Random Flashcards by Luis M

Refeeding syndrome

Hypokalemia
Hypophosphatemia (hallmark)
Hypomagnesemia

How well did you know this?

Not at all

Perfectly

Active antirabies vaccine dose, route, days administered

0.5ml IM days 0, 3, 7, 14, 28

How well did you know this?

Not at all

Perfectly

Passive rabies vaccine

HRIG 20 U/kg 1/2 IM, 1/2 infiltrated around the wound
ERIG 40 U/kg (skin test needed)

How well did you know this?

Not at all

Perfectly

Rabies Immunization
CAT II
Immunologically naive vs Previously immunized

2 sites ID day 0,3,7
Or
1 site IM day 0,3,7 and between 14-28
Or
2 sites IM day 0 and 1 site IM day 7,21
—————
1 site ID day 0,3
Or
4 sites ID day 0
Or
1 site IM day 0,3

How well did you know this?

Not at all

Perfectly

Rabies Immunization
CAT III
Immunologically naive vs previously immunized

CAT II management plus RIG
to be infiltrated as much as possible to wound area, no need to give remaining via IM
———————
Same as CAT II
No RIG

How well did you know this?

Not at all

Perfectly

Tetanus prophylaxis
Clean minor wound
Uncertain or <3 doses

Give TDAP or TD
No need for TIG

How well did you know this?

Not at all

Perfectly

Tetanus prophylaxis
Clean minor wound
3 or more doses given

No need for TDAP OR TD (Except if 10 or more years)
No need for TIG

How well did you know this?

Not at all

Perfectly

Tetanus prophylaxis
All other wounds (Dirty etc)
3 or more doses given

No need for TDAP or TD (Except if 5 years or more)
No need for TIG

How well did you know this?

Not at all

Perfectly

Tetanus prophylaxis
All other wounds (dirty etc)
Uncertain or <3 doses

Give TDAP or TD
Give TIG

How well did you know this?

Not at all

Perfectly

Iron supplementation

LBW 15/0.6 0.3ml PO OD at 2 mos until 6 mos
6-11 mos 30/0.6ml 0.6ml OD x 3 mos
1-5 y/o 30/5ml 5ml OD x 3 mos
Adol 60mg iron/400mcg FA OD

How well did you know this?

Not at all

Perfectly

Deworming

Albendazole
12 mos to 23 mos 200mg single dose q6 mos
14 mos and up 400mg single dose q6 mos

Mebendazole
12 mos and up 500 ng single dose q6 mos

How well did you know this?

Not at all

Perfectly

Ideal body weight computation

<6 months - age in months x 600 + BW
>6 months - age in months x 500 + BW
1-6 age in years x 2 + 8

How well did you know this?

Not at all

Perfectly

Expected length and height during the 1st yr

0-3 mos 9 cm
4-6 mos 8 cm
6-9 mos 5 cm
10-12 mos 3cm

Ave gain during 1st yr 25 cm

How well did you know this?

Not at all

Perfectly

Estimated length or height computation

Cms - age in years x 5 + 80
Inches - age in years x 2 + 32

How well did you know this?

Not at all

Perfectly

Quick sheet in anthropometrics

BW doubled at 4 mos
BW tripled at 1 year
1/2 mature height for boys at 2
3 ft tall at 3
2x birth length at 4
3x birth length at 13
Attained 90% adult head size at 2
Approximates adult head size at 6

How well did you know this?

Not at all

Perfectly

Abd pain, vomiting, +/- distention
Cant pass NG tube, severe pain, emesis, coffee or omega sign

Volvulus

How well did you know this?

Not at all

Perfectly

Abd pain, vomiting, +/- distention
Bloody currant jelly stools, sausage shaped RUQ mass on UTZ, absent bowel sounds on RLQ, coiled spring sign

Intussusception

How well did you know this?

Not at all

Perfectly

Abd pain, vomiting, +/- distention
Post prandial vomiting, nonbilious, down’s syndrome, olive shaped mass, barium studies: shoulder sign, double tract

Pyloric stenosis

How well did you know this?

Not at all

Perfectly

Abd pain, vomiting, +/- distention
Normal
Hx or recurrent obstructive symptoms
Painless rectal bleeding
Intermittent pain
Technetium 99m pertechnetate Scintigraphy scan to detect gastric tissue

Meckel Diverticulum

How well did you know this?

Not at all

Perfectly

Meckel Diverticulum Rule of 2

2% of population
2x more males than females
2 y/o
2 inches long
2 ft from ileocecal valve
2 types of tissue gastric and pancreatic

How well did you know this?

Not at all

Perfectly

Osmotic vs Secretory Diarrhea

Osmotic
<200 ml/day
Stops with fasting
<70 meq/l Na
Reducing substances (+)
Stool ph <5

How well did you know this?

Not at all

Perfectly

First clinical evidence of HBV infection

ALT elevation at 6-7 weeks after exposure

How well did you know this?

Not at all

Perfectly

Most valuable single serologic marker of acute HBV infection

Anti HBc Ag

How well did you know this?

Not at all

Perfectly

Marker of active viral replication, identification of infected people at risk of transmitting HBV

HBe Ag

How well did you know this?

Not at all

Perfectly

First serologic marker to appear, coincides with the onset of symptoms

HBs Ag

Identification if people who have resolved infection, immunity after immunization

Anti HBs

Identification of infected people with lower risk of transmitting HBV

Anti HBe

Identification of people with acute, resolved, or chronic HBV

Anti HBc

Identification of people with acute or recent HBV including HBs Ag neg during window period

IgM anti HBc

Nephritic (HOHA)

Hypertension Oliguria Hematuria Azotemia

Nephrotic (PALE)

Proteinuria (nephrotic range) Albumin low Lipids high Edema

Cafe au lait that spares the face, axillary or inguinal freckling, lisch nodules, optic glioma, CT scan or MRI, genetic counseling and early detection of treatable complications

Neurofibromatosis Von Recklinghausen

Multisystemic, siezures, mental retardation, tubers in cerebrum (candle dripping), ash leaf, shagreen patch, CT/MRI of brain, heart, abdomen, 2d echo, renal utz Seizure control, multidisciplinary approach

Tuberous sclerosis

Upper respi obstructive symptoms Patchy infiltrates and ragged tracheal column

Bacterial tracheitis Tx: clinda/metro + 3rd gen ceph

Upper respi obstructive symptoms Thumbs sign or leaf sign

Acute Epiglottitis If vaccinated: staph aureus If unvaccinated: Hib Tx: 3rd gen cepha + ampisul/clinda

Thrombocytopenia Infections Eczema WASP mutation

Wiskott Aldrich Sydrome

Di George Syndrome TCATCH-22

T cell d/o Cardiac defect (TOF) Abnormal facies Thymic aplasia Cleft palate Hypocalcemia (seizure) 22q11.2 chromosomal deletion

No antibody production Lacks of B cells Bacterial infections and esp enteroviruses Small to absent tonsils No palpable lymph nodes

XLA or Bruton agammaglobulinemia Tx Gammaglobulin IM once a month

Low igg with normal b cells, later age of onset, normal nodes and tonsils, inc risk of granuloma

CVID

Low or absent IgA Respi and GI (giardia) infections Urogenital tract infections

Selective IgA deficiency

Failure to produce IGG IGA IGE Normal or inc IGM Symptomatic during 1at or 2nd yr of life Recurrent pyogenic infections Profoundly neutropenic P. Jiroveci pneumonia

Hyper IgM syndrome

Low Ig, lack of anti EBNA and long lived T cell immunity Inadequate immune response to EBV Healthy males until they acquire EBV Fatal infectious mononucleosis, lymphomas, acquired hypogammaglobulinemia

X linked lymphoproliferative disease or Duncan disease

Low number of T cells and impaired t cell function CATCH 22 Susceptible to fungi, viruses, P jiroveci

Thymic hypoplasia or Digeorge Syndrome

Poor response to candida antigen Chronic and severe candida skin and mucous membrane infections in the 1st month if until 2nd decade of life

Chronic mucocutaneous candidiasis

Absence of T and B cell Poor Ab production to polysaccharides 1st mo of life recurrent and persistent diarrhea, penumonia, OM, sepsis, skin infection with opportunistic agents Unable to reject foreign tissue

SCID

Coarse facies, coronary artery anuerysm, mortality in adulthood, pathologic fractures Recurrent bacterial infection (S. Aureus, pneumococcus, H influenzae) Aspergillus, mucocutaneous candidiasis

Hyper IgE syndrome (AD or sporadic or Job syndrome)

Decreased chemotaxis, degranulation and bactericidal activity Impaired NK function Recurrent pyogenic infection Bleeding diathesis Albinism Peripheral neuropathy Prolonged BT with normal platelet Neutropenia, hepatosplenomegaly

Chediak Higashi Syndrome

Impaired neutrophil adhesion and platelet activation Dec binding of c3bi to neutrophils Neutrophilia, lack of pus formation, delayed umbilical cord separation, slow healing, S aureus, e coli, candida, aspergillus

Leukocyte adhesion deficiency AR

Failure to activate neutrophil respiratory burst leasing to failure to kill catalase positive microbes Recurrent pyogenic inf w catalase positive microorg S aureus, serratia, B cepacia, candida, pneumonia, osteomyelitis, skin inf Hallmark: granuloma formation and inflammatory process

Chronic Granulomatous Disease

Classification of DKA

Mild Ph <7.3 hco3 <15 Oriented alert but fatigued Moderate <7.2, <10 Kussmaul, oriented but sleepy Severe <7.1, <5 Kussmaul or depressed respi, depressed sensorium/coma

SIADH

Serum Na low UO N or low Urine Na high Intravascular volume N or high Serum uric acid low Vasopressin level high

CSW

Serum Na low UO high Urine Na very high Intravascular volume low Serum uric acid N or high Vasopressin low

Central DI

Serum Na high UO high Urine Na low Intravascular vol low Serum uric acid high Vasopressin low

Normal linear growth velocity for age Bone age consistent with chronological Normal age of onset of puberty

Familiar short stature

Delayed growth in one parent but average final stature Normal birth hx and growth for first few mos Chronologic age is greater than bone age

Constitutional short stature

Coryza, cough, conjunctivitis High grade fever Rashes at peak of fever, cephalocaudal Koplik spot 4 day before and 4 days after communicability

Measles (Rubeola)

Low grade fever Cephalocaudal rash Posterior auricular LN Forchheimer spots 7 days before and 7 days after communicability

Ribella (German measles)

Fever 3-5 days Fussiness Seizures Rash appears when fever abates Nagayama spots

Roseola Infantum Exanthem Subitum or 6th Disease

Fever, malaise 1-2 days before rash Different stages of rash at time of presentation Trunk first (like Roseola) 1-2 days before rash to 7 days after rash or til all lesions have crusted

Varicella

Ulcers in tongue, buccal mucosa Tender ulcers on hands and feet

HFMD Coxsackie Virus A16

Slapped cheek Spread to trunk Spares palms and soles Complication: Aplastic crisis

Erythema infectiosum 5th disease Parvovirus B19

Hbs Ag (+) Hbe Ag (+) Anti HBS, Anti HBC (-)

Incubation period

Hbs Ag (+) Anti Hbs (-) Igm Anti Hbc (+) Hbe Ag (+)

Acute Infection

Anti Hbc IgM (+) Hbs ag, anti hbs, hbe ag (-)

Window period

Anti Hbc IgM (+) Hbs ag, anti hbs, hbe ag (-)

Window period

Anti hbc igg (+) Anti hbs (+) Hbs Ag (-) Hbe Ag (-)

Complete recovery

Anti hbc igg (+) HbsAg (+) Anti Hbs (-) Hbe ag (-)

Chronic carrier

Anti hbc igg (+) HbsAg (+) Anti Hbs (-) Hbe ag (+)

Chronic active

Anti hbc (-) HbsAg (-) Anti Hbs (+) Hbe ag (-)

Vaccinated

1. Handedness 2. Bedwetting 3. Ties shoes 4. Language explosion 5. Interest in basic sexuality

1. 3 y/o 2. Upto 4 y/o in girls, upto 5 y/o in boys 3. 6 y/o 4. 2 y/o (20-50 words by end of 2nd yr) 5. 4-5 y/o

Management of Sporotrichosis

Itraconazole Amphotericin B for the severely Ill

Empiric treatment for Lymphogranuloma Venereum

Doxycycline 100 mg orally BID x 21 days

Drug of choice of Syphilis

Single dose of Benzathine Penicillin G 2.4 M U IM

DOC for W. Bancrofti

DEC (contraindicated in onchocerciasis) + Doxycycline 200 mg/day 4-6 weeks

DOC for Mycobacterium marinum

Clarithromycin and Ethambutol + Rifampicin if with deeper organ involvement such as osteomyelitis

DOC for Actinomyces

High dose IV Penicillin 18-24 million U daily for 2-6 weeks followed by oral Penicillin or Amoxicillin for 6-12 mos.

DOC for Nocardiosis

TMP-SMZ but if with sulfa allergy, Imipenem, Ceftriaxone, and Linezolid are options

DOC for Bacillus anthracis (anthrax)

Ciprofloxacin 30mkday q8 (max 400) + Clindamycin 40 mkday q8 (max 900)

DOC for Borrelia Burgdorferi

Doxycycline 2.2mg/kg BID X 10-14 days (best CNS penetration), Amoxicillin, Cefuroxime

DOC for Pasteurella Multocida

Co-amoxiclav

DOC for Bartonella Henselae

Most cases are self-limited May Give Azithromycin

DOC for rickettsia (Rocky Mountain Spotted Fever)

Doxycycline

PEP for measles

Measles IG for prevention and attenuation within 6 days of exposure Measles active vaccine for susceptible children >1 y/o within 72 hours, if <6 mos, pregnant, and immunocompromised - give IG

PEP for Rubella

Active vaccine within 72 hours Use of IG not routinely done except if termination of pregnancy is not an option (0.55ml/kg IM)

A chronic progressive infection developing usually on a distal location on the limbs

Mycetoma caused by Nocardia

PID with liver involvement

Fitz-Hugh-Curtis

Disseminated Gonococcal Infection characterized by fever, chills, skin lesions, polyarthralgia (wrists and hands), negative synovial culture

Tenosynovitis-dermatitis syndrome

Delirium with mumbling speech, tachycardia, dry, flushed skin, dilated pupils, myoclonus, slightly elevated temperature, urinary retention, and decreased bowel sounds. Seizures and dysrhythmias may occur in severe cases

Anticholinergic Toxicity - Antihistamines, antiparkinsonian medication, atropine, scopolamine, amantadine, antipsychotic agents, antidepressant agents, antispasmodic agents, mydriatic agents, skeletal muscle relaxants, and many plants (notably jimsonweed and Amanita muscaria).

Delusions, paranoia, tachycardia (or bradycardia if the drug is a pure α-adrenergic agonist), hypertension, hyperpyrexia, diaphoresis, piloerection, mydriasis, and hyperreflexia. Seizures, hypotension, and dysrhythmias may occur in severe cases.

Sympathomimetic Toxicity - Cocaine, amphetamine, methamphetamine (and its derivatives 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxyethamphetamine, and 2,5-dimethoxy-4-bromoamphetamine), some synthetic marijuana, and OTC decongestants (phenylpropanolamine, ephedrine, and pseudoephedrine). In caffeine and theophylline overdoses, similar findings, except for the organic psychiatric signs, result from catecholamine release.

Coma, respiratory depression, miosis, hypotension, bradycardia, hypothermia, pulmonary edema, decreased bowel sounds, hyporeflexia, and needle marks. Seizures may occur after overdoses of some narcotics, notably propoxyphene.

Opiate, Sedative, Ethanol Intoxication - Narcotics, barbiturates, benzodiazepines, ethchlorvynol, glutethimide, methyprylon, methaqualone, meprobamate, ethanol, clonidine, and guanabenz.

Confusion, central nervous system depression, weakness, salivation, lacrimation, urinary and fecal incontinence, gastrointestinal cramping, emesis, diaphoresis, muscle fasciculations, pulmonary edema, miosis, bradycardia or tachycardia, and seizures.

Cholinergic Toxicity - Organophosphate and carbamate insecticides, physostigmine, edrophonium, and some mushrooms.

Normal size and weight at birth Apnea, cyanosis, severe hypoglycemia, with or without seizures Round and the face is short, broad, prominent frontal bone, depressed nose bridge and saddle shaped, nose is small, mandible and chin underdeveloped, teeth late eruption, high pitched voice, small genitals, delayed puberty

Congenital hypopituitarism

Random Flashcards

(93 cards)