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Koilonychia
Spoon shaped nails, thin, concave- seen in anemia
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Cheilosis
Reddened lips with fissures at angles
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Leiomyoma
Benign lesion of smooth muscle
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Osteosarcoma
Malignant lesion of bone
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Glioma
Malignant lesion of neurological cells
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Palpebral conjunctiva
Mucosal lining covering inner eyelids
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Bulbar Conjunctiva
Mucosal lining covering eyes
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Presbyopia & its causes
Diminished near vision, due to age, and hardening of lenses
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Trismus & what it is seen in
Inability or difficulty opening mouth, seen in peritonsillar abscesses
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Sensitivity
the Test ability to find TRUE positives
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Specificity
the test ability to find TRUE negatives
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Telogen Effluvium & what typically causes it?
Hair falls out in handfuls, due to stress
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Alopecia Areata & What typically causes it?
Autoimmune
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WISEWOMAN- what did it do?
Provide screening/evaluation for midlife, minority uninsured women
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Treatment for Anthrax?
Ciprofloxacin
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Hemoglobin Electrophoresis, what is it, and what does it test?
Gold Standard for thalassemia
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Foods High in Potassium:
Most Fruits & Vegetables, OJ, Bananas,
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Foods High in Magnesium:
Whole Grains, Whole Wheat, Nuts
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Foods High in Folate:
Green Leafy Vegetables, Liver
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Foods High in Saturated Fat:
Animal fats, Coconut Oil All those oils you'd put on your body to tan
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Foods High in Unsaturated Fat:
Olive Oil, Canola oil
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Foods High in Calcium:
Dairy, yogurt cheese
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How can a pregnant mom get calcium ADA easily?
1 quart of milk/day
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Foods High in Sodium :
Cold cuts, canned foods, preserved foods, prepared foods
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Foods High in Iron:
Red Meat, Black Beans, organ meats, Spinach
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Foods High in Vitamin K:
Green Leafy Vegetables
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What foods do you avoid in HTN and what do minerals do you want to get?
Avoid High Sodium Foods. Get Calcium, Mag, and Potassium
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What foods do you avoid in Headaches?
Chocolate, Aged cheeses, red wine, MSG
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What foods do you avoid when taking MAOI meds?
Avoid High Tyramine foods: red wine, aged cheese, beer, chocolate, fermented foods
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What foods do you avoid in Coumadin?
Vitamin K foods, Green leafy veggies
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When is pitting of the nails seen?
Psoriasis
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What is another word for this: Eczema
Atopic Dermatitis
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What is another word for this: Purulent otitis media
AOM (Acute Otitis Media)
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What is another word for this: Group A Beta Streptococcus
Strep Pyogenes
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What is another word for this: Tinea Corpis
Ringworm
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What is another word for this: pinworm
Enterobiasis
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What is another word for this: Scarlet fever
Scarletina
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What is another word for this: Swimmer's ear
Otitis Externa
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What is another word for this: Genital Warts
Condyloma Accuminata
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What is another word for this: Dic Douleureaux
Trigeminal Neuralgia
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What is another word for this: Jock Itch
Tinea Cruris
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What is another word for this: Giant Cell Arteritis
Temporal arteritis
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What is another word for this: asthma
Reactive airway disease
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What is another word for this: scalp ringworm
Tinea capis
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What is another word for this: Virchow's nodes
Sentinel nodes
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What is another word for this: Early Lyme's disease
Erythema Migrans
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When is the CAGE test positive for suspicion of ETOH abuse?
2 or more positives is suggestive of alcoholism
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Leukoplakia, what is it? Where is it?
Slow growing white plaque of tongue, cheeks
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What does Leukoplakia represent?
Precancerous, refer for biopsy to dx
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Who gets and What causes Oral Hairy Leukoplakia?
Seen in HIV/AIDS pts, caused by EBV
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What is a geographic tongue?
Normal variant, inflammatory process, causes grooves, etc
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Smooth shiny tongue? Anything to be concerned about?
Atrophic Glossitis (B12 deficiency, iron deficiency, or chemotherapy)
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Primary or Secondary Prevention? Immunizations, Chemoprophylaxis, condoms
Primary
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Primary or Secondary Prevention? Fall prevention, bike helmets, health education
Primary
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Primary or Secondary Prevention? Mammo, FOBT, Pap
Secondary
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Most common cause of non-occupational poisoning death in adults?
Car exhaust, then cocaine/heroin, then antidepressants, then barbiturates
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Vitamin C Deficiency is manifested in?
Bleeding gums, broken capillaries under skin, pinpoint hemorrhages, nonhealing wounds, collagen issues, muscle degeneration, rough brown scaly skin
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Vitamin B Deficiency, how does it come about?
Inadequate ABSORPTION, no inadequate intake, due to lack of hydrochloric acid or lack of intrinsic factor
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What disease of elderly makes B12 deficiency more common?
Atrophic gastritis
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Vitamin D Deficiency?
Same as calcium deficiency, rickets, Osteomalacia
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Alopecia universalis?
Total body hair loss
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What drugs can cause alopecia?
BCP, ASA, Coumadin, antithyroid drugs, allopurinol, chemotherapy
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Do not take grapefruit juice or supplement EVER with these meds?
Statins, digoxin, benzos, many ACE, ARB, and Calcium channel blockers
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What is atopic triad?
Atopic dermatitis, asthma, allergic rhinitis
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What is Samter's triad?
Asthma, ASA sensitivity, and nasal polyps
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What is the best way to visualize jaundice?
Look for icteric sclera
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What medications increase photosensitivity and therefore should avoid sunlight?
Most antibiotics, hydrochlorothiazide, diltiazem, ibuprofen, naproxen
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What antibiotic won't cause photo sensitivity?
Penicillin, amoxicillin
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What side effect can oral cholecystogram have to urinary system?
Dye can cause burning with urination
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What is dysthymia?
Depressed mood, low level depression
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What is the second leading cause of cancer death?
Colorectal cancer
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What is the leading cause of cancer death for men and women?
Lung
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What does an IRB do (institutional review board)?
Protects the rights of human subjects
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What 3 things must be present for malpractice to occur?
Harm, Duty, Deviation (breach) from the Standard of Care
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Main reason for outpatient malpractice?
Failure to diagnose correctly or in a timely fashion, such as in cancers
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What are the reportable diseases or findings?
Gun Shot Wound, TB, HIV, Syphilis. Also abuse or suspected abuse needs to be reported. Some states also require meningitis, measles.
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At what percentage can the NP be reimbursed with billing?
85% if see patient on own. But can be reimbursed %100 under MDs provider number if MD is involved.
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What is an occurrence based liability insurance policy?
Better one to have. It covers you for an incident that happened during the policy coverage period, even if you are not presently covered by that insurance.
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What is beneficence?
Duty to help others. Obligation to help those in need.
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What is non-malfeasance?
Provider do no harm, with or without intention. If harm unavoidable, try to minimize harm. i.e.: educate person to decease drug side effect
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When is Autonomy is not a right for the patient?
When their disease could harm another, i.e. Tuberculosis and refuse to take meds
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What is Justice?
All people are to be treated in the same equitable manner
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Veracity?
Be honest and give full disclosure
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What is duty?
A relationship that exists between the provider and the patient
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What is breach of duty?
Violation of accepted standards while rendering care
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Negligence?
If no physical or emotional harm or injury occurred
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How long does it take for active immunity to provide protection?
Take onset of 1 month, lifetime duration
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How long does it take for passive immunity to provide protection, how long does it last and how do you get it?
Onset in ONE hour, lasts less than one year
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What vaccines are contraindicated with Baker's Yeast Allergy?
Hepatitis B
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What vaccines are contraindicated with Egg Allergy?
All forms of Influenza virus
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Allergy to Neo Mycin, Streptomycin, polymycin, what vaccines are contraindicated?
Polio vaccine, MMR, varicella, smallpox
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What all pathogens does the pneumovax protect against?
ONLY ONE- Streptococcus pneumoniae
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What vaccine is contraindicated in adult asthmatics, COPD?
Live flu vaccine (Flu Mist) also only for people less than age 50
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What vaccine should be offered if patient is already HPV positive, or has genital warts?
Still give the HPV vaccine, as it covers several strains, and may cover one she does not have
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When is live virus vaccines contraindicated in HIV infection?
When CD4 T lymphocyte count is <200
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Contraindications to the live flu mist vaccine?
<2, >49, egg or chix protein anaphylaxis, Kids on chronic ASA therapy, Guillain-Barre, asthma, reactive airway disease, Heart disease, Immunodeficiency, CD4 <200
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What adolescent and adult vaccines are given in a series of THREE?
HPV, Hepatitis B.
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What adolescent and adult vaccines are given in a series of TWO?
Varicella, Hepatitis A, and Penumovax is repeated after age 65
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What does HPV2 vaccine protect against?
Strains HPV 16 and 18
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What does HPV4 vaccine protect against?
Strains HPV 6,11, 16, 18
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When is Herpes Zoster vaccine recommended?
All adults >age 60
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Who should receive the pneumovax vaccine?
Smokers, COPD, Asthma, Chronic CV disease, DM, Liver disease, Asplenia, immunosuppressed, cochlear implants and CSF leaks, HIV
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Who should be revaccinated with Pneumovax?
Any time after 5 years from the first, and are now >65 if ere vaccinated previously before age 65
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Is there virus shedding after flu mist intranasally?
Yes. For 3-10 days post administration, live flu virus is shed from nose.
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What does hemoglobin electrophoresis test for?
Sickle cell anemia or trait. Thalassemia minors or majors,
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Who is highest risk of suicide?
Men, age 65 or older, or men ages 15-24
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Leading cause of death?
Heart disease
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Second leading cause of death?
Cancer
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Third leading cause of death?
Stroke
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What is the number one cause of infectious diseases?
Influenza and pneumonia
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Highest cases cancer in men?
Prostate
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Highest cases cancer in women?
Breast
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Second and third cause of cancer in men and women?
Lung cancer, then Colorectal
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Leading cause of cancer DEATH in men and women?
Both share Lung cancer as leading cause of death
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What is second leading cause of cancer DEATH for men and women?
Prostate for men, Breast for women
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Mammograms should begin?
Yearly in women at age 40
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Pap smears in women should begin?
3 years after intercourse, but not later than age 21
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When can PAP smears be discontinued or less frequently tests?
Once aged 30, After 3 consecutive normals on PAP test, can then get screening PAP every 2 to 3 years. Once >70 with 3 normal PAPs in past 10 years can quit PAPs.
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DRE or PSA ACS recommendations?
No recommended screening at this time, ALTHOUGH, annual PSA DRE is to be discussed and offered to men at 50. If African American or positive FHx, start at age 45 or even 40 if very positive risk.
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Colon cancer screening should be done how and when?
ALL colon cancer screenings start at AGE 50. Yearly take home FOBT cards x3. Flexible sigmoidoscopy Q5 years. Colonoscopy every 10 years. However, if IBD, polyp hx, + FHx, make begin sooner.
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When would you do endometrial biopsy screening?
NEVER as screening. However, if postmenopausal and bleeding then it is part of the diagnostic work up. However, if age 35 and strong risk or had hereditary non-polyposis colon cancer, annual screening should be offered.
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What is pneumonic for specificity?
SnNout. SeNsitive test when Negative results rules OUT disease. Likelihood of it being sensitive enough to find true positive result in person with the disease
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What is pneumonic for sensitivity?
SpPin. SPecific test when Positive test rules IN disease. Likelihood of it being specific enough to find true negative result in person without the disease
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vaccines contraindicated in pregnancy
MMR, Flu Mist, Varicella, Varicella Zoster, HPV
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When can you get pregnant after live vaccines
3 months
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Neomycin allergy, vaccine contraindicated
IPV, MMR, Varicella, Varicella Zoster
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Egg Allergy, vaccine contraindicated
All Influenza vaccines (live and attenuated)
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Bakers Yeast, vaccine contraindicated
Hepatitis B (B- Bakers)
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Senile cataracts cause what type of exam abnormality and what type of vision abnormality?
Lens clouding is seen. Progressive dimming of distance vision.
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What is risk factor for senile cataracts?
Tobacco use, corticosteroids
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Which glaucoma causes acute vision loss and cupping abnormalities?
Closed Angle Glaucoma. See Disc cupping, instead of normal saucer shape. Due to increased intraocular pressure. Usually unilateral. Pain.
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What vision is lost in macular degeneration?
Central vision
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What vision is lost in Presbyopia?
Close vision loss. Typical of aging.
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What is presbycusis?
Normal age related hearing loss. C8 sensioneuronal hearing loss
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What does Kernigs sign check for and how it is elicited?
Tests for meningeal irritation. Supine position, bend up knee and then try to straighten lower leg. If resistance to leg straightening due to inflamed lumbar root will have pain at hamstring.
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What does Brudzinskis sign test for and how is it elicited?
Meningeal irritation if when supine patients head is lifted up into flexion, the legs also come up in attempt to relieve irritation
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What is anisicoria?
Unequal pupils
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What is important to know about narrow therapeutic drugs and what are some examples?
These are drugs that you need to draw blood levels on to maintain tight control of dose. Phenytoin, Carbamazepine, digoxin, warfarin, theophylline
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What are the Kubler Ross stages of grief?
Shock, Denial, Anger, Bargaining, Depression, Acceptance
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What is an antalgic gait?
Limp of DJD of hip due to functional shortening of leg
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What is the Schamroth sign?
Positive clubbing of fingers when you put nail beds together and lose diamond shaped space. A prominent distal angle between ends of nails
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What is a Hammans sign?
Heart in spontaneous mediastinal emphysema or pneumomediastinum. A Crunch is heart when auscultated over the mediastinum with coincides with systole and diastole
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What is a hydrocele?
Collection of serous fluid that causes painless scrotal swelling. Easily transilluminated
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What is a Varicocele?
Palpable nest of worms scrotal mass that is only evident in the STANDING position
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Testicular torsion exam finding?
Scrotal pain and loss of cremasteric reflex
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What is Phimosis?
Foreskin cannot be pulled back to expose glans
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What is paraphimosis?
Cannot get foreskin back over the glans
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What is cryptorchidism?
Testicle located in inguinal canal or abdomen. An undescended testicle.
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What are the ABCTs of mental health status?
Appearance, Behavior, Cognition, Thought Process
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At what age and how many inches in height is lost?
After age 55, men lose 1 inch in height and women will lose 2 inches
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What is the Phren's test?
Positive test will provide relief of pain with scrotal elevation above pubis
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When is Gumma lesion and Argyll Robertson Pupils seen?
In Tertiary syphilis
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What is amaurosis fugax?
Temporary, transient blindness of one eye
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What is pigueculaae?
Yellow nodules on sclera with thickening of bulbar conjunctiva due to sin, wind, dust
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What is acrus senilis?
Gray-white arch around the iris, seen in hyperlipidemia
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What are lentigines?
Liver spots, age spots, due to due damage. Often on hands
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