question

Balloon sign

answer

compress suprapatellar pouch against the femur and feeling for fluid entering the joint space. Patellar ballotment will be possible in a positive. For major effusions. Place thumb and index finger or your right hand on each side of the patella; with the left hand, compress the suprapatellar pouch against the femur. Feel for fluid entering the spaces next to the patella under your right thumb and index finger.

question

Bulge sign

answer

For minor effusions. Extend knee. Place left hand above the knee and apply pressure on the suprapatellar pouch, displacing or "milking" fluid downward. Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area. Tap the knee just behind the lateral margin of the patella with the right hand. A fluid wave on the medial side between the patella and femur is considered positive and consistent with effusion.

question

corticosteroids in pregnancy

answer

in some studies _________ have been associated with an increased risk of cleft lip/palate if administered in the first trimester.

question

bisphosphonates and pregnancy

answer

category C - unknown and should be avoided

question

Crohn's disease flare ups and pregnancy

answer

UC and Crohn's disease are approximately equally as likely to flare up in pregnant and non-prenant states if in remission at the time of conception.

question

Meningococcal disease

answer

Neisseria meningitidis. Sudden onset of fever, headache, and stiff neck. It can start with symptoms similar to influenza (flu), and will often also cause nausea, vomiting, increased sensitivity to light, rash (lower extremity petechial), and confusion. If known exposure, prophylaxis with rifampin and/or rocephin or cipro depending on age.

question

FABER test

answer

Tests SI joint. Pt supine, places foot on top of other knee. Pain with this position or inability to reach figure 4 position can indicate problems with SI joint or hip flexors. Flexion abduction external rotation = FABER

question

Beighton scale

answer

a popular screening technique for hypermobility. This is a nine - point scale and requires the performance of 5 maneuvers, four passive bilateral and one active unilateral performance.

question

grind test

answer

trap patella, grind patella against femur, + pain

question

Medicare part B coverages

answer

outpatient coverages. DME, medically necessary Dr. visits, home health, preventative care.

question

rheumatic fever

answer

typically develops two to four weeks after a throat infection (GABHS). Symptoms include: fever, multiple painful joints with the joints affected changing with time, involuntary muscle movements, and a characteristic but uncommon non itchy rash known as erythema marginatum. The heart is involved in about half of cases.

question

erythema marginatum

answer

rheumatic fever

question

auscultating heart during rheumatic fever

answer

mitral valve most frequently involved, auscultate at PMI (5th intercostal, left midclavicular line).

question

gravida

answer

number of pregnancies

question

para

answer

number of 20+ week deliveries (twins count as one)

question

live vaccines

answer

MMR, varicella, oral polio, rotavirus, flu LAIV. contraindicate in pregnancy.

question

premature baby development

answer

born prior to 37 weeks. Adjust developmental age by #weeks premature. Continue age correction for 18-24 months, after infant should be caught up with peers.

question

non-english speaking pts

answer

must have interpreter present! Reschedule if there isn't one available (assuming the pt is stable).

question

risk factors for ectopic pregnancy

answer

tubal surgery, IVF, use of IUD, hx of PID, previous ectopic, age

question

primary (deciduous) teeth

answer

baby teeth. All should be in by approx 30 months.

question

Pittsburgh knee rule

answer

blunt trauma or fall as mechanism of injury and either 50 or inability to walk more than four weight bearing steps in ED.

question

dihydropyridine vs non

answer

CCB - dihydropyridines (amlodipine,

question

breast cancer screening

answer

;40 yearly mammography and CBE, 20-39y.o. 1-3yr CBE. If family hx or BCRA positive, enhanced screening.

question

risk factors for peri-partum cardiomyopathy

answer

increased maternal age, hypertension, multiparity, hx pre-eclampsia.

question

chronic antihistamine use

answer

slow tapering is recommended d/t possible anticholinergic rebound effect

question

SSRI side effects

answer

sexual dysfunction (libido and orgasm) Weight gain (paroxetine), fatigue and apathy. (Last 3 less common)

question

Older Americans Act (OAA)

answer

federal funds are granted to states for a variety of community-based services, such as nutrition programs for the elderly, case management, homemaker services, transportation and adult day care services; for those 60 years or older. (Native americans as well)

question

median (statistical)

answer

A measure of center in a set of numerical data. The median of a list of values is the value appearing at the center of a sorted version of the list - or the mean of the two central values if the list contains an even number of values. 50% above and 50% below.

question

von Willebrand's disease

answer

The most common hereditary blood disorder. Platelet disorder with normal number, normal morphology and good response to ADP and collagen. Increases clotting times. Often tested with young female case that has heavy menses and weird bleeding (gums, epistaxis, etc.)

question

CF diagnosis

answer

commonly from chronic obstructive respiratory disease, recurrent sinus infections sx or exocrine pancreatic insufficiency (azotorrhea, steatorrhea, malabsorption of fats and fat soluble vitamins). Sweat chloride test is gold standard.

question

Aortic regurgitation

answer

A wide pulse pressure with a blowing diastolic decrescendo murmur at the left 2nd-4th intercostal space should make you think of what diagnosis?

question

Childhood psych d/o prevalence

answer

generalized anxiety disorders are the most prevalent with MDD prevalence increasing with age. Mood d/o's are more prevalent than substance abuse.

question

polycystic ovary syndrome

answer

A 20-year-old woman presents with a history of amenorrhea (or infrequent menses), hirsutism, and obesity. Blood work-up reveals excess androgenic hormones and imaging studies of her ovaries reveal numerous small cysts. Insulin resistance is associated and DMII prevalence increased in this pop.

question

angle-closure (closed angle glaucoma)

answer

Sudden spike in intraocular pressure that leads to tunnel vision, headache, halos, nausea/vomiting, injected conjunctiva, and/or mid-sized fixed pupil. Blocked outflow of aqueous humor- eye hard to palpation and closed anterior chamber. Leads to nerve damage and blindness. Decongestants and anticholinergics worsen symptoms.

question

Giant cell arteritis

answer

temporal artery granulomatous vasculitis, can cause ipsilateral blindness (ophthalmic artery). Presents as *new headache* (chew and jaw pain), *temporal artery abnormalities* (tender and decreased pulse), *scalp necrosis* and *retinal ischemia*. Use ? glucocorticoids to treat.

question

conjunctivitis

answer

allergic: itchy with red conjunctive and white stringy discharge. Usually associated with allergic rhinitis. Viral: itchy, copious, clear discharge, usually begins in one eye and spreads. Usually associated with viral URI. Bacterial: painful, purulent to mucuopurulent discharge.

question

bell's palsy

answer

Tempory or permanent loss of CN 7 (facial nerve) function. rule out lyme disease. treat with corticosteroids and refer to pt or neurology to increases chances of full recovery. Tape eye shut at night to keep moist.

question

lip carcinomas

answer

basal cell more commonly found on upper lip. squamous cell (95% of all lip tumors). 10% risk of cervical lymph metastases. Upper lip carcinomas have 10%-20% worse 5 year survival rate.

question

Mini mental state exam

answer

This exam test the elderlys orientation, registration, attention and calculation, recall(memory) and visou spatial skills. If the patient score less than twenty indicates cognitive impairment. Aids in detecting dementia

question

CAGE questionnaire

answer

For substance abuse, Cut back, Annoyed by people criticizing your drinking, Guilty about drinking, Eye opener?

question

HEADDSS assessment

answer

evaluates multiple aspects of an adolescents life: Home/friends, Education, Alcohol use, Drug use, Sex, and Suicidal ideation/depression.

question

CRAFFT

answer

Alcohol dependence screening tool. questions: Car high, Use to Relax, Alone, Forget stuff, Friends say, Trouble.

question

fetal growth restriction etiologies

answer

maternal morbidities especially with systemic vascular changes (DM, HTN, renal disease, autoimmune), tobacco, substance abuse, infection (malaria), genetic abnormalities, placental/umbilical disorders, multiple gestation.

question

H. pylori diagnosis

answer

Gold standard: endoscopic tissue biopsy. Urea breath test is a cheap, useful option in dx of H.pylori.

question

breast milk jaundice

answer

peaks later, between 6th and 14th day of life. Substances in milk inhibit normal metabolism of bilirubin. Can occur in up to 1/3 of breast fed babies. Substitute formula for a couple of days, should respond in 48hrs.

question

breast feeding jaundice

answer

peaks early, in first 3 days of life. Caused by insufficient production or intake of breast milk. Characterized by rapid increase of bill with jaundice appearing within 24hrs of birth.

question

Acute gastroenteritis

answer

most common cause of acute abdominal pain in kids. Often Giardia in US and UK (sx include a few days of explosive watery diarrhea followed by greasy, foul smelling stools and N/V/D. Metronidazole.

question

gestational hypertension

answer

methydopa

question

infectious esophagitis

answer

Name the diagnosis of heartburn: dysphagia, assoc. with immunocompromised condition, associated with c albicans, CMV, HSV-1

question

presbycusis

answer

a gradual loss of sensorineural hearing that occurs as the body ages

question

Glucose 6 Phosphate Dehydrogenase

answer

inherited X linked enzyme deficiency (favism). RBC's can be damaged by oxidative stress more easily d/t decreased glutathione which leads to hemolytic anemia. Sulfa drugs, infection and fav beans trigger. Heinz bodies (denatured Hgb), bite cells (d/t macrophage eating RBC). back pain, hemoglobinuria.

question

metronidazole and breastfeeding

answer

do not breast feed for 12-24 hrs after taking

question

RSV

answer

respiratory syncytial virus, causes bronchiolitis and pneumonia. Most frequently during winter in kids 3-6months. Fever, rhinorrhea, coughing and occasionally nausea and vomiting. Retractions and tachypnea common.

question

Croup

answer

upper airway infection usually caused by parainfluenza virus. Fever, nausea/vomiting, hoarseness, difficulty breathing, rhinorrhea, and barking cough (pathognomonic).

question

Valproic acid

answer

increases Na+ channel activation and GABA concentration. Hepatotoxicity and pancreatitis, teratogenic and can inhibit other drug metabolism.

question

hematochezia

answer

Blood in the stool

question

congenital hypothyroidism

answer

Presents soon after birth w/ hypotonia, poor feeding, jaundice, macroglossia, constipation, slow fontanel closure and umbilical hernia. Screened for in newborn screenings in the US. Home births and foreign born children. Cretinism

question

Kernicterus

answer

Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death

question

phenylketonuria

answer

Inherited disease characterized by the inability to break down the amino acid phenylalnine. Requires elimination of phenylalnice from diet, otherwise serious mental retardation will result. Urine said to have "Mousy" smell.

question

Fragile X syndrome

answer

Caused when the bottom of the X chromosome in the 23rd pair is pinched off. Distinctive facial characteristics include long face and large ears. Disorders can vary from mild to severe. In some individuals Fragile X results in learning disabilities, in some it can result in mental retardation and autistic characteristics. Symptoms tend to be more severe in boys due to the fact that males only have one X chromosome in each pair. Fragile X is thought to be the most common hereditary cause of mental retardation.

question

Meniere's disease

answer

increased endolymphatic fluid in inner ear, often associated with hearing loss. Management includes diuretics (HCTZ/triamterene) and salt restriction (<1-2g/day). Antihistamines and antiemetics in acute exacerbation. ENT referral for possible surgery in severe cases.

question

erythema infectiosum (Fifth Disease)

answer

caused by Parvovirus B19. Starts with fever, runny nose, sore throat and headache. Within a few days a characteristic "slapped cheeks" rash appears on face followed by a red lacy rash on chest and trunk. Rash typically lasts a few days and is self-limiting. Can cause a sickle cell crisis. Conservative management with NSAID's.

question

Scarlet fever

answer

caused by strep pyogenes. Presents with fever, sore throat, bright red "strawberry" tongue. Rash occurs 12-72 hours after infection and appears sandpaper-like. Starts on cheeks and typically spreads downward to the chest, trunk and rest of body. In body folds (axilla and intertriginous areas) rash forms classic red streaks known as Pastia lines. Penicillin G is tx.

question

treatment of asymptomatic bacteriurea

answer

in pregnant women d/t increased risk of acute cystitis and/or pyelonephritis and associated risks of these conditions in pregnancy.

question

Kids flu triad

answer

cough, headache and pharangytis

question

projection

answer

projecting one's own undesired attributes onto someone else who doesn't have those attributes. "No you're being selfish!"

question

reaction formation

answer

doing the opposite of what one feels, eg. being super nice to someone you don't like.

question

displacement

answer

displacing feelings onto an uninvolved party. Man who hates his boss and takes it out on his children.

question

US pregnancy dating

answer

use crown-rump measurement during a 7-week US

question

McMurray test

answer

meniscal tear.

question

Lachman's test

answer

knee exam that requires one hand on femur and pulls tibia anteriorly with other hand. Superior to anterior drawer for ACL tear assessment

question

ACE/ARB/renin inhibitors in pregnancy

answer

Class D, don't use due to renal abnormalities in latter half of preg and heart abnormalities in first trimester.

question

Rotterdam criteria

answer

PCOS diagnosis criteria. 2 of 3 of the following: hirsutism, oligomenorrhea, and polycystic ovaries..

question

HMG-CoA reductase inhibitors and livers

answer

NASH and stable hep B or C are ok with statins. Elevated transaminase levels up to three times the normal limit (assuming asymptomatic) are not a contraindication for statins, these elevations resolve in 70% of people taking statins.

question

Nurse expert witness

answer

they want masters prepared nurses. Relevant and recent professional work experience is the priority not understanding and articulation of legal issues.

question

Erythema Marginatum

answer

A less common feature of RF and are characterized by bright pink, non-pruritic, maplike macular lesions occuring mainly on the trunk and proximal extremities which may be exacerbated by heat

question

Placenta previa

answer

placenta partially or completely covers the opening of the cervix. Women with this condition often present with painless, bright red vaginal bleeding. This commonly occurs around 32 weeks of gestation, but can be as early as late second trimester This bleeding often starts mildly and may increase as the area of placental separation increases. Should be suspected if there is bleeding after 24 weeks of gestation.

question

molar pregnancy

answer

an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease. Preeclampsia sx, painless vaginal bleeding in first trimester.

question

Bugs in AOM

answer

Most frequent to least frequent: Strep pneumonia, Haemophilus influenza, Moraxella catarrhalis.

question

Bugs in AOE

answer

Pseudomonas aeruginosa (swimmers ear) and Staph aureus

question

primary prevention

answer

-addresses the needs of healthy clients to promote health and prevent disease with specific precaution

question

secondary prevention

answer

-focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status

question

tertiary prevention

answer

-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functionin

question

deQuervain's tenosynovitis

answer

pain and tenderness of base of thumb, radiation of pain up forearm Positive finklestines test? Gamer's thumb, mommy thumb. inflammation and swelling of the synovial lining of the APL and EPB tendons

question

Colles fracture

answer

the break of the distal end of the radius at the epiphysis often occurs when the pt has attempted to break his/her fall

question

Scaphoid

answer

Fractures of the scaphoid are the most common of the carpal bone injuries, because of its connections with the two rows of carpal bones. The scaphoid can be slow to heal because of the limited circulation to the bone. Fractures of the scaphoid must be recognized and treated quickly, as prompt treatment by immobilization or surgical fixation increases the likelihood of the bone healing in anatomic alignment, thus avoiding mal-union or non-union.

question

anatomic snuffbox

answer

triangular depression located on the posterior surface of the wrist; formed by the tendons of the two major muscles of the thumb. At articulation of radius and scaphoid.

question

initial tx for GERD

answer

lifestyle modifications: weight loss, smoking cessations, avoidance of trigger foods and alcohol, elevation of HOB. PPI daily, 30 min prior to breakfast. H2 blockers less effective but better than antacids

question

Erythema toxicum neonatorum

answer

benign self-limited eruption that occurs primarily in healthy newborns in the early neonatal period. Maculopapular rash with erythema, vesicles and pustules. No systemic sx's, resolves without permanent sequelae. Eosinphils on stain.

question

Acne neonatorum

answer

closed comedones on forehead, nose and cheeks. ~20% of newborns, caused by stimulation of sebaceous glands by androgens. lasts up to 4 mo (*benign*)

question

perioral dermatitis

answer

This typically occurs in young women, often with a history of prior topical steroid use in the area exists. It forms papulopustules on a erythematous base and may become confluent with plaques and scales, vermilion border is spared, and satellite lesions are common. Tx: low strength topical CS and topical abx (metronidazole, e-mycin)

question

Gilbert syndrome

answer

hereditary unconjugated hyperbilirubinemia d/t decreased enzyme activity (glycuronyltransferase): asymptomatic unless under physical/emotional stress (alcohol, infection) 3%-12% of population.

question

Crigler-Najjar syndrome

answer

increase in free unconjugated bilirubin due to problem in enzymatic pathway (genetic absence of glucuronate transferase) Severe jaundice in neonate, can lead to brain damage. RARE!

question

Dubin-Johnson syndrome

answer

Congenital hyperbilirubinemia (conjugated) = hepatocyte bilirubin transport is defective (not conjugation prob); Striking brown-to-black discoloration of the liver at autopsy

question

Rotor syndrome

answer

What is a similar disease to Dubin-johnson syndrome (congenital defect in hepatocyte conjugated bili transport) that is even milder and does NOT cause black liver?

question

Leading cause of PNA in elderly

answer

Streptococcus pneumonia.

question

Pneumococcal vaccine recommendations

answer

PPSV23: All persons 65 years and older should receive once in place of PVC13, adults younger than 65 years who have chronic illness, live in nursing home, cochlear implants/CSF leaks, asplenia and all adults who smoke or have asthma (not for kids =65

question

zoster vaccine

answer

everyone ;60 should get! high dose of the preventive chickenpox vacc. LIVE. Zostavax

question

GRACE ACS risk and mortality

answer

quantifies at admission, 6-mos and 3-year risk for MI or death

question

slipped capital femoral epiphysis

answer

Overweight pre/peripubescent child with no acute injury complains of anterior thigh/hip pain, visible limping. A/P pelvis and frog leg view XR. After dx: non-weigthbearing and referral to Ortho.

question

Ishihara's test

answer

Color vision test with the colored dots in a circle.

question

cover-uncover test

answer

Cover one eye observe other for movement/deviation. remove cover and observe eye for movement. Repeat for other eye. If uncovered eye moves to focus it is weaker. Strabismus test.

question

Strabismus treatment

answer

If found in infancy, parents are instructed to patch the unaffected eye, as it may improve through use. Glasses, eye muscle exercises, and surgery also used.

question

Gestational hypertension

answer

140 sys or 90 dia, no proteinurea, dx post 20wks gestation, resolution postpartum.

question

Metabolic syndrome

answer

HTN, Abdominal obesity (40" or 1.0 waist to hip ratio waist men, 38" or 0.8 waist to hip ratio women), Hyperlipidemia (triglycerides >150, HDL 100. Greater risk for DMII and CVD.

question

Alport syndrome

answer

Nephritis, deafness, cataracts. X-linked inheritance. Young adult with hearing loss or gross hematuria. Persistent microscopic hematuria present first two decades of life.

question

Waardenburg syndrome

answer

lateral displacement of the medial canthi, broad nasal bridge, medial hyperplasia of the eyebrows, partial albinism commonly expressed by a white forelock or heterochromia (or both), and deafness in 20% of cases.

question

Semen Analysis

answer

test that analyzes a semen sample for volume, sperm count, motility, and morphology to evaluate fertility or verify sterilization after a vasectomy. Non invasive test to start with for infertility investigation.

question

Diseases with increased risk of comorbid Celiac

answer

IBS, thyroid disease, oral aptholus ulcers, dermatitis herpataformis, Down's, Turner's syndrome

question

Turner's Syndrome

answer

Females missing one x chromosome (XO) that are short in stature, webbed neck and immature sex organs

question

Thoracic outlet syndrome

answer

a neurological and vascular compression/ entrapment of the brachial plexus and/or subclavian artery/ vein. Can be d/t congenital abnormality or repeated strain/injury.

question

idiopathic thrombocytopenic purpura (aka immune thrombocytopenia)

answer

ITP is an autoimmune disease with antibodies detectable against several platelet surface antigens. ITP is diagnosed by a low platelet count in a complete blood count (a common blood test). However, since the diagnosis depends on the exclusion of other causes of a low platelet count, additional investigations (such as a bone marrow biopsy) may be necessary in some cases. Thrombocytopenia/petichial bleeding of the gums/skin, No splenic enlargement and normal bone marrow.

question

pivot shift test

answer

identifies anterior cruciate ligmament instability|(anterolateral rotary instability). one hand on calcaneous, one hand at joint line. Rotate foot 20° flex and extend leg at knee. If there is a "clunk" at ~ 30° it is positive for ACL instability.

question

anterior drawer

answer

PPV of 29% for ACL tears. It sucks!

question

CAP drug treatment

answer

Macrolides for otherwise healthy pts (no comorbid d/o's), flouroquinolones for pts with comorbid d/o that will be treated outpatient.

question

CURB-65

answer

Confusion, Uremia, Respiratory rate, low BP, 65 or older, if 2 or more present, pt should be admitted for their pneumonia. Differs from more extensive Pneumonia Severity Index.

question

Left heart failure presentation

answer

SOB, non-productive cough, crackles, weight gain (RAAS)

question

Right heart failure presentation

answer

Edema, fatigue

question

Sjogren's syndrome

answer

immunologic disorder characterized by insufficient production of the lacrimal gland to produce tears and the salivary glands to produce saliva that result in abnormally dry eyes and mouth (chronic inflammatory disease. idiopathic. 90% women. 44 fold increase of lymphoma)

question

Common CCB SE's

answer

lower extremity edema, heart block, HA and bradycardia. Contraindicated in 2° HB, HF and bradycardia.

question

one-tailed test

answer

region of rejection of the null hypothesis is only on one side of the sampling distribution. (e.g. mean SBP will be reduced to <140)

question

two-tailed test

answer

a test that indicates the null hypothesis should be rejected when the test value is in either of the two predetermined critical regions. (e.g. the drug has a effect on response time)

question

polymyalgia rheumatica

answer

Pain and stiffness in the hips, shoulders, neck and upper arms especially in am or after sleeping. Long course of corticosteroids is first line tx. Other sx can include fatigue, anemia, weakness, low-grade fever. This condition is frequently associated with temporal arteritis.

question

5 P's of B12 deficiency anemia

answer

pancytopenia, peripheral neuropathy, posterior spinal column neuropathy (ataxia and diminished vibration sense), pyramidal tract signs, papillary atrophy of tongue ( atrophic glossitis). Also seen in blood smear: megaloblastosis, giant platelets, hypersegmented neutrophils.

question

pica and spoon shaped nails

answer

associated with iron deficiency anemia

question

3 C's of rubeola

answer

cough, coryza, conjunctivitis are seen in measles accompanied by morbilliform maculopapular rash that starts at the back of the head and neck. Koplik spots (white papules on buccal mucosa) also common. DROPLET precautions!

question

diagnosing pheochromocytoma

answer

crazy, erratic BP, papilledema, check 24-hour urine fractionated metanephrines or plasma metanephrines before imaging and biopsy.

question

Osgood-schlatter

answer

inflammation of the patellar ligament just below the tibial tuberosity. Patients report pain that is exacerbated by running, jumping, and kneeling activities. No radiographs needed if no trauma. Discontinue activity until it is no longer painful. Sinding-larsen-johanssen syndrome same but at just inferior to the patella, near ligament insertion. Usually teenagers doing sports.

question

Vaginal candidiasis presentation

answer

white, creamy discharge, NO foul smell, NO cervical motion tenderness. Treat with OTC anti fungal (azoles), oral antifungals if persistent or complicated by immunodeficiency.

question

Bacterial vaginosis

answer

clear-grey or yellow, foul smelling vaginal discharge. Dysuria can occur but pruritus is uncommon. Clue cells, increases pH (>4.5) and KOH whiff test all diagnostic. Most common cause of vaginitis, it is related to douching, sexual activity. Tx is metronidazole oral (7days) or intravaginal (5days)

question

Trichomoniasis

answer

protozoa infection of the vagina. Hello-green or grey frothy vaginal discharge and pruritus. Vaginal/cervical epithelium inflammation can cause redness sometimes seen as strawberry cervix. Tx: single dose of 2gm oral metronid or tinidazole, or metronidazole 500 po BID x 7 days.

question

meds that can slow motility

answer

anticholinergics, beta agonists, opioid analgesics, benadryl, H2 agonists, levodopa, PPIs, TCAs

question

infliximab (Remicaide)

answer

anti-TNF alpha monoclonal antibody used in the treatment of Crohn disease, ankylosing spondylitis, psoriasis and rheumatoid arthritis. Can increase the risk of TB reactivation. Indicated for Crohn's induced fistula closure.

question

salmonella gastroenteritis

answer

fluids and symptomatic treatment unless serovar is typhi (typhoid fever). Benign strains are carried by cold-blooded animals that are often pets (lizards, turtles). Treatment of benign serovars risks creating a carrier state.

question

Bouchard's nodes

answer

Bony nodules at the proximal interpharyngeal joints.

question

Heberden's nodes

answer

Bony spurs on DIP joints in patients with osteoarthritis.

question

GRACE ACS

answer

Age, HR, SBP, Creatinine, Killip's (HF class), arrest at admission, cardiac markers, ST elevation? Predicts in hospital mortality risk.

question

chlamydia in preggers

answer

Azithromycin 1g x 1 and a slap in the face.

question

Polymyalgia rheumatica

answer

geriatric inflammatory disorder of the muscles and joints characterized by pain and stiffness in the neck, shoulders, upper arms, and hips and thighs. Pts at greater risk for temporal arteritis. Treat with oral steroids.

question

Sturge-Weber syndrome

answer

definition: rare congenital disorder that affects blood vessls, primarily capillaries. hallmark: facial capillary malformation (port wine stain) usu on the distribution of trigeminal nerve. congential hamartomatous malformation that may affect the eye, skin, & CNS (DD and seizures).

question

Salter-Harris

answer

fracture classification system for epiphyseal, physeal and metaphyseal fractures that applies to fractures in immature animals

question

epiphysis

answer

each end of a long bone; the area beyond the epiphyseal plate

question

metaphysis

answer

growth zone between the epiphysis and the diaphysis during development of a long bone

question

diaphysis

answer

The shaft of a long bone

question

ACOVE

answer

Assessing care of vulnerable elders.

question

ACOVE Hearing screening

answer

should be part of initial eval if 75+

question

central vertigo

answer

Brainstem/Cerebellar Stroke or TIA

question

Iron absorption

answer

best on an empty stomach

question

TZD monitoring

answer

can cause hepatotoxicity, monitor LFT. (Always contraindicated in HF)

question

Macular degeneration

answer

an age related eye issue that destroys central vision. The macula is the central part of the retina. As it degenerates, central vision is lost. Questions should be asked about the rate of loss of vision. Reports of rapid vision loss require urgent ophthalmologic evaluation. Known risk factors are age greater than 50 years (greatest prevalence older than age 65), smoking, family history, and history of stroke, MI, or angina.

question

Arcus senilis

answer

an arc or circle around the cornea that is common in older adults. The circle is due to deposition of lipids in the cornea, but is not necessarily due to hypercholesterolemia. However, when this is seen in young adults, it is termed arcus juvenilis and is often associated with lipid abnormalities

question

AOM tx duration

answer

The recommendations from the American Academy of Pediatrics are 5-7 days of antibiotic therapy for children 2 years or older who have mild to moderate acute otitis media (AOM). Children younger than 2 years of age should be treated for 10 days. Children 2 years and older may be treated for 5-7 days for AOM if they do not have a history of recurrent AOM.

question

Asymptomatic carotid bruit

answer

Asymptomatic bruits in the carotid area are more indicative of atherosclerotic disease than increased stroke risk. A symptomatic bruit requires immediate attention. Patients with carotid artery disease are more likely to die of cardiovascular disease than cerebrovascular disease. The Framingham Heart Study found that patients with an asymptomatic carotid bruit were at increased risk of stroke, but the majority of strokes occurred in an area away from the carotid artery. The overall risk of stroke was insignificant when an asymptomatic carotid bruit was identified.

question

Toxoplasmosis

answer

Consumption of raw or undercooked meat or handling cat feces. (fever and tender lymph nodes). Can cause serious birth defects.

question

TCA toxicity

answer

Convulsions, coma, arrhythmias Respiratory depression, QT prolongation.

question

pinguecula

answer

A yellow bump. Common, non-cancerous growth of the conjunctiva.

question

pterygium

answer

thin tissue growing into the cornea from the conjunctiva, usually caused from sun exposure

question

xanthelasma

answer

soft, raised yellow plaques occurring on the skin at the inner corners of the eyes

question

MCC PUD in elderly

answer

H. pylori

question

Hesselbach's triangle

answer

Rectus abdominis Inferior Epigastrics Inguinal ligament Direct Inguinal hernia

question

encopresis

answer

Failure to control the bowels once the normal age for bowel control has been reached

question

Carotid bruit

answer

In asymptomatic patients, carotid bruits are a poor predictor of carotid artery stenosis or stroke risk. Even when a bruit is identified and the patient has a stroke, the majority of strokes will occur in an area other than the carotid artery. Patients with a carotid bruit have double the risk of stroke compared to patients without an audible bruit. In patients with significant carotid artery stenosis, only 50% have an audible carotid bruit. The value of a carotid bruit is that it is a good marker of generalized atherosclerosis. When it is identified, disease in other vessels should be evaluated. Statistically, patients with an audible carotid bruit are more likely to die of cardiovascular disease than cerebrovascular disease.

question

Aortic stenosis

answer

The three most common symptoms associated with aortic stenosis are angina, syncope, and heart failure evidenced by dyspnea. Syncope is usually exertional. Angina may be due to aortic stenosis, but underlying coronary artery disease accounts for half of anginal symptoms in these patients. There is usually a prolonged asymptomatic phase, but the presence of symptoms usually indicates a need for valve replacement. Without replacement, there is a rapid decline in the patient's status and death will ensue.

question

Urine creatinine to albumin ratio

answer

Nephropathy develops in about 20-40% of patients with diabetes. Patients with type 2 diabetes should be screened for renal nephropathy at the time of diagnosis. Screening for albuminuria is most easily accomplished by performing a random urine collection. Albuminuria may be considered if 2 of 3 specimens of urinary albumin-to-creatinine ratio (UACR) collected within 3-6 months are abnormal. Normal UACR is less than 30 mg/gm Cr. Albuminuria should never be diagnosed on a single reading because many factors can produce false microalbuminuria.

question

Hepatitis B serology

answer

See image

question

Pathologic jaundice

answer

Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and symptoms suggestive of serious illness.

question

kernicterus

answer

refers to the neurologic consequences of the deposition of unconjugated bilirubin in brain tissue. Subsequent damage and scarring of the basal ganglia and brainstem nuclei may occur.5

question

physiologic jaundice

answer

average total serum bilirubin level usually peaks at 5 to 6 mg per dL (86 to 103 ? mol per L) on the third to fourth day of life and then declines over the first week after birth.2 Bilirubin elevations of up to 12 mg per dL, with less than 2 mg per dL (34 ? mol per L) of the conjugated form, can sometimes occur.

question

breastfeeding jaundice

answer

Breast-fed newborns may be at increased risk for early-onset exaggerated physiologic jaundice because of relative caloric deprivation in the first few days of life.12 Decreased volume and frequency of feedings may result in mild dehydration and the delayed passage of meconium. Compared with formula-fed newborns, breastfed infants are three to six times more likely to experience moderate jaundice

question

breast milk jaundice

answer

occurs later in the newborn period, with the bilirubin level usually peaking in the sixth to 14th days of life. This late-onset jaundice may develop in up to one third of healthy breastfed infants.1 Total serum bilirubin levels vary from 12 to 20 mg per dL (340 ? mol per L) and are non pathologic. Underlying causes are not full understood; it is thought that constituents of breast milk may inhibit normal bilirubin metabolism. The bilirubin level usually falls continually after the infant is two weeks old, but it may remain persistently elevated for one to three months.

question

Presumptive signs of pregnancy

answer

symptoms experienced by the woman, such as amenorrhea, breast tenderness, nausea/vomiting, fatigue, and increased urinary frequency.

question

Probable signs of pregnancy

answer

detected by an examiner: eg. enlarged uterus

question

Positive signs of pregnancy

answer

direct evidence of pregnancy: audible heart tones or cardiac activity on US.

question

Chadwick's sign

answer

bluish discoloration of cervix (and labia) from increase in blood flow

question

OCD medications

answer

antidepressants that are approved for OCD by the Food and Drug Administration (FDA) include clomipramine (Anafranil), fluvox- amine (Luvox), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft).

question

Hegar's sign

answer

softening of the lower portion of the uterus and is considered a probable sign of pregnancy.

question

Carpal Tunnel

answer

painful condition caused by compression of the median nerve within the wrist canal.

question

Phalen sign

answer

test for median neuropathy push wrists together and if there is pain/tingling = positive sign

question

Rovsing's sign

answer

Pain in the RLQ at McBurney's point upon palpation of the LLQ . Sign of appendicitis.

question

Dawn phenomenon

answer

early morning hyperglycemia due to nocturnal elevation of growth hormone.

question

Somogyi phenomenon

answer

Nocturnal hypoglycemia causes rebound hyperglycemia in the AM.

Board Vitals Review – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards