HY Review #3 part 2 Flashcards

1
Q

Woman frequently has to pee & can’t get to bathroom in time
post-void residual volume is very LOW (~10s ml)
Dx/Tx

A

Urge incontinence
Muscarinic Antagonist (Oxybutyn)
Beta 3 agonist (Mirabegron)

Bladder muscle spastic/hyper-tonic/reflexive

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2
Q

Woman leaking urine
post-void residual (~100s ml)
± H/o DM or SLE
± Peripheral Neuropathy
Dx/Tx (2)

A

Overflow Incontinence
Muscarinic AGOnist (Bethanechol, Carbachol)
AchE inhibitor (Neostigmine)

Detrusor muscle hypotonic/ hypomobile/hyporeflexic

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3
Q

Chronic overflow bladder
symptomatic (tender suprapubic region)
Unable to void
Tx?

A

Catheterization

(scheduled if necessary)

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4
Q

increased intrabdominal pressure = leaking urine
weak pelvic muscles (hypermobile urethra)
BRF: multiparous or post menopausal (↓ E2) women
Dx/ Dxt/ Tx

A

Stress Incontinence
Q-tip test (+ if coughs & moves ≥30º )
Kegels
—-
(if not working → Mid-Urethral sling)

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5
Q

Pt got Botulism antitoxin or anti-venom
Or rituximab
1-2 weeks later has fever, malaise, urticarial rash and joint pain
Dx/Tx

A

Serum sickness (T3HSR)
discontinue offending agent

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6
Q

Streptococcal infection, sarcoidosis, fungal infections, pregnancy
can all cause what skin finding?

A

erythema nodosum

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7
Q

Pre-Teen or Teenager
Effects last lesson 1 hour and include:
Neuropsychiatric symptoms
(headache, ataxia, slurred speech, hallucinations, mood swings, AMS)
cardiac symptoms
( dysrhythmia, tachycardia, orthostatic hypertension)
± dermatologic, ocular, otolaryngologic, respiratory or GI symptoms
Dx?

A

inhalant abuse

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8
Q

Patient with fatigue, fever, chills, and anemia
↑ LDH, ↓ Hct/Hb
recent exposure to endemic region ( Africa or Central/ South America)
± Cyclic fevers (2-3 days)
Cx: cerebral dz/renal failure
Dx?

A

Malaria
Primaquine (Ovale & Vivax)
Rapid antigen testing → trophozoites and schizonts in RBCs (eggs)
(Plasmodium spp. → Anopheles mosquitoes)

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9
Q

40-50F Multi-gravid
heavy, painful menstrual bleeding
Smooth, enlarged, globular, boggy uterus
Dx/Tx(2)?

A

Adenomyosis
Mirena IUD

Hysterectomy
(Endometrial glands in the myometrium)

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10
Q

Postmenopausal woman ( or premenopausal)
abnormal uterine bleeding
prolonged exposure to estrogen
(Obese, DM, Exogenous E2, nullparity)
normal PE → Pelvic U/S: enlarged endometrial stripe
dx?

A

endometrial carcinoma

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11
Q

Monoamniotic (one amniotic sac) pregnancies may result in (2 cx)

A

conjoined twins
cord Entanglement

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12
Q

Monochorionic (one placenta) pregnancies may result in (2cx)

A

Twin-Twin transfusion syndrome
Selective fetal growth restriction

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13
Q

Ulcer found on a friable cervix
painless vaginal bleeding (with or w/o sex)
Dx?

A

Cervical cancer
(70% squamous cell carcinoma of ectocervix)

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14
Q

Soft, fleshy growths on genitals or anal canal. Generally do not ulcerate.
HPV associated
Dx?

A

condyloma acuminata

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15
Q

Female persistent nausea and vomiting
First trimester vaginal bleeding
uterine size larger than EGA
Pelvic exam → cystic clusters in the vagina
Pelvic U/S → diffuse echogenic structures + ovarian theca lutein cyst
Dx?

A

Hydatidiform mole

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16
Q

mcc (bug) of septic arthritis in children and adults

A

Staph A

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17
Q

65-year-old male with history of tobacco use.
NBSIM?

A

65-75 yo screening for abdominal aortic aneurysm
(Abdominal U/S)

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18
Q

Review following Info

A

Osteodystrophy: Short stature, developmental delay, round face, hypocalcemia, Short finger or toes

Primary hyperparathyroidism:
↑ PTH ↑ Calcium & ↓ phosphate, wnl Vit D → renal failure, bone reception.

Osteomalacia/Rickets: ↑ PTH ↓ Calcium ↓ phosphate, ↓ Vit D, ↑ ALP

CKD: ↑ PTH ↓ Calcium ↑ phosphate, ↓ Vit D

Osteomalacia (adults) → Bone pain
Rickets (children) → bone deformities (bowed legs/Varum)

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19
Q

Painless Jaundice and Weight Loss

Can’t miss dx?

A

Pancreatic Cancer

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20
Q

Acute nausea, vomiting or anorexia
RUQ abdominal pain, jaundice, and tender hepatomegaly
↑ LFTs
Recent exposure to contaminated water and food
(ex: raw shellfish, cruise ship, travel)
dx/tx?

A

Hepatitis A
Supportive Care

Vibrios cause diarrhea

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21
Q

Fever, headache, seizures, FND, and AMS.
inflammation in the temporal lobe on CT
Dx?

A

Herpes simplex Viral Encephalitis

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22
Q

Acute Decompensated CHF can cause Cardiogenic Shock
__ Cardiac Index
__ CVP, PCWP, SVR

A

↓ Cardiac Index
↑ CVP, PCWP, SVR

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23
Q

Pt with Rheumatoid Arthritis is about to get surgery.
NBSIM?

A

Lateral X-Ray for Cervical spine

(flex/ext)

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24
Q

Microcytic Anemia + Weird Hgb labs
± Weird RBCs on smear
Dx?

A

Thalassemia

example: ↓ HgA ↑ HgA2 ↑ HgF

(FYI: SCC = ↑ HgS & ↑ HgF)

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25
Q

Which Antithyroid medication is the ONLY one that can be used in pregnant patients within 12 weeks pregnancy?

A

PTU

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26
Q

Exercise stress testing is appropriate for patients with (2)

A

normal resting ECGs
&
ability to exercise

(contraindicated in aortic stenosis, osteoarthritis, Exertional dyspnea, etc.)

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27
Q

A patient who has expressed desire for end of Life Care supersedes other sources of this information such as previous advance directives or family member wishes.

As long as pt has

A

Capacitance

(Able to communicate verbally or nonverbally & has been making care decisions consistent with previously stated values)

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28
Q

Alzheimer disease initially presents with memory impairment. Neuroimaging generally demonstrates

A

temporal lobe atrophy

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29
Q

Frontotemporal dementia, age of onset 50-60s
presents with personality changes and loss of social inhibition. Neuroimaging shows atrophy of

A

Frontal lobe

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30
Q

ventriculomegaly in the absence of cortical atrophy is more suggestive of ___.

Triad of cognitive impairment, gait disturbance, and bladder incontinence

A

NPH

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31
Q

Characterized by the presence of both upper (spasticity, hyperreflexia)
and
lower (fasciculations, atrophy) motor neuron lesions.

Initially presents with bulbar weakness (difficulty swallowing, speaking, drooling, choking, tongue atrophy/fasciculations)

A

Amyotrophic lateral sclerosis (ALS)

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32
Q

stepwise/ worsening decline in executive function + memory loss

A

Vascular Dementia

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33
Q

Asymmetric Resting tremor
decreases with voluntary movement
“Pill-rolling”
shuffling gait with quick, short steps
Bradykinesia
Rigidity
Dx?

A

Parkinson Disease

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34
Q

Elderly pt with cognitive fluctuations, visual hallucinations, and parkinsonism. Dx?
Contraindications?

A

Dementia with Lewy bodies
(hallucinations before or with motor sxs)

Antipsychotics are c/I

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35
Q

The cardinal signs of Parkinson disease are (3)
Need 2/3 on physical exam to diagnose.

A

resting tremor
rigidity
bradykinesia

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36
Q

4 yo M presenting with acute onset testicular pain. PE is notable for a “bluish nodularity” and tenderness at the upper pole of the R testicle.
Dx/Tx?

A

Blue DOT Sign (one or many) →
Torsion of the Appendix Testes
Supportive care

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37
Q

Mgt of an RCA infarct II,III,aVF (what should be given)?

A

Normal Saline

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38
Q

45M obese + RUQ pain
The radiologist incidentally discovers multiple regions of signal hypoattenuation in the liver.
Negative alcohol use & hepatitis serologies
(except for HBsAb vaccination)
dx

A

Non-alcoholic Fatty Disease (NAFD)

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39
Q

Non-alcoholic Fatty Liver Disease (NAFLD)
↓ (progresses to)
Non-alcoholic steatohepatitis (NASH)

Kind that progresses to cirrhosis:
Reducing risk of progression to cirrhosis (2)

A

cirrhosis: NASH
Reducing risk : Weight-Loss ± vitamin E

Metabolic syndrome → high risk of CVD
↑ TG, HTN, Glucose
↓ HDL
Central obesity

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40
Q

29 yo M with hypomagnesemia, megaloblastic anemia, and an elevated GGT presents for erectile dysfunction
dx?

A

Alcohol use d/o
Causes ED

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41
Q

MCC of erectile dysfunction in these scenarios?
- 49 M recently started on therapy for angina.
- 32 M recently started on therapy for MDD.
- 23 M recently started on therapy for hallucinations.

A

Beta Blocker
SSRI/ SNRIs
Risperidone (↑ Prolactin)

42
Q

Name sites & affected functions if lesion is present

A

A: LMNs (Anterior Horn) → Ipsi motor
B: STT → Contra pain/temp
C: Dorsal Column → Ipsi Propio/Vibration
D: LCST → ipsi motor (contra brain affected)

43
Q

headache
blurry vision
Rock hard Pupil
Dx/contraindication?

A

Acute angle closure glaucoma

(beta/alpha adrenergic agonist are contraindicated bc → Dilate pupil)

44
Q

shining light in R eye = no pupillary response in both R&L eye
But
shining light in L eye = Miosis in both L&R eye

Locate Lesion

A

R optic nerve (CN2– afferent)

45
Q

shining light in R eye = no pupillary response in L & R eye
shining light in L eye = Miosis in L eye only
Locate Lesion

A

R optic-motor nerve (CN3–efferent)

efferent has one pupil that NEVER constricts no matter what eye you shine light on

46
Q

General Region of lesion in homonymous hemianopsia (3)

A

Optic tract
Optic radiations
Optic MIDLINE chiasm

47
Q

Sneezing, rhinorrhea for 5 days then many weeks of post-tussive emesis/syncope/conjuctival hemorrhage. Wakes up with a red eye.
± Crazy high WBCs
Dx/Tx/ppx

A

Pertussis (whooping cough)
Macrolide
(ppx) Treat close contacts too!

48
Q

10 child with intermittent Fevers + “salmon colored” rash on the trunk + Knee pain for weeks ( ± ankle, wrist pain)
Lymphadenopathy

Dx?

A

Systemic juvenile rheumatoid arthritis
(Steele’s/ Stills disease)

Tx: NSAIDs

49
Q

Female Child with fevers + asymmetric, multiple joints pain + eye problems
± rash on trunk & ANA (+)
Dx/Cx/screening?

A

Oligoarticular juvenile rheumatoid arthritis
Anterior uveitis
Annual slit lamp eye exams
Tx: NSAIDS
Good prognosis

50
Q

7 M w/recent episode of AOM.
Now has fever + R hip and knee pain + painful limp
Full range of motion
Joints are not warm or erythematous
dx/tx

A

Transient Synovitis
Acetaminophen

(Recent infection + painful Limp + normal PE)

51
Q

Septic arthritis vs osteomyelitis on NBMEs.

septic arthritis =
Osteomyelitis =

A

septic = JOINT tenderness
Osteomyelitis = BONE tenderness

52
Q

Bugs causing Osteomyelitis
Step on Nail →
Dog/cat bite →
MCC overall →

A

Step on Nail osteomyelitis → Pseudomonas
Dog/cat bite osteomyelitis → Pasturella Multicida
MCC osteomyelitis → Staph A.

53
Q

7M recent trip in New England, MA.
R knee pain + Red, circular rash on the RUE.
Diagnosis?
Treatment:
Treating the pregnant:
Treatment if neurologic (meningitis) disease or cardiac problems are present:

A

Lyme disease (>36hrs stuck)
Doxycycline

Treating the pregnant: Amoxicillin (2nd line: Doxycycline)
Neuro/Cardiac problems: CTX (not Doxy)

54
Q

Bilateral conjunctival injection, fissured lips,
L sided (unilateral) anterior cervical Lymphadenopathy,
T 104, pedal/hand edema (or rash).
Plt count is 900,000.
Dx/Tx?
(HY) RUQ pain present?

A

Kawasaki’s disease
Aspirin + IvIg
Gallbladder hydrops

55
Q

Sick child gets aspirin
becomes comatose
hypoglycemic
and dies
Dx?

A

Reyes syndrome

56
Q

How do we treat newborns from a mom with varicella?

A

VZV immuneglobulin (VZIg)
given for passive immunity

(too young for VZV vaccine)

57
Q

Child with Rash on face that goes down trunk
posterior auricular LND
red spots on the buccal mucosa
dx?

A

Rubella (Red spots)
aka German Measels

58
Q

Child 3 days ago was Febrile (105ºF) has now developed a red rash on the face and trunk.

A

Roseola (HHV6) → Exanthem subitum

59
Q

Cough, runny nose (choriza),
b/l conjunctival injection,
rash below neck going downwards
white spots on the buccal mucosa
dx/tx?

A

Measels (Rubiola)
Vitamin A (Reduces morbidity)

60
Q

15 yo child with history of Measels becomes comatose and dies?
Dx?

A

SSPE (subacute sclerosis panencephalitis)
100% mortality

61
Q

Child with vesicles in posterior oral cavity (Herpangina)
+ vesicles and papules on the hands and feet.
Dx/Tx?

A

HFM disease (Cox A virus)
Acetaminophen

62
Q

Child with preceding flu like sxs later develops a bilateral lacy maculopapular rash on the cheeks.

A

Parvo B-19

63
Q

kindergarten teacher w/joint pain OR sudden drop of Hgb with hemoglobinopathies.
dx?

A

Parvo B-19

64
Q

Parvo B-19 in utero issues:

A

Hydops Fetalis → death (anemia)

65
Q

9m infant is irritable + ear tugging
Mild fever and a red, bulging TYM on otoscopy.
Dx/Tx

A

Acute otitis media

First line: →amoxicillin
2nd line: → Amoxicillin + clauvanate (augmentin)

66
Q

NBSIM for recurrent episodes of acute otitis media?

A

Tympanostomy tubes

67
Q

White reflex in a newborn?
Dx/ Cx?

A

Retinoblastoma → Rb mutation
Osteosarcoma

68
Q

Meniscus (fluid) behind TYM with no signs of inflammation/mild hearing loss/immobile TYM?
dx/tx?

A

Otitis media with effusion (aka serous otitis media)
no treatment

69
Q

Sinusitis in a diabetic
Necrotic face and septic
dx/tx?

A

Mucormycosis (Rhizopus sp)
Tx: Amp-B +
Debride the face (surgical emergency)

70
Q

Macroglossia, L side > R side of body (Hemihypertrophy), neonatal hypoglycemic seizures?
Dx?

A

Beckwith Weidermann Syndrome

Macroglossia, Seizures ± Wilm tumor/Hepatoblastoma

Hemihypertrophy → Pancreatic Beta Cell Hyperplasia → excessive Insulin production → hypoglycemia → Seizure

71
Q

When should you introduce cow milk in a child’s diet?
Goat milk problems?

A

> 1 yo

Folate (B9) Deficiency
(child in rural area/farmer+ Macrocytic anemia)

72
Q

Why are kids polycythemic at birth?

A

No lung use → relative hypoxia → EPO (↑) aka a lot of RBCs.

Once fetus in born they have a lot of RBCs and they breakdown those RBCs into INDIRECT bilirubin (jaundice)

73
Q

Preemie with bilious emesis, bloody stools, and a distended abdomen.
Dx/ Classic imaging finding/ NBSIM?

A

Necrotizing enterocolitis
Abd XR = air in wall of bowel = Pneumatosis intestinalis
→ if perforated go to surgery

74
Q

12 yo boy bedwetting with polydipsia + hyperglycemia
versus
12 yo boy bedwetting with polydipsia + Normal glucose + home/school problems.

A

T1DM
Psychogenic Polydipsia

75
Q

Low birth weight, short palpebral fissures, flat philtrum, thin upper lip. Diagnosis & tip-off?

A

Philtrum problem = Fetal Alcohol Syndrome

(NBME like to mix presentations with FAS, but it is always FAS if ANYTHING is wrong with the philtrum)

76
Q

Child with language delay + h/o of recurrent otitis media.
NBSIM?

A

perform Audiometry

(language delay = hearing problems on NBMEs)

77
Q

Diagnosis of growth delay type:
Bone Age < Chronological Age → Dx/NBSIM
Bone Age = Chronological Age → Dx/NBSIM

A

Constitutional → get an X-RAY
Familial → Reassurance

(Neither ever drops from percentile lines, follow parallel)

78
Q

Midline neck mass + moves with swallowing
Dx/Patho/endo or ecto derm?

A

Thyroglossal duct cyst
Foramen cecum (endodermal structure) doesn’t obliterate

79
Q

Lateral neck mass + does not move with swallowing
Dx/Patho/endo or ecto derm?

A

Brachial Cleft cyst
2nd-4th pharyngeal grooves (ectodermal structure) don’t obliterate

80
Q

What should a healthcare worker do when they encounter an unlabeled syringe?

A

Discard and report as an adverse event

81
Q

A patient has severe post op respiratory depression. The anesthesiologist is finding it difficult to arouse him from the anesthetic he received. NBSIM?

A

Naloxone (mu antagonist)

FYI: anesthesia has opioids

82
Q

23M recently treated for asthma exacerbation is now aggressive, hallucinating, and has altered mentation. Dx/Tx?

A

Steroid induced psychosis
Antipsychotic (Haloperidol)

83
Q

The 2 HPV vaccine schedules?

A

<15 first dose → get 2 doses
>15 first dose→ 3 doses

84
Q

How to reduce the risk of falling in elderly patients?
How to reduce the risk of falling in elderly patients on inpatient admission?

A

Fall Risk Assessment → Modify risk factors (drug list; walkers; bathroom rods)
Bed Alarms (inpatient)

85
Q

27F with lower abdominal pain and fever 3 days after a C-section. Whiff test = fishy smell
Dx/Bug/Tx?

A

Endometritis
Ureaplasma Urealyticum
Doxycycline

86
Q

URI 2 weeks ago now has a new S3 heart sound and lung crackles.
Dx/MCC?

A

Viral Myocarditis
MCC: Coxsackie B virus

URI then HF = COX B myocarditis

87
Q

Newborn gets cyanotic hrs-days after birth. Supplemental O2 not helping.
Immediate NBSIM? :
General dx?

A

Alprostadil (PGE-1 analog) to open PDA before surgery

Cyanotic Congenital Heart Defect (masked by a Patent Ductus Arteriosus)

88
Q

Brachial-femoral pulse delay in an infant?
Dx/Tx?

A

Coarctation of Aorta
Surgery

89
Q

Infant with Loud P2 and cyanotic when crying.
Dx?

A

ToF
(TET spell)

90
Q

Pulmonary vascular markings measure blood flow through pulmonary artery
(more blood = more markings)
Tetralogy of Fallot:
ASD/VSD:

A

TOF: ↓ Vasculature Markings ( s/t Pulmonic Stenosis)
A/VSD: ↑ Vasculature Markings (s/t L → R shunting)

91
Q

Sequelae with non-treatment of VSD →

FYI: loud P2 = Pulmonary HTN

A

Initially: L → R acyonotic shunt
Next: Pulmonary HTN develops
Last: R→ L cyanotic shunt form
(Eisenmenger’s Syndrome)

92
Q

Heart Shapes
Boot shaped heart:
Egg shaped heart/egg on a string:
Snowman heart:
Water bottle shaped heart:

A

Boot → ToF
Egg → TGA
Snowman → TAPVR
Water bottle → Cardiac Tamponade

93
Q

Congenital heart dz mode of inheritance:
Most common congenital heart defect:

A

MOI → Multifactorial inheritance
MCC→ VSD

94
Q

Nightmares vs night terrors?
Nightmares:
Terrors:

A

Nightmares: REM & Remember dreams
Terrors: N3 stage & no recollection

95
Q

Round erythematous plaques with central clearing/scaly borders.
Dx/Tx?
MCC:
2nd MCC:
3rd MCC:

A

Tinea Corporis (Ringworm)
Topical Azole
Mcc: Trichophyton
2nd: Microsporum
3rd: Epidermalphyton

96
Q

Tinea Capitis & Onychomycosis treatment:

A

ORAL Terbinafine
or
ORAL Griseofulvin

97
Q

Formula for galactosemia:

MCCOD in galactosemia:

Formula for cow milk allergy (2):

A

Galactosemia → Soy milk formula

MCCOD → sepsis from E.Coli

Cow milk allergy → Soy Milk formula or Casein Hydrolysate formula

98
Q

Contraindications to breastfeeding (5)

A

Infant w/ Galactosemia (soy milk only)
Mom on chemo
Active TB
HIV
Active substance use

99
Q

Health benefits of breastfeeding.

A

Lowers risk of:
SIDS
Otitis media
Food allergies
Asthma
(weight loss for mom)

100
Q

Rotavirus vaccine contraindications.

A

Disorders that cause GI bleeds (intusucception, MECKELS diverticulum, h/o Henoch Sch Purpura, h/o IgA nephropathy)

101
Q

Cholinergic Toxidrome (↑ Ach)
Bradycardia, Sweaty, Drooling, Diarrhea, Miosis, Bronchocontriction/ wheezing

Ex: Pyridostigmine OD (Inhibits AchE) for Myastenia Gravis

Antidote for Cholinergic toxicity?

A

Atropine
(muscarinic antagonist)