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177 Cards in this Set
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|
sx of otitis externa |
pain on palpation of tragus or traction of the pinna
itchiness, prurulent d/c pseudomonas, staph |
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tx of otitis externa
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acidic drops (less favorable environment for pseudo to thrive)
ABx + steroids |
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tx for complete occlusion by cerumen
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H2O2
cerumenolytics water irrigation (done after cerumenolytics) NEVER use curette to remove unless occlusion is incomplete |
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risk of topical nasal decongestant use
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rebound swelling after vasoconstrictuion wears off
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what does weber test mean if it lateralizes to unaffected side?
if it lateralizes to affected side? |
sensorineural loss
conduction |
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tx of recurrent otitis media infx
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if <4 yo tympanostomy tubes
if >4 yo, adenoidectomy |
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when can kids return to school after starting ABx for strep throat
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after 24 hrs of tx
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where is coccidiomycosis found
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4 Corners
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resp complication of chickenpox
tx? |
pneumonia, esp in pregnancy
IV acyclovir |
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pts who are susceptable to pseudomonas pneumonia
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pts with bronchiectasis
on steroids pts recently taken broad spectrum ABx |
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pts susceptable to aspergillus pneumo
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those with prolonged neutropenia, immunosuppressed
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most common causes for CAP
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S. pneumo
H, flu M. pneumo |
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risk factors for legionella pneumo
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smokers
renal failure CA DM COPD immunosuppression |
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micro classification of legionella
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GNR
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when does breast milk jaundice occur?
what is it and what is elevated? |
btwn 4-14 days
etiology is unknown, but something in breast milk inhibits bilirubin metabolism unconjugated bili is elevated |
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what is breast feeding jaundice?
when does it occur |
jaundice caused by decreased volume of feeding
occurs on day 3 of life |
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tx fo breast milk jaundice
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continue breast feeding as long as possiblead increase frequency of feeds, this helps with conjugating the bili
phototherapy can be added stopping breast feeding is a last resort |
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in what time frame would you expect to see pathologic jaundice
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within 24 hrs post-partum
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tx for ABO incompatibility jaundice
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phototx then exchagne transfusion if absolutely necessary
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progression of kernicterus
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increased bili is toxic to basal ganglia cells and brainstem nuclei --> hypotonicity and lethary, then CP, MR, and hypertonicity
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who's got what blood type in ABO incompatibility of the infant and newborn
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mom has O and fetus has A, B, or AB
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how frequently does jaundice of newborn develop
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60%
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when is phototherapy contraindicated in jaundice of the newborn
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when there is increased conjugated bilirubin
it can lead to bronze baby syndrome (permanent discoloration) |
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criteria for infantile colic
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unexplained fussiness x 3h/d, 3d/w, for longer than 3 wks, in an infant younger than 3 mo
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physical findings in a colicky infant
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tense abdomen, clenched fists, flexed legs into abdomen, and flushing
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which medication --> Reye's syndrome
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ASA
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minimum weight gain during neonatal period
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>20 g/day
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biological agents found in colostrum
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macrophages, complemetn, lysozymes, lactoferrin, AB vs bact/viruses
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which class of AB is present in breast milk
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IgA
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treatment of mastitis
which bacteria is usually implicated |
warm compresses and ABx (methicillin or cloxacillin)
S. aureus no need to stop breast feeding |
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what vitamin is human milk deficient in
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d
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when is solid food added to diet
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6 mo
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major complications of formula feeding
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constipation
overfeeding |
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how to deal with constipation associated with formula feeds
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add increased fluid or corn syrup
if giving soy formula, switch to cow's |
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what is implicated in spitting up
how to reduce sx |
incompetent GE sphincter
sit infant up and increase burping frequency |
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noonan's syndrome
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a rare genetic dz, similar to turner's syndrome, with webbed neck and short stature, but no facial abnormalities
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what are the recommendations for CIN II/III tx
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pap smear w or w/o colposcopy q6 mo until 3 negative results are obtained, then resume nml screening recommended by age.
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how often should pap smears be performed in women <65 yo
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annually until there are 3 consecutive - smears in the setting of 1 monogamous partner
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what immunizations should pts with cirrhosis receive?
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HAV, HBV, pneumococcal, flu
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meaning of dexa scans
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if t score <-1.5 + risk facor or <-2.0 with no risk factors should receive preventive meds (bisphosphonates or SERMS)
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which cholesterol meds will raise HDL?
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fibrates and niacin
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screening protocol for AAA
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in 65-70 yo men who smoke or have h/o smoking should receive a 1-time abdominal US
if aorta >5.5 cm, then repair |
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who receives pneumococcal vaccine
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adults >65 yo or adults with chronic cv, lung, liver, kiney, metabolic dz or immunosuppression
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screening procedure for ovarian ca
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women with isolated family h/o ovarian ca should get transvaginal u/s and CA 125 screening. If strong family hx, check brca 1/2 twice a year and CA 125 and transvaginal u/s
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who should receive routine chlamydia screening
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all women <24 yo, if sexually active
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contraindication for varicella vaccine
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immunosuppression... it's a live attenuated vaccine
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receommended screening for bladder ca
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there is none, no good tests exist
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what is the mortality rate for HAV
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3%
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what is the #1 cause of conjunctivitis in children
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adenovirus
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organism that causes the croup
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parainfluenza
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tx for cluster ha
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triptans, 100% O2 (don't use ergotamine... takes too long to work)
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prevention of menstrual ha
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low dose estrogen supplements, NSAIDS, ergot, tripans (do not use sSris)
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tx for analgesic rebound ha
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tcas
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tx for absence sz
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ethosuxamide
valproic acid clonazepam |
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most common causes for new onset sz in >40 yo
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tumors > stroke > trauma
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most common causes for status epilepticus
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decreased compiance with meds, EtOH w/d, intracranial infx, neoplasm, metabolic d/o
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risk factors for febrile szs in children
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+ fam hx, previous febrile convulsions
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sequelae of febrile szs
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98% of kids with ffebrile sz don't develop addl szs in 5 yrs, but it can progress if there are developmental delays, CP, abnml neuro development, + fam h/o epilepsy
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tx of febrile szs
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diazepam q8 h
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definition of fuo
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fever >38 x 3 wks, without an underlying dx
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orgs that most commonly --> bacteremia in kids
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s. pneumo > hib > n. meningitis
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what ABx should be given if to prevent spread of meningitis
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none!
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prodrome of acute meningitis in kids
what can indicate septicemia |
resp illness, st (precedes fever), ha, stiff neck, vomiting
rash |
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why should juices not be given for rehdration following diarrhea
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increased osm from juices --> hypernatremia and exacerbated stool loss
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#1 cause of bacterial gastroenteritis
preesentation |
campylobacter
fever, malaise, n/v/d, ab pain, bloody bm |
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which ABx is most commonly associated with diarrhea
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ampicillin
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which childhood illnesses might present first with diarrhea
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acute appendicitis
OM UTI PNA |
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describe clinical manifestations associated with slipped capital femoral epiphysis
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seen in overweight sedentary teenage boys, pain is in groin or medial side of knee
there is limited internal rotation of hip |
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tx of slipped capital femoral epiphysis
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it is an emergency and must be stabilized
AVN can result |
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what is a complication of capital femoral epiphysis
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AVN!!!!
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clinical features of legg-calve-perthes
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idiopathic avn in kids
pain in hip/knee, liimp w decreased rom |
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tx for legg-calve-perthes
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braces or casting for 2 yr s
or surgery --> nml fxn in 4-6 mo |
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sequelae of legg-calve-perthes
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50% need hip replacement after adulthood
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osgood schlatter: clinical features
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tenderness over tibial tuberosity
traction apophysitis in tibial tuberosity |
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tx of osgood schlatter:
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NO steroids
tx w rest |
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sequelae of osgood-schlatter
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avulsion fx if patellar tendon can pull off tibial tubercle
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presentation of patellofemoral syndrome
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anterior knee pain, exp when walking up stairs, or running
crepitus and tender undersurface of medial patella |
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tx of patellofemoral syndrome
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vastus medialis exercises to help keep patellar tendon alligned
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when should children have est bladder control
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5 yo
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tx of enuresis
pharm? |
behavior modifications
adh just treats sx, but doesn't tx underlying cause |
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presentation of whooping cough in adult
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can be a post-infx cough lasting 4-6 w post infection
post tussive emesis is common |
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tx of otitis externa
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eardrops conaining hydrocortisone, neomycin, and polymixin
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is methalcholine challenge test effective in exercise induced asthma
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no
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clinical features of vocal cord dysfxn
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presents as difficult to treat asthma wiht nml spirometry (doesn't respond to any of the asthma drug tx)
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how does depression affect sleep
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causes you to go into early REM, makes you easy to awaken... therefore poor quality sleep
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si of intertsitial lung dz
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crackles, clubbing and cxr changes
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pathophys of rotator cuff impingement
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supraspinatus tendon impinges on undersurface of coracoacromial arch
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tx of rotator cuff injury
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strengthening end rom exercises, if not successful, steroid injections
if all else fails afer 3-6 mo, arthroscopc subacromial decompression |
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tx of lateral epicondylitis
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rest, nsaids, possibly steroid injections
surgical debridement is a last resort |
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sx of dequervian's tenosynovitis
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stenosing tenosynovitis of 1st dorsal compartment of wrist
caused by repetitive grasping/use of thumb tenderness to palpation of radial styloid |
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tx of de quervian's tenosynovitis
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thumb splint and immobilitization for 3 w
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"grades" of sprains
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I: tear of a few ligament fibers. joint is tender and painful, no joint laxity
II: mod # of torn fibers; mod swelling/pain; little to no instability of joint III: complete laxity of joint, no endpoint when joint is stressed. prominent swelling |
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what is the most common ligament injured in ankle sprains? how do they occur?
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talofibular joint
inversion type injuries occur most commonly max tenderness occurs at lateral malleolus |
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tx of ankle sprain
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early wb --> hastened return of activity
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effusion seen with acl tear ? why?
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acl is very vascular --> effusion seen immediately
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mechanism of whiplash
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lower c-spine extends
upper c-spine flexes |
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best tx of whiplash
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early exercise
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definition of concussion
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clinical syndrome characterized by immediate and transient post-traumatic impairment of consciousness, vision changes, and equilib changes d/t brainstem involvement
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levels of concussions
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grade I: no LOC, amnesia <30 mins
grade II: LOC <5 min and/or amnesia >30 mins but <24 h grade III: LOC > 5min, amnesia >24 h |
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second impact syndrome
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2nd hit after not recovering from first concssion
autoregulation of brain is lost and there is reactive swelling and edema; >50% mortality LIMIT ACTIVITIES OF ALL ATHLETES W SX AFTER HEAD INJURY!!! |
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who should be screened for osteoporosis?
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all women >65 yo
if risk factors, >60 women |
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how long do RA sx have to be present for dx
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6 wks
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who would get parvovirus? complication?
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adults working wiht kids
--> arthritis |
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sx of dermatomyositis
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pmr+ rash
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is there weakness in fibromyalgia
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no, just muscle pain
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sx of aortic stenosis
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angina, syncope, doe
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what test should be avoided in as?
how is dx made? |
exercise tolerence tests
echo |
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pathophys of baker cyst
when are they seen? |
increased fluid production from synovium; fluid accumulates in popliteal bursa
seen in oa, ra, cartilage tears |
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another name for obesity hypoventilation syndrome
what is associated w it? |
pickwickian syndrome
obesity, thick neck, hypersomnolence, polycythemia (2/2 alveolar hypovent) |
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benefits of lidocaine
adverse effects of lidocaine |
decreased pvc frequency, decreased risk of v-fib,
asystole- thereofre, only use if absolutely needed |
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steps to study the esophagus
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contrast study
esophagoscopy (to exclude mechanical causes of dysphagia) manometry to confirm dx |
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what is the only pharm intervention proven to prolong life in hypoxemic pts?
non-pharm? |
supplemental o2
quitting smoking, and lung volume reduction |
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which drugs prolong sx in copd
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bb, ipratropium, theophylline
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what is the paO2 that supplemental O2 is helpful for?
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55-60 in setting of cor pulmonale
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what do early am ha signify in copd?
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nocturnal co2 retention (O2 won't help)
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tx of htn in pregnancy
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hydralazine
methyldopa |
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what happens to ldl levels following ischemic event
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ldl decreases 24-48 hrs following ischemic event and takes weeks to return to baseline
in pts with known ca, they should go on statins |
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what cholesterol meds are contraindicated in pts with high tgs
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bile acid sequesterants
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which cholesterol med raises ldl
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fibrates
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which cholesterol drug worsens insulin r
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niacin
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what heart sound is heard with wpw
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paradoxically split s2
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which drugs slow conduction at the av node?
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atenolol
diliazem |
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what can result if bb and ccb are combined
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av block
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which is worse: mobitz I or mobitz II? why?
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mobitz II, usually associated wit bbb
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gi sx of dm
tx? |
post-prandial bloating, early satiety, constipation, diarrhea
metoclopramide |
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where are blebs normally found in lungs? what are they?
complication? |
apex (ruptured alveoli)
apical fibrosis |
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indication for hida scan?
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dx acute cholecystitis
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what is the risk of transmitting HBV from mother to fetus?
tx of fetus? |
if HBeAg +, then 90% risk of vertical transmission
HB Ig, follow with HB vaccine (Ig is insufficient alone) |
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sx of vitreous hemorrhage
cause? |
sudden loss of vision and onset of floaters, fundus is hard to visualize
usually DM |
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what effects does acute pancreatitis have on the lung?
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pleural effusion or ARDS (15%)
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proph of breast ca
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49% decrease in dx if tamoxifen is given
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tx for claudication
|
ccb
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test for lactose intolerance
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lactose H-breath test, increase in H2 levels after lactose
+ clinitest for reducing substrates increased osmotic gap, acidic stool |
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what is transferring sat?
|
Serum Fe/TIBC
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relationship between athlete's foot and cellulitis?
|
athlete's foot --> leg cellulitis (latter caused by staph or strep)
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chalazion
complications? |
nodular rubbery lesion, granulomatous; from obstructed
tear gland can turn into squamous cell carcinoma, must bx |
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saddle anesthesia
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cauda equina syndrome
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tx for v-tach w/o cardiac compromise
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amiodarone
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complications from hemochromatosis
|
hypogonadism
arthropathy pancreatic endocrine dysfxn dilated cmp conduction abnormalities |
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how does pulmonary fibrosis affect
lung volume dlco fev/fvc |
decrease
decrease nml |
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S3
S4 |
floppy ventricle, so systolic dysfxn
stiffened ventricle, so distolic dysfxn |
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when should digoxin be used in chf?
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in a-fib w rapid vent rate or with decreased ef
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what is the first line htn med for ppl w/o other complications
|
thiazides
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what htn med should be used in pts with recurrent strokes
|
ace i + thiazide combo
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what htn med should be used to decrease strokes in dm
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ccb
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what htn med should be used in the elderly
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diuretics
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what is the most effective long-term med for chronic bronchitis
|
ipratropium bromide (anti-cholinergic)
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blue bloater
pink puffer |
bronchitis
emphysema |
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tx of prinzmetal's angina
|
ccb and nitrates
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tx for chlamydia
|
azithromycin or doxycycline
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tx for bacterial vaginosis
|
metronidazole, clindamycin
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tx for pubic lice
|
permethrin
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tx for hsv
|
-cyclovir
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tx for yeast infx
|
fluconazole/terconazole
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tx for gc
|
ceftriaxone or quinolones
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tx for trichomonas
|
metronidazole
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tx for chancroid
|
ceftriaxone, azithromycin, erythromycin
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tx for syphilis
|
penicillin g
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tx of condyloma acumulatum
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podofilox, imiquinod, podophillin, benzoin
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when should a pt with gc/chlamydia be retested following tx
|
never, unless there is reason to believe the tx didn't work
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what, if given to a pt with mono --> rash
|
pcn
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describe streptococcal rash
|
feels like sandpaper
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when should tonsillectomy be considered
|
if 3x documented strep throat w/i 3 mo
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complications of strep throat
|
post-strep gn
rheumatic heart dz peritonsillar abscess |
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what bacteria can cause pharyngitis
|
strep
diptheria gonorrhea |
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most common pathogen for otitis externa
|
staph
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watchful waiting in aom?
|
if over the age of 6 mo, wait to see if it gets better in 2-3 days
otherwise, if 100% sure treat aom |
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otitis media with effusion
|
this is not AOM, this is just fluid behind tm
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classic finding of als on muscle bx
clinical sx |
denervation and renervation
flaccid paralysis, foot drop, hand clumsiness, muscle wasting and fasciculations |
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pathology of guillan-barre
|
ascending paralysis ==> demylenation of peripheral nerves
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list the different types of incontinence
|
stress incontinence
urge incontinence overflow incontinence functional incontinence reflex incontinence |
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features of stress incontinence
|
voiding of urine during laughing, sneezing, etc
caused by the urethra that gets pushed below the bladder so that when there is increased intraabdominal pressure, only the bladder gets squeezes, leading to leakage of urine |
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features of overflow incontinence
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incomplete voiding of bladder upon urination --> nocturia and frequent loss of small amounts of urine
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features of urge incontinence
|
involuntary detrusor contractions --> sudden urge to urinate, but can't make it to bathroom
loss of large volumes of urine |
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features of reflex incontinence
|
usually associated w spinal cord injury... can't sense that you need to urinate
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features of functional incontinence
|
secondary to a disease
|
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differential dx of lower back pain
|
musculoligamentous back pain
herniated disc degenerative disc dz ankylosing spondylitis spinal stenosis malignancy compression fracture infection cauda equina syndrome |
