APEA PREDICTOR EXAM 2024-2025 TEST BANK 350+ QUESTIONS& CORRECT VERIFIED ANSWERS.RATED A, Exams of Nursing

Download APEA PREDICTOR EXAM 2024-2025 TEST BANK 350+ QUESTIONS& CORRECT VERIFIED ANSWERS.RATED A and more Exams Nursing in PDF only on Docsity! APEA PREDICTOR EXAM 2024-2025 TEST BANK 350+ QUESTIONS & CORRECT VERIFIED ANSWERS WITH RATIONALES |RATED A+ a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone – ANS dawn phenomenon a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta – ANS molar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? – ANS spina bifida and anencephaly Amenorrhea is considered a risk factor for what? – ANS osteoporosis An anorexic patient will have a BMI of what? – ANS less than 18 Anorexia can put you at risk for what? – ANS osteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? – ANS week 34 At what week of pregnancy is the fundus of the uterus at the umbilicus? – ANS week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? – ANS week 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? – ANS week 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? – ANS week 12 Bursitis can be a __________ issue – ANS recurrent Genu valgum is caused by a problem with what? – ANS the medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? – ANS the lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? – ANS osteoarthritis; rheumatoid arthritis pg. 1 How can we abort cluster headaches? – ANS calcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain pg. 2 Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication pg. 5 What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply pg. 6 What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue pg. 7 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 Bursitis can be a __________ issue - ANSrecurrent Genu valgum is caused by a problem with what? - ANSthe medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSthe lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSosteoarthritis; rheumatoid arthritis How can we abort cluster headaches? - ANScalcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine pg. 10 How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSfirst generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin If a patient has LSIL with a negative HPV test, what would you do? - ANSrepeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSrefer for colposcopy If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSincrease the progesterone If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up If a patient is on birth control and they miss two pills, what should they do? - ANSdouble up for 2 days If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSBactrim increases INR so we would want to decrease the coumadin dose while the patient is on this pg. 11 If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSRifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSdecrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANShold one dose then decrease the weekly dose by 10% If a patient's Coomb's test is negative, what do we do? - ANSgive rhogam at 28 weeks and 72 hours after birth If a patient's Coomb's test is positive, what do we do? - ANSnothing, she is RH positive so we do not need to treat If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP pg. 12 What is bursitis? - ANSa fluid collection in the bursa of a joint What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph pg. 15 What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray What is the radiographic study of choice for the knee? - ANSMRI What is the recommended treatment for acute prostatitis? - ANScipro (if not STI related) or ceftriaxone What is the recommended treatment for Bell's palsy? - ANSsteroids and anti-virals What is the recommended treatment for chronic bacterial prostatitis? - ANSa fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for polymyalgia rheumatica? - ANSsteroids What is the tell-tale difference between a herniated disc and sciatica? - ANSsciatica feels better when you stand, a herniated disc feels better when you sit down What is the trendelenburg sign and when is it positive? - ANSwhen the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What should we tell our patients with PAD NOT to do? - ANSdo not elevate the feet; keep them down pg. 16 When can cervical cancer screening stop if no abnormal screening history is present? - ANSage 65 When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSabout 10 days before menses When do we perform alpha fetoprotein screening in pregnancy? - ANS15-20 weeks When do we screen for group B strep in pregnancy? - ANSweeks 35-37 When does placental abruption most commonly occur? - ANSin the third trimester When should breast cancer screening begin and end with a biannual mammogram? - ANSage 50-74 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage pg. 17 If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up If a patient is on birth control and they miss two pills, what should they do? - ANSdouble up for 2 days If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSBactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSRifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSdecrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANShold one dose then decrease the weekly dose by 10% If a patient's Coomb's test is negative, what do we do? - ANSgive rhogam at 28 weeks and 72 hours after birth If a patient's Coomb's test is positive, what do we do? - ANSnothing, she is RH positive so we do not need to treat If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound pg. 20 Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings pg. 21 What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression pg. 22 What is the tell-tale difference between a herniated disc and sciatica? - ANSsciatica feels better when you stand, a herniated disc feels better when you sit down What is the trendelenburg sign and when is it positive? - ANSwhen the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What should we tell our patients with PAD NOT to do? - ANSdo not elevate the feet; keep them down When can cervical cancer screening stop if no abnormal screening history is present? - ANSage 65 When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSabout 10 days before menses When do we perform alpha fetoprotein screening in pregnancy? - ANS15-20 weeks When do we screen for group B strep in pregnancy? - ANSweeks 35-37 When does placental abruption most commonly occur? - ANSin the third trimester When should breast cancer screening begin and end with a biannual mammogram? - ANSage 50-74 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon pg. 25 a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? - ANSweek 34 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSweek 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSweek 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSweek 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 Bursitis can be a __________ issue - ANSrecurrent Genu valgum is caused by a problem with what? - ANSthe medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSthe lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSosteoarthritis; rheumatoid arthritis How can we abort cluster headaches? - ANScalcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own pg. 26 How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug pg. 27 The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG pg. 30 What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures pg. 31 What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray pg. 32 How can we abort cluster headaches? - ANScalcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache pg. 35 How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSfirst generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin If a patient has LSIL with a negative HPV test, what would you do? - ANSrepeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSrefer for colposcopy If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSincrease the progesterone If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up If a patient is on birth control and they miss two pills, what should they do? - ANSdouble up for 2 days If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSBactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSRifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSdecrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANShold one dose then decrease the weekly dose by 10% If a patient's Coomb's test is negative, what do we do? - ANSgive rhogam at 28 weeks and 72 hours after birth If a patient's Coomb's test is positive, what do we do? - ANSnothing, she is RH positive so we do not need to treat pg. 36 If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl pg. 37 What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp pg. 40 What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray What is the radiographic study of choice for the knee? - ANSMRI What is the recommended treatment for acute prostatitis? - ANScipro (if not STI related) or ceftriaxone What is the recommended treatment for Bell's palsy? - ANSsteroids and anti-virals What is the recommended treatment for chronic bacterial prostatitis? - ANSa fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for polymyalgia rheumatica? - ANSsteroids What is the tell-tale difference between a herniated disc and sciatica? - ANSsciatica feels better when you stand, a herniated disc feels better when you sit down What is the trendelenburg sign and when is it positive? - ANSwhen the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What should we tell our patients with PAD NOT to do? - ANSdo not elevate the feet; keep them down When can cervical cancer screening stop if no abnormal screening history is present? - ANSage 65 When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSabout 10 days before menses When do we perform alpha fetoprotein screening in pregnancy? - ANS15-20 weeks When do we screen for group B strep in pregnancy? - ANSweeks 35-37 When does placental abruption most commonly occur? - ANSin the third trimester When should breast cancer screening begin and end with a biannual mammogram? - ANSage 50-74 pg. 41 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? - ANSweek 34 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSweek 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSweek 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSweek 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 pg. 42 If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSdecrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANShold one dose then decrease the weekly dose by 10% If a patient's Coomb's test is negative, what do we do? - ANSgive rhogam at 28 weeks and 72 hours after birth If a patient's Coomb's test is positive, what do we do? - ANSnothing, she is RH positive so we do not need to treat If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP pg. 45 PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles pg. 46 What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint pg. 47 When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSabout 10 days before menses When do we perform alpha fetoprotein screening in pregnancy? - ANS15-20 weeks When do we screen for group B strep in pregnancy? - ANSweeks 35-37 When does placental abruption most commonly occur? - ANSin the third trimester When should breast cancer screening begin and end with a biannual mammogram? - ANSage 50-74 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? - ANSweek 34 pg. 50 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSweek 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSweek 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSweek 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 Bursitis can be a __________ issue - ANSrecurrent Genu valgum is caused by a problem with what? - ANSthe medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSthe lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSosteoarthritis; rheumatoid arthritis How can we abort cluster headaches? - ANScalcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves pg. 51 How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSfirst generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin If a patient has LSIL with a negative HPV test, what would you do? - ANSrepeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSrefer for colposcopy If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSincrease the progesterone If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up pg. 52 What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression pg. 55 What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place pg. 56 What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray What is the radiographic study of choice for the knee? - ANSMRI What is the recommended treatment for acute prostatitis? - ANScipro (if not STI related) or ceftriaxone What is the recommended treatment for Bell's palsy? - ANSsteroids and anti-virals What is the recommended treatment for chronic bacterial prostatitis? - ANSa fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for polymyalgia rheumatica? - ANSsteroids pg. 57 How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug pg. 60 If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSfirst generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin If a patient has LSIL with a negative HPV test, what would you do? - ANSrepeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSrefer for colposcopy If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSincrease the progesterone If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up If a patient is on birth control and they miss two pills, what should they do? - ANSdouble up for 2 days If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSBactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSRifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSdecrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANShold one dose then decrease the weekly dose by 10% If a patient's Coomb's test is negative, what do we do? - ANSgive rhogam at 28 weeks and 72 hours after birth If a patient's Coomb's test is positive, what do we do? - ANSnothing, she is RH positive so we do not need to treat If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years pg. 61 If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum pg. 62 What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray pg. 65 What is the radiographic study of choice for the knee? - ANSMRI What is the recommended treatment for acute prostatitis? - ANScipro (if not STI related) or ceftriaxone What is the recommended treatment for Bell's palsy? - ANSsteroids and anti-virals What is the recommended treatment for chronic bacterial prostatitis? - ANSa fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for polymyalgia rheumatica? - ANSsteroids What is the tell-tale difference between a herniated disc and sciatica? - ANSsciatica feels better when you stand, a herniated disc feels better when you sit down What is the trendelenburg sign and when is it positive? - ANSwhen the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What should we tell our patients with PAD NOT to do? - ANSdo not elevate the feet; keep them down When can cervical cancer screening stop if no abnormal screening history is present? - ANSage 65 When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSabout 10 days before menses When do we perform alpha fetoprotein screening in pregnancy? - ANS15-20 weeks When do we screen for group B strep in pregnancy? - ANSweeks 35-37 When does placental abruption most commonly occur? - ANSin the third trimester When should breast cancer screening begin and end with a biannual mammogram? - ANSage 50-74 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL pg. 66 Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? - ANSweek 34 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSweek 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSweek 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSweek 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 Bursitis can be a __________ issue - ANSrecurrent Genu valgum is caused by a problem with what? - ANSthe medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSthe lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSosteoarthritis; rheumatoid arthritis pg. 67 If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl pg. 70 The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea pg. 71 What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes pg. 72 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? - ANSweek 34 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSweek 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSweek 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSweek 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 pg. 75 Bursitis can be a __________ issue - ANSrecurrent Genu valgum is caused by a problem with what? - ANSthe medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSthe lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSosteoarthritis; rheumatoid arthritis How can we abort cluster headaches? - ANScalcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own How do we treat any rotator cuff injuries? - ANSwear a sling to stabilize the arm and refer to ortho How do we treat developmental hip dysplasia in a child under 6 months? - ANSPavlik harness; if older than 6 months may need surgery How do we treat lupus flares? - ANSsteroids How do we treat Paget's diseease? - ANSbisphosphonates How do we treat shin splints? - ANSrest and avoidance of exercise until the pain resolves How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid pg. 76 How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSfirst generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin If a patient has LSIL with a negative HPV test, what would you do? - ANSrepeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSrefer for colposcopy If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSincrease the progesterone If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up If a patient is on birth control and they miss two pills, what should they do? - ANSdouble up for 2 days If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSBactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSRifampin decreases INR so we'd want to increase the coumadin dose pg. 77 What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint pg. 80 What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures What is placenta abruptio? - ANSwhen the placenta either fully or partially detaches from the uterine wall What is placenta previa? - ANSwhen the placenta blocks the cervical opening of the uterus What is primary amenorrhea? - ANSwhen the patient has never gotten their period before (there is an absence of menarche) but they have all of their secondary sex characteristics What is slipped capital femoral epiphysis? - ANSwhen the femoral head of the hip is out of place What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility pg. 81 What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray What is the radiographic study of choice for the knee? - ANSMRI What is the recommended treatment for acute prostatitis? - ANScipro (if not STI related) or ceftriaxone What is the recommended treatment for Bell's palsy? - ANSsteroids and anti-virals What is the recommended treatment for chronic bacterial prostatitis? - ANSa fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for polymyalgia rheumatica? - ANSsteroids What is the tell-tale difference between a herniated disc and sciatica? - ANSsciatica feels better when you stand, a herniated disc feels better when you sit down What is the trendelenburg sign and when is it positive? - ANSwhen the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What should we tell our patients with PAD NOT to do? - ANSdo not elevate the feet; keep them down When can cervical cancer screening stop if no abnormal screening history is present? - ANSage 65 pg. 82 How do we treat temporal arteritis? - ANSsteroids How do we treat UTIs in a pregnant woman? - ANScan either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) How does the parathyroid gland regulate calcium? - ANSwhen parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine How is bursitis treated? - ANSa needle to instill intraarticular steroids and then pull off fluid How is fibromyalgia diagnosed? - ANSwhen at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months How is Morton's neuroma diagnosed? - ANSvia a positive Muddler's or squeeze test causing pain How is the pain of trigeminal neuralgia vs temporal arteritis different? - ANSin trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache How long do migraine headaches last? - ANS4-72 hours How should pregnant women wear their seatbelt? - ANSwith the shoulder strap like a normal person and then the groin strap below the belly and across the hips How would you describe the appearance of molluscum contagiosum? - ANSpapules that are umbilicated and contain a caseous plug If a patient has GABHS but has an allergy to penicillins, what is the second line option? - ANSfirst generation cephalosporins, unless the allergy is severe, then you would consider macrolides like a -mycin If a patient has LSIL with a negative HPV test, what would you do? - ANSrepeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? - ANSrefer for colposcopy If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? - ANSincrease the progesterone If a patient is on birth control and they miss one pill, what should they do? - ANSdouble up pg. 85 If a patient is on birth control and they miss two pills, what should they do? - ANSdouble up for 2 days If a patient is on Coumadin but then they may need to go on an antibiotic for an infection and Bactrim is the drug of choice, what should you do? - ANSBactrim increases INR so we would want to decrease the coumadin dose while the patient is on this If a patient is on Coumadin but then they may need to go on Rifampin, what should you do? - ANSRifampin decreases INR so we'd want to increase the coumadin dose If a patient on coumadin's INR is 3.1-4 ,what should you do? - ANSdecrease the weekly dose by 5-10% If a patient on coumadin's INR is 4.1-5.0, what should you do? - ANShold one dose then decrease the weekly dose by 10% If a patient's Coomb's test is negative, what do we do? - ANSgive rhogam at 28 weeks and 72 hours after birth If a patient's Coomb's test is positive, what do we do? - ANSnothing, she is RH positive so we do not need to treat If a patient's INR is greater than 5, what should you do? - ANSconsult cards, likely would hold two doses then decrease the weekly dose If a patient's pap results show ASC-H or HSIL what should you do? - ANSrefer for colposcopy If a patient's pap results show NILM, what should you do? - ANSrepeat in 3 years If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism pg. 86 It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area pg. 87 What is the best indication of an anorexic patient doing better? They tell you they are eating more, they have weight gain, or they get their period back? - ANSthey get their period back What is the biggest side effect of colchicine? - ANSdiarrhea What is the causative organism of mastitis? - ANSstaph What is the Coomb's test and when is this completed? - ANStest given 8 weeks in to pregnancy to determine a woman's RH compatibility What is the first line treatment for mastitis? - ANSkeflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is the first line treatment for trigeminal neuralgia? - ANScarbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the hook test? - ANSused to assess for a bicep tendon issue What is the main characteristic of a slipped capital femoral epiphysis? - ANSwalking with a limp What is the major difference in symptomalogy between placenta abruptio and placenta previa? - ANSa placental abruption is painful whereas placenta previa is painless What is the most common cause of hypercortisolism? - ANSexcessive ACTH production What is the only form of non-hormonal contraception other than barrier methods such as condoms? - ANSIUD What is the radiographic study of choice for the back? - ANSx ray What is the radiographic study of choice for the knee? - ANSMRI What is the recommended treatment for acute prostatitis? - ANScipro (if not STI related) or ceftriaxone What is the recommended treatment for Bell's palsy? - ANSsteroids and anti-virals What is the recommended treatment for chronic bacterial prostatitis? - ANSa fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for polymyalgia rheumatica? - ANSsteroids pg. 90 What is the tell-tale difference between a herniated disc and sciatica? - ANSsciatica feels better when you stand, a herniated disc feels better when you sit down What is the trendelenburg sign and when is it positive? - ANSwhen the patient is standing straight and the pelvis on the unaffected side drops; this is a sign of a slipped capital femoral epiphysis What should we tell our patients with PAD NOT to do? - ANSdo not elevate the feet; keep them down When can cervical cancer screening stop if no abnormal screening history is present? - ANSage 65 When do fibrocystic breasts tend to flare up and cause tenderness and lumps? - ANSabout 10 days before menses When do we perform alpha fetoprotein screening in pregnancy? - ANS15-20 weeks When do we screen for group B strep in pregnancy? - ANSweeks 35-37 When does placental abruption most commonly occur? - ANSin the third trimester When should breast cancer screening begin and end with a biannual mammogram? - ANSage 50-74 When should colorectal cancer screening stop? - ANSage 85 When should patients begin antiretroviral therapy for HIV infection? - ANSas soon as it is detected, even if in the acute phase When will spinal or lumbar stenosis feel better? - ANSwhen the patient sits down Which pap smear result is considered to be HPV positive? - ANSLSIL Which type of headaches come with lacrimation and sinus symptoms? - ANScluster headaches Which type of prevention are vaccinations? - ANSprimary Who qualifies for a low dose CT scan for lung cancer screening purposes? - ANSage 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years a normal rise in blood sugar as a person's body prepares to wake up due to a release of cortisol and growth hormone - ANSdawn phenomenon pg. 91 a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta - ANSmolar pregnancy Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? - ANSspina bifida and anencephaly Amenorrhea is considered a risk factor for what? - ANSosteoporosis An anorexic patient will have a BMI of what? - ANSless than 18 Anorexia can put you at risk for what? - ANSosteoporosis, amenorrhea, cardiac damage At what week of pregnancy is the fundus just below the xiphoid process? - ANSweek 34 At what week of pregnancy is the fundus of the uterus at the umbilicus? - ANSweek 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? - ANSweek 28 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? - ANSweek 16 At what week of pregnancy is the uterus palpable just above the pubic symphysis? - ANSweek 12 Bursitis can be a __________ issue - ANSrecurrent Genu valgum is caused by a problem with what? - ANSthe medial collateral ligament; think valgum as in gum makes your knees stick together Genu varum is caused by a problem with what? - ANSthe lateral collateral ligament Heberden and bouchard's nodes are indicative of what disease process? What about swan neck deformities? - ANSosteoarthritis; rheumatoid arthritis How can we abort cluster headaches? - ANScalcium or 100% oxygen application How can you tell between the dawn and somogyi effect? - ANSIf the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. How do we diagnose PAD? - ANSan ABI < 7; doppler can also be used to diagnose as well but is the second choice How do we treat a broken clavicle in an infant? - ANSno treatment; it should heal on it's own pg. 92 If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? - ANSplacenta previa If a pregnant woman has syphilis, what should we do? - ANStreat it with penicillin while she is pregnant because there is risk for spontaneous abortion If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? - ANSdo a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. - ANSmammogram; ultrasound Increased sweat production is a sign of what endocrine disorder? - ANShyperthyroidism It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? - ANS5 years old; penicillin Legg-calve-perthes disease is most common in which patient population? - ANSyoung children Patients with SLE are going to have what abnormal labwork? - ANSelevated ESR and CRP PDE5 inhibitors (sildenafil, tadalafil) are contraindicated in which patient populations? - ANSin those who are on any type of nitrate or triptan because it could result in hypotension Preeclampsia most commonly shows up at what time in pregnancy? - ANSaround week 20 SCFE is most common in which patient population? - ANSadolescents Secondary amenorrhea is a lack of menses after _________ of not having a period; but you have had one before - ANS3 months The anterior drawer test assesses what? - ANSthe acl The Lachman's test assesses what? - ANSthe ACL The McMurray's test assesses for what? - ANSa torn meniscus The medical term for bow legs - ANSgenu varum The medical term for knock knees - ANSgenu valgum pg. 95 The posterior drawer test assesses what? - ANSthe posterior cruciate ligament (pcl) The vaginal ring for contraception must be taken out how often? - ANSevery 3 weeks The valgus stress test assesses what? - ANSthe medial collateral ligament The varus stress test assesses what? - ANSthe lateral collateral ligament What are common sequelae of fibromyalgia? - ANSinsomnia and depression What are s/s of Addison's disease? - ANSbronze or discolored skin, salt cravings What are s/s of an intraductal breast papilloma? - ANSclear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area What are s/s of peripheral vascular disease? - ANSthink V meaning volume overload aka edema, may ache or be uncomfortable but is not painful, bounding pulses, ruddy discoloration What are s/s of the secondary stage of syphilis? - ANSrash on hands and feet, lymphadenopathy, fever What are shin splints? - ANSa medial tibial syndrome caused by overuse of the muscles What are the first generation antihistamines? - ANSdiphenhydramine (benadryl) and chlorpeniramine (actifed) What are the preventative treatment options for migraines? - ANSbeta blockers, amitriptyline, venlafaxine, topamax, valproate What are the symptoms of peripheral artery disease? - ANSthink P meaning pain, A meaning absent or weak pulses, eschar or shiny legs, intermittent claudication What bacteria is the leading cause of urethritis? - ANSneisseria gonorrhea What can be a sequelae of an ectopic pregnancy? - ANSpelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What changes to the vagina occur with aging? - ANSdryness, loss of rugae, less pubic hair What class of drug is sildenafil (viagra)? - ANSa PDE5 inhibitor which can cause hypotension so you should do a full cardiac assessment before starting a patient on this and maybe do an EKG pg. 96 What do we need to do first when a patient comes in with secondary amenorrhea? - ANSrule out pregnancy What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? - ANSDo HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. What does the apprehension test assess for? - ANSused to assess for stability of the shoulder or knee; assesses for stability What is a great treatment option for fibromyalgia? - ANSamitriptyline (a TCA) because it helps with chronic pain, sleep, and depression What is a navicular fracture? - ANSalso known as a scaphoid fracture; this impacts the snuff box and causes tenderness there. This will have to be casted to stabilize the fracture What is Addison's disease? - ANSadrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What is another name for fifth disease? - ANSparvovirus aka slapped cheek disease aka erythema infectiosum What is bursitis? - ANSa fluid collection in the bursa of a joint What is first line treatment for PAD? - ANSwalking and physical activity to improve circulation. second line is an aspirin or anti-platelet What is Korsakoff syndrome? - ANSa deficiency in thiamine and folate caused by alcoholism What is legg-calve-perthe disease? - ANSavascular necrosis of the femoral head due to a lack of blood supply What is Morton's neuroma? - ANSa mass between the 3rd and 4th toes that feels like a pebble; most common in women who wear high heels or tight shoes What is myasthenia gravis? - ANSan autoimmune disorder that causes muscle weakness of the voluntary muscles What is one of the biggest risk factors for cervical cancer? - ANSnumerous sexual partners What is Paget's disease? - ANSthere is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures pg. 97