Panda fam med: 2 Flashcards
MCCOD <6 m/o
What are some findings on physical exam?
SIDS
PE will show signs of “Terminal Activity”
- Clenched Fists
- Sero-sanguinous discharge from nose / mouth
MC Type of Renal Stones
Ca Oxalate Stones
6 Aspects of Treatment of kidney stones
6 Aspects of Treatment
- IVF
- Low Na
- Normal Ca
- Decrease Oxalate Foods (Spinach, Rubarb, Chocolate, Tea)
- Decrease Protein
- K Citrate To increase pH of urine
Ox stays low likes to ppt at low pH
Which kidney stones are “envelopes” vs. “coffin lids” vs. “Hexagonal”?
Envelope = Ca Oxalate
Coffin Lids = Triple Phosphate (infections)
Hexagonal = cysteine
MCC Movement Disorder
- 2 Ways to Distinguish from PD
- 3 Rx for Treatment
MCC Movement Disorder = Benign Essential Tremor
- vs. PD
1. BET is a 6-12 Hz tremor while PD is 3-6 Hz
2. BET is with intention/purposeful movements while PD is at rest - 3 Rx for Treatment
1. Propranolol
2. Primidone (Phenobarb, Phenylethylmelanomide)
3. Topiramate
MSSA Rx (3) MRSA Rx (6)
MSSA: Nafcillin, Oxacillin, Dicloxicillin
MRSA: 1 Vanc 2. Linezolid 3. Bactrim 4. Doxy 5. Clinda 6. Daptomycin (Depolarizes cell membranes; ADE = myopathy)
- Goal for Hb in DM with CKD
- Goal for A1C for DM
- Goal for BP in DM / CKD
Hb: 10-12
A1C: 7.0
BP: 130/80
DON’T OVERCORRECT
Pinworm:
Enterobius Vermicularis –> Peri-anal itching
Hookworm
Ancylostoma/Necator –> feet on feces-infected soil allowing hook worm to penetrate –> Cutaneous Larva Migrans
Roundworm
Toxacar –> ingest feces-infected soil –> Viceral Larva Migrans
Eczema
- 3 Individual Disorders
= Contact / Atopic / Seborrheic Dermatitis
How to tell contact vs. atopic dermatitis in baby
atopic affects face / flexural areas. Contact affects diaper area.
Approach to treating eczema flare
Approach to flare:
- Topical Steroids
- Emollients / Antihistamines
- IF 2/2 Bacterial = Topical Mupirocen
- IF HSV Infection (Eczema Herpeticum) = Acyclovir
4 Rashes of Pregnancy
- Mesasma/cholesma
- Intrahepatic cholestasis of pregnancy
- PUPP
- Herpes Gestationis
symm hyperpigmentation of face worse with UV light, resolves with pregnancy
Mesasma/cholesma
pruritis and jaundice with NO RASH in 3rd trimester of pregnancy 2/2 increase bile acids.
Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy: tx
Treatment = anti-histamine for itch and ursodiol»_space;> cholestyramine (decrease bile acid resorption, decrease VIT ADEK tho)
wheals and pruritis on abdomen of pregnant woman
PUPP
PUPP tx
Topical Steroids and anti-histamines
vesicles and prurits on abdomen of pregnant woman
Herpes Gestationis (no relation to actual herpes)
Acne Classification + Treatment
- Noninflammatory / Min Inflammatory: Topical Isotretinoin
- Min-Moderate Inflammation: Topical Benzoyl Peroxide
- Mod-Severe Inflammation: PO Doxy, Clinda, Erythromycin
- Severe/Nodulocystic: PO Isotretinoin
Scabies / Lice
- Bug for Scabies
- Location of Scabies on Body
- Mechanism of Transmission for Scabies / Lice
- Treatment for Both
- Bug: Sarcoptes Scabeiei
- Location of Scabies: Kids = Face, Adults = Webbing of hands/feet
- Transmission: DIRECT CONTACT (≠bedding)
- Treatment: Permethrin + Malathion (Lindane bad for the brain)
Perianal GAS Infection
- Presentation
- Mechanism of Infection in these areas
P/w with beefy rash of both the GENITAL and ANAL region (r/o trauma or pinworms)
Mechanism: often occurs @same time as GAS pharyngitis; either auto-innoculation or spread through the GI tract
Spontaneous PT Management
If suspect and negative initial CXR, don’t forget to get the expiratory phase.
Management:
- f/u in 48 hours outpatient with repeat CXR 24-48 hours
Most sensitive test for HSV?
HSV DNA PCR (»> Serology / Tzanck)
CHADS2 Score + Interpretation
CHF, HTN, Age>75, DM, Stroke/TIA (2points)
≤1 = Low Risk = ASA
2-3: Intermediate = Coumadin
≥4: high Risk = Coumadin
ADE of Opiates that don’t resolve with time (2)
Constipation and Miosis
HIV PCP Pneumonia Management
Bactrim + Steroids IF:
1. PaO2 34
Venous Ulcers
- MCC
- Primary Treatment (2)
- Adjunctive Treatment (2)
MCC = Chronic Venous Insufficiency from Post-phlebitic Syndrome
Primary Treatment = Leg Elevation + Compression Stalkings
Adjunctive Treatment = ASA or Pentoxyfilline (thins blood)
Patients with acute LBP are normally managed with ADL +/- NSAID. What situations would you IMAGE (Plain Film > MRI) the back in a person with LBP (5)?
- Neuro symptoms / rapid development of focal deficits
- IVDU
- Malignancy
- Constitutional Symptoms (cancer / abscess)
- Chronic Steroid Use (Concern for Compression Fracture) ~ plain film (≠MRI)
only time to MRI initially = high high high chance of MALIGNANCY, ABSCESS, CAUDA EQUINA (rapid neuro)
3 Disorders with “percussion tenderness” / point tenderness on back?
Compression Fx, Malignancy (Lytic/blastic) or Abscess
Critically ill patient is post-op, no blood loss in OR or now and is currently not responding to fluids (BP remains low). Patient is not septic and does not have anaphylactic or neurogenic shock. DDx?
Cortisol Deficiency
If patient is chronic steroid user or has been critically ill for some time, adrenal hormones may be low = cannot maintain BP
Prenatal Care: initial visit
- UA (with UCx if needed)
- Pap
- CBC with ABO Set Up
- Infections (GC/CT/RPR/HIV/HBV/Rubella)
Prenatal care: 10-13 wk
Nuchal Translucency +/- hCG and PAPP, offer CVS
Prenatal care: 16-18 wk
Quad Screen + Anatomy Scan, offer Amnio
Prenatal care: 26-28 Weeks
Glucolla for Gestational DM and Repeat Rh testing in Rh- moms to check for alloimmunization +/- RhoGam (if +)
Recall, for mothers at risk of alloimunization, give RhoGAM at 28 weeks and @birth
Anticoagulation for DVT / PE
- Initiate Heparin + Coumadin
- Continue for 5 days following INR
- DC Heparin after 5 days and if therapeutic for at least 24 hours (INR ≥2.0)
Summary:
DVT/PE –> Heparain/Coumadin –> DC Heparin 5 days later IF INR≥2.0 for at least 24 hours
What has been shown to decrease risk of atopy?
Breast feeding for at least 4 months
Migraine
- Presentation (3 phases)
- Treatment for Active Migraine
- PPx
Trigger –> Prodromal Phase (≠Aura) –> Migraine (+/- Aura)
Active Treatment: NSAID –> Triptans (Severe)
*Note ≤12 y/o cannot receive triptans
PPx: Propranolol»_space;> Amitriptyaline
HRT (Combined E + P)
- 4 Benefits
- 4 Risks
4 Benefits:
- Decrease ovarian cancer
- Decrease endometrial cancer
- Decrease colon cancer
- Decrease fractures 2/2 osteoporosis
4 Risks:
- Increase CVA
- Increase CHD
- Increase PE
- Increase Breast Cancer
(T/F) H/o of Major Depressive Disorder is the single greatest risk factor for PP Depression.
False, a h/o of PP Depression is #1. #2 = h/o MDD.
(T/F) Gestational DM is the most significant risk factor for developing Type II DM (even more than multiple family relatives having Type II DM)
True.
2 month s/p Lap-chole, 40 y/o female has RUQ pain and jaundice.
- Diagnosis
- Underlying mechanism?
- Diagnosis = post-chole pain
- Mech: retained CBD stone (or else wouldn’t be jaundiced)
USPSTF Breast Cancer Screening Guidlines
≥40: Annual Breast Exam with +/- Mammogram q2 years on personal preference
≥50: Mammogram q2 years
Femoral Anteversion vs. Tibial Torsion
- Presentation
- Treatment
Femoral Anteversion
- P/w intoing in children
- Treatment: NO ORTHOTiCS/SHOES; observe until 8-10 y/o –> Surgery. Surgery earlier if significant complications (gait, etc)
Tibial Torsion
- P/w intoeing in kids who sit on their knees / sleep prone
- Treatment is same as above
Nodes in Hands/Fingers
Osler’s (IE) —> Heberdon (DIP = OA) –> Bouchard (PIP = OA) –> MCP (RA) —> Janeway Lesions (IE)
N/V Pregnancy Management
Best managed with Vit B6 and Doxylamine (1st gen antihistamine)
DMD
- Genetics
- Presentation
- MCCOD
- Confirmatory Test
- Screening Test
- Genetics: X-linked frameshift mutation in dystrophin
- Presentation: pseudohypertrophy of calf + proximal muscle weakness
- MCCOD: respiratory failure
- Confirmatory Test: IHC for dystropin
- Screening Test: CPK!
3 MCC Knee Pain in PEDS
- Patellar Subluxation
- Patellar Tendinitis
- Tibial Apophysitis (Osgood Schlatter)
Tramadol
- MoA
- Indication
- ADE
MoA: Weak opioid agonist
Indicated: chronic pain
ADE: lower seizure threshold
Cilostazol
- MoA
- Indication
MoA: PDE-3 inhibitor
Indication: intermittent claudication
2 Aspects to Management of Ascites
- Diuretic (Spironolactone»_space; Lasix)
2. Salt restriction
Men v. Women ADME, state who is higher for:
- GFR
- BMI
- Fat Stores
- Gastric Acid Secretion
- GI Motility
- GFR: higher in men
- BMI: higher in men
- Fat Stores: higher in women
- Gastric Acid Secretion: higher in men
- GI Motility: higher in men
Aging
- Distribution changes of drug
- Transdermal
- Distribution: increase fat / low mass
- Transdermal: DOES NOT CHANGE
Duration of Dual Anti-Platelet Rx for:
- Drug Eluting Stent
- Sirolimus Eluting Stent
- Bare Metal Stent
- 1 year
- 6 months
- 1 month
(T/F) Medicare pays for preventative measures and treatments.
False, just prevention. Think VACCINES, MAMMOGRAMS, PAP SMEARS. It does NOT pay for hearing aids, dentures, NH care.
Herpangina
- Etiology / Microbiology
- Presentation
- Etiology / Microbiology: coxsackie / echovirus
- Presentation: Fever / decrease PO intake, PE with shallow posterior pharynx ulcers
Compression Fracture
- Diagnosis
- Recommendations
- Rx
- Diagnosis: plain film
- Recs: REST (only back pain with decrease ADL), NO NO NO NSAID
- Rx: Intranasal Calcitonin is only thing used for PAIN relief
Centor Scoring + Interpretation
1: xCough
1: Fever (100.4, 38)
1: Cervical Lymphadenopathy
1: Tonsilar Exudates
1: 3-14
0: 14-44
- 1: >44
Interpretation:
0-1: nothing
2-3: Rapid Strep
≥4: Emperic Abx
Well’s Score
3: Meets sign/symptoms of DVT
3: No other diagnosis fits
1. 5: HR >100
1. 5: Recent immobilization / surgery
1. 5: H/o DVT
1: Hemoptysis
1: Malignancy
PPD Indurations
- 5mm who’s positive?
- 10mm who’s positive?
- 15mm who’s positive?
5mm Positive:
- HIV/IC
- Recent exposure to TB+ person
- +CXR findings of TB
10mm Positive: everyone else
15mm Positive: normal healthy adults
Functions of HIPAA (4)
- Sets minimum privacy protection
- Requires privacy notices signed at FIRST DELIVERY OF HEALTHCARE
- Requires privacy notices in emergency situations, but these can be taken care of after emergent care is given
- Allows patient to inspect / obtain medical files WITH EXCEPTION (harm to self / others / psychotherapy)
Framingham 10 year Risk for CHD
- Who qualifies
- Screening Tools
- When to start lipid lowering therapy?
Qualifies:
- Age 30-74
- No h/o CHD (otherwise why would you screen?)
Screening ~ SHADDy
- Smoking
- HTN
- Advancing Age (Men >45, Women >55)
- DM
- Dyslipids
Lipid Lowering Therapy = with risk ≥7.5
Hiccups
- Pathophysiology
- Treatment
Pathophysiology
- Respiratory reflex involving the phrenic, vagus and SNS nerves
Treatment: inhibit the reflex loop
- Tongue Depression
- Rx: Chlorpromazine
Vanc Trough
- Goal
- Interpretation
Goal for Vanc Trough >10. This is best level to prevent bacterial resistance.
Pyelonephritis in Pregnancy Management
Treat with IV Ceftriaxone / IV Amp+Gent (note Amp/Gent is also the emperic treatment for NB with possible sepsis)
Post-treatment PPx with Macrobid
Best Screening Test for Adrenal Insufficiency, how to f/u with results?
AM Cortisol
- if NL: no further testing
- if low: ACTH stimulation
Define “Frequent PVC” per Framingham.
What to do with patient with “frequent” PVC?
Frequent = ≥30 PVC/HOUR
Patients are at increased risk for SCD / MI, screen these patients for CHD.
