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Clin Med 4 Relearnin
| Question | Answer |
|---|---|
| Neisseria Gonorrhea incubation time | 2-6d |
| Other things Neisseria Gonorrhea can cause | conjunctivitis, pharyngitis, proctitis |
| Complications of Neisseria Gonorrhea | PID, pregnancy complications, Epididymitis, blood stream infection, increased risk HIV |
| Chlamydia is hard to culture because | its intracellular |
| Other things Chlamydia may cause | conjunctivitis, pharyngitis, proctitis |
| Lymphogranuloma venerum incubation time | 5-21 d |
| Leading cause of blindness worldwide | Trachoma |
| Worry w Trichomonias in pregnancy | preterm, rupture of membranes, small for gestational age |
| Syphilis lays dormant where | CNS |
| Cryptorchidism complications | Increased risk infertility, malignancy, torsion |
| Klinefelter increased risk for | SLE, breast cancer, diabetes, osteoporosis, and other |
| Most common cause of ejaculatory dysfunction | premature ejaculation |
| Bacterial vaginosis most common cause | Gardnerella |
| Management of BV | Metronidazole 500mg BID 7d |
| Recurrent BV | 3+ episodes of BV in 1 yr |
| Red flags fibroadenoma | Skin changes, sanguineous discharge, nipple inversion |
| Can look like inflammatory carcinoma | Mastitis |
| Increases risk for vulvar cancer | Vulvar lichen sclerosis |
| Complication of vulvar lichen sclerosis | midline fusion |
| What is hydranitis supportiva not due to | poor hygiene |
| Classified by location | Leiomyoma |
| Most common benign neoplasm | Leiomyoma |
| Smoking decreases risk of | Endometrial cancer |
| Pretty good outcome bc easily caught | Endometrial cancer |
| Most common gynecologic malignancy | Endometrial cancer |
| Most common deadly reproductive cancer | Ovaria cancer |
| 5th leading cause of cancer death in women | Ovarian cancer |
| Uterine prolapse is graded in | stages 0-4 |
| Stage 0 uterine prolapse | Not prolapsed |
| Stage 1 uterine prolapse | over 1cm above hymen |
| Stage 2 uterine prolapse | 1cm above or below hymen |
| Stage 3 uterine prolapse | 1-3cm below hymen |
| Stage 4 uterine prolapse | eversion |
| Leading cause of infertility | PID |
| Leading cause of ectopic pregnancy | PID |
| Complications of PID | Abscess, reoccurrence, dyspareunia |
| Vaginitis | Collective term for infection, inflammation, or change in vaginal flora |
| Less common than other gynecological cancers | Vulvar cancer |
| HPV vaccine can help prevent | Vulvar cancer |
| Vulvar cancer prognosis | Typically good because caught early |
| Typically secondary to STI | Cervicitis |
| 3rd most common gynecological cancer | Cervical cancers |
| Screening/HPV vaccine could prevent 93% of | Cervical cancers |
| HPV+ in 99% of | Cervical cancers |
| Most common location of endometrial tissue | Ovary |
| Endometriosis complications | Chronic pain and infertility |
| Ovarian cyst may contain | blood or regular fluid |
| How PCOS affects ovulation cycle | Dont ovulate regularly |
| PCOS is a diagnosis of | exclusion |
| Most common cause of anovulation infertility | PCOS |
| Complication of ovarian torsion | Sepsis |
| Most common vulvar mass | Bartholian gland cyst |
| If >40 and asymptomatic worries an inflamed bartholian gland may be | Vulvar cancer |
| Most common cause of abnormal discharge | BV |
| Second most common cause of vaginitis | Vulvovaginal candidiasis |
| Complications of vulvovaginal canddiasis | Recurrence, Severe, Non-albicans, comorbidities |
| Causes of abnormal uterine bleeding | infection, cervical disorder, endocrine disorder, hematologic disorder |
| Post menopausal bleeding you are most concerned for | Endometrial cancer |
| Second most common trisomy | Trisomy 18 |
| Most common cause of hypogonadism and infertility in med | Klinefelter |
| Most common sex chromosome abnormality | Klinefelter |
| Majority end in fetal demise | Turner syndrome |
| Complications of Prader Willi | Osteoporosis, sleep apnea, psychosis |
| Complication of constipation | Hemrroids |
| 5% of all pregnant women develop this | Gestational hypertension |
| Pre-Eclampsia causes arterial spasm in | kidneys, brain, liver |
| Pre-eclampsia is most common in | New moms |
| Severity of eclampsia | Emergency |
| When to deliver w gestational HTN | Regular 38w |
| Incompetent cervix predict at what time | 14-16w |
| Gestational diabetes causes | Excessive fetal growth which during birth results in shoulder dystocia |
| Pre-existing DM causes | Excessive fetal growth, miscarriage, or infection |
| Hydrops Fatalis is a complication of | Rh incompatibility |
| Superimposed preeclampsia complications | abruption, mortality, c-section, preterm birth |
| Placental abruption complications mom | DIC, shock, AKI, death |
| Placental abruption complications fetus | growth restrictions, death |
| Placental abruption complications newborn | preterm, small, death |
| Number one cause of third trimester bleed | Placental previa |
| Dont do digital exam in which case | Placental previa |
| Placental increta | into the myometrium |
| Placental percreta | Deep deep |
| Placental accreta increases risk for | hemorrhage |
| Trophoblastic disease | Molar pregnancy where nothing is viable |
| Most common pregnancy complication | Spontaneous abortion |
| Polyhydramnous associated with | fetal malformation and fetal anemia |
| Oligohydramnous associated with | Abnormal developement, or post term pregnancy |
| Most common TOURCH infection | Cytomegalovirus |
| Complication of cytomegalovirus | Hearing loss |
| Suspect in neonates with fever and meningitis symptoms | Herpes Simplex Virus |
| Hutchinson triad | Deaf, cornea, teeth |
| Complication of conjunctivitis | Chemosis |
| Most common intraocular malignancy of childhood | Retinoblastoma |
| Most common chronic disease of childhood | Dental carries |
| Acute otitis media complications | Ruptured TM, chronic effusion, hearing loss, mastoiditis |
| Complication of acute bacterial pharyngitis | Rheumatic fever |
| Rheumatic fever effects | joints, hearts, nodes, erythema, sydenham |
| Complication of tonsillectomy | Post op hemorrhage or hyper nasal speech |
| Contraindications of tonsillectomy | Palate abnormalities, bleeding disorder, acute tonsillectomy |
| Complications of cleft lip/palate | Food coming through nose, otitis media with effusion, failure to thrive because he cannot eat |
| Most common cause of conductive hearing loss | Otitis media w effusion |
| Complications of rhinosinitus | Cellulitis, empyema, brain abscess, osteomyelitis, meningitis |
| Acute stomatitis examples | Canker sore, HSV, thrush, trauma |
| Most frequently identifiable cause of intellectual disabilities | Down syndrome |
| ADHD may be combined with | other psych disorders |
| Screen for ... with intellectual disorders | sleep, feeding, obesity, GI, behavioral, psych |
| Etiologies of muscular dystrophy | Dystrophinopathy, myotonic dystrophy, facioscapulohum, limb-girdle |
| Duchene | Heart asymptomatic until late in disease |
| Female delayed puberty lowers the risk for | breast, ovarian, endometrium |
| Delayed puberty is associated with | lower bone mass, metabolic disease, cardiovascular disease |
| Mono incubates for | 4-8 weeks |
| Complication of mono | Splenomegaly |
| Turner syndrome complications | Coarc of the aorta and bicuspid aorta valve |
| Epiglottitis is more rare now because | H. Flu vaccine |
| Most common cause of wheezing in infants | Acute bronchiolitis |
| When to screen for bronchiopulm displasia | Eval 38w (normal birth time) |
| Life expectancy for cystic fibrosis | 30s |
| Pectus excavatum | Minor other than cosmetic |
| Acute bronchitis | common |
| This is a complication of other respiratory diagnoses | emphysema |
| Most common chronic ped condition | asthma |
| Highest rate of childhood mortality | Bacterial pneumonia |
| Scoliosis most common cause | idiopathic |
| After 1st UTI pt needs | ultrasound to evaluate for vesicouteral reflux |
| Most common urologic abnormalities in neonates | Vesicoureteral reflux |
| Complications of cryptochordism | Infertility, neoplasm, torsion, hernia |
| Most common kiddo surgery is for | appendicitis |
| Appendix perforation happens ...h after onset | 36 |
| 50% of these patients need transplant or dialysis by 20s | Autosomal recessive polycystic kidney disease |
| Pulm complications of this are what lead to death | Autosomal recessive polycystic kidney disease |
| Acute interstitial nephritis | Fever, eosinophilia, acute renal insufficiency, rash |
| Most common cause of nephritic syndrome | Glomerulonephritis from strep |
| Complication of pyloric stenosis | Metabolic alkalosis |
| Complication of celiac | Malabsorption and malnutrition |
| Most common cause of obstruction less than 2 | Intussussception |
| Most common cause of intussussception | idiopathic |
| Botulism symptoms in older | diplopia, dysarthria, dysphagia |
| Most common congenital abnormality of GI tract | Meckel diverticulum |
| Complication of developmental displasia | Avascular necrosis |
| RF for developmental dysplasia | Female, first born, breech |
| Most common cause of acute hip pain in kiddos | Transient monoarticular synovitis |
| Transient monoarticular synovitis is a diagnosis of | exclusion |
| Knee pain requires eval of | the hips |
| Genu valgum | normal until about 4yr |
| Genu varum | Bow legged |
| Genu valgum | knocked knees |
| Second most common peds spinal deformity | Kyphosis |
| Growing pains is a diagnosis of | exclusion |
| DDX for growing pains | Infection, metabolic, tumor, trauma |
| Most common salter harris fracture | 2 |
| Scary salter harris fractures | 3-5 |
| Complication of supracondylar fracture | Neurovascular compromise |
| Most common cause of functional constipation | Purposefully holding |
| If you see coin face on AP its in the | esophagus |
| Most common location of atrial septal defect | Near foramen ovale |
| Types of ventricular septal defect | Perimembranous, supracristal, inlet, muscular |
| Most common ventricular septal defect | Perimembranous |
| Most common kiddo heart condition | Ventricular septal defect |
| Coarction of the aorta | Doesn't get blood to lower body efficiently |
| Types of atrioventricular canal defect | Complete, intermediate, transitional, partial |
| Truncus arteriosus | One great vessel leaving the heart |
| Most common cyanotic defect in newborns | Transposition |
| Most common cyanotic defect | Tetralogy of fallot |
| Most common cause of heath from cardiac in the first month of life | Hypoplastic left heart syndrome |
| Multidrug resistance | Pathogens that are resistant to 1+ antimicrobial agents |
| Key factors in prevention of antibiotic resistance | Antibiotic stewardship, universal precautions, active surveillance, personal/environmental hygiene |
| Healthcare associated infections | CAUTI, HCAP, vascular catheter, surgical site infxn, C. diff |
| Most expensive HCA infextion | Central line |
| CAUTI rx | abx based on culture |
| Most effective rx for CAUTI | prevention |
| If a CAUTI is asympomatic | dont rx |
| Bugs for CAUTI | #1 E. Coli, #2 Candidia, #3 Enterococcus |
| Most common HCA infection | CAUTI |
| Complication of CAUTI | mortality |
| Second most common HCA infection | HCAP |
| HCAP rx | Culture driven abx- Antipseudomonal cephalosporin |
| Best HCAP rx | prevention |
| Bugs causing HCAP | #1 Pseudomonas, #2 MRSA |
| CLABI rx | Line out ASAP and send to lab for pathology, Abx based on culture |
| Top cause of CLABSI | Hub contamination |
| Riskiest place for IV cath due to infx | Femoral |
| CLABSI causes | #1 Hub contamination, contamination of fluid running through, skin organisms, contaminated device prior to insertion |
| Bugs causing CLABSI | #1 Staph, at femoral Enterococcus and E. Coli |
| CLABSI grows staph coag negative treat with | Vancomycin for 1 week |
| CLABSI grows stap treat with | Vancomycin for 2 weeks and TEE |
| CLABSI grows gram negative rod treat with | Beta lactam for two weeks |
| CLABSI grows candida treat with | Fluconazole 2w |
| Complicated CLABSI rx | 4-6weeks of abx |
| Surgical site infection bugs | Skin- SSE |
| Surgical site infection rx <5cm | open and drain |
| Surgical site infection rx >5cm | open and abx |
| Abx for small surgical site infection | Cephalosporin or combo |
| Stress incontinence symptoms | Leakage with laugh, exercise, cough, incontinence, no dysuria |
| Urge incontinence symptoms | Frequency, urge, nocturia |
| Overactive bladder symptoms | Frequency, urge, nocturia |
| Overflow bladder symptoms | Spontaneous or continuous leak |
| Stress incontinence rx | Kegals and timed void |
| Urge incontinence rx | Antimuscarinic + B3 adrenergic, kegals |
| Overflow incontinence rx | Bladder training, intermittent cath, alpha adrenergic antagonist |
| BPH rx | Alpha adrenergic antagonist |
| Insomnia | Difficulty falling or staying asleep, waking up early, associated with daytime impairment |
| Consequences of insomnia | Lower health related quality of life, increased medication use, cognitive decline, greater health care utilization |
| Common primary sleep disorders | Insomnia, obstructive sleep apnea, restless leg syndrome, periodic leg movements in sleep |
| Insomnia screening | are you satisfied with your sleep, does sleep or fatigue interfere with daytime activities, do bed partners complain of snoring/interrupted breathing/or excessive movements |
| Meds that impact sleep | Meds that cause lighter, shorter/fragmented sleep, nightmares, nocturia, sedation, stimulation |
| Meds that cause lighter, shorter/fragmented sleep | Alcohol, sedatives, cholinesterase inhibitors |
| Meds that cause nightmares | Antidepressants, anti-Parkinson, anti-HTN, cholinesterase inhibitors |
| Meds that cause nocturia | Diuretics |
| Meds that cause sedation | Antidepressants, clonidine, phenytoin, sedatives |
| Meds that are stimulants that keep you from sleeping | Bronchodilators, caffeine, nicotine, corticosteroids, sympathomimetics, antidepressants |
| Rx to improve sleep | #1 Non-pharm, #2 meds |
| Non-pharm things to do for sleep | Stimulus control, sleep restriction, cognitive intervention, relaxation, CBT, light exposure |
| Pharm things to do for sleep | smallest shortest duration, to discontinue med do behavior changes and taper |
| SSRI/benzos help with | anxiety |
| Meds for insomnia | Zolpidem, Zalepon suvorexant |
| Polypharmacy | Therapeutic duplication or medical insufficiency through 5+ meds |
| Meds we worry about with polypharmacy | Benzos, opioids, anticholinergic, sedatives/sleep, muscle relaxants, tricyclic antidepressants, antipsychotic |
| Leading cause of death from injury >65 | Complications from falls |
| Falls are associated with | Increased use of medical services, decline in functional status, nursing home placement, increased mortality |
| Fall screening | Have you fallen in the last year, do you feel unsteady when walking or standing, do you fear falling |
| Test for fall | Timed Get Up and Go |
| Things to exclude with falls | syncope or seizure |
| Meds to worry about with falls | drugs that cause bradycardia, drugs that cause orthostatic hypotension, CNS active meds, general meds |
| Meds that can cause bradycardia | Cholinesterase inhibitors, antiarrhythmics, beta blockers |
| Meds that can cause orthostatic hypotension | Antihypertensive meds, nitrates, SGLT2, diuretics, antipsychotic, some antidepressants |
| CNS active meds | Benzos, antidepressants, antipsychotics, anticonvulsants |
| General meds that can cause falls | Anticholinergics, antihistamines, insulin and oral hypoglycemics, narcotics, sedative hypnotics |
| Incontinence red flags | Sudden onset, pelvic or abd pain, hematuria, dysuria, severe straining, inability to void |
| A common but NOT normal part of aging | incontinence |
| Incontinence screening | Do you have trouble with your bladder, do you ever loose urine when you do not want to, do you ever wear pads to protect yourself in case you loose urine |
| Meds that may impact incontinence | sedative/reduced mobility, urgency/frequency, sensory, sphincter tone, edema, cough, incomplete emptying, bladder irritants |
| When to refer incontinence to urology | Hx lower urinary surgery or radiation, recurrent symptomatic UTI, marked pelvic prolapse, suspected prostate cancer, sterile hematuria |
| Geriatrics mindset | change from acute care to healthy aging |
| Functional geriatric disabilities | Independent living, self-care, ambulatory, cognitive, vision, hearing |
| Challenges of geriatric care | difficult to develop age-related guidelines for diagnoses and rx, multiple comorbidities, >50% of 80yr have 3+ chronic conditions, majority have some type of cognitive impairments, reduced social support, limited finances, functional disabilities |
| Geriatric syndromes | Delirium, functional decline, new incontinence, pressure injury, fall |
| Cytomegalovirus rx | Grancyclovir |
| Herpes Simplex virus rx | Acyclovir |
| HSV 1 | Oral herpes |
| HSV 2 | Genial herpes |
| Herpes bugs | HSV 1, HSV 2, CMV, EBV, HHV 6, 7 ,8 |
| Toxoplasmosis rx | Pyrimethamine w sulfadzine |
| Rhinovirus rx | supportive |
| Croup rx mild | Humidity |
| Croup rx moderate | Dexamethasone |
| Croup rx severe | Steroids, O2, epi inhaler, admit |
| Parovirus | B19- Fifths |
| Adenovirus symptoms | Conjunctivitis, diarrhea, cold symptoms |
| Poxvirus examples | Cow pox, monkey pox, small pox |
| Picornavrus | GI or Respiratory |
| Diptheria rx | Azithromycin and penicillin |
| Diptheria bug | Cornebacterium diptheria |
| Rheumatic fever bug | Group A strep |
| Bacterial meningitis bug | N. Meningitidus |
| Bacterial meningitis rx | Penicillin |
| Acute otitis media rx | Amoxicillin |
| Acute otitis media bug | Strep pneumo, Staph, M Cat, H flu |
| Acute bacterial pharyngitis rx | Amoxicillin or Penicillin |
| Acute bacterial pharyngitis bugs | Group A strep |
| Rhinosinusitis rx | Amoxicillin |
| Epiglottitis bug | H flu |
| Epiglottitis rx | Ceftriaxone and Dexamethasone |
| Primary tuberculosis bug | Mycobacterium tuberculosis |
| Cellulitis rx | Cephalexin |
| Cellulitis bug | Staph |
| MRSA rx | #1 Trimethoprim-sulfamethoxazole or Clindamycin, #2 Doxy |
| Tetanus rx | #1 Wound debridement and metronidazole, #2 Neutralize toxin, #3 Supportive care, #4 Tdap |
| Tetanus bug | Clostridium tetani |
| Erysipelas bug | Beta hemolytic Strep A |
| Erysipelas rx | Amoxicillin or Penicillin |
| Hidranitus supportiva rx | Tetracycline |
| Do not use these antibiotics when pregnant | Antimetabolites |
| Why we do not use antimetabolites in pregnancy | They inhibit folic acid metabolism |
| Chlamydia trachomatis rx | Doxycycline |
| Bacterial vaginosis rx | Metronidazole |
| PID rx | Metronidazole, Doxy, and Ceftriaxone |
| Gonorrhea rx | Ceftriaxone |
| Treponema pallidum rx | Penicillin G |
| Trichomonas rx | Metronidazole both partners |
| Lyme bug | Borella Burgdorferi |
| Rocky Mountain Spotted fever bug | Rickettsia Rickettsii |
| Bartonella bug | Bartonella henselae |
| Botulism bug | Clostridium botulism |
| Botulism rx | Botulism antitoxin |
| Salmonellosis bug | Non-typhoidal salmonella |
| Salmonellosis rx | Not abx |
| Shigellosis rx | Not abx |
| Campylobacter jejuni rx | No abx |
| Clostridiodes difficle abx | Oral vanc or ... |
| Cholera bug | Vibrio cholera |
| Rashes that have a fever and affect oral mucosa | Hand Foot and Mouth, Herpangina, HSV 1, Herpatic Gingivostomatitis, Erythema Mulitforme major |
| Rash that has a fever and rash on the face | 5ths |
| Rash that has a fever and goes head down | Measles and Rubella |
| Rash that has a fever and honey crust | Impetigo |
| Rash that comes 24-48 hours after a fever | Roseola |
| Bullae rash with fever | Staph scalded skin |
| Sandpaper rash with fever | Scarlet fever |
| Raised rash with fever and pain out of proportion typically on legs | Erysipelas |
| Erythematous rash with fever typically on legs | Cellulitis |
| Petechiae rash +/- neuro, and fever | Meningococcus |
| 5 days of fever and rash | Kawasaki |
| Maculopapular rash 7-10 d after starting medication may or may not have fever | Drug rxn |
| Harold patch rash with fever | Pityriasis Rosea |
| Papular rash on palms soles and face with fever | Gianotti Crosti |
| Target lesion rash on palms and soles with fever | Erythema Multiforme Minor |
| Mucocutaneous rash on hands with fever | Herpetic Whitlow |
| Annular rash central is white everywhere without fever | Tinea corporis |
| Pearly waxy papule rash everywhere without fever | Molluscum |
| Cauliflower rash everywhere without fever | Verrucae |
| Baby rash on face and trunk without fever | Neonatal acne |
| Baby booty rash without fever | Diaper dermatitis |
| Rash where feet peel without fever | Tinea Pedis |
| Annular patch on scalp without fever | Tinea capitis |
| Greasy flakes on scalp without fever | Seborrheic dermatitis |
| Hand Foot and Mouth Rx | Self-resolving supportive care |
| Herpangina rx | Self-resolving supportive care |
| Gianotti Crosti rx | Self-resolving supportive care |
| Measles rx | Self-resolving but MMR vaccine can prevent |
| Rubella rx | Self-resolving but MMR vaccine can prevent |
| Erythema infectiosum rx | Self-resolving supportive care |
| HSV 1 rx | |
| Herpetic whitlow rx | Self-resolving, supportive, or acyclovir |
| Eczema herpeticum rx | |
| Varicella rx | Vaccine |
| Roseola infantum rx | Self-resolving supportive care |
| Tinea corporis rx | Antifungals |
| Tinea capitis rx | Oral grisoful or ketoconazole shampoo |
| Tinea pedis rx | Antifungals |
| Diaper dermatitis rx | Kep area clean and dry, treat yeast with nystatin |
| Staph scalded skin rx | Fluids, abx, skin care, ADMIT |
| Scarlet fever rx | Amoxicillin |
| Erysipelas rx | IV penicillin, ADMIT |
| Staph cellulitis rx | Oral or IV abx |
| Impetigo rx | Topical abx if there is a small area or oral abx if diffuse |
| Meningococcus rx | Penicillin |
| Kawasaki rx | IVIg, hgh dose aspirin |
| Drug rxn rx | stop med |
| Henoch Schoenlein purpura rx | Steroids for joints and GI, NSAIDS for pain |
| Neonatal acne rx | self-resolving |
| Seborrheic dermatitis rx | self-resolving, selenium sulfide shampoo, or mineral oil |
| Eczema rx | Moisturize, remove triggers, steroids if needed |
| Molluscum rx | Self-limited can be removed |
| Verrucae rx | Self-limited can be removed |
| Pityriasis rosea rx | Self-resolve 8-10w |
| Scabies rx | Permethrin cream, wash all things on hot |
| Lice rx | Permethrin, sklice, Nit removal, wash all things on hot |
| Geriatric syndromes | Common health conditions in older adults that do not fit into distinct organ-based disease categories and often have multifactorial causes |
| Geriatric disorders that affect the mind | Dementia, Delirium, Depression |
| Geriatric disorders that affect mobility | Amount of mobility, impaired gait and balance, fall injury |
| Geriatric disorders that affect medications | Polypharmacy, optimal/safe prescribing, adverse medication effects and medication burden |
| Impact of elder abuse | Physical injury/pain, worsening chronic conditions, dehydration, pressure ulcers, emotional distress, loss of income and savings |
| Abandonment signs | Evidence patient is left alone unsafely, patient is dropped off and needs a responsible party |
| Physical abuse signs | Anxiety, nervousness, withdraw, bruising, wounds in unusual locations, repeated ED visits, repeated falls, signs of SA |
| Exploitation signs | Evidence of misuse of patients assets, change in ability of patient to account for money and property or pay for essential care, reports of demands unreasonable amounts of money or goods in exchange for caregiving, unexplained loss of checks, refills meds |
| Neglect signs | Contractures, dehydration, depression, fecal impaction, malnutrition, inappropriate use of meds, pressure ulcers |
| Psychological abuse signs | Observed impatience, irritability or demeaning behavior |
| Basic tenets of geriatric care | Aggressive primary care, patient centered, technology to track, teamwork, efficient, slow decline |
| Pathogenesis of HTN | Increased arterial stiffness, dysfunction of the endothelium, fibrosis of glomerulosclerosis and interstitial |
| Goal of systolic BP >65 | 130 |
| Nonpharm treatment of HTN | Decrease Na, Decrease alcohol, Exercise, stop smoking, loose weight |
| Meds that increase BP | NSAIDS, venlafaxine, steroids |
| Number one pharm treatment for HTN | Chlothalidone |
| Med classes to treat HTN | thiazide, calcium channel blockers, (dihydropuridine and nondyhydropurdine), ACE, ARB, BB |
| Not recommended to treat HTN in geriatrics | Potassium sparing diuretic, alpha blockers, alpha adrenergic receptors |
| CAD nonpharm treatment | Lifestyle- smoking cessation, BP control, lipid management, diabetes management, weigh and diet management, physical activity |
| Pharm for CAD | Aspirin, Nitrates, BB, ACE/ARB, Statins |
| Other than the big two what are the lung related diseases that impact geriatrics | Interstitial disease and pulmonary hypertension |
| Asthma diagnoses <12 is likely from | atopy |
| Asthma diagnosis >40 is likely from | smoking and obesity |
| Grade 1: Mild COPD | FEV >80 |
| Grade 2: Moderate COPD | FEV 50-80 |
| Grade 3: Severe COPD | FEV 30-50 |
| Grade 4: Very Severe COPD | FEV <30 |
| treatment for COPD | SABD, LABA/LAMA, LABA+LAMA, LABA+LAMA+ICS, Biologics |
| What may impair patient's self treatment of diabetes | Cognitive, visual, or functional impairment |
| Diabetes pharmalogical rx | #1 Metformin, #2 SGLT-2, #3 DPP-4, #4 Insulin |
| Diabetic rx not preferred in geriatrics | Thiazolidines, Sulfonurea, GLP1 |
| Pathophys of osteoarthritis | Changes to cartilage architecture, changes to subchondral bone, synovitis and synovial hypertrophy |
| Systemic diseases associated with developing osteoarthritis | RA, SLE, hyperparathyroidism, gout, diabetes, bone dsplasia |
| osteoarthritis affects which joints | Knees, hips, hands, back |
| Osteoarthritis is a | Clinical diagnosis |
| Challenges to caring for geriatric patients | No age-related guidelines, multiple comorbidities, 3+ chronic conditions, cognitive impairment, reduced social support, limited finances, functional disabilities |
| Advanced directive | gives you the right to make any health care decisions in advance; ensures that you, your loved ones, and your healthcare team honor your wishes |
| Leading cause of fatal and nonfatal injuries among people >65 | Falls |
| Intrinsic fall risk factors | Cognitive impairment, functional limitations, medications |
| Extrinsic fall risk factors | Footwear or foot problems, home hazards, improper use of assistive devices, eyeglass use, substance use |
| Easier quick fixes for fall risk factors | extrinsic risk factors |
| Polypharmacy | Multiple meds being taken for the same problem, higher risk if >5meds |
| Prescribing cascade | older adults often experience drug side effects> AE from drugs>new drug to deal with AE>possible new side effects |
| Deprescribing | planed or supervised process of dose reduction or stopping meds that may cause harm or no longer providing benefit |
| Dementia warning signs | trouble remembering, "poor historian", cant follow instructions, getting lost, problems with self care, unexplained weight loss |
| DSM5 criteria for Dementia | Evidence of decline in memory and learning as well as one other cognitive domain, progressive gradual decline in cognition without extended plateaus, no mixed etiology |
| Meds for dementia | Acetylcholinesterase inhibitors and NMDA antagonists |
| Lag to benefit | Time between the preventive intervention to the time when improved health outcomes are seen |
| estimating prognosis | Prognostic indices based on clinical situation |
| Geriatric syndromes | Common health conditions in older adults that do not fit into distinct organ-based disease categories and often have multifactorial causes |
| Geriatric Mind | Mentation, dementia, delirium, depression |
| Geriatric Mobility | Amount of mobility, function, impaired gait and balance, fall injury prevention |
| Geriatric medication concerns | Polypharmacy, deprescribing, optimal/safe prescribing, adverse medication effects and medication burden |
| What matters most to geriatrics | Each individual's own meaningful health outcome goals and care preferences |
| Fall | An event that results in a person coming to rest inadvertently on the ground, floor, or other lower level without known loss of conciousness |
| Falls are associated with | Increased use of medical services, decline in functional status, nursing home placement, increased mortality |
| Circumstances of fall | Frequency, location, activity at time of fall, trip/slip, environmental hazard |
| Symptoms associates with falls | Dizzy, cardiovascular, focal neural, volume depleted |
| UTI rx | antibiotics, do not treat asymptomatic |
| Atrophic vaginitis/urethritis rx | topical estrogen |
| Stool impaction affecting bladder rx | Fecal disimpassion, appropriate use of bowel regimen |
| Metabolic reaction affecting bladder rx | Treat underlying |
| Volume overload affecting urine production rx | Compression socks |
| Venous insufficiency with edema effecting urine rx | leg elevation and sodium restriction |
| Psych conditions associated with sleep disturbance | adjustment disorders, anxiety, bereavement, depression, PTSD |
| Cardiopulm conditions associated with sleep disturbance | cough, dyspnea, apneas, palpitations, chest paiin |
| Neurologic symptoms associated with sleep disturbance | Pain, paresthesia, Parkinson, RLS, seizure, stroke |
| Abandonment | Evidence patient is left alone, unsafely, patient is dropped off with no one to care |
| Physical abuse | Anxiety, nervousness, withdraw, bruising, wounds in unusual places, repeated ED visits, repeated falls, signs of sexual abusee |
| Exploitation | Evidence of missuses of patients assets, change in ability of patient to account for money and property or pay for essential care |
| Neglect | Contractures, dehydration, depression, diarrhea, fecal impaction, malnutrition, inappropriate use of medications, poor hygiene, pressure ulcers, repeated falls, repeated hospital admission, urine burns |
| Psychological abuse | Observed impatience, irritability, demeaning behavior, anxiety, fearfulness, ambivalence or anger shown by patient about caregiver |
| Aggressive primary care for geriatrics include | Proactive monitoring and early intervention |
| Pathogenesis of hypertension | Increased arterial stiffness due to decreased elastin, dysfunctional endothelium, renal glomerulosclerosis and interstitial fibrosis |
| Number one med for HTN rx geriatrics | Chlorthalidone |
| Meds not to take for HTN geriatrics | Triamterene, Terazosin, Doxazosin, Prazosin, Clonidine |
| Gold standard coronary artery disease diagnostic | coronary angiography |
| Lung-related diseases with lower prevalence in geriatrics | interstitial disease and pulmonary HTN |
| <12 asthma cause | atopy |
| >40 asthma cause | smoking and obesity |
| Curative cancer | involves surgery, radiation, and or chemo, all poorly tolerated in geriatrics |
| Palliative cancer treatment | Preferred in patients w advanced-stage cancer w low probability of cure, shorter life span, comorbidities that might limit more aggressive rx, or patient choice |
| Toxoplasmosis rx | Premethamine w sulfadaziine |
| CMV rx | Grancyclovir |
| CMV transmission | Cross placenta to baby, get from toddler waste, also concerned for in immunocompromised |
| CMV symptoms | blueberry rash, microcephaly, fever, mental retardation, developmental delays |
| HSV-1 rx | Acyclovir |
| HSV-2 rx | Acyclovir |
| Rhinovirus trasmission | Secretions |
| Rhinovirus is part of which family | Picornavirus |
| Croup rx mild | humidity |
| Croup rx moderate | dexamethasone |
| Croup rx severe | steroids, O2, nebulized epi |
| Fifth type of genome | Single stranded DNA |
| Fifths targets what | Erythropoietin progenitor cells |
| Fifths S+S | Transient aplastic crisis, anemia, may have cold symptoms, slapped cheeks |
| Complication of Fifths | Hydrops fatalis |
| Adenovirus type of genome | Non-enveloped DNA |
| Adenovirus in immunocompromised | Disseminated infxn |
| Pox viruses | smallpox, cow pox, monkey pox, moluscum |
| Poxvirus rx | None |
| Pox virus transmission | Spread by direct and indirect contact |
| Polio is in what family | Picornavirus |
| Cocksackie is in what family | Picornavirus |
| Rhino virus is in what family | Picornavirus |
| Enterovirus is in what family | Picornavirus |
| Varicella/Zoster transmits via | secretions and skin |
| Varicella/Zoster lays dormant where | Dorsal root ganglia |
| Epstein Bar Viruses long term complications | B lymphoma, or Burkette lymphoma |
| Diphtheria bug | Corynebacterium diphtheria |
| Corynebacterium diphtheria bug classification | Gram + rod |
| Diphtheria rx | Azithromycin or penicillin |
| Pathophys of diphtheria | Exotoxin to skin and respiratory, causes cell death |
| Diphtheria symptoms | Gray pseudomembranous, malaise, fever, lymphadenopathy, sore throat |
| Rheumatic fever rx | IV penicillin |
| Rheumatic fever can affect | heart, skin, and joints |
| Jones criteria | Two major or one major and two minor criteria |
| Acute otitis media rx | Amoxicillin |
| Rhinosinusitis rx | Amoxicillin |
| Epiglottitis rx | Ceftriaxone and Dexamethasone |
| Most common bugs for skin and soft tissue | Strep pyrogens and Staph |
| Cellulitis rx | Cephalexin |
| HA-MRSA transmission | hands and surfaces |
| CA-MRSA transmission | person or object |
| Tetanus bug | Clostridium tetani |
| Clostridium tetani classification | Anaerobic, spore forming, gram positive rod |
| Pathophys of Tetanus | Motor neurons are continuously firing bc of tetanospasm (toxin) |
| Erysipelas rx | IV penicillin or amoxacillin |
| Impetigo bug | staph |
| Salmonella class | Gram negative rod, aerobic |
| Salmonella enters what part of GI | small intestine and colon |
| Shigella class | Gram negative rod, anaerobe |
| Complications of shigella | seizures or toxic encephalopathy |
| Where does shigella enter the GI tract | Colon at recto sigmoid |
| Campylobacter invades what part of GI tract | small intestine to rectum |
| Shigella stool | Bloody and mucus |
| C diff bug class | Gram positive bacilli, anaerobic, spores |
| Cholera bug | Vibrio cholerae |
| Vibrio cholerae bug class | Gram negative bacilli |
| Cholera transmission | Contaminated water and food |
| Chlamydia bug class | Intracellular oblique |
| Chlamydia discharge | white/yellow |
| BV discharge | clear/gray |
| Gonorrhea discharge | purulent |
| Trich discharge | Green froth |
| Syphilis transmission | STI or placenta |
| Burgdifore class | spirochete |
| Lyme is endemic to where | Northeast and midatlantic |
| Rocky Mountain Spotted Fever bug | Rickettsia Rickettsi |
| Rickettsia rickettsi class | Gram negative oblique intracellular |
| Rickettsia rickettsi transmit via | Dog tick and wood tick |
| Rickettsia rickettsi symptoms | Hemorrhage in skin, intestines, pancreases, liver, skeletal muscle, kidneys |
| Rickettsia rickettsi is endemic to where | Southeast and Central US |
| Bartonella H stain via | silver stain |
| Bartonella bug class | Gram negative bacillus |
| Botulism bug | Clostridium botulism |
| Clostridium botulism class | Gram positive rod |
| Botulism leads to | cranial nerve palsy, descending paralysis, but no altered mental status |
| Surgical site most common bugs | Skin flora |
| Surgical site infection rx <5cm | open and drain |
| Surgical site infection rx >5cm | open and abx (cefalosporin) |
| Systemic surgical site infection rx | reopen, debried, abx |
| Rx for C. Diff | #1 Fidaxomycin or oral Vanc, #2 oral metronidazole |
| CAUTI most affective rx | prevention |
| CAUTI rx asymptomatic | do not treat |
| CAUTI bugs | #1 E. coli, #2 Candida, #3 Enterococcus |
| Most common HCA infection | CAUTI |
| HCAP bugs | #1 Pseudomonas, #2 MRSA |
| Staph coag rx in CLABSI | Vanc for 1w |
| Staph rx in CLABSI | Vanc 2w with TEE |
| Gram negative rods rx in CLABSI | Beta lactams |
| Complicated CLABSI rx timline | 4-6w |
| #1 cause of CALBSI | hub contamination |
| CLABSI bugs | Skin flora- STAPH, or femoral GI |
| Cryptosporidium symptoms | watery diarrhea |
| Cryptosporidium comes from | Feces |
| Cryptosporidium rf | AIDS |
| Cryptosporidium rx | Nitrazoxinide |
| PJP gold standard ds | PCR or stain |
| PJP rx | ART (AIDS), Bactrim, Steroids if respiratory compromised |
| If CD4 > 200 and respiratory symptoms likely | community acquired pneumonia |
| Histo symptoms | Respiratory and flu like |
| Histo CD4 count | <150 |
| Histo rx | Intraconazole |
| Do you prophylaxis hisot | yes- CD4 <150 |
| When to rx histo | Symptomatic >1M or immunocompromised |
| Histo RF | Ohio river valley and Mississippi |
| Toxoplasmosis symptoms | White retinal lesion and pigmented scars |
| Toxoplasmosis diagnostic studies | MRI most sensitive- Ring enhancing lesions |
| Definitive diagnosis for toxoplasmosis | Brain biopsy |
| Toxoplasmosis rx | Pyrimethamine and sulfadiazine with fulinic acid |
| If you are pregnant with toxoplasmosis | add spiramy to your rx |
| Kaposi sarcoma symptoms | widespread rash, including mucosa |
| Kaposi sarcoma rx | ART (AIDS) and Chemo |
| Diagnostic studies for kaposi | clinical diagnosis |
| MAC symptoms | pulmonary, fever, night sweats, weight loss |
| MAC diagnostics | Bronchial lavage, chest CT, blood culture |
| MAC rx | 12m Clarithomycin and Ethambutol |
| MAC facts | no latent infection, may mimic hematologic malignancy |
| Candida likes | blood and mucosa |
| Candida diagnostics | KOH budding hyphae |
| Candida rx | topical azole or nystatin |
| Invasive candida rx | Amphotericin, Fluconazole, Echinocandia |
| Most common type of candidia | Candida albicans |
| Coccidio symptoms | flu like, back ache, headache |
| Coccidio diagnostics | CXR - patchy nodular lobe |
| Coccidio is found where in the US | South |
| Coccidio rx | Itraconazole or fluconazole 6m |
| Do you propholax for coccdio | no |
| Fungal coccidio meningitis rx | for life |
| Constipation rx mild | bulk forming, senna, poly glycol |
| Constipation rx sever | suppository, enema, mag citrate |
| Death rattle rx | Atropine eye drops or scopolamine patch |
| What is the death rattle from | extra secretions |
| When do you hear the death rattle | Last 48 hours of life |
| Anxiety medication for geriatrics | Lorazepam, therapy |
| Mild pain rx geriatrics | Tylenol and NSAIDS |
| Moderate pain rx geriatrics | Mild opioids and Non opioids |
| Severe pain rx geratrics | Opioids |
| How to schedule pain meds | every 4-6 hours with break through |
| Most common symptoms patients experience | Pain |
| Breathless rx | O2, circulation, change position, morphine |
| Nausea rx | Zofran, prochioperaz, haloperidol |
| Asthma rx | LAMA/LABA |
| Do not use this in geriatric asthma patients | SABA |
| Difference between young v old with asthma | 4x increase in geriatric mortality |
| Diabetes geriatric A1C goal | 7-7.5 |
| Diabetes rx | #1 Metformin, #2 SGLT-2, #3 DPP, #4 Insulin |
| Do not use as diabetes rx in geriatrics | Sulfonurea or thiazolid |
| do not use as HTN rx in geriatrics | Clonodine |
| Goal bp for geriatrics | 130/80 |
| Anemia in women | Hgb <12 |
| Anemia in men | Hgb <13 |
| Overflow incontinence symptom | spontaneous or continuous release |
| Stress incontinence rx | kegals and times void |
| Overactive/urge rx | Antimuscarinic |
| Overflow rx | Alpha adrenergics |
| Down syndrome diagnostics | Nuchal translucency |
| Fetal alcohol syndrome presentation | wide eyes, flat filtrum, thin upper lip, microcephally |
| Cerebral palsey RF | Birth or pregnancy brain trauma |
| ADHD symptoms | Inattention, hyperactivity, and impulsive |
| How to assess ADHD | vanderbuilt assessment scale |
| Duche Muscular dystrophy symptoms | Heart and gowers sign with standing |
| MCC of peds conductive hearing loss | Otitis media wit effusion |
| Acute viral rhinitis symptoms | <10d common cold |
| Bacterial rhinosinusitis | >10d common cold |
| Acute viral pharyngitis bug | Adenovirus |
| Negative red reflex | Leukocoria |
| Retinoblastoma mutation | RB1 |
| MC cause of pediatric ocular cancer | Retinoblastoma |
| Bugs of Acute otitis externa | Staph or pseudomonas |
| Dont do a tonsillectomy if | Palate abnormality, bleeding disorder, tonsilitis |
| Transposition | aorta and pulmonic trunk did not twist- aorta goes to left atrium |
| Tricuspid atresia | Tricuspid valve fails to form |
| Tetralogy of fallot | Tet spells and pulmonic stenosis murmor |
| Most common cyanotic defect | Tetralogy of fallot |
| Most common cause of cardiac death in the first month | Hypoplastic left heart syndrome |
| Most common defect of the heart | VSD |
| Machine like murmor | Patent ductus arteriosis |
| Coin face in AP | Coin in esophagus |
| Coin side in AP | Coin in trachea |
| Celiac test | tTG and total serum IgA |
| Intussusception stool | Currant jelly stool |
| Most common cause of bowel obstruction <2 | Intussusception |
| Most common congenital abnormality of the GI tract | Meckels diverticulum |
| Acute interstitial nephritis cast | WBC |
| Glomerulonephritis post strep cast | RBC |
| Most common cause of nephritis syndrome | Glomerulonephritis post strep |
| Complication of sigella | HUS |
| Scoliosis angle <20 | watch |
| Scoliosis angle 20-50 | brace |
| Scoliosis angle >50 | surgery |
| Pulmonary agenisis | failure for one of the lungs to form |
| Bronchio displasia | how much O2 baby needs at 36 weeks from conception |
| Most cancer dx are | after the age of 65 |
| Malaria fever pattern | fever every 3/4 days |
| Undulant fever in brucellosis pattern | fever in the evening, gone by morning |
| Lyme fever pattern | Long week fever with a long week of remission |
| Hodgkin fever pattern | Week long HIGH fever with week long remissions |
| Two fever spikes a day point to | Still, Malaria, or typhoid |
| Neonate fever bugs | #1 E. coli, Group B strep, Listeria, Neonatal HSV |
| When peds fever needs further workup | Over 3 days or above 102.2 |
Created by:
kendallmk