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Barkley 2012 Adult NP all flashcards
Entire Barkley 2012 NP program flashcards
Terms in this set (513)
"In a fundoscopic exam you are examining the right eye, which eye would you be looing throught the opthalmoscope, and which hand would it be in?"
"Right eye, Right hand"
What is the normal cup to disc ration
"Cup is 1/2 size of disc, if larger"
If the cup to disc ratio is laerger than 1/2 what should your diagnosis include
Describe the optic disc
Doughnut like orange and pink neuroretinal rim and a central white depression (cup)
In the eye which are brighter red? Veins or arteries
What is the correct artery to vein ration
2:3 or 4:5
Where is the macula located in relation to the optic disc?
2-2.5 disc diameter temporal to the disc. (Patietn right eye-look to the left)
If the macula is difficult to visualize where should the patient look?
directly into the opthalmoscope
If a patient has 20/40 vision what does it mean
they can see at 20 feet what a normal person sees at 40 feet
Using a smellen eye chart if the denominator is larger what does it mean
the larger the number the worse the vision
If a person has hyperopia what does it mean
Farsighted-can see far away OK not close up
If a person has myopia what does it mean
Nearsightedness - can see close up not far away
What does it mean if the person has presbyopia
"Need reading glasses, commmon after age 40"
What anatomically causes presbyopia
lessening of flexability of lens and weakening of ciliary muscles which control focus
What is arcus senilis
Cloudy appearance of the cornea with a pray/white arc or circle around the limbus due to lipid deposits-no effect on vision.
What is Pterygium
"Raised wedge shaped growth of thin noncancerous tissue over the conjuctiva, "
What causes prergium
"Sun wind exposure, dry air"
What is another name for hordeolum
What is hordeolum
acute inflammatory infectious process affecting eyelid-cause by Saph aureus
SS of Stye
"abrupt onset with pain and redness on eyelid, tender mass on eye lid"
What do you do for Stye
"Warm compress, topical bacitracin or erythromycin ophthalmic ointment- refer if not improved in 2 days"
What is a chalazion
"Beady nodule on eye lid, infection or retention cycst of a meibimian gloan-usually upper eye lid"
SS of chalazion
"Swellinf on eyelid, eyelid tenderness, senitive to light, increase tearing, "
Management of chalazion
"warm compresses, refere out"
Danger of chalazion
can cause astigmatism due to pressure on the cornea
What is blepharitis
staphylococcus infection or seborrheic dermatitis of the lid edge
"Greasy, red scaly flakes, thickened crusted lid marins, burning itching tearing"
Management of blepharatis
"warm compress, bacitratin or erythromycin scub lashes and lid margins with eye closed and thouroughly rinse"
What is the official name for Pink eye
what is conjuctivitis
"inflamation / infection of the conjuctiva from allergy, chemical irratation, bacterial or viral, also GG and chlamydial inf"
SS or conjuctivitis
"itching,burning, redness, increased tearing, blurred vision, eyelids swelling, sense of foreing body in eye crust on eye lids, mocopurulent draiange (pus)"
"conjuctiva has purulant discharge, what is it how do you treat it"
"self limiting, AB-Levo, Cipro, (Ofloxacin) & Tobr, Gent (Mycin)"
"conjuctiva has Copious purulent discharge, what is it how do you treat it"
"GG and Chlamydial - GG-ceftriaxone 250mgIM, and Chl- erythromyci oinment and tetra and doxy cycline & erythro clarithro and azithromycin"
"conjuctiva has stringy increased tearing discharge, what is it how do you treat it"
"conjuctiva has watery discharge, what is it how do you treat it"
What is the national screening recommendation for glaucoma
tonometry by age 40
What is glaucoma
Increased introccular pressure
SS of open angle glaucoma
"SS of open angle glaucomaasymtomatic, increased cupping of disc, constriction of viual fields, elevated IOP"
SS of closed angle glaucoma
"extreme pain, blurred vision, halos around lights, pupils fixed or dialated."
managemnt of Open angle glaucoma
alpha 2 adrenergic blockers Brimonidine or Alphagan (reduce production of aqueous humor) beta blocker timolol-and miotic agents-pilocarpine all reduce pressure
managemnt of Closed angle glaucoma
"carbonic anhydrase inhibitors like Diamox (acetazolamide) reduce aqueous humor, asmotic diuretics Mannitol, surgery"
Risk factors for Cataracts
"Age, heredity, trauma, toxins (drugs, cheicals, alcohol) congenital, diabetes, AV sunlight"
SS of Cataracts
"NO RED REFLEX, Opainless, clouded blurred vision, halos around lights sensitivity to light and glare, yellowing of colors. Diplopia(double vision in one eye), opacity in lense, need for brighter reading lights"
Clouding and opacity of normally clear lens of the eye
TX for cataracts
"change glasses, surgery"
What is retinal detachment
Separation of light sensitive mebrane in th eback of the eye (retina) from its supporting layers
SS of retina detachment
"flashes of light, especially in peripheral vision, floaters, blurred vision, shadow or blindness in a part of the visual fiels of one eye"
mgmt of retinal detachment
What is otitis externa
inflamation and or infection of the external auditory canal(and auricle and tympanic membrane)
Types of acute otitis externa
furnuculosis and difusse bacterial-swimmers ear
Types of chronic otitis externa
"chroninc fungal, eczema"
SS of otitis externa
"pustules and furncles in outer third of ear canal, sever pain (otalgia) with area of cellutitis, itching, erthema, scaling, crusting, fissuring, exudates"
management of otitis externa
"clean and debride the ear, topical otic drops, cortisporin (antibacterial and antiinflamatory) pain control with NSAIDS, topical corticosteriouds"
What is ottitis meida
presence of fluid in middle ear with SS of infection
Serous otitis media
chroninc Otitis media resulting in effusion (collection of fluid)
Causes of Acute otitis media
"URI. Strep pneumoniae, haemophilus influenzae. Moraxella, catarrhalis"
SS of otitis media
"otalgia (slight to sever spreading to temporal region, otorrhea, vertigo, nystagmus, tinnitus, fever, lethargy, N&V, anorexia, local inflamation, diminshed light reflex, fluid in middle ear, middle ear exudate, puroulant exudate, poor motility of tympanic membrane..depending on phase"
is erythema alone diagnostic of acute otitis media
"No, can occur with URI, crying, nose lowing"
managemtn of otiis media
"hydraation, avoid irratants, decongestant, cool mist humidification, if bacterial amoxicillan"
What is cholesteatoma
chrionic otitis media consititing of peeling layers of scaly keratnized epithelium
Is cholesteateoma dangerous
can cause nerver damage and deafness may erode middle ear
SS of cholesteateoma
"squamous epithelium lined sac, filled with desquamated keratin, chroninc infection, painless otorrhea, unremittin or frequent, hearing loss, tymapnic memebrane perferation, canal filled with pus and granulation tissue"
Mgmt for cholesteatoma
What is vertigo
sensation of motion either of the peson or environement
What is BPPV
"Benign paroxysmal postitional vertigo, characterizd by sensation of motion initiated by sudden head movements"
Causes of Vertigo
"tumors, medication, otitis media, menieres disease, acuoustic neuroma, head neck trauma, migrains, hemoorrhage"
"sensation of disorientation or motion, N&V, sweating, nystagmus, hearing los tinnitus visual disturbance, weakness, difficulty walking, speaking, decreased LOC. Positive Diz Hallpike (Nylen baranay maneuver)"
What is Positive Diz Hallpike (Nylen baranay maneuver)
performed with the patient sitting upright with the legs extended. The patient's head is then rotated by approximately 45 degrees. The clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension. This extension may either be achieved by having the clinician supporting the head as it hangs off the table or by placing a pillow under their upper back. The patient's eyes are then observed for about 45 seconds as there is a characteristic 5-10 second period of latency prior to the onset of nystagmus. If rotational nystagmus occurs then the test is considered positive for benign positional vertigo.
What test do you order for Vertigo
"CT, VDRL, RPR for syphillus, serum med levels, hearing exam, bgt and ECG"
What is the managemnt of Vertigo
"diazepam (valium) Meclizine(antivert) benadryl, antiemetics"
"In conductive hearling loss, the weber test where does te sound lateralize to"
"In conductive hearling loss, the rhine test would show what"
abnormal in effected ear (AC<BC
"In sensorineural hearling loss, the rhine test would show what"
Normal to affected ear
"In sensorineural hearling loss, the weber test where does te sound lateralize to"
what is hearing loss
loss of ability to detect pure tones in decibles >20db
Conductive hearing loss causes
"foreign body, hematoma, perforated tympanic membrane, otitis media, externa and otosclerosis (an abnormal growth of bone near the middle ear. ) (MIDDLE EAR, MEMBRANE, INNER EAR,)"
Sensorineural hearing loss causes
"damage to hari cells, acuotic trauma barotrauma in divers, head trauma, ototoxic drugs, meniere disease, acoustic neuroma, infection like measles mumps. (INNER EAR< CRANIAL NERVE AND CENTRAL PON)"
How do you do Weber test
"In the Weber test a vibrating tuning fork (256Hz used for Weber vibration test) is placed in the middle of the forehead, above the upper lip under the nose over the teeth, or on top of the head equi-distant from the patient's ears on top of thin skin in contact with the bone. The patient is asked to report in which ear the sound is heard louder. A normal weber test has a patient reporting the sound heard equally in both sides. In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear. In an affected patient, if the normal ear hears the tuning fork sound better, there is sensorineural hearing loss on the other ear (defective ear)."
How do you do Rinne test
"a vibrating tuning fork (typically 512Hz) is placed initially on the mastoid process behind each ear until sound is no longer heard. Then, the fork is then immediately placed just outside the ear with the patient asked to report when the sound caused by the vibration is no longer heard. A normal or positive Rinne test is when the sound heard outside of the ear (air conduction or AC) is louder than that heard of the initial sound heard when the tuning fork end was placed against the skin on top of the mastoid process behind the ear (bone conduction or BC). Therefore, AC > BC; which is how it is reported clinically for a normal or positive Rinne result. In conductive hearing loss, bone conduction is better than air or BC > AC, a negative Rinne."
What lab and diagnostic test do you use to evaluate hearing loss
"otoscope, general neuro exam, audiometry testing, CT scan, serum blood test as needed"
Management of conductive hearing loss
"clear canal, treat underlying cause"
Management of sensorineurol hearing loss
what antibiotic do you give for a common cold
What is pharyngitis / tonsillitis
inflamation of pharynx / tonsils
causes of pharyngitis / tonsillitis
"viral (respiratory synctycial virus, influenza A and B, Epstein Barr: Bacteria"
SS of pharyngitis / tonsillitis
"erythematous pharynx, rhinorrhea (viral) cough, anterior cervical adenopathy, fever(bacterial) painful throat, macropapular rash (flat res or bright red rash on skin)"
What is the Centor criterea for strep
"FLEA fever over 100.4 (38C) lack of cough, pharyngotonsillar exudate, anterior adenopathy"
strep lab and diagnostic test
"rapid strep test, monospot for mono, CBC diff for infection"
Mgmt of Strep
"fluids hydration, salt water gargle, aspirin tylenol, AB for bacterial (penicillin V, erythromycin, ceftreaxone for bonococcal infection GG, refer"
What is influenza
acute afebrile illness caused by infection with type a or b virus
"abrupt onset, fever, HA, myalgia, coryza(nasal congestion) anorexia, malaise and cough"
What lab test diagostic for flu
virus isolation from nasal throat or sputum
mgmt of flu
"antipyretics, antibiotic only if bacterial infection is proven, zanamivir (relenxa 0 inhaler or osteltamivir (tamiflu) oral "
what is monnucleosis
symptomatic infection caused by epstein barr virus.
what is the incubation period for monnucleosis
1-2months fatigue can last months
"fever chills malaise, fatigue, anorexia, pharyngitis(most sever symptom) white tonsilar exudates, adenopathy, posterior cervical region, splenomeegally, no contact sports)"
Lab diagnostic test for monnucleosis
monospot positive increased WBC with lymphocytosis and neutropenia
mgmt of monnucleosis
"supportive care, prednisone taper for severely enlarged tonsils, avoid contact sprots."
what is sinusitis
"inflamation of mucous membranes lining one or more of the paranasal sinuses, almost always accompnied by inflamation of the nasal mucosa"
causes of sinustitis
"s. pneumonia, h influenza various anaerobes (same as otitis media)"
ss of sinustitis
"recent URI, red nasal mucosa, pressure over face, nose cheeks teeth, purulent nasal draiange, fever bacterial, tender sinuses, dull throbbing HA, foul smelling post nasal drip"
lab diagnostic test of sinusitis
"culture as needed, radiographs CT, decreased transillumination"
mgmt of sinustitis
"hydration, decongestant, antihistimines analgesic, AB for bacterial only, Augmentin, clarithromycin (biaxin), cefaclor (ceclor) supportive care"
SS symptoms of nose blee
"bleeding from one nostril, nausea from blood going down throat, dizziness, weakness confusiton fainting from blood loss."
Causes of nose bleeds
"anterior septum most frequent most NP can control, posterior septum more complicated, originating form artery in back of nose-more profuse bleeding."
mgmt of nose bleeds
"sit upright, constant pressure to nose, apply ice"
40 week process which embryo grow into infant within the uterus
Symtoms of first trimester
"Amenorrhea, N&V Fatigue, breast tenderness, urinary frequency"
Symptoms of second trimester
"fetal movement, abdominal discomfort 2nd to streching, skin pigmentation, syncopal episodes"
Symptoms of third trimester
"Abdominal growth, Braxton Hicks Contractions, Urinary frequency, increased repiratory effort"
What is Goodells Sign
Softening of Cervix
What is Chadwicks Sign
Cervical Cyanosis Blue -purple colored
What is Hegers Sign
palpate or compress the connection between the cervix and the fundus
When would you begin to hear fetal heart tones
1st trimester 10-12 weeks
What trimester would you begin to see breast tenderness
What trimester would you see Goodwells Sign
What trimester would you see Chadwicks sign
What trimester would you expect to see hegers sign
When can you start to do the Leopold Manuever
20 weeks -2nd trimester - 20 weeks
When is the fundus palpable at the umbilicus
20 weeks -2nd trimester - 20 weeks
What is fundal height
the distance from the top of the uterus to the pubic bone measured in centimeters.
Where is fundal height at 20 weeks
When will stria apear on breast hips or abdomen
When will you have braxton hicks contraction
When will you loos mucous plug
1 week before delivery
When will lightening occur
3-4 weeks prior to delivery
What is lightening
"the sensation of decreased abdominal distention produced by the descent of the uterus into the pelvic cavity, two to three weeks before labor begins."
What diagnostic test- 1st trimester of first visit
"All-UA with cultre, CBC Blood group and Rh,antibody screening, rubella HbsAg-Hep, Syphillis, HIV, PAP, STD, Ultrasound, CVS -Chronic villus sampling to to determine chromosomal or genetic disorders in the fetus."
What does the triple screen detect
"hcG, estriol, alpha-fetoprotien--for neuro tube defect"
What does the quad screen detect
"hcG, estriol, alpha-fetoprotien--for neuro tube defect and inhibin A"
What doe sthe quad screen results tell us
Inhibin A (DIA) will be found high in cases of Trisomy 21 and low in cases of Trisomy 18.
What does the triple screen results tell us
classify a patient as either high-risk or low-risk for chromosomal abnormalities (and neural tube defects).
When would you want to start ultrasound
18-20 weeks for fetal survey
When would you want to start one hour GTT
"20 weeks if family histrory or over 200#, 28 weeks for routing screening"
When do you do Rhogam for RH neg mothers
When do you do NST?BPP
Why do NST?BPP
Determine fetal wewll being
Every four week visits are ok for what weeks?
Every two week visits are ok for what weeks?
Every week visits are ok for what weeks?
What is Naegles Rule
EDC=LNMP +1 year -3 months+7 days
When will the baby come if the LNMP is July 3
What is ectopic pregnancy
conceptus that implants and grows outside uterus
Synmtoms of Ectopic pregnacy
"Amenorrhea, dark brown to tarry spotting, abdominal pelvic pain, unilateral lower quad pain, lower back pain or shoulder pain, henodynamic changes in vital signs-shock and rupture"
Physical exam of Ectopic pregnancy
"tender adnexa (adjoining anatomical parts, as ovaries and oviducts in relation to the uterus.) with palpable mass, positive cervial motin tenderness (CMT) uterine enlargement with hegars sign, positive peritoneal sing if rupture occurred and vaginal bleeding."
Lab test for Ectpic pregnacy
"serum hcG (quantative) CBC, type, RH ultrasound, pre op testing she is heading there"
What is abortion
Pregnacy termination prior to viability (spontaeus or medical/surgical
Abortion Loss in second trimester due usually to
Symptoms of sponateous abortion
"Vaginal bleeding, cramping, pelvic pressure, low back pain, ruptured membranes, hemodynamic chages if rhemorrage is involved."
Diagnostic test for abortion
"HCG, ultrasound, CBC type and RH coag profile"
Abortion methods up to 49 days
Abortion Medication in second trimester
Criteria for Pregnacy induce Hypertension (PIH)
BP over140/90 (stage 1) or rise in systolic over 30 and diastolic over 15 above baseline on two occasions
Criteria for Preclampsia
PIH (what is it) + proteinuria + general edema after 20 weeks
Criteria for Eclampsia
Preclamsia + seizures
Criteria for HELLP syndrom
Hemolysis Elevated Liver enzymes and Low platelet count
PIH risk factors
"preexisting htn, renal or cardiovascular disease, dm, lupus, multiple gestation, primigravida, family history young or old"
Testing for PIH
"BP surveilance, CBC, LFT, 24 urine, fpr protein, creatnine and creatnine clearance, NST after 32 to34 weeks, ultrasound PRN"
Managment for PIH
"Rest at home if condition worsens left lateral recumbent position, fetal surveilance - NST, kick count"
Sign and symptoms of Preeclampsia
"Sudden weight gain, progression from extremitiyand facial edema to general edema, frontal and occipital headaches, visual disturbance"
Physical finding s of preclamsia
"stage 1 htn, proteinuria, nondependant edema, worsening edema, wt gain more than 2#week or 6#month, laggin fundal ht, decrease reflexes"
Testing for preclampsia
"BP surveilance, CBC, LFT, 24 urine, fpr protein, creatnine and creatnine clearance, NST weekly, ultrasound PRN"
Managment for Preclamsia
"refer, strict BR, fetal surveilance, kick count, steriod injection B methasone for lung maturity of over 34 weeks, hopitalization with magnesium to stabile delivery ASAP"
Symtoms of Eclampsia
"PIH+Preclampsia+seizure, severe unrelenting headache, epigastric or RUQ paingets worse, Stage 2 htn, tonic clonic seizure, oliguria (reduced) to anuria (none). Fetal distress in Utero, visual chages"
Symptoms of HELLP syndrome
"preclamsia plus nausea w/wo vomiting, jaundice, fatigue"
Physical findings of HELLP
"hepatomegaly, RUQ pain extending to epigastric area, jaundice, ascites"
Test for HELLP
"preclampsia test , thrombocytopenia, below 50000 platelets, reduced clotting factor, hemoconcentration, elevated LFT, proteinuria"
Management of HELLP
"refer, hospitalization, delivery ASAP"
What os placenta previa
mal implantation of the placenta in the lower uterine segment
What is abruptio pacentea
separation of the placenta from the uterine wall
SS of placenta previa
"painless beeding, follows intercourse, no contraction, no uterine tenderness, no fetal comprimise unless bleeding is sever"
SS of abruptio pacentea
"severe abdominal pain, bright red bleeding, can be heavy or lightbleeding, rigid uterus, shock, fetal distress"
test for abruptio pacentea
"US, EFM (external fetal monitor)for fetal distress, CBC type RH coag and monitor hemodynamic changes"
test for placenta previa
"US, EFM (external fetal monitor) for fetal distress, CBC type RH coag and monitor hemodynamic changes CBC"
Management of placenta previa
"no bimanual exam, speculum only, hospitalization, NST and BPP(Bio physical profile) vaginal rest, anticiapte delivery"
Management of abruptio pacentea
risk factors for abruptio pacentea
"trauma, chronic htn, pre clampsia and eclampsia, cocaine use, alcohol, cigaretts uterine tumor"
worst outcome of abruptio pacentea
premature labor definition
"contractions over 20 weeks under 37 weeks resulting in dilation and or effacement of cervical os, contractions may not even be felt"
premature labor risk factors
"coaone, smoking low income multiple gestation, cervical trauma, young and old"
Symptoms of pre mature labor
"uterine cramping, lower back pain, uterine contraction 10-12 minutes (5 per hour)spotting crevical effacement"
prevention of premature labor
"eliminate risk factors, educate patient"
management of premature labor
"hospitilaztion, tocolytic therapy if cervical changes occur(terbutaline or ritodrine)vaginal, bedrest, weekly cervical checks"
Side effects of progesterone
"Weight gain, depression, htn"
medication in Mini pill
norethindrone (type of medication)
norethndrone acetate (type of medication)
ethanediol diacetate (type of medication)
norethynodrel (type of medication)
norgestrel (type of medication)
levonorgestrel (type of medication)
desogestrel (type of medication)
gestodene (type of medication)
norgestimate (type of medication)
Progestational mechanism of action (effects)
"thickens cervical mucous, capacitation inhibited, ovum transport slowed, suppresion of endometrium"
Estrogenic effects mechanism of action (effects)
"ovulation inhibited by suppresion of FSH/LH, alterated endometrium, ovum transport accelerated, causes progesteron level to fall"
Birth control pill names combined
"ortho-cyclen, othro tri-cyclen, ortho triclen lo"
Non contraceptive benefits of Oral birth contriol pills
"decrease menstral cramps, less menstral flow, improved acne"
disadvantages to Oral birth control pills
"mood changes, no hiv protecton, cost, rare circulatory problems, nausea, headaches, breakthrough bleeding"
9 absolute contraindications to oral contraception
"history of thromboembolic disorder, CVA, CAD, Pregnant, cholelithiasis during pregnancy, liver tumor or impaired liver function, breast CA, estrogen dependant neoplasia, and ab uterine bleeding"
Oral pills - if missed one dose
"Take two for one day, then resume normal scheule, use back up plan"
Oral pills - if missed two doses
"Take two for two days, then resume normal scheule, use back up plan"
Oral pills - if missed three doses
"Buy a crib-start over, use back up plan"
Estrogen Pregancy category
X==immediately DC if pregnant
Estrogen and breast CA education
"estrogen promotes Breast CA risk, if family history should not take."
Oral Birth Control hypertension risk
"increases with age, dose and length or therapy"
Dosing of Oral birth control
begin low dose or multiphasic
"Recommended oral birth control pill recommendation for women with migraines, breast feeding or contraindication to combined pills "
Progestin Only pills
High progestin side effect
"weight gain, increaseed appetite, fatigue, depression, and acne and hirsutism (lower the dose)"
High estrogen side effect
"nausea, edema, breast tenderness (lower dose)"
What drugs interact with Oral birth control and how
"Decreases effetiveness of warfrin, insulin, and metformin, antibiotics decrease effectiveness of OC's"
"Nuva ring (what is it, how does its medications act)"
"releases estrogen and progesterin activated by vaginal contact - thickens cervical mucus, inhibits capacitation, alters endometrium"
How often is nuva ring changed
monthly ring -change after 3 weeks- reinsert after cycle on the same days as last nuva ring inserted
If the nuva ring falls out
"OK for three hours, after that back up method"
Contraindications of Nuva ring
"over 35 years old, smoker, htn, hx of blood clots, OTHERS???"
Can Nuva Ring make depression worse or better?
worsend in previously depressed patients
Name for the Patch
Mechanism of action of Ortho Evra (Patch)
Transdermal patch releases estogenand progestrin
How often is the Otho evra patch changed?
Every 7 dasy for 3 times (3 weeks) then not replaced on last week until after period.
Weight limit for the patch
Major risk for the patch
"MI, CVA, PE - 60% more estrogen released than oral contracptive"
Containdications of the patch
"over 35, smoker, htn, blood clots or cardio events"
Injected Contraception is called what?
Depo-provera (DMPA) IM
Mechanism of action in Dep Prover (DMPA)
"Suppresses FSH and LH thus blocking th eLH surge INHIBITS OVULATION, Thickens cervicla mucous which interferes with capacitation, alters endometrium by creating thin atrophic lining"
Advantae of Depo provera
"long acting, decreases amenia, cramps, ovulatory pain, reduces risk of PID and endo and ovarian CA"
Active element in Depo provera
Disadvantage of Depo provera
"Menstral irregularities-amenorrhea, delayed fertility, injection every three months"
Undesirable effects of Depo provera
"Menstral irregularities, Decrease in HDL, reduction in Bone density with long term use"
Absolute contraindication to Depo Provera
"Allergies to Depo Provera, Unexplained uterine bleeding, pregnancy"
Depo provera Administration guidelines
"Pregancy test if more than 2 weeks since 3 month period ended, Deep IM, Do not massage area, use back up unless administered by DOC 5"
Implant contraception is called what
Mechanism of action of Implanon
Rod contains progestin and give low diffusion of progestin from rod.
Advantages of Implanon
"3 years, no estrogen SE, absent menses/decreased anemia, decreased menstral pain, decreased endometrial CA risk"
Disadvantages of Implanon
"Slightly visible, High expense"
IUD Copper is caled what
IUD progestin releasing is called what
Mechanism of action of IUD
"Immobilizes sperm, causes lysis of the blastocyst through inflamitory response."
Advantages of IUD
"Progestin releasing decrease menstral loss and dysmenorrhea, and prevent Ashermans syndrom (Uterine Adhesions)"
Disadvantages of IUD
"Pain and cramping, increase in menstral bleeding and anemia, Pregnancy-spontanius abortion of left in uteris, ectopic pregnancy in 5% users"
Undesirable effects of IUD
"spotting bleeding, cramping, pain, hemorrhage, anemia, pregnancy, lost iUD string, PID rate is increased, "
Contradiciton for IUD
"Active revurrent or recent pelvic infection including gonerhea or chlamydia, undiagnosed abnormal uterine bleeding"
Patient education of IUD
"Danger signs-menses late, abdominal pain, dyspareunia, fever chills, check for string monitor bleeding and pain"
Mechanism of action of Diaphragm / Cervical Cap
"Dome shapped construction prevents sperm from going through cervical OS, when used with spermacided, destroys sperm cell membrane"
Failure rate of Diaphragm
Advantage of Diaphragm
"Some STD protection, safe easy, immediate use, inserted before intercourse and does not interfere with sex"
Disadvantages of Daiphragm
"skin irratation with spermacide, risk of UTI and vulvovaginitis"
Contraindications of Diaphragm
"allergy to latex or rubber or spermacide, inability to install it"
Management of Diaphragm
"Resize if 20# weight change, no oil based lubes, must be left in for 6 hour following intercourse, instill spermicide in vagina for repeat intercourse"
"vaginal or skin irratation, unpleasant taste, allergy, "
"Slight risk for toxic shock, Increase candidiaasis, contraindicated if allergic to spremacides"
"Inserted 6 hours befroe sex, not felt, Some STD protection"
Management of sponge
"Insert 6 hour before, leave in for 6 hours after, safe for up to 12 hours, replace after 30 hours"
Emergency contracepton offerings
Morning after pill Levonorgestrel or copper IUD
Calendar method of birth control pill
fertility phase subtract 18 from shortest and 11 days fromlongest cycle - abstain
BBT basil body temp
avoid intercoure 2-3 days befor drop in temp avoid intercourse fo 3 days folowing rise
What is Billings test
Cervical Mucous test
What is Spinnbarkeit
Cervical mucous method
abstain form time mucous after mucous changes form thick to thin for four days
"Circumscribed flat area of skin ,Less than 1 cm in size "
"A large macule, Greater than 1 cm inDiameter "
"small solid Elevated lesion , Less than 1 cm in size "
"Elevation of skin, Greater than 1 cm in diameter "
"a visible accumulation of purulent fluid under the skin , less than 1 cm in diameter "
"A circumscribed elevation of the skin , Less than 1 cm in diameter "
Example of a macule
freckles and moles
Example of the patch
Example of a papule
"ant bite, mole wart"
Example of plaque
Example of pustule
acne and impetigo
Examples of vesicle
"herpes simplex, chicken pox shingles"
Lesions that develop on previously unaltered skin
Lesions that either change impression over time or occurs when a primary lesion is scratched- it may become infected
"Solid mass of skin, Observed as an elevation or can be palpated , greater than 1 cm in diameter, extends into the Germans "
Examples of a nodule
xanthoma and fibroma
"Large blister, Circumscribed elevation containing fluid , greater than or equal to 1 cm in diameter , extends only into the epidermis "
Example of bulla
"Burns, superficial blister, contact dermatitis "
"Elevated white or pink compressible papule or plague, Red, axon mediated flare around it, Associated with allergic reactions "
Examples of wheal
PPD test Mosquito bites
"Any closed cavity or sac, Contains fluid or semi solid material, normal or abnormal epithelium"
Example of a cyst
"The localized collection of purulent Fluid in a cavity formed by disintegration or necrosis of tissue, Greater than 1 cm in size "
Example of abscess
furuncle or carbuncle
"mass, Greater than a few centimeters in diameter, Firm or Soft , Benign or malignant "
"Circular, begins in center spreads to periphery "
"Lesions run together , Fungal infection "
"Twisted, coiled, spiral snake like "
"Scratch, streak, line, stripe"
annular lesions merge
solitary or discrete
Individual and this thing lesions that remains separate
"Resembles irus of the eye, Lesions with concentric rings of color "
Linear arrangement along the nerve root
Blackheads- openings capped with blackened skin debris
whiteheads- obstructed openings
Labs for acne
mgmgt of acne
"wash, avoid oil based products, comedolytic agents and atibiotics and combos - "
what AB for acne
"topical -clindamycin, erythromycin, tetracycline, metrodiazole oral -tetracycline erythromycin, minocycline, doxycycline"
what is folliculitits
inflamation of hair follicle (most common is staph)
What is furuncle
"individual boil, localized infection originating in hair folicle, staph"
what is carbuncle
"larger than furuncle, generalized contagious, group or furuncle, can be necrotizing, staph"
Most common cause of outpatient cellulitis
Most common cause of inpatient cellulitis
gram negative organisms
"Bactrim (trimethoprim-Sulfamethoxzole, docy, clindamycin"
Treating CAMRSA in low CAMRSA areas would include what
dicloxacillan or cephalexin (Keflex)
what is erysipelas
rapid progression of erythematous warm indurated area
What is hidradentis suppurativia
"infection in groin or axilla, collection of pustules, abscess formation s common"
What is impetigo
"Lesion, thin walledvesicle that breaks easily, honey coloed crust at edge, satelitte lesions can appear and spread to remote areas of skin"
what is paronychia
"red and pus around nail, staphylocci around the nail fold"
signs of bacterial inflamation
"regional lymphadenophathy, pain, swelling, warmth, redness, vesicles pustules purulant drainage"
signs of systemic bacterial inflamation
"fever, malaise, chills, anorexia"
mgmgt of bacterial infection
"incision and draiange, systemic treatment, minor infections - topical AB like bactitratin, oral AB cephalexin, dicloxacillan, augmentin "
what is a fingernail hematoma
collection of blood in space between nail bed and fingernail - slammed finger in door
mgmgt of fingernail hematoma
What is trephination
"drilling a hole thorugh nail into hematoma - heated instrument drill, needle or laser"
What is Candida Balantis
fungal infection of penile head
What is Candida Intertrigo
fungal infection of area warm and moist - under breast
What is Tinea Capitus
fungal infection of scalp - ringwork on head and scalp
What is Tinea Corporis
fungal infection of skin - ringworm
What is Tinea Cruris
fungal infection of groin
What is Tinea Pedis
fungal infection of foot
What is Tinea Unguim
fungal infection of toe nail or finger nail
What is Tinea Versicolor
fungal infection of skin (hyper or hypo pigmentation macules on skin)
Treatment of Candida Balantis
"AZOLES -MiconAZOLE, ClotrimAZOLE, FluconAZOLE and sterios"
Treatment of Candida Intertrigo
"Drying agents like corn starch, topical antifungals, ciclopirox and oral antifungals like fluconazole"
Treatment of tinea Capitus
selenium shampoo and griseofulvin
Treatment of Tinea corporis
"topical antifungals like AZOLES -MiconAZOLE, ClotrimAZOLE, econAZOLE"
Treatment of Tinea cruris
topical antifungals and oral antifungals in extreme cases
Treatment of Tinea pedis
"topical antifungals like AZOLES -MiconAZOLE, ClotrimAZOLE, and alumium subacetate soaks"
Treatment of Tinea unguium
oral antifungals - terbinafine (Lamictal)
Treatment of Tinea Versicolor
"topical antifungals like AZOLES -MiconAZOLE, ClotrimAZOLE, and topical selenium sulfide"
definition of herpes zoster (shingles)
acute vesicular eruption due to infection with varicella-zoster can be life threatening
ss of herpes zoster
"pain along dermatone, grouped vesicles of erythema and exudate, regional lymphadenopathy"
mgmgt of herpes zoster
"acyclovir, famciclovire, valaciclovir, if in eye invovlement-ophthamologist, pest herpatic neuralgia-gabapentin and lyrica -zostavax"
what is actinic keratosis
"small patched on sun exposed parts of body, premalignant lesions progress to squamous cell carcinoma, tender asymptomatic patches, rough flesh colored pink or hyperpigmented"
How do you treat actinic keratosis
What is squamous cell carcinoma
"firm irregular papule or nodule, develops over afew months, prolonged sun exposure in fair skin people, keratictic scaling bleeding, appears non healing wound aggressive-gets to lymph nodes"
Treatment for squamous cell carcinoma
biopsy or surgical excision
What is seborrheic keratosis
"benign not painful lesions, beige, brown, black palques, stuck on appearance, 3 to 20mm diameter"
treatemtn of seborrheic keratoses
none or liquid nitrogen
what is basal cell carcinoma
"most common skin CA, slow growing lesion, 1-2 cm after years, waxy peearl appearance, may be shiny red, central depresison or rolled edge, volcano look, rarely goes to lymph nodes"
Treatment for Basal Cell Carcinoma
shave punch biopsy and surgical excision
What is malignant melanoma
"highest mortatlity of all skin cancers, median age 40, may metastaize to any organ, ABCDE"
What does ABCDE stand for
"Asymetry is different, Border Irregularity, Color Variation light brown then dark brown, diameter greater than 6cm, elevation and enlargement"
treatmetn for malignant melanoma
biopsy and surgical excision
What is Eczema (Atopic Dermatitis)
"chronic skin condition characterized by intense pruritis, acute flare up, red shiny or thickened patches, inflamed scabbed lesions with erythema/scaling, dry leather lictification"
Treatment for Eczema (Atopic Dermatitis)
"topical steroids, rubed in well, clobetasol crea lotion - moisturize"
What is Allergic contact dermatitis
"acute or chronic dermititis characterized by inflamation at the site of contact with chemical allergans, example is poisen ivy, redness, pruritis, scabbing, sharp defined borders"
Treatmetn for Allergic contact dermatitis
"topical steriods do not scrub with soap an water, prednisone taper if severe"
What is psoriasis
"benign hyperprolferative inflamation of the skin that can be acute or chronic, auto immune response, silver scales, itching red precislydefined plaqu with silvery scales, fine pitting of the nails, auspitz sign (droplets of blood when scales removed)"
Treatment of psoriasis
"topicals for scalp (tar/slicylic acid shampoo) topical steriods, UVB light exposure"
What is pityriasis rosea
"mild acute inflamatory disorder, comon in females in spring and fall, pruritic rash on trunk and proximal extremities Intital lesion 2 to 10 cm, christmas tree patern, last 4 to 8 weeks"
Treatment of pityriasis rosea
"Oral antihistimines, topical antipruritic, cool compresses, topical steriods, UVB light, oral erythromycin"
Labr test for pityriasis rosea
"Test for syphilis if lesions are not itching, lesions are located on palms and plantar surface, lesions are few and perfect"
What are Xanthelasma
"yellow plaques asa aresult of fat build up under skin, ususally near the inner canthus (around eye)"
What causes Xanthelasma
"hyperlipidemia, DM is secondary cause"
What lab test do you order for Xanthelasma
"Lipid, biopsy to rule out any other condition"
Treatment for Xanthelasma
"surgical exision, laser ablasion, chemical cauterization, electro discetion, cryotherapy"
What is lyme disease
"spread by black legged tick or deer tick, borrelia burgdorferi - bulls eye rash"
Testing for Lyme disease
Elisa Testing and Western Blot
SS of Lyme disease
"bulls eye pattern, flu like symptoms, erythema migraines, expanding red lesion with central clearing"
Treatmetn of Lyme disease
Doxycycline for adults and amoxixillan in kids
What is Rocky Mountain spotted Fever (RMSF)
"lethal bacterial infection, transmitte d by tick bites, Rickettsiae (R rickettsii) transmitted to host"
SS of RMSF
"maculopapular rash, patechial rash, abdominal pain, joint pain, flu like symptoms"
Lab test for RMSF
"Polymerase chain reaction PCR, Immunohistochemical Staining, Indirect immunofluorescence assay (IFA) with R rickettsii antigen."
Treatemtn for RMSF
Doxy and refer
What is small pox
"infectious disease unique to humans caused by virus variants, localizes in blood vessels of the skin, mouth and throat"
SS of Small Pox
"sudden onset of flu like symptoms and sign fever headache back pain vomitting and diarrhea, small pox rash (major Ugly)ON ANY ONE PART OF THE BODY ALL LESSION ARE IN THE SAME STAGE OF DEVELOPMENT, excruciating pain"
Treatmetn of Small pox
"vacine before infection, no cure once infected, supportive therapy and AB to treat secondary infections, isolated infected individuals"
What is anthrax
"acute disease cause by bacillus anthracts spores --not fungal, used in war, can be lethal transported by clothing shoes, dead bodies"
SS of anthrax
"cutaneou-prutic ulcers leading to ulcer, black necrotic tissue, occurs on arms, hands face and neck, regional lymphadenophathy"
SS of pyrodomal phase of anthrax
"flu like symptoms, fever, dyspnea, malaise, myalgia"
SS of fulminant phase of Anthrax
"fever, diaphoresis and septic shock"
Labs of Anthrax
Gram stain of specimin
Treatmetn of antrax
"VaCINE before infection, CIPRO, penicillan, doxy, report to health department"
Definition of warts
"benign epidural neoplasms casued by HPV, transmitted by direct contact"
SS of commmon warts
flesh colored papule with rough surface
SS of Filiform warts
Located on face finer like appearance with cvarious projections
SS of flat warts
pink or yellow
SS of plantar warts
roughened surface slightly raised amy be painful
SS genital warts
Pale pink with several projection (cauliflower)
Treatment of genital warts
"cyrosurgery, trichloric acid (TCA and Bicholoracetic acid BCA, Pododerm, Podofilox"
Treatment of plantar warts
salicylic acid compound w laser
Treatment of comon warts
salicylic acid compound w electrocautery
Treatment of filiform warts
tretinoin cream liquid nitrogen electrocautery
Treatment of flat warts
tretinoin cream liquid nitrogen electrocautery
What is DM
Metabolic disease resulting from the breakdown in the bodys ability to either produce and or utilize insulin resulting in hypergycemia
General stuff about DM1
"common in adolescent, HLA-DR3 and HLA-DR4, islet cell antibody found, ketones, result of infection to pancreatic B cells"
General stuff about DM2
"circulating insulin enough to prevent ketones, but not enough to meet needs, assocated with obesit, tissue insensitivity to insulin or resistance"
What is metabolic syndrome
"Men waist over 40inches or 101 cm, women 35 inches 89 cm, bp = or >130/85 trig => 150, FBG =>100 hdl men <40, women<50"
significnce of Metbolic syndrome
associated with obesity and syndrom x
SS of Type 1 DM
"poyuria, polydipsea, polyphagia, nocturnal enuresis (bedwetting), weight loss, weak fatigue"
SS of Type2 DM
"often symtptomatic, poyuria, polydisea, recurent vaginitis, peripheral neurophaty, blurred vision chronic skin infection"
Labs for DM1
"random glucose over 200 with polyuria, dipsea and weight loss, serum fastin over 126on two occasions, ketones bun creatnin elevated (dehydrated) oral glucose test >200, A1c 6-6.5, GTT "
Labs for DM2
Sames as DM1 except no ketones and weight loss
Insulin therapy for DM1
"Insulin therapy starts when patient has Ketones, 50% NPH 50% Reg, 2/3 in Am 1/3 evening"
What is somogyi effect
nocturnal hypoglycemia. Hypoglycemic at 3AM elevated at 7AM
What is dawn phenomenon
"tissues become desensitied to insulin nocturnally, BGT elevated throughout night "
Treatmetn for somogyi effect
reduce or omit the bedtime dose of insulin
Treatmetn for dawn phenomenon
add or increase glucose
What is DKA
"state of elevated bgt, intracellular dehydration, often presenting symptom of DM1"
SS of DKA
"polyuria, polydipsea, weakness fatigue, N and V kussmauls breathing, rapid depp breathing, altered LOC, fruity breath, hypotension and tachycardia and poor skin turgor"
Labs of DKA
"Serum glucos over 250 and often over 300, ketonemia, glycosuria, acidosis, elevated hct, Bun and Cr, hyperkalemia, hyperosmolality"
Management of DKA
"Protect airway give O2 fluids rescuscitation, NS then 1/2 ns then D5 1/2NS"
What is HHNK
"state of greatly elevated serum glucose, hyperosmolality, and serum dehydration without ketones, ususally a complication of DM2, mortality rate 30 to 50%, osmotic diuresis and extracelular fluid depletion"
SS of HHNK
"polyuria, weaknessm altered LOC, hypotentsion, tachycardia, poor skin turgor, dehydration"
Labs of HHNK
"greatly elevated serum glucose over 600 often over 1000, hyperosmolality, elevated Bun Cr elevated A1c, normal ph, normal anion gap"
Management of HHNK
"protect airway, give O2, NS IV massive fluid (deficit may be 6-10 liters), 15 units regular insulin IV, then 10-15 Units SQ additional insulin as needed"
Examples of sulfonylurea
"G's - glipizide, glyburide, glimepride"
Mechanism of action of sulfonylurea
stimulates pancreas to release insulin
comment of sulfonylurea
"adjust dose in renal imairment, less effective after 5 years-bc already running out of insulin, watch hypoglcemia, cheap"
Example of Biguanide
Mechanism of action of metformin
reduces hepatic glucose output and insulin sensitizer
Comments of metformin
"Must check creatnine B4 starting, monitor creatnine, SE weight loss GI issues"
Examaples of Thiazolidinediones
Avandia and actos (rosiglitazone and piolitazone)
Comments of Thiazolidinediones
"Monitor ALT liver = (ALT is actos and avandia, liver infection like hepatitis, and toxic therapuetic agents) DC if over 3 time upper normal limit"
Mechanisms of Thiazolidinediones
"insulin sensitizer at PPAR (regulates fatty acid storage and glucose metabolism) receptors, found in muscle adipose and other tissue"
Examples of melitinides
prandin and sstarlix (repagliidie and nateglinide)
Mechanism of melitinides
"mimics the effect of rapidly acting insulin, "
Comment of melitindes
"take 1 -30 minutes before meal, provides quick insulin burst, no additonal benefit is usinf sulfonyreas"
Examples of alpha glucosidase inhibitors
acarbose and miglitol (precose and glyset)
Mechanism of alpha glucosidase inhibitors
"Bind to disaccharides more readily than sucrose so less glucose is absorbed by gut, blocks enzyme that helps digest starches, slows absorbtion, "
Comments on alpha glucosidase inhibitors
"take with first bite of meal, lots of gas"
Exmple of Incretin mimetics
mecahism of Incretin mimetics
injectable that mimics the effects of incretins (signals pancreas to increase insulin and stpp liver form producing glucose)
comment on Incretin mimetics
may cause NVD
Examples of DPP4
Januvia and Galvus
Mechanism of DPP4
"increase levels of incretin, increase synthesis and release of insulin from pancreatic cells and dcrease release of glucagon from pancreatic cells."
Diet for DM
"Carbs 56-60% , fats 20-30%, protein 10-20% fiber 14gram per 1000 calories"
SS of hyperthyroidism
"nervous, anxiety, increased sweating, fatique, fine tremours, hyperreflexes, goiter, increased appetite, weight loss, fine thin hair, lid lag, tachycardia"
SS of hypothyroidism
"extreme weakness, muscle fatigue, cramps, cold intolerance, cramps, constipaton, wiehgt gian, puffy eyes, brady, slow DTRs, hypoactive bowel sounds"
Labs of hyperthrioid
TSH is low T# and T4 increased sometime T$ is normal and T3 elevated
Labs of hypothroid
"TSH is elevated, T4 is low or low normal, T3 not reliable but decreased"
Mgmt of hyperthyroid
"refer, propraolol radioctive iodine, "
mgmy of hypothyroid
What is cushings syndrome
"ACTH hypersecreation by pituitary, adrenal tumors"
What is addisons disease
"deficiency in cortisol, aldosterone and androgens, destruction of adrenal glans decreased ACTH"
SS of cushing disease
"central obesisty, , moon face buffalo hump, acne, hirtuitism, amenorrhea, impotentce, weakness, polyuris, thirst, hypertension"
SS of addisons disease
"hyperpigmentation of skin, especially knuckels nail beds and nipples, diffuse tanning and freckles orthostais and hypotension scant axillary and pubic hair."
Lab test of cushings
"check cortisal level in AM, hypokalemia, serum acth, hyperglycemia and hypernatremia"
Lab test of addisons
"hypoglycemia, hyponatremia, hypernatremia, hyperkalemia, elevated ESR cortisol in AM"
mgmt of cushings
manage casue dc offending medication refer out
mgmt of addisons
"refer out, glucocorticoid replacement and mineralcorticoid replacemtn. Refer aout for adrenal crisis"
Soft tissue injuries
"The injury that occurs in non osseous Structures of the musculoskeletal system , such as muscles , bursa, Ligaments and tendons or cartilage "
What is the ligament
connects bone to bone
What are tendons
Muscle to bone
what is cartilage
Connective tissue with no blood supply
What is a strain
A muscle injury
What is a sprain
A joint injury - partiallly torn or completely ruptured ligaments
The most accurate diagnostic tests performed during acute gouty arthritis is
Joint aspirate analysis
Would you use allopurinol To treat an episode of acute Gouty arthritis
"No it is used to prevent Gout Not to treat acute attacks,cant start it until pain and swelling are gone "
What is the McMurrays test
"Patient the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole with the other hand an audible /palpable click is positive for medial meniscal injury"
What is Lachmans test
drawer test Two assess for anterior and posterier crucial ligaments 1+ to 3+ is positive
What is the Apleys test
"Prone position, flex knees 90 degrees, for medial or lateral collateral ligament damnge and or meniscus injury, pain or click is positive"
What causes sprain
lateral ankle sprain is most common sports related injury
grade of sprain
"1=mild localized tenderness, normal ROM, no disbility, Grade 2=moderate/sever pain with weight bearing; difficulty walkingg swelling and echymossi, pain after injury; grade3=impossible to ambulate, resist any motion of feet, egg shaped swelling within 2 hours of injury"
What does drop arm test determine
rotator cuff injury
What does the talar tilt test look for
drawer test of ankle
What test is used to determine carpal tunnel syndrom
"tinel test, phalon test and carpel tunel commpression"
What is muscle strain
overuse of muscle tendons often occuring with reptitive movement resulting in inflamation
magmt of muscle strain
"RICE, assistive devices, anagesics, NSAIDS, prevention"
SS of strain
"pain during ROM, edema, echymosis"
What is bursitis
inflamation of bursa (closed sac lined with synovial like membrane in an area subject to friction or pressure)
Key sign of Bursitis
Pain especially with movement
Diagnositic test for Bursitis
"aspiration with C & S, WBC, Plain X Rays to rule out fracture"
Mgmt of Bursitis
"Spinting, RICE, heat x 30 minutes BID or TID, sterios injection into bursa, "
How many steriod injection in one year
"Max of 3, can cause addisons crisis"
What is OA
Degenerative joint disease with slow destruction of the articular cartilage
Joint affected by OA
"knees hip, distal and proximal interphalangeal joints (heberdens nodes and bouchards nodes"
Pain in OA
better in AM worse as day goes on
Risk factors in OA
"genetic predisposition, age obesity, angular deformity, limited ROM, crepitus"
x ray finding s of OA
"Key one is Osteophytes, narrowing of joint "
Magmt of OA
"ASA, tylenol, NSAIDS, Ibuprofen, Narproxen , Cox2"
Suppotive care od OA
"Weight loss, cane on opposite side, ICE, moist heat, PT refer out"
What is RA
Systemic autoimmune disease casuing inflamtion of connective tissue
Inflamation SS in RA
Pain in RA
Worse in AM better as day progresses
General stuff about RA
"autoimmune, fatigue, weakness, malaise, anorexia"
Labs for RA
"ESR, ANA, rheumatoid factor"
X ray fidings or RA
"osteopenia (KEY PT), joint swelling, joint space swelling, "
Mgmt of RA
"high dose salysylate, NSAIDS, DMARDS-corticosteroids, methotrexate, antimalarial, gold salt injections"
Supportive care of RA
"rest, PT, refer"
What is carpal tunnel syndrome
median nerve compression of the wrist beneath the transverse carpal ligament
How do you do steroid taper
"40 x , 20 x 2, 10x 2, 5x 2 off or 2.5 x 2"
Causes of Carpal tunnel syndrome
idiopathic-associated with repeated wrist flexion
SS of Carpal tunnel syndrom
"numbness, tingling, burning, nocturnnal pain, pain with dorsiflexin, positive tinnel, phalen , and carpel tunnel test"
Diagnostic test of carpal tunel syndrom
"x ray to rule out other problems, electromyography to document motor movement"
mgmnt of carpel tunel
"cock up slpint, eleevation, nsaids, steriod inj, surg"
What is low back pain
"any pain originating in lumbosacral region on the spinal column, can be localized or radiate to legs and feet."
SS of low back pain
"numbness along dermatone, bowel bladder dysfunction, pain in low back may radiate, decreased muscle strength, decreased reflexes, ataxic gait, decreased proprioception, poistive straight leg raise, positive pelvic rock test,"
SS of L3L4 disk problems
"have pateitn squat and rise if pain or cant it is positive, pain down malleous"
SS of L4L5 disk problems
"patient cant walk on heels, pain radiating in lower calf, numbness of the dorsum of foot an lateal calf"
SS of S1 and L5
"patient cant walk on toes, pain in buttocks, lateral leg and lateroul malleolus"
Diagnostic test for lower back pain
x ray ct and mri
Mgmt of lower back pain
"orthotic devices, rest, pt, heat / ice thrapy, weight loss, body mechanics NSAIDS stress mgmnt"
What is mortons neuroma
compressions neuropathy of intermetatarsal plantar nerver in 3rg or 4 th intermetatarsa space
Cause of morton neuroma
"high heeled shoes, high impact activities"
SS of morton neuroma
"stading on peeble, numbness in toes pai in contigous halves of two toes"
mgmt of morton neuroma
"orthotics and steriod injections, refer"
What is plantar fasciitis
inflamation of the thick tissue of the bottom of the foot that connect the heel to the toes and creates an arch
risk factors for plantar fasciitis
"obesity, runner, age 40-70"
ss of plantar fasciitis
"heel pain, bottom of foot burns and aches, pain worse in AM"
Mgmt of plantar fasciitis
"nsaids, steriods, orthotics pt"
what is osgood schlatter
rupture of growth plate in the tibial tuberosity
ss of osgood schlatter
"painful limp below knee cap, can be one leg or two, pain worse with jumping, running, and climbing stairs, swelling rangesfrom mild to severe"
mgmt of osgood schlatter
"RICE, nsaids refer for surgery, avoid sctivities that involve quads"
What is costochondritis
inflamation of cartilage that connects ribs
Cause of costochondritis
"chest injury, strain, URI infection fibromyalsia"
SS of costochondritis
pain on breasbone pain when taking deep breath or coughing
mgmt of costochondritis
"ususally resolve on own, local heat or ice, NSAIDS"
What is polymyalgia rheumatica
inflamatory disorder invoving pain and stiffness in shoulder and hip
SS of polymyalgia rheumatica
"stifness in neck, shoulder and hips, loss of ROM in affected areas, fatigue anemia fever"
Diagnosis of polymyalgia rheumatica
Elevated ESR x ray
mgmt of polymyalgia rheumatica
"steriouds, symptom mgmgt"
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