Do not take grapefruit juice or supplement EVER with these meds?
Statins, digoxin, benzos, many ACE, ARB, and Calcium channel blockers
What is pruritis?
What is atopic triad?
Atopic dermatitis, asthma, allergic rhinitis
What is Samter's triad?
Asthma, ASA sensitivity, and nasal polyps
What is the best way to visualize jaundice?
Look for icteric sclera
What medications increase photosensitivity and therefore should avoid sunlight?
Most antibiotics, hydrochlorothiazide, diltiazem, ibuprofen, naproxen
What antibiotic won't cause photo sensitivity?
What side effect can oral cholecystogram have to urinary system?
Dye can cause burning with urination
What is dysthymia?
Depressed mood, low level depression
What is the second leading cause of cancer death?
What is the leading cause of cancer death for men and women?
What does an IRB do (institutional review board)?
Protects the rights of human subjects
What 3 things must be present for malpractice to occur?
Harm, Duty, Deviation (breach) from the Standard of Care
Main reason for outpatient malpractice?
Failure to diagnose correctly or in a timely fashion, such as in cancers
What are the reportable diseases or findings?
Gun Shot Wound, TB, HIV, Syphilis. Also abuse or suspected abuse needs to be reported. Some states also require meningitis, measles.
At what percentage can the NP be reimbursed with billing?
85% if see patient on own. But can be reimbursed %100 under MDs provider number if MD is involved.
What is an occurrence based liability insurance policy?
Better one to have. It covers you for an incident that happened during the policy coverage period, even if you are not presently covered by that insurance.
What is beneficence?
Duty to help others. Obligation to help those in need.
What is non-malfeasance?
Provider do no harm, with or without intention. If harm unavoidable, try to minimize harm. i.e.: educate person to decease drug side effect
When is Autonomy is not a right for the patient?
When their disease could harm another, i.e. Tuberculosis and refuse to take meds
What is Justice?
All people are to be treated in the same equitable manner
Be honest and give full disclosure
What is duty?
A relationship that exists between the provider and the patient
What is breach of duty?
Violation of accepted standards while rendering care
If no physical or emotional harm or injury occurred
How long does it take for active immunity to provide protection?
Take onset of 1 month, lifetime duration
How long does it take for passive immunity to provide protection, how long does it last and how do you get it?
Onset in ONE hour, lasts less than one year
What vaccines are contraindicated with Baker's Yeast Allergy?
What vaccines are contraindicated with Egg Allergy?
All forms of Influenza virus
Allergy to Neo Mycin, Streptomycin, polymycin, what vaccines are contraindicated?
Polio vaccine, MMR, varicella, smallpox
What all pathogens does the pneumovax protect against?
ONLY ONE- Streptococcus pneumoniae
What vaccine is contraindicated in adult asthmatics, COPD?
Live flu vaccine (Flu Mist) also only for people less than age 50
What vaccine should be offered if patient is already HPV positive, or has genital warts?
Still give the HPV vaccine, as it covers several strains, and may cover one she does not have
When is live virus vaccines contraindicated in HIV infection?
When CD4 T lymphocyte count is <200
Contraindications to the live flu mist vaccine?
<2, >49, egg or chix protein anaphylaxis, Kids on chronic ASA therapy, Guillain-Barre, asthma, reactive airway disease, Heart disease, Immunodeficiency, CD4 <200
What adolescent and adult vaccines are given in a series of THREE?
HPV, Hepatitis B.
What adolescent and adult vaccines are given in a series of TWO?
Varicella, Hepatitis A, and Penumovax is repeated after age 65
What does HPV2 vaccine protect against?
Strains HPV 16 and 18
What does HPV4 vaccine protect against?
Strains HPV 6,11, 16, 18
When is Herpes Zoster vaccine recommended?
All adults >age 60
Who should receive the pneumovax vaccine?
Smokers, COPD, Asthma, Chronic CV disease, DM, Liver disease, Asplenia, immunosuppressed, cochlear implants and CSF leaks, HIV
Who should be revaccinated with Pneumovax?
Any time after 5 years from the first, and are now >65 if ere vaccinated previously before age 65
Is there virus shedding after flu mist intranasally?
Yes. For 3-10 days post administration, live flu virus is shed from nose.
What does hemoglobin electrophoresis test for?
Sickle cell anemia or trait. Thalassemia minors or majors,
Who is highest risk of suicide?
Men, age 65 or older, or men ages 15-24
Leading cause of death?
Second leading cause of death?
Third leading cause of death?
What is the number one cause of infectious diseases?
Influenza and pneumonia
Highest cases cancer in men?
Highest cases cancer in women?
Second and third cause of cancer in men and women?
Lung cancer, then Colorectal
Leading cause of cancer DEATH in men and women?
Both share Lung cancer as leading cause of death
What is second leading cause of cancer DEATH for men and women?
Prostate for men, Breast for women
Mammograms should begin?
Yearly in women at age 40
Pap smears in women should begin?
3 years after intercourse, but not later than age 21
When can PAP smears be discontinued or less frequently tests?
Once aged 30, After 3 consecutive normals on PAP test, can then get screening PAP every 2 to 3 years. Once >70 with 3 normal PAPs in past 10 years can quit PAPs.
DRE or PSA ACS recommendations?
No recommended screening at this time, ALTHOUGH, annual PSA DRE is to be discussed and offered to men at 50. If African American or positive FHx, start at age 45 or even 40 if very positive risk.
Colon cancer screening should be done how and when?
ALL colon cancer screenings start at AGE 50. Yearly take home FOBT cards x3. Flexible sigmoidoscopy Q5 years. Colonoscopy every 10 years. However, if IBD, polyp hx, + FHx, make begin sooner.
When would you do endometrial biopsy screening?
NEVER as screening. However, if postmenopausal and bleeding then it is part of the diagnostic work up. However, if age 35 and strong risk or had hereditary non-polyposis colon cancer, annual screening should be offered.
What is pneumonic for specificity?
SnNout. SeNsitive test when Negative results rules OUT disease. Likelihood of it being sensitive enough to find true positive result in person with the disease
What is pneumonic for sensitivity?
SpPin. SPecific test when Positive test rules IN disease. Likelihood of it being specific enough to find true negative result in person without the disease
vaccines contraindicated in pregnancy
MMR, Flu Mist, Varicella, Varicella Zoster, HPV
When can you get pregnant after live vaccines
Neomycin allergy, vaccine contraindicated
IPV, MMR, Varicella, Varicella Zoster
Egg Allergy, vaccine contraindicated
All Influenza vaccines (live and attenuated)
Bakers Yeast, vaccine contraindicated
Hepatitis B (B- Bakers)
Senile cataracts cause what type of exam abnormality and what type of vision abnormality?
Lens clouding is seen. Progressive dimming of distance vision.
What is risk factor for senile cataracts?
Tobacco use, corticosteroids
Which glaucoma causes acute vision loss and cupping abnormalities?
Closed Angle Glaucoma. See Disc cupping, instead of normal saucer shape. Due to increased intraocular pressure. Usually unilateral. Pain.
What vision is lost in macular degeneration?
What vision is lost in Presbyopia?
Close vision loss. Typical of aging.
What is presbycusis?
Normal age related hearing loss. C8 sensioneuronal hearing loss
What does Kernigs sign check for and how it is elicited?
Tests for meningeal irritation. Supine position, bend up knee and then try to straighten lower leg. If resistance to leg straightening due to inflamed lumbar root will have pain at hamstring.
What does Brudzinskis sign test for and how is it elicited?
Meningeal irritation if when supine patients head is lifted up into flexion, the legs also come up in attempt to relieve irritation
What is anisicoria?
What is important to know about narrow therapeutic drugs and what are some examples?
These are drugs that you need to draw blood levels on to maintain tight control of dose. Phenytoin, Carbamazepine, digoxin, warfarin, theophylline