PEM Notes Q2 Flashcards
5 findings in infantile glaucoma
Unilateral pain Cloudy cornea Ciliary flush Epiphoria / photophobia poorly reactive pupil Enlarged eye
causes of sudden vision loss
central retinal aa occlusion retinal detachment stroke optic neuritis glaucoma complicated migraine
causes of red painful eye
conjunctivitis retained foreign body traumatic iritis uveitis/keratitis globe rupture
CF in neurogenic shock
- hypotension + relative bradycardia
- flaccid extremities
- incontinence
- loss of bulbocavernous reflex
- decreased rectal tone
ddx bullous impetigo
- rhus dermatitis
- varicella
- HSV infection
- staph scalded skin syndrome
- Hand-foot-mouth dz (coxsackie)
- lupus
- drug mediated reaction
ddx blistering rash s/p canoe trip
- poison ivy / rhus dermatitis
- cercarial dermatitis (swimmer’s itch)
- dyshidrotic eczema
- bullous impetigo
- friction blisters
- bullous cellulitis (vibrio vulnificus)
bacteria that cause soft tissue infxn from water exposure
A- aeromonas E - erysipelothrix E - edwardsiella V - vibrio vulnificus M- mycobacterium marinum
Electrolyte changes in CAH
hyponatremia, hypochloremia
hyperkalemia
hypoglycemia
metabolic acidosis
RF for cerebral edema in DKA
- new onset DM
- age < 3 years
- Elevated BUN
- Decreased PCO2
- tx with bicarb
- failure of Na+ to rise w/ treatment
- admin of insulin w/in 1st hr of fluid
how do you differentiate between SIADH and cerebral salt wasting?
Both have LOW Na, LOW Sosm and LOW Uosm
CSW = polyuria, dec BP and volume depletion, vasopressin decreased
5 causes of gynecomastia
- hyperthyroidism (Graves disease)
- primary or secondary hypogonadism
- prolactin secreting tumor
- drugs: THC, antipsychotics, reglan
- testicular neoplasm
- physiologic
what meds can u use to tx HTN w/ pheochromocytoma
- alpha blocker: phentolamine (1-5 mg)
- sodium nitroprusside
- do not use BB (unopposed alpha stimulation worsens HTN)
tx of thyroid storm
- IVF
- BB - propranolol
- lower body temperature / cooling measures
- methimazole
- steroids - inhibit TH release
- iodide - dec TH prod in 24 hrs
Tx. necrotizing fasciitis
Tx. PCN (Nafcillin) + Clindamycin (Vancomycin if MRSA)
IVF
Surgical debridement
MOA and CF of Tetanus
Neurotoxin –> uses retrograde axonal transmission to enter brain/spinal cord –> descending mm spasms that start at neck /jaw and progress to chest/abdomen
- flexion/abduction of arms with extension of legs
- risus sardonicus
- resp failure due to mm spasm in chest wall
Tx of tetanus
TIG - neutralizes unbound toxin Metronidazole Sedation w/ benzos Paralysis - pancuronium Baclofen
Kocher criteria for septic arthritis
- WBC > 12000
- ESR > 40
- Fever > 38.5 (101.3)
- Non-weight bearing
Abx for septic arthritis
< 3 mos: Amp + Cefotaxime
> 3 mos: Ancef, Clinda, Nafcillin, Vanco (either one)
Dx criteria for toxic shock syndrome
High fever Erythroderma Abnormal VS Atleast 3 organ systems involved: - NVD or increased LFTs - myalgias or inc CPK - elev BUN/Cr - Plt < 100 000 - altered mental status
Tx toxic shock syndrome
Vancomycin + Ceftriaxone
mild: ancef + clinda
3 findings in exudative pleural effusion
- pleural fluid: serum protein ratio > 0.5
- pleural fluid: serum LDH ratio > 0.6
- pleural LDH > 2/3 UNL for serum
RF for MRSA
crowded living conditions MSM Prisoners poor hygeine cuts/abrasions close skin/skin contact with MRSA (+) person
When do you tx with abx for abscess?
incision & drainage for all
- give abx if fever, associated cellulitis or < 3 months
Abx choices for abscess
< 1 month: vanomycin (clinda if well and < 1 cm)
1-3 mos: Bactrim until cx back, then switch to Keflex
> 3 mos and well: obs
> 3 mos + fever or cellulitis: bactrim + keflex until cx results
tx of tinea capitis with kerion
Griseofulvin is not available in canada Terbinafine x 4 weeks < 20 kg: 62.5 mg daily 20-40 kg: 125 mg > 40 kg: 250 mg
causes of acute diplopia
trauma (blowout fx) papilledema toxins (anticholinergics) CNS - mass, bleed myasthenia gravis refractive error head trauma
findings in orbital fx
restricted upward gaze
numbness of I/L malar region
swollen, painful eyelids
diplopia
Neuro complications of Varicella (5)
- acute cerebellar ataxia
- meningitis
- encephalitis
- transverse myelitis
- Reye syndrome
Ophtho complications of Varicella
- conjunctivitis
- keratitis
- uveitis/iritis
- acute retinal necrosis
- corneal ulcers (dendritic)
when can you perform watchful waiting for AOM
> 6 months of age mild illness (fever < 39) responsible parents symptoms < 48 hours child is otherwise healthy w/ no other underlying conditions
3 abx choices for AOM
- amoxicillin 90 mg/kg/day x 10 days (or 5 days if > 2)
- Ceftriaxone 50 mg/kg IM x 3 days
- augmentin 45-60 mg/kg/day div TID
- cefuroxime 30 mg/kg/day div TID
3 stages of pertussis
- catarrhal: 1-2 wk
- paroxysmal: 2-4 wk
- convalescent: 2-3 mos “100 d cough”
definitive criteria for PID
- endometrial biopsy
- imaging w/ fluid filled/thickened fallopian tubes, TOA abscess or tubal hyperemia
- laparoscopic findings
3 stages of pertussis
- catarrhal: 1-2 wk
- paroxysmal: 2-4 wk
- convalescent: 2-3 mos “100 d cough”
DDx purpuric rash
- tickborne illness
- HSP
- meningococcemia
- DIC
- endocarditis
CF of hemolytic uremic syndrome
Hematuria* Proteinuria* Elevated BUN/Cr* decreased plts microangiopathic anemia
Prophylaxis for meningitis
Contacts in last 7 days
- household contacts
- people sharing sleeping arrangements
- direct contact with oral/nasal secretions
- daycare classmates
- health care workers if no PPE with close contact
- traveller’s seated next to index pt on flight > 8 hrs
Ddx of unilateral cervical LAD
atypical mycobacteria brucellosis tularemia staph aureus group A strep EBV TB
CANMEDS - 6
- communicator
- collaborator
- manager
- health advocate
- scholar
- professional
how can you tell which pupil is abnormal with anisocoria?
in LIGHT –> larger pupil is abnormal due to inappropriate pupillary constriction
in DARK –> smaller pupil is abnormal due to inappropriate pupillary dilation
CANMEDS - 6
- communicator
- collaborator
- manager
- health advocate
- scholar
- professional
definition of menorrhagia
- excessive uterine bleeding at regular intervals
2. prolonged bleeding > 7 days
4 things in management of pt w/ menorrhagia and syncope
- Obtain lab studies including CBC for anemia, iron studies
- Obtain pelvic US
- Consider beginning hormonal therapy such as OCP
- If Hb < 7, consider blood transfusion
- Consult gynecology
