OME/Book 2 Flashcards by Christian Bernardo

2 year old, viral prodrome, barking/seal like cough, stridor in between cough, improves with winter air

dx and rx

croup 2/2 PARAINFLUENZA

rx with RACEMIC EPI, steroids, o2 if severe

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croup that doesn’t improve with racemic epi consider….

bacterial tracheitis 2/2 STAPH AUREUS

dx with tracheal culture and give IV abx

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no vaccine history, rapid onset high spiking fever, tripod/drooling/accessory muscles, muffled voice

epiglottitis

rx: endotracheal intubation, visualize cherry red epiglottitis….IV abx

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super sick, abrupt onset high spiking fever, drooling, tripod, neck stiffness, muffled voice, anterior chain unilateral LAD, tender mass

retropharyngeal abscess

dx with CT scan, I+D, iv abx

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older kid, muffled voice, sore throat, drooling, uvular deviation

peritonsillar abscess

I/D, iv abx

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rx sarcoidosis

systemic corticosteroids

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“egg shell” calcifications on chest xray

silicosis

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pathophys of Goodpasture

IgG antibodies directed against basement membrane of alveoli and glomeruls (type II) hypersensitivity

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how can respiratory failure cause coma

resp failure = hypercarbia = vasoDILATION of cerebral vessels = increased ICP nad coma

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scales antecubital fossa, itchy, vesicles crusts

dx and rx

atopic dermatitis (eczema)
rx: avoid trigger, emulsions, topical steroids (short term)

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contact dermatitis hypersensitivity what kind

TYPE IV (delayed)

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peripheral edema, erythematous skin then darkens, chronic condition predisposing to swelling in legs
dx and rx

stasis dermatitis (a/w stasis ulcers i .e. malleloar)
rx diuretics, compression stockings, leg elevation

(think dude with uncontrolled DM nephropathy you saw in ER)

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too much hand washing can cause…?

hand dermatitis

rx: stop washing too much, avoid harsh soaps

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fever simultaneous with red rash on cheek

erythema infectiousum (parvob19)

supportive

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complications parvo

aplastic crisis
hydrops fetalis (kid gives pregnant mom parvo, can pass it on to baby in utero)

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prodrome (cough, runny nose) conjunctivis, koplick spots/white dots in month) with fever+rash simultaneously…rash starts in face works its way down

measles
usually seen in non vaccinated patient
rx supportive

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long term effect of measles

subacute sclerosing panencephalitis

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generalized+tender LAD with fever and rash that starts in face spreads to down to trunk

rubella
supportive rx
vaccine!

no associated sequela

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very high spiking fever>104, rthen after fever breaks and THEN RASH…rash starts trunk and expands outward

roseola (HHV6)

rx supportive, watch out for febrile seizures…abort with benzos if>5min, use acetominophen

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diffuse vesicles on erythematous base, in diff stage of healing, eruptions/crusting NO FEVER

chicken pox, varicella

rx supportive, dx clinicals

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rash that abruptly stops at midline

shingles (herpes zoster, vcv)

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how to prevent shingles

shingles vaccine in patient’s who have had chicken pox over age 60

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pubertal male with parotid swelling and orchitis

mumps
rx supportive

MMR vaccine!

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long term complication mumps

infertility (if orchitis)

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rash sparing extremities and trunks

coxsackie | HFMD

recommended treatment for measles infection

VIT A

MOA Wiskot Aldrich

XLR in WAS gene (impaired cytoskeleton) thrombocyto eczema recurrent infection

how to prophylax against RSV bronchiolitis (esp in premies, chronic lung diseas prematurity, congenital heart)

palivizumab

long term complication RSV

apnea | respiratory failure

ped brain tumor with hydrocephalus (ICP symptoms), truncal/gait ataxia

medulloblastoma (posterior fossa tumor)

ped tumor with visual field defects, bitemporal hemianopsia, short stature

craniopharyngioma

ped tumor/mass with limitaion of upward gaze, bilateral eyelid retraction, light near disssociation

parinaud syndrome 2/2 pinealoma

ped tumor presenting with aphasia

low grade astrocytoma

paroxysmal cough, post tussive emeiss, subconjunctival hemorrhage, questionable vaccine status

pertussis need five dose Dtap 4-6 then Tdap in adolescence RX WITH MACROLIDES (azithro, erythromycin)

sequence of DM nephropathy

1. glomerular hyperfiltration (1st) 2. basement membrane thickening 3. mesangial expansion 4. nodular sclerosis (last)

how to manage ARDS

1. low tidal volume (prevents alveolar distension) 2. high PEEP (15-20) - prevent alveolar collapse 3. FI02 oxygenation <0.6 with goal to oxygenate for SPo288-95)

prolactin level in prolactinoma

usually >200 (nml = 15)

adolescent develops ataxia/dysarthria, scoliosis/feet deformities, and cardiac myopatyh (concetnric hypertrophic cardiomyopatyh)

freiderich ataxia | MCC death is cardiomyopathy

small papules with central umbilication, diffuse, can effect face and eyelid

molloscum contagiosum (poxvirus)

tic doloreaux (trigeminal neuralgia) rx

carbemazepine

acute thyrotoxicosis, low radioiodine uptake, elevated T4, low TSH, mild enlargement of thyroid, non tender

silent/painless thyroiditis

DM patient with watery diarrhea, skin lesions (crusting enlarging erythematous plaques), weight loss

glucagonoma

rx active seizure

benzos

rx simple febrile seizure

acetominophen | NOT ASA

bilateral symmetrical limb jerking NOT GENERALIZED, no fever, young infant <1 yo dx , dx test, rx

infantile spasm (west syndrome) dx with intraictal EEG/hypsarythmia rx with ACTH, watch out for MR

infant presents with infantile spasm, what to screen for?

tuberous sclerosis angiofibromas, ash leaf spots (woods lamps get CT/MRI rx supportive, poor prognosis

seizure, LOC, no loss of tone, generalized

absence seiuzure dx EEG rx ethosux

rx upper aiway cough syndrome (post nasal drip)

first generation antihistamine (

transudative pleural fluid has what kind of pH

7.45

foreign body aspiration extrathoracic vs intrathoracic

extra - inspiratory stridor (call ENT) intra - exp wheezes bronchoscopy - if in resp endoscpy - if GI laryngoscopy - if ENT

first step when patient comes back with asthma refractory to meds

PATIENT EDUCATION

inheritance CF

AR | CFTR gene

recurrent hexagonal kidney stones during childhood | dx and what test

cystinuria test with urinary cyanide nitroprusside

teenage boy dull aching pain in leg, occurs mostly at night, improved with NSAIDs, not related to physical activity xrray shows hypodense lesion on proximal femur

osteoid osteoma (small round lucency) serial exam q4-5 months

if patient has abnormal first trimester combined test (increased b hcg, PAPP-A, nuchal translucency)...what to do at 15 weeks?

NOT QUAD SCREEN (this isn't diagnostic) offer amniocentesis for definitive diagnosis for abnormal initial 1st trimester test chorionic villus is before 12 weeks

most common murmur infective endo

new REGURGITANT murmur MITRAL REGURG

premie with GI bleed, pneumatosis intestinalis on xray...what to do next

NEC! NPO IVF TPN IV Abx

painless hematochezia, 2 year old, intermittent | dx test

meckel's tech 99 toddler CT in teenager

Apts test?

tests if baby swallowed moms blood (melena in newborn)

rx anal fissure in neonate

nothing | usually self resolving

how to prevent CIN

fluids + acetycystine (mucomist)

young man with hemptysis, dyspnea, renal failure

good pasture | rx with cyclophos + steroids

heart manifestation of extreme renal failure

uremic pericarditis

rx acute closure glaucoma

acetazolamide BBs pilocarpine

cohort vs case control study

cohort - start with risk factor, see who develops disease, RELATIVE RISK RATIO case control - start with disease, then work backwards to identify risk factor, ODDS ratio

experimental study where control group switches to getting intervention and intervention group stops getting intervention

cross over study GOOD WAY TO REDUCE BIAS

way to reduce bias

randomization, control group, blinding (esp double blinding)

bias that arises when study subjects act differently when they know they're being observed

hawthorne effect

bias that arises when subjects (esp those in sick group) remember more about exposures what kind and how to reduce this kind of bias

recall bias use single blinding

when researchers divide subjects into groups that are different at baseline (give rx to sickest patients, and placebo to not sickest patients)

selection bias counter this with randomization ( don't let researcher know who goes into whch group) or matching (subjects have similar demographics)

researcher knows who's in each gorup so it changes how you evaluate the study subjects

observer bias counter this with blinding

how to counter confounding....

randomize, better study design, matching

OCPs increase risk of DVT (so make study linking DVT) but you also find that smoking WITH DVT can increase risk

effect modification | third factor related to outcome=dvt, not necessarily OCP use, but enhances relationship

benefits and risks of hydroxyurea

reduce pain crises reduce stroke risk BUT risk myelosuppression

tick bite, flu like illness, neurologic symptos NO RASH, LEUKOPENIA, THROMBOCYTOPENIA ELEVATED LIVER ENYMES

erlichosis (e ewingii, chaffenesis) south eastern US rx with DOXY (same as lyme)

heart complication ankylosing spond

aortic regurg

POD#1 fever what to do

"WIND" get chest xray to r/o pneumonia but its probably ATELECTASIS

POD#2 fever what to do

"WIND" chest xray it's probably pneumonia treat with rx abx

POD#3 fever what to do

"WATER" U/A START ABX always take FOLEY out!

POD#7 fever

WOUND U/S for wound abscess but probably cellulitis

POD#10-14 fever

get U/S probably an ABCESS GO BACK TO OR FOR I&D

structure of tetanus vaccine

TOXOID!!!!

admin IVIG | what kind of immunity?

passive (gives preformed antibodies) active (antigen toxoid to prime PATIENT'S OWN IMMUNE SYSTEM)

vaccine c/i egg allergy

yellow fever (YELLOW EGG)

kid gets vaccine (fever>104, anaphylaxis)

don't give that vaccine in the future

what to do if baby born with HepB positive om

give vaccine and HbIG NOW!

DtAP and TDAP

DTAP - 3 doses 1st year, 2 doses 1-4 years | Tdap - booster every 10 year

if patient gets behind on HepB vaccine

just give whenever | 3 HepB, 2 HepA

nail wound, less than 3 TdAP doses....what to do

clean - tdap dirty - tdap + TIG dirty = rust, dirt, feces, metal, soil, saliva IF LESS THAN 3 LIFETIME DOSES OR UNKNOWN, TIMING DOESN'T MATTER

if nail wound, patient has more than 3 doses Tdap..what to do....

check timing clean wounds = within 10 years, send home, if greater then 10 years give Tdap diryt wounds = tdap within last 5 years, send home, t dap greater than 5 years give tdap

patient comes with fever, dysphagia, dypnea with pseudomembranes what to do

IF QUESTIONABLE VACCINE STATUS this is diptheria intubate, give anti toxin iv abx

what vaccine contraindicated in intussuseption

rotavirus

hx of angioedema in family, low C4

C1 esterase inhibitor deficiency

AIHA is what kind of hypersensitivity

type II (preformed IgG and IgM)

MOA type 4 hypersensitivity

delayed hypersens due to sensitized T cells releasing T inflammatory mediators ex: contact derm, granulomatous/sarcoid, chronic transplant rejection

patient presents with mon like syndrome (sore throat, pharyngitis, fever , malaise) what else to consider

HIV initial seroconversion can present like this

how to confirm diagnosis of HIV rapid test

ELISA western BLot initial rapid testing can be negative, re check in 6 months

giant granules in neutrophils, recurrent infetions, ocularcutaneous albinism

chediak higashi bad microtubule polymerizaiton

deficient Nitrobule terazolium in granulocytes

CGD

recurrent, chronic candida infection in mouth, head, skin, no other immunodeficiencies dx and a/w"?

chronic mucutaenous candidiases a/w hypothyroidism

complications of SGA infant

hypoxia -> polycythemia hypoglycemia hypocalcemia hypothermia everything LOW

OME/Book 2 Flashcards

(101 cards)