Family Np Exam Review Questions Part 2

Front 1

What does SNOOP stand for in reference to headaches?

Back 1

Use this when you are considering diagnosis other than primary headache, these are the red flags.
S- systemic: fever, HA, preg, HIV etc.
N- neurological symptoms: confusion, AMS, nuchal, cranial nerve abnormalities
O- Onset: sudden, with exertion,
O: onset- age
P:previous history

Front 2

At what ages are headaches more serious?

Back 2

>50 and <5

Front 3

What should you suspect with a thunder clap headache?

Back 3

Sub arachnoid

Front 4

What kind of headache is pressing, non-pulsatile pain, that lasts 30 minutes to 7 days, and is usually bilateral?

Back 4

Tension headache

Front 5

What kind of headache last 4-72 hours, is usually unilateral, pulsing quality, aggravated by activity and is accompanied by either nausea, vomiting, photophobia or phonophobia?

Back 5

Migraine headache

Front 6

When does the aura occur with migraines?

Back 6

Typically before or during

Front 7

What are some examples of an aura that occurs with migraines?

Back 7

feeling o dread, anxiety, fatigue, nervous, Gi upset, visual or olfactory alteration
NO AURA should last >1 hours- consider alt. dx

Front 8

What type of headache occurs most commonly with males?

Back 8

Cluster

Front 9

What type of headache presents in groups at typical times of the year/day, usually unilateral, and is associated with increased lacrimation, conjunctival injection, ptosis and nasal stuffiness?

Back 9

Cluster

Front 10

Which headache is associated with the release of histamine?

Back 10

CLuster

Front 11

Which headache is associated with "hot poker" eye?

Back 11

Cluster

Front 12

Which headache do people complain of an "alarm clock" headache?

Back 12

Cluster.
Headache awakens them from sleep

Front 13

Which headache is called suicide headache?

Back 13

Cluster
follow a crescendo, decrescendo pattern

Front 14

What are some prophylactic medications for headache?

Back 14

BB, Ca blockers (verapamil), TCA's, anitepileptic drugs (neurontin) and lithium (cluster HA's)
Goal is to reduce severity and frequency and allow rescue medications to be more effective

Front 15

Which headache medications are specific to migraines?

Back 15

Triptans (SSRI agonists, Imitrex rizitriptan)
Ergot derivatives (ergotamine- vascular suppressant)

Front 16

What is the most important differential dx in headache?

Back 16

hemorrhage
Detect with CT (acute), 2nd MRI (days to weeks)

Front 17

What type of headache medications are rizatriptan and ergotamine?

Back 17

abortive migraine therapy

Front 18

What kind of headache medication is propanolol or verapamil?

Back 18

Preventative/prophylactic

Front 19

What is the most serious complication of giant cell arteritis?

Back 19

Blindness
Inflammation of the lumen of the vessel
The temporal artery feels like a cord and you can palpate it. It is very painful for the patient

Front 20

What is giant cell arteritis associated with ?

Back 20

Polymyalgia rheumatica
Autoimmune imflammatory disorder, characterized by pain in neck, shoulder, hip assoc. with fever, anemia "illness" and morning pain

Front 21

What is Reiter's syndrome?

Back 21

Reactive arthritis, can't see can't pee can bend the knee.
Autoimmune usually triggered by bacteria, find source treat it, NSAIDS and immune agents

Front 22

How to you treat giant cell arteritis?

Back 22

6 months to 2 years of corticosteriods

Front 23

What are some common side effects of steroids?

Back 23

peptic ulcer

Front 24

What medication is known to cause duodenal ulcers?

Back 24

NSAIDS

Front 25

Which medications will help with duodenal ulcers?

Back 25

PPI's (nexium, protonix and the -azoles)
H2RA's don't prevent ulcers (-adine group, pepcid)

Front 26

What is alendranate?

Back 26

Fosamax.
Helps prevent bone demineralization.
Also use to counteract steroid side effects (bone loss)

Front 27

What is mispristol/cytotec?

Back 27

Used to prevent ulcers - increases the thickness of the lining of the stomach.
Abortions, induce labor- synthetic prostaglangins.
Use to counter act NSAID use

Front 28

What is beta lactamase?

Back 28

Enzyme produced by bacteria that breaks down antibiotics.
Many antibiotics have a beta lactam ring, so when a bacteria possess beta lactamase it will render the medicine ineffective and win the fight!

Front 29

What are in the most common pathogens in pneumonia? (CAP)

Back 29

1- S. pneumoniae (g+)
2- M. pneumonae & C. pneumoniae (atypical, no cell membrane)
3- H. Influenzae (g-)
4- Legionella (atypical, no cell wall)

Front 30

What are the risk factors for DRSP?

Back 30

1- recent antibiotic use
2- day care
3- > 65 y/o
4- ETOH abuse
5- medical comorbidities and immunosuppression

Front 31

Why use caution with telithromycin?

Back 31

LIVER
macrolide derviative
acid stable antibiotic

Front 32

A college kid presents with pneumonia, what bacteria is the likely cause?

Back 32

M. pnuemoniae & C. pneumoniae.
Tx with macrolide because produces beta lactamase

Front 33

A male that smokes presents with pneumonia, what bacteria is likely to be the cause?

Back 33

H. influenzae
tx with macrolide, cephalosporin, flouroquinolone, augmentin or tetracycline.

Front 34

Where would Legionella most likely be found?

Back 34

Mist or aspiration from a water source or liquid. Air conditioner, shower or fountain.
Not spread from person to person.
Tx with macrolide, flouroquinolone, or doxycycline
Presents as dry cough, not classic s/s.

Front 35

Can you give doxycycline in pregnancy?

Back 35

No stains teeth, preg category D.

Front 36

Which 2 antibiotics are potent CYP3A4 inhibitors?

Back 36

Clarithromycin and erythromycin. Will increase potency of subtrates.

Front 37

If a patient has comorbidities and you are treating them for pneumonia, what antibiotic should you use?

Back 37

Fluoroquoinolone.
Levaquin

Front 38

Which bacteria causes pneumonia in the acute care setting?

Back 38

Pseudomonas Aureginosa (g-)(ventilator patients)
S. Aureus, K. Pneumonia

Front 39

Which bacteria most often causes "walking pneumonia"

Back 39

M. pneumoniae
Presents with normal vitals, bilateral inspiratory crackles, and infiltrates on CXR

Front 40

If you percuss with pneumonia the sound will be ----------

Back 40

dull

Front 41

Tactile fremitus with pneumonia will be increased or decreased?

Back 41

Increased

Front 42

How do you prescribe zithromax when treating pneumonia?

Back 42

500mg daily for 3 days
do not use Z-pack

Front 43

What are neutrophils?

Back 43

Most abundant type of red blood cell.
60% of WBC's
Seen with BACTERIAL infection
aka PMN, segments

Front 44

What are lymphocytes?

Back 44

30% of WBC's
Seen with VIRAL infections.

Front 45

What are monocytes?

Back 45

6% of WBC's
elevated with FB, splinted, debris
sign of tissue damage

Front 46

What are eosinophils?

Back 46

3% of WBC's
Seen with ALLERGENS or PARASTIES
Giardiasis infection, addison's disease as well

Front 47

What is the breakdown of WBC's?

Back 47

60 neutrophils
30 lymphocytes
6 monocytes
3 eosinophils
1 basophils
"nobody likes my educational background'

Front 48

What does a shift to the left mean?

Back 48

Elevated WBC's
Elevated Neutrophils > 70%
bandemia (increased immature neutrophils >400/mm3 or greater than 4%)

Front 49

What are BANDS?

Back 49

Immature white blood cells that are called up from the bone marrow to fight significant bacterial threat.
Called BAND because nucleus is in the shape of a band.
Normally 0-4% are present in circulation.

Front 50

How do you calculate the absolute neutrophil count?

Back 50

ANC= % neutrophils x total white blood cells

Same for all other, just multiple the % to get the actual count

Front 51

What is the most common cause of acute bronchitis?

Back 51

Virus

Front 52

What URI presents with a protracted cough?

Back 52

Pertusis, whooping cough.
Cause by B. pertussis
Tx: macrolide or tetracycline
may also want steroid with protracted cough :)

Front 53

What does asthma consist of?

Back 53

airflow obstructions, bronchial hyper-responsiveness, and underlying inflammation

Front 54

What is the key to making the diagnosis of asthma?

Back 54

Spirometry.
Use peak flow to continually monitor

Front 55

What are controller drugs for asthma?

Back 55

Inhaled corticosteroid: Asmanex- mometasone, Flovent- fluticasone, Budesonide-Pulmacort (decreased inflammatory mediators)
Leukotriene receptor antagonist & leukotriene modifiers: montelukast-Singulair (inhibits leukotrienes, which are fatty compounds produced by the immune system that cause inflammation in asthma and bronchitis, and constrict airways)
Mast cell stabilizers: cromolyn-intal, nedocromil Tilade (stabilizes cell so doesn't release histamine)

Front 56

How much of inhaled corticosteroids are systemically absorbed?

Back 56

<20%

Front 57

How should the LABA be used?

Back 57

With ICS. Not advised to use alone.
Increased risk for asthma death with certain groups. AA. Can cause rebound life threatening exacerbation.

Front 58

What are some examples of long acting beta agonists?

Back 58

salmeterol (servent)
formoterol

Now made in combination: in products like Symbicort (budesonide with formoterol) and Advair (fluticasone with salmeterol)

Front 59

What are rescue medications for ACUTE Asthma?

Back 59

SABA- albuterol (salbuterol), levalbuterol (xopenex)

Steroids during acute flare for 3-10 days

Front 60

What is the therapeutic index for theophylline?

Back 60

10-20
need periodic monitoring
too many contraindications
mild to moderate bronchodilator

Front 61

What is omalizumab (Xolair)

Back 61

Recombinant DNA dervied IgG monoclonal antibody that selectively binds to IgE on the surface of mast cells and basophils. Decreases the release of mediators of the allergic response.
Rx by specialist.
$20,000 a year
-mab (monoclonal antibody technology)

Front 62

How should the LABA be used?

Back 62

With ICS. Not advised to use alone.
Increased risk for asthma death with certain groups. AA. Can cause rebound life threatening exacerbation.

Front 63

What are some examples of long acting beta agonists?

Back 63

salmeterol (servent)
formoterol

Now made in combination: in products like Symbicort (budesonide with formoterol) and Advair (fluticasone with salmeterol)

Front 64

What are rescue medications for ACUTE Asthma?

Back 64

SABA- albuterol (salbuterol), levalbuterol (xopenex)

Steroids during acute flare for 3-10 days

Front 65

What is the therapeutic index for theophylline?

Back 65

10-20
need periodic monitoring
too many contraindications
mild to moderate bronchodilator

Front 66

What is omalizumab (Xolair)

Back 66

Recombinant DNA dervied IgG monoclonal antibody that selectively binds to IgE on the surface of mast cells and basophils. Decreases the release of mediators of the allergic response.
Rx by specialist.
$20,000 a year
-mab (monoclonal antibody technology)

Front 67

Intermittent asthma: symptoms and treatment

Back 67

symptoms & inhaler use <2 days a week, NO interference with activity
FEV >80%
Tx: SABA prn

Front 68

Mild asthma: symptoms and treatment

Back 68

symptoms & inhaler use 2 days a week, minor limitation
FEV> 80%
Tx: low dose inhaled corticosteroid +SABA

Front 69

Moderate asthma: symptoms and treatment

Back 69

symptoms & inhaler use daily, some limitation
FEV>60% but less than 80%
Tx: Medium dose ICS +SABA

Front 70

Severe asthma: symptoms and treatment

Back 70

symptoms & inhaler use multiple times throughout the day, extremely limited
FEV <60%
Tx: ICS, possible oral steroids, + SABA

Front 71

What is the most common type of asthma?

Back 71

Moderate persistent

Front 72

What is considered well controlled asthma?

Back 72

2 or less times a week with symptoms

Front 73

Corticosteroids cause which type of ulcer?

Back 73

Gastric

Front 74

When is there spirometric evidence of airway obstruction?

Back 74

if the FEV1/FVC <70% (0.70)

This is important because subject symptoms are occasionally absent

Front 75

What is FEV1

Back 75

Forced expiratory volume in the first second of expiration

Front 76

What is FVC

Back 76

forced vital capacity, total respiratory effort

Front 77

What is used to treat mild COPD

Back 77

SABA
FEV1 >80%

Front 78

What is used to treat moderate COPD

Back 78

long acting bronchodialtors- Spiriva, Atrovent, Serevent, formoterol and SABA

Front 79

What is used to treat Severe COPD

Back 79

ICS, long acting bronchodilators and SABA
** ADVAIR and SYMBICORT**

Front 80

What is used to treat Very severe COPD

Back 80

LONG term oxygen and other treatments. ICS, long acting bronchodilators and SABA

Front 81

What is Advair?

Back 81

Fluticasone and salemeterol
ICS & LABA

Front 82

What is the goal of oxygen therapy in COPD?

Back 82

To bring sp02 higher than 90%
ps02 => 60 mmhg

Front 83

When is it indicated to initiate long term oxygen therapy (>15 hours/day)?

Back 83

with pa02 <55 mmhg or with Sa02 <88%
or
when pa02 55-59 or Sa02 = 89% in the presence of cor pulmonale, right heart failure or polycythemia (hct >56%)

Front 84

How should o2 be used?

Back 84

Minimum of 15 hours a day

A vasodilator that decreases the workload of the heart

don't wait to take it when SOB

Front 85

What is cor pulmonale?

Back 85

Enlarged righth ventricle due to pulmonary hypertension

increased resistance = increased pulmonary blood pressure

Front 86

When do you add steroids to a COPD exacerbation?

Back 86

When FEV1 < 50%
add for 10 days

Front 87

What findings are most common with inhalation anthrax?

Back 87

Fever, malaise, widened midastinum, and DRY cough.

Patients with inhalational anthrax present initially with nonspecific symptoms, including a low-grade fever and a nonproductive cough. They may report substernal discomfort early in the illness. After initial improvement, inhalational anthrax progresses rapidly, causing hemorrhagic mediastinitis and rapid clinical deterioration.

Front 88

What is hantavirus?

Back 88

characterized by a febrile prodrome that was followed by acute respiratory failure and finally death due to circulatory collapse.RNA zoonotic virusesHPS occurs primarily in the fall, when small rodents (eg, field mice) inhabit human dwellings to protect themselves from the cold weather. 25% develop cardiac and may require vent.Ribavirin has been used to treat Hantavirus infections, but its efficacy in HPS remains unproven.

Front 89

Where does botulism come from?

Back 89

Bee honey and canned foods

C botulinum is an anaerobic gram-positive rod that survives in soil and marine sediment by forming spores

Front 90

What bacteria breed in reheated rice?

Back 90

Bacillus Cereus
fried rice syndrome
can produce a toxin that might be fatal, but usually manifests as food poisoning

Front 91

When should diabetes testing begin?

Back 91

In the absence of symptoms start @ age 45.
Otherwise in BMI>25 and other conditions may convince you to start earlier ;)

Front 92

In reference to laboratory testing, what results are postive for DM?

Back 92

FSBS 126 or higher
a1c => 6.5%

OGTT=> 200mg/dl (75 mg load)
random of =>200

Front 93

What the heck is prediabetes?

Back 93

FSBS =100-125
OGTT 140-199
A1c = 5.7- 6.4%

Front 94

What does post prandial mean?

Back 94

After a meal

Front 95

What is the goal for A1C?

Back 95

<7 for a diabetic (ADA)
< 6 for normal population

use tighter control for younger, can be a little more lenient with shorter life expectancy

Front 96

What is a sulfonylurea?

Back 96

Insulin secretagogue- forces the pancreas to release more insulin
-IDE suffix

Ex) glipizde-Glucatrol, glyburide-Diabeta, glimepiride-Amaryl (most potent and $4.00)

must adjust dose in renal impairment
*** sulfonamide alllergy
less effective in older years b/c beta cells are less functional and less likely to respond

Front 97

What is a biguanide?

Back 97

Reduces hepatic glucose production and intestinal glucose absorption, insulin sensitizer via increased glucose uptake and utilization.

less GI upset if take with meal

risk of lactic acid build up with hypovolemia

monitor creatinine, DO NOT give with impaired renal function. avoid in heart failure. Stop glucophage before IV contrast > 48 hours before

Front 98

What are the thiazolidinedione, TZD or glitazone?

Back 98

Insulin sensitizer at receptors found in muscle adipose and tissue.
Risk of liver toxicity.
Actos and Avandia (glitazones)
Risk for edema and may exacerbate heart failure.

$$$$$$$

Front 99

What are the incretin mimetics?

Back 99

Injection only, stimulates insulin production in response to increased plasma glucose. Slows gastric emptying.
ex-Byetta-exenatide
use after other orals fail to improve
risk of pancreatitis
caution in renal impairment

Front 100

What are the dipeptidyl peptidase inhibitors? DPP-4

Back 100

causes increased levels of incretin which cause release of insulin from beta cells and decreases release of glucgon from pareatic cells

careful in renal
use in combo with glucophage or TZD
pancreatitis risk

ex- Januvia-stiagliptin

Front 101

What are the meglitinides?

Back 101

Short acting insulin secretegogue, increases insulin secretion
ex- prandin-repaglinide
take 30 min prior to meal
quick burst of insulin within 20 minutes
"covers a meal"

Front 102

what are the alpha-glucosidase inhibitors?

Back 102

they delay carb absorption by reducing digestion of straches

+ GAS
take them with first bite of meal
carbs break down over 3 hours instead of one
ex- Acarbose-precose

Front 103

What are the amylin analogs?

Back 103

injection only
changes gastric emptying helping post prendial sugars, increased feeling of fullness resutls in decreased calories and weight loss.
HYPOGLYCEMIA risk. Can only use iwth meal > 250 calories
ex- pramlintide-Symlin

Front 104

What is incretin?

Back 104

hormone that stimultes the beta cells to secrete insulin

careful with incretin and workload it puts on pancreas

Front 105

How do you go about treating a patient with type 1 DM?

Back 105

Treat all patients with a basal insulin with adjustments for meals.

Example- The pumps delivers insulin at a basal rate. Pancreas secretes 50% basal insulin and the other 50% in response to meals. Want to mimic this with insulin therapy.

Front 106

Are there any contraindications to insulin?

Back 106

No it's bioidentical to human form

Front 107

What is the onset, peak and duration of lispro-Humalog

Back 107

Onset- 15-30 minutes
peak - 30min-2.5 hrs
duration- 3-6.5hrs

RAPID

Front 108

What is the onset, peak and duration of Aspart-Novolog?

Back 108

Onset - 10-20 minutes
peak - 1-3 hours
duration - 3-5 hours

RAPID

Front 109

What is the onset, peak and duration of insulin glulisine-Apidra?

Back 109

Onset - 10-15 minutes
peak - 1-1.5 h
duration- 3-5 h

Front 110

What is the peak, onset and duration of regular insulin?

Back 110

Onset - 30 minutes -1 hour
peak- 2-3 hours
duration- 4-6 hrs

Front 111

What is the peak, onset and duration of NPH-novalinN, Humilin N?

Back 111

Onset - 1-2 hrs
peak - 6-14 hrs
duration- 16-24 hrs
use as basal insulin
INTERMEDIATE

Front 112

What is the peak, onset and duration of glargine insulin-Lantus?

Back 112

Onset -1 hour
peak -none
duration- > 24 hours
LONG ACTING

Front 113

What is the onset, peak and duration of detemir insulin-Levemir?

Back 113

Onset - 1-2 hrs
peak - 6-8 h
duration- 12-20 hrs
LONG ACTING

Front 114

How do you treat new onset DM?

Back 114

insulin and oral medication
2 weeks of intensive insulin (basal and meals)
Accucheck QID

Front 115

What are additional care measures to consider using in DM?

Back 115

ASA or ACE
BB
Cholesterol Meds (goal LDL<100 and HDL > 45
Diet
Exercise and eye care
Foot care
Goals, review then periodically

Front 116

Can you use Plavix if you have an ASA allergy?

Back 116

Yes. 75 mg/day

Front 117

What is the earliest sign of deteriorating renal function?

Back 117

Microalbumin
early warning system as early as 10 years

Front 118

What is the recommended physical activity for DM?

Back 118

150 min per week
>30 minutes 5 x week
resistance exercise > 3 x week

Front 119

What is the difference between proliferative and non-proliferative retinopathy?

Back 119

Non occur before and there are no new vessels. Usually progresses to proliferative, where you see new vessels on the retina.
See cotton wool spots

Front 120

Which side of the heart has a lower pressure?

Back 120

Right
allows for venous return

Front 121

Which side of the heart has increased pressure?

Back 121

left side
the left atrium is the highest

Front 122

What side of the stethoscope do you hear high pitched sounds

Back 122

diaphragm
low pitched with bell

Front 123

What happens during S1?

Back 123

Beginning of systole
Mitral and tricuspid close
lub
PULSE

Front 124

what happens during s2?

Back 124

heart at rest and it gets perfused.
Closing of aortic and pulmonic valves

Front 125

What is physiological splitting?

Back 125

The widening of interval between aortic and pulmonic components of the second heart sound. Caused by the pulmonic component. Heard best in pulmonic region.
INCREASES ON INSPIRATION.
Benign

Front 126

Where is the apex of the heart?

Back 126

Bottom

Front 127

What is pathological splitting?

Back 127

A fixed split that does not change with inspiration. It may narrow or close with inspriation. Heard in pulmonic region.
Usually from septal defect. If paradoxical then may be LBBB.

Front 128

What is S3?

Back 128

Ventricular overload or systolic dysfunction. Heard early in diastole, as if it's hooked on the back of s2.
Hear it with Bell.

Front 129

What is S4

Back 129

Marker of poor diastolic function. Poorly controlled HTN or recurrent MI. Sounds more like it's hooked on to s1. Sometimes called a presystolic sound. Best heard with bell.

Front 130

What is an incompetent valve?

Back 130

failure to close adequately.
Refers to regurg.
The valve does not close therefore will regurg back.

Front 131

What kind of murmur are pathological, systolic or diastolic?

Back 131

DIASTOLIC are always pathological

Front 132

What are the systolic murmurs?

Back 132

Mitral
Regurgitation
Physiological
Aortic
Stenosis
Systolic
Mitral
Valve
Prolapse

Front 133

What are the diastolic murmurs?

Back 133

Mitral
Stenosis
Aortic
Regurgitation
Diastolic

Front 134

What is mitral reguritation?

Back 134

systolic murnur
holosystolic (same volume all the way throughout systole)
radiates to axillary area

Front 135

If it radiates to the neck what kind of murmur is it?

Back 135

Aortic

Front 136

What is aortic stenosis?

Back 136

crescendo-descrscend murmur that sounds harsh
occurs during systole
picture a diamond <>

Front 137

What is mitral valve prolapse?

Back 137

a midsystolic murmur

Front 138

What is mitral stenosis?

Back 138

late diastolic murmur that sounds like a rumble
bowling ball going down gutter

Front 139

What is aortic regurgitation?

Back 139

early diastolic murmur, blowing sound

Front 140

What is a Still's murmur?

Back 140

benign
see with this 3 y/o boys
sound like a cell phone on vibrate

Front 141

How do you grade a murmur?

Back 141

1- faint
2- quiet but quickly heard
3- moderately loud, no thrill
4- loud thrill
5- very loud with thrill
6- hear without scope

Front 142

if a murmur softens or disappears when going from supine to standing it is most likely benign or pathological?

Back 142

Benign
the heart widens up with the movement
this is the same as the squat eval

Front 143

If a murmur increases with intensity when changing from supine to standing is it benign or pathological?

Back 143

Pathological
consider IHHS

Front 144

What murmur is systolic and loud?

Back 144

Mitral regurgitation.
holosystolic.
Radiates to axiallae

Front 145

Who has the highest risk for bacterial endocarditis?

Back 145

1- prothetic valves
2- past hx of endocarditis

Front 146

What murmur is a crescendo decrscendo murmur?

Back 146

aortic stenosis
calcification present that prevents outflow= DOE
hear it in neck

Front 147

What is IHHS?

Back 147

Ventricular hypertrophy, when stand ventricles butt up against each other and there is less blood flow in the heart

from hypertrophy and overgrowth of muscles

Front 148

increased pulse pressure = increased peripheral vascular resistance... true or false?

Back 148

True
BP= Hr x SV X PVR
Pulse pressure = systolic- diastolic

Front 149

What are the target organs for HTN?

Back 149

Brain- CVA, dementia
Cardio- atherosclerotic, MI, hypertrophy, CHF
Kidney- failure and nephropathy
eye- retinopathy and blindness

Front 150

What is the most common cause of left ventricular hypertrophy?

Back 150

HTN

Front 151

When will you see creatinine rise in kidney failure?

Back 151

When 50% damaged
first sign is proteinuria

Front 152

What changes will you see with HTN retinopathy

Back 152

narrowing of terminal branches then eventually vessels, hemorrhage in retina, and permanent findings then ICP leads to papilledema

Front 153

Stage 1 HTN

Back 153

140-159
90-99

Front 154

Stage 2 HTN

Back 154

>160
>100

Front 155

What are the goals of HTN?

Back 155

Avoid target organ damage.
non-DM <140/<90
DM and renal disease <130/<80
renal disease with proteinuria 1g/24hrs <125/<75

Front 156

What are the lifestyle modifications for HTN?

Back 156

Weight reduction (BMI 18.5- 24.9)
DASH eating plan
Dietary sodium reduction (2.4 g)
aerobic activity
moderate ETOH consumption: men< 2/day women < 1/day

Front 157

What is the primary use for loop diuretics?

Back 157

Volume reduction
as with CHF

Front 158

How do you treat stage 1 HTN without compelling indications?

Back 158

Thiazide for most.
Consider ACE, ARB, BB, CCB or combo

Front 159

How do you treat stage 2 HTN without compelling indications?

Back 159

2 drug combo for most
Thiazide plus and ACE, ARB, CCB or BB

Front 160

How do you treat HTN with compelling indications?

Back 160

Diuretics, ACE, ARB, BB, CCB as needed

Front 161

What are the thiazide diuretics?

Back 161

HCTZ-hydroDiuril, chlorthalidone-Hygroton.
Causes low volume sodium depletion that leads to decreased PVR.
WIll increase lipoprotein
Good for women with osteo
increased insulin resistance
NA, MG and K depletion possible (spars CA)
less effective with renal impairment--> use loop

Front 162

What are the beat blockers?

Back 162

-olol group
Caution with COPD, asthma and heart block
worsens insulin resistance and may mask hypoglycemia
to discontinue taper dose
these meds work by blunting the catecholamine response to decreased HR and stroke volume

Front 163

What are the alpha-beta adrenergic blockers?

Back 163

Alpha adrenergic blockers
use caution with COPD, asthma and heart block
work by blunting catecholamine response
Carvedilol-Coreg, labetalol-trandate

Front 164

B1 is the -----------
B2 is the ---------

Back 164

(one) heart
(two) lungs

Front 165

What are the ACE inhibitors?

Back 165

-pril group
risk of angioedema
hyperkalemia risk
cough common side effect
Cat D in pregnancy
NEVER USE WITH BILATERAL RENAL ARTERY STENOSIS
works by blocking angiotensin II which is a super powerful vasoconstrictor--> decreased PVR

Front 166

What are the ARB's?

Back 166

Angiotensin recpetor blockers
works like ACE
no risk for angioedema
no cough
ex- cozaar, lorsartan, telmisartan-Micardia
SARTAN
K+ sparring, risk of hyperkalemia

Front 167

What are the direct renin inhibitors?

Back 167

Aliskiren-Tekturna
$$$$
similar to ACE risks

Front 168

What are the calcium channel blockers?

Back 168

POWER HOUSES
-ipine suffix
amlodipine-Norvasc, felodipine-Plendil
nonDHP ones are cardiazem, and verapimil
WORK BY CAUSING VASODILATION!
risk for edema
CYP450
renal protective
non-DHP's caution with >1st degree heart block
avoid in heart, renal or liver failure

Front 169

What are the aldosterone agonists?

Back 169

Spironolactone (Aldactone)
blocks aldosterone and regulates sodium and water better
risk for hyperkalemia
gynecomastia
K sparring
tx hirsutism

leads to decreased peripheral vascular resistance

Front 170

What are the alpa adrenergic antagonists?

Back 170

AZOSIN group
terazosim-Hytrin, doxazosin-Cardura
causes vasodilation and therefore decreased PVR
should not use as solo drug
helpful in prostatism

Front 171

What are the centrally acting agents for BP/HTN?

Back 171

Clonidine-catapres, methyldope-aldomet
Work at center of brain for BP control
risk for sedation
DO NOT ABRUPTLY WITHDRAWAL

Front 172

What are the direct vasodilators?

Back 172

Hydralazine-Apresoline, minoxidil
peripheral vasodilation by relaxing the smooth muscle
risk for sedation
"tired and hairy"
may cause drug induced Lupus(hyralasize)
tx hirsutism with monoxidil

Front 173

What is chlorthalidone?

Back 173

diuretic, thiazide
causes increased sodium secretion therefore water goes with it
DO NOT USE IN GOUT CAN PRECIPITATE ATTACK-will increase levels of uric acid

Front 174

When must you do a fasting lipid profile?

Back 174

Those with significant cardio risk and those with elevated non fasting levels

Front 175

What is the goal for LDL?

Back 175

<160 if no risk factors
<130 if 1 risk
<100 with CHD or DM
<70 if high risk

Front 176

What is the goal for HDL?

Back 176

>60 in women

Front 177

what is the goal for total cholesterol?

Back 177

< 200

200-230 borderline high
>240 high

Front 178

What are the lifestyle modifications for cholesterol?

Back 178

increase fiber, decreased fat intake, increase omega fatty acids, lose weight, activity

Front 179

What are the HMG Co Reductase inhibitors?

Back 179

STATINS
powerhouse LDL reducers
watch liver
CK, rhabdo
grapefruit juice will increase effect!!!!!!!!!!!!!

Front 180

What are the bile acid resins?

Back 180

Sequestrants- Qustran-cholestyramine, Welchol
DIARRHEA
lower LDL
binds to comadin and renders it ineffective
works by sitting in gut absorbs bile acid and therefore decreases cholesterol

Front 181

What is Zetia?

Back 181

ezetimibe
selective cholesterol inhibitor
works in the lumen of the gut and blocks the absorbance of cholesterol
few systemic effect due to limited absorption

Front 182

How does niacin work?

Back 182

lowers lipoprotein
FLUSHING- minimize by taking ASA
contraindicated in gout, lever disease and peptic ulcer

Front 183

What are the fibric acid derivatives?

Back 183

Tricor,fenofibrate
dypepsia, gallstones, myopathy and rhabdo
not with renal or hepatic disease

Front 184

How does fish oil work?

Back 184

Lower tirglycerides, GI upset, increased risk of bleeding due to modest antiplatelet effect
discontinue 10 days prior to surgery

Front 185

How does red yeast work?

Back 185

This is what statins are derived from. Stop cholesterol synthesis. Same risks as statin- rhabdo.
CYP450
no grapefruit juice and some macrolides
lowers LDL

Front 186

Do ace inhibitors cause hypertriglyceridemia?

Back 186

No, will raise HDL and lower tri's
also insulin sensitizing

Front 187

What is a therapeutic INR?

Back 187

2-3
normal - 1-2

Front 188

At what tanner stage does menarche occur?

Back 188

4

Front 189

What has a fishy odor on KOH whiff test?

Back 189

BV

Front 190

What has pseudohyphae on KOH test?

Back 190

yeast, candidia

Front 191

What has gray discharge?

Back 191

BV

Front 192

What has clue cells

Back 192

BV

Front 193

How to you treat trichomonasis?

Back 193

Metro one time large dose (2 g)

Front 194

What is the most common cause of penile discharge?

Back 194

Gonorrhea
irritative voiding symptoms
rocephin
use spectinomycin if have beta lactam allergy

Front 195

What is the cause of non-goncoccal urethritis/cervicitis?

Back 195

C. trachomatis, ureaplasma, mycoplasma
tx- zithromax 1g dose

Front 196

What is the cheapest med to tx herpes with ?

Back 196

acyclovir
valtrex is much more expensive

Front 197

What has green yellow frothy discharge?

Back 197

Trich
alkaline pH

Front 198

What is the pH in atrophic vaginitis?

Back 198

alkaline- the most alkaline
tx with estrogen

Front 199

How do you treat PID?

Back 199

roceph+doxy or zith
with or without metro (when suspect anerobes as source)

Front 200

What can you treat with clindamycin cream?

Back 200

BV

Front 201

With what do you see strawberry hemorrhages on the cervic?

Back 201

Trich

Front 202

What do you suspect in candida infection in males?

Back 202

HIV, DM
this is not normal
tx with topical

Front 203

What is G6PD?

Back 203

enzyme deficiency resposible for RBC synthesis
RBC start to hemolyze with a lot of different medications
X linked
painless jaundice
MUST RX Non-oxidative drugs (ex cefixime is safe)

Front 204

Most common organism in UTI?

Back 204

E. coli (g-)
S. saprophyticus (g+)
Enterococci (g+)

Front 205

How do you treat a UTI?

Back 205

Bactrim: if unlikely resistant E. coli
If resistant or sulfa allergy: CIPRO, LEVO
nitrofurantonin as well (safe in preg not 3rd tirmester)

Front 206

How do you treat pyelonephritis in out pt setting?

Back 206

Cipro
levo
for a week

Front 207

What is test result is most sensitive to g- bacteria in urine testing?

Back 207

nitrite and leukocyte esterase

Front 208

What does a boggy prostate indicate?

Back 208

prostatitis

Front 209

What will you see with BPH?

Back 209

obilterated median sulcus, enlarged prostate, sensation of incomplete emptying of bladder

Front 210

What do you tx epididymitis with?

Back 210

if , 35 y/o most common cause is gonorrhea or chlamydia- tx with roceph and zith
if > 35 most common cause is enterobacteriaceae. tx with cipro

presents with irritative voiding s/s, painful and swelling to scrotum, infertility possible post infeciton

Front 211

How do you tx acute bacterial prostatitis?

Back 211

same as epididymitis.
<35 roceph and zith
> 35 cipro

will present with fever, voiding s/s, perineal pain, boggy prostate

Front 212

if you have treatment failure when treating prostatitis, what should you suspect?

Back 212

prostate stones- need a long course of cipro

Front 213

What is the most common finding with bladder cancer?

Back 213

painless gross hematuria
you may see persistent microscopic hematuria

Front 214

Should the ovaries be palpable on a post menopausal woman?

Back 214

Nope.

Front 215

What is a hydrocele?

Back 215

colleciton of serous fluid that causes painless scrotal swelling easily seen by transillumination

Front 216

What is a varicocele?

Back 216

bag of worms
scrotal mass that in only evident in standing position
tx; jock strap and sx

Front 217

what is characterized by the loss of the cremasteric reflex?

Back 217

testicular torsion

Front 218

What is phimosis?

Back 218

Can not pull the foreskin back to expose glans

Front 219

What is paraphimosis

Back 219

can not replace foreskin to cover the glans

Front 220

What is cryptorchidism?

Back 220

testicle located in the inguinal canal or abdomen
undescended
assoc. with increased risk for CA

Front 221

When should antiretroviral therapy be started in HIV/AIDS?

Back 221

CD4 of 350 or less
and initiate regardless is pregnant, hep B, or nephropathy

Front 222

Should pt's go on and off antiretrovirals?

Back 222

NO- will create resistance
commitment is lifelong

Front 223

If have PCP and HIV when should u start antiretrovirals?

Back 223

ASAP, no delay

Front 224

Which medication is preventative for gout

Back 224

Allopurinol

Front 225

Is colchicine for acute or preventative?

Back 225

Acute

Front 226

What route is most common for Hep A

Back 226

fecal oral

Front 227

What route is most common for tranmission of Hep B

Back 227

blood and body fluids

Front 228

What route is most common for transmission of Hep C

Back 228

Blood, body fluids- NO vaccine

Front 229

Ig G blood testing means what if positive?

Back 229

It's GONE

Front 230

IgM testing means what if it's positive?

Back 230

You have it now and are MISERABLE

Front 231

IgM testing means what if it's positive?

Back 231

You have it now and are MISERABLE

Front 232

What are the major differences between delirium and dementia?

Back 232

Delirium- sudden, hours to days, potentially reversible, change in psychomotor activity
Dementia- progressive, months to years
can coexist, should consider delirium when there is a sudden change

Front 233

What is the leading cause of delirium in an older adult?

Back 233

Infection. Older adults not good at localizing infection.

Front 234

What type of head injury/bleed can result from minor head trauma?

Back 234

Subdural hematoma.
Due to a combination of brain atrophy and relatively fragile vessels in the elder

Front 235

What is the difference between dementia and depression in the older adult?

Back 235

Depression is rapid, they are oriented, difficulty concentrating but not usually with memory.

Front 236

What is the most common type of dementia?

Back 236

Alzheimer type

Front 237

How do you treat early Alzheimer's?

Back 237

Want to slow the decline
Vitamin E
Selegeline (MAO inhibitor)
Aricept-donepezil, cholinesterase inhibitor (increases acetylcholine, only works on live neurons so want to start early to prolong progression of disease)
Namenda-memantine, creates an environment that allows for storage and retrieval of information

Front 238

What are some side effect of risperdal-risperdone?

Back 238

Weight gain
increased insulin resistance
increased blood clots --> increased stroke and cardiac events

Front 239

Can a cholinesterase inhibitor improve mental status?

Back 239

Yes. May return to pre-demetia baseline

Front 240

What are the signs of a major depressive episode?

Back 240

Sleep disturbances, interest decreased, guilt, energy, concentration, appetite, psychomotor, suicide
SIGECAPS

Front 241

What are the goals in the treatment of mood disorders?

Back 241

Prevent relapse
virtual elimination of symptoms

Front 242

When should ECT be considered?

Back 242

Major depressive disorder with high degree of symptom severity and functional impairment
- in cases with psychotic symptoms and catatonia
-need an urgent response, suicidal or refusing food

Front 243

Which SSRI is the most energizing?

Back 243

Prozac-fluoxetine

Front 244

Which SSRI has the longest half life?

Back 244

Fluoxetine-Prozac

Front 245

Which SSRI has anticholinergic effect?

Back 245

Paroxetine-Paxil

Front 246

Which SSRI has the least interactions?

Back 246

Escitalopram-Lexapro
Citalopram-Celexa

Paxil and Prozac have the most interactions

Front 247

Which meds are better to use with anxiety, SSRI or SSNRI?

Back 247

SSNRI
helpful in anxious depression
reports of being energized

Front 248

Which psych med is the worst to OD on?

Back 248

TCA's- nortriptyline and amytriptyline
Prolonged QT- cardiac arrest and seizure

Front 249

If a pt is likely to miss a dose of SSRI, which med will be better for them?

Back 249

Prozac-fluoxetine, long half life so no withdrawl

Front 250

What is the best way to differentiate between septic arthritis and and gout?

Back 250

Joint aspirate
will see crystals with gout

Front 251

Is the main problem with gout overproduction of uric acid or undersecretion?

Back 251

undersecretion
worsens with renal insufficiency, ETOH, diuretics and ASA
they don't secrete enough uric acid

Front 252

What foods should those with gout avoid?

Back 252

high purine
sweetbreads, liver, sardines, anchovies, kidney

Front 253

When testing the bicep reflex you are checking what?

Back 253

c 5&6

Front 254

When testing the tricep reflex you are checking what?

Back 254

c7

Front 255

When testing the brachioradialius reflex you are checking what?

Back 255

c6

Front 256

When testing the patellar reflex you are checking what?

Back 256

L4

Front 257

When testing the achilles reflex you are checking what?

Back 257

s1&2

Front 258

What is clonus?

Back 258

oscillations

Front 259

What is the McMurray test?

Back 259

for meniscal tear

Front 260

What is the Talar tilt test?

Back 260

ankle instability

Front 261

What is the Spurling test?

Back 261

cervical nerve root compression

Front 262

What is the tinel's test?

Back 262

carpal tunnel
tap on wrist

Front 263

What is the Lachman test?

Back 263

like anterior drawer test but on an angle
check for ACL tear

Front 264

What is the Straight leg raise test?

Back 264

lumber nerve root compression

Front 265

What is the drop arm test?

Back 265

rotator cuff injury

Front 266

What is the finkelstein test?

Back 266

DeQuervian tenosynovitis

Front 267

What is Osgood-Schlatter disease?

Back 267

during growth spurt
swollen tibal tuberosity
pain with movement
tx with decreased activity
The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit.

Front 268

Characteristics of Lumbar sacral strain

Back 268

Normal neuro exam
spasm, ache and stiffness

Front 269

What is the muscle relaxer with greatest risk of sedation?

Back 269

Soma=Coma
greatest risk for abuse

Front 270

Characteristics of lumbar radiculopathy?

Back 270

Most common site L4 L5 S1 (bulging disc)
sharp electric shock sensation
sneeze, cough and strain evokes sharp pain
+Straight leg raise
altered DTRs

Front 271

What is Pagets disease?

Back 271

Paget's disease of bone, the rate at which old bone is broken down and new bone is formed becomes distorted. Over time, the affected bones may become fragile and misshapen.

Front 272

When do you get and MRI or CT with back pain?

Back 272

Persistent lower back pain with s/s of radiculopathy or spinal stenosis
also if candidate for sx or corticosteriod injections

Front 273

Dorsifelxion innervates what?

Back 273

L5

Front 274

What is an important characteristic of spinal stenosis?

Back 274

pain unilateral, common with agina, pseudoclaudiculation
worse when you stand or walk
lessen or disappear when you sit down or lean forward
cannot walk for a long period of time.
Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.
s/s > 1 month = MRI

Front 275

What is the most helpful intervention to minimize hip fracture in an older woman?

Back 275

Aldendronate use (Fosamax)
biphosphonates
give with vitamin D and calcium
treat early to minimize damage

Front 276

Osteopenia is defined as how many standard deviations from the normal?

Back 276

1-2.5 on DXA scan
checked in spine, hip or forearm
1 SD is ok
Osteoporosis is 2.5 SD
treat at 1-2.5

Front 277

Who should be tested for osteoporosis?

Back 277

women >65, man >70
those with increased risk factors: post HRT therapy, smoker, diease presence, family hx etc

Front 278

What will you see on xray with osteoarthritis?

Back 278

Narrowing of joint space

Front 279

Signs of osteoarthirtis

Back 279

hypertrophic joint
Bouchard-PIP
Heberden- DIP

Front 280

What is ankylosing spondylitis?

Back 280

Joint b/w spine and pelvis fuse
+ pain with inactivity
decreased pain with movement
in the scaroilliac jointsbegins between ages 20 and 40

Front 281

What are some lifestyle modifications for GERD?

Back 281

raise HOB
lose weight
stop smoking
limit ETOH, fatty and other offending foods
eliminate some meds- CCB, nitrates and theophylline

Front 282

What are the meds for GERD

Back 282

anatacids- all metals, immediate acid neutralization (careful will chelate other meds) THESE ARE SUPERIOR
H2 blockers- pepcid , zantac IDINE (avoid tagamet b/c drug interections)
PPI-Nexium,protonix AZOLE

Front 283

Which medication is most effective against duodenal ulcer?

Back 283

Antibiotics- most commonly caused by H.pylori
otherwise ulcers with heal and then come back so you need to irradicate it
flagyl biaxin and amox

Front 284

What is Cullen's sign

Back 284

ecchymotic areas noted in the periumbilical region caused by retroperitoneal and intraperitoneal blood leak
"ecchymosis from the inside out"
Ectopic or hemorrhagic pancreatitis

Front 285

What is Markle's sign

Back 285

stand on tip toes and let body weight fall quickly onto the heels
+ if abd pain increases and suggestive of perotineal inflammation

Front 286

What is blumberg's sign

Back 286

elicited by deeply palpating an area of abd tenderness and tehn rapidly releasing the pressure
pain is worse with release usually indicating abd wall or perotineal inflammation
known as rebound tenderness

Front 287

What is murphy's sign

Back 287

Painful arrest of inspiration triggered by palpating the edge of inflamed gallbladder

Front 288

What should you suspect if vomiting and fever occur at the onset of abd pain?

Back 288

Gastroenteritis
infection hits the gut at the same time

Front 289

What are obturator and psoas signs

Back 289

seen with perineal inflammation
move those muscles to elicit the pain

Front 290

Characteristics of erosive gastritis?

Back 290

NSAIDS
pain worse after eating (get huge acid surge)
disease of too much
tender LUQ and hyperactive bowel sounds

Front 291

Characteristics of acute pancreatitis

Back 291

ETOH use
epigastric pain that radiates to back with bloating (distention because gut is not working so well)

Front 292

Characteristics of duodenal ulcer

Back 292

pain is worse when tummy is empty, therefore pain is decreased after eat

Front 293

Characteristics of diverticulitis

Back 293

LLQ pain
fever, cramping, and loose stoos

Front 294

Characteristics of Inflammatory bowel disease -crohn and ulcerative colitis

Back 294

crampy abd pain, diarrhea, weight loss and fatigue, tenesumus, sometimes fever
pale, tachy, diffuse abd tenderness
long hx of problem

Front 295

Characteristics of acute cholecystitis

Back 295

RUQ pain with radiation to shoulder, pain improved with vomiting, no fever

Front 296

Difference b/w crohn and ulcerative colitis

Back 296

Crohn goes from mouth to anus with cobblestone appearance
Colitis only in colon

Front 297

what is the normal hepatic span

Back 297

7 cm at midclavicular line on right

Front 298

What does it mean if HBsAG is present

Back 298

Hep B present
if HBsAB- means you have antibodies to it from past infection or immunization

Front 299

Is there a risk for cancer with hepatitis

Back 299

Yes. Hepatocellular carcinoma with hep B or C

Front 300

who should not use and IUD?

Back 300

PID
cerivcitis
unexplained bleeding
cervical CA
fibroids with distorted uterus
+antiphospolipids

Front 301

When should you test for DM in child?

Back 301

Tanner 2 onset of puberty or about 10 years
consider the risk factors

Front 302

What conditions make a teen emancipated for medical treatment

Back 302

smoking cessation
birth control and pregnancy
std treatment

Front 303

Which is more serious rubella or rubeola?

Back 303

rubeola, 10 days measles
rubella, is 3 day or german measles

Front 304

Differences between rubella and rubeola

Back 304

rubella- 3 days, longer incubation 14-21 days, mild and self limiting, posterior cervical lymphadenopathy prior to rash
rubeola- lasts 10 days, incuation 10-14 days, CNS and respiratory complications
Both transmissible for a week prior to rash and 2-3 weeks after rash, both treated with supportive care

Front 305

What do you want to tx kawasaki's with ?

Back 305

ASA and IgG to reduce cardiac abnormalities (dilation and aneurysm

Front 306

When is the uvula deviated

Back 306

Peritonsillar abscess

Front 307

characteristics of epiglottis

Back 307

rare, steeple sign, often caused by H. influenzae in children 2-7
abrupt onset with high fever and drooling

Front 308

What infants need iron supplementation

Back 308

preterm, those fed milk/breast milk (1 mg/kg/day started at 4 months until iron fortified foods are introduced)

do not need with formula

Front 309

what murmur obliterates the heart sounds

Back 309

mitral regurgitation

Front 310

What is stridor?

Back 310

Inspiratory wheeze, problem is getting air in as opposed to out with a expiatory wheeze
most often in kids

Front 311

With what do you see a hot potato voice

Back 311

PTA
also have trismus

Front 312

Can you give trimaminec to kids

Back 312

no pulled from shelves
5 deaths from this

Front 313

Can you give fluoroquinolones to kids

Back 313

nope
issue with growth plates

Front 314

What does an effusion mean in AOM?

Back 314

fluids behind the ear
usually from eustachian tube dysfunction
should only be air behind drum, no fluid

Front 315

What is bullous myrngitis

Back 315

painful
the surface of TM ruptures (not the TM)
be sure to give topical pain agent

Front 316

How to you distinguish a severe otitis vs. non

Back 316

fever > 102.2
treat with sever, may watch with non b/c high rate of spontaneous resolution without meds
always treat if you can not follow up

Front 317

what are the components of AOM

Back 317

bulging TM, erythema, no mobility, air-fluids level behind ear
purulent drainage

Front 318

Most likely pathogen in AOM

Back 318

s. pneumoniae

Front 319

What is OME

Back 319

otitis media with effusion, there are no signs of infection only effusion (fluid in the middle ear)
75-95 resolve without tx
if have persistent and language delay-->tympanostomy

Front 320

What is a hemiangioma

Back 320

vascular lesion, likely ill increase in size over first year of life
watch and wait, maybe steroids, sx laser

Front 321

what is a port wine spot

Back 321

grows proportionately with child, like a birth mark

Front 322

What is erythema neonatorium toxicum

Back 322

common and benign fluids filled lesions loaded with eopeinophils, reassure parents

Front 323

What are milia

Back 323

on sebaceous area after birth

Front 324

When does neonatal acne appear

Back 324

3-5 weeks after birth

Front 325

Can you palpate a mongolian spot

Back 325

no, they are non-tender as well
blue black patches

Front 326

Common site for eczema in babies

Back 326

face, no so common when older

Front 327

If a baby has a fever, when do they get a sepsis work up

Back 327

<1 month old-->ADMIT
pale, decreased cap refill, lethargic, irritable, not clinging to parent, tachy, no fluid food
toleration, want to see they viod every four hours

Front 328

what is pleocytosis

Back 328

WBC in CSF
consistent with viral or bacterial meningitis

Front 329

What is the clinincal presentation of lead poisoning

Back 329

none, few symptoms if any
if severe poisoning will have anorexia, constipation, and recurrent abd pain
tx: chelation if lead levels > 45ug/gl

Front 330

Who is at greatest risk for lead poisoning?

Back 330

2-3 y/o
consider if < 6
Those who live in house with lead based paint, built prior to 1957, also increases risk with renovation of these homes
toys from unregulated sources
in latino folk meds
chinese meds to calm fussy kids
candy from mexico

Front 331

what are normal lead values

Back 331

0-9.9ug/dl
no level is considered safe
if get a + repeat and confirm testing, repeat test sooner if high levels (10=1-3 mo, 15=1-2 mo, 20= 1 wk, 45= 1 week)
> 70 medical emergency hospitalize and repeat test immediately

Front 332

When is post partum depression most common?

Back 332

2-4 months post preg, but can occur any time within 1 st year

Front 333

When does post partum psychosis occur

Back 333

3 days
may need to hospitalize due risk for harm (baby and mother)

Front 334

Do older adult have increased or decreased serum albumin

Back 334

decreased

Front 335

What kind of half life do you want in elder

Back 335

shorter the better
go low and go slow

Front 336

what happens to CYP450 with age

Back 336

CYP450 isoenzymes drop in older

Front 337

Does GFR increase or decreased with age

Back 337

decrease

Front 338

What is true about nitrofurantoin and elders

Back 338

careful because with decreased Creat clearance you will not get an adequate concentration and treatment may fail
others-Januvia
no antimicrobial adjustment with rosh, doxy clinda moxy

Front 339

What is true about elders and cholinesterase inhibitors

Back 339

increased risk for cardia event (aricept)

Front 340

What is preterm

Back 340

<37 wks

Front 341

most accurate measurement of baby

Back 341

crown rump- most accurate dating, done in 1st trimester

Front 342

what size is fetus at 8 weeks

Back 342

tennis ball or orange

Front 343

what size is fetus at 10 weeks

Back 343

baseball, FHT with doppler possible in thin

Front 344

what size is fetus at 12 weeks

Back 344

grapefruit

Front 345

what size is fetus at 16 weeks

Back 345

halfway between syphsis and umbillicus

Front 346

what is thiamine deficiency

Back 346

b1
seen in ETOH
Wernecke=korsakoff

Front 347

what is folic acid deficiency

Back 347

b9
anemia
there is plenty of folic acid in green veggies
neural tube defects

Front 348

What do you see with vit. k deficiency

Back 348

clotting disorders
also used to reverse excessive coagulation (reverse coumadin)

Front 349

What effect do antidpressants have most on depression

Back 349

allevating sleep disturbances and helping with appetite

Front 350

What is the most common cause of dementia

Back 350

alzheimers and vascular disease

Front 351

What valerian root

Back 351

anxioltic and sleep aid
herbal

Front 352

What are some mediations that have depression as a side effect

Back 352

antiparkinsons, hormones, htn meds

Front 353

What are the s/s depression

Back 353

Sleep
intertes
guilty
energy
concentrate
appetite
psychomotor

Front 354

What is a thymectomy

Back 354

Removal of thymus
therapeutic in myesthenia gravis

Front 355

What are some medications use in Myethenia gravis

Back 355

cholinesterase inhibitors-neostigmine
immunosuppresives