Flashcards in AAFP Review Questions Deck (466)
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151
Congenital rubella findings
Deafness and cataracts as well as numerous purpuric skin lesions, (“blueberry muffin” baby).
Congenital rubella syndrome occurs when the mother contracts rubella early on in her pregnancy – the risk of congenital rubella syndrome is very low after 20 weeks. Since the MMR vaccine contains a live attenuated virus, there is at least a theoretical risk of causing congenital rubella syndrome, and for this reason the vaccine is avoided in pregnant women.
152
Most common causes of hypercalcemia
Malignancy and hyperparathyroidism
CHIMPANZEES
-calcium supplementation
-hyperparathyroidism
-immobility // iatrogenic (from thiazide diuretics)
-milk alkali syndrome
-Paget's disease
-Acromegaly // Addison's disease
-Neoplasm
-Zollinger-Ellison syndrome (when associated w/ MEN-1)
-Excess vitamin D
-Excess vitamin A
-Sarcoidosis
153
Signs of hypercalcemia
Bones, stones, abdominal groans, psychiatric overtones
bone fractures, kidney stones, vomiting and constipation, and weakness, fatigue, and altered mental status
154
Hypercalcemic crisis
MEDICAL EMERGENCY d/t heart conduction abnormalities
Calcium > 14 or severe symptoms
Check EKG and begin IV fluids and furosemide (lose Ca++)
155
Charcot's triad
of acute cholecystitis
RUQ pain, jaundice, and fever/chills
156
Reynold's pentad
of acute cholecystitis
Charcot's triad (RUQ pain, jaundice, and fever/chills) plus shock and mental status changes
157
Treatment of isolated chlamydia infection
Azithromycin (single dose) or doxycycline (1 wk)
(1 wk of erythromycin also reasonable but causes GI upset)
(Fluoroquinolones like ofloxacin and levofloxacin are more expensive alternatives)
(Pregnant: azithromycin or erythromycin)
158
Treatment of acute dystonia
Benztropine or diphenhydramine
159
What is leukoria and what does it signify?
Leukoria is a white pupillary reflex (as opposed to the normal red reflex).
It can indicate
-disorders of the lens (e.g., cataracts)
-disorders of the vitreous (e.g., hemorrhage)
-disorders of the retina (e.g., retinoblastoma)
160
Isolated elevated opening pressure
Cryptococcal meningitis
also see lymphocytosis in CSF
161
Treatment of cryptococcal meningitis
amphotericin B and flucytosine
162
If early pregnancy loss, think:
cytogenetic abnormalities (abnormalities of chromosome number or structure)
163
Elevated BUN/Cr ratio
Pre-renal azotemia
164
Causes of late pregnancy loss
-cervical incompetence
-uterine anomalies
-leiomyoma
-intrauterine synechiae
165
PANDAS
pediatric autoimmune neuropsychiatric disorder associated with group A streptococci
-pediatric onset
-presence of obsessive compulsive disorder and/or a tic disorder
-abrupt onset with episodic symptom course
-associated with group A strep infections
- association with neurological abnormalities like motoric hyperactivity, choreiform movements and tics
166
Superficial thrombophlebitis treatment
rest, elevation, NSAIDs, heat
NO NEED FOR ANTICOAGULATION
167
SVT vs. DVT
Palpable cords: superficial vs. deep
Both cause swelling, pain, and warmth
Only DVT can cause PE
The saphenous vein is a superficial vein; the femoral (and superficial femoral) and popliteal veins are deep veins!
168
What antibodies are found in primary biliary cholangitis?
Anti-mitochondrial
169
What antibodies are found in celiac sprue?
Anti-TTG (most SN + SP), anti-gliadin, anti-endomysial
170
What is leukoria and what does it signify?
Leukoria is a white pupillary reflex (as opposed to the normal red reflex).
It can indicate
-disorders of the lens (e.g., cataracts)
-disorders of the vitreous (e.g., hemorrhage)
-disorders of the retina (e.g., retinoblastoma)
171
Treatment of mild comedonal acne
topical retinoid and/or other topical agents such as salicylic acid, azelaic acid, glycolic acid, and benzoyl peroxide
172
Test for primary adrenal insufficiency (Addison's disease)
Cosyntropin (synthetic ACTH) stimulation test, along with a measurement of plasma cortisol
If adrenals are functioning: cortisol should rise upon stimulation
173
Symptoms of Addison's disease
fatigue, weight loss, hypotension, hyponatremia, and hypoglycemia
174
Elevated BUN/Cr ratio
Pre-renal azotemia
175
Otitis media antibiotic guidelines
The American Academy of Pediatrics (AAP) recommends antibiotic therapy for children 6 months of age
or older with severe signs and symptoms of acute otitis media (AOM), including moderate or severe otalgia
or otalgia for more than 48 hours, or a temperature ³39°C (102°F), whether the AOM is unilateral or
bilateral (SOR B). Children younger than 24 months without severe symptoms should receive antibiotic
therapy for bilateral AOM, whereas older children or those with unilateral AOM can be offered the option
of observation and follow-up.
The usual treatment for AOM is amoxicillin, but an antibiotic with additional beta-lactamase coverage, such
as amoxicillin/clavulanate, should be given if the child has received amoxicillin within the past 30 days,
has concurrent purulent conjunctivitis, or has a history of AOM unresponsive to amoxicillin (SOR C).
Penicillin-allergic patients should be treated with an alternative antibiotic such as cefdinir, cefuroxime,
cefpodoxime, or ceftriaxone.
176
Treatment of salmonella infection
NOTHING
The recommended management for patients who have non-severe Salmonella infection and are otherwise
healthy is no treatment. Patients with high-risk conditions that predispose to bacteremia, and those with
severe diarrhea, fever, and systemic toxicity or positive blood cultures should be treated with levofloxacin,
500 mg once daily for 7–10 days (or another fluoroquinolone in an equivalent dosage), or with a slow
intravenous infusion of ceftriaxone, 1–2 g once daily for 7–10 days (14 days in patients with
immunosuppression).
177
Treatment of cervical lymphadenitis
Systemic symptoms, unilateral lymphadenopathy,
skin erythema, node tenderness, and a node that is 2–3 cm in size. The most common organisms associated
with lymphadenitis are Staphylococcus aureus and group A Streptococcus. Empiric antibiotic therapy with
observation for 4 weeks is acceptable for children with presumed reactive lymphadenopathy (SOR C). If
symptoms do not resolve, or if the mass increases in size during antibiotic treatment, further evaluation
is appropriate.
178
What needs to be tested before beginning PrEP w/ Truvada (emtricitabine/tenofovir disoproxil )
HIV antibody test
Need to make sure they're HIV negative since Truvada is insufficient for treating HIV
179
What is recommended in all patients w/ croup, even with mild disease?
Single dose of po dexamethasone
180
