BARKLEY 3P EXAM QUESTIONS AND ANSWERS
What would cause decrease in Digoxin levels Antacids
Taking Pyridium for UTI, what can Pyridium cause? Hemolytic Anemia
What can PCOS result in? increased insulin levels, Androgens, hirsutism
What is a hypertensive used in pregnancy Methyldopa
What is a characteristic of Placenta Previa? painless red bleeding
What is a characteristic of Rheumatoid arthritis ? Red hot joints
Medications that cause ototoxicity Aminoglycosides, nasal decongestants, antihistamines
Treatment period for enterobiasis 2 weeks
CBC Interpretation MCV – mean corpuscular volume help diagnose different types of anemia (High=macrocytic like B12, Low=microcytic like Fe anemia)
Rhogham given at how many weeks gestation? 27 weeks
Janesway lesions Happen with endocarditis, non painful lesions seen on hands and feet, Osler same but painful
Warfarin management – forgot a dose? If under 12 hours take missed dose, if over skip and need INR redraw
Taking an ACE or ARB what to know? ACE (dry hacking) cough starts 1-2 weeks after med started, ACE (Lol) ARB (sartan) first line in HTN avoid initially in african americans, angioedema can occur
Contraindication for hydrochlorithiazide sulfa allergy, asthma, PCN hypersensitvity
Murmurs Systolic “MR=Mitral regurge (SOB/Fatigue HF)Peyton Manning=phys murmur (asymptomatic)AS=Aortic Stenosis (Angina, syncope HF)MVP=Mitral valve prolapse (palps, CP, “”click””)”
Diastolic Murmurs (ABnormal) AR= Aortic Regurge (angina, HF, dizzinness, CP)MS=Mitral stenosis (Dyspnea, Afib)
Motivated Systole-S1 closure of AV Mitral/tricuspid valve (lub)Mitral, Tricuspid, atrioventricular valves
Apples Diastole s2 closure of the aortic pulmonic valves (dub)aortic pulmonic semilunar
Abnormal (extra) heart sounds S3- CHF; possible normal for adolescent athletes, S4 LVH poorly controlled HTN, unstable angina
Assessment of PAD antiplatelets (Plavix, ASA), Pentoxifylline (decreases blood viscosity) to treat, ankle brachial index to check, angiography gold standard to diagnose
Coronary artery Disease tx Atorvastatin/rovustatin- use high dose meds for LDL>150, watch for LFTs and arthralgia. Change type and dose if problems. Stabilization of plaque with statins
HF treatment ACEI, ARB, or ARNI with BB and aldosterone receptor antagonist
Scabies Treatment (Sarcopter Scabiei) Topical Permethrin massaged from head to soles of feet and wach off with shower or bath after 8-14 hours. Treat again in 1 week
Names of skin findings Macule; freckle <1 cm, Papule Macule >1 cm chloasma, Papule <0.5cm elevated nevi (molluscum wart), Plaque (psoriasis, lichen planus), Nodule 0.5-2 cm lipoma, vesicle (herpes simplex contact derm, Keloid hypertrophic scar that is invasive beyond point of original injury Skin continued Bulla-second degree burn, friction burnWheal- raised, mosquito bite, hiveScales;dandruffCrusts-scab from abrasian, impetigo Tinea Fungal infections; Tinea capitis-round patchy scales on scalp (cradle cap) treatment Grisefulvin take with high fat meal 4-6 weeks 500 mg tinea corporis -red and scaly plaque on trunk (ring worm) Treatment is an azole for 2 weeks Melanoma How do you assess ABCDE Asymmetry, border, color, diameter >6 mm, elevation
Psoriasis silvery white scales, nails are pitted; positive Auspitz sign- pinpoint bleeding occurs when lesions are scraped
Shingles (Herpes Zoster) Unilateral dermatomal rash- painful as it progresses to vesicles, Acyclovir within 48-72 hours or symptoms. May only transmit chickenpox virus to susceptible patients that have not gotten exposed or vaccinated yet. Post herpetic neuralgia pain is longer than 1 month after rash has resolved.
Contact dermatitis papules or vesicles 5mm or less, scaling, crusting, oozing. Tx corticosteroids/antihistamines
Acne Vulgaris Inflamm disorder where androgen-dependent sebaceous glands produce excess sebum. Areas most commonly affected are face, anterior and posterior chest, arms and shoulders. Treatment: Erythromycin/Benzyl peroxide=limit exposure to sunlight peroxide can decrease resistance to erythromycin
Atopic dermatitis Patchy plaque like rash with inflammation. common in people with other atopic illnesses (asthma, allergic rhinitis)
Eye Findings in HTN and DM AV nicking-arteries indent and displace veins, cotton wool spots-gradual vision loss, flame hemorrhages- blot and dot hemorrhages
Tx of acute sinusitis in adults and pediatrics Viral symptomatic tx only, is bacterial- amoxicillin first line symptoms>10 days purulent nasal discharge, fever, unilateral face or tooth pain
Snellen test Test for visual acuity; CN II
What medications can cause ototoxicity Aminoglycosides (tx otitis externa) , loop diuretics, quinine, ASA
Rhinitis Eosinophils due to WORMS, wheezes, weird diseases. Most effective tx for allergic rhinitis- Fluticasone Flonase
Acute bacterial rhinosinusitis For empiric tx of patients with acute bacterial rhinosinusitis who are allergic to penicillin, the best alternative first line therapy is Doxycycline
Which immunoglobulin is responisble for the symptoms in the patient with allergic rhinitis? IgE
Assessment of a 4 year old visual acuity resulted in 20/30 in L eye and 20/40 in R eye. Means vision is normal for his age, 20/20 vision at 6 years old
Distinctive feature of cataracts Absent red reflex
Meclizine Given for patients who present with Positional vertigo
Pterygium growth on conjunctiva of fleshy tissue, sx redness, swelling, yellow spot or bump dry itchy like sand in eye
Eye emergencies papillaedema (increase ICP, swollen optic disc engorged tortuous retinal veins), Acute closed angle glaucoma is unilateral eye pain rapid onset and loss of vision
Presentation with foreign body in eye only remove with wet cotton swab if not able to send to opthamologist
Meniere’s Disease A 45 year old patient complains of vertigo, tinitus, and pressure in the right ear
Hyperopia Light that is focused behind the retina causes the visual disturbance
Mononuleosis Most commonly caused by EBV can be passed sexually
Which medication is most commonly associated with hypoglycemia Glyburide
How does myxedema present and what is its indicative of found in patients with hypothyroid, hypothermia, thickening of the tongue, and disorientation
Assessment findings PCOS Hirsutism, hyperinsulinemia, elevated lipids, abnormal hair, acne
Assessment finding and RX for hyperthyroidism M/C cause is Graves’ disease, finding include tachyC, Afib, weight loss, hyperactivity, warm, moist skin, flushed
Hyperprolactinemia Menstrual dysfunction, ED, pain in breast, loss of libido, lactation, vaginal dryness, infertility
Hyperandrogenism High levels of Androgens in females, sx include acne, seborrhea, hair loss on scalp, increased body or facial hair, infrequent or absent menstruation, Can be caused by PCOS
DM A1c over 6.5 or fasting glucose over 126, initiate Metformin at initial diagnosis
Assessment of neuropathy In distal lower extremities, long effect of hyperglycemia, paresthesias and burning
Treatment and Presentation of Giardiasis Foul smelling stools, abdominal pain, flatulence spread fecal-oral route. Tx is Metronidazole 250 mg TID
Presentation and assessment of Cirrhosis Coagulopathy, variceal bleed, hepatic encephalopathy, extrahepatic sx- neuro, psychiatric, arthralgia, autoimmune disorders, glucose intolerance. Pt early stage of cirrhosis likely to have thrombocytopenia
Assessment of Hepatitis Malaise, fever, jaundice, fatigue, weight loss, joint pain, dark urine, RUQ pain, liver enlargement, pancytopenia. Elevated ALT/AST, bili, alk phos
GERD Pyrosis (heartburn), burning beneath sternum, regurgitation, postnasal drip, throat clearing, chronic cough, chronic sore throat, hoarseness. Tx 8 week course of PPI
H Pylori Algorithm Amoxicillin BID, Clarithromycin BID, PPI BID x 14 days. If PCN allergy tx would change to Metronidazole BID, Clarithromycin BID, PPI BID x 14 days
Which of the following symptoms associated with GERD is considered an alarm symptom? Odynophagia (Pain with swallowing, maybe w/wo difficult swallowing)
Crohn’s Disease Chronic bloody diarrhea- fatigue, abdominal pain, prolonged diarrhea, with/without bleeding, weight loss and fever. Skip lesions, cobblestone appearance and fistulas common. Slow progressive inflammation small intestine and or large intestine or TI. TX- Budesonide 5-aminosalicylates
Common pathogens that cause Gastroenteritis Common pathogen gastroeneritis <1 y.o., adults (norovirus, enteric adenovirus, astrovirus), campylobacter jejuni in children, Salmonella most common foodborne illness, Giardia Lambia most common parasitic Pyloric Stenosis Presentation narrowing of the pyloric sphincter due to hypertrophy of pyloric muscle- forceful vomiting usually 2-3 weeks of age Hepatitis B Bloodborne/body fluids highly infectious, patients who test positive for HBV and HCV should also be screened for HIV due to common transmission routes Pinworm infection Enterobiasis vermicularis- Helminths can be transmitted by the bite of blood sucking insects. TX: 3 doses of medication sep by 3 weeks Pyrantel Pamoate- two weeks apart and retest in two weeks post tx Ulcerative Colitis Only present in colon Pancreatitis Pancreas Enzymes amylase and lipase are inactivated when the pH is below 5. which of the folowwing is NOT an enzyme produced in the panceas? Pepsin Small Bowel Obstruction Abd pain, vomiting, inability to pass gas. Proximal- nausea and vomiting more present. Pain described as crampy and intermittent ALL Most common type of leukemia in children. Signs and symptoms fever thrombocytopenia, anemia, gingival swelling, bone pain Beta Thalassemia Mediterranean descent, genetic disorder, decreased or absent production of hemoglobin results in microcytic/hypochromic anemia. TX: Desferal removes excess iron in patients Lymph nodes Posterior auricular drain lymphatic fluid from the posterior part of the temoporparietal region.Facial nodes drain from the eyelids, the conjunctiva, and skin and mucous membranes of the nose and cheekThe infraorbital or maxillary buccinators and supamandibular lymph nodes drain fluid from the eyelids, conjunctiva, and skin and mucous membranes of nose and cheek. Tonsillar lymph node is located at the angle of the mandible Lymph continued -Deep cervical nodes drain fluid from the head and neck, -Anterior mediastinal lymph nodes drain fluid from the thymus, thyroid, and anterior part of the pericardium -Axillary- fluid from breast-internal iliac lymph receive lymph from all pelvic viscera, deep part of the perineum, and the gluteal region -sup/inf mesenteric drain into small and large intestines Iron Def Anemia Microcytic/Hypochromic anemia occurs when Iron loss exceeds iron intake and iron stores deplete. (blood loss). Pica, atrophic glossitis. Vitamin B 12 Deficiency (Pernicious anemia, cobalmin def) Macrocytic/Megoblastic, B12 is water soluble vitamin necessary for RBC production. Results from a decrease in intrinsic factor due to the autoimmune destruction of parietal cells leading to reduced vitamin B12 absorption. S/S:cog impairment, fatigue, ataxia, weakness, neuropathy, glossitis, mouth ulcers When and how long to take iron supplementation for? Take 1-2 hour before meal, empty stomach, with Vitamin C. Take for 4-6 months, after iron was replaced continue to take for 12 weeks. Repeat CBC Rh incompatibility hemolutic disease of the fetus and newborn desctruction of RBC’s by maternal IgG antibodies. Can lead to jaundice, anemia, fetal hydrops. Rhogam shot at 28 weeks and 72 hours of delivery to prevent Sickle Cell Repeated episodes of sickling can cause the cells to become irreversibly sickled. Hemoglobin electroparesis confirms dx. it is autosomal recessive characterized by ischemic tissue injury and chronic severe hemolytic anemia. BPH Enlargement of the prostate that narrows the urethral lumen. Risk factors Elevated PSA increased age, genetics, black and Asian. Firm smooth prostate enlarged- usually nontender, hesitancy, dribbling, incomplete bladder emptying. Avoid caffeine, ETOH, diuretics. Alpa 1 adrenergic antagonist – immediate relief, relaxes smooth muscle in the prostate (tamsulosin). 5 alphs reductase inhibitor (finasteride)- long term therapy takes 6-12 months. inhibits conversion of testosterone to DHT. Hydrocele peritoneal fluid collection in scrotum. Painless swelling in scrotum, feels heavy, transillumination of scrotum (will light up brightly) Penile Cancer Squamous cell carcinoma; risk factors: HPV, AIDS, uncircumcised, smoking, psoriasis, cryptochordism. Thick white plaques, large scaly growths. Bleeding is late sign Erectile Dysfunction Treatment PDE-5 inhibitor, usual reason HTN meds, antidepressants, antiandrogens, recreastional drugs High risk of penile and testicular cancer development Cryptochordism Prostatitis Inflammation of the prostate usually bacterial origin. S/S: frequency, urgency, fever, enlarged boggy warm prostate. Tx Chronic prostatitis: Ciprofloxacin or Fluoroquinolones for 4-12 wk tx or Bactrim. 4-6 weeks tx guided by results of C&S. NOT KEFLEX. Levofloxacin yes Determining testicular torsion from Epididiymitis Testicular torsion- acute onset testicular pain and loss of cremasteric reflex on affected side. Most common acute ain in prepubertal boys- epididymitis, but testicular torsion must be ruled out. Symptoms onset testicular torsion- few hours vs epididiymitis- few days and pain with cremasteric reflex Gonorrhea/Chlamydia tx Doxycycline 100 mg BID x 14 days, and Ceftriaxone x1 IM Migraine Treatment Rescue- Triptans, prophylactic- Beta Blockers, antidepressants, anticonvulsants. (Topamax, Propranolol, Inderal) Migraines presentation Mostly inulateral, crescendo, cool, quiet dark rooms usually lasts 4-72 hours. Tension Headaches Bilateral pressure, tightness, band like, waxes and wanes. Fiorcet can help pain, Butalbital Cluster Headaches ALWAYS unilateral, begins around the temple or eye. excruciating/explosive, sudden onset. Lasts 30-90 min can be up to 180 mins associated symptoms includes red eye, tears rhinorrhea. Most common at night. Secondary headache underlying causes Person with VP shunt – headache upon awakening, Meningitis accompanied with stiff neck/fever, brain tumor- frequent headaches worsens when coughing or sneezing. Parkinson’s disease Deficiency of Dopamine and destruction of cells in the substantia nigra. Presentation: Bradykinesia(slow movement and decrease speed), rigidity, resting tremor (pill rolling, appears in hands and arms, legs, jaw, and face), postural instability. Dx is supported with therapeutic response to Levodopa. Tx: Dopaminergic agents, Carbidopa/levodopa (do not give in pts with narrow angle glaucoma) Anticholinergics and confusion in the elderly “Beer’s List- list of meds you should not give to the elderly; anticholinergics, scopolamine, ALL “”mines”” Meclizine, promethazine. High risk of confusion, dry mouth, constipation. Antispasmodics (atropine, dicyclomine)” Cranial Nerves I-OlfactorySmellII-Visual AcuityOptic nerve,III-Occulomotormuscle fx (focus)and pupil responseIV-Trochlear-superior oblique muscle (down, out, and inward eye movements)V-Trigeminal- Opthalmic, maxillary, mandibularVI-Abducens-lateral rectus musclesVII-Facial- facial expression, sense of taste, spit and tears, outer parts of earVIII-Vestibulocochlear- hearing and balance IX-Glossopharyngeal- sense of taste back of tongue, voluntary movement back of throat, sensory information X-Vagus- XI-AccessoryXII-Hypoglossal Patho meningitis Inflammation of the brain and spinal cord meninges resulting from bacteria, virus, or fungi. Meningeal headache is caused by meningeal irritation. Macrolides/clindamycin not first choice tx. usually Ceftriaxone cephalosporin TIA Transient Ischemic Attack- differs from stroke because symptoms resolve within a few hours Seizures Uncontrolled electrical activity within the brain. first line treatment is generalized tonic clonic. Keppra- partial seizures Scoliosis Lateral curvature of the spine greater than 10 degrees. structural scoliosis=true deformity not a structural problem RA vs OA RA=Worn cartilage, bone loss, thickened synovial membrane. joints are hot, swollen, Autoimmune, eats away boneOA=extremely worn cartilage and bone spurs, Positive Heberden and Bouchards nodes, bony and hard Treatment OA Exercise, Weight loss, and RICE, Tylenol NOT recommended. SHort acting NSAIds ok. Cymbalta (multiple joints affected), duloxetine, and Tramadol longer acting. Refer to ortho for injections Sprain vs Strain Ligaments are fibrous tissue that attach to bones, A sprain is a stretch or tear in a LIGAMENT. A train is a stretch or tear in a muscle or tendon. Tx is RICE for both. Ortolani’s click “a “”click”” is heard or felt as dislocation is reduced (good until one year)” Barlows Maneuver Feeling of a slip of the femoral head slips away from the Acetabulum (toward the butt) Meningitis signs Positive Kernig (flex hips 90 degreed pain with extension of leg), Brudzinski (involuntary flexion of legs when neck is flexed) Adams sign examiner stands behind pt looks for spinal curvature, pt bends over and touches toes(-) functional scoliosis if curve straightens out(+) structural scoliosis if curve remains*if no scoliosis present = no Adam’s Sign indicated Fat pad sign test for elbow fracture McMurray Test Audible palpable click when knee is raised with tibia externally rotated and then straightened, medial meniscus tear assessment Gout and treatment Acute joint pain with swelling, warmth, and erythema begins abruptly and involves single joint. Normal uric acid levels are common during acute attack. Colchicine for acute gout long term is Allopurinol (urate lowering agents dosed 2 or more attacks/year renal stones. decreases production of uric acid. for preventative attacks. GTPAL Gravida # of times women has been pregnant, multiples=1 Term=number of children >37 weeks or more Preterm=20-37 weeks Abortion or miscarriagesL=living children, twins./multiples count individually
Fundal Height Distance from the pubic bone to the top of the uterus measure in centimeters. After 24 weeks fundal height should match the number of weeks youve been pregnant
Preeclampsia BP >140/90 and proteinuria (300 mg/24 hour) or edema, pulmonary edema, visual impairments, renal or hepatic function. Tx: magnesium sulfate, antihypertensives, corticosteroids for long development
Naegeles Rule First day of LMP-3 months+7 days+add one year
Placenta previa Bright red, painless bleeding in a woman>20 weeks gestation. Abnormal placement of the placenta near or covering the internal cervical os
First line treatment of UTI in pregnancy Nitrofurantoin/Macrobid
Rhogam At approx 28 weeks gestation, within 72 hours of delivery and any maternal hemorrhage, ectopic pregnancy, abortion.
Vaccines that are safe in pregnancy Flu vaccine, TdAP
Abruptio Pacentae Profuse to absent vaginal bleeding, abnormal painful uterine contractions, uterine tenderness, board-like uterus on palpation.
Bulimia Presentation Recurrent episodes of eating binging and purging. Russells sign= scarring on knuckles from induced vomiting. Avoid Bupropion (seizures/electrolytes), tx: SSRIs Prozac/sertraline
Depression and treatment Depression usually treated with SSRI for a unipolar -sertraline/escitolopram. 4 weeks of treatment then re-evalfor dose adjustmentfor minimum of 6 months Cymbalta- cant get off the couchBuspar- AnxietyAnxiety and depression coexist use GAD 7 scale to dx
Eval for mood disorder SIGECAPSS-sleep issueI-interests lackG-GuiltE-EnergyC-ConcentrationA-AppetiteP-Psychomotor agitationS-Suicidality
Presentation of Bipolar and MDD Major depressive disorder or bipolar 5 or more symptoms Anhedonia- loss of pleasure or interest in things that previously provided joy or pleasure
Hormones in depression Serotonin- calmness and relaxed stateNorepinephrine and dopamine inhance productivity, ambition, concentrationGABA- feelins of calmnessNMDA- excitatory neurotransmitter
Munchausen by proxy caregiver makes up or causes an illness or injury in a person under his or her care
Suicide screening 3 questions: Are you thinking of hurting yourself, whats your plan, do you have means or a gun?At risk, prior attempt, adolescents, males, elderly white males highest risk.
Asthma Mild intermittent- symptoms 2 or less days per week or 2 less nights per month with short exacMild persistent- symptoms greater than 2/week but less than once per dayModerate persistant- daily symptoms or more than 3-4 nights per monthSevere persistant- continual symptoms or frequents symptoms >1 night per month
Asthma Diagnostic Spirometry, pulmonary function tests, allergy testing, peak flowTX: Mild int- SABA
COPD Progressive pathological changes to the airway and/or alveoli due to increased inflammatory response to pollutants or inhaled irritants. Gold standard dx: spirometry with bronchodilation. Progressive dyspnea, cough with or without sputum, prolonged expiratory phase, wheezing on forced exhalation, barrel chest tripod position late phase
Empyema Presence of pus in the pleural space. Develops when pulmonary lymphatics become blocked leading to an outpouring of contaminated lymph flui into pleural space. Fever, cyanosis, tachyC, pleural pain.
Pleural Effusion Presence of fluid in the pleural space from blood or lymphatic vessels. Dyspnea, atelactasis, pleural pain. Dullness on percussion. , mediastinal shift
Treatment of CAP Mycoplasma- walking pna, Strep pna- will kill your patient. TX Macrolide i.e. Azithromycin. Infant Amoxicillin, school age amox or macrolide. Outpatient previously healthy- Macrolide OR DoxycyclineOutpatient recent ABs- Resp flouroquinolone OR advanced macrolide (azithromycin) plus high dose amoxicillinOutpatient comorbidities no recent AB-Advanced macrolide OR resp fluoroquinolone Outpatient comorbidities recent AB- resp fluoroquinolone or advanced macrolide plus beta-lactam
Pertussis Lasts six weeks to two months. Caused by Bordatella Pertussis, tx macrolide (Azithromycin) or sulfonamide (Bactrim), everyone in household treated, Pregnant women get Dtap shot 27/28 weeks.
TB Dx Quantiferon gold, T spot, TB skin test. Tx is very liver toxic: Isoniazid, Rifampin. DO TREAT LATENT but not infectious. Sx: Fever cough >3 weeks, hemoptysis, weight loss, night sweats.
Croup Acute viral illness barking cough, stridor, cough, hoarseness subglottal swelling. No tongue depressors can spasm. Racemic epi?
Chlamydia Most common STI in US, genital ulceration, lymphadenopathy, ocular trachoma, proctitis. Often asymptomatic, cervical motion tenderness, Nucleic acid amplification test (NAAT) and Gen probe gold standard. Tx azithromycin if pregnant Amoxicillin. Can cause PID
Gonorrhea Common with Chlamydia. Ceftriaxone 500 mg x1, highsuspension for chlamydia give doxycycline. Purulent discharge , blood tinged, prostatitis
Bacterial Vaginosis not an STD, more common in sexually active females. Fishy smell, watery discharge, clue cells. increased alkalosis. Tx is Flagyl Metronidazole. Lactobacillus is diminished or absent
Genital Herpes Herpes Simplex virus type 1 or 2, transmitted direct contact with active lesions or with virus containing fluid. Is a virus, Tx is antivirals pt can be infectious while shedding virus.
HPV 6 and 11 cause genital warts 16 and 18 can cause cervical cancer. Soft painless, flesh colored warts can be cauliflower like if perianal.
Syphilis Primary, secondary, latent and tertiary. Primary chancre at site, secondary systemic rash, latent is asymptomatic, tertiary is neuro symptoms. Tx is Benzathine pcn G IM.
Trichomoniasis Caused by Protozoan, copious pale yellow to grey green discharge. NAAT to dx, Flagyl to treat. Can cause Petechaie on the cervix, is a protozoal pathogen
Pediculosis Pubis Treat with Permethrin (Nix), pubic hair, inflammation in groin area
Last and early signs in HIV Fever usually one of first symptoms, fatigue, swollen nodes, sore throat. Late stages: Rapid weight loss, recurring fever, night sweats, fatigue, sores, chronic diarrhea, swollen glands. If TD4 under 200 than progressed to AIDS
Stress Incontinence vs urge vs overflow Overflow- unable to empty, urinary retention with underachieve bladder or blockage. Muscle of bladder underactive or obstructed. tx Bethanechol, foley cath, alpha blocker finasteride for BPH, FlomaxUrge- Bladder is active detrusor muscle overactive constant urge. tx: oxybutynin anticholinergicStress- amount of bladder is normal has too little tone near exit, bladder leaks out with any activity. weak pelvic muscles sphincter intontinence. Tx Pseudophedrine
First line treatment UTI Nitrofurantoin, Macrobid. Pyridium can be used to help pain- do not use longer than 3 days can cause hemolytic anemia. Pregnancy-Amoxicillin or Nitrofurantoin <3rd trimester. Avoid quinolones or sulfa
UTI Positive leukocytes and nitrites on UA. Assessment findings pain, burning, urgency frequency fever chills
When to adjust meds with kidney disease If GFR less than 60 adjust meds
Assessment of Breast cancer Painless, firm fixed mass, skin or nipple changes, nipple discharge, swelling, lymph enlargement, Pagets disease scaly nipple lesion.Peau d orange, nipple retraction, redness, persistent itching, warm skin.
Who does and doesnt get combined oral contraceptive and contraindications Do not give COC to a women of child bearing age that also has migraines with an aura
How to assess and tx dysmenorrhea Painful cramping with menstruation pelvic exam has to be normal tx with heating pad non pharmacological, NSAIDs, oral contraceptives.
Assessment and tx of PMS symptoms depression, anger, anxiety, confusion, soacial withdrawal, irritability, breast tenderness, bloating, HA, swelling.
estrogen replacement CONTRAindicated in women with breast cancer, undiagnosed vaginal bleeding, pregnancy, clots, and active liver disease
PEDS: Medication Sinusitis- Augmentin, DDAVP desmopressin acetate for enuresis, succimer for lead
PEDS ESRD Erythropoeitin is safe for use in children
Surbstance abuse and assessment PEDS Risk factor-ADD tx is atomoxetine
Contraindications to decongestants in Peds FDA discourages the use of OTC decongestants to under 2 years old
Acromegaly presentation Gigantism is peds, giantism is adults. Presents with bone overgrowth big hands, face, and feet. Overproduction of pituitary gland.
Patients with aortic regurgitation present with dyspnea and angina
endocarditis tx zosyn/vanco
mechanism of action of prostaglandin with transposition of the great vessels provide vasodilation and adequate oxygenation
HTN and CAT acronym “CCB-amlodipineACE/ARB- “”pril””Thiazide or chlorthalidonenephropathy or diabetic start with ACE/ARBblack- thiazide first”