ABEM Recert Exam pt. 2 Flashcards
Scarlet fever: Cause
Group A Beta-hemolytic strep
Scarlet fever: si/sx
Sore throat, then rash 12h later
Scarlet fever: Rx
PCN
Staph Scalded Skin Syndrome (SSSS): Age involved
<5 yo
Staph Scalded Skin Syndrome: Rx
Fluids, just like a burn patient with excess fluid loss from skin
Staph Scalded Skin Syndrome: Skin involved
Almost everywhere but no mucous membrane involvement
Erythema Multiforme: Appearance
Target lesions, symmetric on extensor surfaces, elbows and knees
DOES have mucous membrane involvement
Steven Johnson syndrome vs TEN: How to diff
SJS has >30% BSA involvement, TEN has less
Almost all TEN is from drugs, SJS is mostly drugs too but can also be from infection, or graft versus host
Measles: Incubation period
1-2 weeks
Measles: si/sx
3 Cs
Cough
Conjunctivitis
Corzya (irritation of nasal mucous membrane, runny nose)
Fever
Morbiliform rash starts on face then spreads
Measles: Rx
IVIG
Henoch-Schonlein Purpura (HSP): si/sx
ARENA Abdominal pain Rash Edema (hands & feet) Nephritis Arthritis/arthralgias
Henoch-Schonlein Purpura: What complication is at increased risk with
HSP has increased risk of intussecption
Do petechiae and purpura blanch? Why?
DO NOT blanch. Is a vasculitis, so vessels are leaky and blood that you see is outside vessel, so when you press on it, it doesn’t go back in
Erythema Infectiousum: AKA
Fifth disease (slapped cheek disease)
Erythema Infectiousum: Complications
Aplastic anemia in patient’s with sickle cell dz
Fetal demise in pregnant patients
Roseolla: si/sx
3-5 days of fever, which then resolves
As fever resolves, blotchy, macular rash appears
Roseolla: Rx
None
Impetigo: Causes
GAS
Staph aureus
Characteristics of life-threatening rashes
Mucous membrane involvement (but not always, i.e. Hand ,Foot, Mouth disease) Pain out of proportion to exam Skin sloughing Petechiae / purpura Altered LOC Persistent fever
Myocarditis: When to think about it
When an ill-appearing child gets worse after a fluid bolus, not better
Classes of congenital heart disease
Blue baby (right to left shunt) Gray/mottled baby (cardiac outflow obstruction) Pink baby (left to right shunt)
HOCM murmur: What changes the murmur?
Gets worse with standing or Valsalva
Better with squatting, isometric hand grips or lying down
Intussecption: Radiographic findings
Target sign on ultrasound
Decreased bowel gas in RLQ on KUB
Meckles rule of 2s
2% of population affected
Most are 2’ from ileocecal valve
Most are 2” in length
Most present before age 2
Most common disorder requiring surgery in infants
Pyloric stenosis
Pyloric stenosis: Ages affected
2 weeks - 2 months
Pyloric stenosis: si/sx
Projectile non-bilious emesis
Hypochloremic hypokalemic metabolic acidosis secondary to vomiting
What to be concerned about in newborn who hasn’t passed a meconium stool?
Hirschprung’s disease
Most common GI emergency in neonates
Necrotizing enterocolitis (NEC)
Necrotizing enterocolitis: Ages affected
2-3 weeks old
Necrotizing enterocolitis: si/sx
Classic triad is abdominal distention, bloody stools, pneuomotosis intestinalis on xray
Necrotizing enterocolitis: Rx
Abx, NGT, surgery consult
Disc or button battery injestion: Rx
Immediate removal if in esophagus
If passed lower esophageal sphincter, can observe and repeat xray to ensure passing
Lowest normal SBP in kids
70 + age/2
How to correct sodium in hyperglycemia
Add 1.6 for every 100 glucose is over 100
Congenital adrenal hypoplasia: Si/sx
Low Na, High K, low glucose
Sometimes see ambigious genitalia
Primary syphilis: si/sx
Painless chancre
1-3 month incubation
Secondary syphilis: si/sx
Maculopapular rash, involves palms & soles
Resolves spontaneously in 1-2 months without therapy
Tertiary syphilis: When does it occur?
Anytime 2+ years after initial infection
Lymphogranuloma venerium (LGV): cause
Chlymadia trachomonas
Lymphogranuloma venerium (LGV): rx
Doxy, azithromycin, erythromycin
Uterine fibroid: other name of
Uterine leiomyoma
Most common uterine cancer
Endometrial cancer
Vulvovaginitis: MCC
Bacterial vaginosis
Bacterial vaginosis: Rx in pregnany
Oral metronidazole
Bacterial vaginosis: Rx in non-pregnant
Oral metronidazole or intravaginal clindamycin
Ward catheter: How long to leave in
6-8 weeks
Herpes vaginalis: Appearance
Vessicles on an erythematous base (dew drops on a rose petal)
Beta HCG: How does it change in pregnancy
Doubles every 48h for first 8 weeks, then starts to level off
Maximum safe total radiation exposure in pregnancy
5-10 rads
Less than this causes no greater increase in birth defects
Is barbituate withdrawal life threatening?
Yes
Botulism: Pathophysiology
Toxin irreversibly binds to presynaptic ACh release mechanisms, which prevents release of ACh
Types of botulism
Infant (most common, 75% of cases)
Food borne
Wound
Botulism: si/sx
Descending weakness
Cranial nerve deficits
Usually have double/blurred vision
NO sensory deficits
Botulism: Rx
Antitoxin
Tetanus: Causative agent
Clostridium tetani
Anthrax: Types
Dermatologic (most common, 90% of cases)
GI (rare)
Pulmonary (hilar adenopathy and effusions)
Anthrax: Rx
Quinolones or doxy
Is anthrax contageous from one patient to another?
No
Most common ricketsial infection in US
RMSF
RMSF: Time of year it is typically seen
Spring & early summer
RMSF: Cause
Ricketsial ricketsia
RMSF: si/sx
Rash (starts on periphery and moves to trunk)
Fever, HA, malaise
Sometimes leukopenia, thrombocytopenia and inc LFTs
RMSF: Rx
Doxycycline or chloramphenacol
Pertussis: Causative agent
Bordatella pertussis
Pertussis: How is it spread?
Droplet transmission
Ehrlichiosis: si/sx
Spotless RMSF (but sometimes will have slight rash) Fever, HA, malaise
Ehrlichiosis: Rx
Doxycycline
Pertussis: Phases
1st: Catarrhal phase (1-2 weeks, URI, cough, anorexia)
2nd: Paroxsymal phase: whooping cough
3rd: Convalescent phase
Pertussis: Rx
Macrolides
Plague: Causative agent
Yersinia Pestis
Plague: Vector
Fleas
Plague: Resevoir
Rats
Plague: Rx
Aminoglycosides
Most common vector borne disease in US
Lyme disease
Lung abscesses: Causative agent
Most are anaerobes (from aspiration of oropharyngeal flora)
Lung abscesses: Rx
Clindamycin or ampicillin-sulbactam
Add gram negative coverage for immunocompromized patients
Beta HCG: When does it start rising?
At implantation (6-7 days after conception)
Preeclampsia: Rx
Magnesium sulfate 4-6 gm IV bolus then drip at 2-4 gm/h
Placental abruption: Dx
Clinical
Can’t r/o with ultrasound, but you may see evidence of
How does vaginal bleeding work up differ between trimesters?
No blind speculum/digital exam in 2nd/3rd trimester until ultrasound to r/o placenta previa
Post partum fever: Causes
Endometritis (rx with IV abx & hospitalization)
Mastitis
Mastitis: Rx
If no abscess, abx and can continue breastfeeding
If abscess, no breastfeeding and will need I&D in OR
DVT/PE: Rx in pregnancy
Heparin / LMWH
NO warfarin