final memorize Flashcards
anemia:
levels
risks
H/H <11/33 in 1st and 3rd trimester
H/H <10.5/32 in 2nd
intrauterine growth restriction
preterm labor
ASTHMA SEVERITY: Intermittent symptoms wake's SABA use activity
S: <2days/week
W: 0-4y 0 / >5y 2/month
SABA: <2 d/wk
A: none
SABA prn
Flu antivirals
start w/in 48 hours
DOC: Tamiflu
Relenza - no asthma, must be >7y/o
LABA example
Salmeterol
6 month vision screening
cover test (what for movement of eye after cover is removed)
folic acid recommendations
History/family hx neural tube defect - 4mg/day several months before pregnancy
insulin Diabetes / seizure meds (depakote, carbamazepine) - 1mg/day
others - 0.4mg/day 1 month before pregnancy
ibuprofen pediatric dosage
5-10 mg/kg q6-8h
max 40mg/kg/day
must be >6 months
What organism most commonly causes otitis externa?
Pseudomonas aeruginosa (staph aureus and staph epidermis are also frequent causes, fungi common in DM and immunocompromised)
viral croup:
agent
s/s
parainfluenza virus (RSV) s/s: steeple sign
AOM treatment?
1st line: Amoxicillin
2nd line: Augmentin or ceftriaxone (taken amoxicillin in last 30 days or doesn’t improve - might be H.influenza)
PCN rash - ceftriaxone, cefdinir, cefuroxime, cefpodoxime
PCN allergy - bactrim, macrolide(azithromycin), clindamycin
What is the first line medication for allergic rhinitis in adults?
Intranasal corticosteroids (oral antihistamines are useful but may cause drowsiness, nasal anticholinergics are useful for vasomotor rhinitis, decongestants may help w/ stuffiness but do not address inflammation)
ZIKA dx
culture
-can be found in semen up to 69 days after symptom onset
10 day old with staccato cough, tachypnea, and conjunctivitis. Most likely organism?
Chlamydia trachomatis can be passed to the infant during birth if the mother has an infection. The presenting symptoms are tachypnea, a staccato cough and conjunctivitis in a young baby
Pneumonia vaccines
PCV13:
all >65 y/o
19-64 if immunosuppressed , renal figure, CA, cochlear implant, CSF leak
PPSV 23:
all >65 y.o
19-64, 1 dose: smoke, chronic disease, DM, ETOH, long term facility
2 doses 5 yrs apart: HIV, CA, immunocompromised
give PCV13 first then wait 1 year before PPSV23
fetal movement onset
18-20 wks primiparous
14-18 wks multigravida
COPD Group C
> 2 moderate exacerbations, >1 hospital admit
LAMA
AOM must have to diagnoses?
bulging TM and middle ear effusion
Empiric treatment for 42 yr old with CAP, no comorbidities, no recent antibiotic use, allergic to azithromycin.
She has no risks for antibiotic resistance, so we would use either a macrolide or tetracycline. Since she is allergic to azithromycin (macrolide), tetracycline (Doxycycline) would be appropriate. They are not in the same class.
kids & adults oral corticosteroid dosage
KIDS: 1-2 mg/kg/day single or divided BID
ADULTS: 40-60mg/day single of divided BID
med for uncomplicated cystitis
bactrim and macrobid
fundal height
8 wks - just at pubic symphysis
16 was - midpoint between pubic symphysis and umbilicus
20 wks - at umbilicus
18-34 weeks - match gestational age in weeks
after 26 weeks - may not match b/c baby defended
grand multis may not measure correctly d/t thinning of uterus and poor uterine support
ASTHMA CONTROL:
not well controlled
symptoms wake's SABA activity oral med exacerbations
symptoms >2/wk wake's 0-4: >1/mth 5-11: >2/mth >12: 1-3/wk SABA: >2/wk activity: some oral med exacerbations: 0-4: 2-3/yr >5: >2/yr
Blepharitis treatment
eyelid hygiene
COPD Group D
> 2 moderate exacerbations, >1 hospital admit
LAMA
OR
LAMA/LABA
OR ICS+LABA if eos >300
celiac disease diet NOs
wheat, rye, barley
endometritis meds
clindamycin
gentamicin
(IV)
Pre-eclampsia definition
BP >140/90 on 2 occasions 4 hours apart plus 1 of:
- proteinuria
- thrombocytopenia
- renal insufficiency
- impaired liver fx
- pulmonary edema
- cerebral/vision sx
ASTHMA CONTROL:
poorly controlled
symptoms wake's SABA activity oral med exacerbations
symptoms: throughout day wake's 0-4: >1/wk 5-11: >2/wk >12: >4/wk SABA: several a day activity:very limited oral med exacerbations: 0-4: >3/yr >5: >2/y
AOM most common pathogen
strep pneumo
acute otitis externa:
S/S
treatment
s/s: acute onset of severe ear pain, can’t see into ear (swollen)
use wick for Abx (fluoroquinolone)
if can’t see TM d/t swelling give Ciprodex (safe if TM perforated)
-Cortisporin if can see TM NOT perforated
acute cystitis meds in pregnancy
cefpodoxamine
amoxiciilin-clavulante
fosfomycin
nitrofurantoin (until 38 weeks)
Bronchiolitis testing & tx
don’t do RSV swab (doesn’t dictate tx)
don’t give meds (no steroids, albuterol, abx)
Tx if severe ill - ribovirin if immunocompromised
pregnancy initial labs
CBC Rh/antibody RPR/VDRL HIV Hep B surface antigen rubella/varicella titers UA Pap/HPV GC/Chlamydia
suspect w/ painless bleeding after 24 weeks
placenta previa
McBurneys
RLQ (appendicitis)
optimal glucose levels
fasting 70-95
1 hr postprandial <130-140
2 hr postprandial <120
COPD dx
spirometry
ASTHMA SEVERITY: SEVERE PERSISTENT symptoms wake's SABA use activity
S: throughout day
W: 0-4y >1/wk / >5y 7x/wk
SABA: several/day
A: very limited
0-4y: medium dose ICS
5-11: medium dose ICS + LABA (+oral med)
>12: medium dose ICS + LABA OR high dose ICS + LABA
CURB-65
admission tool for CAP: Confusion Urea (BUN >7) BP (<90/60) Age >65 0=outpt 1-2=admit 3-4=ICU
high dose IIV3 and IIV4
give to >65
AOM watchful waiting criteria
6mth-2y: all ABx (except unilateral w/o otorrhea may observe)
> 2y:
Abx - otorrhea w/ AOM or AOM (uni or bi) w/ severe symptoms
may wait: bilateral or unilateral w/o otorrhea
What are the side effects of tiotropium?
Tiotropium is an anticholinergic long-acting bronchodilator. Anticholinergic medications can cause urinary retention. Caution is needed if Rx to a male with BPH
depression SSRI in kids
prozac
vision screening: referral reason
absent red reflex
2 line discrepancy
PP hemorrhage meds
oxytocin
methergine
prostin
viral croup: tx
mild-moderate: supportive, 1 dose dexamethasone, DC if symptoms resolve <3hrs
moderate-severe: humidified O2, racemic epi - if recurrent epi admit
CAP: adults vs kids agents
adults: bacterial
kids: viral (RSV, parainfluenza, influenza A/B)
Review the choice of antibiotics for strep pharyngitis if mono may also be present. Are there any antibiotics that you should AVOID?
amoxicillin
use cephalexin, azithromycin, clindamycin
Treatment of uncomplicated cystitis?
Monurol, Macrobid, Bactrim
mastitis meds
cephalosporins
erythromycin
dicloxacillin
bactrim if MRSA
appendicitis imaging & earliest sign
CT
periumbilical pain that moves to RLQ
Epistaxis treatment plan
direct pressure 15 minutes
tilt head forward
topical decongestant (Afrin)
COPD Group B
0-1 moderate exacerbations, no hospital admit
LABA or LAMA
likely to have comorbidities
may need 2 bronchodilators
pediatric tylenol dosage
10-15 mg/kg q 4-6h
max 5 dose, 4g
HTN meds contraindicated pregnancy
ACE ARBS
-prils
Bronchiolitis S/S
<2y/o, hx prematurity
starts as URI
ADA gestational diabetes screening
1 step: 8 hour fast >92 75g OGTT: 1 hr >180 2 hr > 153
-takes 1 abnormal-
What medication is recommended for the treatment of urticaria (rash & itching) in a 3 yr old?
antihistamine
GDM treatments
(1) diet
(2) insulin
or hypoglycemic agent - metformin, glyburide
invasive genetic testing
> 35y/o of family hx
- chorionic villous sampling 10-13 wks by transabdominal or transvaginal
- amniocentesis 15-20 wks
most accurate way to obtain temp, what value is fever
rectal
>100.4
asymptomatic bacteriuria in pregnancy meds
beta lactic: PCN and cephalosporins
-amoxicillin, amoxicillin-clavulante, cephalexin, cefpodoxine
- fosfomycin (single dose tx)
- nitrofurantoin in 2nd trimester
5-14 days, repeat cx 1-2 weeks after tx
What is the first line treatment for mania
Valproic acid
AOM amoxicillin dosage
80-90mg/kg divided BID
-max 2000mg/day
ACOG gestational diabetes screening
2 step:
(1) 50g non fasting GCT
1hr >130-140
-abnormal proceed to OGTT-
(2) 100g OGTT fasting >95 1hr > 180 2 hr > 155 3 hr > 140 -take 2 abnormals-
determine risk of GABHS
center criteria: fever >100.4 tender anterior cervical adenopathy lack of cough exudate
2: strep test
3: PCN
Zika wait time
men - 6 months after symptoms or exposure
women - 8 weeks after symptoms or exposure
diverticulitis where is pain?
LLQ pain
Myopia vs. Hyperopia
M: nearsighted (distance blurred)
H: farsighted
pertussis tx
works best in early disease
azithromycin
clarithromycin
erythromycin >1m/o
Obtruator
Rovsing
Iliopsoas
O: RLQ pain on internal rotation of right hip
R: push LLQ pain RLQ
I: extension R hip pain RLQ
allergic rhinitis tx
non sedating antihistamines
Mast cell stabilizers
CAP causes/tx
adults - bacterial S. pneumoniae
tx:
macrolide (azithromycin/doxycycline)
> 65, comorbidity, recent abx 90 days- resp. fluoroquinolones (moxifloxacin) OR macrolide + b-lactam (amoxcil)
severe chronic HTN meds pregnancy
1st - methyldopa, labetalol, nifedipine
2nd - diuretics
HTN types delivery goals
chronic - 38-40 weeks
gestational - 37 weeks
pre-eclampsia - 37 weeks
severe pre-eclampia - strive for >34 weeks
Pertussis 3 stages
(1) catarrhal (7days-3wks): runny nose, low-grade fever, mild cough (URI)
(2) paroxysymal (1-10wks): whooping cough worse @ night
(3) convalescent (7days-3 weeks): gradual recovery
retinal detachment: S/S
curtain, floaters/flashers
What is a FDA approved medication for the prevention of migraines in a 15 year-old?
Topirimate
S/S: acute closed angle glaucoma
sudden onset
halos around lights
pupil dilated and unreactive to light
recombinant influenza vaccine (RIV4)
give to >18 w/ egg alley
PE s/s
sudden shortness of breath
tachycardia
anxious
Aneuploidy Screening
(1) stepwise
11 wks - 13/6 weeks - US measurement of fetal nuchal translucency + serum PAPP-A and BHCG
15 wks - 18 wks - maternal AFP (open neural tube defect)
(2) quadruple screening (15-20 wks, ideal 16-18)
- maternal AFP
- BHCG
- unconjugated estriol
- inhibin
PUPPS when & tx
3rd trimester - 2 weeks PP
topical steroids
antihistamines
sarna lotion
GAD med
benzo
ASTHMA SEVERITY: MODERATE PERSISTENT symptoms wake's SABA use activity
S: daily
W: 0-4y 3-4/mth / >5y >1x/wk
SABA: daily
A: some
0-4y: medium dose ICS
5-11: medium dose ICS + oral med
>12: low dose ICS + LABA OR medium dose ICS (+oral med)
Baloxavir (Xofluza) is approved for which patients?
- Balozavir is approved by the FDA for treatment of acute uncomplicated influenza within 2 days of illness onset in people 12 years and older. The safety and efficacy of baloxavir for the treatment of influenza have been established in pediatric patients 12 years and older weighing at least 40 kg. Safety and efficacy in patients less than 12 years of age or weighing less than 40 kg have not been established. One oral dose is given.
- Dose: Weight 40-79kg: 40mg po x 1 dose
- Weight > 80kg: 80mg po x 1 dose
- CDC does not recommend use of baloxavir for treatment of pregnant women or breastfeeding mothers.
- CDC does not recommend use of baloxavir for chemophylaxis
Asthma and LABA
never give alone to Asthma patient - slow acting so can’t use as rescue
ASTHMA SEVERITY: MILD PERSISTENT symptoms wake's SABA use activity
S: >2days/week
W: 0-4y 1-2x/mth / >5y 3-4x/month
SABA: >2 d/wk
A: minor
low dose ICS
iron teaching
continue 3 months after iron levels normal
take on empty stomach w/ OJ
beef, liver, beans, whole grains, nuts, dark leafy greens
prenatal weight gain
underweight BMI <18.5: 28-40lbs
normal BMI 18.5-24.9: 25-35lbs
overweight 25-29.9: 15-25lbs
obese >30: 11-20lbs
epiglottitis: S/S
drooling
sudden high fever
tripod
pregnancy UTIs do not give
fluorquinolones tetracyclines 3T: sulfonamide (jaundice) 1T: trimethoprim (folic acid antagonist) after 38 weeks - nitrofuratoin (anemia)
Live attenuated influenza vaccine (LAIV4)
mist
2-49
healthy
NOT pregnant, healthcare, close contact w/ high risk, kids<18 taking ASA, cochlear implant, CSF leak, 2-4y w/ asthma, antiviral w/in 48 hrs
COPD Group A
0-1 moderate exacerbation, no hospital admit
bronchodilator
Antibiotic of choice to treat CAP that covers mycoplasma pneumonia
A macrolide, like azithromycin, is used to treat CAP when you suspect Mycoplasma pneumonia.
ASTHMA CONTROL:
well controlled
symptoms wake's SABA activity oral med exacerbations
symptoms <2/wk wake's 0-4: <1/mth 5-11: <2/mth >12: <2/mth SABA: <2/wk activity: none oral med exacerbations: 0-1/yr
Treatment of viral CAP in children
The most common causes of CAP in children are viruses, but clinical exam, CXR and lab work can not reliably distinguish between viral and bacterial CAP. Therefore, we usually treat with empiric antibiotics to cover for possible co-existent bacterial pneumonia. Amoxicillin is the drug of choice. You also give supportive care and anti-viral medication if the test positive for influenza
Empiric treatment of CAP in 39 yr old, smoker, alcoholism and chronic liver disease
This patient has comorbidities that make use of a fluoroquinolone or a combination of macrolide plus beta-lactum the recommended treatment. Moxifloxacin was the only fluoroquinolone listed and there were no combination regimes listed
Which are stimulant laxatives?
Bisacodyl
CAPS: kids treatment
bacterial: amoxicillin
viral: abx usually indicated, if flu + give tamiflu
Sinusitis Abx
10-14 days w/o improvement
amoxicillin or Augmentin
What is a complication of Pseudotumor Cerebri?
Vision loss
acute pyelonephritis med
cipro
prenatal visit schedule
<28 weeks - every 4 weeks
28-26 weeks - every 2 weeks
36-40 weeks - every week
What is a FDA approved medication for acute migraine in child >12 years-old?
Almotriptan
