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IM Review pt 2
Nova Orlando - Rotations
225
Health Care
Graduate
09/26/2011

Additional Health Care Flashcards

 


 

Cards

Term
MCC of anemia worldwide
Definition
iron deficiency anemia
Term
where does iron absorption occur in the body
Definition
stomach, duodenum, and upper jejunum
Term
In menstruating women, how much iron must be absorbed from the diet each day in order to avoid deficiency
Definition
3-4mg per day - often requires supplementation
Term
MCC of iron deficiency anemia? other causes?
Definition
MCC - blood loss
other causes - prolonged ASA use, anti-inflammatory durgs, menorrhagia, repeated blood donations, deficient diets, decreased absorption, increased requirements (prego, lactation), hemoglobinuria, pulmonary hemosiderosis
Term
S&S of iron deficiency anemia
Definition
fatigue, pica, koilonychia, pallor, dysphagia, tachycardia, palpitations, tachypnea on exertion, impaired muscular performance, glossitis, angular stomatitis, gastritis, RLS
Term
what type of anemai is iron deficiency?
Definition
hypochromic, microcytic
Term
tx for iron deficiency anemia
Definition
ferrous sulfate 325mg PO TID
Term
when PO ferrous sulfate is give to correct deficiency, how long does it take to work?
Definition
3 wks hct should be halfway to normal
2m all values should be back to baseline
should continue supplementation for 3-6m after correction
Term
when response to PO iron is poor, what should be added to help absorption?
Definition
ascorbic acid 500mg PO BID/TID and meat
Term
which food supplements inhibit the absorption of iron in the body
Definition
calcium
fiber
tea
coffee
wine
cholestyramine
colestipol
neomycin
quinolone abx
tetracycline
magnesium
manganese
zinc
Term
what are some common sources of vitamin B12? how long is B12 stored in the liver?
Definition
sources - meat, poultry, milk, eggs
stores last 3+ years
Term
who is at risk for iron deficiency anemia?
Definition
strict vegans
hx of gastric/intestinal surgery
hx of atrophic gastritis
pernicious anemia
gastric malabsorption
people who take acid blockers/PPIs
Term
how does B12 deficiency present?
Definition
megaloblastic anemia but can also present with peripheral neuropathy and neuropsychiatric complaints
Term
sxs of B12 deficiency anemia
Definition
parethesias
ataxia
decreased vibration sense
+ romberg
pallor, petechiae
glossitis, angular cheilitis
cognitive impairment
seizures, hypotonia
Term
labs in B12 deficiency anemia
Definition
elevated MCV, low HCT
low B12, low retic count
High MMA, homocysteine, LDH, indirect bilirubin
Term
tx for B12 deficiency
Definition
asx = diet and PO B12
sxs = Im cyanocobalamin
Term
long term complications of B12 deficiency
Definition
progrsesive neurologic damage
progressive anemia, leukopenia, and thrombocytopenia
gastric cancer - long term complication of untx pernicious anemia
Term
what is pernicious anemia
Definition
insufficiency of intrinsic factor (requiered for B12 absorption)
Term
what foods contain folic acid
Definition
fruits and green leafy veggies
Term
what are the causes of folate deficiency? (4)
Definition
malabsorption (celiac)
malnutrition (alcoholics)
increased requirements (prego/lactation)
drugs (phenytoin, bactrim, sulfasalazine, ethanol, pyrimethamine, diphenylhydration, barbituates)
Term
S&S of folate deficiency?
Definition
sleep deprivation
fatigue
depression
irritability
forgetfulness
prolonged diarrhea
HA
loss of apetite
SOB
pallor
tachycardia, tachypnea
Term
tx of folic acid deficiency?
Definition
PO/parenteral folic acid
Term
complications of folate deficiency?
Definition
leukopenia
thrombocytopenia
CV dz
venous thrombosis
colorectal cancer
Term
what is anemia of chronic disease?
Definition
normocytic, normochromic anemia in pts with long standing inflammatory disease, malignancy, AIDS, or chronic infection
Term
whaty is erythropoesis stimulating agent?
Definition
EPA - used in the tx of severely sx pts who have anemia of chronic disease, need urgent transfusions, jehovah's witnesses, rare blood types, and those with multiple alloantibodies
Term
risks of EPA
Definition
mortality is increased when Hb is raised to > 12 because there is increased likelihood of vascular events. monitor weekly
Term
HbS
Definition
sickle cell anemia
Term
hx of sickle cell offers protection against
Definition
malaria
Term
what provokes acute sickle cell crisis?
Definition
infection
dehydration
hypoxia
Term
MC places affected by sickle cell crisis
Definition
bones (esp long bones and back), liver, heart, kidney, eyes, lungs
Term
MCC of death in a person with sickle cell anemia
Definition
multiple organ failure
life expectancy 40-50 years
Term
tx of acute sickle cell crisis
Definition
exchange transfusion and hydroxyurea
Term
what is hbg C disorder?
Definition
non sickling disorder that produces mild jaundice with splenomegaly and pigment (calcium) gallstones
Term
causes of aplastic anemia
Definition
radiation, chemo, toxins, SLE/autoimmune suppression of hematopoiesis by a T cell mediated cell mechanism
Term
pancytopenia is often indicative of
Definition
aplastic anemia
Term
lab values of aplastic anemia
Definition
2+ cytopenia
decreased hb, platelet, and absolute neutrophil count
low retic count
hypocellular bone marrow - should be an absence of blasts
Term
tx of aplastic anemia
Definition
if not severe = supportive
if infxn - abx only
severe < 40 = allogenic stem cell transplant then immunosuppresive therapy
> 40 = immunosuppressive therapy then allogenic stem cell transplant
Term
aplastic anemia is closely related with what disorder?
Definition
proxysmal nocturnal hemoglobinuria
Term
how often should pts with severe aplastic anemia follow up with their health care provider?
Definition
weekly/bi-weekly
Term
complications of aplastic anemia
Definition
graft failure following stem cell transplant
graft vs host disease
AVN following immunosuppressive therapy
paroxysmal noctural hemoglobinuria
myelodysplastic syndrome
AML
solid tumors
Term
how do hemolytic anemias present?
Definition
acute/subacute development of jaundice, pallor, SOB, dizziness, fatigue, orthostasis, mild splenomegaly, active infections, epidsodic dark urine (hemoglobinuria), exposure to cold
Term
what are the common lab values in hemolytic anemia?
Definition
low hgb
high MCHC, retic count, indirect bilirubin, LDH
low haptoglobin
abnormal cells in peripheral smear - schistocytes, spherocytes, elliptocytes, spur cells
hemaglobinuria
Term
what does the direct antiglobulin test (coombs test) analyze in hemolytic anemia?
Definition
+ = immune etiology
- = nonimmune etiology
Term
mutation of JAK2V617 is strongly associated with what blood disorder?
Definition
polycythemia vera
Term
risk factors for polycythemia vera (3)
Definition
> 40
Budd-Chiari Syndrome
Affected Family Member
Term
common S&S of polycythemia vera
Definition
thrombosis
hemorrhage
HA
weakness/fatigue
post-bathing pruritis
erythromelalgia
redness of ringers/palms/toes/heels
facial redness
splenomegaly
Term
common lab values seen in polycythemia vera
Definition
elevated hgb, hct, wbc, platelet, serum uric acid
low erythropoietin
Bone Marrow bx shows hypercellularity
Term
tx of polycythemia vera
Definition
low dose ASA and phlebotomy
phlebotomy - 250-500ml of blood is replaced with normal saline 2x/wk until hct <45%
Term
how often should a pt with polycytehmia vera follow up with a hematologist?
Definition
every 1-2 wks until stable and then every 2-3 after that
Term
complications of polycythemia vera
Definition
thrombosis
hemorrhage
severe erthromelalgia
acute leukemia
Term
lymphoproliferative disorder associated with monoclonal gammopathy that can present wiht an unexpected skeletal fx, renal failure, hematologic abnl, hypercalcemia, or a combo of these
Definition
Mutliple Myeloma
Term
S&S of MM
Definition
bone pain
anemia
infections
fatigue
neuropathy
renal failure
heart failure
Term
basic tx for MM
Definition
pulse corticosteroids in combo with chemotherapy
Term
fever, sore throat, sandpaper rash, strawberry tongue
Definition
scarlet fever
Term
renal complications following strep pharyngitis
Definition
glomerulonephritis
Term
cardiac complication following strep pharyngitis
Definition
rheumatic fever
Term
Jones criteria
Definition
Major: carditis, erythema marginatum, subcutaneous nodules, chorea, arthritis
Minor: fever, prolonged PR interval, elevated ESR and CRP, leukocytosis, polyarthralgias
Term
residual complication of rheumatic fever
Definition
mitral stenosis
Term
tx of strep infections
Definition
PCN and cephalosporins
Term
initial sxs of botulism
Definition
visual disturbances (diplopia, ptosis) followed by respiratory paralysis
Term
gram positive box-car shaped rods in chains
Definition
anthrax
Term
tx of anthrax
Definition
cipro or another flouroquinolone, report to CDC
Term
rice water diarrhea
Definition
cholera
Term
causative agent of uncontrolled spasm and exaggerated reflexes
Definition
clostridium tetani
Term
MC form of salmonella infection
Definition
gastroenteritis
Term
causative agent and tx of dysentery
Definition
shigella
bactrim
Term
tenacious grey membrane covering the pharynx
Definition
diptheria
Term
treatment of diptheria
Definition
antitoxin obtained from CDC, PCN or erythromycin
Term
real name for whooping cough
Definition
pertusis
coughing fits followed by high picthed inspiration
Term
treatment of pertussis
Definition
erythromycin
Term
mononucleosis and Burkitt's lymphoma are both associated with what virus?
Definition
EBV
Term
administration of amoxicillin to EBV patients induces
Definition
maculopapular rash
Term
antibodies associated with EBV?
Definition
heterophile
Term
causative agent of genital warts
Definition
HPV
Term
orthomyxovirus
Definition
infleunza
Term
painful erruption following a dermatomal pattern
Definition
Varicella Zoster
Term
hydrophobia - painful spasms caused by drinking water are associated with
Definition
rhabdovirus
Term
antigen to which HIV attaches
Definition
T4 (primarily CD4)
Term
AIDS is defined by
Definition
CD4 count < 200
Term
HIV diagnosed by which labs
Definition
ELISA
Western Blot
Term
Infection similar to EBV without pharyngitis, respiratory sxs, or heterophile antibodies
Definition
CMV
Term
tissue biopsy of CMV reveals
Definition
intracytoplasmic inclusions "owl's eyes"
Term
labs for syphilis
Definition
VDRL, RPR, FTA-ABS
Term
tx of syphilis
Definition
benzathine PCN-G
Term
gram negative intracellular diplococci
Definition
gonorrhea
Term
tx of gonorrhea
Definition
ceftriaxone IM and concurrent doxycycline/azithromycin for chlamydia
Term
MCC of urethritis and cervicitis
Definition
chlamydia
Term
tx of chlamydia
Definition
azithromycin, doxycycline, erythromycin
Term
flagellated protozoan infects Skene's glands in females
Definition
trichomonas
Term
signs of trichomonas
Definition
malodorous, frothy-green discharge, motil flagellates on wet mount
Term
tx of trichomonas
Definition
metronidazole
Term
Bull's eye lesions are associated with
Definition
Lyme disease
Term
drug of choice for pts with erythema migrans associated with Lyme Disease
Definition
Doxycycline
Term
causative agent of Rocky Mountain Spotted Fever
Definition
Ricckettsia Rickettsii
Term
tx of RMSF
Definition
doxycycline
Term
painless nodules associated with punctures by plant thorns, may progress to LAD
Definition
sporothrix shenkii
Term
honey colored crusts common in children
Definition
impetigo
Term
layers of skin superficial --> deep
Definition
stratum corneum
stratum lucidum
stratum granulosum
strautm spinosum
stratum basale
Term
cells that provide pigment
Definition
melanocytes
Term
myelocytes (melanocytes) are present in what layer?
Definition
stratum basale
Term
coin shaped plaques
Definition
nummular eczema
Term
yellowish-grey scaly macules or patches with greasy appearance
Definition
seborrheic dermatitis
Term
stasis dermatitis
Definition
hyperpigmentation of lwoer extremities associated with venous insufficiency
Term
Lichen Simplex Chronicus
Definition
a pruritic plaque caused by excessive rubbing or scratching
Term
causative agent of fifths disease
Definition
parvovirus B19
Term
erythema infectiousum
Definition
Fifth disease "slapped cheeks"
Term
herald patch followed by widespread popular rash
Definition
Pityriasis Rosea
Term
Flesh colored umbilicated papules common in children
Definition
molluscum contragiousum
Term
"Tapioca" appearance of vessicles, common on hands and feet. Pruritic, sometimes painful
Definition
Dyshidrosis
Term
pink plaque with silvery scales
Definition
Psoriasis Vulgaris
Term
Type of psoriasis seen after viral illness
Definition
guttate psoriasis
Term
nail pitting
Definition
psoriasis
Term
rash on rash triggered by heat, alcohol, sun, spicy foods, etc
Definition
rosacea
Term
rhinophyma is associated with
Definition
rosacea
Term
inflammation of hair follicles
Definition
folliculitis (caused by staph aureus)
Term
causative agent of hot tub folliculitis
Definition
pseudomonas aeruginosa
Term
life threatening condition involving high fever, photophobia, sore throat, mucosal inflammation, followed by cutaneous lesion
Definition
Stevens Johnson Syndrome or Toxic Epidermal necrolysis
Term
Disease of apocrine glands
Definition
hydradenitis suppurativa
Term
deep seated infection of a single hair follicle
Definition
furuncle
Term
conglomerate mass of multiple infected hair follicles
Definition
carbuncle
Term
swollen, hot, red, tender skin
Definition
cellulitis
Term
tinea versicolor causative agent
Definition
malassezia furfur
Term
treatments for scabies
Definition
lindane
permethrin
Term
which scabies tx should be avoided in kids < 2 yo
Definition
lindane
Term
warts are caused by?
Definition
HPV
Term
actinic keratosis can progress to
Definition
squamous cell carcinoma
Term
harmless brown plaque
Definition
seborrheic keratitis
Term
most comomon neoplasm of the skin
Definition
basal cell carcinoma
Term
hyperpigmentation associated with Dm and obesity
Definition
acanthosis nigricans
Term
hyperpigmentations of sun exposed areas associated with pregnancy or OCP use
Definition
melasma
Term
hypopigmented skin commonly seen on hands
Definition
vitiligo
Term
treatment for urticaria
Definition
H1 and H2 blockers
Term
diaper dermatitis
Definition
candidiasis
Term
tx of vulvovaginal cadidiasis
Definition
oral fluconazole
Term
candidal fungemia (systemic fungal infection) tx?
Definition
IV amphotericin B
Term
pt works with exotic birds and develops a cough
Definition
Chlamydial Psittaci
Term
common cause of pneumonia in HIV pts
Definition
pneuocystis jiroveci
Term
tx for worms
Definition
membendazole/albendazole
Term
mosquito that carries malaria
Definition
female anopheles mosquito
Term
tx and prophylaxis of malaria
Definition
chloroquine
Term
causative agent of syphilis
Definition
treponema pallidum
Term
painless ulcer with inderated margins in the inguinal region
Definition
syphilis stage 1
Term
gummas
Definition
late stage syphilis
Term
where is the infarct?
weakness and cortical sensory loss in the contralateral leg and sometimes mild weakness of the arm, especially proximally. May be a contralateral grasp reflex, paratonic rigidity, and abulia or frank confusion. Can cause urinary incontinence.
Definition
anterior communicating artery
Term
brain infarction that can lead to behavioral changes
Definition
bilateral anterior communicating artery
Term
where is the infarct?
leads to contralateral hemiplegia, hemisensory loss, and homonymous hemianopia. can lead to Wernicke Aphasia
Definition
middle cerebral artery
Term
where is the infarct?
thalamic syndrome in which conrtalateral hemisensory disturbance occurs, followed by development of spontaneous pain and hyperpathia
Definition
posterior cerebral artery
Term
where is the infarct?
ipsilateral spinothalamic sensory loss involving face, ninth and tenth cranial nerve lesions, ataxia and numbness, Horner syndrome, combined with contralateral spinothalamic sensory loss involving the limbs
Definition
posterior inferior cerebellar artery
Term
where is the infarct?
vertigo, N/V, nystagmus, ipsilateral limb ataxia, contralateral spinothalamic sensory loss in the limbs
Definition
cerebellar arteries
Term
how long are thrombolytics a viable option for stroke?
Definition
12 hours
Term
when is endarterectomy recommended for carotid arteries?
Definition
if occlusion is > 70%
Term
MC type of dementia
Definition
Alzheimer's
Term
senile plaques, neurofibrillay tangles, neuronal loss, cortical atrophy
Definition
Alzheimers
Term
hallmark sxs of Alzheimers (3)
Definition
memory loss
impairment of daily activities
neurobehavioral abnormalities
Term
tx of Alzheimer's
Definition
supportive - caregiver support, mental health support, home safety, exercise
cholinesterase inhibitors (aricept, exelon, razadyne,) enhances or prevents decline of cognitive function
anti-depressants (zoloft, celexa, lexapro) depression is common, SSRI's are first line
antipsychotics (risperdal, zyprexa, seroquel, abilify)
management of insomnia
moderate for severe AD = memantine
Term
characteristics of subcortical dementias
Definition
motor impairments
reduced attention
psychomotor slowing
loss of executive functioning
personality change
Term
personality changes + compulsive behavior without visuospatial changes
Definition
Frontotemporal dementias (Pick Dz) associated with ALS
Term
caused by acute deficiency of thiamine in a susceptible host
Definition
Wernicke's Encephalopathy
Term
tx of Wernicke's Encephalopathy
Definition
stabilize/resuscitate
thiamine (250-500mg in 100ml NS over 30 min TID x 3d), Mg (2-4g/d), multivitamin
Term
review GCS
Definition
Eyes - 4
Verbal - 5
Motor - 6
worst score = 3
best score = 15
Term
MCC of death in young people
Definition
trauma
Term
what are secondary insults to the brain? (2)
Definition
hypoxia
hypotension
Term
MCC of epidrual hematoma
Definition
injury to the middle meningeal artery
Term
triad of brain herniation
Definition
coma
fixed, dilated pupils
decerebrate posturing
Term
likely location of bleeding in subdural hematomas
Definition
venous
Term
MCC of subarachnoid hemorrhage
Definition
rupture of an aneurism or AV malformation
Term
carpal tunnel syndrome is associated with what electrolyte abnormality?
Definition
hypothyroidism
Term
heat intolerance
cold intolerance
Definition
heat = hyperthyroid
cold = hypothyroid
Term
polymorphonuclear neutrophils
Definition
acute tubulointerstitial nephritis
Term
mononuclear cell predominance
Definition
chronic tubulointerstitial nephritis
Term
4 MCC of nephrotic syndrome
Definition
minimal change disease
focal glomerular sclerosis
membranous
membranoproliferative
Term
peripheral edema, hypoalbuminuria (< 3g/d), proteinuria (> 3.5 g/d), lipiduria
Definition
nephrosis
Term
bones, stone, abdominal groans, psychic moans, with fatigue overtones
Definition
hyperparathyroidism
Term
serm PTH, alk phos, and calcium are increased
Definition
hyperparathyroidism
Term
+ Chovsteks and Trousseaus
Definition
hypoparathyroidism
Term
tx of hyperparathyroidism
Definition
IV hydration
loop diuretics
bisphosphonates
calcimimetics
surgery - remove pathological parathyroid gland
Term
MCC of hypoparathyroidism
Definition
thyroidectomy
Term
tx hypoparathyroidism
Definition
IV calcium gluconate
calcium salts
vitamin D
calcitriol
Term
HDL goals men and women
Definition
men > 40
women > 50
Term
one or more lesions having high bone turnover and disorganized osteoid formation. weak and deformed bone structure
Definition
Paget's Disease
Term
normal calcium
normal phosphate
extremely increased alk phos
normal PTH
Definition
Paget's Disease
Term
MCC subacute endocarditis
Definition
strep viridans
Term
MCC acute endocarditis
Definition
staph aureus
Term
review rheumatoid antibodies
Definition
Term
CREST
Definition
calcinosis
Raynaud's
esophageal dysfunction
sclerodactyly
telangiectasias
(specific type of limited scleroderma)
Term
tx of scleroderma
Definition
no specific rx
PPI for reflux
ACEI for renal disease
avoidance of triggers
CCB for Raynaud's
immunosuppressive drugs for HTN
Term
inflammatory disease of striated muscle affecting the limbps, neck, and pharynx
Definition
polymyositis
if it affects the skin as well = dermatomyositis (increased risk of malignancy)
Term
tx of polymyositis
Definition
high dose steroids, methotrexate, azathioprine until sxs resolve
Term
dry mucous membranes + enlarged parotid glands
Definition
Sjogren's Syndrome
Term
test of Sjogren's Syndrome
Definition
Schrimer's test - decreased tear production
Term
increased risk of what disease with Sjogren's Syndrome
Definition
lymphoma
Term
disease associated with polyarteritis nodosa
Definition
Hep B
Term
C ANCA
Definition
Wegener's Granulomatosis
Term
upper and lwoer respiratory tract involvement, pauci-immune glomerulonephritis
Definition
Wegener's
Term
tests for thoracic outlet syndrome
Definition
Adson
Roos
Allen's
Term
MCC of osteomyelitis in sickle cell pts
Definition
salmonella
Term
MCC of osteomyelitis in normal population
Definition
staph aureus
Term
causative agent in osteo from penetrating injury to the foot
Definition
pseudomonas
Term
most common benign bone tumor
Definition
osteochondroma
Term
MC benign tumor of the hands
Definition
enchrondroma
Term
highly malignant tumor that affects mostly children, typical "onion skin" reaction on xray
Definition
Ewing's Sarcoma
Term
MC primary malignant lesion of the bone, sunburst pattern on xray
Definition
osteosarcoma
Term
T scores
Definition
1-2.5 = osteomalacia (osteopenia)
2.5 + = osteoperosis
Term
MC fracutres sites with osteoperosis
Definition
spine(lumbar vertebra) and hip
Term
proximal muscle weakness associated with fever, fatigue, weight loss, depression. also has an association with temporal arteritis
Definition
polymyalgia rheumatica
Term
difference between Steven Johnsons Syndrome and Toxic Epidermal Necrolysis
Definition
SJS if < 10% BSA involved
TEN if > 10% BSA involved
Term
common drugs associated with SJS and TEN (4)
Definition
sulfonamides
NSAIDs
allopurinol
anticonvulsants
Term
pearly or waxy papule with telangiectasias, erythematous patch, or non healing ulcer in sun exposed areas
Definition
basal cell carcinoma
Term
MC type of skin cancer
Definition
basal cell carcinoma
Term
lesions appear as small red, conical, hard nodules that occasionally ulcerate
Definition
squamous cell carcinoma
Term
leading cause of death due to skin cancer
Definition
melanoma
Term
tx of bulemia nervosa
Definition
CBT
SSRI/SNRI
Term
1st line meds for neuropathic pain
Definition
neurontin/lyrica
TCA's
Term
condition in which the pt has blindness, paralysis, or other nervous system symptoms which cannot be explained
Definition
conversion disorder
Term
a belief that real or imagined physical symptoms are signs of serious illness, despite medical reassurance and other evidence to the contraray
Definition
hypochondriasis
Term
a long term condition in which a person has physical symptoms that are caused by psychological problems and no physical problem can be found
Definition
somatization disorder
Term
mental disorders in which a person acts as if he or she has physical or menal illness when in fact, he or she has consciously created his or her symptoms
Definition
factitious disorder
Term
4 major compoenents of ABG's
Definition
pH
PaCO2
PaO2
HCO3
Term
indications for TEE (2)
Definition
rule out endocarditis
assess LAE
Term
3 categories of info provided by PFT's
Definition
lung volume
flow rate
diffusing capacity
Term
contraindications to thoracentesis
Definition
uncooperative pt
coagulation/bleeding disorders
Term
complications of thoracentesis (5)
Definition
pneumothorax
hemothorax
hemorrhage
hypotension
pulmonary edema
Term
indications for bronchoscopy (6)
Definition
abnormal CXR
hemoptysis
opportunistic lung infection
retained secretions and mucous plugs
unexplained cough > 6 wks
cancers
Term
MUGA indications
Definition
gives info about cardiac output, ejection fraction, velocity, and wall motion abnormalities thru use of radiolabeled RBC's injected into the pt to assess the fxn of the heart
Term
best test to obtain info on peripheral vascular disease
Definition
coronary angiography
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