TB Testing Principles
The PPD is 5 tuberculin units in 0.1 ml is administered intradermally on the volar aspect of the lower arm and read 48 hours after
... [Show More] the test is given. The PPD result must have induration and measure 10 mm or greater to be positive in a low-risk patient. Greater than 5 mm is considered positive in high risk population such as those with known exposure to TB.
Any HIV person needs annual testing for TB.
A positive result warrants chest x ray.
Diagnosis confirmation with sputum culture.
TB Risk factors
Compromised immune system, high-risk populations (minorities, foreign-born people, prisoners, nursing home residents, indigents, migrant workers and healthcare providers), steroid therapy and blood disorders.
AFP (Alpha Feta Protein)
Produced in the fetal and maternal liver, higher levels are commonly seen in multiple gestations due to the growing fetuses and enlargement of the livers.
Calcium Channel Blockers
Act by blocking the calcium channels in the heart muscle and the blood vessels, thereby keeping more calcium in the bones.
Lachman Maneuver
Test performed to assess for knee instability. Knee instability indicates a tear of the anterior cruciate ligament.
Tanner Staging
After stage III, expect menses.
Stage IV is secondary breast mound
Stage III for males is lengthening of penis.
Stage IV is increased breadth and width.
S2
Caused by closure of the semilunar valves
Medicare Part B:
1. outpatient physician visits, lab, and x-ray
2. durable medical equipment
3. mammograms/colonoscopy yearly after age 50
4. rehab
Atopic Dermatitis
Skin condition in which the lesions occur in a linear fashion. they may have many different stages including erythematous papules and vesicles, with weeping, drainage, and/or crusting. Lesions are commonly found on the scalp, face, forearms, wrists, elbows, and backs of knees. commonly pruritic. Also known as eczema.
A positive Coombs test on an Rh-negative pregnant women means.
The mother's antibodies can attack the fetus's Rh-positive red blood cells and cause destruction of these cells, which can cause severe anemia and complications in the fetus. Today this is preventable with the administration of anti- RhD immunoglobulin to an Rh-negative mother at 28 weeks gestation and after birth if the newborn is Rh positive.
RhoGAM
Give to mothers with Rh negative blood when the fetus has Rh positive blood. RhoGAM protects the mother from developing antibodies by destroying the Rh-positive fetal RBCs in the mother's blood system.
Fitz-Hugh-Curtis
a complication of having pelvic inflammatory disease that was caused by a vaginal infection, such as gonorrhea or chlamydia. This causes inflammation and infection in the pelvic cavity. Left untreated, this infection can cause adhesions that stretch from the peritoneum to the liver.
Preeclampsia
Hypertension
Edema
Proteinuria
Presumptive Signs of Pregnancy
These are the signs that are experienced by the patient such as amenorrhea, breast tenderness, nausea, vomiting, fatigue, increased urinary frequency, etc.
Probable Signs of Pregnancy
These are the signs that are detected by the examiner such as enlarge uterus, Hegar's sign, and Chadwick's sign.
Positive Signs of Pregnancy
These are the signs that are direct evidence of pregnancy such as audible FHT or cardiac activity on ultrasound.
Chadwick's Sign
Bluish discoloration of the cervix and vagina.
Placenta abruptio
Bright red vaginal bleeding, board-like uterus on palpation, and pain.
Placenta previa
Painless vaginal bleeding
Jarish-Herxheimer reaction
Immune mediated reaction precipitated by the destruction of a large number of spirochetes due to the antibiotic injection
BV
Large amount of bacteria coating the squamous cells (Clue Cells) and very few leukocytes or RBCs.
Proventil (Beta Agonist) vs steroids and luekotriene
Proventil is a short acting bronchodilator and is used for immediate relief of shortness of breath. It acts quickly to dilate the tubes of the lungs where as steroids and leukotriene inhibitors help the inflamed channels of the lungs to remain open and clear over time. They are much slower acting than SABAs.
Hepatitis C
When a patient tests positive for anti-HCV, labs should be ordered and include hepatitis C PCR (polymerase chain reaction) to further evaluate the patient
When anti-hep C is positive then a HCV RNA should be performed.
Which of the following viral infections is associated with occasional abnormal forms of lymphocytes during an acute infection?
A. CMV
B. Epstein Barr -A test for an acute infection of the EBV will show abnormal lymphocytes
Will also demonstrate positive EBV titers, elevated liver enzymes, and elevated BUN and creatinine
C. HPV
D. Coxsackie Virus
Cafe au lait spots are associated with:
Neurofibromatosis or von Recklinhausen's disease. They are caused by an increase in melanin content, often with the presence of giant melanosomes. They have irregular borders and vary from light to dark brown.
Treatment for erythema migrans or Lyme Disease
Doxycycline 100 mg BID x 21 days
Risk factors for Coronary Heart Disease
Hypertension
Hypercholesterolemia
Women 55 years and older
Fundoscopic exam
A normal exam includes sharp disc margins, yellow-orange appearing macula and vein to artery ratio of 3:2
Snellen Chart
If a patient's vision results are 20/30 then the patient can see at 20 ft what a person with normal vision can see at 30 feet.
Somogi Phenomenon
Nocturnal hypoglycemia (2 a.m. to 3 a.m.) stimulates the liver to produce glucagon to raise the blood sugar. The fasting blood glucose levels will be elevated from this glucagon production.
Initial evaluation for intermittent claudication would include:
Checking the ankle and brachial blood pressure before and after exercise
Peak expiratory flow is determined using
Height, gender, and age.
Retinoblastoma
Retinoblastoma is a rare type of cancer in which a cancerous tumor of the retina is present. This is diagnosed by noting a pupil that appears white of has white spots on it. One or both eyes may be affected. It is often seen in photographs, where there will be a white glow in the eye instead of the usual "red eye" noted in pictures from the flash.
You are reviewing the bilirubin level on a 3 day old full term neonate. You note that it is 10. The infant has a slight yellow color to his skin, mucous membranes, and sclera. The infant is feeding well, is not irritable, and has 8 to 10 wet diapers per day.
Keep on monitoring the infant's bilirubin level until it returns back to normal in about one week.
Bilirubin is excreted through the urine and feces. Increased fluids and wetting 8-10 diapers a day is sufficient fluid intake/excretion to help bring down the bilirubin level. Levels should continue to be monitored and should improve in approximately 1 week.
Atrophic Vaginitis
Symptoms include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0.
Koilonychia
Abnormal shape of the nail caused by iron-deficiency anemia. Nail bed is thin, with irregular edges, and curves inward.
S3 heart sound
S3 heart sounds occur early in diastole and are sometimes referred to as a "opening snap". It is a normal variant in children, healthy young adults, and athletes. Bibasilar crackles in lung bases and the presence of S3 heart sounds are classic findings of CHF.
Heberden's Nodes vs Bouchard's Nodes
Bony nodules on the distal interphalangeal joints commonly seen in degenerative joint disease
Bony nodules on the proximal interphalangeal joints commonly seen in Rheumatoid Arthritis
B comes before H. Proximal joint comes before distant.
Hordeolum
Painful, acute bacterial infection of the hair follicle on the eyelid.
Pterygium
Thickening of the conjunctiva located on the nasal or temporal cornea. It is caused by UV light of long-term sun exposure [Show Less]