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40 Cards in this Set
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Indications for Adult Immunization for TD.
Dosing? Can you give this to PG women? |
1. never had primary series <65
2. HCP 3. in contact with kids <12 mo Dosing: Primary=Tdap/TD (0) + Td (2 mo) + Td (6-12mo) Booster every 10yrs or at least at age 50 (should be Tdap) PG-2nd/3rd trimester or immed post partum |
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Indications for Adult Immunization for MMR
Dosing? Can you give this to PG women? |
1. ppl born after 1957 (before = immune)
2. High risk ppl = HCP, college students/close quarters, international travel Dose = 2 doses at least one month apart PG = can't -- screen during childbearing years -- can't if you suspect pg w/in 4wks of admin can't if they are IMCP CAN if they are HIV with at least 200 CD4 |
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Indications for Adult Immunization for Influenza
Dosing? Can you give this to PG women? |
1. Cardiopulm dz
2. longer term care facilities 3. adults at least 50yrs or over 4. Chronic dz pts = DM, HIV, Renal, IMCP Dose = annually PG = 2nd/3rd trimester during influenza season 9october may) |
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Indications for Adult Immunization for Pneumococcal
Dosing? Can you give this to PG women? |
1. all pts >65
2. >50 if imcp or with chronic dz dose: give primary dose - revaccinate every 5 yrs when >65 at high risk (chronic dz, asplenia, smokers, chemo, asthma, etc) |
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Indications for Adult Immunization for Varicella
Dosing? Can you give this to PG women? |
pt with no hx of chicken pox
dose:2doses 1-2mo apart PG=post partum only |
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screening recs for women under:
25yo 50yo 65yo |
25:
-osteoperosis counseling starting at 18yo - adequate Ca intake -chlamydia (18-25) -congenital rubella (18-50) 50yo: -osteo (see above) -chlamydia (see above_ -congenital rubella (see above) + Lipds starting at 45 under 65 (add osteopersosis screen for women at risk) at 65 - screen all women for osteo |
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all pg women get screened for :
(8) |
bacteriuria w/sx
chlamydia HBV HIV NTD RHd syphilis tobacco |
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folic acid req for:
1. women of child bearing age 2. 1mo prior to conception 3. with hx of NTDs i npg |
1. 0.4mg/day
2. 0.4-0.8mg/d 3. 4mg/d |
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when do we screen for Rhd?
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first prenatal visit
again at 24-28 wks |
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short term drug used for wt loss
Concern? |
phentermine, diethylpropion
SE: think sympathomimmetics (tachy, high bp, psychosis) abuse potential |
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long term drugs for wt loss and SE
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1. sibutramine = htn (increases NE and 5HT)
2. orlistat = panc lipase inhib -->ab cramps, oily stool and flatulence |
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antidepressants that are commonly used for wt loss
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fluoxetine
bupropion |
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2 things associated with pellagra
tx? |
dermatitis, diarrhea, dementia
ETOHism niacin (B3) deficiency oral nicotinamide |
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deficiency assoc wtih glossitis, cheliosis, and other nonspec sx + seborrh derm and anemia
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B2 riboflavin
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ppl on INH or OCPs are predisposed to ____def
sx? |
B6 pyridoxine
think periph neuropathy, anemia, seizures give IM or oral |
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def common with vegans
sx? |
B12 def
meg anemia, glossitis, anorexia, periph neuropahty, balance probs |
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vit C def -- 6 groups that are common
sx? |
poor
elderly etoh CA smokers Renal fail scruvy - bleed gums, poor heal, anemia-->edema IC hem, neuropathy |
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if you eat a bunch of raw eggs you may get what sx ?
2/2 to def of ? |
biotin
myalgia, dermatitis, alopecia |
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costochondral beading
think: dz? cause? predisposed? |
rickets (bowlegs, kyphoscoliosis)
Vit D def anticonvuslants, br feeed infants manlutrition |
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areflexia
gait abnl opthalmoplegia periph neuropathy decr proprioception ddx from wernicke |
vit E def - malapsorption pts
wernicke - etohics = muscle crappsm paresthesias, confusino, ataxia, opthalmoplegia = thiamine |
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malria prophylaxis:
drug of choice? if resistant? if resistant to both? which can be used with kids and pg? SE: |
chloroquine
mefloquine doxy or atoquone/proguanil C&M - C anytime, M = 2n/3rd trimester only D&A can, but have limits, no PG here C-blurred vision, GI, pruritis, insomnia M-vertigo, bad dreams, paranoid, seizures, psychosis D: photosensivity rx A- GI + rash |
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traveler's diarrhea
decr incidence with _____ avoid use with ____ (6) |
pepto
ASA allergy kids -- reye Renal insuff gout anticoags probencid mtx |
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sx/tx of traveler's diarrhea
when do you use ABs and which? |
sx: malaise, anorexia, watery diarrhea
tx: fluid replacemnt (1/2tsp sugar + 1/2 baking soda +4 sugar) >4stools/daily (unformed), F, blood, pus, or mucus in stool -- use ABs (cipro or aZithromycin w/ resistance to FQ) |
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pt presents with abnl CXR = nodules or fibrosis
you think _____ possible sx _____ predisposed? |
silicosis
cough, sob sandblasters, crystal miners, masonry, ceramics |
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pt presents with CXR of interstitial fibrosis and pleural involvement
sx: bibasilar crackles and clubbing + sob on exertion |
asbestosis
think textiles, ships, cement, insulation, pipes (20-30yrs to dev) |
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exposure to moldy hay may give you what ? sx?
ddx this from hypersensitivity pneumonitis |
toxic organic dust syndrome
F, cough, wheezing, dysphnea hypersensitivity pneumonitis has not wheezing exposures=farmers lung, hot tub lung, humidifieers, pultry, grains, lumber chronic hypers = wt loss, fatigue, sob, clubbing, recurrent pnemo |
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list the 14 reportable diseases:
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1-6 = GI
botulism cholera EO157 HAV Salmonella Shigella 7-10 = communicative/Resp measles rubella meningococal TB 11-14=STDs chlamydia gonorrhea syph HIV |
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TB proph candidates:
tx/ |
close contacts of Active TB-->PPD w/ >5mm induration-->if negative, repeat in 10-12 wks
INH |
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HAV proph candidates and tx
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1. houselhold/sex contacts
2. shared needles 3. day care/nursing home workers (all) 4. food handlers (all) tx: admin IVIG + HAV vaccine dose 1 |
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HBV, HCV, HIV proph candidates and tx
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All -->must get source tested
HBV: if unvaccinated prior to exposure -- give HB IVIG and start vaccine series HCV: no PEP, get LFTs, RNA, and serology at 0 and 4 wks HIV: -start w/in 72hrs of exposure -4 weeks of Zidovudine (AZT) + lamivudine (3TC) OR either emtricitabine (FTC) or tenofovir (TDF) + lamivudine (3TC) or emtricitabine (FTC) 2 nonnuc reverse trancriptase inhibitors |
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dx and tx of anthrax
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dx: gram stain (g+rods) + culture lesion, PCR, or serology
tx: doxy or cipro = cutaneous multidrug for inhalational |
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dx of smallpox
tx? when do you report |
dx: clinical
confirmed via cx of lesion and serologic tests tx = resp/contact lesion, none available -- vaccination during incubation period might prevent dz spread (7-19d) when you have all 3 major criteria 1. same stage lesions 2. febrile prodrome(F, backache, V, HA) 3. classic lesions (tongue/palate/face to forearms to palms/soles -- confulent and crusting) macules >papules>vesicles>pustules spreads centrifugal |
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ppl req annual PPD
one time screen recs? |
1. HIV
2. HCP, prison guards, lab ppl 3. certain chronic conditions: DM, IMCP, end stage renal dz, etoh, rapid wt loss or chronic malnutrition) 4. homeless 5. IVDA 6. long term care facilities one time for single exposure fibrotic lung immigrants/refugges |
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what do you need to a dx of TB:
1. indivs with no risk 2. IMVDA/Immigrants, employees at high risk |
at least 15mm induration
2. at least 10mm |
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5 groups that only need 5 mm induartion for positive TB dx
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HIV
recent contact chronic steroids transplant/IMCP inactive TB on xray, untreated tb |
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if you are less than 4 yr or <18 with high risk indiv of TB, induration to be postiive?
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at least 10
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if your ppd is positive, next step?
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cxr
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common false + on PPD
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HIV/malignancy
CSC/IMCP concurrent viral inf newly dx TB or extra pulm TB (converts 2-12 wkspost inf) |
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how do we minimize risk of SE with INH tx with +PPD ers
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1. Monitor montly LFTs
give pyridoxine 25-50mg /d to br feeding, PG, ETOH, kids, HIV, DM, chornic liver dz, renal fail |
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if you see a pt with a lone nontender LN that is a cervical LN-->next steP
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FNA or excisional biopsy
coudl be scrofula (LN TB) |
