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85 Cards in this Set
- Front
- Back
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Symptoms of Colic occur at what age? When does it resolve? |
Symptoms occur 2-16 weeks of age. Improves beyond 4 months of age. |
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What are Infant Colic signs and symptoms? |
- excessive crying - increased motor activity - increased muscle tone - altered patterns of sleeping and eating - excessive regurgitation & vomiting |
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Rome III criteria for infant colic <4 months. |
1. Paroxysms of crying/fuzzy start and stop with no obvious cause.
2. Episodes > 3 hrs/d, occur 3x/wk, for 1 week 3. No failure to thrive |
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Colic risk factors. |
Parent smoking Age: 2-16 weeks |
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Colic red flags. |
- Persist >3hrs - Occur <2weeks or >16weeks - Fever >38C - Lack of weight gain - Excessive vomiting or change in stool or urination - Change in behaviour, lethargy, decreased responsiveness - Result of an injury/fall -> pain or itch - Parent afraid of hurting baby - Parent tried >3d to help baby but didn't work |
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Colic 1st-line treatment |
Non-pharmacological Treatments - Physical methods (movement, carrying, skin-skin contact, swaddling, gentle pressure on abs, massage, chiropractic) - Behavioural methods (cry diary, counselling) - Environmental methods (change scenery, white noise machines) - Dietary manipulation (maybe switch breastfeeding mothers to hypoallergenic diets) - Feeding manipulation (reduce air swallowed by sitting baby upright, correct nipple size, curved bottles) |
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Colic 2nd-line treatment |
Pharmacological Treatments - Probiotics are effective (fridge) - Carbohydrates (sucrose) are effective (fridge) - Carminatives (simethicone) are ineffective |
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Non-RX Pharms for oral hygiene. |
Dentrifice cleans teeth, freshen mouth, strengthen enamel, minimize plaque and calculus - fluoride caries protection (not <12y staining) - Tartar-control (pyrophosphate, zinc, triclosan) prevents supragingival calculus - Antiplaque (triclosan+fluoride) antibacterial |
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Toothpaste Ingredient: Detergents (SLS) |
- foaming, maybe helps with solubilizing plaque - causes aphthous ulcers - not for dry mouth |
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Toothpaste Ingredient: Abrasive agents - CaCO3 - silicates - phosphates - salts - MgCO3 - Aluminum trihydrate |
- remove debris and residual stain - can cause burning sensation, drying mucous membrane, taste alteration, gingival abrasion, enamel erosion |
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Toothpaste Ingredients: - K Nitrate - Strontium Cl - Strontium Acetate |
- help with tooth desensitization - reduce pain from sensitive teeth (blocks tubules in exposed dentin) |
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Toothpaste Ingredients: - pyrophosphate - triclosan - zinc citrate |
- prevent tartar formation on supragingival calculuses only - maybe chelates cations to prevent crystal growth of plaque |
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Toothpaste Ingredients: - stannous fluoride - triclosan - zinc citrate |
- prevent gingival inflammation - antibacterial and reduces plaque - stannous fluoride DI: chlorhexidine |
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Toothpaste Ingredient: Humectants - xylitol - glycerol - propylene |
- prevents toothpaste from drying out - xylitol = superior humectant to booths fluoride activity |
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Chemical Management of Plaque: Peridex (chlorhexidine 0.12%) mouthwash |
- antibacterial mouthwash - once daily or BID - AE: tooth staining, taste disturbances - DI: stannous fluoride |
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Chemical Management of Plaque: Cepacol, Scope Outlast (cetylpyridinium Cl) |
- less effective than chlorhexidine - AE: tooth staining (not as bad) |
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Chemical Management of Plaque: Listerine Antiseptic Mouthwash (essential oils - thymol, eucalyptol, menthol, methylsalicylate) |
- use 30s BID - high alcohol content - AE: burning sensation, bitter |
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Chemical Management of Plaque: Fluoride |
- Safe and effective prevention/control of caries - SE (ingest high dose): N/V, ab pain, synovitis, bleeding - SE (ingest chronically): wt loss, anemia, bone issues, fluorosis |
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Systemic Fluoride Supplementation |
- Fluor-a-Day (chew tabs, drops) - Supplements should only be given >6mos - fluoride in drinking water <0.3ppm - child doesn't brush BID - child susceptible to caries |
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Oral Hygiene: Infants |
- regular dental exams - soft-bristled toothbrush - inappropriate use of pacifiers (>5y) may cause dental caries, malocclusion, gingival recession |
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AU: Treatment Non-pharms |
- remove trauma-causing agent - apply ice - dry ulcer to promote healing (NS) |
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AU: Treatment Non-RX Pharms |
- oral debriding and wound cleansing agents (all equal efficacy to NS), if swallowed chronically can cause black hairy tongue - antiseptics - topical anesthetics (-caines) qid <1wk (dont eat afterwards) - acetaminophen (no NSAIDs) - mucosal protectants = temp pain relief - supplementation (B12, B6, Folate, Zn) - MOM + diphenhydramine (1:1) 5 ml q4-6h prn - NHPs dont work - cauterizing silver nitrate sticks more rapid improvement in pain |
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AU: Treatment RX Pharms |
- topical corticosteroids anti-inflam but does not help recurrence, AE: candidiasis - tetracycline mouth rinse reduce pain, ulcer size, duration of RAU but not recurrence - benzydamine rinse anti-inflam and numbs pain (careful not to swallow) - systemic therapy (dapsone, colchicine, pentox) |
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Halitosis: Non-Pharms |
- meticulous oral hygiene - proper denture hygiene - visit dentist regularly - avoid masking odour, longterm use mouthrinse, odorous foods, smoking, sugary foods |
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Halitosis: Non-RX Pharms |
Mouthwash - Cetylpyridium Cl - Cetylpyridium Cl + fluoride Sugarless gum Herbal Remedies: - chlorophyll, menthol, parsley, mint, mangosteen |
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Halitosis: RX Pharms |
Peridex (Chlorhexidine 0.12%) - antibacterial on plaques and tongue - causes teeth staining |
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Signs and Symptoms of Dehydration |
- Capillary refill time >2s - Decreased skin turgor - Rapid breathing |
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WHO Classification of Severe Dehydration |
2 of the following signs: - lethargic/unconscious - sunken eyes - not able to drink - skin pinch goes back slowly |
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WHO Classification of Some Dehydration |
2 of the following: - restless, irritable - sunken eyes - thirst, drinks eagerly - skin pinch goes back slowly |
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Gastroenteritis Red Flags |
- <6mos or wt <8kg - fever in <2mos or >39C in >3mos - diarrhea >48h - >6unformed stools/day - signs of severe dehydration - bloody/mucous stools - symptoms >14d - abdominal pain - Previous treatment: subop repsonse to ORT or unable to give ORT - Chronic medical conditions (renal, immunocomp, surg recovery, RTIs) |
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Signs & Symptoms of Traveller's Diarrhea |
3+ unformed stools in 24h with one of: - fever, N/V, ab cramp, bloody stool, tenesmus, rectal urgency |
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Bacterial causes of TD |
80% of TD = Bacteria - 50% ETEC (Latin America, Caribbean, Africa) - 10-25% campylobacter jejuni (Thailand) - 10-25% salmonella and shigella spp - Others: vibrio cholerae (India, Ecuador), yersinia |
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Viral causes of TD |
5-10% of TD = Viral - Norwalk virus (norovirus) on cruises - Rotavirus |
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Parasitic causes of TD |
10% of TD = Parasitic - insidious onset - persistent symptoms - lasts >2 weeks (dx back home if abx treated bacteria during trip) |
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Prevention of TD with Bismuth Subsalicylate |
- first dose upon arrival - SE: black tongue and stool, nausea - CI: ASA allergy, renal insufficiency - DI: anticoagulants, probenacid, MTX, FQs - Caution: Children with viruses, <3yo |
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Prevention of TD with Dukoral |
- effective prevention for vibrio cholerae and ETEC 50% of the time - short-term protection of 3 months - protection begins 1 week after immunization |
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Treatment of TD with antibiotics |
- use only if >2 loose stools or symps too severe - stop if symps improve after 24 hrs - continue 2-3 days if persisting symps - blood in stool = treat for 3 days - Zithromax for Thailand Severe symptoms (fever, blood, >5 stools/24h) - abx alone and no loperamide |
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Treatment of TD with antimotility agents |
Loperamide for mild symptoms - 1-2 stools/24h Loperamide for moderate symptoms - >2 stools/24h |
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Non-infectious causes of vaginitis - vulvovaginal pruritus without discharge |
- poor hygiene
- irritant or allergic dermatitis - skin disorders (psoriasis, etc.) |
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Non-infectious causes of vaginitis - primarily vaginal discharge |
- desquamative inflammatory vaginitis - atrophic vaginitis - foreign bodies - excessive physiologic secretions |
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Bacterial vaginosis - symptoms - discharge - clinical findings - pH |
Bacterial vaginosis - not itchy, 50% asymptomatic - milky white, grey with fishy odor - no inflammation - pH>4.5 |
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Trichomoniasis - symptoms - discharge - clinical findings - pH |
Trichomoniasis - itchy, 64-90% asymptomatic - frothy off-white, yellow-green, malodorous - strawberry cervix - pH>4.5 |
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Vulvovaginal candidiasis - symptoms - discharge - clinical findings - pH |
Vulvovaginal candidiasis - super itchy, <20% asymptomatic - thick, clumpy, cottage cheese, no odour - erythema +/- edema of vulva - pH<4.5 |
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Bacterial Vaginosis Treatment |
- metronidazole 500 mg BID x 7 days or - metronidazole gel daily x 5 days or - clindamycin cream daily x 7 days - dont have to treat partner |
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Trichomoniasis Treatment |
- metronidazole 500 mg BID x 7 days - metronidazole 2g single dose - treat partner, avoid sex - if pregnant and asymptomatic, do not treat |
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Vulvovaginal Candidiasis Treatment (general) |
- antifungals - dont treat partner unless they uncircumsized, C. balanitis, RVVC - no sex |
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What is difference between uncomplicated and complicated VVC? |
Uncomplicated - sporadic, infrequent, <4/year - mild-moderate symptoms - C. albicans - Not immunocomp |
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VVC Red Flags |
- pregnant - premenarche - 1st time presentation of symptoms - concurrent symptoms of fever or pelvic pain - DM or HIV (predisposed) - taking predisposing meds - recurrent VVC >4/year or 2 within last 2 months |
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When not to test with VagiSense? |
- pregnant - first day of cycle - menstruation or vag bleeding - <12 hrs after sex or douching - <72 hrs after applying vag preparations |
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How to treat complicated VVC? (ie. pregnant) |
- best option is the longer duration (pregnancy needs longer contact time) - usually not systemic therapy nor single dose regimens - AVOID fluconazole and boric acid |
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How to treat complicated VVC? (ie. compromised host getting steroids, diabetic) |
- boric acid 600 mg PV daily x 14 days - azole PV daily x 10-14 days |
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How to treat severe VVC? (ie. extensive erythema, edema, excoriations) |
- fluconazole 150 mg po q72h x two doses - CI: pregnancy - Intravag azole x 10-14 days - nystatin 100000U/g: 5g BID x 14 days |
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How to treat non-albicans VVC? (ie. C. galbrata) |
- no azoles because they dont work well at galbrata - boric acid (64-81% efficacy) - flucytosine cream (90% efficacy) - amphotericin B (80% efficacy) - flucytosine + amphotericin B (100% efficacy) - if recur then more boric acid or nystatin |
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How to treat RVVC? - induction - maintenance |
Induction - fluconazole 150 mg q72h x 3 doses - topical azole 10-14 days - boric acid cap PV daily x 14 days Maintenance - fluconazole qweekly - topical azole tab PV qmonth - boric acid cap PV x5 days qmonth - ketoconazole 100 mg po daily |
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Dysmenorrhea Risk Factors |
- Young age <30 y - Tobacco smoking - Stress - Diet (omega-6) - No children |
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Dysmenorrhea Non-pharms |
- Heat therapy - Exercise, stress reduction - Stop smoking |
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Dysmenorrhea Pharms |
- NSAIDs (1st line) start 1-2 day before menses x 3 days - ASA (if CI to NSAIDs) for mild symptoms - Acetaminophen (if CI to NSAIDs) for mild symptoms - Vitamin B1 - COCs (if want contraception) |
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How to diagnose PMS? |
- occur in luteal phase - resolve at start of menses - creates problems or impairment - confirmed through prospective monitoring of women's symptoms for 2+ cycles |
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Treatment for PMS 1st Line |
Nonpharms - stress reduction - more veggies - Calcium + Vitamin D (mood and phys sx) - Chasteberry (overall symps) |
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Treatment for PMS 3rd Line - physical symptoms |
Pharms - NSAIDs relieve pain - OCs for both mood and physical symptoms - MPA for breast tenderness & bloating - Spironolactone for tenderness & bloating - bromocriptine, venlafaxine XR, clomipramine |
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Treatment for PMS 3rd Line - psychological symptoms |
- SSRIs - buspirone - +/- alprazolam (for anxiety) |
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Treatment for PMS last line - severe mood symptoms |
- continuous high dose progestin - leuprolide depot qmonth, Goserelin, Nafarelin (GnRH analogues induce pharmacologic menopause) - danazol (androgen) |
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What % of US are obese? What % of CAN are obese? Obesity rates have ____ since 1970s. |
US: 69% CAN: 62% tripled |
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Or your calories: _____ should be from carbs. _____ should be from protein. _____ should be from fat. |
45-65% from carbs 10-35% from protein 20-35% from fat |
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Atkins Diet (low carb) |
- high fat, low carb - unlimited meat, fish, egg, cheese - no fruits, sweets, starchy snacks Phase 1: 20g carbs/d Phase 2: can add back some carbs (veg, nuts) Phase 3: "pre-maintenance" can add 10g carb/wk Phase 4: lifetime maintenance 45-100g/d Benefits: short-term wt loss SE: HA, bad breathe, constipation, other diseases |
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South Beach Diet (low carb) |
- similar to Atkins - 3 phases - good and bad carbs as defined by glycemic index - ban unhealthy fats (like omega-3) - count g of digestible carbs only |
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Dukan Diet (low carb) |
- unlimited lean protein, oat bran, water, 20min walk - veg allowed in 2nd and 3rd phase - SE: bad breath, constipation, dry mouth, fatigue - oat brain contains 50% more fiber than oatmeal |
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Ornish Diet (low fat) |
- success is from watching what you eat and not restricting your caloric intake - eat whenever hungry (grains, veg, bean, fruit ONLY - some dairy, no meat/fat/sugar/EtOH) - <10% from fat, many little meals - >30min exercise daily or 1hr 3d/wk - stress management |
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Raw Food Diet (low calorie) |
- most people on this eat 1/2 of what normal ppl eat - cooking kills all the enzymes vitamins nutrience - typically 75-80% plant foods <115F |
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Dr. Bernstein Diet (low calorie) |
- 20 lbs lost/month - Vitamin B6 and B12 injections 3x/week - $$$$$ |
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The Zone (balanced diet) |
- 40% carbs, 30% protein, 30% fat - this balance maintains insulin in "the zone" - difficult to follow |
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Mediterranean Diet (balanced diet) |
"following the food tradition to lose weight" - olive oil (monounsat) - fruits and vegs (antioxidants) - oily fish (omega 3) - wine (decrease heart attack by increase HDL) - it is the combo of these foods that decrease mortality |
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Weight Watchers (balanced diet) |
"healthy choices that fill you up = eat less" - nutritionally balanced food plan - activity plan - weekly support groups - NEW points+ program, assign higher points for calorie dense foods, target individualized |
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Physical Activity: goal for lifestyle management |
- lose 10% of body wt in first 6 months or - steady loss of 1lb/week - BMI 27-35: decrease calorie 300-500kcal/d - BMI >35: decrease calorie 500-1000kcal/d |
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Red Bull Energy Drink |
- 35 AEs in Canada, 3 deaths
- 27g sugar, 110 calories - caffeine, taurine, glucuronolactone |
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Rockstar Energy Drink |
- 33 serious AEs - 31g sugar, 140 calories - gingseng, milk thistle, gingko |
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Monster Energy Drink |
- >40 AEs, 5 deaths - 27g sugar, 10 calories - guarana, caffeine, L-carnitine, glucose, Vit B's |
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Health Canada recommendations for caffeine in children <12y |
- <2.5mg/kg - 45 mg child 4-6 - 62.5 mg child 7-9 - 85 mg child 10-12 |
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Patient counselling on energy drinks |
- drink in moderation - don't drink on empty stomach - should not replace food - don't use with EtOH - don't use as fluid replacement |
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Dosing Statistics Canada - Mock Scenario Findings on acetaminophen |
- 40% calculated correct dose to give
- 67% measured correct dose to give - 30% calculated and measured correctly :( |
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Dosing Statistics NYC Clinic - Dosing accuracy using standardized equipment |
- Health literacy associated with making errors - Largest dosing errors (>40% deviation) seen in cup with etched markings and cup with printed markings |
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Vomiting and repeat dose?
- short-course infrequent regimens |
- repeat if <1hr passed |
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Vomiting and repeat dose? - narrow therapeutic range meds |
- weight risk vs benefits - consider redose if low serum levels before vomiting |
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Vomiting and repeat dose? - Long-acting products (ie. morphine SR) |
- if unsure, skip dose - rely on short acting BT opioids |
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Vomiting and repeat dose? - PRN meds |
- redose if vomit <15min - if vomit >15min, probably absorbed so redose in 1-2 hr if symptoms uncontrolled |
