PANCE

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Author:
kmcody
ID:
30616
Filename:
PANCE
Updated:
2010-08-26 22:40:19
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Medicine
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PA Recertification
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  1. Peripheral edema, (+) proteinuria, oval fat bodies...
    Nephrotic Syndrome
  2. Lisinopril

    Type
    Action
    (ACEI) Angiotensin Converting Enzyme Inhibitor

    • Blocks production of aldosterone
    • May cause hyperkalemia (Peaked T-wave on ECG)
  3. Paget's Dx
    • Ca: Breast, Vulva etc
    • Associated with pruritis of the vulva, along with lesions that resemble eczema
    • Pathology: Eosinophilic Paget's cells
  4. Osteoarthritis
    (Bouchard nodes) deformity
    These are particularly common in the hands and lead to enlargement of the PIP joints
  5. Osteoarthritis
    (Heberden nodes)
    These are particularly common in the hands and lead to enlargement of DIP joints
  6. Prazosin
    (Alpha Blocker)
  7. Impetigo
    Tx for Staph Aureas pcn resistant
    Dicloxacillin
  8. Gamekeeper's thumb or Skiier's Thumb Injury
    acute injury to the ulnar collateral ligament
  9. Shortened QT interval
    • hypercalcemia
    • *Sarcoidosis can be assoc c hypercalcemia
  10. CXR c aoric dissection
    widened mediastinum
  11. Psoriatic Spondylitis

    Tx
    Sulfasalazine
  12. HTN medication used with a pregnant patient with a diastolic pressure >100
    Methyldopa
  13. Mycoplasma pneumoniae

    Tx
    • Macrolide
    • Azithromycin 500 mg 1st dose then 250 mg X 4/days for CAP especially Mycoplasma pneumonia
  14. Zanamivir
    Vaccine for influenza AB

    *Contraindicated in asthma/COPD
  15. Impetigo (mild)

    Tx
    Mupirocin cream for small areas
  16. Mallet Finger
    (DIP) Mallet finger refers to a condition in which the end joint of a finger bends but will not straighten by itself. In this situation, the joint can be pushed straight but will not hold that position on its own.
  17. Swan neck or Boutonniere deformity
    (DIP hyperflexion with PIP hyperextension)
  18. Most common elbow fracture in childres ages 2-12
    Supracondylar fracture

    *FOOH
  19. Bence Jones Protein
    • Finding this protein is often suggestive of multiple myeloma.
    • The proteins are immunoglobin light chains. The light chains have traditionally been detected by heating or electrophoresis of concentrated urine.
  20. Post streptococcal glomerulonephritis (group A beta-strep)

    Dx test
    Anti DNAase B serology
  21. Antidote for acetaminophen OD
    < 4 hours: N-acetylcysteine (NAC) is the treatment of choice and can be given either orally, nebulized (mucomyst), or intravenously.
  22. Topamax (Topiramate)

    uses:
    Seizures & Migraine Prophylaxis (50 mg 2X/day)

    *mechanism of action unknown
  23. Zithromax
    • Subclass: Macrolides
    • Mechanism of Actionbacteriostatic; binds to P site of 50S ribosomal subunit, interfering w/ protein synthesis
  24. Levaquin
    • Subclass: Quinolones
    • Mechanism of Action: bactericidal; inhibits DNA gyrase and topoisomerase IV
  25. Zithromax
    • Subclass: Macrolides
    • Mechanism of Action: bacteriostatic; binds to P site of 50S ribosomal subunit, interfering w/ protein synthesis
  26. Amaurosis Fugax
    Transient monocular vision loss due to retinal emboli

    • s/sx: temporary curtain
    • The arterial supply branches off from the internal carotid artery
  27. Diabetes Insipidus

    Central
    Nephrotic
    • Disorder characterized by polydipsia, polyuria, increased thirst, and formation of hypotonic urine.
    • Two types exist: central DI, due to defective/decreased synthesis or release of arginine vasopressin (AVP) from the hypothalamo-pituitary axis; and nephrogenic DI, due to renal insensitivity to AVP (inability to concentrate urine due to resistance to ADH on the kidney
  28. TB

    Tx
    • Primary Options
    • isoniazid : 5 mg/kg orally once daily for 9 months, maximum 300 mg/dose; or 15 mg/kg orally twice weekly for 9 months, maximum 900 mg/dose. Adverse effects: hepatitis, peripheral neuropathy
    • Secondary Options
    • rifampin : 10 mg/kg orally once daily for 4 months, maximum 600 mg/dose; or 10 mg/kg orally twice weekly for 4 months, maximum 600 mg/dose
    • or
    • rifampin : 10 mg/kg orally once daily for 4 months, maximum 600 mg/dose; or 10 mg/kg orally twice weekly for 4 months, maximum 600 mg/dose. Adverse effects: hepatitis, etc
    • and
    • isoniazid : 5 mg/kg orally once daily for 4 months, maximum 300 mg/dose; or 15 mg/kg orally twice weekly for 4 months, maximum 900 mg/dose
  29. Rosacea

    Tx
    Topical metronidazole cream
  30. Indirect Inguinal Hernia

    Direct Inguinal Hernia
    Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels

    Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring
  31. Celiac Disease
    Celiac Sprue
    • Celiac disease is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.
    • Gluten free diet

    **May eat things like potatoes, Rice...
  32. Anticholinergics are contraindicated in...
    GERD
  33. Test for eosinophils
    Nasal Smear
  34. Diphtheria

    S/Sx
    Sore throat, nasal discharge, hoarseness, fever, lesions: brownish/grey membranous
  35. What Medication causes gingival hyperplasia & lymphadenopathy?
    Phenytoin (Dilantin)
  36. Syphylilis

    Diagnostics
    1st Tests To Order

    • dark field microscopy of swab from lesion
    • serum treponemal enzyme immune assay (EIA)
    • serum T pallidum particle agglutination (TPPA)
    • serum T pallidum hemagglutination (TPHA)
    • serum fluorescent antibody absorption (FTA-ABS) tests
    • immunocapture assay (ICE)
    • serum Venereal Disease Research Laboratory (VDRL) test
    • serum rapid plasma reagin (RPR) test
    • serum cardiolipin-based test
  37. Syphilis

    Tx
    • Without penicillin allergy
    • intramuscular benzathine penicillin-G

    • With penicillin allergy: nonpregnant
    • oral doxycycline
    • oral tetracycline
  38. Patent Ductus Arteriosus
    • A ductus arteriosus is a vascular fetal structure that usually closes in the first 48 hours after birth.
    • Persistence of the ductus arteriosus can result in heart failure, increased pulmonary pressures and endarteritis.
    • S/Sx: DOE, Machine-like continuous murmur heard at left sternal border, widened pulse pressure, loud S2.
    • Dx: MRI, CT, and Echo is helpful
    • Tx: Indomethacin
    • Surgery (duet closure)
  39. Ventricular septal defect
    • A defect in the interventricular septum that allows shunting of blood between the left and right ventricles.
    • S/Sx: R, L, or Biventricular hypertrophy, murmur, thrill, heave, R-L shunting, ejection systolic murmur at the R upper sternal border
    • Also: pulmonary HTN (Eisenmenger physiology).
    • Dx: Echo, also MRI, CT
    • Tx: Meds,
  40. Traveler's Diarrhea

    Tx at onset
    • Loperamide (Imodium)
    • Cipro (Quinolone)
  41. Turner's Syndrome
    • Chromosomal abnormality involving a complete or partial absence of the second sex chromosome occurring in approximately 1 in 2500 live female births.
    • Key Factors
    • poor growth, short stature, delayed/absent pubertal development, primary amenorrhea, dysmorphic features, skeletal abnormalities,
    • webbed neck, peripheral lymphedema, Possible bicuspid aortic valve and aortic dilation
  42. Tetralogy of Fallot
    • 1) Ventricular septal defect with 2) overriding aorta and 3) right ventricular (RV) outflow tract obstruction and 4) resulting RV hypertrophy.
    • S/Sx: Hypercyanotic episodes, harsh systolic ejection murmur, cyanosis, tachypnea, "boot shaped heart"
    • Dx: Echo
    • Tx: Meds (supportive; i.e. B-blockers, O2) & Surgery
  43. Tinea Cruris
    • Jock itch, also called tinea cruris or ringworm of the groin, is an infection of the groin area caused by fungus.
    • S/Sx: Itching in groin, thigh skin folds, or anus. Red, raised, scaly patches that may blister and ooze -- The patches often have sharply-defined edges and are often redder around the outside with normal skin tone in the center.
    • Tx: Keep the skin clean and dry. Don't wear clothing that rubs and irritates the area.
    • Apply topical over-the-counter antifungal or drying powders, such as those that contain miconazole, clotrimazole, or tolnaftate.
  44. Charcot's Triad
    RUQ pain, jaundice, fever

    (+) in 20-70% of pts c acute cholangitis
  45. Cholera
    Asia (India/Africa)

    S/Sx: Rice watery stools, profuse, gray, watery diarrhea

    Tx: Hydration
  46. Onychomycosis

    Tinea unguium (nails)
    Organism: (Fungus) Trichophyton rubrum

    Dx: KOH (potassium hydroxide) microscopy

    Tx: Systemic Terbinafine or azol therapy
  47. SSRIs vs. Tricyclic Antidepressants
    • Suicial ideations are less common with SSRIs
    • SSRIs are safer
  48. Transudative Pleural Effusion
    Transudative pleural effusions are defined as effusions that are caused by systemic factors that alter the pleural equilibrium, or Starling forces. The components of the Starling forces: hydrostatic pressure, permeability, oncotic pressure (effective pressure due to the composition of the pleural fluid and blood), are altered in many diseases e.g., CHF-left ventricular failure, renal failure, hepatic failure, and cirrhosis.
  49. Exudative pleural effusion
    Exudative pleural effusions, are caused by alterations in local factors that influence the formation and absorption of pleural fluid (e.g., bacterial pneumonia, cancer, pulmonary embolism, and viral infection).
  50. Mycoplasma Pneumonia
    Atypical pneumonia that occurs more often in younger age groups

    S/Sx: low grade fever, malaise, non-productive cough

    • Tx:
    • Erythromycin (macrolide)
    • or
    • Doxycylcine (tetracycline)
  51. Virchow's Triad
    Stasis, intimal injury, hypercoagulability

    *major risk factor for venous thrombosis and pulm embolism
  52. Scleroderma

    (systemic sclerosis)
    Initial symptoms: gatigue, musculoskeletal complaints, swelling of hands, Raynauds phenomenon, talangiectasias
  53. Raynaud Phenomenon

    Dx:
    Tx:
    MC Dx:
    • DX: Clinical, ANA, ESR, CBC: anemia, >creatinine (strongly positive in secondary RP)
    • Primary RP: U/A = RBCs & protein, the rest of results are normal

    TX: CCB

    * Seconday RP is more common in women (9:1) in conditions such as SLE, scleroderma, Sjogren syndrome, and other connective-tissue diseases.
  54. Plantar fasciitis
    • Results of excess stress on achilles tendon that attaches to plantar fascia
    • S/Sx: Burning heel pain. pain increases while bearing wt after resting.
    • Tx: Conservative treatment involves combination therapy (e.g., heel padding, shoe changes, low-Dye strapping, NSAIDs and stretching exercises).
    • Less conservative: Corticosteroid injections if necessary, PT, surgery
  55. Knee Pain

    Medial Meniscus tear
    S/Sx: knee catching or locking, pain, TTP at joint line

    Dx: (+) McMurray test (+) Apley test, < flexion/extension
  56. Diabetic retinopathy

    S/Sx:
    Proliferative vs. nonproliferative
    Proliferative diabetic retinopathy: Neovascularization is hallmark

    Nonproliferative diabetic retinopathy: blot hemmorrhages, cotton wool spots, microaneurysms

    • *Diabetic retinopathy usually occurs before nephropathy.
    • *Can occur within 5 yrs but usually occurs 10 to 20 years after DM onset
  57. Chlamydia trachomatis

    Tx:
    Doxycycline (tetracycline) or Azithromycin (macrolide)

    Pregnant: Azithromycin, Erythromycin (Macrolides)
  58. Bacterial Vaginosis

    S/Sx
    Tx
    S/Sx: dysuria, fever, pruritis, increased pH, fishy odor, discharge, clue cells

    Tx: metronidazole, clindamycin, or tinidazole
  59. Atrophic Vaginitis
    Estrogen therapy
  60. Lambert-Eaton Myasthenic syndrome

    Definition
    Dx
    TX
    • A rare, autoimmune disorder of the neuromuscular junction. Can occur with cancer or just autoimmune disease.
    • Symptoms include insidious and gradual onset of fatigue, weakness, and a dry mouth.
    • Dx: Anti Acetocholine studies, nerve conduction studies, etc
    • Tx: intubation, immunoglobins, treat underlying cause 3,4diaminopyridine (3,4-DAP), ± pyridostigmine, supportive care.
  61. Myasthenia Gravis
    • A chronic autoimmune disorder of the postsynaptic membrane at the neuromuscular junction in skeletal muscle.
    • A chronic autoimmune disorder of the postsynaptic membrane at the neuromuscular junction in skeletal muscle.
    • Characterized by muscle weakness that increases with exercise (fatigue) and improves on rest. Commonly presents with drooping eyelids, double vision, oropharyngeal and/or appendicular weakness and shortness of breath.
    • Raised serum acetylcholine receptor antibody or muscle tyrosine kinase antibodies are present. Clinical electrophysiology shows decremental response on repetitive nerve stimulation or increased jitter on single fiber study.
    • Treatments include anticholinesterases and immunotherapy. Thymectomy may be required.
  62. SIADH

    Patho:
    Tx:
    • Syndrome of inappropriate antidiuretic hormone (SIADH) is defined as euvolemic, hypotonic hyponatremia secondary to impaired free water excretion, usually from excessive arginine vasopressin (AVP) release.
    • Paraneoplastic syndrome associated with bronchogenic carcinoma.
    • Labs: hyponatremia, high urin osmololity.
    • Tx: Water restiction, supportive, lasix, vasopressor receptor agonist
  63. Adhesive Capsulitis
    (Frozen Shoulder)

    Dx:
    Tx:
    • Chronic fibrosing condition characterized by insidious, progressive, and severe restriction of both active and passive shoulder range of motion.
    • More common in women, previous trauma, diabetes
    • Dx: MRI, Plain film
    • Tx: Activity modification, PT, NSAIDs, Surgery
  64. Lasix can cause...(hint: ear)
    Ototoxicity secondary to lasix/loop diuretics which may cause sensory hearing loss.
  65. Prinzmental angina

    Tx:
    Nifedipine (CCB)
  66. Toxoplasmosis (Toxoplasma gondii)
    • A protozoan parasite spread through food or water contaminated with oocysts, through infected meat or though contact with oocysts from feline feces.
    • S/Sx: Usually asymptomatic. Symptomatic in immunocompromised pts. (HA, Sz, confusion, malaise, etc) Congentital abnormalities in fetus.
    • Tx: HIV-positive with CD4+ T lymphocyte counts <100
    • *Prophylactic trimethoprim/sulfamethoxazole
    • **Active: pyrimethamine (malarial, antiparasitic), sulfadiazine (sulfonamide-like Bactrim), & leucovorin (oncologic toxicities)
  67. Toxoplasmosis

    Dx:
    CT or MRI usually shows multiple ringed enhancing cerebral lesions
  68. Otitis Media

    MC pathogen:
    streptococcus pneumoniae
  69. Colon Cancer

    S/Sx:
    Most important test:
    Progressive weight loss, constipation, decrease in stool caliber "pencil thin stools"

    Most important diagnostics are colonoscopy and biopsy
  70. Barret's esophagus

    Patho:
    Gerd > Barret's (premalignant) > adenocarcinoma
  71. Gerd resulting in cancer of esophagus

    Type:
    Adenocarcinoma

    (Barret's esophagus = lower esophagus epithelial lining changes from squamous to columnar (Barret's change) leading to adenocarinoma)
  72. Esophageal Cancer caused by smoking

    Type:
    Squamous cell
  73. CXR that shows diffuse bilateral infiltrates with a ground glass appearance

    Dx:


    Hint: HIV (+)
    Pneumocystis carinii
  74. Clozapine
    (2nd generation antipsychotic medication)

    Lab:
    Monitor pt for:
    CBC and (ANC) absolute neutrophil count

    Agranulocytosis (low WBC count, specifically neutrophils)
  75. MC thyroid cancer
    Papillary
  76. Occupational exposure to Benzene is a risk for the development of:
    Leukemia
  77. Pott disease
    • Pott's disease, is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints.
    • Pott’s disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space.
  78. Ethambutol (TB med)

    Side effects:
    optic neuritis with (red-green color discrimination)
  79. Pheochromocytoma

    Patho:
    S/Sx:
    • A tumor arising from catecholamine-producing chromaffin cells of the adrenal medulla
    • Classic: episodic; HA, diaphoresis, palpitations, paoxysmal HTN
  80. Pheochromocytoma

    Dx:
    Tx:
    • 24-hour urine collection for catecholamines, metanephrinnes, normetanephrines and creatine
    • MRI, CT Scintigraphy, clonidine suppression etc

    • HTN control: alpha blockers, hydration, CCB
    • Surgery

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