You have been treating Jason, 35 y\/o M, for HIV infection, and the course of his treatment requires that he be hospitalized for a few days. His medical bill is paid by his Aunt, Sylvia, who wants to know why her nephew was in the hospital, but Jason is not willing to share that information. What is the appropriate course of action?
the NP should not release the details of Jason’s health status to his aunt<\/p>\n\n\n\n
Which of the following best describes a II\/VI heart murmur?
Audible but faint<\/p>\n\n\n\n
21 y\/o M comes complaining of a painful bump with small, red-looking halo on his penis. The affected area is about 5 mm in diameter, soft and TTT. he states that the halo has been there for about a week and is painful. he doubts that he has a STI, since the only unprotected sex he has ever had has been with his current, longtime GF. he adds that his GF “can be trusted” and that she has never had an STI. What is the most likely diagnosis?
Chancroid<\/p>\n\n\n\n
While treating 29 y\/o F for vulvovaginitis, you inquire about her sexual hx. She explains that she has been sexually active for about 10 years. There are many cases of vulvovaginitis, but only one is an STI. Which one?
Trichomoniasis<\/p>\n\n\n\n
35 y\/o sarah says she her partner are in committed relationship and are looking for long lasting, effortless BC method. She wants to explore her BC options but mentions that she has an allergy to estrogen=based BC. What choice should be recommended?
Implanon<\/p>\n\n\n\n
Differences b\/t glaucoma and cataracts. Which test would be test?
T test<\/p>\n\n\n\n
Which of the following CN does NOT control eye movement
CN II (Olfatory)<\/p>\n\n\n\n
A man who recently attempted suicide is brought to your office by his wife. Having conducted a significant amount of research on her own about suicide prevention, she has many questions. Which of the following choice is the LEAST effective treatment for her husband?
? Intervention is the pt’s risk is escalating<\/p>\n\n\n\n
During a physical exam, Brett mentions that he wants to quit his job but is worried about losing health insurance. you inform him that HIPAA will provide protection for workers when they change or lose their jobs. This includes certain private information that pertains to Brett’s experience with the healthcare system. What is NOT true about HIPAA?
? All sharing of pt’s information requires written authorization<\/p>\n\n\n\n
Using the Dubowitz\/Ballard exam to estimate the gestational age of a Caucasian newborn, you determine him to be post-term. Which of the following is a finding NOT related to a criterion included in the Dubowitz\/Ballard exam?
Elasticity of cartilage in nose<\/p>\n\n\n\n
plantar creases over sole of feet
thickness and size of breast tissue
Hypertonic flexion of knees are included<\/p>\n\n\n\n
There is concern at your clinic that some children with developmental delays are not being identified soon enough. You are examining a 6 y\/o M. Which is the best tool to identify risk for developmental delay in this child?
Denver II<\/p>\n\n\n\n
Doris, 77 y\/o F, reports abd pain in the LLQ. For the last several weeks, Doris experienced frequent constipation and has taken laxatives for relief. However, her abd pain has become increasing severe and has been accompanied by n\/v. Her lab work shows an ESR of 45 mm\/hour and leukocytosis. Additionally, a sigmoidoscopy reveals inflamed mucosa. What is the most likely diagnosis?
Diverticulitis<\/p>\n\n\n\n
Donna, 25, took pregnancy test a week ago and learned that she is pregnant. Her mother is currently on insulin therapy to control diabetes, and Donna has BMI of 31. Since she is in her first trimester, which of the following diagnostic tests should you first order to assess the risk specific to this pt?
Urinalysis<\/p>\n\n\n\n
Kaitlin is 18 y\/o and has recently become sexually active. She requests a contraceptive prescription at your clinic. A physical exam indicates that she is 5’6 and 205lbs. Based on her ht and wt, which would be the LEAST effective form of contraception?
? Nuva ring<\/p>\n\n\n\n
Tanya is 10 y\/o, 4’8, and 110 lbs. Tanya’s mother is concerned about her wt and eating habits, as she has found junk food wrappers hidden around the house. She adds that Tanya is very defiant when it comes to food restrictions. Which of the following is the most appropriate way of approaching the topic of diet with Tanya?
Review the new MyPlate standards with Tanya and help her understand why a balanced diet and maintaining a healthy wt are important<\/p>\n\n\n\n
Dori, 64, has experienced recurring bouts of shingles. although you note during todays appointment that her skin eruptions have disappeared, she complains of pain and burning sensations that remain in the areas of outbreak. These sensations, she adds, have been severe enough to interfere with her sleep. What would be prescribed?
Gabapentin<\/p>\n\n\n\n
24 y\/o comes in for sore throat, nasal congestion, and cough. Pt repeatedly clears her watery congestion into tissue. Pt does not have fever, and PE is unremarkable. What is the most likely cause?
Common cold<\/p>\n\n\n\n
59 y\/o M is having FU eval 2 years after conclusion of chemo for leukemia. He tells you that he has been feeling “run down” and report unexplained wt loss, pain below the ribs on his left side, and night sweats. You determine he also has a fever. You consider chronic myelogenous leukemia Which finding is hallmark?
? Lymphocytosis<\/p>\n\n\n\n
15 y\/o penelope, who complains of regularly being tired. You note that she has dry skin, thinning hair, and intolerance to cold. Which of the following should be tested for in order to verify the most likely diagnosis?
? Elevated TSH and decreased T4<\/p>\n\n\n\n
65 y\/o in recent months noticed persistent, sharp, and painful spasms in her left cheek. They occur primarily when she is applying makeup and do not occur on the other side of her face. The pain feels like “an electric shock”. Which fo the following would be LEAST appropriate treatment for this condition?
Calcium channel blocker<\/p>\n\n\n\n
*Anti-seizure drugs
Muscle relaxants
Tricyclic antidepressants<\/p>\n\n\n\n
What is the purpose of case mgmt?
To mobilize, monitor, and control resources used by pt during illness<\/p>\n\n\n\n
16 y\/o M, with no abnormalities in his medical records, presents with unusual body proportions and underdeveloped sexual characteristics. Blood test indicates Klinefelter syndrome. Which is NOT typical feature of klinefelter syndrome?
Short stature<\/p>\n\n\n\n
*Hypogonadism
learning disability
Gynecomastia<\/p>\n\n\n\n
Elderly have a blunted fever response to infection due to an impairment in which body system?
Nervous system<\/p>\n\n\n\n
Prophylactic treatment of Pneumocystis jirovecii
Co-trimoxazole (trimethoprim-sulfamoxazole)<\/p>\n\n\n\n
ECG changes in hypokalemia
broad T wave and prominent U waves<\/p>\n\n\n\n
Atypical UTI symptoms usually found in elderly pts
lethargy
decreased appetite
incontinence<\/p>\n\n\n\n
acidosis and hyperthermia have what affect on the oxyhemoglobin dissociation curve
oxygen has a decreased affinity for hemoglobin shifting the curve to the right + to the tissues<\/p>\n\n\n\n
alkalosis and hypothermia have what effect on the oxyhemoglobin dissociation curve
oxygen has a greater affinity for hemoglobin shifting the curve to the left = to the blood<\/p>\n\n\n\n
What does it mean when there is a right shift in the oxyhemoglobin dissociation curve?
means that a higher PO2 is required to achieve hemoglobin saturation compared to baseline
*oxygen is more willing to unload into the tissues<\/p>\n\n\n\n
What does it mean when there is a left shift in the oxyhemoglobin dissociation curve?
it means that less PO2 is required to achieve hemoglobin saturation compared to baseline
*oxygen is less willing to unload into the tissues<\/p>\n\n\n\n
JNC 8 threshold for treatment of HTN in the elderly
150\/90<\/p>\n\n\n\n
Immediate treatment after diagnosis of pheochromocytoma is what?
Phentolamine to stabilize before surgery<\/p>\n\n\n\n
Criteria for diminished renal reserve
nephron loss of 50% and double baseline Cr<\/p>\n\n\n\n
Criteria of renal insuficiency
nephron loss of 75% and mild azotemia<\/p>\n\n\n\n
Treatment of bacterial vaginosis
metronidazole or clindamycin<\/p>\n\n\n\n
End-stage renal disease criteria
90% nephron loss, azotemia, and metabolic alterations<\/p>\n\n\n\n
American Burn Association: Burn Center Referral Criteria<\/p>\n\n\n\n
dislocation
displacement of a bone from its joint<\/p>\n\n\n\n
subluxation
partial dislocation<\/p>\n\n\n\n
Labs in temporal arteritis
high ESR
normal WBC<\/p>\n\n\n\n
Temporal arteritis treatment
High-dose steroids<\/p>\n\n\n\n
Normal CVP
2-6<\/p>\n\n\n\n
CVP is elevated in conditions that cause a(n) _<\/strong><\/em><\/strong> in the amount of fluid in the right atrium Shock states that cause an elevated CVP CVP is decreased in conditions that cause a(n) _<\/strong><\/em><\/strong> in the amount of fluid in the right atria Shock states that cause a decreased CVP MAP formula Normal pulmonary wedge pressure Shock states with elevated PWP Shock states that cause low PWP PWP is a measure of what PWP is increased in conditions that __<\/strong><\/em><\/strong> the pressure in the left ventricle at the end of diastole Conditions that increase PWP PWP is decreased in conditions that ___<\/em><\/strong><\/em><\/strong> the pressure in the left ventricle at the end of diastole Normal CVP Normal PWCP Cardiac Output Normal CO Normal CI SVR Normal SVR Where is SvO2 measured? What is SvO2 Normal SvO2 What does low SvO2 indicate What does high SvO2 indicate? Hypovolemic shock hemodynamics Cardiogenic shock hemodynamics septic shock hemodynamics Anaphylactic shock hemodynamics obstructive shock hemodynamics Neurogenic shock hemodynamics Herbal agents that increase risk of bleeding Herbal agents that increase clotting Use of St. Johns wart Normal Plts Lower UTI drugs Upper UTI drugs Prerenal Diagnostics Intrarenal diagnostics Postrenal diagnostics Management of Prerenal AKI Management of intrarenal AKI Management of post renal AKI Criteria of dialysis Most common nephrotoxic drugs<\/p>\n\n\n\n Differential for testicular pain Management of nephrolithiasis Black box warning for Reglam BPH onset Use of Saw Palmetto Normal GFR GFR diminishes __<\/strong>% per decade after 30yo Normal Renal Gerontology changes GFR formula Which patients do we treat for asymptomatic bacteriuria Valve activity in S1 Valve activity in S2 S3 heart sound S4 heart sound Murmur grades Ms. Ard and Mr. Ass Murmur locations NYHA Classification of HF Treatment of acute pulmonary edema decreased cortisol levels increased cortisol levels ACC\/AHA Stage 1 HTN ACC\/AHA Stage 2 HTN<\/p>\n\n\n\n 140 OR >90<\/p>\n<\/blockquote>\n\n\n\n First line HTN medication Management of HTN urgency Treatment of HTN emergency What is Prinzmetal’s angina? Lipid panel normals Meds for angina What is the Pooled Cohort Equation used for High intensity statins Therapeutic INR Therapeutic PTT Contraindications for TPA 3 hours Medication management of PVD Normal ABI ABI indicative of PVD ECG changes in pericarditis Treatment of pericarditis Major complication of pericarditis Causes of night sweats in adults Fever Top fiver killers of adults in US Cranial nerves Signs of vertebrobasilar stroke Potassium considerations in burn pts How to remove tar in tar burns signs of temporal arteritis Eye cup : disk Cause of increased cup size in eye A\/V ratio in the eye Signs of diabetic retinopathy AV nicking is most commonly seen on retinal exam of which chronic condition? Differentiation of Conjunctivitis and treatments Gonococcal and chlamydia treatment Normal intraocular pressure (IOP) Treatment of open angle glaucoma treatment of closed angle glaucoma -eyedrops: timolol, pilocarpine, apraclonidine Major differences in acute\/closed angle glaucoma and cataract exam Adult Portion<\/p>\n\n\n\n Contraceptive Options<\/p>\n\n\n\n What would cause break through bleeding on Day 1-9 of cycle? What would cause break through bleeding on Day 20-21 of cycle What are the absolute contraindications of COC? What type of pill for migraine HAs, breastfeeding, contraindication to COC? When should a diaphragm\/cervical cap be refitted? How long should a diaphragm be left in vagina following intercourse? EENT<\/p>\n\n\n\n If cup is more than 1\/2 the size of the disc diameter, consider __<\/em> Raised area at where an artery and vein meet infection of the eye usually by S. aureus management of hordeolum (stye) beady nodule on eye lid, infection or retention cyst of meibomian glad, usually on upper lid management of chalazion Staph infection or seborrheic dermatitis of lid edge management of blepharitis treatment for bacterial conjunctivitis gonorrhea in eye chlamydia in eye treatment for allergic conjunctivitis increased intraocular pressure type of glaucoma: type of glaucoma: Tonometry screening nationally recommended by age clouding and opacification of the normally clear lens of the eye separation of the light-sensitive membrane in the back of the eye (retina) from its supporting layers type of chronic otitis media consisting of peeling layers of scaly or keratinized epithelium; if untreated, may erode the middle ear, leading to nerve damage and deafness<\/p>\n\n\n\n squamous epithelium lined sac, filled with desquamated keratin What are some medications for the management of vertigo? sensorineural hearing loss, vertigo, & tinnitus Weber test normal Rinne test normal Conductive loss Weber & Rinne Sensorineural loss Weber & Rinne watery rhinorrhea anterior cervical adenopathy Centor criteria for strep (FLEA)<\/p>\n\n\n\n very specific test- the negatives test negative management of strep throat ABRUPT onset of fever, HA, myalgia, coryza, anorexia, malaise, cough management of flu white tonsillar exudates management of mono inflammation of mucous membranes lining one or more of the paranasal sinuses<\/p>\n\n\n\n recent URI, with relapse decreased transillumination management of bacterial sinusitis Skin<\/p>\n\n\n\n circumscribed flat area of skin ex. freckle, petechiae, flat nevi large macule, >1cm in size<\/p>\n\n\n\n ex. mongolian spot, cafe au lait small, solid, elevated lesion ex. ant bite, elevated nevus, verruca (wart) elevation of skin<\/p>\n\n\n\n 1cm in diameter<\/p>\n<\/blockquote>\n\n\n\n ex. psoriasis a visible accumulation of purulent fluid under skin ex. acne, impetigo circumscribed elevation of skin containing serous fluid herpes, varicella solid mass of skin 1cm in diameter ex. xanthoma, fibroma “blister” 1cm in diameter ex. burns, superficial blister, contact dermatiti elevated white or pink compressible papule or plaque ex. PPD test, mosquito bites any closed cavity or sac ex. sebaceous cyst a localized collection of purulent fluid in a cavity formed by disintegration or necrosis of tissues<\/p>\n\n\n\n 1cm in size “mass”<\/p>\n\n\n\n a few cm in diameter LIVE vaccines most frequently used topical antibiotic for acne PO antibiotics for acne<\/p>\n\n\n\n 2 major skin pathogens boil that looks like a spider bite inflamed area of skin most common pathogens of cellulitis management of CA-MRSA if area of very low CA-MRSA infection management of Group A strep<\/p>\n\n\n\n Which antibiotic will cover both CA-MRSA & Strep looks like a big sunburn Staph infection What treatment for minor skin infections? 1st gen cephalosporin- cephalexin (Keflex) What pathogen is impetigo usually caused by? What is paronychia? bruise under finger nail inflammation of the superficial tissues of the penile head caused by Candida albicans<\/p>\n\n\n\n and its treatment miconazole, clotrimazole, steroids, fluconazole<\/p>\n\n\n\n irritation of the fold of the skin, commonly occurring in warm, moist body areas treatment for capitus What 2 meds for post-herpectic neuralgia small patches in sun-exposed parts of body What can AKs progress to? management of AKs firm, irregular papule or nodule common on geros treatment of seborrheic keratoses most common skin CA mortality rate highest of all skin CAs What is the initial treatment for psoriasis? mild, acute inflammatory disorder What tests do you order if you suspect lyme? management of lyme What kind of rash do you have with lyme vs. rocky mountain spotted fever? What tests for RMSF? sudden onset flu-like symptoms pruritic papule leading to ulcer surrounded by vesicles antibiotic for anthrax Endocrine<\/p>\n\n\n\n insulin dependent lab findings DM1 What lab specific to DM 1? normal BUN which one fluctuates? most sensitive indicator of renal fxn? good a1c What percent of diet should be carbs? when should insulin be started? how should insulin be split up during the day? include dosage review pg. 228-230<\/p>\n\n\n\n nocturnal hypoglycemia develops a stimulating surge of counter regulatory hormones. treatment of Somogyi tissue becomes desensitized to insulin nocturnally; progressive elevation of glucose at night treatment of Dawn phenomenon most common presentation of hyperthyroidism? most common presentation of hypothyroidism? most important lab for hyperthyroid? Most important for hypothyroid? hyperthyroidism hypothyroid symptomatic treatment of hyperthyroid meds of hyperthyroid ACTH hyper secretion by pituitary s\/s of Cushings deficient cortisol, androgens, aldosterone s\/s of Addison’s outpatient management of Addison’s hydrocortisone (glucocorticoid) labs of Cushings labs of Addisons Musculoskeletal<\/p>\n\n\n\n What lab would be important before high-dose NSAIDs? knee locking & immediate swelling palpable\/audible click when knee is raised slowly with one foot externally rotated knee in 20-30 degree flexion, grasp leg wit one hand with anterior force to proximal tibia while opposite hand stabilizes the thigh (graded 1+ to 3+) patient prone up to how many steroid injections per year? What are the dangers of too many steroid injections? endocrine dysfunction- Addison’s crisis- no steroid made by body- hypotension<\/p>\n\n\n\n Heberden’s nodes and Bouchard’s nodes seen with which type of arthritis? Heberden’s are where Bouchard’s are where test for carpal tunnel that involves tapping over median nerve put them in the pharaoh position for 1 min (wrist flexion) quad muscle weak weakness with dorsiflexion of great toe and foot weakness of plantar flexion of great toe and foot benign neuroma causing a compression neuropathy of an inter metatarsal plantar nerve, most commonly of the 3rd or 4th inter metatarsal spaces inflammation of plantar fascia, the thick tissue on the bottom of the foot that connects the heel bone to toes and creates the arch of the foot rupture of growth plate at the tibial tuberosity as a result of stress on the patellar tendon management of Osgood-Schlatter disease an inflammatory disorder involving pain and stiffness in shoulder and usually the hip What lab will be increased with polymyalgia rheumatica? management of polymyalgia rheumatica STDs<\/p>\n\n\n\n What is the initial test for HIV? What is the confirmatory test for HIV? What is the normal CD4 lymphocyte count?<\/p>\n\n\n\n 800<\/p>\n<\/blockquote>\n\n\n\n What is the CD4 count that is considered AIDS? What is the ideal viral load? You want the _ to be high and the _<\/em><\/strong> to be low? What is the leading killer of AIDs patients? When does the CDC recommend AART be started? gram-negative bacillus the degree to which those who have a disease screen\/test positive the degree to which those who do not have a disease screen\/test negative if there is a question about sensitivity, you would mark hose who DO\/DO NOT have it if there is a question about specificity, you would mark those who DO\/DO NOT have it Treatment of chancroid The 2 STDs where it hurts when they pee What 4 things cause dyspareunia in women? treatment for chlamydia treatment for gonorrhea fever, malaise, dysuria, painful\/pruritic ulcers on genitalia recurrence with less painful ulcers lasting for __<\/em> days which vir drug especially useful for asymptomatic viral shedding of HSV 2 immunotypes L1, L2, or L3 of Chlamydia trachomatis treatment of lymphogranuloma venereum (LGV) lesions are 1-5mm smooth, rounded, firm, shiny flesh-colored to pearly-white papules treatment of molluscum treatment of syphilis GYN<\/p>\n\n\n\n malodorous, frothy yellow-green discharge, pruritus, vaginal erythema, “strawberry patches” on cervix and vagina, dyspareunia, dysuria how to do wet-prep for trich? watery, gray, fishy smelling discharge, vaginal spotting thick, white, curd=like discharge, vulvovaginal erythema with pruritus Wet prep for BV? Wet prep for candidiasis? treatment of trich treatment of BV treatment of candidiasis the flu + gyn treatment of PID What are the 3 major concerns when considering hormonal therapy for menopausal symptoms?<\/p>\n\n\n\n if not clear, refer<\/p>\n\n\n\n DEXA -1.0 SD<\/p>\n<\/blockquote>\n\n\n\n osteopenia T score osteoporosis T score dietary sources of calcium management of lower UTI other considerations UTI during pregnancy amoxicillin What is the black box warning about cipro? usually younger man Positive Prehn’s sign treatment for epididymitis <35 treatment for epididymitis >35 UTI-like in man antibiotic choices for acute bacterial prostatitis s\/s 2 med classes and 1 herb for BPH Psychosocial<\/p>\n\n\n\n difficulty with speech inability to perform a previously learned task inability to recognize an object What are the meds for Alzheimer’s disease? vise-like or tight quality which cranial nerve associated with migraine? What would you use sumatriptan (imitrex) for? a degenerative disorder as a result of insufficient amounts of dopamine? trio of finds for parkinson’s GI<\/p>\n\n\n\n Anti-HAV, IgM Anti-HAV, IgG ABsAG, HBeAg, Anti-HBc, IgM ABsAG, Anti-HBc, IgM, IgG Anti-HBc, Anti-HBsAg Anti-HCV, HCV RNA Cardiac<\/p>\n\n\n\n What happens during S1? What happens during S2? What is systole? What is diastole? What does S3 mean? What does S4 mean? Hematologic & oncologic disorders<\/p>\n\n\n\n Hct normal male\/female TIBC- capacity to store iron Serum iron MCV- microcytic\/macrocytic SIZE normal MCH- expression of av amount & weight of Hgb in a single RBC normal MCHC- hypochromic\/normochromic normal 2 anemias with low MCV- small in size 2 anemias with high MCV- big- megaloblastic Normocytic anemia Iron deficiency labs Management of IDA Foods high in iron Thalassemia labs Thalassemia management Folic acid def labs Folic acid def signs Treatment folic acid def Pernicious anemia labs Pernicious anemia signs Pernicious anemia treatment anemia of chronic disease labs Anemia chronic disease treatment Sickle cell labs Sickle cell crisis treatment leukemia definition 80% of acute leukemia in adults more difficult to cure in adults than children (90% remission in children) most common leukemia in adults occurs in individuals 40 and older S\/S leukemia Labs leukemia Management of leukemia Non-Hodgkin’s lymphoma Hodgkin’s desease Lymphoma management Psychosocial disorders<\/p>\n\n\n\n Depression- In Sad Cages Alcoholism- Cages questionnaire cause of Alzheimer’s meds of Alzheimer’s Cognitive defect definitions<\/p>\n\n\n\n test for object recognition draw 6 in palm aphasia apraxia agnosia Cranial nerves mnemonic CN 7- facial. Which disease? Entirely sensory Move the eyes CN associated with migraine Meds for daily prophylactic therapy of migraines occurring more than 2-3x per month Meds for acute migraine What 2 types of HA do you use sumatriptan (Imitrex) for? sign of stroke w\/ altered vision- ipsilateral monocular blindness HTN<\/p>\n\n\n\n Simple partial seizure Complex partial seizure absence (petite mal) tonic-clonic (grand mal) status epilepticus Labs\/diagnostics Management of seizures Seizure prevention meds Parkinson’s definition trio of findings in Parkinson’s 2 med classes in Parkinson’s<\/p>\n\n\n\n Myasthenia gravis Myasthenia gravis s\/s Myasthenia gravis labs Myasthenia management MS def MS s\/s MS findings MS management Bell’s CN Bell’s treatment Trigeminal neuralgia Trigeminal neuraligia management GI<\/p>\n\n\n\n murphy’s sign diverticulitis gnawing epigastric pain H. pylori What kind of ulcers in older 55-65y? What kind of ulcers in younger 30-55y? relief of pain with eating more pain eating 1st line PUD 2nd consideration for PUD- diagnosed officially basic combo therapy for H. pylori eradication pain with right thigh extension pain with internal rotation of flexed right thigh RLQ pain when pressure applied to LLQ Lower respiratory<\/p>\n\n\n\n normal percussion sound of chest asthma percussion mainstay of COPD treatment (chronic bronchitis and emphysema) most common bug in CAP treatment of CAP unhealthy, old- fluoroquinolone- levofloxacin (Levaquin), gemifloxacin (Factive), or moxifloxacin (Avelox)<\/p>\n\n\n\n Cardiovascular<\/p>\n\n\n\n ST segment changes with angina vs MI Total cholesterol normal Trigylcerides HDL<\/p>\n\n\n\n 40<\/p>\n<\/blockquote>\n\n\n\n LDL 3 common med categories for the outpatient treatment of angina Meds for hyperlipidemia Extra heart sound common with infarct ECG changes with MI Leads I, aVL II, III, aVF V leads or V3 and V4 Cardiac enzymes Hx CAD, 68yoM, hyperlipidemia, smokes 2ppd, diabetic, calf hurts, numbness to toes, pain Woman, maybe genetic, aching of LE’s, relieved by elevation, edema when up on feet, night cramps, trophic changes, brown blotches, dermatitis low pitched rumble during 1st heart sound EENT<\/p>\n\n\n\n What does it mean if the cup is more that 1\/2 the size of the disc diameter? retinal vessels raised area where A & V meet hyperopia myopia presbyopia arcus senilis hordeolum (stye) chalazion blepharitis eyes itching, burning, redness, tearing, blurred vision, swelling of eyelids, foreign body sensation Increased intraocular pressure asymptomatic acute clouding and opacification of the normally clear lens of the eye You have been treating Jason, 35 y\/o M, for HIV infection, and the course of his treatment requires that he be hospitalized for a few days. His medical bill is paid by his Aunt, Sylvia, who wants to know why her nephew was in the hospital, but Jason is not willing to share that information. 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increase<\/p>\n\n\n\n
cardiogenic shock
obstructive shock
*also FVO<\/p>\n\n\n\n
decrease<\/p>\n\n\n\n
distributive shock
hypovolemic shock<\/p>\n\n\n\n
(SBP + 2DBP)\/3<\/p>\n\n\n\n
6-12<\/p>\n\n\n\n
cardiogenic
low then high – septic<\/p>\n\n\n\n
hypovolemic
obstructive
anaphylactic
neurogenic<\/p>\n\n\n\n
left ventricular function
end-diastolic left ventricular pressure<\/p>\n\n\n\n
increase<\/p>\n\n\n\n
FVO
decreased elasticity of the left ventricle<\/p>\n\n\n\n
decrease<\/p>\n\n\n\n
2-6 mmHg<\/p>\n\n\n\n
6-12 mmHg<\/p>\n\n\n\n
HR x SV<\/p>\n\n\n\n
4-8 L\/min<\/p>\n\n\n\n
2.5-4<\/p>\n\n\n\n
the resistance of systemic circulation<\/p>\n\n\n\n
800-1200<\/p>\n\n\n\n
Pulmonary artery<\/p>\n\n\n\n
a measurement of effectiveness of O2 delivery<\/p>\n\n\n\n
60-80%<\/p>\n\n\n\n
increased tissue extraction of O2
decreased O2 supply (decreased CO, decreased FiO2, anemia)
increased O2 demand (fever, shivering, increased WOB)<\/p>\n\n\n\n
decreased tissue extraction of O2
increased O2 supply (FiO2 > need)
decreased O2 demand (hypothermia)
decreased effectiveness of O2 delivery and uptake by cells (sepsis, shift of oxyhemoglobin dissociation curve to the left)<\/p>\n\n\n\n
SVR HIGH, everything else low
CO\/CI – low
CVP – Low
PWP – low
SVR – HIGH
SvO2 – low<\/p>\n\n\n\n
LOW CO\/CI & SvO2 everything else high
CO\/CI – low
CVP – HIGH
PWP – HIGH
SVR – HIGH
SvO2 – low<\/p>\n\n\n\n
CO\/CI: High then low (only shock state with high CO)
everything else: low then high<\/p>\n\n\n\n
everything low<\/p>\n\n\n\n
LOW CO\/CI and normal to low PWCP; everything else HIGH
CO\/CI – low
CVP – HIGH
PWP normal\/low
SVR – HIGH
SvO2 – HIGH<\/p>\n\n\n\n
everything low<\/p>\n\n\n\n
if it starts with G it increases bleeding
Ginger
Ginko Biloba
Garlic
Ginseng<\/p>\n\n\n\n
St. Jon’s Wart<\/p>\n\n\n\n
depression
BPH
Sleep<\/p>\n\n\n\n
150,000-400,000\/mm3<\/p>\n\n\n\n
trimethoprim-sulfamethoxazole (Bactrim) <20% resistance nitrofurantoin (Macrobid) >20% resistance
Fosfomycin (expensive)<\/p>\n\n\n\n
Ciprofloxacin
Levofloxacin
Ceftriaxone (IV)<\/p>\n\n\n\n
Serum BUN:Cr – >10:1
urine Na – <20 mmol SG – >1.015
Fractional Excretion of Na <1
Urinary Sediment – normal\/few hyaline casts<\/p>\n\n\n\n
Serum BUN:Cr – 10:1
Urine Na – >40 mmol
SG <1.015 Fractional Excretion of Na >3
Urine Sediment Granular with white casts<\/p>\n\n\n\n
Serum BUN:Cr – 10:1
Urine Na – >40 mmol
SG <1.015 Fractional Excretion of Na – usually >3<\/p>\n\n\n\n
expand volume<\/p>\n\n\n\n
maintain perfusion, stop nephrotoxic drugs, RRT<\/p>\n\n\n\n
remove obstruction<\/p>\n\n\n\n
A – acidosis (metabolic)
E – electrolyte abnormalities
I – intoxication
O – oliguria <400 cc\/day
U – uremia<\/p>\n\n\n\n\n
renal stone (no relief with testicular lift)
epididymitis (relief with testicular lift)
torsion (no relief with testicular lift)<\/p>\n\n\n\n
CT scan
PRN morphine or dilaudid and x1 toradol, and x1 reglan
possible lithotripsy (large stone)<\/p>\n\n\n\n
EPS – tardive dyskinesia in long term use<\/p>\n\n\n\n
50 yo<\/p>\n\n\n\n
BPH
no evidence for Prostate Cancer prevention!!<\/p>\n\n\n\n
125 mL\/min<\/p>\n\n\n\n
10<\/p>\n\n\n\n
decreased kidney size and number of nephrons
reduced response to vasopressin and impaired Na conservation
decreased bladder tone, elasticity, and capacity
prostate enlargement<\/p>\n\n\n\n
(140 – age) x (WT x .85 {for women})\/73 x Serum Cr<\/p>\n\n\n\n
pregnancy
urologic interventions
renal transplant<\/p>\n\n\n\n
mitral\/tricuspid close
aortic\/pulmonic open<\/p>\n\n\n\n
aortic\/pulmonic close
mitral\/tricuspid open<\/p>\n\n\n\n
Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles, pregnancy<\/p>\n\n\n\n
Atrial Gallup;
related to stiffness of the ventricular myocardium to rapid filling<\/p>\n\n\n\n
I\/VI – barely audible
II\/VI: audible but faint
III\/VI: moderately loud
IV\/VI: loud with a thrill
V\/VI: very loud
VI\/VI: loudest<\/p>\n\n\n\n
Mitral Stenosis & Aortic Regurgitation = Diastolic
Mitral regurgitation & Atrial Stenosis = Systolic<\/p>\n\n\n\n
Aortic – Right sternal boarder 2nds ICS
Pulmonic – left sternal boarder 2nd ICS
Tricuspid – left sternal boarder 4th ICS
Mitral – 5th ICS at midclavicular line<\/p>\n\n\n\n
class 1 -no symptoms
class 2 – slight symptoms on exertion
class 3 – marked symptoms on exertion
class 4 – symptoms at rest<\/p>\n\n\n\n
low flow O2
4 morphine
40 mg lasix x2 q10<\/p>\n\n\n\n
-Adrenal hyperplasia
-Addison’s disease
-Anterior pituitary hyposecretion
-Hypothyroidism<\/p>\n\n\n\n
-Hyperthyroidism
-cushing’s syndrome
-Stress d\/t trauma\/surgery
-carcinoma
-Overproduction of ACTH d\/t tumors in ant. Pituitary
-Adrenal adenoma
-Obesity<\/p>\n\n\n\n
130-139 or 80-89<\/p>\n\n\n\n\n
thiazide diuretics<\/p>\n\n\n\n
oral meds
clonidine (Catapres)<\/p>\n\n\n\n
IV Nicardipine, Nitroprusside or labetalol
decreased 25% first hour
then to 160\/100 next 2-6 hr<\/p>\n\n\n\n
coronary artery vasospasm<\/p>\n\n\n\n
Normal LDL <100 or <70 if DM HDL>40 (M), >50 (F)
and triglycerides <150<\/p>\n\n\n\n
nitrates, beta blockers, calcium channel blockers<\/p>\n\n\n\n
Est 10 year ASCVD risk<\/p>\n\n\n\n
Atorvastatin 40-80 mg
Rosuvastatin 20-40 mg<\/p>\n\n\n\n
2-3<\/p>\n\n\n\n
1.5-2 x normal or control values<\/p>\n\n\n\n
Neuro surgery\/head trauma within 3 months
Prior ICH
BP: >185 or Diastolic >110
Lumbar puncture recently<\/p>\n\n\n\n\n
If it is a hemorrhagic stroke
Seizures
Abnormal glucose levels <50 >400
Any known bleeding disorders
Active internal bleeding
Suspected dissection
Malingnant intercranial neoplasmq<\/p>\n<\/blockquote>\n\n\n\n
Cilostazol (pletal)<\/p>\n\n\n\n
0.9-1.3<\/p>\n\n\n\n
<1<\/p>\n\n\n\n
ST segment elevation and T wave inversion
PR depression<\/p>\n\n\n\n
NSAIDs
Indomethacin
Corticosteroids if NSAID failure after several wks
ABX – only if bacterial<\/p>\n\n\n\n
cardiac tamponade<\/p>\n\n\n\n
endocarditis
TB
menopause
HIV\/AIDS
leukemia<\/p>\n\n\n\n
malaise
night sweats
WT loss
endocarditis<\/p>\n\n\n\n
Heart disease (CAD)
Cancer
Accidents
Lower Respiratory disease (Asthma&COPD)
CVA<\/p>\n\n\n\n
I: Olfactory, smell, Sensory
II: optic, vision, sensory
III: oculomotor, EOM, motor
IV: trochlear, downward and inward eye movement, motor
V: Trigeminal, mastication, sensation of face, scalp, cornea, and mucous membranes, both
VI: abducens, lateral eye movement, motor
VII: Facial, facial sensation and movement, both
VIII: acoustic, hearing and equilibrium, sensory
IX: Glossopharyngeal, phonation, gag, carotid reflex, swallowing, 1\/3 taste, both
X: Vagus, talking, swallow, carotid reflex, both
XI: Spinal Accessory, shoulder and head movement, motor
XII: Hypoglossal, tounge movement, motor<\/p>\n\n\n\n
vertigo, ataxia, dizziness, visual field deficits, wkns, confusion<\/p>\n\n\n\n
monitor for hyperkalemia firs 24-48 hr
monitor for hypokalemia 3 days post burns<\/p>\n\n\n\n
petroleum products – ie bacitracin, petroleum jelly<\/p>\n\n\n\n
Visual LOSS!
Swollen pale disc with blurred margin on eye exam
Jaw claudication
Age over 50
scalp tenderness
fever
Temporal artery nodular or enlarged and tender<\/p>\n\n\n\n
1:2<\/p>\n\n\n\n
galucoma<\/p>\n\n\n\n
2:3 or 4:5, opposite in body, arteries are brighter red and narrower<\/p>\n\n\n\n
cotton wool spots
ruptured microaneurysm
hard exudates<\/p>\n\n\n\n
HTN<\/p>\n\n\n\n
Chemical – none, flush with NS
Bacterial – Purulent, ABX – levofloxacin, ciprofloxacin, moxifloxacin, tobramycin, gentamycin)
Viral – watery – saline drops, decongestants\/antihistamines, mast cell stabilizers, NSAIDS
Herpetic – bright red and irritated – refer to opthalmologist
Gonococcal or chlamydial – Copious purulent – Ceftriaxone 250 mg IM + Azithromycin<\/p>\n\n\n\n
Ceftriaxone 250 mg IM + azithromycin<\/p>\n\n\n\n
10-20 mmHg<\/p>\n\n\n\n
-prostaglandins (lantanoprost, bimatoprost): inc outflow
-beta blockers (timolol, bextalol): dec aqeuous humor production; or
-pilocarpine to inc aqeuous humor outflow
-carbonic anhydrase inhib can work too
-if meds fail, lsaer trabeculoplasty or trabeculectomy<\/p>\n\n\n\n
-medical emergency! goal: decrease IOP<\/p>\n\n\n\n1: mannitol<\/h1>\n\n\n\n
-systemic meds: (oral\/IV acetazolamide, IV mannitol)
-curative: Laser peripheral iridotomy (create hole in peripheral iris)<\/p>\n\n\n\n
similar presentation except cataracts are painless<\/p>\n\n\n\n
deficiency of estrogen<\/p>\n\n\n\n
deficiency of progesterone<\/p>\n\n\n\n
hx thromboembolic disorders
CVA
CAD
breast CA
estrogen-dep neoplasia
pregnancy
liver tumor; impaired LF
previous cholelithiasis during pregnancy
undiagnosed, abnormal uterine bleeding<\/p>\n\n\n\n
progestin-only mini pill<\/p>\n\n\n\n
gain or loss of 20lbs<\/p>\n\n\n\n
6 hours<\/p>\n\n\n\n
glaucoma<\/p>\n\n\n\n
nicking = hypertension<\/p>\n\n\n\n
abrupt onset
painful
erythema
localized tender mass in eyelid
hordeolum (stye)<\/p>\n\n\n\n
warm compresses
topical bacitracin or erythromycin<\/p>\n\n\n\n
painless
swelling, tenderness, sensitive to light, increased tearing
chalazion<\/p>\n\n\n\n
warm compresses
refer for surgical removal<\/p>\n\n\n\n
red, scaly, greasy flakes
thickened, crusted lid margins
burning, itching, tearing
blepharitis<\/p>\n\n\n\n
hot compress
topical bacitracin or erythromycin
scrub lashes and lids<\/p>\n\n\n\n
antibiotic drops- levo, oflo, cipro floxacin, or tobramycin or gentamycin soln<\/p>\n\n\n\n
Ceftriaxone (rocephin) 250 mg IM<\/p>\n\n\n\n
1 gm azithromycin<\/p>\n\n\n\n
po antihistamines<\/p>\n\n\n\n
glaucoma<\/p>\n\n\n\n
-asymptomatic
-incr IOP
-cupping of disc
-decr peripheral vision
open-angle<\/p>\n\n\n\n
-extreme pain
-blurred vision
-halos around lights
-pupil dilated or fixed
closed-angle<\/p>\n\n\n\n
40<\/p>\n\n\n\n
-painless
-clouded, blurred vision
-halos around lights
-night vision difficulty
-sensitivity to light and glare
-fading\/yellowing of colors
-diplopia (double vision) in single eye
-no red reflex
cataract<\/p>\n\n\n\n
-flashes of light (photopsia), esp. peripheral
-floaters in eye
-blurred vision
-shadow or blindness in a part of visual field
retinal detachment<\/p>\n\n\n\n1, #2, #3 causes of otitis, sinusitis, & CAP<\/h1>\n\n\n\n
\n
painless otorrhea, hearing loss, canal filled with mucous and granulation tissue
tympanic membrane perforation 90% of cases
cholesteatoma<\/p>\n\n\n\n
diazepam (valium)
meclizine HCl (antivert)
diphenhydramine (benadryl)
scopolamine patch
antiemetics<\/p>\n\n\n\n
Meniere’s disease<\/p>\n\n\n\n
sound heard bilaterally, does not lateralize<\/p>\n\n\n\n
AC > BC<\/p>\n\n\n\n
Weber- sound materializes to affected ear
Rinne- Abnormal in affected ear (AC < BC)<\/p>\n\n\n\n
Weber- sound materializes to the unaffected ear
Rinne- normal in affected ear<\/p>\n\n\n\n
erythematous nasal mucosa
sneezing, nasal\/sinus blockage, HA, sore throat, cough, malaise
common cold; viral rhinitis<\/p>\n\n\n\n
macropapular rash
fever
strep throat<\/p>\n\n\n\n
if 2 or more yes- do rapid strep
Fever >100.4
Lack of cough
Phargynotonsillar Exudate
Anterior cervical adenopathy<\/p>\n\n\n\n
PCV V
erythromycin if PCN allergic<\/p>\n\n\n\n
influenza<\/p>\n\n\n\n
neuraminidase inhibitors<\/p>\n\n\n\n\n
shorten duration of s\/s by 2 days<\/li>\n<\/ol>\n\n\n\n
posterior cervical adenopathy
fever, chills, SEVERE malaise\/fatigue, anorexia, pharyngitis, splenomegaly
Mono (Epstein-Barr virus)<\/p>\n\n\n\n
supportive care
prednisone\/steroid taper for severely enlarged tonsils
avoid contact sports for 3 weeks- months (to prevent splenic rupture)<\/p>\n\n\n\n
red nasal mucosa
pain\/pressure over face, cheeks, teeth
postnasal drip
fever
HA- supine or bending<\/p>\n\n\n\n
sinusitis<\/p>\n\n\n\n
amox w\/ clav (Augmentin)
clarithromycin (Biaxin)<\/p>\n\n\n\n
different in color & texture from surrounding tissue
<1cm in size<\/p>\n\n\n\n
macule<\/p>\n\n\n\n
patch<\/p>\n\n\n\n
<1cm in diameter<\/p>\n\n\n\n
papule<\/p>\n\n\n\n\n
plaque<\/p>\n\n\n\n
<1cm<\/p>\n\n\n\n
pustule<\/p>\n\n\n\n
<1cm<\/p>\n\n\n\n
vesicle<\/p>\n\n\n\n
observed as an elevation or can be palpated<\/p>\n\n\n\n\n
often extends into the dermis<\/p>\n<\/blockquote>\n\n\n\n
nodule<\/p>\n\n\n\n
circumscribed elevation containing fluid<\/p>\n\n\n\n\n
extends only into the epidermis<\/p>\n<\/blockquote>\n\n\n\n
bulla<\/p>\n\n\n\n
a red, axon-mediated flare often surrounds it
commonly associated with allergic reactions<\/p>\n\n\n\n
wheal<\/p>\n\n\n\n
contains fluid or semisolid material
normal or abnormal epithelium<\/p>\n\n\n\n
cyst<\/p>\n\n\n\n\n
abscess<\/p>\n<\/blockquote>\n\n\n\n\n
firm or soft
benign or malignant
tumor<\/p>\n<\/blockquote>\n\n\n\n
varicella
MMR
zoster
flu mist<\/p>\n\n\n\n
clindamycin<\/p>\n\n\n\n\n
Staph
Strep<\/p>\n\n\n\n
MRSA<\/p>\n\n\n\n
cellulitis<\/p>\n\n\n\n
Group a strep
s. aureus<\/p>\n\n\n\n
TMP-SMZ (bactrim)
doxy\/mino
clindamycin<\/p>\n\n\n\n
dicloxacillin
or cephalexin (Keflex)<\/p>\n\n\n\n\n
clinda<\/p>\n\n\n\n
bright, red, warm
rapid progression of erythema
usually cause by Strep
erysipelas<\/p>\n\n\n\n
groin or axilla
hidradenitis suppurativa<\/p>\n\n\n\n
consider topical- bacitracin, bactroban (mupirocin)<\/p>\n\n\n\n
PCNase- resistant PCN (dicloxacillin)
alternatives: clinda or amox-clav<\/p>\n\n\n\n
staph aureus<\/p>\n\n\n\n
staph around nail fold<\/p>\n\n\n\n
and its treatment
subungual hematoma
trephination- drill a hole<\/p>\n\n\n\n
candida balanitis<\/p>\n\n\n\n
& its treatment
candida intertrigo
drying with talc or cornstarch
topical antifungals
po antifungals<\/p>\n\n\n\n
selenium shampoo<\/p>\n\n\n\n
gabapentin (neurontin)
pregabalin (lyrica)<\/p>\n\n\n\n
premalignant
rough, flesh colored, pink or hyperpigmented
actinic keratosis<\/p>\n\n\n\n
squamous cell carcinoma<\/p>\n\n\n\n
liquid nitrogen<\/p>\n\n\n\n
develop over a few months
3-7% metastasize
prolonged, sun-exposed areas in fair skinned
keratitic, scaly bleeding
squamous cell carcinoma<\/p>\n\n\n\n
benign, not painful lesions
beige, brown or black plaques
stuck on appearance
seborrheic keratoses<\/p>\n\n\n\n
none
liquid nitro<\/p>\n\n\n\n
slow growing
waxy, pearly appearance
central depression or rolled edge
telangiectatic vessels
basal cell carcinoma<\/p>\n\n\n\n
dx at 40yo
metastasize anywhere
malignant melanoma<\/p>\n\n\n\n
tar\/salicylic acid shampoo
topical steroids (BMTZ)
UVB light exposure<\/p>\n\n\n\n
more common in females during spring and fall
pruritic rash on trunk and proximal extremities
initial lesion 2-10cm: “herald patch”
generalized rash within 1-2 weeks
lesions in Christmas tree pattern
eruption lasts 4-8 weeks
pityriasis rosea<\/p>\n\n\n\n
ELISA initial
Western blot confirmatory<\/p>\n\n\n\n
doxy
amox<\/p>\n\n\n\n
lyme- erythema migrans
RMSF- maculopapular rash, petechial rash<\/p>\n\n\n\n
PCR
immunohistochemical IHC staining
Indirect immunofluorescence assay (IFA) for R. rickettsii antigen<\/p>\n\n\n\n
1st lesions on oral mucosa\/palate, face, or forearms
centrifugal distribution with greatest concentration of lesions on face and distal extremities
all lesions in same stage of development
scabs leading to deep, pitted scars
excruciating pain
small pox
no cure, only supportive<\/p>\n\n\n\n
arms\/hands, followed by face and neck
black necrotic eschar with edema
cutaneous anthrax- report to heath department<\/p>\n\n\n\n
PCN
cipro
doxy<\/p>\n\n\n\n
juvenile onset
human leukocyte antigens (HLA-DR3 or HLA-DR4)
islet cell antibodies
ketones
poly’s- uria, dipsia, phagia
DM1<\/p>\n\n\n\n
random glucose >200 with polyuria, polydipsia, weight loss
ketonemia, ketouria
BUN\/creat elevated<\/p>\n\n\n\n
human leukocyte antigens (HLA-DR3 or HLA-DR4)<\/p>\n\n\n\n
normal creat
10-20
.5-1.5<\/p>\n\n\n\n
BUN- elevated with dehydration<\/p>\n\n\n\n
serum creatinine<\/p>\n\n\n\n
6<\/p>\n\n\n\n
55-60%<\/p>\n\n\n\n
ketones<\/p>\n\n\n\n
0.5 u\/kg\/day with 2\/3 of dose in am, 1\/3 evening<\/p>\n\n\n\n
hypoglycemic at 0300, rebounds with elevated blood glucose at 0700
Somogyi effect<\/p>\n\n\n\n
reduce\/omit bedtime dose of insulin<\/p>\n\n\n\n
elevated glucose at 0700
Dawn phenomenon<\/p>\n\n\n\n
add\/increase the bedtime dose of insulin<\/p>\n\n\n\n
Grave’s<\/p>\n\n\n\n
Hashimoto’s<\/p>\n\n\n\n
Hyper- T3, Hypo- T4<\/p>\n\n\n\n
TSH ?
T3 ?
TSH down
T3 up<\/p>\n\n\n\n
TSH ?
T4 ?
TSH up
T4 down<\/p>\n\n\n\n
propranolol (inderal) 10-80mg qid<\/p>\n\n\n\n
thiourea drugs- methimazole (tapazole) 30-60mg qd in 3 doses
propylthiouracil 300-600mg qd in 4 doses
radioactive iodine 131-I to destroy goiters
lugol’s solution 2-3gtts po qd x10d to reduce vascularity of gland<\/p>\n\n\n\n
adrenal tumors
chronic administration of glucocorticoids
Cushing’s syndrome<\/p>\n\n\n\n
central obesity
moon face, buffalo hump
acne
poor wound healing
purple striae
hirsutism
HTN from vasoconstriction
weakness
amenorrhea
impotence
HA
polyuria, thirst
labile mood
frequent infections<\/p>\n\n\n\n
autoimmune destruction of adrenal gland
mets CA
bilateral adrenal hemorrhage from anticoagulant therapy
pituitary failure resulting in decreased ACTH
Addison’s disease (primary adrenocortical insufficiency)<\/p>\n\n\n\n
hyperpigmentation in buccal mucosa and skin creases (knuckles, nail beds, nipples, palmar creases, and posterior neck)
diffuse tanning and freckles
orthostasis and hypotension
scant axillary and pubic hair
rapid worsening of chronic s\/s (acute)
fever (acute)
LOC changes (acute)<\/p>\n\n\n\n
glucocorticoid and mineralocorticoid replacement<\/p>\n\n\n\n
fludrocortisone acetate (Florinef) mineralocorticoid<\/p>\n\n\n\n
hyperglycemia
hypernatremia
hypokalemia<\/p>\n\n\n\n
hypoglycemia
hyponatremia
hyperkalemia<\/p>\n\n\n\n
renal fxn
BUN & creat- esp creat<\/p>\n\n\n\n
meniscal tear<\/p>\n\n\n\n
test for medial meniscal injury
McMurray’s test<\/p>\n\n\n\n
assess for anterior\/posterior cruciate ligament tear
Lachman (drawer) test<\/p>\n\n\n\n
flex knee 90 degrees, pressure on heel with one hand while rotation the lower leg internally and externally
pain or click is positive for medial or lateral collateral ligament damage and\/or meniscus injury
Apley’s grind test<\/p>\n\n\n\n
3<\/p>\n\n\n\n
breaks down joint tissue<\/p>\n\n\n\n
osteo<\/p>\n\n\n\n
distal interphalangeal nodes (DIPs)<\/p>\n\n\n\n
proximal interphalangeal nodes (PIPs)<\/p>\n\n\n\n
Tinel’s sign<\/p>\n\n\n\n
Phalen’s test<\/p>\n\n\n\n
pain radiates into medial malleolus, numbness along the same path especially medial aspect of knee
*decr\/absent patellar reflex
screening exam: have patient squat and rise
L3-L4 disk pathology<\/p>\n\n\n\n
pain radiated into lateral calf; numbness of dorsum of foot and lateral calf
screening exam: have patient walk on heels of foot
L4-L5 disk pathology<\/p>\n\n\n\n
pain along buttocks, lateral leg and lateral malleolus; numbness to lateral aspect of foot and in posterior calf
diminished\/absent Achilles reflex
screening exam: have patient walk on toes
L5-S1 disk pathology<\/p>\n\n\n\n
high heels with closed toes
“standing on a pebble”
shooting pain affecting the contiguous halves of 2 toes
tingling\/numbness in the toes
morton’s neuroma<\/p>\n\n\n\n
foot arch pain\/problems
common in runners
pain and stiffness in the bottom of the heel
pain worse in the am
plantar fasciitis<\/p>\n\n\n\n
painful limp with pain below knee cap
one or both legs
pain worse with activities
swelling
Osgood-Schlatter disease<\/p>\n\n\n\n
RICE
NSAIDs\/tylenol
rare cases- surgery referral<\/p>\n\n\n\n
over 50yo
may be associated with temporal arteritis
stiffness in neck, shoulders, and hips
loss of ROM in area
fatigue, anemia, mild fever
polymyalgia rheumatica<\/p>\n\n\n\n
ESR<\/p>\n\n\n\n
corticosteroids
symptomatic treatment<\/p>\n\n\n\n
ELISA<\/p>\n\n\n\n
Western Blot<\/p>\n\n\n\n\n
<200<\/p>\n\n\n\n
<5000<\/p>\n\n\n\n
CD4
viral count<\/p>\n\n\n\n
Pneumocystis jirovecii (PCP pneumonia)
they take bactrim qd for this<\/p>\n\n\n\n
CD4 350<\/p>\n\n\n\n
co-factor for HIV
painful, erythamatous base with halo
ulcers may be necrotic or severely erosive
chancroid<\/p>\n\n\n\n
sensitivity<\/p>\n\n\n\n
specificity<\/p>\n\n\n\n
DO, remember +<\/p>\n\n\n\n
DO NOT, remember –<\/p>\n\n\n\n
1 gm azithromycin
or
250 mg IM ceftriaxone (rocephin)
or
Cipro 500 mg PO bid x3 days<\/p>\n\n\n\n
Gonorrhea and chlamydia<\/p>\n\n\n\n
chlamydia
PID
menopause
trich<\/p>\n\n\n\n
1gm azithromycin x1 dose
or
doxycycline 100mg bid x7 days
or
alternatives erythromycin, ofloxacin, levofloxacin<\/p>\n\n\n\n
Ceftriaxone (rocephin) 250mg IM x1
plus give 1gm azithro PO x1 to cover chlamydia<\/p>\n\n\n\n
lasting for usually 12 days
initial herpes outbreak<\/p>\n\n\n\n
5<\/p>\n\n\n\n
valacyclovir<\/p>\n\n\n\n
2-3 mm painless vesicle, bubo, or non-indurated ulcer
regional adenopathy
lymphogranuloma venereum (LGV)<\/p>\n\n\n\n
Doxy 100 mg bid x21 days
aspirate buboes to prevent ulcerations<\/p>\n\n\n\n
common on trunk and anogenial region
molluscum contagiosum<\/p>\n\n\n\n
cryo with liquid nitro<\/p>\n\n\n\n
benzathine PCN G 2.4 million units IM
PCN allegic- doxy 100 mg bid or erythro 500 mg qid<\/p>\n\n\n\n
trichomonas<\/p>\n\n\n\n
Normal saline shows motile trichomonads<\/p>\n\n\n\n
BV<\/p>\n\n\n\n
candidiasis<\/p>\n\n\n\n
normal saline shows clue cells<\/p>\n\n\n\n
KOH mixture shows pseudo hyphae<\/p>\n\n\n\n
metronidazole (Flagyl) 2gm PO x1 or 500mg bid x7days<\/p>\n\n\n\n
metronidazole (Flagyl) 500mg bid x7 days or 2gm PO x1
gel 0.75% 5gm intravag bid x5 days
or
clindamycin (Cleocin) vag cream 2% 5gm qhs x 7days or 300mg bid x7days<\/p>\n\n\n\n
miconazole or clotrimazole 1 % 5gm vag qhs x7days
terconazole 80mg suppository qhs x3days<\/p>\n\n\n\n
+CMT
adnexal tenderness
abd tenderness
fever
dyspareunia
PID<\/p>\n\n\n\n
page 260<\/p>\n\n\n\n\n
what is the normal T score?<\/p>\n\n\n\n\n
-1.0 to -2.5<\/p>\n\n\n\n
below -2.5<\/p>\n\n\n\n
dairy, sardines, salmon w\/ bones, green leafy vegetables, tofu, calcium fortified foods, take vit D<\/p>\n\n\n\n
x3 days
TMP-SMZ (Bactrim)
Cipro
Amox w\/ clav (Augmentin)<\/p>\n\n\n\n
amoxicillin, levofloxacin, nitrofurantoin (Macrobid, Macrodantin),<\/p>\n\n\n\n
x7-10 days<\/p>\n\n\n\n
nitrofurantoin (Macrobid) until 36 weeks
cephalexin (Keflex)- never really used<\/p>\n\n\n\n
achilles tendon rupture<\/p>\n\n\n\n
UTI symptoms
marked scrotal edema
usually chlamydia in <35yo
epididymitis<\/p>\n\n\n\n
lift scrotum to symphysis pubis- pain relieved<\/p>\n\n\n\n
Ceftriaxone (rocephin) 250 IM x1 and doxy (vibramycin) 100mg bid
or
azithro 1gm PO x1<\/p>\n\n\n\n
TMP-SMZ (Bactrim) DS bid x10d
or
Cipro 250mg bid x10d<\/p>\n\n\n\n
usually E.Coli gram –
fever, chills, low back pain, dysuria, urgency\/frequency, nocturne
edematous prostate, may be warm, tender\/boggy to palpation, pain
acute bacterial prostatitis<\/p>\n\n\n\n
TMP-SMZ (bactrim)
or fluoroquinolones- levoflox, norflox, oflox<\/p>\n\n\n\n
urgency\/frequency, nocturia, dribbling, retention
bladder distention
non-tender prostate symmetrical\/asymetrical enlargement
smooth, rubbery consistency
BPH<\/p>\n\n\n\n
alpha-blockers (relax muscles of bladder and prostate)- terazosin (hytrin), prazosin (minipress), tamsulosin (flomax)
5-alpha-reductatse inhibitors (shrink large prostates)- finasteride (proscar) and dutasteride (avodart)
Saw palmetto- effective for some<\/p>\n\n\n\n
aphasia<\/p>\n\n\n\n
apraxia<\/p>\n\n\n\n
agnosia<\/p>\n\n\n\n
acetylcholinesterase inhibitors
donezepil (aricept)
galantamine (razadyne)
rivastigmine (exelon)<\/p>\n\n\n\n
usually generalized
intense about neck or back of head
no neuro symptoms
several hours
tension headache<\/p>\n\n\n\n
trigeminal- V<\/p>\n\n\n\n
migraine and cluster<\/p>\n\n\n\n
parkinson’s disease<\/p>\n\n\n\n
tremor, rigidity, bradykinesia<\/p>\n\n\n\n
active Hep A<\/p>\n\n\n\n
recovered Hep A<\/p>\n\n\n\n
active Hep B<\/p>\n\n\n\n
chronic Hep B<\/p>\n\n\n\n
recovered Hep B<\/p>\n\n\n\n
same in chronic and acute Hep C<\/p>\n\n\n\n
mitral\/tricuspid (A\/V) valves close<\/p>\n\n\n\n
aortic\/pulmonic (semilunar) valves close<\/p>\n\n\n\n
period between S1 and S2<\/p>\n\n\n\n
period between S2 and S1<\/p>\n\n\n\n
Ken-tuck-y, increased fluid states (CHF, pregnancy)<\/p>\n\n\n\n
Ten-ne-ssee, stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension)<\/p>\n\n\n\n
40-54% M, 37-47% F<\/p>\n\n\n\n
250-450<\/p>\n\n\n\n
50-150<\/p>\n\n\n\n
80-100<\/p>\n\n\n\n
26-34<\/p>\n\n\n\n
32-36<\/p>\n\n\n\n
IDA, thalassemia<\/p>\n\n\n\n
B12 or folate deficiency; also, alcohol, liver fx, drugs<\/p>\n\n\n\n
anemia chronic disease, sickle cell, renal fx, blood loss, hemolysis<\/p>\n\n\n\n
Microcytic, hypochromic
Low Hgb, Hct, MCV, MCHC, RBCs, iron, ferritin
High TIBC
High RDW<\/p>\n\n\n\n
ferrous sulfate 300-325mg qd-bid<\/p>\n\n\n\n
raisins, green leafy veggies, red meats, citrus, iron fortified breads\/cereals<\/p>\n\n\n\n
Microcytic, hypochromic
Low Hbg, MCV, MCHC,
Normal TIBC, normal ferritin<\/p>\n\n\n\n
Usually nothing
RBC transfusion\/splenectomy if severe
iron contraindicated<\/p>\n\n\n\n
Macrocytic, normochromic
Hct & RBCs decreased
MCV increased
MCHC normal
Serum folate low
RBC folate <100<\/p>\n\n\n\n
fatigue etc.
Glossitis
NO neuro symptoms vs B12 does<\/p>\n\n\n\n
1mg folate qd
foods: bananas, peanut butter, fish, green leafy, iron fortified breads\/cereals<\/p>\n\n\n\n
Hgb, Hct, RBCs decreased
MCV increased
Serum B12 <0.1
Anti IF (intrinsic factor) and anti parietal cell antibody test
Schilling test for cause<\/p>\n\n\n\n
glossitis, NEURO signs- paresthesia, loss vibratory sense, fine motor control, + ROMBERG, + BABINSKI<\/p>\n\n\n\n
B12 100 IM qd x1week
then q month for life<\/p>\n\n\n\n
normocytic, normochromic
Hgb, Hct low
MCV normal
MCHC normal
Serum iron & TIBC low (capacity for more iron is low)
Ferritin high (stores of iron high)<\/p>\n\n\n\n
Treat underlying disease
Nutritional support<\/p>\n\n\n\n
Hgb low
peripheral smear shows sickled cells
cellulose acetate and citrate agar gel electrophoresis to confirm Hgb genotype<\/p>\n\n\n\n
fluids, pain management<\/p>\n\n\n\n
neoplasms arising from hematopoietic cells in bone marrow<\/p>\n\n\n\n
remission 50-85%
long-term survival ~40%
Acute nonlymphocytic leukemia (ANL)\/ Acute myelogenous leukemia (AML)<\/p>\n\n\n\n
pancytopenia with circulating blasts is hallmark of disease (all lab values decreased)
Acute lymphocytic leukemia (ALL)<\/p>\n\n\n\n
occurs in middle age and old age
median survival 10 years
lymphocytosis (large increase 42K) is hallmark of disease
Chronic lymphocytic leukemia (CLL)<\/p>\n\n\n\n
median survival 3-4 years
Philadelphia chromosome seen in leukemic cells is hallmark of disease
Chronic myelogenous leukemia (CML)<\/p>\n\n\n\n
asymptomatic
fatigue, weakness, anorexia
generalized lymphadenopathy
weight loss<\/p>\n\n\n\n
Subnormal RBCs and neutrophils
Elevated ESR
Bone marrow req for confirmation<\/p>\n\n\n\n
chemo
bone marrow transplant<\/p>\n\n\n\n
unknown etiology, may be viral
lymphadenopathy
common 20-40
diffuse small b cells found<\/p>\n\n\n\n
males, 32 years old
cause unknown
cervical adenopathy, spreads predictably along lymph groups
Reed-Sternberg cells<\/p>\n\n\n\n
radiation
chemo
sometimes bone marrow transplant<\/p>\n\n\n\n
Interest- loss of pleasure
Sleep disturbances
Appetite changes
Depressed mood
Concentration difficulty
Activity- agitation\/retardation
Guilt feelings or low self-esteem
Energy loss
Suicidal ideation<\/p>\n\n\n\n
C- have you ever felt the need to cut down on your drinking?
A- have people annoyed you by criticizing your drinking?
G- have you ever felt guilty about your drinking?
E- have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (eye-opener)<\/p>\n\n\n\n
acetylcholine deficiency<\/p>\n\n\n\n
acetylcholinesterase inhibitors
donezepil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon)
often prescribed in conjunction with NMDA receptor antagonists such as memantine (Namenda) to improve thinking and activities of daily living<\/p>\n\n\n\n
recognize a paperclip in the palm
steriognosis<\/p>\n\n\n\n
gravisthesia<\/p>\n\n\n\n
difficulty with speech<\/p>\n\n\n\n
inability to perform a previously learned task<\/p>\n\n\n\n
inability to recognize an object<\/p>\n\n\n\n
On Some
Old Say
Olympus Marry
Towering Money
Tops But
A My
Fin Brother
And Says
German Big
Viewed Bras
Some Matter
Hops Most<\/p>\n\n\n\n
Bell’s palsy<\/p>\n\n\n\n
1, 2, & 8<\/p>\n\n\n\n
3, 4, & 6<\/p>\n\n\n\n
5-trigeminal<\/p>\n\n\n\n
amitriptyline (Elavil)
dialproex (Depakote)
propranolol (inderal)
imipramine (tofranil)
clonidine (catapres)
verapamil (Calan)
topiramate (Topamax)
gabapentin (neurontin)
methysergide (sansert)
magnesium<\/p>\n\n\n\n
ASA
Sumatriptan (Imitrex) 5mg SQ at onset, repeat in 1h, total of 3x per day<\/p>\n\n\n\n
migraine
cluster<\/p>\n\n\n\n
amaurosis fugax<\/p>\n\n\n\n1 cause of heart failure<\/h1>\n\n\n\n
common w\/ cerebral lesions
NO loss of consciousness
rarely >1min
motor symptoms in one muscle group, spread to entire side of body
paresthesias, flashing lights, vocalizations, hallucinations<\/p>\n\n\n\n
simple partial followed by impaired level of consciousness
may have aura, staring, or automatisms such as lip smacking and picking at clothing<\/p>\n\n\n\n
arrest of motor activity w\/ blank stare<\/p>\n\n\n\n
may have aura
Contractions (tonic), loss of consciousnes, then clonic (maintained involuntary contraction of muscle)
last 2-5 min
incontinence may happen
postictal period<\/p>\n\n\n\n
medical emergency
series of grand mal >10min
don’t gain consciousness between attacks
most uncommon, but life-threatening<\/p>\n\n\n\n
EEG- seizure classification
CT- for new onset seizures<\/p>\n\n\n\n
supportive
protect from injuries, nothing in airway
Benzos- Diazepam (valium) or lorazepam (ativan)
Phenytoin (dilantin)
Fosphenytoin (cerebyx) prodrug of dilantin
Phenobarb (luminal) if phenytoin unresponsive<\/p>\n\n\n\n
Carbamazepine (tegretol)
phenytoin (dilantin)
phenobarb (luminal)
valproic acid (depakene)
primidone (mysoline)
clonazepam (klonopin)<\/p>\n\n\n\n
degenerative disorder as a result of insufficient amounts of dopamine in the body<\/p>\n\n\n\n
tremor
rigidity
bradykinesia<\/p>\n\n\n\n\n
autoimmune, reduction of number of acetylcholine receptor sites at the neuromuscular junction
weakness worse after exercise, better after rest<\/p>\n\n\n\n
***ptosis
diplopia, dysarthria, dysphagia, extremity weakness
sensory modalities and DTRs normal<\/p>\n\n\n\n
antibodies to acetylcholine receptors
edrophonium (Tensilon) test to differentiate a myasthenic vs. cholinergic crisis<\/p>\n\n\n\n
anti cholinesterase drugs- pyridostigmine
immunosuppressives
plasmaphoresis
ventilator support<\/p>\n\n\n\n
autoimmune, attacks myelin<\/p>\n\n\n\n
weakness, numbness, tingling, unsteadiness of limb
spastic paraparesis
diplopia<\/p>\n\n\n\n
Mild lymphocytosis common
elevated protein in CSF, CSF IgG
MRI<\/p>\n\n\n\n
steroids for acute
antispasmodics
***interferon therapy
immunosuppressive therapy
plasmapheresis<\/p>\n\n\n\n
CN 7, usually right side of face<\/p>\n\n\n\n
Prednisone taper 7-10 days
Acyclovir
eye drops and patch if can’t close eyes<\/p>\n\n\n\n
stabbing, electric shock in part of face<\/p>\n\n\n\n
anti-seizure drugs
muscle relaxants
TCAs<\/p>\n\n\n\n
cholecystis<\/p>\n\n\n\n
female, older, LLQ px<\/p>\n\n\n\n
epigastric tenderness<\/p>\n\n\n\n
NSAIDs, ASA, glucocorticoids
smokers
stress
PUD<\/p>\n\n\n\n
gastric<\/p>\n\n\n\n
duodenal<\/p>\n\n\n\n
duodenal ulcer<\/p>\n\n\n\n
gastric ulcer<\/p>\n\n\n\n
H2 receptor antagonist
$4 drug list
cimetidine (tagamet) 800mg qhs
ranitidine (zantac) 300mg qhs
famotidine (pepcid) 40mg qhs
nizatidine (axid) 300mg qhs<\/p>\n\n\n\n
PPIs
30 min before meals
lansoprazole (prevacid)
rabeprazole (aciphex)
pantoprazole (Protonix)
omeprazole (prilosec)
dexlansoprazole (dexilant)
esomeprazole (nexium)<\/p>\n\n\n\n
2 antibiotics + PPI or bismuth<\/p>\n\n\n\n
Psoa’s sign<\/p>\n\n\n\n
obturator sign<\/p>\n\n\n\n
positive Rovsing’s sign<\/p>\n\n\n\n
resonance<\/p>\n\n\n\n
hyperresonance<\/p>\n\n\n\n
inhaled anticholinergic- ipratropium bromide (Atrovent)<\/p>\n\n\n\n
Strep pneumoniae<\/p>\n\n\n\n
healthy, young- macrolide (azithromycin), clarithromycin (Biaxin), erythromycin, or doxycycline<\/p>\n\n\n\n
Angina- down sloping\/depression of ST
MI- ST elevation<\/p>\n\n\n\n
<200<\/p>\n\n\n\n
<150<\/p>\n\n\n\n\n
Gen pop <130
2+ risks <100
diabetic, previous MI <70<\/p>\n\n\n\n
Nitrates
Beta blockers
CCBs<\/p>\n\n\n\n
Statin
Niacin if not controlled
If still trouble, time for fibrate (gimfibrazol)<\/p>\n\n\n\n
S4<\/p>\n\n\n\n
Peaked t waves, ST elevation, Q waves<\/p>\n\n\n\n
lateral MI<\/p>\n\n\n\n
inferior MI- bottom of heart dying<\/p>\n\n\n\n
anterior MI<\/p>\n\n\n\n
CK-MB, Troponin I are 100% cardioselective
then Troponin T<\/p>\n\n\n\n
Exam: shiny, hairless skin, w\/ dependent rubor, and elevational pallor, ulcerations
Doppler, ABI, arteriography
-stop smoking, exercise
-Pentoxifylline, cilostazol
PVD-atherosclerotic narrowing<\/p>\n\n\n\n
use stockings, bed rest w\/ elevated legs
CVI- impaired venous return<\/p>\n\n\n\n
mitral stenosis<\/p>\n\n\n\n
glaucoma<\/p>\n\n\n\n
arteries vs veins
arteries brighter and narrower
A:V ratio 2:3 or 4:5<\/p>\n\n\n\n
nicking = htn<\/p>\n\n\n\n
farsighted = old people<\/p>\n\n\n\n
nearsighted = young people<\/p>\n\n\n\n
common after 40, difficult maintain clear focus at a near distance due to decr. flexibility of lens and weakening of the ciliary muscles<\/p>\n\n\n\n
cloudy appearance of the cornea with a gray\/white arc or circle around the limbus due to deposition of lipid material = hyperlipidemia<\/p>\n\n\n\n
infection, S. aureus
pain and erythema
warm compress
topical bacitracin or erythromycin<\/p>\n\n\n\n
beady nodule on eye lid
infection or retention cyst of a meibomian gland
painless aside from swelling
warm compress & surgery referral<\/p>\n\n\n\n
Staph infection or seborrheic dermatitis of the the lid edge<\/p>\n\n\n\n
NO PAIN
conjunctivitis<\/p>\n\n\n\n
glaucoma<\/p>\n\n\n\n
elevated IOP
cupping of the disc
constriction of visual fields- decr visual fields
open-angle<\/p>\n\n\n\n
extreme pain, blurred vision, halos around lights, pupil dilated\/fixed
closed-angle<\/p>\n\n\n\n
cataracts<\/p>\n","protected":false},"excerpt":{"rendered":"