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Bundle of PAEA exam updated 2023
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PAEA Psych EOR Practice questions with complete solutions
The histrionic personality disorder would be listed in what cluster? (A) Cluster A (B) Cluster B (C) Cluster C (D) Cluster D (E) Cluster E (B) Cluste... [Show More] r B Which complication can be found in anorexia nervosa and not bulimia? (A) Salivary gland hypertrophy (B) Reversible cerebral atrophy (C) Petechial hemorrhages (D) Hypokalemia (E) Osteoporosis (E) Osteoporosis What is another name for multiple personalities? (A) Dissociative amnesia (B) Dissociative fugue (C) Depersonalization (D) Dissociative disorder not otherwise specified (E) Dissociative identity disorder (E) Dissociative identity disorder The diagnostic criteria for anorexia nervosa include: (A) Less than 85% of normal weight for their height (B) Patient feels lack of control overeating (C) Use of inappropriate compensatory behaviors (D) Two binge episodes a week for 3 months (E) Patient is concerned about weight and shape of their body (A) Less than 85% of normal weight for their height A patient presented to your office with multiple somatic complaints. During the mental status exam you notice that the patient loses the thread of conversation and discusses irrelevant topics based on external stimuli. The patient never gets back to the main point he or she was trying to express. What is the thought process called? (A) Tangentiality (B) Circumstantiality (C) Looseness of association (D) Word salad (E) Neologisms (A) Tangentiality Tangentiality is a disturbance in thought causing the person to start a train of thought, but never getting to the point. Circumstantiality is seen in someone who eventually gets to the point after a delay in the thought process. Word salad is a mixture of words and phrases that are incoherent. Looseness of association is when the ideas shift between subjects that are totally unrelated to each other. Neologisms are the creation of new words. Which of the following personality disorders is listed in Cluster C? (A) Avoidant (B) Antisocial (C) Borderline (D) Schizoid (E) Paranoid (A) Avoidant Treatment for a paranoid personality disorder would include: (A) Confirm paranoid beliefs (B) Challenging paranoid ideas (C) Confrontation of delusions (D) Do not empathize with the patient (E) Outline a treatment plan in detail (E) Outline a treatment plan in detail Mr. Smith leaves home and does not return, nor does he go to work. A friend of Mr. Smith's sees him in another state while on vacation. When he approaches Mr. Smith, he does not recognize him and has a totally different demeanor. What type of disorder does Mr. Smith have? (A) Amnesia (B) Fugue (C) Schizophrenia (D) Dissociative identity disorder (E) Depersonalization (B) Fugue Dissociative or psychogenic fugue is precipitated by a stressful event that causes the patient to develop amnesia, leave home, and assume another identity. What type of disorder develops within 3 months of an identified stressor such as finances, going to school, divorce, or illness in their life? The stressor causes impairment in their job and relationships, but the symptoms resolve within 6 months. What is the most likely diagnosis? (A) Depression (B) Bereavement (C) Posttraumatic stress disorder (D) Personality disorder (E) Adjustment disorder (E) Adjustment disorder DSM IV classifies disorders into five axes. What type of information should be provided on Axis IV? (A) Global assessment (B) Clinical disorders (C) Medical conditions (D) Psychosocial stressors (E) Personality disorders (D) Psychosocial stressors Which medication should be prescribed for generalized anxiety in a patient who has a history of alcohol dependence? (A) Lorazepam (B) Paroxetine (C) Venlafaxine (D) Buspirone (E) Sertraline (D) Buspirone Buspirone is recommended in treating generalized anxiety disorders in a patient who has a history of drug or alcohol dependence because of its nonaddictive nature. Personality disorders would be listed on which axis? (A) Axis I (B) Axis II (C) Axis III (D) Axis IV (E) Axis V (B) Axis II Generally, patients who are malingering (A) use illness to attain a goal (B) are perfectionists (C) are workaholics (D) have a history that agrees with their physical symptoms (E) will demonstrate function only when being observed (A) use illness to attain a goal Which of the following statements is true regarding the avoidant personality disorder? (A) symptoms do not improve in time (B) symptoms of anxiety do not need to be treated (C) can use beta-blockers (D) they seek interpersonal contact (E) will stay in treatment (C) Can use beta-blockers Avoidant personality disorders will avoid some medical treatments and interpersonal contact because they fear embarrassment or are not willing to take risks. Symptoms will resolve in time. Any anxiety or depression associated with avoidant personality disorders should be treated. Which of the following criteria is considered to be a high risk factor for "successful" suicide? (A) People who live in climates with limited amount of sun (B) Lower socioeconomic status (C) Male (D) Committed religious beliefs (E) Married (C) Male A patient that has depressive symptoms on more days than not for greater than 2 years would be diagnosed as (A) Major depressive disorder (B) Psychotic (C) Bipolar (D) Dysthymic (E) Situational depression (D) Dysthymic Performing a mental status exam will assist in showing how the patient's brain is currently processing. Upon completion of the exam, the one process that CANNOT be determined is (A) Thought disorders (B) Affect (C) Intelligence quotient (D) Cognition and memory (E) Insight and judgment (C) Intelligence quotient 1. A patient presents to your office claiming that the FBI is trying to poison him. These types of beliefs would be considered to be a(n) (A) Somatic delusion (B) Delusion of persecution (C) Illusion (D) Delusion of grandeur (E) Hallucination (B) Delusion of persecution What question does the "C" represent in the alcohol abuse screening tool CAGE? (A) Have you ever felt the need to cut down? (B) Has anyone ever cautioned you not to drink? (C) Have you been caught having an "eye opener" in the morning? (D) Has anyone ever criticized you about your drinking? (E) Do you care that you are feeling guilty about drinking? (A) Have you ever felt the need to cut down? A phobia is an excessive fear of an object or place that leads to or can be preceded by (A) Panic attack (B) Depression (C) Hallucinations (D) Delusions (E) Confabulations (A) Panic attack The hallmark of a manic episode is (A) Hypersomnolence (B) Psychosis (C) Depression (D) Anxiety (E) Euphoria or irritability (E) Euphoria or irritability What type of pharmacological agent would be used as a first-line medication to treat obsessive-compulsive disorder? (A) Risperidone (B) Clonazepam (C) Fluoxetine (D) Trazadone (E) Venlafaxine (C) Fluoxetine Fluvoxamine, Paroxetine, and Sertraline are all approved for the treatment of obsessive compulsive disorder. Use of an SSRI in combination with behavioral therapy is recommended. Ms. Jones wakes up from a deep sleep after having a nightmare. The nightmare caused her to reexperience the time she received third degree burns on her arms. The next day at work, she was very jumpy and had difficulty concentrating. What diagnosis would be given to Ms. Jones? (A) Adjustment disorder (B) Posttraumatic stress disorder (C) Personality disorder (D) Anxiety (E) Schizophrenia (B) Posttraumatic stress disorder ECT is effective in several conditions. What condition would NOT be appropriate for treatment with ECT? (A) Severe depression (B) Manic disorders (C) Psychosis during pregnancy (D) Obsessive-compulsive disorder (E) Depression unresponsive to medication (D) Obsessive compulsive disorder ECT is used for treating severe depression or when patients do not respond to medication for depression, manic disorder, chronic schizophrenia, and psychoses during pregnancy, but not obsessive compulsive disorder. To achieve a quick response to relieve depressive symptoms, ECT can also be used. A patient who is intoxicated presents to the emergency department. On ocular exam, you notice mydriasis. Which one of the following substances could he have been using? (A) Sedatives (B) ETOH (C) Opioids (D) Cocaine (E) PCP (D) Cocaine Which one of the following symptoms is related to delirium tremens? (A) Hypersomnolence (B) Normal temperature (C) Bradycardia (D) Hypotension (E) Perceptual distortions (E) Perceptual distortions A student is told that he failed a course in school and forgets that he has been given this information. The defense mechanism utilized by this student is (A) Sublimation (B) Reaction formation (C) Displacement (D) Repression (E) Denial (E) Denial Which of the following statements is true regarding vascular dementia? (A) Occurs more frequently in females (B) Those patients with a stroke are at increased risk (C) Chronic onset (D) The patient has a normal fundoscopic (E) The cardiac chambers are normal size (B) Those patients with a stroke are at increased risk Mr. Johnson comes to the clinic today. Based on the history, you suspect he is the victim of domestic violence occurring in the home. Which of the following would not be an indicator for domestic violence? (A) Bruises at different stages of healing (B) Delay in treatment for an injury (C) Eye contact with provider (D) Inconsistent explanation for injuries (E) Repeated office visits for nonspecific complaints (C) Eye contact with provider A misinterpretation of an external stimulus is (A) Delusions (B) Hallucinations (C) Illusions (D) Neologisms (E) Tactile hallucinations (C) Illusions Which personality disorder is characterized by eccentricities, social isolations, "magical thinking," and suspiciousness? (A) Avoidant (B) Antisocial (C) Borderline (D) Schizoid (E) Schizotypal (E) Schizotypal Which of the following diseases is known for "plaques and tangles"? (A) Parkinson's disease (B) Vascular dementia (C) Huntington's Chorea (D) Alzheimer's disease (E) ALS (D) Alzheimer's disease You are asked to see a patient that was admitted to the hospital. Upon attempts to obtain a history, you notice the patient states words that sound similar, but do not have the same meaning. He also does some rhyming of his words. What type of thought process would this be? (A) Flight of ideas (B) Circumstantiality (C) Looseness of association (D) Word salad (E) Clanging (E) Clanging A patient present to the emergency room with alcohol withdrawal syndrome. What is the pharmacological agent of choice to be administered? (A) Clonidine (B) Phenobarbital (C) Neuroleptics (D) Benzodiazepines (E) Methadone (D) Benzodiazepines A 56-year-old man presents to your office stating he has no desire to have sex. He has recently gotten back into dating after being divorced for 10 years and is being pressured by his current girlfriend. The gentleman states he has no desire to be with his girlfriend or any other person. What would be the most likely diagnosis? (A) Sexual aversion disorder (B) Hypoactive sexual disorder (C) Hyperactive sexual disorder (D) Erectile disorder (E) Sexual arousal disorder (B) Hypoactive sexual disorder Women most commonly commit suicide by what method? (A) Overdose (B) Jumping (C) Hanging (D) Firearms (E) Slashing wrists (A) Overdose [Show Less]
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Surgery EOR Exam [PAEA Blueprint, questions with verified answers
_______is the most important anesthetic complication. Anesthesia causes an uncontrolled increase in skeletal muscle oxidative metabolism, which overwhelms ... [Show More] the body's capacity to supply oxygen, remove CO2, and regulative body temperature. Malignant hyperthermia If patient is hyperkalemic (normal range 3.8-5.0), how should you treat the patient? treat with glucose/insulin, and calcium +/-bicarb _______is the reversing agent for opiods. Naloxone _______is the reversing agent for benzodiazipines. Flumazenil What is the best indicator used to monitor nutritional status? prealbumin - every 2-3 days Intervention: _________require central access and indicated when no enteral feeding for > 7 days. TPN - total peripheral nutrition The _________is the most important part of the history before surgery. cardiac history -- history of MI, unstable angina, valvular disease In patients with known cardiac disease, aggressive intraoperative lowering of myocardial oxygen demand with ____ has been shown in RCT's to improve outcomes and should be used. beta blockers When accessing cardiac disease prior to surgery, what is the most important thing to access? aortic stenosis -- crescendo diastolic rumble at apex Guidelines for the use of antibiotics include administration within _______ of surgery and redosing after 4 hours. What is the abx of choice? 1 hour Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria? 3/5 to diagnose: 1 - diabetes 2 - central obesity 3 - HTN 4 - high serum triglycerrides 5 - low HDL levels ______should be monitored before surgery bc it is a stimulant and vasoconstrictor -- can lead to severe tachycardia Cocaine Pre-Op -- What are the indications for EKG and CXR? EKG - men >40, women>50, known CAD, DM, or HTN CXR - age >50, known cardiac or pulmonary disease What are the 5 classic "W's" of post operative fever? W - wind (atelectasis) W - water (UTI) W - wound (wound infection) W - walking (DVT/thrombophlebitis) W - wonder drugs (drug fever) If the post op fever occurs within the first 24 hours of surgery, what is the most likely cause? wind/atelectasis If the post op fever occurs within days 3-5 post op, what is the most likely cause? water/UTI, catheter related phlebitis, pneumonia If the post op fever occurs within days 5-10 post op, what is the most likely cause? wound infection, pneumonia, abscess, infected hematoma, C diff colitis, anastomotic leak, DVT, peritoneal abscess, drug fever, PE, parotitis _______is the most common pathogen in wound infections and around foreign bodies. Staph aureus _______invades the inner ear and enteric tissues as well as the lung. Klebsiella ______organisms are often found together with anaerobes. Enteric organisms ie. enterobacteriaceae and enterococci Among the anaerobes, ___&___are often present in surgical infections and _____species are major pathogens in ischemic tissue. Bacteroides & Peptostreptococci; Clostridium ___&___are usually nonpathogenic surface contaminants but may be opportunistic. Some fungi and yeast cause abscesses in sinus tracts. Pseudomonas & Serratia History of recent surgery, trauma, cancer, prolonged immobilization, or oral contraceptive use increases the risk of ____. DVT - deep vein thrombosis What is Homan's sign? pain on passive dorsiflexion of ankle What is the test of choice for DVT? doppler ultrasound How is the D-dimer text useful? It is good at ruling a DVT out (if the text is negative) but not rule it in Tx of DVT -- 1. Initiate use of ____or____to what dose? 2. Overlap with the use of ____to what therapeutic range? 3. Why overlap therapies? DVT 1. Initiate Heparin to PTT of 0.3-0.7 U/mL or LMWH wo monitoring. 2. Overlap with warfarin to INR between 2-3. 3. Overlap therapies to decrease changes of hypercoagulable state. The most common cause of SIRS (systemic inflammatory response syndrome) is sepsis. What are the criteria for dx of SIRS? At least 2 of the following: 1. temp >38C or <36C 2. tachy >90 3. tachypnea > 20 breaths/minute 4. PCO2 <32mmHg 5. WBC > 12,000/uL or <4000/uL After sepsis, what are the next two most common causes of SIRS? pancreatitis and drugs What is the difference between hypovolemia and dehydration? hypovolemia is loss of both water and sodium while dehydration is loss of intracellular water or deficit with hypernatremia -- dehydration occurs when patient can not adjust water intake for water loss What are the clinical signs of dehydration and hypovolemia? tachycardia, hypotension, pale skin, increased capillary refill time, dizziness, faintness, nausea, thirst, decreased urine output -- in hypovolemia, urine will demonstrate low sodium concentration What are 2 common conditions with dehydration? diabetes insipidus (lack of ADH or unable to respond to ADH), fever with increased water loss Hyponatremia Causes _______ = cirrhosis, CHF, nephrotic syndrome, massive edema _______=states of severe pain or nausea, trauma, brain damage, SIADH _______=prolonged vomiting, decreased oral intake, severe diarrhea, diuretic use Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency, malnourished states, primary polydipsia Hypervolemic, Euvolemic, Hypovolemic What are the two most common treatments for hyponatremia? Other less common treatment? salt tabs and fluid restriction; vasopressin receptor antagonist in SIADH, CHF, and cirrhosis Hypernatremia is almost always due to _______. Therefore, what is the treatment? dehydration; rehydrate! What s/s can result in a hyperkalemic patient? cardiac arrhythmias (tall peaked T waves) and weakness If the potassium level is above 6meq/L or the patient has EKG changes, what treatments can lower K temporarily? calcium gluconate, sodium bicarbonate, insulin and glucose, kayexalate (takes longer to be effective) ______&______ is extremely effective in decreasing potassium. Dialysis and furosemide Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high aldosterone levels. How is it treated? potassium loss; replacement must be slow!!! Mild loss: oral KCl supplements or K containing foods Severe loss: IV supplementation - rate 10mEg/hr Causes of ________are VITAMIN D METABOLIC DISORDERS, abnormal PTH function, primary hyperparathyroidism, Lithium, malignancy, disorders related to high bone turnover rates (hyperthyroidism, prolonged immobilization, thiazide use, vit A intoxication, Pagets dz of bone, multiple myeloma), renal failure hypercalcemia How should hypercalcemia be treated? fluid and diuretics, bisphosphonates, and calcitonin _______is usually caused by ineffective PTH (chronic renal failure, absent active vit D, ineffective active vit D, pseudohypoparathyroidism), deficient PTH. Hypocalcemia How should hypocalcemia be treated? intravenous calcium gluconate, Tums Increased CO2, hypoventilation, or decreased pH is aka ___. respiratory acidosis Decreased CO2, hyperventilation, or increased pH is aka ___. respiratory alkalosis Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. metabolic acidosis Loss of H+ is aka ________. metabolic alkalosis The d/d of post op ___________can be MI, atelectasis, pneumonia, pleurisy, esophageal reflux, PE, musculoskeletal pain, subphrenic abscess, aortic dissection, pneumo/chyle/hemothorax, or gastritis. chest pain Who classically gets silent MI's? diabetics How should syncope be initially evaluated? It is important to distinguish syncope from cardiac arrest from other nonsyncopal conditions causing LOC Syncope d/d: Prodrome or aura usually associated with ____. seizures (as is loss of continence) Cardiac syncope's onset is usually ____without a prodrome. Monitor vitals regularly, EKG, orthostatic challenge, neuro exam etc. sudden In a surgery patient with dyspnea on exertion, what should be ruled out? PE or pneumothorax What are some chronic dyspnea on exertion causes? asthma, COPD, interstitial lung disease, myocardial dysfunction, obesity What are some acute dyspnea on exertion causes? angioedema, anaphylaxis, foreign objects, airway trauma, pulmonary infection, pleural effusion, peritonitis/ruptured viscous, bowel obstruction __________is pain, cramping, or both of the lower extremity (usually calf muscle) after walking a specific distance; then resolves for a specific amount of time while standing. Claudication What is claudication associated with? peripheral vascular occlusion D/D of lower extremity claudication? neurogenic/nerve entrapment/discs, arthritis, coartation of the aorta, popliteal artery syndrome, neuromas, anemia, diabetic neuropathy pain A _________is an abnormal dilation of an artery. Involve all layers of the arterial wall. aneurysm At what size is surgical repair of aneurysm recommended? 5.5 cm 95% of aneurysms are associated with ___________. atheroschlerosis -- other causes are trauma, infection, syphilis, & Marfan's syndrome What is the classic triad of s/s related to ruptured AAA? abdominal pain, pulsatile abdominal mass, hypotension Where does the aorta bifurcate? At the level of umbilicus Because the ________is often sacrificed during AAA repair, colonic ischemia can occur. IMA - inferior mesenteric artery _______is a separation of the walls of the aorta from an intimal tear and disease of the tunica media; a false lumen is formed and a "reentry" tear may occur, resulting in a "double barrel" aorta. Aortic dissection Explain the DeBakey classifications (Type 1,2, & 3) of aortic dissections. DeBakey Type 1 - ascending & descending aorta DeBakey Type 2 - ascending aorta DeBakey Type 3 - descending aorta Explain the Stanford classifications of aortic dissections. Type A -- ascending +/- descending aorta Type B - descending aorta [Show Less]
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PAEA Internal Medicine EOR questions and answers graded A+
Bell's Palsy causes cranial nerve 7 dysfunction S/S of Bell's Palsy Has forehead involvement (whereas a stroke does not affect forehead movement),... [Show More] facial weakness, inability to keep one eye closed 00:43 01:30 Treatment for Bell's palsy Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x 7 days, artificial tears, lacri lube at night When can I use tPA? ischemic stroke presenting within <3 hrs and CT head negative How do you treat high BP with stroke? Nitroprusside (short half life, easy to titrate) or IV labetalol What do you use for anticoagulation/antiplatelet therapy in stroke? ASA (not in hemorrhagic), heparin for thrombosis What do you do differently to treat hemorrhagic stroke? Give prophylactic anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy contraindicated Types of Hemorrhagic Stroke 1. Intracerebral (10%): results from rupture of small arterioles 2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into subarachnoid space) Causes of Intracerebral hemorrhagic stroke are what? HTN, amyloidosis, iatrogenic anticoagulation, vascular malformations, cocaine use Causes of Subarachnoid hemorrhagic stroke are what? berry aneurysm rupture, vascular malformation rupture Signs and symptoms of Intracerebral hemorrhagic stroke are what? ICP rises, vasoconstriction-sweating Signs and symptoms of Subarachnoid hemorrhagic stroke are what? may be preceded by warning headache, neck/back pain, "worst headache of my life," thunderclap, may have loss of consciousness 00:21 01:30 Treatment of Subarachnoid hemorrhage surgery, control hypertension, analgesics What is Complex regional pain syndrome (CRPS) Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack. Signs and symptoms of complex regional pain syndrome are what? Pain out of proportion to injury. ANS sx: swelling, extremity color changes, increased nail and hair growth. Treatment for complex regional pain syndrome Amitriptyline, nortriptyline, gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive therapy; Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation Vit C prophylaxis after fx Imaging modality used to diagnose Subarachnoid Hemorrhage? CT without contrast. If CT negative but still suspect SAH, do LP to look for RBC or xanthochromia (will not develop until 12hrs after onset) Delirium transient disorder characterized by impaired attention, perception, memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced alertness, activity levels change rapidly. Treatment of Delirium treat underlying cause, Haloperidol 5-10mg for agitation, Lorazepam 0.5-2 mg Dementia Loss of mental capacity. Psychosocial level and cognitive abilities deteriorate and behavioral problems develop. Largest categories are Alzheimer dz and vascular dementia. Hallucinations, delusion, depression, repetitive behavior are common. Treatment of Dementia Antipsychotics to manage psychosis [Show Less]
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PAEA Emergency Medicine EOR Topics questions and answers 100% accurate
what is the most common cause of heart failure? specifically left sided? right sided? -MC is CAD (coronary artery disease) -L sided: CAD & HTN -R sided:... [Show More] L sided HF & pulmonary dz decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop (filling of dilated ventricle) is associated with systolic or diastolic heart failure? systolic (MC form of CHF) *(the sound is actually heard in the diastole though) -memory trick: "sys-to-lic" 3 consonants = S3 00:18 01:30 normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop (atrial contraction into a stiff ventricle) is associated with systolic or diastolic heart failure? diastolic -memory trick: "di-a-sto-lic" 4 consonants = S4 what are the causes of systolic vs diastolic heart failure? -systolic: post MI, dilated cardiomyopathy, myocarditis -diastolic: HTN, LVH, elderly, valvular heart dz, hypertrophic or restrictive cardiomyopathy, constrictive pericarditis when the metabolic demands of the body exceed normal cardiac function (d/t thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the bone) this is termed ________ heart failure high-output *fairly uncommon -low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN what are some causes of acute vs chronic heart failure? -acute: largely systolic; hypertensive crisis, acute MI, papillary muscle rupture -chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic) explain class I-IV New York Heart Association functional classes -class I: no sx's, no limitation during ordinary physical activity -class II: mild sx's (dyspnea or angina), slight limitation during ordinary activity -class III: comfortable only at rest (sx's caused maked limitation in activity even with minimal exertion -class IV: sx's even while at rest, severe limitations, inability to carry out physical activity what compensations does the body make when heart failure (can be due to something that causes either inc pre/afterload or dec contractility) begins? 1. sympathetic nervous system activation 2. myocyte hypertrophy/remodeling 3. RAAS activation: fluid overload the following are signs/sx's of what sided heart failure? inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-productive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4, pale skin/cool extremities, sinus tachy, fatigue L-sided HF the following are signs/sx's of what sided heart failure? inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V, hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver palpation) R-sided HF -CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion, pulmonary edema -echo with dec EF -inc BNP on labs are all signs of? heart failure *BNP released from atrium with preload too high (volume overload) what drugs have shown to decrease mortality rates in pts with heart failure? ACE inhibitors (-prils), ARBs, beta-blockers (-lols), hydralazine + nitrates, spironolactone 00:59 01:30 in pts who experience the following common side effects of an ACE inhibitor to treat heart failure, what is the alternative medication? -1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema ARBs (-sartans) what vasodilators are often used to treat heart failure? hydralazine + nitrates -good for african americans -safe in pregnancy -acts to dec pre/afterload -used if pt not able to tolerate ACEi/ARBs/BB or if more control needed what is the most effective treatment for symptoms of heart failure? diuretics -loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on these electrolytes), other s/e: hyperglycemia, hyperuricemia -K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e: hyperkalemia, gynecomastia with spirono -HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia, hyperuricemia, hyperglycemia what medications are used to treat acute severe heart failure? sympathomimetics (positive inotropes to inc contractility) -digoxin: but has a narrow therapeutic index (can cause arrhythmias, seizures, dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST segment; antidote: Digoxin Immune Fab -dobutamine: inc contractility (B1 agonist), peripheral vasodilation -dopamine: inc contractility giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart failure? -dec RAAS activity -inc Na+/H2O excretion why are beta-blockers started after ACE inhibitors/diuretics in heart failure? want to decrease afterload/preload before slowing down the heart rate at what EF do heart failure patients need to receive an implantable cardioverter defibrillator? EF <35% because they tolerate arrhythmias poorly and there is inc mortality rate what medication used to treat systolic heart failure is a selective sinus node inhibitor that slows the sinus rate? ivabradine: dec mortality rate in pts w/ EF ≤35%, in sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB dose or unable to take BB what medication used to treat systolic heart failure works by increasing levels of natriuretic peptides? sacubitril-valsartan: decreases mortality rate in class II-IV HF w/ reduced EF what is the treatment for acute pulmonary edema/congestive (aka decompensated) heart failure? LMNOP -Lasix: removes fluids- improves sx's -Morphine: reduces preload reducing heart strain -Nitrates: vasodilator to reduce pre/afterload -Oxygen -Position: upright to dec venous return if severe may also need inotropic support although primary HTN makes up 95% of cases, when should secondary HTN be considered? what are some causes of secondary HTN? -if refractory to antihypertensives or severely elevated -causes: renal artery stenosis, fibromuscular dysplasia, atherosclerosis, 1° hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the aorta, sleep apnea, EtOH, OCPs, COX-2 inhibitors what are the complications of HTN? -CV (CAD, HF, MI, LVH, aortic dissection, aortic aneurysm, PVD) -neurologic (TIA, CVA, rutured aneurysms, encephalopathy) -nephropathy (renal stenosis & sclerosis leading to ESRD) -optic (retinal hemorrhage, blindness, retinopathy) thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the nephron to increase water excretion? what are the side effects? -distal diluting tubule -s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in gout and DM pts) *these are 1st line in uncomplicated HTN loop diuretics (furosemide, bumetanide) are the strongest class of diuretics and can cause s/e's of volume depletion, hypokalemia/natremia/calcemia, hyperuricemia/glycemia, hypochloremic metabolic alkalosis, and ototoxicity; what are they contraindicated in? sulfa allergy what are the DHP (dihydropyridine) and non-DHP calcium channel blockers? what are they indicated and contraindicated in? -DHP CCBs: nifedipine, amlodipine (potent vasodilators) -non-DHP CCBs: verapamil, diltiazem (vasodilators but also act on heart to dec contractility and conduction/HR) so often used in pts w/ HTN w/ concomitant Afib -indications: HTN, angina, raynauds -contraindications: CHF (esp non-DHPs), 2nd/3rd degree heart block what are the cardioselective and nonselective beta blockers? -cardioselection (B1): atenolol, metoprolol, esmolol -nonselective (B1, B2): propranolol -a, B1, B2: labetalol, carvedilol what are contraindications for using beta-blockers? -2nd/3rd degree heart block, decompensated heart failure -specifically in nonselective agents: asthma/COPD, may worsen PVD or raynauds, hypotension, or pulse <50 what is the pathophysiology behind a hypertensive urgency/emergency? -abrupt rise in BP -increase in SVR (systemic vascular resistance) -endothelial cell deterioration a murmur that is accentuated by sitting up and leaning forward is due to what valve malfunctioning? murmur accentuated by lying on left side? -sitting up/leaning forward = aortic murmurs (AS, AR) -lying on left side = mitral (MS, MR) what is the MC valvular disease? aortic stenosis (can lead to obstruction, LVH then LV failure) what are the causes of aortic stenosis? -degenerative: calcifications (atherosclerotic/wear & tear in pts >70y -congenital heart dz: bicuspid valve in pts <70y -rheumatic heart dz: from strep what are the clinical manifestations of symptomatic (<1cm^2) aortic stenosis? -dyspnea -angina -syncope (extertional) -CHF a systolic "ejection" crescendo-decrescendo murmur at right upper sternal border that radiates to carotid/neck; decreases in intensity with valsalva/standing/handgrip (inc venous return) and increases with squatting/leg raise/sitting/leaning forward (dec venous return); narrowed pulse pressure aortic stenosis for aortic stenosis, what diagnostic studies can be ordered? what can be seen? -echo: small aortic orifice during systole, LVH, thickened/calcified valve -EKG: LVH -CXR: calcifications -cardiac cath: definitive diagnosis; usually used prior to surgery what are the management options for aortic stenosis? -valve replacement (AVR): mechanical last longer but requires long term anticoagulants, bioprosthetic does not -percutaneous aortic valvuloplasty (PAV): results in 50% inc in area but 50% restenosis at 6-12 mos; used as bridge to AVR -intraortic balloon pump: temporary stabilization; bridge to AVR -medical therapy (although not truly effective): avoid things that may decrease preload- physical exertion, venodilators (nitrates), negative inotropes (CCBs, BBs) what are the causes of aortic regurgitation/insufficiency? 1. valve disease- rheumatic heart dz, endocarditis, bicuspid AoV 2. aortic root disease- HTN, marfan syndrome, syphilis, RA, SLE, aortic dissection, ankylosing spondylitis what kind of CHF can aortic regurgitation cause? LV filling from LA and aortic regurg -> LV dilated cardiomyopathy -> systolic HF dx? diastolic, decrescendo, blowing murmur maximal at L upper sternal border, inc intensity with squatting/sitting forward/ handgrip/expiration, dec intensity w/ valsalva/standing/amyl nitrate, austin-flint murmur, bounding pulses (d/t inc stroke vol), wide pulse pressure, laterally/inferior displaced PMI, pulsus bisferiens (double pulse carotid upstroke) aortic regurgitation/insufficiency *austin-flint murmur is a mid-late diastolic murmur from regurgitant flow competing with antegrade flow from LA to LV what are the tx options for aortic regurgitation/insufficiency? -medical mgmt- reduction in afterload w/ vasodilators (ACEi, ARBs, nifedipine, hydralazine) -surgical predominately AVR- in severely symptomatic pts or w/ EF ≤50% what is the MC cause of mitral stenosis? rheumatic heart disease dx? early-mid diastolic rumble at apex especially in LLD position, opening snap (at beginning of diastole), prominent S1 , dyspnea, hemoptysis, pulmonary HTN, Afib, R HF, flushed cheeks with facial pallor, signs of atrial enlargement (dysphagia, hoarseness) mitral stenosis what are the tx options for mitral stenosis? 1. percutaneous balloon valvuloplast/valvotomy: best for younger pts 2. open mitral valvotomy 3. mitral valve repair or replacement 4. medical mgmt (not great) w/ loop diuretics & Na+ restriction if congestion present, B blockers [Show Less]
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Pediatric Milestones & Vaccines- PAEA questions and answers
Car seat requirements <20 lbs rear facing seat 20-40 lbs front facing 40-60 lbs booster seat >60 lbs lab belt 4' regular shoulder/lap belt How ... [Show More] should a 2 wk old sleep? back to sleep Teething starts when? usually 6 months Temper tantrums start when? 12 months When should you try to toilet train? 18 months Signs and symptoms with teething crying, drooling, gingivial swelling, eruption cysts, diarrhea, pull at ears How much weight do babies lose in the first few days of life but regain in 7-10 days? 5-10% of birth weight How long does it take a newborn to double their birth weight? 4-5 months When does a newborn triple their birth weight? 1 year Increasing weight in the face of falling height suggests what? hypothyroidism Kids with >/= 95th percentile BMI are considered what? obese What age do you start vision and hearing screens? age 3 Moro Reflex allows infant's head to come off take a few inches and gently move back suddenly. Results in startling the infant. Infant should abduction and have upward movement of arms followed by adduction and flexion. -disappears at 3-4 months Rooting Reflex touching corner of infant's mouth should result in lowering of the lower lip on the same side with tongue movement toward the stimulus Sucking Reflex occurs with almost any object placed in the newborn's mouth, infant respond by sucking Grasp Reflex placing an object (such as a finger) on the infant's palm (palmar grasp) or infant's sole (plantar grasp) should cause a flexing of the fingers or a curling of the toes Asymmetric Tonic Neck Reflex place infant supine and turn head to the side, should result in ipsilateral extension of the arm and leg into a "fencing" position. The contralateral side flexes as well. When does stranger anxiety develop? Between 9 and 18 months 2 Month developmental milestones coos, symmetric movements, tracks 180 degrees 4 Month developmental milestones holds rattle, rolls front to back, passes objects across midline, bobble head, introduce cereal, babbling, pushes chest to elbows 6 Month developmental milestones babbles, rolls over, sits w/ support, introduce solids with spoon, introduce cup, responds to name, hand to mouth, stands supported and bounces 9 Month developmental milestones pincer grasp, mama/dada nonspecific, pulls up, reaches for objects, plays peek a boo, sits without support, points to objects, stranger anxiety, encourage self feeding 12 Month developmental milestones talks 1-2 words, 3 meals, 2 snacks, whole milk, limit juice, iron rich foods, waves bye bye, mama/dada specific, stands alone may walk 12 Month Anticipatory Guidance apply fluoride varnish, dentist referral, childproof home, rear facing car seat, read books, limit TV, store guns unloaded and in locked areas 15 Month developmental milestones 18 Month developmental milestones 2 Year developmental milestones at least 50 words, throws ball overhand, jumps up 2 Year Old Anticipatory Guidance discipline, read books, limit TV, encourage play with children, encourage exercise, care seat in back, bike helmet, fire plan 3 Year developmental milestones potty training, speech 75% understandable, feeds & dresses self, gender identity, copies circle 3 Year Old Anticipatory Guidance encourage interactive games, taking turns, family time, exercise 4 Year developmental milestones fantasy play, knows full name, knows what to do if tired/cold/hungry, knows 4 colors, hops on 1 foot, copies cross, dresses self 4 Year Old Anticipatory Guidance opportunities for play with other kids, read and talk with child, regular bedtime, no secrets from parents, review safety rules and private parts 5-6 Year developmental milestones balances on 1 foot, hops and skips, able to tie knot, ready for school, grips pencil, draws person with 6 parts, copies square and triangle, good articulation, counts to 10 7-8 Year Developmental milestones Ask how they are doing in school, do they understand rules and consequences 9-10 Year Developmental milestones promote independence, assign chores, safety rules, safety equipment Universal Screening: vision and hearing at 10 y/o Vaccination actual process of administering an agent; can be a toxoid, antitoxin or Ig. Results in active immunity and immunologic memory consistent with natural infection but without risk of disease. Usually contain preservatives or stabilizers (to inhibit microbial growth), and adjuvants (Al salts that enhance immune response) Immunization process of inducing immunity which is active or passive Active Immunity via vaccination or natural infection; permanent Passive Immunity via exogenously formed antibodies; temporary Live attenuated vaccine effectiveness depends on ability to replicate, response is similar to natural infection, usually effective with single dose Types of live attenuated vaccines MMR, varicella, rotavirus, Flu, yellow fever Inactivated vaccine cannot replicate in host usually requires multiple doses protected in vivo against circulating antibodies Types of inactivated vaccines Flu, polio, Hep A and B, diphtheria, tetanus, pneumococcal, meningococcal, HIB, HPV Which vaccine is given PO? rotavirus When is Hep A vaccine given? 2 doses: 1st dose at 12-15 months, 2nd dose 6-12 months after first dose (usually 2 y/o) -inactivated vaccine, given IM When do you give Hep B vaccine? 3 doses: 1st dose before child leaves hospital after born, 2nd dose at 1 month, 3rd dose between 6-9 months [Show Less]
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Women's Health PAEA questions and answers with verified content
What is the most sensitive area in radiation therapy ovaries treatment of preterm labor magnesium sulfate treatment for lymphogranuloma ven... [Show More] erium doxycycline erythromycin ** azithromycin snow storm on ultrasound molar pregnancy parabasal cells on pap. blood on urinalysis. what is the next step urine culture - do nothing - biopsy - renal sonogram MCC of death in women over 65 heart disease In the follicular phase of granulosa cells form at this at the edge of the follicle corona radiate zona pellucule centrum semiovula LH surge allows for ovulation how often should a woman get a pap smear 3 years after 21 tear through the anal mucosa grade 4 patient with family history of breast cancer, mother diagnosed age 35, died age 40. what year should patient start doing mammon 25 - 10 years prior to familial diagnosis patient presents with hypertension at 20 weeks with negative proteinuria. What do you recommend life style modifications strawberry cervix trichmonoiasis tx with flagyl vesicles on ren inflamed area herpes HSV 2 risk factors for endometritis advanced maternal age * multiple gestations breast feeding abdominal surgery menstrual pain for 3 weeks, young girl 15 yo treatment? NSAIDS patient presents with the inability to become pregnant for 11 months. recommendation come back in 1 month hormone to check when you reach menopause FSH will be elevated Patient with pelvic pain and missed period. First step qualitative BHCG (not quant) breast cancer risk factor nulliparity breast abscess tx I&D patient is Rh negative, father is positive. What test measures the amount go Rh antibodies of the mother Indirect coombs endometritis tx gentamycin and ampicillin patient has a positive GCT what to do next GTT what is the treatment for gestational diabetes regular insulin when is insulin highest physiologically 25 weeks diagnose preterm labor positive ferning test patient has PCOS- what diuretic to use spironolactone preterm labor maternal side effects of magnesium sulfate SOB and chest pain signs and symptoms of endometriosis + adhesions stage 3 what Fetal heart tracing is okay? early decelerations wha week do you test GBS 36 weeks what do you treat GBS with penicillin Petechial rash, and periventricular calcifications CMV 13 weeks, no heart beat, closed cervix missed abortion tx of missed abortion D&E (evacuation) what level is placement for epidural L3-4 epidural effects labor how prolongs it overweight female, facial hair, ovarian cyst PCOS patient has ovarian cyst removed. it has hair a calcified deposits what is it dermoid cyst breast development. no period. 17 yo primary amenorrhea mcc of secondary amenorrhea pregnancy when is amniocentesis done 16-18 weeks what vaccine is not recommended during pregnancy MMR, intranasal flu, oral polio, varicella what anemia is common in pregnancy decreased H&H patient has muscle pain, fever and enlarged nuchal lymph nodes cat scratch disease - toxo smoker, wants birth control copper T Stin levanthel syndrome (PCOS) initial treatment OCP tamoxifen is best for what type of breast cancer ER + postmenopausal invasive cercial carcinoma had a cone biopsy invaded into the pelvic wall. no mets stage 3a patient with htn + seizure eclampsia what is the most reliable test for IGUR estimated fetal weight - it is based on abdominal circumference, head circumference and femur length Lady from Russia adopted. no known family history genetic testing ? risk factor for breech position previous breech and polyhydramnios endometritis post c-section genta and ampicillin - also clinda is c-section fever, rash, joint pain early in pregnancy - now IUGR MMR vaccine could've prevented this mcc of postpartum hemorrhage uterine atony bulbo on labia lympho granulatum second stage of syphillis diffuse maculopapular rash on palms and soles stage of labor. Fully dilated and 100% effaced stage 2 first leopold feels for? 1. what fetal part occupies the FUNDUS 2. what side is the BACK on? 3. what lies over PELVIC INLET 4. what side is CEPHALIC PROMINENCE ROM diagnosis nitrazine, fern, alkali VEAL CHOP Variable - Cord Early - Head Acceleration - okay Late - placental insufficiency breast mass dx mammo --> US --> biopsy painless ulcerating chancer syphilis PMS first line tx NSAID no blood flow to adnexa ovarian torsion wide nipples turners unopposed estrogen can lead to what endometrial cancer perimenopausal symptoms check FSH post partum 6 months wants birth control - she is breast feeding give mirana (mini-pill of progesterone only) dyspareunia, dysmenorrhea, dyschezia endometriosis [Show Less]
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Women's Health PAEA questions with answers 2023
What is the most sensitive area in radiation therapy ovaries treatment of preterm labor magnesium sulfate treatment for lymphogranuloma ven... [Show More] erium doxycycline erythromycin ** azithromycin snow storm on ultrasound molar pregnancy parabasal cells on pap. blood on urinalysis. what is the next step urine culture - do nothing - biopsy - renal sonogram MCC of death in women over 65 heart disease In the follicular phase of granulosa cells form at this at the edge of the follicle corona radiate zona pellucule centrum semiovula LH surge allows for ovulation how often should a woman get a pap smear 3 years after 21 tear through the anal mucosa grade 4 patient with family history of breast cancer, mother diagnosed age 35, died age 40. what year should patient start doing mammon 25 - 10 years prior to familial diagnosis patient presents with hypertension at 20 weeks with negative proteinuria. What do you recommend life style modifications strawberry cervix trichmonoiasis tx with flagyl vesicles on ren inflamed area herpes HSV 2 risk factors for endometritis advanced maternal age * multiple gestations breast feeding abdominal surgery menstrual pain for 3 weeks, young girl 15 yo treatment? NSAIDS patient presents with the inability to become pregnant for 11 months. recommendation come back in 1 month hormone to check when you reach menopause FSH will be elevated Patient with pelvic pain and missed period. First step qualitative BHCG (not quant) breast cancer risk factor nulliparity breast abscess tx I&D patient is Rh negative, father is positive. What test measures the amount go Rh antibodies of the mother Indirect coombs endometritis tx gentamycin and ampicillin patient has a positive GCT what to do next GTT what is the treatment for gestational diabetes regular insulin when is insulin highest physiologically 25 weeks diagnose preterm labor positive ferning test patient has PCOS- what diuretic to use spironolactone preterm labor maternal side effects of magnesium sulfate SOB and chest pain signs and symptoms of endometriosis + adhesions stage 3 what Fetal heart tracing is okay? early decelerations wha week do you test GBS 36 weeks what do you treat GBS with penicillin Petechial rash, and periventricular calcifications CMV 13 weeks, no heart beat, closed cervix missed abortion tx of missed abortion D&E (evacuation) what level is placement for epidural L3-4 epidural effects labor how prolongs it overweight female, facial hair, ovarian cyst PCOS patient has ovarian cyst removed. it has hair a calcified deposits what is it dermoid cyst breast development. no period. 17 yo primary amenorrhea mcc of secondary amenorrhea pregnancy when is amniocentesis done 16-18 weeks what vaccine is not recommended during pregnancy MMR, intranasal flu, oral polio, varicella what anemia is common in pregnancy decreased H&H patient has muscle pain, fever and enlarged nuchal lymph nodes cat scratch disease - toxo smoker, wants birth control copper T Stin levanthel syndrome (PCOS) initial treatment OCP tamoxifen is best for what type of breast cancer ER + postmenopausal invasive cercial carcinoma had a cone biopsy invaded into the pelvic wall. no mets stage 3a patient with htn + seizure eclampsia what is the most reliable test for IGUR estimated fetal weight - it is based on abdominal circumference, head circumference and femur length Lady from Russia adopted. no known family history genetic testing ? risk factor for breech position previous breech and polyhydramnios endometritis post c-section genta and ampicillin - also clinda is c-section fever, rash, joint pain early in pregnancy - now IUGR MMR vaccine could've prevented this mcc of postpartum hemorrhage uterine atony bulbo on labia lympho granulatum second stage of syphillis diffuse maculopapular rash on palms and soles stage of labor. Fully dilated and 100% effaced stage 2 first leopold feels for? 1. what fetal part occupies the FUNDUS 2. what side is the BACK on? 3. what lies over PELVIC INLET 4. what side is CEPHALIC PROMINENCE ROM diagnosis nitrazine, fern, alkali VEAL CHOP Variable - Cord Early - Head Acceleration - okay Late - placental insufficiency breast mass dx mammo --> US --> biopsy painless ulcerating chancer syphilis PMS first line tx NSAID no blood flow to adnexa ovarian torsion wide nipples turners unopposed estrogen can lead to what endometrial cancer perimenopausal symptoms check FSH post partum 6 months wants birth control - she is breast feeding give mirana (mini-pill of progesterone only) dyspareunia, dysmenorrhea, dyschezia endometriosis Theca Lutein Molar pregnancy pelvic pressure, lumpy belly, heavy bleeding leiomyoma indications for genetic testing advanced maternal age risk factor for ectopic pregnancy salpingitis, PID, chlamydia patient has HTN and protein in the urine, begins to have seizures. How do you treat? this is eclampsia, deliver the baby patient with chlamydia and is pregnant. how can you treat her azithromycin is safe in pregnancy best test to diagnose ovarian cancer sono candida dx KOH wet mount thick, white adherent stuff in the vagina candida how to suppress herpes valacyclovir vaginal itching tx HRT treatment for PID other than azithromycin Ceftriaxone, Doxy what lab values are decreased in pregnancy H&H when do menses return postpartum week 6 abnormal rise in Bhcg and gestational sac in adnexal area ectopic pregnancy choriocarcinoma aneuploidy luteal phase secretory phase perineal laceration is what degree second degree treatment of endometritis ampicillin and gentamycin most significant risk factor for breech presentation polyhydramnios and multiparity what is a complication of a transverse lying fetus prolapsed umbilical cord how to diagnose premature rupture of membranes ferning test PCOS screening glucose levels ambiguous sign of ovarian cancer ascites PAP comes back high risk, what do you do next colposcopy and biopsy presenting part of breech presentation buttock first line treatment of PMS NSAIDS painless shallow ulcer with lymphadenopathy lymphogranuloma venerum painless ulcer with foul discharge + lymphadenopathy chancroid calcium intake for postmenopausal woman 1200mg most common type of cervical cancer squamous cell carcinoma most common cause of post menopausal bleeding vaginal atropy - second is endometrial biopsy treatment of choice for PMDD SSRI- fluoxetine When is GTT and GCT performed 24-28 weeks if GCT is >140 what do you do next? GTT cauliflower appearance condyloma acuminatum (HPV) Condyloma LATUM laten syphilis organ is at the introits and moves upward when valsalva is performed rectocele when to do an endometrial biopsy? >4mm stripe Endometritis treatment after C-SECTION gentamicin and CLINDAMYCIN Risk factor for preterm labor infection E.COLI medication to prevent preterm labor mag sulfate which FHT is okay during labor? early deceleration karyotype: clenched fists and rocker botton feet trisomy 18 [Show Less]
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