Content Flashcards

1
Q

Physiologic jaundice

A

Presents between days 3-5 and is due to normal breakdown of fetal hemoglobin and immature liver metabolism, causing increased unconjugated bili

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2
Q

Pathologic jaundice

A

Increased conjugated bili; or occurs in the first 24 hours of life

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3
Q

How much of the med does baby receive through breast milk

A

1%

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4
Q

How long does pumping and dumping have to occur for

A

3-5 1/2 lives of the drug

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5
Q

6 month red flag

A

no smiles

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6
Q

9 month red flag

A

No sharing of sounds or other facial expressions

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7
Q

12 months red flag

A

Lack of response to name, no babbling, no pointing or reaching or waving

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8
Q

16 months red flag

A

No spoken words

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9
Q

24 months red flag

A

No 2 word phrases

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10
Q

Screening for type 2 DM in children

A

Begins at age 10 if at risk and continues every 2 years

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11
Q

Pharmacology agents for dyslipidemia in peds

A

If >8 years and LDL >190 + >2 risk factors

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12
Q

Limit cows milk after 12 months to

A

16-24oz per day

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13
Q

BP monitoring in peds

A

> 3 years old

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14
Q

MMR and infant travelling abroad

A

1 dose can be given between 6 and 11 months

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15
Q

MMR vaccine in lactation/pregnancy

A

safe in lactation, CI in pregancy

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16
Q

When was universal Hepatitis B vaccine recommended

A

For infants in 1991, for adolescents in 1996

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17
Q

Complications of varicella

A

Bacterial skin infections, pneumonia, encephalitis, toxic shock, reyes syndrome

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18
Q

If a child >12 months has been exposed to varicella

A

Give vaccine within 3-5 days to prevent disease

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19
Q

Tx pertussis

A

Azithromycin

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20
Q

Do not give IPV if allergic to

A

Neomycin, streptomycin or polymyxin B

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21
Q

Plumbism

A

Lead poisoning

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22
Q

Lead poisoning leads to

A

Iron deficiency anemia has it inactivates heme synthesis

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23
Q

What enhances lead absorption

A

Diet low in Ca, Iron, Zn, Mg, Cu and high in fat

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24
Q

Sx of lead poisoning

A

Abdominal pain, constipation, difficulty sleeping, HA, irritable, low appetite, loss of skills

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25
Bronchiolitis
Due to RSV Wheezing, tachypnea, fever, conjunctivitis, pharyngitis 2-3 week course Supportive therapy Palivizumab can be used as prophylaxis for preemies or infants with congenital heart disease
26
Tx of hemangioma
Oral propanolol, systemic steroids, interferon alpha
27
Erythema toxicum neonatorum
Benign rash resembling flea bites; usually resolves in 5-7 days
28
AOM most common bacterial pathogens
Strep pneumoniae, H. Influenzae, Moraxella catarrhalis
29
Most common predisposing factor to AOM
Eustachian tube dysfunction due to URI
30
1st line tx AOM
High dose amoxicillin Targeted at strep pneumoniae due to low rate of spontaneous resolution if penicillin allergy: cefdinir, cefuroxime, ceftriaxone If abx failure after 48-72 hours, try Augmentin or ceftriaxone
31
Tympanostomy tubes recommended for
Chronic >3 monts bilateral OME
32
Risk factors for bacterial sinusitis
Viral infection, allergies, second hand smoke, sinus abnormalities
33
Consider ABRS if
New fever at day 6/7 or persistence of cold >10 days
34
Most common causes of ABRS
Strep pneumoniae or H influenzae
35
Tx sinusitis
amoxicillin
36
UTI manifests in younger children as
irritability, lethargy, fever
37
Biggest cause of UTI in children
Vesicoureteral reflex
38
Tx of UTI in children
Amoxicillin, Bactrim or 2nd/3rd cephalosporin for 7-10 days | Cipro approved for >1 year old
39
Rubella
Fever, sore throat, malaise, nasal discharge, maculopapular rash, posterior lymph nodes 5-10 days before rash
40
Marker of effective asthma control
Nocturnal sx
41
Theophylline approved for
>5 years old
42
Levalbuterol vs albuterol
Levalbuterol has greater bronchodilation and fewer SE at lower dose than albuterol
43
Most common cause of gastroenteritis in kids
Norovirus
44
Shigellosis
Fever, bloody stools | tx: bactrim
45
When do girls typically achieve adult height
1 year after menstruation
46
Adrenarche
Development of pubic hair
47
Tanner 2
Males: testes enlarge, scrotal reddening, long and sparse pubic hair at base of penis Females: Breast buds and papilla elevated, downy hair along labia majora
48
Tanner 3
Males: Penile length increased, scrotal enlargement, dark pubic hair and coarser, growth spurt Females: breast mound, coarser and curling pubic hair, growth spurt
49
Tanner 4
Males: increased penile length and width and development of glans; adult pubic hair but no spread Females: areola and papilla elevated to form second mound, adult pubic hair with no spread, menarche
50
Tanner 5
male: hair spreads to thighs Female: hair spreads to thighs
51
What should not be used if pt has varicella
Ibuprofen | Risk of NEC
52
Early indicator of hypoperfusion in kids
Cap refill <2 seconds
53
Initial tx of bacterial meningitis in children
Ceftriaxone with vancomycin
54
Most sensitive finding for pneumonia in children
Tachypnea
55
Tx pneumonia in children
Amoxicillin to cover strep pneumoniae | Macrolide to cover atypicals
56
Dx criteria for kawasaki disease
Fever >5 days Erythema, edema and peeling of extremities Bilateral nonexudative conjunctivitis polymorphous rash and cervical lymphadenopathy Strawberry tongue -Obtain echo early as it can cause coronary artery obstruction Tx: immunoglobulin IV and aspirin
57
Bells palsy
Acute paralysis of CN 7 due to inflammation - Can be linked to virus - Obtain antibody testing to lyme disease - Tx: steroid
58
Tx cluster HA
Triptans, high dose NSAIDs, high flow O2
59
Triptans
Serotonin receptor agonists | -Cause vasoconstriction: CI in CAD or pregnancy
60
Ergotamines
Act as 5-HT1A and 5-HT1B agonists; do not affect cerevrak blood flow - Cause vasoconstriction: CI in CAD or pregnancy - Not helpful for tension HA
61
HA provoking meds
estrogen, progesterone, vasodilators
62
Beta blockers used for HA prophylaxis
Metoprolol, propranolol, atenolol
63
Incubation period for bacterial meningitis
3-4 days
64
CSF findings in bacterial meningitis
Pleocytosis, increased CSF opening pressure, 90-95% neutrophils, decreased glucose, increased protein
65
Which type of meningitis causes rash
N. Meningitidis
66
Chemoprophylaxis bacterial meningitis
Single dose Cipro or IM ceftriaxone or 4 doses rifampin
67
Sx of MS
``` Weakness/numbness of limb Monoocular visual loss Diplopia Vertigo Facial weakness Ataxia Nystagmus Heat sensitivity -Most common b/w 20 and 40 years Tx exacerbations: steroids Long term Tx: interferon beta 1-b ```
68
Dopamine agonists
Tx PD Ropinirole and prampexole -Better SE than levodopa
69
TIA
Stroke like sx resolve within 24 hours
70
Agents to decrease BP post stroke
Thiazide diuretic, CCB, ACEI/ARB
71
Temporal arteritis
Autoimmune vasculitis most common 50-85 years - Causes inflammation - Tender, pulseless vessels and severe unilateral HA' - Most serious complication: blindness - Tx: high dose steroids (prednisone) then low dose 6 months-2 years; give with PPI and biphosphanate + Ca.Vit D - Dx: arterial biopsy
72
Types of skin lesions
Macule: Flat <1cm (freckle) Patch: Flat >1cm (vitiligo) Papule: Raised <1cm (raised nevus) Vesicle: Fluid filled <1cm (herpes) Plaque: Raised >1cm (psoriasis) Purpura: petrchiae, ecchymosis Pustule: Vesicle like with purulent content (acne, impetigo) Wheal: circumscribed area of skin edema (hive) Nodule: raised >1cm, mobile (epidermal cyst) Bulla: fluid filled >1cm (burn blister)
73
Lease potent topical steroid
Hydrocortisone
74
Absorption rates of lotion, cream, ointment
Lotion < cream < ointment
75
Impetigo
2-5 years peak Due to GAS or staph aureus Tx with mupirocin if small lesions -Bacitracin and neomycin not recommended
76
Acne inducing drugs
lithium, dilantin
77
Tx post herpetic neuralgia
TCAs, gabapentin, pregabalin, topical lidocaine
78
Onychomycosis
Nails are dull, thickened | -Nail fungal infection
79
Basal cell carcinoma
``` PUT ON Pearly papule Ulcerating Telangiectasis On face, scalp, pinnae Nodules are slow growing ```
80
Squamous cell carcinoma
``` -evolves more rapidly NO SUN Nodular Opaque Sun exposed areas Ulcerating Nondistinct borders ```
81
Actinic keratoses can evolve into
Squamous cell carcinoma Sandpaper quality Tx: liquid nitrogen cyrotherapy
82
Tx cellulitis if no MRSA risk
Dicloxacillin or azithromycin
83
First line tx for cellulitis abscess <5cm with no fever
Incision and drainage and obtain culture | -If >5cm, add abx
84
Tx cellulitis-MRSA
Bactrim, doxy or clinda
85
Angular cheilitis
Caused by candida Risk increased in advanced age, malnutrition, HIV 1st line: topical nystatin
86
Burrelia burgdorfen
Causes Lyme disease | Infected tick on host for at least 24 hours
87
Stages of lyme disease
1: flu like illness with target lesion (erythema migrans) 2: Months later develop a rash with multiple lesions, euthralgias, HA, fatigue, heart block, bells palsy 3: 1 year later develop joint pain and neuro issues
88
Common pathogens for bacterial conjunctivitis
Staph aureus, strep pneumoniae, H. influenzae | Tx: fluoroquinolone ocular solution (levo, moxi, gati); 2nd line is polymyxin B + trimethoprim ocular solution
89
Viral conjunctivitis
Usually due to adenovirus
90
Common pathogen in OE
Pseudomonas | Tx: mild acetic acid with propylene glycol otic drops or moderate cipro otic drops with hydrocortisone
91
Do not use what drop if TM ruptured
Neomycin
92
Common pathogens in AOM
Strep pneumoniae, H. Influenzae, M. Catarrhalis Tx: amoxicillin high dose If ABX in last month: Augmentin, cefdinir, cefpodoxime, cefprozal
93
Classic ophthalmological emergency
Red, painful eye with change in visual acuity
94
Anterior uveitis
Pupil constricted, nonreactive and irregularly shaped; dull and painful eye
95
Primary open angle glaucoma
Increased IOP >25, optic disc cupping, gradual loss of peripheral vision Tx: timolol, brimonidine, dorzolamide, latanoprost
96
Complication of a hordeolum
Cellulitis
97
Meniere disease
Dizziness, tinnitus, low frequency hearing loss Due to increased pressure within endolymphatic system; fluids mix causing change in vestibular nerve firing rate causing vertigo Risk factors: aminoglycoside, salicylates, loud noises Tx: meclizine, antiemetics, benzos/steroids
98
PE in Meniere disease
Nystagmus, weber lateralizes to UNAFFECTED ear, Rinne AC >BC (Normal); pneumatic otoscopy in affected ear elicits symptoms of nystagmus Romberg + Fakuda +
99
Risk factors for oral CA
HPV 16, male gender, increasing age, tobacco/alcohol use
100
Most common oral CA
Squamous cell | painless, firm ulceration or raised lesion; immobile lymph nodes that are non-tender
101
Risk factors for OE
Recent ear canal trauma, cerumen impaction, frequent swimming Due to candida or pseudomonas
102
Dx test for malignant OE
CT, radionucleotide bone scanning, gallium screening
103
What usually precedes AOM
Eustachian tube dysfunction due to URI, allergic rhinitis, tobacco air pollution
104
Strep pneumoniae mechanism of resistance
Alteration of intracellular protein binding sites | -Overcome by high doses of amoxicillin
105
Strep pyogenes
Group A beta hemolytic strep Causes strep throat Incubation period of 3-5 days
106
Rheumatic fever
Carditis + arthritis | Usually begins 19 days after onset of sore throat
107
Poststrep glomerulonephritis
Usually self limiting | Abx use does not minimize risk
108
Tx strep throat if allergic to penicillin
Azithromycin, clarithromycin, clindamycin
109
Most common cause of perennial allergy
Dust mites
110
Tx for acute relief of allergic rhinitis
Antihistamines, decongestants, oral steroids
111
Controller meds for allergic rhinitis
Intranasal steroids, leukotriene modifiers (singulair), mast cell stabilizers (cromolyn)
112
Risk factors for bacterial sinusitis
Virus, allergies, tobacco, abnormalities in sinus structure
113
Dx for bacterial sinusitis
URI symptoms persistent >10 days who have maxillary/facial pain and purulent nasal discharge -Most common cause: strep pneumoniae
114
Most common cause of bacterial sinusitis
Strep pneumoniae | Tx with high dose amoxicillin or fluoroquinolone
115
Empiric therapy for bacterial sinusitis
1st: augmentin 2nd: doxy If failed therapy: increase augmentin or try levaquin or moxiflox
116
Mono
Incubation of 30-50 days HA, malaise, myalgias, anorexia, followed by sore throat for 5-15 days Splenomegaly in 50% of patients 30% have concurrent strep throat Dx test: heterophile antibody test (monospot) Tx: prednisone for tonsillar hypertrophy
117
Normal spleen
1X3X5 inches Weighs 7oz Lies between ribs 9 and 11
118
Target organ damage due to htn
Brain ,eye, heart, kidneys
119
4 1st line agents for htn
Thiazide diuretics, CCB, ACEI/ARB
120
Most important goal of htn management
Avoid target organ damage
121
Non-dihydropyridine CCB
Verapamil or diltiazem - Good for BP control and renal protection - Limit to pts with good LV fxn - CI in heart block
122
Dihydropyridine CCB
More potent vasodilators | -Reserve for difficulty to treat htn
123
Risk factors for endocarditis
Prosthetic valves, history of endocarditis, injection drug use S/S: fatigue, aching joints, SOB, edema, cough, fever, chills, weight loss, hematuria, spleen tenderness, oslers nodes, petechiae tx: IV abs for 4-6 weeks
124
Meds indicated post MI
Beta blockers, nitroglycerine, statin, ACEI
125
S3 and S4
S3: HF S4: Myocardial ischemia
126
CK-MB levels return to normal in
60 hours
127
Leading causes of HF
Hypertensive heart disease and atherosclerosis
128
When does peripheral edema occur
>5L of extracellular fluid
129
Chest X ray findings in HF
Cardiomegaly and alveolar edema with pleural effusions and bilateral infiltrates in butterfly pattern Loss of sharp definition of pulm vasculature, haziness of hilar shadows, kerley B lines
130
Cornerstone of HF therapy
ACEI/ARB | -Goal is to decrease preload, decrease afterload and inhibit renin and SANS
131
Improvement of asthma sx with ICS
in 2-8 days | Local SE: oral candidiasis, hoarseness, sore throat
132
GOLD categories for COPD
GOLD 1: FEV1 <80%--tx SAMA or SABA prn GOLD 2: FEV1 between 50 and 80%--tx LAMA or LABA GOLD 3: FEV1 between 30 and 50--Tx ICS + LABA or LAMA GOLD 4: FEV1 < 30%--Tx ICS + LABA and/or LAMA
133
COPD exacerbations tx
Oral prednisone | If need abx: doxy, amoxicillin, bactrim, ceph
134
What percent of people exposed to TB become infected?
30%
135
Primary TB
Sx free Organisms can lie dormant within granulomas for years Latent TB not contagious
136
Active TB
Sx develop over 4-6 weeks | Malaise, weight loss, fever, night sweats, chronic cough
137
TB propylaxis meds
Isoniazid for 6-9 months | -Rifampin alt
138
PPD +
>5mm: HIV, recent contact with TB, X ray +, organ transplants, immunocompromised >10mm: Recent immigrant from TB endemic, IV drug users, <4 years old >15mm: General pop
139
pneumonia
Cough, dyspnea, sputum, pleuritic chest pain X ray: interstitial infiltrates with atypical pathogens or viruses; Consolidation with strep pneumoniae -Strep pneumoniae most common pathogen in adults -H. influenzae most common pathogen in COPD
140
CURB criteria for pneumonia
Confusion, BUN >19, RR>30, BP<90/60, >65 years - score of 1 or less = outpatient - >1=hospital
141
Tx of bacterial pneumonia
Respiratory fluoroquinolone | -Macrolides or tetracycline if atypical
142
Causes of bacterial bronchitis
B. pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae
143
Risk factors and tx for anal fissures
Constipation, recurrent diarrhea, childbirth, anal intercourse Tx: increase fiber and stool softener and laxative -If sx continue, intra-anal nitroglycerine can be tried -Surgery and botox for more severe cases
144
Internal hemorrhoids grading
Grade 1: no prolapse Grade 2: prolapse upon defecation but reduce spontaneously Grade 3: prolapse on defecation and need manual reduction Grade 4: prolapsed and can not be reduced
145
Risk factors and tx for hemorrhoids
Excessive alcohol, chronic diarrhea or constipation, obesity, high fat and low fiber diet, prolonged sitting, sedentary lifestyle, receptive partner in anal intercourse, loss of pelvic muscle tone Tx: astringents and topical steroids, sitz bath, analgesics
146
Peak age for appendicitis
10-30 years
147
S/S appendicitis
- Pain aggravated by coughing or walking - N/V late sx (differentiates from gastroenteritis) - WBC left side (leukocytosis, neutrophilia, bandemia) - Myelocytes and metamyelocytes is ominous finding
148
Imaging of choice in appendicitis
CT | -US can be considered
149
Appendiceal perforation findings
WBC 20-30,000 Fever >102 Peritoneal findings Sx >48 hours
150
Most common form of gallstones
Cholesterol
151
Risk factors for gallstones
>50, Female, obese, hyperlipidemia, rapid weight loss, pregnancy, high glycemic index diet
152
S/S cholelithiasis
Intermittent discomfort within 1 hour of fatty meal; radiating pain to right scapula (Collin's sign), vomiting provides pain relief
153
Cholecystitis
Inflammation of gallbladder due to gall stones - RUQ pain and tenderness with vomiting and occasional fever - + Murphy's sign - Leukocytosis usually present - RUQ US test of choice - Complications: pancreatitis and sepsis
154
Risk factors for colon CA
History of IBD, personal CA hx, >50 years, family history of colon CA, familial polyposis syndrome
155
Risk factors for diverticulosis and sx
Aging, family history, connective tissue disorder Sx: L abdominal cramping, increased gas, alternating constipation and diarrhea Tx: high fiber diet and fiber supplements
156
Diverticulitis
Diverticula are inflamed causing fever, leukocytosis, diarrhea, LLQ pain -CT with contrast helpful to dx Tx: flagyl + Cipro or Bactrim
157
Physiology of gastric cells
Gastric parietal cells secrete HCl, mediated by H2 receptor sites Gastric acid production increases by 30-50 after a meal Endogenous prostaglandins stimulate and thicken the mucus layer, enhance bicarb secretion and promote blood flow COX1: maintenance of protective gastric mucosal layer (NSAIDs block this)
158
Gastric ulcer vs duodenal ulcer
Gastric: increased pain with eating due to increased acid Duodenal: Increased pain 2-3 hours after eating
159
Tx H Pylori ulcer
PPI + amoxicillin + clarithromycin OR pepto bismol + flagyl + tetracycline + PPI Stool antigen testing is most cost effective dx Urea breath testing is most helpful but expensive
160
H2 blockers MOA
Block binding of histamine, reducing the secretion of gastric acid
161
PPI MOA and long term risks
Inhibit final step in acid secretion | Long term use can cause fractures, pneumonia, C Diff
162
Misoprostol
Prostaglandin analog | -Gastric protection for NSAID use
163
Meds that decrease lower esophageal sphincter pressure, increasing risk of GERD
Estrogen, progesterone, theophylline, CCB, Nicotine
164
Antacid use
Use 1-3 hours after meals and at bedtime | -Use 2-4 hours before or 4-6 hours after fluoroquinolone
165
Labs in Hep A
Serum aminotransferase levels increase by 20 | +IgM Hep AV
166
Sx in hep A
Onset 15-50 days after exposure | Incubation period of 28 days
167
Post-exposure prophylaxis in hep A
immunoglobulin (within 2 weeks of exposure) and HAV vaccine
168
How many people with HBV go on to develop chronic Hep B
50%
169
Tx chronic hep B
Pegylated interferon + antiviral (entecavir, adefovir, lamivudine)
170
Hep D can only occur with
Hep B
171
Monitoring of hepatic tumor growth
Alpha feto protein
172
Tx IBS
Loperamide + dicylomine for diarrhea TCA to decrease gut threshold Metoclopramide for constipation
173
Labs in IBD flare
Increased CRP, ESR, Leukocytes
174
Tx IBD
Aminosalicylates (sulfasalazine)
175
Most common risks for pancreatitis
Gallstones, alcohol, increased triglycerides | Other risks: opioids, steroids, thiazide diuretics, viral infection, blunt abdominal trauma
176
S/S pancreatitis
Abdominal pain, weight loss, anorexia, N/V | Pain improved by sitting or leaning forward
177
DRE findings in BPH
Prostate enlarged, rubber consistency, lost the median sulcus or furrow
178
Post-renal azotemia
Increased BUN and CR, urinary retention, outflow tract obstructions
179
Tx of BPH
Alpha 1 blockers: Terazosin | 5-alpha reductase inhibitors: Finasteride
180
Chancroid
Vesicular form to pustular form lesion that creates a painful, soft ulcer with necrotic base Tx: azithromycin, erythromycin, cipro, ceftriaxone
181
Treponema Pallidum
Cause of syphilis -Chancre: firm, round, painless, genital ulcer with clear base Tx: IM penicillin, tetracycline, doxy
182
Acute epididymitis causes
<35: due to chlamydia or gonorrhea >35: due to prostatitis Men + men: E Coli or pseudomonas
183
Prehn sign
Decreased pain when scrotum is elevated above symphysis pubis + sign for epididymytis
184
Gonorrhea
Incubation period 1-5 days S/S: Dysuria with milky discharge Tx: IM ceftriazone or oral cefixime + 1g azithromycin PO
185
Acute bacterial prostatitis
Fever, tender and boggy prostate, leukocytosis and neutrophilia, urine culture + Irritative voiding, suprapubic pain, perineal pain Tx: IM ceftriaxone + doxy if <35, fluoroquinolone if >35
186
Which testicle is most affected by torsion
Left
187
Which testicle most often has varicocele
Left
188
When is syphilis contagion greatest
2nd stage
189
Condyloma acuminatum
Verrociform lesion seen in genital warts Due to HPV (6+11 most common) Tx: podofilox, imiquimod, trichloroacetic acid, cryotherapy
190
Primary syphilis
Painless, genital ulcer with clean base, localized lymphadenopathy
191
Secondary syphilis
Diffuse maculopapular rash involving palms and soles, generalized lymphadenopathy, low grade fever, malaise, arthralgias, myalgias
192
Tertiary syphilis
Gumma (granulomalous lesions involving skin, mucous membranes and bone) Aortic insufficiency, aortic aneurysms
193
Herpes
S/S: painful ulcerated genital lesion + inguinal lymphadenopathy + fever/chills Vital culture gold standard +virological test with - serological test would suggest new infection
194
How long does it take for person to show antibodies to HIV when infected
3-12 weeks
195
Pre-patellar bursitis
Bursal aspiration considered first line due to increased pain relief
196
Lateral epicondylitis
Forearm weakness and point tenderness over inner aspect of humerus Hand grip weakened ROM normal
197
Medial epicondylitis
inside of elbow | Pain worsens with wrist flexion and pronation
198
Risk factors for gout
obesity, DM, family history, men
199
Meds that may precipitate gout
thiazide diuretics, niacin, aspirin, cyclosporine
200
Secondary gout causes
Psoriasis, myeloproliferative disease, hemolytic anemia, kidney disease
201
Dx for gout
Analysis of joint aspirate
202
SE allopurinol
Rash, nausea, decreased liver fx
203
Probenecid
Increase kidney's ability to remove uric acid | -Increased risk of kidney stones
204
High purine foods
Scallops, mussels, organ and game meats, beans, spinach, asparagus, oatmeal, brewers yeast
205
How to choose long term tx of gout
24 hour urine for uric acid--assesses whether patient overproduces or undersecretes Probenecid is tx for undersecretion Allopurinol is tx for overproduction
206
Pseudogout
Calcium pyrophosphate deposition - Swollen, warm, painful joints - Increased age, joint trauma, fam hx, hypothyroid - tx: NSAIDs, colchicine, oral steroids