Family Medicine Shelf Study Guide – Flashcards

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question
In addition to cardiac disease, chest pain could be attributed to 4 other causes. Name them
answer
MSK, pulmonary, GI, or psychological
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name the 4 emergent causes of chest pain
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PE, MI, aortic dissection, pneumothorax
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Chest pain can emanate from inflammation or injury to or around the thoracic cavity. Name 3 locations.
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muscular chest pain (inflammation or overuse pf chest wall muscles); costochondral joint (reproduced on palpation and patient may not want to take a deep breath in); rib fractures
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How can GERD (or esophageal motility disorders) lead to chest pain?
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reflux of acid into lower esophagus -> esophagitis -> pain indistinguishable from cardiac chest pain
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T or F; lung tissue has pain fibers?
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False- pain from inflammation or irritation is detected only by the parietal pleura. the parietal pleura is the source of chest pain during pneumonia or PE
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patients with herpes zoster may experience what symptom before the rash appear?
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pain
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Describe the presentation of myocardial pain?
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substernal chest tightness or pressure, that radiates to the left arm, shoulders, or jaw. Patients may also describe: diaphoresis, SOB, nausea, vomiting
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Describe the presentation of angina?
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typically brought on exercise, eating, emotional excitement; pain lasts 5 - 15mins, disappears with nitroglycerin or at rest; if the pain lasts 30mins it should not be considered anginal
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Describe the presentation of pericardial pain
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persistent, sharp, severe, relieved by sitting up; aggravated by breathing, laying back, coughing
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Describe the presentation tracheobronchitis
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upper sternal area burning pain, associated with a productive cough
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Describe the presentation of pneumonia
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occurs in overlying chest wall, and aggravated by breathing and coughing
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sudden, sharp, unilateral, pleuritic, associated with SOB
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pneumothorax
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sudden sharp chest pain, preceded by viral illness
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pleurisy
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true or false: MI, pericardial tamponade, PE, GI bleed, are associated with hypotension
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true
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complete the sentence: pericarditis can cause frictional rub and......
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pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)
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When does troponin rise following myocardial injury or infarction?
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1st enzymes to rise and remain elevated for 5 - 14days; most sensitive and specific for infarct
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When does the MB fraction of creatinine phosphokinase rise following myocardial injury or infarction?
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w/in 4hrs and peaks 24hrs; it is important to obtain serial markers since the first set of cardiac markers are negative in 25 - 50% of patients with an acute MI
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patients who present with an MI, unstable angina, or PE should be hospitalization of evaluation
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stabilize on oxygen, nitroglycerin, morphine for pain, aspirin (to decrease mortality by 20%), clopidogrel or ticolodipine. (beta blockers, heparin, nitrates, ACEi, thrombolytics (if <75 with ST segment elevation, and a history consistent with an acute MI; w/in 12hrs for older patients)
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What are the most common causes for the common cold?
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1. Rhinovirus 2. Coronavirus 3. Others: Influenza, Parainfluenza, RSV, Adenovirus
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What are the common causes for laryngitis?
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Influenza, Rhinovirus, Adenovirus, Parainfluenza
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______ infections cause approximately 95% of bronchitis cases in healthy adults.
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Viral -Non viral causes: Chemical irritation, Mycoplasma, and Chlamydia
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Name 4 factors that predispose an individual to develop pneumonia.
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1. Abnormal host defenses 2. Altered consciousness 3. Ineffective cough 4. Abnormal mucociliary transport
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Describe the history and PE of patient presenting with common cold
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Hx: Scratchy throat, runny nose, nasal congestion, rhinorrhea, malaise, fever, hoarsenss, cough, low grade fever, headache PE: Swollen red nasal mucosa, fever, purulent discharge, facial tenderness
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History for Sinusitis
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Persistent purulent discharge, facial pain exacerbated by leaning forward, maxillary tooth ache, "double sickening"=relapse
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History for Acute bronchitis
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Productive cough and URI symptoms (runny nose, scratchy throat, nasal congestion), low grade fever, fatigue
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History and PE for Pneumonia
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Hx: High fever, dyspnea, chills, chest pain, develop hypoxia or cardiopulmonary failure PE: Abnormal Vital signs (fever, tachypnea, tachycardia), Lungs (localized rales, bronchial breath sounds, wheezing, signs of consolidation-dullness to percussion)
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Difference between Pneumonia and Bronchitis
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Bronchitis: Antecedent URI, Cough, No or low-grade fever, clear lungs or coarse rhonchi, Normal CXR Pneumonia: Acute onset of cough, fever, and tachypnea, chest pain, leukocytosis, pulmonary infiltrate on CXR
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What type of imaging is need for chronic sinusitis?
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CT
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Initial treatment for Rhinosinusitis
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-Hydration -OTC decongestants -Topical Nasal decongestant no more than 4 days -Guaifenesin
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Treatment of Rhinosinusitis for symptoms persisting longer than 7-10 days
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Consider AB: 1st line: Amoxicillin, Cefuroxime Penicillin allergy: clarithromycin, azithromycin, trimethoprim/sulfamethoxazole 2nd line: amoxicillin/clavulanic acid, levofloxacin, gatifloxcin
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Pneumonia tx: suitable for healthy adults less than 60
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Erythromycin, Macrolide (i.e. azithromycin), Doxycyline
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Pneumonia tx: suitable for healthy adults older than 60
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Fluoroquinolone with good activity again Pneumococcus (levofloxacin), Macrolide, 2nd generation cephalosporin
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Four muscles of rotator cuff
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SITS: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
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The degenerative process that results in bursitis, tendonitis, and shoulder impingement often begins in the _____ or ____ tendons, which have a poor blood supply and are often under stress.
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Supraspinatus and bicipital tendons
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When do degenerative changes in the rotator cuff begin and what anatomy does this process usually involve?
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-Usually occurs in individuals over 50 to 60 yo -Involves tendons, bursae, and sometimes entire capusule
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Things that need to be included in history of shoulder pain
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Age, dominant hand, medications, PMHx, type of work, and activity level, Pain-acute or chronic, Associated trauma (swelling, rendness, laxity, catching, decrease ROM)
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Patient presents with aching shoulder, which becomes acutely painful with overhead activity
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Rotator Cuff problem
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Discomfort with abducting the arm past 90 degress
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Rotator Cuff tendonitis
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Chronic pain and shoulder stiffness with limited motion
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Adhesive capsulitis (frozen shoulder): most common in middle age women
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Pain in shoulder when throwing, swimming, or serving a tennis ball
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Rotator cuff tendonitis
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Shoulder pain with pain radiating to elbow
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Cervical radiculopathy
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Range of motion testing: How do you tell the difference between joint/ligament involvement vs. muscular and/or tendon involvement?
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-Ligament involvement: Pain with Active ROM and Passive ROM -Muscular and/or tendon injury: Pain with ONLY Active ROM
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What test done in PE measures instability of shoulder?
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Apprehension test: abducting the arm to 90 degrees, rotating it externally, and then applying anterior traction to the humerus
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Mainstay treatment for soft tissue inflammation (Shoulder)
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NSAIDs, combined with ice or heat, and brief periods of rest followed by PT (maintaining ROM, flexibility, strength) -Severe: Cortisone shot
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Who should have Xray testing for shoulder pain?
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Reserved for pats with hx of traumatic injury or persistent pain despite therapy
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Describes what occurs during squamous metaplasia of the cervix.
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Columnar cells are replaced by squamous cells and creates the squamocolumnar junction (where squamous metaplasia is most active)
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Where does the development of abnormal cervical cells begin?
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Squamocolumnar junction=most common site of cervical cancer
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What places women at higher risk of getting cervical cancer?
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Early sexuality and multiple pregnancies (immature cells are more common at menarche and ruing the postpartum period), hx of STDs, smoking, HIV, current or prior history of condyloma, and previously abnormal Pap smears
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Natural history of cervical cancer
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Mild dysplasia--> Carcinoma in situ-->Invasive carcinoma
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Why is the pap smear one of the most effective cancer screening tools?
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-Slow progression of cervical cancer changes -Availability of effective early treatment
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What HPV serotypes are most commonly associated with cervical cancer?
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Serotypes 16, 18, 31,52,58
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When does the American Cancer Society recommend obtaining Pap smear in low-risk women
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Every 3 years after 2 negative smear 1 year apart. Screening may be discontinued after age 65 provided that previous testing has been normal
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In regards to a Pap smear, what should be done if a pt has cervical inflammation from infections such as Chlamydia or yeast that may cause cells to appear abnormal.
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Repeat Pap after infection treated
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Pt has Atypical squamous cells of undetermined significance (ASCUS): When to do repeat pap?
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4 to 6 mo until 3 consecutive normal smear have been obtained *subsequent abnormal smear=colposcopy should be performed
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An alternative method for stratifying risk for cervical cancer in women with atypical squamous cells of undetermined significance (ASCUS)
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HPV testing -Pos=colposcopy -Neg=repeat pap smear
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What procedures should be performed on women with low-grade and high-grade intraepithelial lesion on pap smear?
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Colposcopy, Endocervical curettage, and directed cervical biopsy
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Carcinoma in situ is generally referred to a gynecologist and requires ______
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conization (or LEEP): removeal of a portion of the cervix and thus pts are at risk of preterm labor, incompetent cervix, or cervical stenosis in future pregnancies
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After treatment of dysplasia, women need Pap smears every...
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4 mo for 1yr, then every 6 mo for another yr. If remain normal for 2 years=screening can occur annually
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What is considered normal blood loss during a menstrual cycle?
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Less than 80 ml of blood
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Answer: Irregular cycles with excessive flow, duration, or both
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Menorrhagia
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Metrorrhagia
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Irregular bleeding between cycles
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Menometrorrhagia
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Excessive bleeding in amount, duration , or both at irregular intervals
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Answer: Regular bleeding at intervals of less than 21 days
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Polymenorrhea
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Oligomenorrhea
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Regular bleeding at intervals of more than 35 days
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Uterine bleeding between regular cycles
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Intermenstrual bleeding
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What is the role of FSH in one's menstrual cycle
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FSH released by the pitu stimulates a primary ovarian follicle to release estrogen, which stops menses and stimulates the endometrium
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What is the role of LH in the menstrual cycle
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LH surge triggers ovulation
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What occurs after ovulation
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The luteal or secretory phase begins, the corpus luteum develops, and pregesterone levels increase
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Cycle length variabilty is primarily due to what?
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Variability in the time for follicle development during the proliferative phase
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What is most common form of abnormal vaginal bleeding? (give what causes it with answer)
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Dysfunctional Uterine bleeding: caused by hormonal imbalances from a functionally abnormal hypothalamic-pitu-ovarian axis resulting in abnormal follicle development and anovulation (metorrhagia) -Corpus luteum does not develop=progesterone-deficient state
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Describe the Hx for a pt getting an abnormal vaginal bleeding work-up
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Hx: Onset of menarche and duration and frequency of the menstrual period, Bleeding pattern, hx of liver, renal, thyroid disease, use of anticoags, oral contraception, hormone replacement, ROS: weight change, hirsutism (indicating PCOS=LH:FSH--2:1), exercise, increased stress, presence of galactorrhea or visual changes
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PE for a pt getting an abnormal vaginal bleeding work up
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Vital signs, orthostatic blood pressure (indicating acute bleeding) and pulse, signs of pregnancy, systemic disease, and sterile speculum and bimanual exam)
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Diagnostic Evaluation of Abnoraml vaginal bleeding
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-Pap Smear (unless recent normal pap) -CBC -Pregnancy test -Ultrasound if uterus is enlarged -Cervical culture in pts high risk of infection -Thyroid test and testing for systemic diseases
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What should be considered in younger pts with menorrhagia
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Coag disorders
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Abnormal Vaginal Bleeding: Women over the age of ____ require an endometrial biopsy that considers the possibility of endometrial cancer.
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35 (exception for postmenopausal women who have recently been started on HRT)
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A woman with which medical conditions is at risk for complications for herself and fetus during pregnancy
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DM, HTN, DVT, seizures, depression, or anxiety
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What hypertension medications should be avoided in the 1st and 2nd trimesters of pregnancy?
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ACEi, ARBS, thiazide diuretics
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HIgh risk pregnant patients should be evaluated for ____ and ____
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HIV and syphilis
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Vaccines that should be updated before planned pregnancy
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Hep B and rubella (if necessary) Note: pregnancy should be avoided up to 1-3 months after rubella and varicella immunizations=live attenuated viruses
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What should preconception counseling include?
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Genetic screening, medical assessment for chronic diseases, screening for infectious diseases, and updating of immunizations, advice on proper nutrition and exercise, help with quitting unhealthy habits, and advice on avoiding environmental hazards
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Prenatal visit schedule for low-risk pregnancies
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-Preconception visit: up to 1 yr before conception -1st prenatal visit: 6-8wks after missed menses -Every 4 wks: up to 28 wks gestational age -Every 2 wks: up to 36 weeks gestational age -Every week: until delivery
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What treatments are the cornerstone for treating cases of functional constipation?
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-Increasing fluid (8, 8oz glasses of water/day) -fiber
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_____ _____ _____ are high in fiber and increase stool volume by absorbing water given to patients with constipation.
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Bulk forming: Psyllium, Methycellulose, Polycarbophil
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What is the mechanism of action for stimulant agents in treating constipation?
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Alters mucosal permeability and stimulates the activity of intestinal smooth muscle -Ex: Bisacodyl (dulcolax)
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How is constipation clinically defined?
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Less than 3 stools per week
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Constipation: What are indications for lab testing?
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Refractory constipation, a new onset of constipation in an older individual, heme-positive stools, and situations in which the etiology is unclear or the clinical evaluation suggests underlying pathology
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Name types of laxatives
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-Bulk forming agents -Osmotic laxatives -Stimulant laxatives -Stool Softeners -Suppositories -Enemas
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Diarrhea is defined as an ____ in stool weight to more than ____g per day
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Increase; 200 g/day
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What are the two common clinical presentations of acute diarrhea?
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1. Watery, noninflammatory diarrhea 2. Inflammatory diarrhea with the presence of either blood or WBC in stool
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Whats the diagnosis: Severe abdominal pain in an elderly individual accompanied by acute diarrhea
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Possibility of Ischemic colitis
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Whats the diagnosis: Watery stools accompanied by a low-grade fever, headache, nausea or vomiting, and achiness
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Viral gastroenteritis
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Diarrhea from custard filled pastries
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S. Aureus
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What microganism is causing this array of presentations: Mild, crampy, nonbloody diarrhea to life-threatening hemorrhagic colitis complicated by hemolytic uremic syndrome or thrombopenic purpura
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E. Coli O157:H7
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What is the leading cause of parasitic diarrhea that presents as foul, greasy, bulky stools with associated weight loss or neuropathy?
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Giardia
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What are the most common viral causes of diarrhea in kids and adults?
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Kids: Rotavirus Adults: Norwalk Virus
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Define proteinuria
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>150mg per 24hrs
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Define nephrotic range proteinuria
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>3.5g of protein per 24hrs
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At was quantity does urine dipstick test detect elevated protein?
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100mg; means pt can be trace protein positive and not be detected
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What are the primary glomerular diseases?
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Focal glomerular sclerosis, membranous glomerular nephripathy, IgA nephropathy
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What are the secondly causes of glomerular disease?
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Post-streptococcal glomerular nepritis; systemic diseases such as SLE or a drug related effect on the glomerulus
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Glomerular disease usually results in excess __ excretion; whereas tubular disease produce a of ______protein
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Albumin; low molecular weight proteins
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How do you define persistent protein uria?
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Presence of proteinuria on at least two separate ocassion
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Define the patient population typically affected by orthostatic or postural proteinuria
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Affects 60% of patients with asymptomatic proteinuria; pts are usually <30, secrete less than 2g protein/day: proteinuria occurs in the upright, but not supine position
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What are the features of glomerular nephritis
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RBC casts and old to moderate HTN
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What are the features of nephrotic syndrome?
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Massive proteinuria and edema, hypoalbuminemia, hyperlipidemia, lipiduria
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Name some medications that can cause proteinuria
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ACEi, penicillin, cephalosporin, cyclosporine, NSAIDs, heavy metals, aminoglycosides, sulfonamides
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What is benign transient proteinuria?
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Common problem that resolves spontaneously and is most often seen in children and young adults
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1+ protein level on urine dipstick usually represents how much protein in the urine?
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300mg/dl protein excreted in the last 24hrs; 4+ indicates over 1g/dl per day
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Although urine dipstick test binds to albumin what, other important protein can it fail to detect?
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Bence-Jones
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What is the next best step if a patient has two or more positive dipstick tests?
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A 24hr urine protein collection and urine creatinine clearance determination
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Name the diagnosis of heartburn: regurgitation, dysphagia
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GERD
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Name the diagnosis of heartburn: gnawing epigastric pain, nausea, vomiting, bloating
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Peptic ulcer disease or gastritis
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Name the diagnosis of heartburn: upper abdominal/ epigastric pain, bloating, belching, flatulence, nausea
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nonulcer dyspepsia
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Name the diagnosis of heartburn: chest pressure, nausea, diaphoresis, palpitations
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coronary artery disease/ angina
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Name the diagnosis of heartburn: colicky right upper quadrant pain, with meals, radiation to scapular regions
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cholelithiasis
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Name the diagnosis of heartburn: severe constant mid abdominal pain
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pancreatitis
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Name the diagnosis of heartburn: dysphagia, assoc. with immunocompromised condition
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infectious esophagitis
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Name the diagnosis of heartburn: dysphagia, assoc. with ingestion
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medication or chemical esophagitis
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Name the diagnosis of heartburn: associated with signs of connective tissue disease, potential risk of stricture/ dysphagia
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scleroderma/polymyositis with secondary gastroesophageal reflux
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What drugs do you use to treat H.pylori + PUD?
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clarithromycin, amoxicillin, metronidazole PPI: cimetidine, ranitidine, famotidine, nazatidine
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What is the 1st step in treatment for patients with normal renal function and nondiabetic patients with preHTN?
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Lifestyle modification: Salt restriction, weight reduction, regular aerobic exercise
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What are the four classes of medications that are most commonly used for 1st line agents in HTN?
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-Diuretics -BB -CCB -ACEi
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What type of diuretic is the most widely used for HTN? What are some SE of this drug?
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Thiazide (useful in patients without renal impairment) -SE: sex dysfxn, dyslipidemia, hyperglycemia, and elevation in uric acids
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Which diuretic is best for HTN patients with renal impairment? What should be checked before administered?
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Loop diuretics (Check serum K+ levels before drug admin)
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SE Of Beta blockers?
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Bradycardia, fatigue, insomnia, sex dysfxn, and adverse effects on the lipid profile
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What type of drug is particularly beneficial for CHF and provide renal protection for those with diabetes?
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ACEi
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Why don't ACEi work well for the elderly and African Americans when treating HTN?
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These patients are associated with low renin states=less likely to respond to medication
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Hyperinsulinemia can increase vascular tone by what 4 mechanisms?
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1)Promoting Na+retention 2) Promoting hypertrophy and hyperplasia of vascular smooth muscles through its mitogenic properties 3) Modifying ion transport, leading to increase in intracellular Ca2+ 4) Sympathetic activation
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Clinical Manifestations of HTN
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Ischemic heart disease, stroke, peripheral vascular disease, renal insufficiency, retinopathy characterized by exudates and hemorrhages, and, in severe HTN, papilledema
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Diagnosis of HTN
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Increase BO (systolic >140 or diastolic >90) at least 2 consecutive visits 2 wks apart
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What lab test is recommended as baseline for future evaluation of HTN in the event of medication induced neutropenia or agranulocytosis?
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CBC
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What lab tests are recommended for newly diagnosed hypertensive pts?
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Fasting serum glucose, K+, serum creatinine, UA, lipid profile, serum Ca2+, uric acid
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What medications can cause heart palpitations?
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Theophylline, Digoxin, B agonists, OTC stimulants (pseudophedrine), antiarrhthymic med
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Palpitations: Which patients warrant hospitalization, monitoring and aggressive eval?
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Pts with palpitations and dizziness, near syncope, or syncope
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Isolated, extra pounding beats
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PVC or Premature atrial contraction (PAC)
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What are the 2 psych disorders most commonly associated with palpitations?
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Generalized Anxiety disorder and panic disorder
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Predictors of cardiac etiology
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Male, report irregular heartbeat Sx duration >5min, hx of heart disease
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How do you know if heart palpitations are due to stimulant or medication use?
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Less abrupt onset and cessation of palpitations
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Lab testing for heart palpitation
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Hgb, Electrolytes, and TSH
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What imaging is used to assess cardiac anatomy in patients with heart palpitations?
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Echocardiogram
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A ___ ___ ____records the cardiac rhythm for 24 hours and can detect arrhythmia.
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24 hour halter
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Treatment for supraventricular tachycardias
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BB or CCB, catheter ablation of identified bypass tract
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Tx of chronic or intermittent afibs
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Anticoag with warfarin to prevent thromboembolism
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How to NSAIDs contribute to gastritis and ulcer formation?
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NSAIDs block COX-1 production of prostaglandins that maintain mucosal blood flow, secretion of mucus, and bicarbonate. Without these protective factors, acid-induced inflammation and ulcers my result.
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What is the standard tool used for diagnosis of GERD?
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EGD
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What is the peripheral cause of vertigo?
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inflammation, stimulation, or destruction of the hair cells of the eighth cranial nerve
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What is the cause of benign positional vertigo?
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Particulate matter or otoliths may form in the semicircular canal. The otoliths become dislodged and stimulate the sensory hair cells in the semicircular canals, leading to vertigo.
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What is the cause of acute larbyrinthitis or vestibular neuronitis?
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Viral infection of the semicircular apparatus
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What is the cause of Meniere disease? What are the cardinal symptoms?
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enodlymphatic hydrops results in incrased pressure within the semicircular canals and damage to the sensory hair cells? -tinnitus, vertigo, hearing loss
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What is an acoustic neuroma?
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a tumor of the 8th cranial nerve that compresses the 8th cranial nerve and the brainstem
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What is a markers of CNS vertigo?
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other brainstem or cranial nerve findings
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What is the Barany maneuver?
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The patient is seated with the head turned to the right and is quickly lowered to the supine position with the head over the edge of the examination table 30 degrees below horizontal. The test is then repeated with the head turned to the left. The test is positive if symptoms are reproduced. It is a test for true vertigo.
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What does orthostatic positional changes that bring on dizziness suggest?
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-dehydration, anemia, cardiac causes
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What are the medications used to treat labyrinthitis, vestibular neuronitis, and BPV?
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meclizine, dimenhydrinate, antiemetics, and benzodiazepines
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What is the Epley maneuver?
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It is a test for BPV. Rotate the patients through a series of positions in an attempt to relocate the debris in the semicircular canal into the vestibule of the labyrinth.
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True or false: Migraine headaches require two of these four headache characteristics for diagnosis: unilateral location, pulsatile quality, moderate to severe intensity, or aggravation by movement. They must also be associated with one of the following symptoms: nausea, vomiting, photo or phonophobia. They last between 4-72 hours and may be accompanied by an aura.
answer
True
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Name the type of headache: mild to moderate intensity; located in the bilateral occipital-frontal areas; dull or band-like; lasts for hours; often assoc. with stress.
answer
tension headache
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Name the type of headache: severe, unilateral, localized to the periorbital/ temporal area; usually accompanied by one of the following symptoms- lacrimation, rhinorrhea, ptosis, miosis, nasal congestion, and eyelid edema; attacks occur every day, 1-8 days times per day, for 15 to 90 minutes, for 4-6 weeks. More comon in men.
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cluster headache
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Name the type of headache: The patient chronically uses analgesic or antimigraine drugs, esp. those with caffeine
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analgesic headache
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What diagnosis does the "worse headache of my life" suggest?
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subarachnoid hemorrhage
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What are the signs of cerebral hemorrhage?
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-acute headache, ataxia, profuse nausea, and vomiting
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What are the signs of acute sinusitis?
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-fever with frontal or maxillary tenderness
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What are the signs of malignant hypertension?
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-high blood pressure, focal neurologic defecit, or papilledema
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When is a lumbar puncture contraindicated?
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When an increase in intracranial pressure is suspected because it can lead to brainstem herniation
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What does treatment for migrans include?
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-triptans, ergotamine, DHE (emergency); prophylaxis- beta blockeres, tricyclic antidepressants, CCBs, anticonvulsants, serotonin antagonists, MAOIs; avoidance of stress, alcohol, caffeine, tyramine (red wine and cheese), nitrates (cured meats), artificial sweeteners
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What are the indiciations for neuroimaging?
answer
-headache of recent onset (<6 months) -headache beginning after 50 years of age -worsening headaches -headache that does not fit primary headache pattern -associated seizure -focal neurologic signs or symptoms -personality change -severe headaches unresponsive to therapy -history of significant trauma -new headache in a cancer patient
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Name the diagnosis: older patient with pain or palpation of the temporal artery? What is the definitive diagnosis?
answer
-temporal arteritis -biopsy of the temporal artery
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True or False: hyperthyroidism, pheochromocytoma, anemia, dehydration, hypovolemia are non-cardiac causes of palpitations.
answer
True
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What are the symptoms of palpitations?
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lightheadedness, dizziness, syncope
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Name the diagnosis: paroxysmal episodes that begin and resolve abruptly.
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paroxysmal atrial fibrillation or supraventricular tachycardia
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Name the diagnosis: isolated extra or pounding beats; often disappear with excertion
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premature ventricular contractions (PVCs) or premature atrial contractions (PACs)
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Name the diagnosis: A short PR interval and delta wave on ECG; assoc. with paroxysmal supraventricular tachycardias
answer
Wolff-Parkinson-White syndrome
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When should a patient get a stress test?
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When the patient has symptoms in association with exercise or who describe chest pain or pressure
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What is the difference between a Holter monitor or an event monitor?
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Holter monitor: 24 hours, detect an arrhythmia; patient keeps a log of symptoms Event monitor: can be carried for 30 days or more and are patient activated at the time of symptoms; event recroding ca nbe transmitted by telephone to a monitoring symptoms
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When should invasive eletrophysiologic study should be considered?
answer
in syncopal or near syncopal patients iwth heart disease and those iwth suspected ventricular tachycardia or heart block
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What are the three major risk factors for heart failure?
answer
hypertension, CAD, valvular heart disease
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What is the preload?
answer
aka left ventricular end diastolic pressure; the pressure required to distend the ventricle at a given volume
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What is afterload?
answer
the resistance against which the heart contracts and is clinically reflected by systolic blood pressure
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What are signs of pulmonary congestion?
answer
orthopnea, paroxysmal nocturna dyspnea, rales, jugular venous distention, and edema
question
What the consequences of decreased cardiac output?
answer
-activation of the RAAS, increased levels of catecholamines, secretion of atrial natriuretic hormone -This leads to vasoconstriction, fluid retention, increased afterload, which further inhibits cardiac output -late changes are mycoardial and vascular remodeling and fibrosis
question
What are the consequences of diastolic dysfunction?
answer
-higher filling presure, pulmonary congestion, and decreasd cardiac return
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What are symptoms are CHF?
answer
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema, weight gain, fatigue, chest pain, abdominal pain, anorexia, mental status changes
question
What are the physical exam signs of CHF?
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-jugular venous distension: elevated venous pressures -PMI is displaced laterally and downward: cardiomegaly -bibasilar rales -third and fourth heart sounds: fluid overloaded, stiff ventricles -murmurs: valvular pathology -hepatomegaly: right sided heart failure, venous congestion -lower extremity edema --> stasis dermatitis
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How does CHF present on X-ray?
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-cardiomeagly -redistribution of vascular markings -prominent interstitial markings -Kerley B lines -perihilar haziness -pleural effusions
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How does systolic vs. diastolic heart failure present on the echocardiogram?
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systolic dysfunction- ejection fraction is reduced to less than 45% diastolic dysfunction- ejection fraction is preserved or high; use doppler techniques- abnormal flow across the mitral valve
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What should blood work include for suspected heart failure?
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-CBC, UA, electrolytes, BUN, creatinine, albumin, TSH -BNP: elevated in CHF
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What is the goal of CHF treatment? What drugs should be used?
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-reduce symptoms, prevent complications, improve survival -diuretics, ACE inhibitors (slow progression of heart failure, decrease the number of hospitalizations and decrease mortality), beta blockers (decrease mortality and sudden death), spironolactone, digoxin
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Name the microorganism: folliculitis, cellulitis, furuncles (abscess/ boil), bullous impetigo and staphylococcal scaleded skin syndrome
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S. aureus- beta hemolytic streptococcus
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Name the microorganism: impetigo, erysipelas, cellulitis, lymphangitis
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Streptococci
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What is HSV1 associated with? What is HSV 2 associated with? What are the two phases of HSV infections? Describe the rash?
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HSV1: oral HSV2: genital -primary infection: transmitted by respiratory droplets or by direct contact with an active lesion or infected secretions -secondary phase: reactivation of the latent virus from dorsal root ganglia -grouped vesicles on an erythematous base and is uniform in size
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Name the diagnosis: transmitted by airborne droplets or vesicular fluid; patients are contagious from 2 days before onset of the rash until all lesions have crusted. The rash has a centripetal distribution, starting at the trunk and spreading to the face and extremities. Lesions appear as a "dewdrop on a rose petal" with a thin-walled vesicle, clear fluid, and a red based. Appear as constellations of lesions in different stages at the same time. Can cause cutaneous reactivation of varicella typically involving the skin of a single dermatome
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Varicella virus
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Name the diagnosis: epidermal warts; transferred by touch and occurs at sites of trauma
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HPV
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Name the diagnosis: umbilicated skin lesion that is spread by autoinoculation, scratching, or touching a lesion. Discrete 2 to 5 mm slightly umbilicated flesh-colored, dome shaped papules occurring on the face, trunk, axillae, and extremities in children and in the pubic and genital areas in adults
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molluscum contagiosum- pox virus
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Name the diagnosis: a ringowrm fungi that infects and survives only on dead keratin (stratum corneum), the hair and the nails
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dermatophytes i.e. tinea- funus infection such as tinea captis- fungal infection of the scalp
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Name the diagnosis: live in the mouth, vaginal tract, and gut; produce budding spores, pseudohypahe (elongated cells), or true hypae
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Candida albicans
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Name the diagnosis: a fertilized female mite burrow through the stratum corneum to being a 30 day life cycle of egg laying and deposition of fecal matter. After the eggs have hatched, the mites can migrate to other areas such as the finger webs, wrists, extensor surfaces of the elbow and knees, axillae, breasts, waist, sides of hands and feet, ankles, penis, buttocks, scrotum ,and palms and soles of infants. Transmitted by direct skin contact with an infected patient.
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Scabies
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What are the three types of lice?
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Pediculus humanus capitis- head louse P. humanus corporis- body louse Phthirus pubis- pubic or crab louse
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Name the skin lesion: honey colored crusts
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Impetigo
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Name the skin lesion: erythema, warmth, edema, pain, fever
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cellulitis
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Name the skin lesion: pustule in association with a hair follice
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folliculitis
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Name the skin lesion: larger fluctuant erythematous lesions that also occur in association with hairy legions
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furucnle
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What is the Nikolsky sign (elicted when a local skin separation occurs after minor pressure) suggest?
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Staphylococcal scalded skin syndrome
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Name the skin lesion: small tumors of the skin that obscure normal skin lines, have a mosaic surface pattern, and may have thrombosed vessels appeairng as black dots on the surface
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Warts
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What does the classic ring worm lesion have?
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a central clear area
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How are fungal infections diagnosed?
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with a KOH wet mount preparation
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