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FM CF 30-52
FM CF 30-52
127
Medical
Graduate
03/13/2014

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Term
in an elderly pt who is suspecious for alzhiemers what labs do you order. image?
Definition
b12
rpr (for neurosyphillis)
tsh
hiv

ct mri
Term
major features of dementia
Definition
memory loss
decline of executive functioning
Term
most common cause of dementia
Definition
alzhiemers
Term
pathological dx of alzheimers
Definition
plaques and neurofib tangles
Term
diagnostic criteria of alzhiemers
Definition
1. gradual onset and progression of cognitive dysfuntion in one or more area of mental function (aphasia, apraxia or agnosis)
2. not caused by anything else
Term
pseudodementia
Definition
dementia in the elderly 2/2 depression
Term
ade of alzhiemers drugs
Definition
nausea, vomit, diarrha, dizziness, ha
arrythmia, bradycardia, urinary retention
Term
moa of memantie
Definition
nmda antagonist
Term
manage hallucinations and agitation in alzhiemers pts
Definition
antipsychotics
Term
dementia, gait distrubance and incontinence
Definition
normal pressure hydrocephalus
Term
lewy body vs alzhiemers
Definition
lewy: more ups and downs, hallucinations earlier
Term
do you do imaging in migraines?
Definition
only if they have "red flag" symptoms
Term
1st line for migraine
Definition
triptan

if otc nsaids dont work
Term
migraine unilat or bilat?
Definition
unilat
Term
time frame for migraine
Definition
4hrs-3days
Term
red flags in headache
Definition
rapidly increasing headache frequency
focal deficits
ha awakens pt from sleep
Term
sudden onset HA
Definition
hemorrhage
Term
work up of sudden onset HA
Definition
image
then lumbar puncture if image -
Term
HA increasing in severity or frequency
Definition
mass
subdural
medication
Term
HA begining after age 50
Definition
temporal arteritis
mass
Term
work up of temporal arteritis
Definition
esr
Term
focal neuro deficits + HA
Definition
mass, vascular malformation, stroke
Term
papilledema
Definition
mass ledion
pseudotumor
meningitis
Term
who gets migraine prophylaxis
Definition
ppl who require acute tx more than 2 x week
Term
goal tx in migraine prophylaxis
Definition
reduction in severity and freq of HA by 50%
Term
other drugs to use vs migraine
Definition
propanolol
timolol
divalproex sodium
Term
most common form of primary HA
Definition
tension
Term
time frame of tension HA
Definition
30 minutes-7 days
Term
photophobia and phonophobia in tensino HA
Definition
may have one, but not both
Term
tx of tension HA
Definition
ASA
tylenol
nsaids

CCB, BB
Term
cluster HA bilat or unilat
Definition
unilat
Term
time frame of cluster HA
Definition
15 min- 3 hrs
Term
tx of cluster HA
Definition
o2 at 6L min
dihydroergotamine
triptans
Term
prophylaxis of cluster HA
Definition
verapamil
Li
divalproex sodium
prednisone
Term
when do htn pts have HA
Definition
with diastolic >110
Term
rebound HA
Definition
HA from caffeine, NSAIDS or other pain killers
Term
throbbing
Definition
migraine
Term
types of vague medical issues associated with domestic violence
Definition
chronic pain
frequent abdo or pelvic pain
depression, fatigue
Term
exam/tests to order when suspicious of child abuse
Definition
retinal exam (retinal hemorrhage)
xray
Term
what is the drs legal obligation in abuse
Definition
domestic violence against an adult does not need to be reported

violence against children ALWAYS needs to be reported
Term
stocking glove burns of extremities
Definition
immersion in scalding water
Term
burns on butt/groin
Definition
immersion in hot bath
Term
retinal hemorrhage
Definition
shaken baby
Term
bucket handle fracture or corner fracture
Definition
metaphysis of long bone has the corner chipped off. sign of child abuse
Term
posterior rib fracture
Definition
result of grabbing and squeezing the chest violently

very suspicious for abuse
Term
spiral fracture of tibia
Definition
aka toddlers fracture
common injury often confused with abuse, more often from learning to walk
Term
multiple bruises on shins of child
Definition
more common from falls and learning to walk in toddler aged children
Term
drugs that more commonly cause fever
Definition
beta lactams
sulfa
heparin
amphotericin B
Term
how do you get malignant hyperthermia
Definition
autosomal dominant disroder
Term
features of malignant hyperthermia
Definition
fever > 104
tachycardia
metabolic acidosis

calcium accumulation in skeletal mm --> rigidity
Term
when does malignancy hyperthermia happen
Definition
up to 24 hours after exposure to anestheis like halothane, succinly choline
Term
tx of melignancy hyperthermia
Definition
antipyretics
oxygen
cooling blankets
dantrolene IV
Term
5 Ws of postoperative fever
Definition
Water, Wind, Wound, Walk, Wonder Drugs
Term
fever within 24 hours of surgery
Definition
sepsis from:
preexisting infection
intraperitoneal leak
toxic shock

malignant hyperthermia
Term
time frame to get uti after surgery
Definition
1 day to 1 week
Term
when is dvt a risk after surgery
Definition
1 day - 4 weeks
Term
fever 1 month after surgery
Definition
delayed trasnfusion issues
transplant rejection
infective endocarditis
Term
what factors indicate an infectious cause of fever
Definition
1. preoperative trauma
2. ASA score > 2 (aneasthesia)
3. onset on second post op day
4. WBC > 10,000
5. BUN > 15
6. chills/rigors
Term
SIRS criteria
Definition
temp over 38 or under 36
HR over 90
RR over 20, or PaO2 <32
WBC > 12000 or under 4000
Term
fever
Definition
over 100.5
Term
most common pathogen in post operative sepsis
Definition
gram negative
Term
when is atelectasis a risk factor
Definition
48-72 hrs post op
Term
cxr in atelectasis
Definition
discoid inflitrate
elevated hemidiaphragm
Term
major risk of atelectasis
Definition
pneumonia
Term
what type of abx do you use in aspiration pneumonia
Definition
anything with gram negative coverage
Clindamycin or
amox/clav or
metro + amox or penicillin
Term
how many days of iv puts pt at risk for iv site infction
Definition
3
Term
largest cause of postoperative morbidity
Definition
pulmonary complications
Term
most important risk factory for pneumonia
Definition
mechanical intubation
Term
most common non infectious cause of post op fever is
Definition
drug fever
Term
bronchiolitis
Definition
viral infection
nonspecific inflammation of small airways
Term
most common cause of bronchiolitis
Definition
rsv
Term
signs of bronchiolitis
Definition
starts with rhinorrhea in child
then they wheeze
then low grade fever
then rhinorrhea gets worse
then on PE they have wheeze, fine crackels, and increased work of breathing
Term
irritable bowel syndrome
Definition
functional GI disorder characterized by chronic abdominal pain and altered bowel habits
Term
area of abdomen that has most pain in IBS
Definition
LLQ
Term
type of pain in IBS
Definition
cramping sensation of intermittent frequency and variable intesity
Term
initial screening in someone with IBS signs and no other systemic issues
Definition
hemoccult
CBC
Term
tx ibs abdo pain
Definition
antispasmodic: dicyclomine or
TCA if more severe

SSRI
Term
tx diarrhea predominate ibs
Definition
loperamide
Term
first line therapy in constipation predominant IBS
Definition
fiber supplement
Term
most common valvular heart defect in US
Definition
MVP
Term
palpitation
Definition
subjective sensation of unduly strong, slow, rapid or irregular heart beats that may be related to an arrythmia
Term
most common causes of palpitation
Definition
40% from primary rythm disturbance
31% anxiety/panic
6% drugs
Term
what does long QT put you at risk for
Definition
ventricular arrhythmia
sudden cardiac death
Term
who gets long QT sydrome
Definition
autosomal dominant but more commonly seen in women
Term
presentation of long QT
Definition
palpitations, syncope and fam hx of syncope or sudden death
Term
what qualifies as a prolonged QT
Definition
QTc over 470 msec in men or 480 in women
Term
heart issue in marfans
Definition
MVP
Term
palpitations in ppl over 50
Definition
consider CAD
Term
syncope with resting tremor or brisk reflexes
Definition
hyperthyroidism
Term
holter monitor
Definition
ambulatory ekg
Term
best drugs for supraventricular rythms
Definition
BB
CCB
Term
tx ventricular responses to atrial arrythmias (like flutter or fib)
Definition
dig PRN
Term
what is carotid sinus massage used for. how does it work
Definition
SVT
stimulates vagus nerve action to turn off AV node
Term
other things to use besides carotid massage that work the same way
Definition
valsalva maneuver
cold applications to face
IV adenosine
Term
tx of chronic afib
Definition
warfarin (per chads2) +
BB or CCB
Term
new onset PVCs usually indicate
Definition
initial presentation of coronary artery disease
Term
first imaging in suspected stroke
Definition
CT w/o contrast
Term
most important risk factor for stroke
Definition
htn
Term
most common cause of TIA
Definition
embolisms from heart, large vessels or small vessles
Term
MCA infarct signs
Definition
contralat hemiparesis, sensory loss, neglact and impaired gaze

aphasia if dominant hemisphere
Term
R cerebellum infarct
Definition
IPSILATERAL limb ataxia
Term
when do you give antihypertensives in the setting of a stroke
Definition
only if systolic is >220 or diastolic >120

goal 185/110
Term
drugs most commonly used to dec bp in setting of stroke
Definition
labetalol
nicardipine
sodium nitroprusside
Term
LDL goal in htn
Definition
under 100
Term
when do you consider CEA
Definition
symptomatic with 50-70% stenosis
Term
what long term therapy would you give to pt with noncardioembolic stroke
Definition
ASA (not warfarin)
Term
does hepatitis cause unconjugated or conjugated hyperbilirubinemia
Definition
conjugated
Term
stigmata of alcohol abuse
Definition
caput medusa
spider veins
Term
Gilberts syndrome
Definition
congenital reduction of conjugation of bilirubin
in 5% of population, nbd
during times of illness, drug use or stress the bilirubin level will increase.
Term
is gilberts conjugated or unconjugated
Definition
unconjugated
Term
route of transmission of hep A
Definition
fecal oral

also IVDA
Term
hep A signs
Definition
jaundice, fever, malaise, abdo pain, self limiting
Term
how long does hep A last
Definition
4-6 weeks
but can last up to 6 mo
Term
tx hep A
Definition
symptomatic tx
Term
serology in acute hepA
Definition
anti-hepA virus IgM
Term
who should get hepA vaccine
Definition
ppl traveling to endemic area
MSM
children who live in areas with lots of hepA
ppl with chronic liver disease
Term
prophylaxis of HepA in contacts of ppl with acute hepA
Definition
Ig injections
Term
incubation period of hepB
Definition
6 weeks
Term
HBsAg means
Definition
acute or chronic infection
pt is infectious to others
Term
antiHBs means
Definition
pt was either vaccinated or they resolved an infection
Term
antiHBcAg is IgM or IgG
Definition
IgM
Term
what does anti HBcAg mean
Definition
acute infection
Term
tx acute hep B
Definition
supportive therapy
Term
tx chronic hepB
Definition
antivirals
Term
who gets hepB vaccine
Definition
all children
Term
most common cause of chronic liver disease
Definition
hepC
Term
hepatitis C
Definition
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