FM Case Files Combined Flashcards
HIV category C
-symptomatic AIDS defining conditions
OTC tx of acute diarrhea
- will help slow down the frequency of the stool
- can make certain infections worse bc they prevent your body from getting rid of the organism that is causing the diarrhea
Tx for thyroid storm
- High doses of propothyluracil (PTU)
- Beta blockers –> to control tachycardia and other peripheral sx
- Hydrocortisone –> prevent possible adrenal crisis
Imaging and serologic testing for primary hypothyroidism
-once dx for primary hypoTH is made and the thyroid is normal on physical exam, no other tests are required
4 most common animal bites causing rabies in US?
- Bats
- Skunks
- Dogs
- Foxes
Antibiotics for tx of acute diarrhea
- can help with bacterial diarrhea
- quinolones are usually used (ciprofloxacin) for 1 or 2 days
- -cannot be used in children or pregnant women
- azithromycin as a single dose in adults and for 3 days in children
- -can be used in prego moms
- rifaximin can be used in diarrhea caused by noninvasive strains of e. coli (wont work for fever or blood in stool)
Thyroid storm
- acute hypermetabolic state associated w/ sudden release of lg amnts of thyroid hormone into circulation
- causes autonomic instability and CNS dysfunction
- can cause altered mental status, coma, or seizures + fever, restlessness, or psychoticlike behavior
- high mortality risk! MEDICAL EMERGENCY!
Chronic diarrhea
-present for more than 4 wks
What are the most common bacterial causes of conjunctivitis?
- Staph
- Strep
- H. Influenzae
- Morexella
- Pseudo
Causes of illness after eating a mayo containing salad w/in 6 hrs, 8-12 hrs, or w/in 12-14 hrs
- < 6 hrs = s. aureus
- 8-12 hrs = c. Perfringens
- 12-14 hrs = e. coli
Anosognosia
-no awareness of disability
Tx of HTN with strokes
- unless a hypertensive encephalopathy, aortic dissection, acute renal failure, or PE is present, tx of HTN should be cautious!
- give anti-HTN meds when systolic BP is > 220 or diastolic is > 120
- if anti-thrombolitics will be given, then decrease pts systolic P to < 185 and diastolic to < 110
- most commonly used:
1. Labetalol
2. Nicardipine
3. Sodium nitroprusside
Ssx of traveler’s diarrhea
- > 3 loose stools in 24 hrs
- Abdominal cramping
- Nausea
- Vomiting
- Fever
- Tenesmus
* *usually occurs within first 2 wks of travel
Aspirin and strokes
- most pts w/ non-hemorrhagic stroke should receive aspirin w/in first 48hrs
- EXCEPT when anti-thrombolytics are given
What is usually the cause of prehepatic jaundice?
- hemolysis of RBCs
- they overwhelm the liver’s ability to conjugate and clear the bilirubin through its normal pthwys
- causes hyperbilirubinemia of unconjugated bilirubin
Bacterial Conjunctivitis: tx
- can be self-limiting in 10-14 days
- give a sulfonamide instilled locally 3x daily to clear the infection in 2-3 days
Causes of hepatic hyperbilirubinemia
- causes either conjugated or unconjugated hyperbilirubinemia
- viruses and alcohol decrease the liver’s ability to transport bilirubin AFTER it has been conjugated, so get conjugated hyperbilirubinemia
P. jiroveci pnuemonia: ssx?
- Nonproductive cough
- Fever
- Dyspnea that worsens over few days to few weeks
- Tachypenia
- Hypoxic
- Bilateral infiltrates seen on CXR w/ “ground glass” appearance
Tx for diarrhea caused by c. diff?
- Metronidazole
2. Vancomycin
Work up for pt that presents with stroke sx?
- CT scan WITHOUT contrast –> look for hemorrhage, tumor, abcess
- Glucose level
- Drug screen
- Coagulation studies
- Serum electrolytes
- Renal function tests
- Lipid profile
- CBC
- Ekg
What is the tx of choice for graves dz?
- radioactive iodine
- as long as the pt is not pregnant, breastfeeding, or a child
Hepatitis A: ssx? Incubation period? Transmission period? How long does the illness last? Tx?
- ssx: jaundice, fever, malaise, abdominal discomfort
- incubation period: 2-8 wks
- transmission: possible for 2-3 weeks after symptoms begin
- lasts: 4-6 wks (buts can last up to 6 mnths)
- tx: supportive
Contraindications to TPA
- Stroke occurred > 3 hrs ago
- Recent surgery
- Trauma
- GI bleeding
- MI
- Use of certain anticoag meds
- Uncontrolled HTN
What does anti-HBcAg IgM mean?
-acute hep B infection
What are the 3 laboratory categories of HIV pts?
- CD4 cell count of 500 or more
- CD4 cell count of 200-499
- CD4 cell count of < 200 cells
Which antibiotics can cause c. diff?
- classically associated w/ clindamycin, but ANY antibiotic can cause pseudomembranous colitis
- most common:
1. Clinda
2. Cephalosporins
3. Penicillins
Risk factors for breast cancer
- Having first child after age 30
- Family hx of breast cancer
- Personal hx of breast cancer or atypical hyperplasia found on previous breast bx
- Known carrier of BRCA-1 or BRCA-2
Recommendations for mammographies for general population?
-start at age 40 (or some sources say 50) and screen every 1-2 yrs
Causes of posthepatic jaundice
- usually caused by obstruction to the flow of bile through the bile ducts
- can be caused by stones, strictures, or tumors
- get a conjugated hyperbilirubinemia
What disease puts children at risk for a stroke?
-sickle cell anemia
What is the definitive tx of hyperthyroidism? What in a sfx? Who is it contraindicated in?
- radioactive iodine –> destroys thyroid gland
- 40% of pts will become hypothyroid & will need thyroid hormone replacement
- contraindicated in pregnant women, bc fetus thyroid can take it up and it will destroy their thyroid too –> creatinism
What are 3 medications that can be used to tx hyperthyroidism? MOA? Sfx?
- Propylthiouracil –> preferred in pregnancy
- Methimazole
- Carbimazole
- MOA: inhibit the organification of iodine
- sfx: most serious = agranulocytosis
AIDS
- advanced stage of HIV infection
- opportunistic infections are required for the dx
5 species common in human bites?
- Staphylococci
- Streptococci
- Haemophilus species
- Eikenella species
- Anaerobes
Tx of graves dz in adolescents?
-use antithyroid drugs bc Grave’s may go into spontaneous remission for them after 6-18 mnths
How many postmenopausal women will have an osteoporosis related fracture in their lifetime?
-HALF!!
Residual ischemic neurological deficit (RIND)
-a neurologic deficit of greater than 24 hrs and less than 3 wks
When are grass pollens typically present?
- late spring through early fall
- but can be present year-round in warner weather too
What should be done when a thyroid nodule is found?
-further work-up bc 5-6% of identified nodules are malignant
HIV category B
-have symptomatic conditions that are either indicative of a defect in cell-mediated immunity or that are complicated by HIV infections (NOT AIDS defining infections!)
3 Sx of oral decongestants
- Tachy
- Trenors
- Insomnia
“Alarm features” of GI sx
- Fever
- Anemia
- Involuntary weight loss of > 10 lbs
- Hematochezia
- Melena
- Refractory or bloody diarrhea
- Family hx of colon cancer of inflammatory bowel dz
* *these usually point to an underlying organic etiology & may warrant further workup
HIV dx
- standard screening test = ELISA
- positive ELISAs must be confirmed with Western Blot to rule out false positives
HIV clinical category A
- asymptomatic
- primary infection and generalized lymphadenopathy
- persistent generalized lymphadenopathy = enlarged lymph nodes that involve at least 2 noncontiguous sites other than inguinal nodes
What is measured in the direct bilirubin?
-the conjugated bilirubin
What are the calcium and vit D recommendations for women > 50 yrs
- 1200mg calcium
- 400-800 IU of vit D per day
Prophylaxis for P. jiroveci?
-TMP/SMX in HIV pts with CD4 count < 200 cells/microL
Tx for diarrhea-predominant IBS
- Loperamide
- reduces frequency of loose stools and urgency
In what ots are thyroid nodules more likely to be malignant in?
- children
- adults younger than 30
- adults older than 60
- pts with hx of head or neck irradiation
Decongestants: MOA? Use? Most common one used?
- can be taken orally or intranasally
- constrict the blood vessels of the nasal mucosa and reduce the overall volume of the mucosa
- pseudophedrine is the most commonly used
Tx of animal bites
- Clean wound with soap and water
- Irrigate the wound with saline
- Debridement
- Tetanus vaccine if needed
- Contact animal control about rabies
- 5-7 days of antibiotic prophylaxis (amoxicillin-clavulanate = augmentin), or longer if cellulitis is present
- Hospitalization or surgery might be necessary if severe!
Diarrhea from undercooked hamburger
-enterohemorrhagic E. coli
Tx for constipation-predominant IBS
-increase giber intake, via diet or supplement
Hep B vaccine recommendations
- universally for all children
- adults at high risk
Transient ischemic attack
-a focal neurologic deficit lasting less than 24 hrs
Mycobacterium avium prophylaxis
- should be initiated in HIV pts if their CD4 count falls to less than 75 cells/microL
- azithromycin
What are the 3 most common causes of hyperthyroidism?
- Graves disease
- Autonomous nodule that secretes thyroxine
- Thyroiditis (usually early stage)
When should you begin screening women for lipid disorders?
-age 45
Poststroke cerebral edema tx
- mannitol
- decompression surgery
How to remove a stinger
- remove ASAP
- better to scrape or brush the stinger off the skin, rather than grasp it bc grasping it at the base can compress the venom-containing sac and causes increased venom release
- BUT its better to rapidly remove the stinger than to spend time looking around for something to scrape the stinger out with (ex credit card)
Delayed rxns to insect stings?
- large local rxns mediated by immunoglobulins (IgE) that are reactive to the venom
- lg (> 10 cm in diameter) area of redness and warmth–> often confused with cellulitis
- develops 24-48 hrs later
- tx: oral steroids
- tetanus prophylaxis should be done!
- a person with a lg delayed rxn to a sting is more likely to have another one in the future, but this does not change their risk or anaphylaxis
Risk factors for animal bites becoming infected?
- Larger
- Deeper
- Hand wounds
- Presence of chronic illness or immune suppression
- Cat & humans > dogs to become infectious
Diarrhea from mayo
- Staph aureus
2. Salmonella
Describe the abdominal pain commonly seen with fibromyalgia
- usually in the lower abdomen, esp in the left lower quadrant
- cramping pain of intermittent frequency and variable intensity
- pain often improves or is relieved with defication
- pain will NOT wake a person up from sleep
Osteoporosis screening recommendations
-women > 65 & > 60 in higher risk women
Which bilirubin is excreted in the urine? What does a high level mean?
- conjugated
- high urine level = conjugated hyperbilirubinemia
Tx of abdominal pain with IBS?
- Antispasmodics –> dicyclomine and hyoscyamine as needed
2. Low-dose tricyclic antidepressants –> when pain is frequent and severe
Which bilirubin can be high in Gilbert’s syndrome?
-unconjugated
Allergic shiners
-dark circles around the eyes related to vasodilation or nasal congestion
Desensitization tx
- used in pts who remain symptomatic despite mac medical tx
- steps:
1. Test to figure out specific antigens
2. Inject pt with highly diluted antigen
3. Inject weekly or bi-weekly while gradually increasing the concentration of the antigen
In what 2 groups of women apis cervical cancer seen in?
- Women not screened in over 5 yrs
2. Women who had an abnormal pap and did not follow-up on it
What is the most common cause of diarrhea? Tx?
- viral
- tx: rehydration, antibiotics WONT help!
3 most common causes of hypothyroidism?
- Hashimoto thyroiditis
- Post-Graves dz thyroid ablation and surgical removal of thyroid gland
- Secondary hypoTH related to hypothalamic or pituitary dysfunction
Antibiotic prophylaxis for traveler’s diarrhea
- not indicated unless the pt is at incased risk for complications from diarrhea or dehydration (ex inflammatory bowel dz, renal dz, or immunocomp)
- fluoroquinolones are used
Most common cause of chronic liver dz in the US?
-hepatitis C
3 causes of diarrhea in daycare settings?
- Shigella
- Giardia
- Rotavirus
Hep B and hepatocellular carcinoma
-hep B causes 80% of the hepatocellular carcinoma cases worldwide
Diarrhea from raw seafood
- Vibrio
- Salmonella
- Hep A
Lubiprstone: MOA? Use? Sfx?
- MOA: activates intestinal chloride channels and increases fluid secretion
- use: for IBS in women with constipation
- sfx: nausea
What is the LDL goal for a pt that had a stroke?
-less than 100
Antihistamines: MOA
-competitively antagonize the receptors for histamine, which is released from the mast cells
Tx for pts with IBS and depression or anxiety?
-SSRIs
Acute diarrhea
-present for less than 2 wks
Risk factors for cervical cancer (4)?
- Early onset of sexual intercourse
- Multiple sex partners
- HPV infections
- Tobacco use
Leukotriene inhibitors: use?
- indicated for both allergic rhinitis and maintenance tx for persistent asthma
- especially useful in pts with both asthma and allergies or in pts whose asthma is triggered by allergies
Diarrhea from undercooked chicken
-salmonella or shigella
Nephritic
-hematuria
Common cause of diarrhea in campers
-giardia
What is the most common bacteria involved in human bites that cause a closed fist injury?
-eikenella species
Tx of acute Hep B v. Chronic Hep B? Acute –> chronic?
- acute = supportive
- chronic = antiviral tx
- the younger the pt = the more likely an acute infection is to become chronic
Subacute diarrhea
-present for 2-4 wks
Noninfectious causes of conjunctivitis: tx
-oral antihistamines or topical antihistamines or anti-inflammatory eye drops
Tx of anaphylaxis
- injection of aqueous epi 1:1,000 in a dose of 0.2 to 0.5 mL (0.2-0.5 mg) –> given subcutaneously or IM ASAP, can be repeated in 10-15min if needed
- Fluid replacement –> lots of fluid moves into interstitial space
- Antihistamines –> if severe
- Steroids –> if severe
- Bronchodilators –> if severe
* *should be observed in hospital for 12-24 hrs bc sx can reoccur!!
Risk factors for a stroke?
- HTN –> most important!
- DM
- Age
- Male sex
- Family hx
- Dyslipidemia
- Smoking
- Certain CV conditions –> a fib, MI, endocarditis, carotid stenosis, rheumatic heart dz, presence of mechanical valve, advanced dilated cardiomyopathy, patent foramen ovale or AsD
Hymenoptera
- order of insects that cause the most insect stings
- includes:
1. Wasps
2. Yellow-jackets
3. Hornets
4. Honeybees
5. Bumblebees
6. Fire ants
4 Most common causes of conjunctivitis?
- bacterial
- viral
- allergy
- chemical irritants
How is screening for osteoporosis done?
- with a DXA scan = dual-energy x-ray absorptiometry
- this is the best predictor of a hip fracture
- measurement is compared to that of young adults –> result reported as a T score
- osteoporosis = at or below 2.5 SD less than than that of the young adults
- osteopenia = at or below 1.0-2.5 SD less
IBS dx
- in absence of structural or biochemical explanation (or “alarm features”) of sx and the Rome Criteria a pt can be dx
- avoid expensive and unnecessary tests when possible
- a CBC and stool Hemoccult test should be done!
- a colonoscopy should be done in any pt > 50 yrs old!
Nephrotic
-proteinuria
What is the most common cause of epidemic keratoconjunctivitis? Tx?
- adenovirus
- highly contagious
- tx:
1. sulfonamide tx to prevent secondary infections
2. Hot compress to reduce discomfort
3. Weak topical steroids to tx corneal infiltrates - usually lasts 2 wks
Once HIV is dx, what should be done before tx?
- report to local health authorities –> partner notification laws vary by state
- HIV genotype testing –> to ID strains that may be resistant to tx
- determine HIV RNA levels to help assess the disease activity
- measure CD4 lymphocyte counts
- CBC, metabolic panel, & urinalysis
- screening for other STDs
- PPD
Ssx of vertebrobasilar strokes?
- Motor or sensory loss of ALL 4 limbs
- Crossed signs
- Disconjugate gaze
- Nystagmus
- Dysarthria
- Dysphagia
Local rxns of insect stings: ssx? When do they occur? Tx?
- ssx: redness, swelling, pain, & itching
- occur almost immediately, last for a few hrs
- caused by histamine release in response to the venom
- tx: ice and anti-histamine ps for itching
- also give TETANUS prophylaxis
What can happen with chronic use of nasal decongestants?
-rebound hyperemia and worsening of sx
When is ragweed present?
-late summer and early fall
Diarrhea in travler’s to Mexico
-caused by enterotoxigenic E. coli
What can be the cause of diarrhea if the stool was found to have leukocytes present in it?
- Salmonella
- Shigella
- Yersinia
- E. colic
- C. Diff
- Campylobacter
- Entamoeba histolytica
4 Common bacteria involved in cat and dog bites?
- Staphylococci
- Streptococci
- Anaerobic species
- Pasturella species
Status asthmaticus
-an airway obstruction that lasts for days or weeks and is refractory to tx
Dx of diarrhea?
- most patients dont need work up bc disease is self limiting
- exceptions:
1. Fever > 100.4 *F
2. Bloody diarrhea
3. Severe abdominal pain
4. Profuse diarrhea
5. Dehydration
6. > 48 hrs
7. Kids, elderly, Immunoincomp pts
Perfect use effectiveness (w/contraceptives)
-efficacy of a method when always used correctly, consistent and reliable use occur
When should follow-up visits for pregnancy take place?
- first every 4 weeks until 28 weeks
- then every 2 weeks until 36 weeks
- then every week from 36 wks til birth
Acral lentiginous melanoma: where is it commonly found? Who is it most common in?
- most common melanoma in African Americans and Asians
- commonly found under nails, on the soles of feet, and on palms of the hands
Trichomonas: ssx?
- copious amnts of thin, frothy, green-yellow or grey malidorous vaginal discharge
- vaginal soreness or dyspareunia
- sx start, or are exacerbated during the time of their menses
- cervix will be “strawberry red”
- motile trichomonads seen on wet prep
Postpartum depression: what is it? Ssx? Tx?
- sx are the same as major depression
- occur within 4 wks postpartum and can be seen up to 1 year later
- severity can range from mild to sever and suicidal
- high rate of recurrence in subsequent pregnancies
- SSRIs = first line tx
Vertical transmission
-infectious passage of infection from mom to fetus whether in utero, during labor and delivery, or post partum
Strategy to enhance motivation to quit smoking (5 Rs)?
- Discuss specific Relevance to quit smoking
- Risks of ongoing use
- Rewards to quitting
- Roadblocks to quitting
- Repetition = bring it up at each visit
How many times a week should short-acting beta-agonists be used?
-no more than 2 times a week, or the asthma is considered to be poorly controlled
What does the triple screen test for?
- hCG
- Unconjugated estriol
- Alpha-fetoprotein
Uterine atony
- most common cause of postpartum hemorrhage
- failure of the uterus to contract adequately
- results in continued bleeding from the uterine vasculature
- risks:
1. Prolonged labor
2. Prolonged use of oxytocin during labor
3. Large baby
4. Grand multipara (5 or more previous children)
Dosage of nicotine nasal sprays?
- each spray provides 0.5mg of nicotine
- should start by using 1-2 sprays per hour with maximum of 40 doses per day
Most common cause of pharyngitis?
-viral
When do most women resume sexual activity after giving birth?
-by 3 mnths postpartum
Isoimmunization
- development of specific antibodies as a result of antigenic stimulation by material from the rbcs of another individual
- ex w/ Rh positive fetus and Rh negative moms
What baseline heart rate is considered normal for a fetus during delievry?
- 110-160 bpm
- less than 110 = bradycardia
- greater than 160 = tachycardia
When can a child stop using a booster seat in the car?
-when they are tall enough to sit with their back to the seat and their legs bent at the knees over the front of the seat (usually 4’9” and btwn ages 8-12).
What does actinic keratosis raise the risk for?
-squamous cell carcinomas
Sx of alcohol withdrawal (7)?
- Tremulousness
- Insomnia
- Anxiety
- Depressed mood
- GI upset
- Heart palpitations
- Sweating
RERA
-respiratory effort-related arousals
Lochia
- yellow-white discharge, consisting of blood cells, decidual cells, and fibrinous products
- usually occurs for 3-6 weeks following delivery
Failure rate of Rhythm method?
-14-47%
Common sx of acute bronchitis (10)?
- cough with purulent sputum production –> MOST COMMON
- Fever
- Malaise
- Rhinorrhea or nasal congestion
- Sore throat
- Wheezing
- Dyspnea
- Chest pain
- Myaligias
- Arthralgias
4 Signs that can confirm the rupture of membranes (“water broke”)?
- Visualization of amniotic fluid leaking from the cervix
- Presence of pooling of amniotic fluid in the posterior vaginal fornix
- pH above 6.5 in fluid collected from the vagina (usually vaginal secretions have a pH less than 5.5), using Nitrazine paper, or visualization of “ferning” on a sample of fluid on an air-dried microscope slide
What meds can reduce the effectiveness of OCPs?
- Some antibiotics
- Barbiturates
- Antifungal medications
What is considered a long QT interval?
- > 470 msec in men
- > 480 msec in women
- ANY pt with an interval > 500 msec is at increased risk for dangerous dysrhythmias!
Possible complications of OM?
- Mastoiditis
- Bacterial meningitis
- Brain abscess
- Subdural empyema
Tx of choice for pneumonia in a healthy pt?
- macrolide (clarithromycin or azithromycin)
- doxycycline
What should be checked in an eye exam of every newborn?
- red reflexes
- can mean congenital cataracts or retinoblastoma
What are 2 common side effects of narcotics?
- Constipation
2. Sedation
What finding on a physical exam is most suggestive of obstructive sleep apnea?
-obesity
Common ssx of mitral valve prolapse?
- Palpitations
- Fatigue
- Chest discomfort
- Dyspnea
Active phase of labor
- part of the first stage of labor
- starts at 3-4cm of cervical dilation, rate of cervical dilation is at its maximum
- contractions are strong and regular
Early deceleration
- coincides with a contraction, fetal heart rate declines and then returns to the baseline
- thought to be the result of increased vagal tone caused by compression of the fetal head by the contractions –> not associated with fetal hypoxia or acidemia
What are 4 features of benign skin lesions?
- < 6 mm
- Symmetric
- Uniform in color
- Well-defined borders
Depo-provera: what is it? How long does it last? Sfx?
- injectable form of progestin = medroxyprogesterone
- lasts for 14 wks, injected every 3 mnths
- sfx: irregular menses, weight gain, facial/body hair growth
- *most women develop amenorrhea after a year of use
4 Steps in management of CHF?
- Supplemental oxygen w/ checking ABCs
- Loop diuretic - furosemide is drug of choice
- Nitrates = to reduce oxygen demand, by reducing preload and afterload
- Morphine = venodilator, arterial dilator, and analgesic effects
What are the 4 cardinal movements of the fetal head as it descends through the birth canal?
- Flexion = fetal chin to the chest
- Internal rotation = fetal occiput moves anteriorly toward the maternal symphysis pubis
- Extension = as the head approaches the vulva
- External rotation = to face either the maternal right or left side
Pregnancy category C
-animal studies have shown adverse fetal effects and there are no adequate studies in humans OR no animal studies have been conducted and there are not adequate studies in humans
Alcohol dependence
-mental and physical need to consume alcohol in order to prevent the pains of withdrawl and obtain certain results, and associated with in increasing consumption to obtain the same effect
Neonatal benefits of breast-feeding
- Ideal nutrition
- Increased resistance to infection
- Reduced risk of GI difficulties
Smoking during pregnancy can cause (5)?
- Prematurity
- Interuterine growth restriction
- Stillbirth
- Spontaneous abortion
- Infant death
Strabiusmus
-ocular misalignment
What are the 2 nonnicotine medications that can be used for smoking cessation?
- Bupropion = zyban
2. Varenicline = chantix
3 most common causes of acute bacterial sinusitis in children?
- S. pneumoniae
- H. Influenzae
- Morzxella catarrhalis
When should a 12-lead EKG be done on a pt presenting with palpitations?
- always!!
- even if they are symptom free at the time of the exam
Trichomonas: tx?
- oral metronidazole to BOTH partners
* * also make sure to screen for other STDs
Tx for pt with v-tachy who is stable? Unstable? Allergic to iodine?
- stable = amioderone
- unstable = electrically cardioverted
- allergic to iodine = lidocaine
What is the onset of action, time to peak, and how long do short-acting beta-agonists last?
- onset in 5 min or less
- peak in 30-60 min
- last 4-6 hrs
What do “minipills” contain?
-only progestrin
What labs are recommended at initial prenatal visit?
- CBC
- Hep B surface antigen
- HIV testing
- Syphyllis screening
- Urinalysis
- Urine culture
- Rubella antibody
- Blood type and Rh status w/antibody screen
- Pap smear
- Cervical swab for gonorrhea and chlamydia
What is the failure rate for the minipill? For combination OCPs?
- minipill = 1-3%
- combination = 1-2%
What does Atypical pneumonia usually look like on xray?
-bilateral, diffuse infiltrates (rather than focal)
Gonorrhea: tx?
- ceftriaxone IM
- empiric tx should be considered in areas of high prevalence of infection or when follow-up is unlikely
Risk factors for endometrial carcinoma
- Hx of anovulatiry menstrual cycles
- Obesity
- Nuliparity
- > age 35
- Use of tamoxifen or unopposed exogenous estrogen
What test should be done if a pheo is suspected?
-24 hr urine collection for catecholamines and metanephrines
What are the two long-acting beta agonists? When are they used?
- Salmeterol = serevent
- Formoterol = foradil
- act for more than 12 hrs
- can be used with SABAs
* *should NEVER be used as monotx
- consider increasing dose of ICS before adding a LABA
- increase in sever exacerbations and deaths with use of LABAs
Dosing for nicotine gum?
- 2mg pieces for pts who smoke less than 25 cigarettes a day
- 4mg pieces for pts who smoke more than 25 cigarettes a day
6 Common causes of menorrhagia:
- bc the bleeding is regular it means that ovulation is occur and that the endocrine pthwys are intact
1. Leiomyomata = fibroids (common cause) –> cause an increased endometrial surface area = increased menstrual bleeding
2. Endometrial polyps (similar mechanism to ^^)
3. Coagulopathy –> most commonly von Willebrands
4. Medications –> ex warfarin
5. Liver dz
6. Thrombocytopenia
Bupropion: MOA
-blocks uptake of norepi and/or dopamine
What are the 6 etiologies of palpitations (in order of most to least common)?
- Primary rhythm disturbance
- Underlying mental health problem - anxiety or panic disorder
- No identifiable cause
- Drugs/meds
- Noncardiac cause
- Intrinsic structural problem with heart
How does pneumonia caused by pneumocystis jiroveci usually look on xray? Who commonly gets this kind of pneumonia?
- bilateral, “ground glass” appearing infiltrate
- commonly seen in AIDS pts
What is the leading cause of death in children < 1 yr old? What can be done to reduce these risks?
- SIDS
- risk reducers: “back to sleep”, sleeping on a firm mattress, nothing else in the crib
Apnea hypopnea index (AHI)
-number of apneas and hypopneas per hour of sleep
Tx of substance-induced depression?
- antidepressant meds can be ineffective and even harmful
- refer to substance abuse tx first and then reassess depression 1 month postabstinence
Cyst
-closed saclike, membranous capsule containing a liquid or semisolid material
What is the most prognostic factor in melanoma?
- the thickness of the tumor
- less than 1-mm thick = low rate of metastasis
Legg-Calve-perthes (LCP) disease: what is it? Who is it seen in? Ssx? Dx? Tx?
- avascular necrosis of the femoral head
- typically seen in kids age 4-8
- boys > girls
- etiology of the disruption of blood flow is unknown
- ssx: gradual onset of hip, thigh, or knee pain, and limping over a few months
- dx: xray may appear normal at first, then see collapsed, flattened, and widened femoral head
- tx: conservative, protect the joint and maintain ROM
Contraindications to breast feeding?
- HIV infection bc of vertical transmission
- Acute & active hep B (chronic hep B & C can breastfeed)
- Previous Breast-reduction surgery with nipple transplantation
When shoukd emergency treatment for asthma be considered?
- Peak flow < 40% of the predicted normal
- Failure to respond to beta agonist
- Severe wheezing or coughing
- Extreme anxiety due to breathlessness
- Gasping for air, sweaty, cyanotic
- Rapid deterioration over a few hours
- Severe retractions and nasal flaring
- Hunched forward
What are standard drink measurements for: beer? Wine? Shot?
- beer = 12 oz
- wine = 5 oz
- shot = 1.5 oz
Transient synovitis
- self- limited inflammatory response that often follows a viral infection
- common cause of hip pain in children
- occurs typically in kids ages 3-10
- boys > girls
- sx: gradually increasing hip pain that results in a limp or refusal to walk, low grade fever or no fever, normal WBC count, and normal ESR
- if not better in a few days, consider septic joint
OCP use in non-breastfeeding women?
- wait 3 weeks postpartum, risk of thromboembolic dz if start earlier
- use combines OCPs
When and how should women be tested for gestational DM? What is considered positive? What should be done with a pt that tests positive?
- at 24-28 weeks
- w/ 1hr 50g glucose challenge test, a value >135 mg is abnormal, >200 mg is diagnostic
- positive 1hr –> do fasting 3 hr challenge test
2 most common antibiotics used for acute sinusitis?
- Amoxicillin
- Trimethroprim-sulfamethoxazole
* *usually 10-14 day prescriptions
Contraindications to ACEi?
- Pregnancy
- Hypotension
- Hyperkalemia
- Bilateral renal artery stenosis
Intermittent asthma
- symptoms of asthma that occur less than 2 times a week
- nocturnal awakenings that occur less than 2 times a month
- need for oral corticosteroids less than 2 times a year
- no limitations in normal activities
- spirometry is normal btwn exacerbations
Monoamine oxidate inhibitors: MOA
-increase the amnts of serotonin and norepi to be released during nerve stimulation
What lab tests should be done to rule out noncardiac causes of palpitations?
- CBC
- Chemistry panel
- TSH
How many rads until a fetus is at risk from radiation exposure?
-greater than 5 rads
What is an acceleration in the fetal heart rate? What can it be in response to? What does it mean?
- increase in the fetal heart rate of 15 bpm or more for 15 sec or longer
- this is a reassuring finding
- can occur spontaneously or in response to a contraction
- ensures that the fetal arterial pH is greater than 7.2
What is the most common mechanism that triggers pneumonia?
-upper airway colonization by pathogenic organisms that are aspirated
Which 2 newborn screening tests are required by ALL states?
- PKU
2. Congenital hypothyroidism
Bacterial vaginosis: definition
-excessive anaerobic bacteria in the vagina that leads to a discharge that is alkaline
Severe sx of chronic alcohol use withdrawal?
- Tonic-clonic seizures w/in 6-48 hrs
- Hallucinations w/in 12-48 hrs
- Delerium tremens w/in 48-72 hrs
Sore throat with rhinorrhea and cough is most likely to be?
-more likely to be viral
What are the 3 short-acting beta-agonists that are used for tx of asthma?
- Albuterol
- Levalbuterol = xopenex
- Pirbuterol = maxair
Plaque
-a small plateaulike, raised, solid area on the skin that covers a large surface area in relation to its height above the skin
What position do children with a septic hip joint usually assume?
-laying with their hip flexed, abducted, and externally rotated
Diaphragm: use? Failure rate?
- use: flexible rubber disk that is inserted to cover the cervix, must use spermicide too, & must be properly fitted by a dr
- must be left in for at least 6hrs after intercourse
- failure: 6-18%
What are the top 2 leading causes of death in children over the age of 1?
- Accidents
2. Injuries
In which asthmatic patients can anticholinergic bronchodilators be used?
- such as ipratroprium = atrovent
- can be used in combination with a SABA for tx of severe asthmatic attacks or those induced by beta blockers in the urgent care setting
GAS causes what percentage of pharyngitis in adults? Kids?
- 15% in adults
- 30% in kids
Chlamydia: tx?
- doxycycline orally for a week or one dose of azithromycin orally when compliance is a concern
- empiric tx should be considered in areas of high prevalence of infection or when follow-up is unlikely
- tx other partner too!
Macule
-discoloration on the skin that is neither raised nor depressed
What is the gold standard for dx of GAS pharyngitis infections?
- throat cultures
- they take 24-48 hrs
- can do rapid antigen test in the office, it has high specificity, but low sensitivity
SCFE: tx? Prognosis?
- tx:surgical w/ pinning
- prognosis: follow closely bc 1/3 develop avascular necrosis and 1/3 develop SCFE on contralateral side
Nodule
-small mass of rounded or irregular shape that is greater than. 1.0 cm in diameter
How can beta-blockers be used for palpitations?
- they can be used for sx that are short lived or episodic
- act as short-acting negative chronotrophs
Labor: when does it usually occur? What is preterm? What is posterm?
- labor begins spontaneously and occurs normally within 2 wks of the estimated date of confinement (= 280 days after the first day of the last menstrual period)
- preterm = onset of labor more than 3 wks before the estimated date of confinement (EDC)
- postterm = labor that does not spontaneously start by 2 weeks after the EDC
What sx does legionella commonly cause with pneumonia?
-diarrhea
What is the gold standard for pneumonia diagnosis?
-infiltrated on chest xray
What is the most important risk factor for the development of skin cancer?
-exposure to UV radiation
Trisomy screen: when is the optimal time? When can the screen be done?
- optimal = 16-18 weeks gestation
- can be done = 15-20 wks
Otitis externa tx?
- Irrigation
- Topical antibiotics
- Steroids
Which polio vaccination is used today?
-inactivated, injected vaccine (rather than the oral one)
Can vaccines be given to a child with a minor illness? With a low-grade fever?
- yes and yes!
- so acute illness visits can be used to update immunizations too!
Failure to thrive
- weight below the third or fifth percentile for age
- OR decelerations of growth that have crossed 2 major growth percentiles in a short period of time
- significant loss or gain of weight should be investigated
Dosage of nicotine cartridge inhalers?
- one cartridge has 4mg of nicotine in 80 inhalations
- recommended dose is 6-16 cartridges per day
What should routinely be addressed at well-child visits?
- Injury prevention
- Nutrition
- Development
- Discipline
- Exercise
- Mental health issues
- Need for ongoing care - ex vaccines, etc.
How long does breast feeding provide natural contraception?
- 6 mnths postpartum
- after 6 mnths menses restarts & alternative contraception is needed
Dysthymic disorder
-chronic depression of mood which does not meet the criteria for major depression, in terms of either severity or duration of individual episodes, yet the patient still has loss of interest, lack of appetite or pleasure, and low energy
Palpitations association with what are pathologic?
- palpitations associated with syncope
- consider hospitalizations
Which types of condoms are effective against preventing STDs?
-of the 3 types (latex, rubber, or natural skin) ONLY latex condoms are highly effective in preventing STDs
When is the MMR vaccination recommended?
-at 12-15mnths and 4-6 yrs
Pregnancy category B
-animal studies have shown no harm to fetus, but human studies are not available OR animal studies have shown harm to fetus, but studies in pregnant women have not shown harm
Long QT syndrome: ssx?
- palpitations and/or syncope
- have family hx of syncope or sudden death
Papule
-small circumscribed ELEVATED lesion of the skin that is less than 0.5cm in diameter
What are two leukotriene receptor antagonists? When are they used?
- Montelukast = singulair
- Zafirlukast = accolate
- use in ots who are unwilling or unable to use inhaled corticosteroids
- can be used in mild persistent asthma
- indicated in exercise-induced asthma
* *tx of choice for aspirin-sensitive asthma!
Otitis media: causes (3)?
- caused by upper respiratory tract pathogens, promoted by obstruction to drainage via swelling of congestion of eustachian tubes
1. S. pneumo
2. H. Influenzae
3. M. Catarrhalis
What pregnancy category are buproprion and varenicline?
-C
Second stage of labor: what is it? How long does it last in a nulliparous and parous woman?
- from complete cervical dilation (10 cm) through the delivery of the fetus
- normally lasts less than 2 hrs in a nulliparous woman and less than 1 hr in a parous patient
Valvovaginal candidiasis: ssx?
- present with thick, whitish discharge that has no odor
- significant puritus of the external and internal genitalia
- vaginal area is edematous and erythema is often present
- discharge pH is 4.0-5.0
- pseudohyphae or budding yeast are seen on KOH prep
Respiratory disturbance index (RDI)
-number of apneas, hypopneas, and respiratory effort-related arousals (RERAs) per hour of sleep
Complications of pneumonia (3)?
- Bacteremia
- Pleural effusions
- Empyema
Maternal benefits of breast feeding?
- More rapid return of uterine tone w/ reduced bleeding and a quicker return nonpregnant size
- More rapid return to pre-pregnancy body weight
- Reduced incidence of ovarian and breast cancer
- Connivence of always having food supply
- Lower cost
What are 3 reasons to get a chest x-ray on a pt that is acutely ill with a cough?
- Dullness to percussion
- History of fever
- Clinical suspicion
Emergency contraception
- if combined high dose oral contraceptives are taken within 72hrs of unprotected intercourse, risk of pregnancy is 74%
- *only RU-486 is effective after 72 hrs!
Sx of bacterial rhinosinusitis?
- 7 days of sx in adults and 10 days of sx in children
- Purulent nasal discharge
- Maxillary tooth or facial pain
- Unilateral maxillary sinus tenderness
- Worsening of sx after initial improvement
What are the 3 “Ps” in the progress of labor?
- Power = strength of contractions and mom’s pushing, contraction strength can be measured
- Passenger = fetus, its size, lie, presentation, and position in the birth canal
- Pelvis = shape and size of the pelvis can result in a delay or failure of descent of the fetus bc of the relative disproportion btwn the fetal and pelvic size
What is the first line tx in pts w/ CHF and reduced left ventricular function?
- ACEi = reduce preload, reduce afterload, improve CO, and inhibit-RAS
- reduce sx & mortality
Common complications of breast feeding?
- Sore or cracked nipples
- Mastitis = obstruction of milk glands, sometimes secondarily infected w/ bacteria
- tx = continues feeding or pumping + oral antibiotics (cephalexin or dicloxacillin) –> dont discontinue nursing!!
Fetal lie
- the relationship of the long axis of the fetus to the long axis of the mother
- either longitudinal or transverse
What are the 5 As?
- Ask
- Advise - tell pt about their specific risks
- Assess
- Assist
- Arrange - follow-up and support
