling prior to pregnancy. Alpha male with an alpha female has 1 in 4 chance of having baby with thal MAJOR. Difference from MAJOR = 4 genes, MINOR - 2 genes.
Has a very high stillbirth rate.
3 macrocytic anemias
1- b12
2- folate, b9 folic acid
3- pernicious
What does anemia of chronic disease look like on hemogram?
Normochromic, normocytic, normal RDW low RBC, hg/hct
What does it mean if the reicutulocyte count in low?
The body is make no attempt to correct the anemia or insult.
What does the hemogram look like in iron deificiency anemia?
Microcytic, hypochromic, increased RDW, low hg, hct and rbc.
How should iron pills be taken?
On empty stomach.
Do not mix with metals- AL, MG & CA because they wil chelate each other.
What is leukemia?
Monoclonal disorder with progressive accumulation of functionally incompetent lymphocytes.
What are the symptoms of leukemia?
Insidious onset, occasionally diagnosis is made as an incidentallaboratory finding.
Fatigue, Predisposition to repeated infection (pneumonia, herpes
simplex, herpes zoster), Pallor, Early satiety, abdominal discomfort if splenomegaly, Mucocutaneous bleeding, petechiae if thrombocytopenia, Localized or generalized lymphadenopathy (usually not as pronounced as with lymphoma),Splenomegaly (30-40%)
What lab value is elevated in leukemia?
WBC >50,000
Symtomatic @ 200,000-1,000,000
What is non-hodgkins lymphoma?
Tumors originating from lymphoid tissues, primarily lymph nodes. Progressive clonal expansion of B cells or T cells and/or natural
killer (NK) cells. Viral, genetic factors implicated
Signs and symptoms of non-hodgkins lymphoma?
* Painless Lymphadenopathy!!!
Presentation variable but usually includes:
Slowly progressive, painless peripheral most common,
with spontaneous node regression possible
Splenomegaly in ~ 40%
Hepatomegaly
Fever, night sweats, weight loss, fatigue, malaise not
common in early disease but can be seen in advanced
disease.
What lab values are elevated in non-hodgkin's lymphoma?
Anemia, thrombocytopenia, elevated lactate dehydrogenase.
What is the difference between Hodgkins and Non-Hodgkins?
Both are in the lymphocytes the difference is the lymphocyte involved.
Hodgkin's- Reed Sternberg cells, less common, and more sensitive to radiation.
Non HL- Most common, and grows more aggressively.
What are the causative organisms for acute bacterial rhino-sinusitis?
S. Pneumoniae
H. Influenzae
M. Catarrhalis
What should you prescribe for a pt with acute bacterial rhino-sinusitis...
1- a 35 year old with no comorbid conditions?
2- a 55 year old with poorly controlled type 2 diabetes and HIV?
1- Amoxicillin (no consequences to failed therapy)
2- Augmentin (need to use bigger guns because at risk for orbital cellulitis, abscess and sepsis)
What kind of bacteria is Strep pneumoniae?
Gram positive diplococci.
Most common in acute bacterial rhinosinusitis, otitis media and community acquired pneumonia.
There is some drug resistance aka DRSP.
What are the risk factors for having drug resistant strep pneumoniae?
Work/child in a day care.
Advanced age.
Recent microbial use in the past 4-6 weeks.
What kind bacteria is H. influenzae?
Gram negative bacillus.
Common cause of ABRS, AOM, CAP.
Most common pathogen with tobacco users.
50% of time with have spontaneous resolution.
30% of PCN's will not work with this due to resistance.
What kind of bacteria is M. catarrhalis?
Gram negative coccus.
lesser common pathogen in AOM, ABRS, and CAP.
90% Spontaneous resolution.
90% is PCN resistant.(produces beta lactamase)
What can you recommend to ease Gi side effects of Augmentin?
Peanut butter or cheese. The fat content helps.
What antibiotics can you use with acute bacterial rhino sinusitis when worried about DRSP?
1-Augmentin
2- high dose amoxicillin
3- cefpodoximine, cefuroxime, cefdinir ( have g+ and g- acitivity and still stable in the presence of beta lactamase)
What do you given in acute bacterial rhino sinusitis when the pt is allergic to PCN?
Bactrim, doxycycline, zithromax
What is a potentially harsh side effect of clindamycin?
C. diff
good protection against g-
also has GI symptoms
What antibiotic do you given with acute bacterial rhino sinusitis in pt s with prior anitmicrobial use
augmentin
levaquin
rocephin (IM for 3 days)
What does zithromax and clarithromycin work well with beta lactams?
No lactam ring, so stable in the presence of beta lactamases
good g- neg converage
What is the key to treating acute bacterial rhino sinusitis?
Re-evalute in 72 hours. May have to increased coverage if no improvement.
No cipro because it has poor S. pneumoniae coverage.
What is the definition of substrate? as related to CYP 450
Medication or substance that is metabolized by the isoenzyme, utilizing this enzyme in order to be modified so it can reach drug site of action and or be eliminated.
Ex- CYP 450 3A4
What is the definition of inhibitor? As related to CYP 450
Blocks the acitivity of the isoenzyme, limiting substrate excretion, allowing increased in substrate levels, and possible risk of substrate toxicity. ex. ertythromycin combined with a subtrate (viagra, simvastatin etc) results in increased substrate levels---> toxic
What is the definition of inducer? as related to CYP 450.
Accelerates the activity of the isoenzyme so that substrate is pushed out the exit pathway, leading to a reduction in the substrate level. ex St john's wort combined with a substrate will reduce the effect of the drug levels and lose therapeutic effect.
What are some examples of CYP substrates?
Viagra, atorvastatin, simvistatin, effexor, xanax
What are some examples of CYP 450 inhibitors?
erythromycin, clarithromycin, telithromycin
Which antibiotic do you use caution with as it will interfere with a lot of medications?
CLARITHROMYCIN- Biaxin
CYP450 inhibitor
Can you use augmentin in PCN allergy?
Nope
Does weber test lateralize to dense or non-dense tissue?
Denser tissue.
Ex- if have effusion/fullness to one ear it will most likely lateralize to that ear
What is presbycusis?
Hearing loss associated with aging. Slow progressive, symmetric, and high frequency loss.
What does it mean when there is conductive hearing loss?
There is something between, ex- cerumen or fluid
What is the first line treatment of allergic rhinitis?
Avoid triggers
Controller therapy to prevent formation of inflammatory mediators (corticosteriod nasal spray, Singulair, accolate, NasalCrom or Opticrom).
Rescue medication to inactivate mediators ( antihistamines, claritin, astelin, panatol, short term oral steriods)
what are the second generation antihistamines?
Loratadine (claritin), desloratadine (clarinex), zyrtec, allegra

have drying anticholinergic effect
When does controller therapy for allergic rhinitis take effect?
1-4 weeks.
Medication like corticosteriod nasal sprays, singulair
Has little to no effect on acute symptoms.
Why do you need to use caution when using oral decongestants?
Potential for vasoconstriction with potential for increased blood pressure and heart rate. Avoid with HTN or cardiovascular disease.
What are some other medications that have anticholinergic effects other than antihistamines?
Tricyclic antidepressants (elavil- amytriptyline)
overactive bladder medication (ditropan - oxybutonin)
What are some examples of Mast cell stabilizers and how to they work?
NasalCrom, optic cromolyn, opticrom
Work by preventing the release of histamine. Takes 1-4 weeks to work.
What is a good treatment for allergic conjunctivitis?
Panatol- olopatadine HCL
How does Atrovent work?
drys up secretions, helpful with profuse nasal discharge in treating allergic rhinitis
What kind of cancer do you suspect in pt with 60 pk year history and firm non-tender madibular node?
Squamous cell carcinoma.
90% of oral cancers are SCC.
What does cranial nerve I innervate?
olfactory.
test by smell
What does cranial nerve II innervate?
Optic
test with visual acuity
What does cranial nerve III innervate?
Oculomotor
Test with EOM.
"keeps your eyelid open"
Innervates most EOM's
What does cranial nerve IV innervate?
Trochlear
Test EOM.
Superior oblique
"cross eyes"
What does cranial nerve V innervate?
Trigeminal
Test chew, mouth, face, touch and pain. Test 3 areas on forehead, cheek and chin to evaluated bilateral sensation.
What does cranial nerve VI innervate?
Abducens
Test EOM
Lateral eye movement
What does cranial nerve VII innervate?
Facial
Test facial expressions.
Tears, saliva and taste.
What does cranial nerve VIII innervate?
Acoustic
Hearing, equlibrium sensation
What does cranial nerve IX innervate?
Glossopharyngeal
Taste, caroptid blood pressure.
What does cranial nerve X innervate?
Vagus
Blood pressure, heart rate, digestion and taste.
What does cranial nerve XI innervate?
Accessory
Swallowing and head and neck movements.
What does cranial nerve XII innervate?
Hypoglossal
Tongue movements
Should you use contact or glasses when testing visual acuity?
Yes. If normally used.
What does 20/200 mean?
Legally blind.
Can only see top letter E.
Average person could read this from 200 feet away, whereas this person is reading it at 20ft away.
What is the triad for refferal for eye complaints?
Red eye, painful eye and vision change.
What are the characteristic of the optic disc?
The fiber converge to from the optic disc (when trying to locate it follow the vasculature).
it's yellow-orange to pink in color, round to oval in shape with SHARP margins.
The optic disc raio is <1:2
What is the optic disc ratio and what does it mean?
It is the ratio of the "cup" inside the disc.
Helpful in glaucoma (where increased cup to disc ratio is seen with advanced disease progression)
The hole in the center of the donut.
Raio should be less than 1:2
What is the ratio of arteries to veins in the retinal vessels?
2:3- 4:5
Arteries are brighter and thinner than veins.
What is the Macula?
Highly sensitive are of the retina, responsible for vision.
Allows for reading and other close observation.
What is the difference between open angle glaucoma and closed angle glaucoma?
Open angle: The meshwork is not blocked, more like a "clogged drain" that allows less fluid to leave eye. It's painless and can go unnoticed.

Closed angle: The angle of the eye is narrow and causes decrased outflow. Common in farsighted pt's. Can have acute onset where outflow tract closes off -painfull red eye, blurry vision, headache and nausea. Medical emergency.
What happens with glaucoma?
1-Increased intraoccular pressure
2- Damage to optic nerve
3- decreased peripheral vision
When do you see papilledema?
Late manifestation of increased intracranial pressure- appears as bulging disc (opposite of appearance of glaucoma)
When do you see AV nicking of the eye?
Atherosclerotic disease.
When do you see hemorrhagic lesions in the eye?
DM, HTN, and head trauma
Who has "tunnel vision"?
Glaucoma
What is myopia?
Nearsighted, Can see near
What is hyperopia?
Farsighted, can see far.
What vision changes are typical with senile catarcats?
glare, loss of vivid colors, reading road signs while driving is difficult.
What is usually the cause of central vision loss?
macular degeneration
What is the amsler girt test used for?
Testing macular degeneration
What is the most common cause of blindness?
Macular degeneration
What does the eye exam look like with acute glaucoma?
Slightly dilated, poorly
reactive pupil, markedly
injected conjunctiva, firm
eyeball, hazy cornea.
Tx- optho! diamox and bblocker
What does the eye exam look like in uveitis/iritis?
Pupil usually constricted,
nonreactive, irregularly
shaped, perilimbal injection
(ciliary flush)
Seen with diseases like Reiters and ankylosis spondylitis and more
What is anosmia, hyposmia?
Diminished sense of small, with resulting declind in fine tatse discrimintation.
Acclerated by tobacco use.
What is presbycusis?
Loss of 8th cranial nerve sensitivity.
Difficult with conversation in the noisy environment. Person can hear but cannot understand what is said.
What is the most common cause of conjuntivitis? What is the treatment?
Adenovirus- usually self limiting (use cold artificial tear solution).
S. aureus
S. pneumoniae (resistant to tobra and genta)
H. Influenzae
Tx: opthalmic flouroquinolone or polymyxin B
What is the most common cause of otitis externa?
Swimmer's ear
Pseudomonas
Proteus
enterobacteriaceae
S. aureus
Rarely a fungus will cause it too
Tx: otic drops with ofloxacin, or cipro with hydrocortisone
Can you use Neomycin with a punctured/perforated TM?
NO!
In the case of a perforated tympanic membrane, it is critical to avoid using the otic solution, which increases the risk of aminoglycoside ototoxicity. In this setting, suspension drops are safer to use.
Fluoroquinolones are not associated with ototoxicity, and ofloxacin is safe in cases of a perforated tympanic membrane.
What is the most common cause of Malignant Otitis externa?
Pseudomonas
Occurs in those with DM, HIV, or on chemo.
Tx with cipro in early disease.
May be need for surgical debridement (osteomyelitis)
IV antibiotic for severe disease.
What causes "strep throat"
group A beta-hemolytic streptococcus
How do you treat an exudative pharyngitis?
1-PCN
2-erythro, 2nd generation ceph, zithro, clarithromycin
Is a crust an example of a secondary or primary lesion?
Secondary.
It formed over the original or primary lesion.
What are the layers of the skin?
Epidermis- outer layer, protects, has keratin and melanocytes
Dermis- connective tissue, glands, folicles and nerve endings
Hypodermis-anchors skin to unerlying structure (bone/muscles)
What is vitiligo
autoimmunity against melanocytes
Seen with RS, lupus, DM and other autoimmune diseases.
Flat nonpalpable area of skin discoloration. >1 cm
What is a plaque?
rasied lesion, same of different color from surrounding skin can resutl from a coalescence of papules
ex. psoriasis
What is a plaque?
rasied lesion, same of different color from surrounding skin can resutl from a coalescence of papules
ex. psoriasis
What type of skin lesion would a frecle be?
Macule- totally flat, non-palpable discoloration
What are purpura?
Flat red-purple discoloration cuased by RBC"s lodges in the skin.
if <1cm = petechaie
usually cause = thrombocytopenia (acute leukemia, meningitis)
Do purpura blanche?
No. Vacular lesions will blanche, purpura will not.
Does ring worm blanche?
No
What is a bluebrry muffin rash?
Seen with meningitis. Looks like exploded blueberries
When you see a rash on the wrist or nape of the neck what should you suspect?
Nickel allergy - contact dermatitis
What do you suspect when you lichenification in the AC?
Eczema
What is an annular rash?
Ring shaped
ex. erythema migrans- lymes - bull's eye rash with a central clearing
What is an acneform rash?
clustered, comedones, papulopustules, cysts, or nodules that resemble acne vulgaris
seen with lithium, iodine and dilantin- not a reason to stop medicine
What rashes occur in a linear pattern?
Contact dermatitis caused by pioson ivy- will see linear vesciles
What is erythema infectosum?
Rash seen with 5th's disease. Lacey rash on cheek that appears in retiuclar pattern (net-like cluster0
What are the most important differentials to consider when you see a painless oral ulcer?
Syphillis, squamous cell carcinoma
What are the most important differentials to consider when you see a painless oral ulcer?
Syphillis, squamous cell carcinoma
What are the most important differentials to consider when you see a painless oral ulcer?
Syphillis, squamous cell carcinoma
Prior to the appearance of shingles you will have pain or itching for how many days?
2 days before eruption
What is a pyogenic granuloma?
Capillary hemangioma, seen in 1st trimester of pregnancy (increased rate of growth due to hormonal changes)
What is erythema nodosum?
Panniculitis, inflammation of fat cells, fever, joint pain, red tender lumps, seen in both shins most commonly. Evolve to purplish brown/bruise.
Usually self limiting. tx with Nsaids.

In about 30-50% of cases, the cause of EN is unknown.[10] EN may be associated with a wide variety of diseases, including infections (e.g., hepatitis C, tuberculosis, streptococcal, Mycoplasma pneumoniae, Yersinia, and Epstein-Barr virus), Coccidioides immitis, sarcoidosis, autoimmune disorders (e.g., Inflammatory bowel disease or Behçet's disease), pregnancy, medications (sulfonamides, oral contraceptives, bromides), and cancer
What is erythema multiforme?
Rash with pink red ring around pale center that starts on the extremities. Itchy and blotchy. SYMMETRICAL
Usually from infection or drug exposure.
Steven's Johnsons
What is toxic epidermal necrolysis?
Cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. Although the majority of cases are idiopathic (without a known cause), the main class of known causes is medication, followed by infections and, rarely, cancers.
Steven's Johnson's is considered the milder form of this.
Lesions usually begin on the mucus membranes.
What are the differences of chicken pox vs. small pox?
Both 2-mm vesciles.
Chicken: starts on trunk and then spreads to limbs, lesions are at a variety of stages, pt s are more "miserable than sick"
Small: no pattern to lesions, lesions present all in the same stage, pt's have a severe illness with > 35 % mortality rate
What is actinic keratoses?
Dry crusty rash that appears on sun exposed area of skin. red brown, scal and often tedner. Can feel when running finger over skin.
Most common precancerous lesion, possible early stage squamous cell carcinoma.
Topical cream (imiquimod 5-flourouracil, cryotherapy.
What is a keratoacanthoma?
Rapidlu evolving rash on sun exposed areas, skin colored or slightly reddish at firs then develops to a smooth dome haped and then grows into a crates with crusted out rim.
tx-surgical removal or cream.
(looks like a crusty wart-eww like on a witch's nose)
What is the difference between basal cell carcinoma and squamous cell carcinoma?
Both: sun exposed areas
Basal: more common, arises from nothing, papule/nodule with pearly waxy appearance, telangiectasia (circulation visible). low risk for metastases
SCC: less common, can come from AK or de novo, red conical hard lesions, no distinct borders, greater metastatic risk (esp if on lip, oral cavity or genitalia)
True or false: Most melanomas come from new lesions?
true
What are the ABCDE's of melanoma?
A- asymmetric
B- borders are irregular
C- color is not uniform
D- diameter > 6mm
E- evolving- new or change in old -or- elevated
What do you treat scabies with?
Premetharin (elemite)
What do you treat verruca vulgaris with?
imiquimod (aldara)
What do you treat keratosis pilaris with?
Ammonium lactate
(bumps on arm where keratin has plugge the folicles)
What do you treat psoriasis with?
vitamin D, corticosteriods
With what rash to do you see a herald patch?
Pityriasis rosea
What is molluscum contagiosum?
Viral self limiting rash. Contagious untill rash disappers.
Flesh colored, dome shaped and pearly in apperance.
What rash typically presents on the anterior surface of the knees?
Psorasis vulgaris
Which rash typically presents over the waistband area?
sacbies- and web folds of fingers looks like worms from the burrows
With what rash to you see a christmas tree pattern of distribution?
Pityriasis rosea
What is the most common cause of ulcerating skin lesions?
MRSA
they try to make you think it is spider bites
What are the signs of a brown reculse spider bite?
Blue at center, then white ring and outer ring is red.
Central blistering with surrounding gray to purple discoloration at the site fo the bite. Surrounded by a ring of blanched skin surrounded large are of redness.
what is rock mountain spotted fever?
tick bourne disesease from bacteric Rickettsia. Triad of fever, rash and tic bite.
1-2 wks after bite presents with flu like illness and then rash presents. Rash starts on extremities and then spreads to trunk. Small flat non-itchy macules. can be on palms and soles.
Tx: Doxy is DOC
What is the drug of choice for lymes?
Doxy.
10 days normally
with arthtitis = 30 days
A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.
Treatment of lymes in pregnant breastfeeding or <8 years old
Amoxicillin or cefuroxime
Signs and symptoms of hypothyroid?
Dry skin, hung up patellar reflex, hyporeflexes, thoughts slower, increased weight, constipation, heavy menses, cold
What are the signs and symptoms of hyperthyroid?
skin is smooth and silky and moist, hyperreflexes, mind racing, weight loss, low volume loose stolls, olgiomeorrhea, hot
What are the most common causes of hypothyroidism?
Hashimoto thyroiditis - autoimmune
Post radioactive iodine - cells destroyed
medication use- lithium, amidarone, interferon, others
What are the most common causes of hyperthyroidism?
Grave's disease
toxic adenoma- metabolically active lesion
thyroiditis- can be viral, immune or post partum ( mom is jittery 2-3 months post preg, 2-4 months hypothyroid and 1 year later normalizes)
medication use- amiodarone, interferon
What is the single most reliable test to dx hypo or hyper thyroid?
TSH
produced by anterior pituitary
elevated in hypo
decreased in hyper
What is free T4
unbound metabolically active portion of thyroxine.

If test total T4 then often have false +
What is free T3
unbounde metabolically active portion of T3. When compared with T4, T3 is four times more metabolically active.
What is antiperoxidase?
Detects autoimmune thyroid disease.
Tests for an antibody to peroxidase- which is an enzyme within the thyroid.
AKA- TPO or TPOab
What is the goal in hypothyroidism for TSH?
1.2 (population norm)
Why is iodine important to the thyroid?
Needed to make thyroid hormone.
T4 T3
T4 converts to T3
What should you suspect with the following labs:
TSH= 84
Free T4= 3
untreated hypothyroidism
What is the normal value for TSH?
0.4 - 4.0

free t4= 10-27 (want this test, part of feedback loop)
free t3= 3.5 7.7 (best for hyperthyroid)
What do you use to treat hypothyroidism?
Synthroid-levothyroxine (bioidentcal to T4)
1.6 mcg/kg adults
1.0 mcg/ke elderly
4.0 mcg/kg children

increased dose by 50% in pregnancy
How often do you check TSH to determine effective treatment with synthroid?
8-12 weeks, but no soon than 6-8 weeks
due to long half life
How many half lives does it take for a drug to reach a steady state?
3-5 half lives
How many half lives does it take for a drug to be eliminated?
3-5 half lives
Can synthroid be taken with other mediations?
yes, but caution with metals it will lead to lower doses of synthroid, and be subtherapeutic
There are your labs, what do you suspect?
TSH <0.15
Free T4 79
untreated hyperthyroidism
Graves
How do you treat hyperthyroidism?
Beta blocker
Antithryroid med- PTU, methimazole
Radioactive iodine- thryoid ablation (may lead to hypothyroidism)
There are your labs, what do you suspect?
TSH 8.9
Free T4 15
elevated antithyroid antibodies?
subclinical hypothyroidism

Treat if TSH >5 if have goiter or anitbodies present. Also you can treat if the pt doesn't have these but is symptomatic.

antithyroid antibodies normal <1:1,000