1
Q
Most common bacterial infection in pregnancy
A
UTI
2
Q
Asymptomatic bacteriuria is more common in ____ women, and these are also at higher risk for progression to upper UTI or pyelonephritis (predisposed to retention, stasis, vesicoureteral reflux, etc)
A
pregnant
3
Q
Upper genital tract vs lower
A
Uterus, tubes, ovaries, pelvic peritoneum compose the upper and are all normally sterile while cervix and vagina are lower and are an infection waiting to happen
4
Q
All pregnant women should be screened with a clean catch urine culture and sensitivity as well as a urine dipstick at which prenatal visit….
A
….first prenatal visit (12-16 weeks gestation)
5
Q
Most common causative organism of UTI’s in pregnancy (1)
A
-E coli
6
Q
Asymptomatic bacteriuria
A
Pregnancy disease significant bacterial colonization of the bladder without symptoms, as little as 100CFU/mL can indicate active infection depending on bacteria type***, risk of pyelonephritis is already increased in pregnancy
7
Q
Risk factors of asymptomatic bacteruria (4)
A
- prior history of UTI
- anatomic abnormalities
- sexual behavior (poop in the vag hole)
- immunocompromised (DM, HIV)
8
Q
Cystitis in pregnancy
A
Pregnancy disease symptomatic infection fo bladder with significant number of organisms >100organisms/mL with accompanying pyuria, dysuria being the most significant symptom and may be difficult to distinguish from pregnancy related complains, pelvic exam considered for all symptomatic patients
9
Q
UTI in pregnancy treatment (4) and what should you NOT use and why? (3)
A
- nitrofurantoin 100mg oral (1st-early 3rd trimesters only)
- augmentin
- fofsomycin
- test for cure after treatment and repeat each trimester for recurrent infection (do this in ANY infection of pregnancy actually)
- sulfa drugs (inhibits folate and bilirubin kernicterus)
- fluorquinolones (fetal arthropathy)
- tetracyclines (detect fetal bones and teeth)
10
Q
Pyelonephritis in pregnancy
A
Most common UTI complication in pregnant women most often occurring in 2nd trimester, frequently associated with septicemia, marked fetal/maternal morbidity and mortality, fetal bloodstream infection is rare so few direct fetal sequalae, but issue of hypoperfusion to placental vasculature and potential fetal cerebral hypoperfusion
11
Q
Most common cause of neonatal sepsis, gold standard for diagnosis
A
GBS, culture with vaginal and rectal swab routinely done at 35-37 weeks gestation
12
Q
Neonatal GBS presentation (4)
A
- septicemia
- pneumonia
- meningitis
- potential infant mortality
13
Q
Treatment of maternal GBS (2)
A
- treat at least 4 hours before delivery
- intrapartum prophylaxis using empiric treatment if culture results unknown
14
Q
TORCHES viruses
A
Toxoplasmosis
Other (hep B, coxsakie, west nile, measles, HIV, zika)
Rubella
Cytomegalovirus
Herpes simplex
Erythema infectiosum (parvovirus B19 5th disease)
Syphilis
Infections developing intrauterine or during birth process
15
Q
Toxoplasmosis risk factors in pregnancy (3), signs and symptoms, and treatment (1)
A
- raw or undercooked meat
- cat litter
- contaminated soil
- asymptomatic to mild fatigue and myalgias, congenital toxo in fetus causing blindness, microcphaly, etc.
- ID consult for intense meds
16
Q
If mother infected with rubella in early pregnancy, __% of assing it to fetus (congeintal rubella syndrome)
A
90%
17
Q
Congenital rubella syndrome presentation (5)
A
- blueberry muffin purpura
- small gestational age
- cataracts
- heart defects
- hearing defects
18
Q
Congenital rubella syndrome is contagious for up to…
A
….1 year (isolation required)
19
Q
CMV in pregnancy clinical presentation (2)
A
- majority asymptomatic
- congenital effects on the infant including sensorineural hearing loss***, IUGR, hepatosplenomegaly, etc
20
Q
HSV passage from mother to child
A
Infected birth canal (HSV2 infection of pregnant woman), indication for c section if active visible vesicles, if mother doesn’t want to need informed consent documentation
21
Q
Syphilis presentation in neonates (3)
A
- maculopapular rash on palms and soles
- lymphadenopathy
- hearing loss
22
Q
Syphilis treatment option in pregnant women (1)
A
-PCN is only one
23
Q
Sever disseminated varicella in the infant symptoms (3)
A
- hemorrhagic lesions
- sepsis, hepatitis, meningoencephalitis
- severe pneumonia
24
Q
Severe disseminated varicella in the infant treatment options
A
- acyclovir
- varicella IG
25
Only ___ (type of presentation of varicella zoster virus) has pregnancy concerns, not ___
varicella (chickenpox), herpes zoster (shingles)
26
Listeria monocytogenes infection in pregnancy treatment options (2)
- ampicillin
- bactrim as backup (remember this isn't good for the mother we want to avoid)
27
Chorioamnionitis and risk factors (4) and treatment (2)
Ascending infection of uterus and contents (palcenta, amniotic membranes/fluid, umbilical cord)
- prolonged rupture of membrane
- prolonged labor
- preterm labor
- meconnium staining of amniotic fluid
- Induction of delivery
- antibiotic treatment
28
After day 1 of a post partum fever, it should be considered..
....pelvic infection until proven otherwise
29
Episiotomy infection
Post partum wound infection, very rare and unlikely cause of post partum fever, risk factors include smoking and coagulation disorders and can be classified into different categories based on level of tissue involved and corresponding causative agent
30
Episiotomy infection clinical presentation (1) and treatment (2)
-painful dysuria discharge from site
- Surgical wide debridement
- adjunctive antibiotics clindamycin + B lactam
31
Risk factors for post partum endometritis (3) and causative agents(1) and treatment options (1)
- c section****
- Prolonged rupture of membrane
- prolonged labor
- multiple 2-3 organisms
- triple therapy, ampicillin gentamicin and clindamycin (post c section) or gent and clinda post vaginal
32
Post abortion infection presentation (5)
- 4 days post abortion
- fever
- chills
- tachycardia
- lower abdominal pain
33
Post abortion infection diagnostic studies (4) and causative agent (1) and treatment (2)
- positive pregnancy test 4-6 weeks post abortion indicates retention of fetal material
- gram stain
- C&S
- abdominal film
-polymicrobial infection
- amp and gent + clinda or metronidazole
- uterine suction curettage
34
Most common agent of mastitis in mother
-staph aureus
35
Treatment of mastitis (2)
- continuation of nursing (emptying breast)
- cephalexin to prevent abscess
36
Mastitis in a nonbreastfeeding woman could indicate....
...breast cancer
37
Chlamydia 1st line treatment and 2 backups
- azithromcin 1g po one time
- erythromycin
- amoxicillin
38
Chlamydia in pregnancy
Most common STI, can cause cervicitis or PID in mother or conjunctivits in newborn, screened at 1st visit and all at risk or younger than 25 should be rescreened in 3rd trimester
39
Gonorrhea 1st line treatment in mother and in newborn
- cephtriaxone + azithromycin
- erythromycin opthalmic ointment routine prophylaxis in newborns
40
Osteoarthritis differs from rheumatoid arthritis in that it commonly affects this joint of the hands, while it is spared in rheumatoid arthritis
DIPs
41
X ray findings consistent with osteoarthritis (3)
- Narrowing of joint space (RA has preserved joint space)
- subchondral sclerosis
- osteophytes
42
Orthopedics definition
Branch of medicine concerned with acute, chronic, traumatic, and overuse injuries and other disorders of the musculoskeletal system
43
Articulation definition
Joint or junction between any 2 bones or cartilages
44
Genu varum vs genu valgum
Varum is outward bowing knees (collapsing of the joint space medially and gapping of it laterally either traumatic or degenerative) then test with valgus stress test to see if repairable with bracing or LCL integrity test via varus stress testing, valgum is inward bowing of the knees (loss of joint space laterally and expansion medially) that can be tested with varus stress test to see if repairable with bracing or MCL integrity test via valgum stress testing
45
Epiphyseal plate (physis) definition
Growth plate, open in children allowing them to grow, sealed off in adults
46
3 compartments of the knee
- medial
- lateral
- patellofemoral compartment (front of knee space between patella and femur)
Osteoarthritis can occur in any of these 3
47
Sprain vs strain
Stretching or tearing of the ligaments supporting an articulation (includes capsules ligaments are located within as well), vs stretching or tearing of a musculotendinous unit
48
Tendonitis definition
Inflammation/irritation of a tendon most commonly due to overuse
49
Tendinosis (chronic tendonitis) definition
Degenerative condition affecting the tendon, commonly associated with micro tears that can be seen only on MRI (not x ray)
50
Shoulder dislocation vs shoulder separation
Dislocation refers to glenohumeral joint (humerous head in the glenoid fossa pops out most often anterior), vs separation refers to acromial clavicular joint (clavicle not aligned with acromion, clavicle pops up creating characteristic bony step off)
51
Osteoarthritis/degenerative joint disease
Mechanical wearing of articular surfaces with loss of articular cartilage collapsing of joint space and new bone growth (osteophytes) and hardening (sclerosis) of bone, either primary (unknown cause) or secondary (to injury)
52
Angulation of fracture description
Condition where fracture fragments are not anatomically aligned, fracture fragments are at an angle to one another in comparison to anatomical alignment, described by direction that apex is pointing relative to long axis of bone in anatomical position (ex - volar angulation in a colles fracture)
53
Displacement/translation of fractures description
When fracture fragments/dislocations are not axially aligned, describe direction of placement based on DISTAL fragment relative to proximal (ex - dorsal displacement in a colles fracture)
54
Rotation of fractures description
Condition in which fracture fragments are rotated relative to each other, described according to the direction in which the distal fragment is rotated relative to proximal portion, very important in the digits
55
Reduce/reduction ortho definition
To restore a fracture or dislocation to correct positioning/alignment, either closed (manipulation of joints thru skin) or open (surgical procedure)
56
External fixation/fixator or "ex-fix" definition
External device that has pins entering the skin into the bone proximal and distal to the fracture site with metal bars connecting to adjust the length and tension in order to realign properly in the process of reducing a bone
57
ORIF definition
Open reduction, internal fixation, involves making incision thru skin, identifying fracture and placing it into proper alignment, and placing a fixator device (plates, screws, rods, etc)
58
Volar vs dorsum of wrist
Volar is the anterior surface in anatomical position and dorsum is the posterior surface
59
If the distal fragment of a bone moves medial relative to the proximal fragment, we call it ___ displacement
medial displacement
60
What should be rechecked following any and all orthopedic procedures and treatments?
Neurovascular status - you don't want to be the cause of why they lose a limb!
61
Splint definition
External fixation to support body parts or structures, noncircumferential as it immobilizes but allows for swelling**** and easy removal, want to put on a splint in the acute stage of an injury
62
Cast definition
Form for a body part in a stiff mold made of bandage and hardening material (plaster more flexible and fiberglass less flexible but more supportive), circumferential for fixation of extremity, do not want to put on in presence of any swelling for fear of compartment syndrome or shrinkage resulting in loose cast, used in the long term
63
3 layers of splinting and casting materials
1) stockinette (cotton, tubular, sock like material)
2) undercast padding (cotton or gore-tex [skip the 1st step in this case - can get wet])
3) Casting tape/splint material
64
Position of function vs position of rehabilitation
Positioning for most splints/casts as it preserves normal lay of extremity and provides least tension on fracture fragments (body going limp)
Positioning for some casts/splints as it maintains reduction while preserving functional balances and preventing contractures/adhesions
65
Where should adequate cotton padding be used especially in a cast?
How do we smooth over plaster/fiberglass?
What temp water is used?
- at bony prominances and edges of cast
- Gloved palm, no fingers
- Cool to room temp, not hot, the resin activation is already warm
66
3 most common imaging modalities in orthopedics
- radiographs (xray)
- MRI
- CT
67
X rays (radiographs)
Best for imaging bony structures, differentiates well between bone (white), soft tissue (grey), and air (black), 2D in nature so often have to get multiple films to get a better view of structure, full eval should always include joint above and below, indicated in deformity of bone or joint or suspicion of fracture, or pain/inability to use the extremity. Children and pregnant women need shielding to minimize radiation exposure
68
Maisonneuve fracture definition
Fracture of proximal fibula near the head (around knee) associated with a distal tibial fracture (ankle) based on the interosseous membrane that runs between these that pulls on the proximal fibula, emphasizes importance of evaluating joint above and below when imaging to not miss things like this
69
Periosteum definition
Dense connective tissue sheath around the bone where osteoblasts develop, can become thickened (reactive) when injured, elevated in bone irritation/inflammation, or disrupted in a fracture
70
Epiphysis vs physis vs metaphysis vs diaphysis
Caps on the end of bone proximal and distal, growth plate, transition of bone into body (flare), body shaft of compact cortical bone
71
Sail sign/posterior fatpad sign
Suggestive of occult fracture of the proximal radius based on x ray finding where we see subcutaneous tissue being pushed off the soft tissue due to swelling of pooling blood
72
Arthrogram definition and 2 risk factors with performance
Injection directly into joint capsule often under ultrasound guidance, often the shoulder, of contrast dye that is then taken under x ray for analysis of leakage, less costly than CT or MRI, does have increased risk of infection or allergic rxn
73
MRI use in ortho
Imaging study with advantage of seeing soft tissue details, can identify minor tumors excellent for imaging of spine (disc herniation, nerve compression) or joints (esp. associated torn ligaments and tendons or occult stress fractures), can be combined with contrast materials, might be indicated for preoperative planning or sorting out diagnostic dilemmas (generally not first line unless suspected neurological/soft tissue involvement)
74
MRI contraindications (2)
- Metallic foreign body presence in welders, shrapnel, implants, etc
- claustrophobic patients (sedation or anxiolytic might be needed)
75
CT scans use in ortho
Imaging study that offers visualization of bone, muscle, and fat, bone is excellently visualized but soft tissue less so, indicated in preoperative planning for bony fractures, or complex fracture patterns with fractures involving articular surfaces, also often used in patients with degenerative spine disease
76
Bone scan definition
Nuclear medicine study useful for displaying blood flow and metabolic activity of bone thru injection of IV radioisotope and study of its distribution, indicated in identifying infections, tumors, or occult fractures (all places where there is increased metabolic activity)
77
Knee dislocations always require what radiologic study?
Angiography
78
Torus/buckle fracture definition
Fracture most often seen in children where the periosteum is elevated due to bone irritation/inflammation from a fracture of the bone that has not extended out past the periosteum, leaving it completely in place
79
Fracture callus definition
Repair that bridges the proximal and distal bone in a healthy healing bone
80
Diagnostic ultrasound in orthopedics
Can assist in guiding procedures but not effective at identifying details of bone pathology, moreso used in soft tissue/malignancy detection
81
Ankle mortus definition
The true ankle joint between distal fibula and tibia and talus dome, want consistent space between the structures, if see widening on x ray will see ankle joint shifted indicative of ligamentous tear
82
Femur fractures often sees what cutaneous manifestation?
Significant bruising/hematoma from exceptional blood loss
83
Always tell a patient times when you cannot honor confidentiality, what 3 times are those?
- Child abuse
- Threat to self
- Threat to others
84
___ fraction of patients have experienced a traumatic life event
1/4
85
Counter transference definition
A tendency for providers to bring emotional bias to a patient interaction that might influence the situation from objectivity, should be mitigated with good self awareness in patient interactions
86
Family history of suicide can increase patient risk of...
...suicide themselves
87
The 4 groups of major psychiatric disorders
- Mood disorders
- Anxiety disorders
- Psychotic disorders
- Substance abuse disorders
88
SIGECAPS mneumonic to determine presence of neurovegetative symptoms of depression
```
Sleep disorder
Interest deficit (anhedonia)
Guilt
Energy deficit
Concentration deficit
Appetite disorder
Psychomotor retardation or agitation
Suicidality
```
89
3 questions to always ask about suicide ideation
- Are you suicidal?
- Do you have a plan?
- Do you have a means to carry it out?
90
Persistent depressive disorder (dysthymia) definition
Chronic depression lasting at least 2 years that does not meet the criteria for major depression
91
DIG-FAST mneumonic for cardinal symptoms of mania
```
Distractibility
Indiscretion (excessive involvement in pleasure activities)
Grandiosity
Flight of ideas
Activity increase
Sleep deficit (decreased need for sleep)
Talkativeness (pressured speech)
```
92
Red flags for borderline personality disorder (3)
- History of doctor shopping or legal action against providers
- Several marriages
- Idealization and excessive violation of boundaries
93
CAGE questionairre
Screening for alcoholism, with a positive response to 2 or more items implies a 95% chance of alcohol abuse or dependence (sensitive to how it is asked, do not assume)
Cut down on it?
Annoyed by people criticizing your drinking?
Guilty about drinking?
Eye opener drinking first thing in the morning?
94
Biopsychiatry definition
Study that aims to understand mental disorder in terms of biological function (looks at mental illness like a physical illness) as human behavior and thoughts are related to many biological processes
95
Example of biological basis for depression
An overactive area of the brain - brodmann area 25, is overactive in them
96
Genetic link in bipolar and schizophrenia
First degree relatives of people with either schizophrenia or bipolar disorder are at increased risk of both these conditions
97
Infectious disease that can be strongly associated with OCD development
Streptococcal infection
98
Socioeconomic factors associated with mental illness (4)
- Be female
- Divorce
- Live alone
- Single parents
99
Personality definition
Individual difference in pattern of thinking, feeling, and behaving combined determination from genetic temperament and environmental influences
100
4 personality types (temperament)
-Sanguine (optimistic, active social)
Choleric (short tempered, fast irritable)
Melancholic (analytical wise quiet)
Phlegmatic (relaxed and peaceful)
101
Neuroplasticity definition
Ability of the brian to change as a result of one's experience, brain's ability to reorganize itself and form new neural connections thru out life. This allows neurons to compensate for injury or disease (CVA, audism, addiction, depression, etc) or develop further and make new connections through psychotherapy and mediation
102
Kindling theory in psychology
Development of hypersensitivity to a stimulus that initially causes very little response that after repetition produces a full response, the idea that small misfires in the brain in repetition can lead to massive impact (seizure, depression, etc) that sees actual structural changes in neurons occur in response to stimulation leaving an enhanced susceptibility for lifetime persistence
103
Norepi is elevated in these 2 conditions and decreased in these 2
Manic episodes and panic attacks, ADHD and depression
104
Dopamine is elevated in this condition and low in these 3
Schizophrenia, ADHD/fatigue/depression
105
Locus coeruleus definition
Major adrenergic nucleus in brain that contains norepi producing cells that have an excitatory effect on most of the brain, when stimulated by a lack of drug it drives addiction to do anything necessary to receive stimulation again, involved in panic attacks, PTSD, anxiety, and drug abuse majorly
106
Amygdala definition
Part of limbic system located in temporal lobe that controls emotional arousal, survival instincts, and memory. When stimulated results in aggression, strongly linked to libido (low T has smaller amygdala) and appears to be linked to BPD, anxiety, and PTSD
107
George Vaillant's 6 adult tasks necessary for maturity
- Development of identity (separation of adolescent from parents)
- Development of intimacy (expanding sense of self to include another person)
- Career consolidation (finding career valuable to self and society)
- Generativity (being in a relationship but not in control)
- Becoming keepr of the meaning (passing traditions to next generation)
- Achieving integrity (peace about life and world as they exist)
108
Social clock
Idea that there is culturally preferred timing for certain life events such as job, leaving home, retirement, etc.
109
Narrative psychology
Idea that humans construct stories to deal with experiences, that human activity/life experiences are filled with meaning and there are implications behind the stories, that there is a development of self that is continuous as one constructs own life's story
110
Carol Ryff's 6 dimensions of well being
- Self acceptance of both good and bad
- Control over one's surroundings (influence one's environment and adapt to difficult circumstances)
- Positive relationships with others
- Autonomy
- Personal growth
- Life purpose
111
Costa and Mccrae's 5 basic dimensions of personality and acronym to remember them by
-Extraversion (includes excitability, sociability, etc)
-Agreeableness (attributes such as trust, altruism, affection)
-Conscientiousness (thoughtful and good impulse control)
-Neuroticism (instability, anxiety)
-Openess (imagination and insight)
OCEAN
112
Cognitive appraisal theory
Idea that an individual's interpretation of an event determines their emotional reaction
113
Effects of institutionalization on the elderly (6)
- Loss of sense of identity and autonomy
- Reduction of ADLs
- Worsening cognition
- Sense of abandonment by family and friends
- Sense of loss of freedom, privacy, community
- Depression
114
2 most common psychiatric diseases in the elderly
- Dementia
- Depression
115
Signs of elder abuse (4)
- Bruises
- lack of basic hygiene
- Unexplained behavioral changes
- Large withdrawals from bank account
116
3 criteria that must be met to diagnose a mental disorder being caused by a general medical condition and 2 types of conditions it does NOT include
- Evidence the disturbance is a direct consequence of the condition
- Disturbance is not better accounted for by a mental disorder
- Disturbance does not occur exclusively during course of delirium
-Neurocognitive disorders or substance intoxication
117
Rabies common mental associated symptoms (3)
- 4-8 week incubation followed by nonspecific symptoms
- paresthesias/fasciculations at the bite site
- episodic confusion/psychosis/combativeness
118
Lyme common mental associated symptoms (4)
- Ticks must stay attached over 36 hours to transmit
- Flulike symptoms after laying dormant for months to years
- erythema chronicum migrans rash
- Diagnosed via ELISA
119
Neurosyphilis common mental associated symptoms (3)
- Argyll robertson pupils (bilateral asymmetrical small irregular pupils hard to dilate
- Personality and neurological changes
- Hyperactive reflexes
120
Creutzfeldt Jacob disease common mental associated symptoms (2)
- 10-15 year delay in onset of symptoms most often 55-75 year olds
- perception/vertigo/psychosis
121
Metabolic encephalopathy (hepatic or renal) common mental associated symptoms (3)
- Asterixis
- Jaundice
- Porphyria (build up of natural chemicals in the body causing nonspecific/cognitive syndromes often genetic in origin)
122
Triad of porphyria
- Episodic acute colicky abdominal pain
- motor polyneuropathy
- psychosis
123
Flat affect is often seen in patients with....
....Parkinson's disease
124
Hypercalcemia 4 common presenting symptoms
- Stones (urinary ca2+)
- Bones (osteoporosis)
- Groans (fatigue, peptic ulcer, constipation)
- Psychiatric overtones
125
Porphyria definition
group of inherited disorders affecting ability to produce heme, with attacks causing abd pain, skin changes, seizures, muscle weakness, and attacks can be triggered by hormone changes, alcohol, stress, smoking, and certain meds, some types can be managed with trigger avoidance while others require meds or rarely transplants
Professional Development
flashcards
Decks in class (62)
# Cards
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Part 1122
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Part 2123
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Part 3120
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Part 4150
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Part 5124
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Part 6125
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Part 7148
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Part 8160
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Part 9198
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Part 10119
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Part 11131
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Part 12119
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Part 13126
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Part 14123
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Part 15133
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Part 16142
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Part 17124
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Part 18135
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Part 19127
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Part 20108
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Part 21160
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Part 22125
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Part 23145
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Part 24160
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Part 25170
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Part 26120
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Part 27130
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Part 28153
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Part 29124
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Part 30144
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Part 31181
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Part 32121
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Part 33165
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Part 34133
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Part 35116
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Part 36175
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Part 37170
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Part 38191
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Part 39222
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Part 40150
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Part 41124
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Part 42154
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Part 43183
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Part 44132
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Part 45103
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Part 46125
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Part 47165
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Part 48126
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Part 49114
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Part 50155
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Part 51151
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Part 52101
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Part 53128
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Part 54151
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Part 55130
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Part 56132
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Part 57149
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Part 58131
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Part 59151
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Part 60151
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Part 61136
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Part 62111
