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CMN 568 > final memorize > Flashcards

final memorize Flashcards

1
Q

anemia:
levels
risks

A

H/H <11/33 in 1st and 3rd trimester
H/H <10.5/32 in 2nd

intrauterine growth restriction
preterm labor

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2
Q 
ASTHMA SEVERITY:
Intermittent
symptoms
wake's
SABA use
activity
A

S: <2days/week
W: 0-4y 0 / >5y 2/month
SABA: <2 d/wk
A: none

SABA prn

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3
Q

Flu antivirals

A

start w/in 48 hours
DOC: Tamiflu

Relenza - no asthma, must be >7y/o

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4
Q

LABA example

A

Salmeterol

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5
Q

6 month vision screening

A

cover test (what for movement of eye after cover is removed)

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6
Q

folic acid recommendations

A

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

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7
Q

ibuprofen pediatric dosage

A

5-10 mg/kg q6-8h
max 40mg/kg/day

must be >6 months

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8
Q

What organism most commonly causes otitis externa?

A 
Pseudomonas aeruginosa
(staph aureus and staph epidermis are also frequent causes, fungi common in DM and immunocompromised)
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9
Q

viral croup:
agent
s/s

A 
parainfluenza virus (RSV)
s/s: steeple sign
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10
Q

AOM treatment?

A

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

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11
Q

What is the first line medication for allergic rhinitis in adults?

A 
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)
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12
Q

ZIKA dx

A

culture

-can be found in semen up to 69 days after symptom onset

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13
Q

10 day old with staccato cough, tachypnea, and conjunctivitis. Most likely organism?

A

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

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14
Q

Pneumonia vaccines

A

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

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15
Q

fetal movement onset

A

18-20 wks primiparous

14-18 wks multigravida

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16
Q

COPD Group C

A

> 2 moderate exacerbations, >1 hospital admit

LAMA

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17
Q

AOM must have to diagnoses?

A

bulging TM and middle ear effusion

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18
Q

Empiric treatment for 42 yr old with CAP, no comorbidities, no recent antibiotic use, allergic to azithromycin.

A

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.

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19
Q

kids & adults oral corticosteroid dosage

A

KIDS: 1-2 mg/kg/day single or divided BID

ADULTS: 40-60mg/day single of divided BID

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20
Q

med for uncomplicated cystitis

A

bactrim and macrobid

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21
Q

fundal height

A

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

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22
Q

ASTHMA CONTROL:
not well controlled

symptoms
wake's
SABA
activity
oral med exacerbations
A 
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
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23
Q

Blepharitis treatment

A

eyelid hygiene

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24
Q

COPD Group D

A

> 2 moderate exacerbations, >1 hospital admit

LAMA
OR
LAMA/LABA
OR ICS+LABA if eos >300

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25
celiac disease diet NOs
wheat, rye, barley
26
endometritis meds
clindamycin gentamicin (IV)
27
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
28
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 ```
29
AOM most common pathogen
strep pneumo
30
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
31
acute cystitis meds in pregnancy
cefpodoxamine amoxiciilin-clavulante fosfomycin nitrofurantoin (until 38 weeks)
32
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
33
pregnancy initial labs
``` CBC Rh/antibody RPR/VDRL HIV Hep B surface antigen rubella/varicella titers UA Pap/HPV GC/Chlamydia ```
34
suspect w/ painless bleeding after 24 weeks
placenta previa
35
McBurneys
RLQ (appendicitis)
36
optimal glucose levels
fasting 70-95 1 hr postprandial <130-140 2 hr postprandial <120
37
COPD dx
spirometry
38
``` 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
39
CURB-65
``` admission tool for CAP: Confusion Urea (BUN >7) BP (<90/60) Age >65 0=outpt 1-2=admit 3-4=ICU ```
40
high dose IIV3 and IIV4
give to >65
41
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
42
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
43
depression SSRI in kids
prozac
44
vision screening: referral reason
absent red reflex | 2 line discrepancy
45
PP hemorrhage meds
oxytocin methergine prostin
46
viral croup: tx
mild-moderate: supportive, 1 dose dexamethasone, DC if symptoms resolve <3hrs moderate-severe: humidified O2, racemic epi - if recurrent epi admit
47
CAP: adults vs kids agents
adults: bacterial kids: viral (RSV, parainfluenza, influenza A/B)
48
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
49
Treatment of uncomplicated cystitis?
Monurol, Macrobid, Bactrim
50
mastitis meds
cephalosporins erythromycin dicloxacillin bactrim if MRSA
51
appendicitis imaging & earliest sign
CT | periumbilical pain that moves to RLQ
52
Epistaxis treatment plan
direct pressure 15 minutes tilt head forward topical decongestant (Afrin)
53
COPD Group B
0-1 moderate exacerbations, no hospital admit LABA or LAMA likely to have comorbidities may need 2 bronchodilators
54
pediatric tylenol dosage
10-15 mg/kg q 4-6h | max 5 dose, 4g
55
HTN meds contraindicated pregnancy
ACE ARBS | -prils
56
Bronchiolitis S/S
<2y/o, hx prematurity | starts as URI
57
ADA gestational diabetes screening
``` 1 step: 8 hour fast >92 75g OGTT: 1 hr >180 2 hr > 153 ``` -takes 1 abnormal-
58
What medication is recommended for the treatment of urticaria (rash & itching) in a 3 yr old?
antihistamine
59
GDM treatments
(1) diet (2) insulin or hypoglycemic agent - metformin, glyburide
60
invasive genetic testing
>35y/o of family hx - chorionic villous sampling 10-13 wks by transabdominal or transvaginal - amniocentesis 15-20 wks
61
most accurate way to obtain temp, what value is fever
rectal | >100.4
62
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
63
What is the first line treatment for mania
Valproic acid
64
AOM amoxicillin dosage
80-90mg/kg divided BID | -max 2000mg/day
65
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- ```
66
determine risk of GABHS
``` center criteria: fever >100.4 tender anterior cervical adenopathy lack of cough exudate ``` 2: strep test 3: PCN
67
Zika wait time
men - 6 months after symptoms or exposure women - 8 weeks after symptoms or exposure
68
diverticulitis where is pain?
LLQ pain
69
Myopia vs. Hyperopia
M: nearsighted (distance blurred) H: farsighted
70
pertussis tx
works best in early disease azithromycin clarithromycin erythromycin >1m/o
71
Obtruator Rovsing Iliopsoas
O: RLQ pain on internal rotation of right hip R: push LLQ pain RLQ I: extension R hip pain RLQ
72
allergic rhinitis tx
non sedating antihistamines | Mast cell stabilizers
73
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)
74
severe chronic HTN meds pregnancy
1st - methyldopa, labetalol, nifedipine | 2nd - diuretics
75
HTN types delivery goals
chronic - 38-40 weeks gestational - 37 weeks pre-eclampsia - 37 weeks severe pre-eclampia - strive for >34 weeks
76
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
77
retinal detachment: S/S
curtain, floaters/flashers
78
What is a FDA approved medication for the prevention of migraines in a 15 year-old?
Topirimate
79
S/S: acute closed angle glaucoma
sudden onset halos around lights pupil dilated and unreactive to light
80
recombinant influenza vaccine (RIV4)
give to >18 w/ egg alley
81
PE s/s
sudden shortness of breath tachycardia anxious
82
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
83
PUPPS when & tx
3rd trimester - 2 weeks PP topical steroids antihistamines sarna lotion
84
GAD med
benzo
85
``` 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)
86
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
87
Asthma and LABA
never give alone to Asthma patient - slow acting so can't use as rescue
88
``` 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
89
iron teaching
continue 3 months after iron levels normal take on empty stomach w/ OJ beef, liver, beans, whole grains, nuts, dark leafy greens
90
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
91
epiglottitis: S/S
drooling sudden high fever tripod
92
pregnancy UTIs do not give
``` fluorquinolones tetracyclines 3T: sulfonamide (jaundice) 1T: trimethoprim (folic acid antagonist) after 38 weeks - nitrofuratoin (anemia) ```
93
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
94
COPD Group A
0-1 moderate exacerbation, no hospital admit bronchodilator
95
Antibiotic of choice to treat CAP that covers mycoplasma pneumonia
A macrolide, like azithromycin, is used to treat CAP when you suspect Mycoplasma pneumonia.
96
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 ```
97
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
98
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
99
Which are stimulant laxatives?
Bisacodyl
100
CAPS: kids treatment
bacterial: amoxicillin viral: abx usually indicated, if flu + give tamiflu
101
Sinusitis Abx
10-14 days w/o improvement | amoxicillin or Augmentin
102
What is a complication of Pseudotumor Cerebri?
Vision loss
103
acute pyelonephritis med
cipro
104
prenatal visit schedule
<28 weeks - every 4 weeks 28-26 weeks - every 2 weeks 36-40 weeks - every week
105
What is a FDA approved medication for acute migraine in child >12 years-old?
Almotriptan

CMN 568 (10 decks)

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