Rosh Review/Week 1 Flashcards
When should adults get pneumococcal vaccine and how should it be administered?
age 65 if no risk factors
any age with these risk factors: smoking, immunocompromised, cochlear implant, alcohol use disorder
PSV13 then wait a year then PPSV 23
pneumococcal is inactivated vaccine
when do you do US for AAA
65-75 male smoker
don’t use metformin when
renal insufficiency - creatinine over 1.4 (F) and 1.5 (M)
also CHF, certain radiographic contrast studies, acidosis, and seriously ill people
alternative recommendation to metformin if contraindications present
short acting sulfonurea glipizide
“Cross eyed”
stabismus
exotropia
one eye looks ahead and the other looks laterally
esotropia
one eye looks ahead and the other looks medially
aniscoria
different sized pupils
what can stabismus lead to
exotropia, esotropia, aniscoria
ectropion
outward turning of lower eyelid
what tests for stabismus
cover-uncover
light reflex test
someone gets in a motorcycle accident with gravel stuck in cut - what kind of tetanus booster do they get
tdap - if no tetanus shot in past 5 years
tx for ITP
Glucocorticoids, IVIG and immunosuppressive therapy is used to help patients achieve and maintain safe platelet counts.
new onset thrombocytopenia with no preceding illnesses or med changes is usually
ITP - idiopathic thrombocytopenic purpura *can have purpura but don’t have to and low platelets will be only blood finding
tx of cataracts
phacoemulsification of the opacified lens followed by implantation of an artificial lens.
tx of severe frostbite
place hand in circulating warm water - 90-102 degrees
typical symptoms of sarcoidosis - what will this person look like
black female (40s) dyspnea, dry cough, painless lymphadenopathy, maculopapular lesions on face, bilateral hilar lymphadenopathy
tx for sarcoidosis
oral steroids
Immediate treatment for severe symptomatic hypercalcemia is
volume repletion with normal saline. Long-term therapy of hypercalcemia of malignancy involves treatment with bisphosphonates, which may cause osteonecrosis of the jaw. Hypercalcemia of malignancy (driven by PTH related peptide) is most commonly seen as a consequence of squamous cell, renal, breast, or bladder cancer. Hypercalcemia may also be caused by hematologic malignancies via the upregulation of cytokines and vitamin D, as well as via local osteolysis, which is seen in breast cancer and multiple myeloma. In hypercalcemia of malignancy, bisphosphonates are the cornerstone of long-term therapy. Bisphosphonates inhibit osteoclastic activity, reducing both the formation and the resorption of hydroxyapatite. They are used in malignancy-associated hypercalcemia as well as Paget’s disease of the bone and postmenopausal osteoporosis. Important toxicities to remember are corrosive esophagitis nausea, diarrhea, and osteonecrosis of the jaw.
bulging tympanic membrane
acute otitis media
first line for acute otitis media
HIGH dose amoxicillin
most common cause of viral stomach bug
salmonella
retrocele location of appendix - what sign
psoas sign
tx for patent ductus arteriosis
ligation
machinery like murmur
PDA
most common head sign of child abuse
retinal hemorrhages
what do you do when a healthy 15 month old child is exposed to a contact who has been diagnosed with the flu in the last 24 hours?
give tamiflu (osletamivir)
4Hs: hemorrhages (petechiae, bleeding gums), hyperkeratosis (rough skin, loose teeth), Hypochondriasis (irritability, emotional changes), hematologic abnormalities (easy bruising) = what type of vitamin def
C
results from “tea and toast” diet of elderly
A: Night vision loss, dry skin, growth retardation, Bitot spots on the conjunctiva
B1 (Thiamine): Alcoholism, malnutrition, Wernicke-Korsakoff syndrome
B2 (Riboflavin): Cheilosis, corneal vascularization (the 2 Cs of B2)
B3 (Niacin): Dermatitis, dementia, diarrhea, corn-based diet (Pellagra)
B6 (Pyridoxine): Sideroblastic anemia, convulsions, peripheral neuropathy, INH use
B12 (Cobalamin): Megaloblastic anemia + neurological symptoms, hypersegmented neutrophils
C (Ascorbic acid): Scurvy (↑ bleeding, anemia, loose teeth)
D: Rickets (children), osteomalacia, tetany
E: Anemia, peripheral neuropathy, ataxia
K: ↑ bleeding, ↑ PTT, ↑ PT
just for reference
tricuspid valve stenosis most likely caused by
rheumatic fever
epiglottitis tx
iv antibx and admission
apple core sign on x ray =
colorectal cancer
necrotizing fasciitis tx
vanco and clinda
4 things you will see on xray with osteoarthritis
narrowed joint space
osteophytes
sclerosis
subchondral cysts
difference between rickets and osteomalacia
rickets - kids
osteomalacia - epiphysis have closed
tx of hemodynamically stable a fib and wolff-parkinson-white syndrome
ibutilide
widened mediastinum on chest xray =
aortic dissection
avascular necrosis of femoral head
intermittent limp
worse after activity
leg calves perthes disease
dry cough, bilateral hilar adenopathy, subcutaneous nodules
sarcoidosis
tetany - hypercalcemia or hypocalcemia
hypocalcemia
what bacteria is responsible for traveler’s diarrhea and how do you treat it?
entertoxigenic e coli
supportive care + 3 days of cipro and maybe antimotility agents
how does traveler’s diarrhea present
watery diarrhea with abdominal cramping
overuse of albuterol inhaler results in what electrolyte abnormality
hypokalemia
if a child drinks more than 16 oz of milk a day, what are they at an increased risk for
iron deficiency anemia
compartment syndrome is most commonly assoc with what
long bone fractures
what is a kerion?
delayed hypersensitivity reaction to tinea capitis; can lead to scarring alopecia
how do ischemic colitis patients present?
mild to severe cramping with acute onset on left side of abdomen, older, rectal bleeding or bloody diarrhea in the first 24 hours, thickening of bowel wall on CT with free peritoneal fluid
if pt presents with hair loss consistent with telogen effluvium, which blood test should you run
serum ferritin - may be iron deficient
rubeola symptoms
rash that moves from face to trunk, fever. cough, coryza, conjunctivitis, Koplik spots *pinpoint greyish spots with surrounding red inflammation in lateral buccal mucosa” - pathognomonic
hypocortisolism (addison’s disease) = what other two electrolyte abnormalities
hyponatremia and hyperkalemia due to aldosterone levels being affected (Na+ not be absorbed correctly and potassium not be excreted properly)
which type of medication is used to prevent variceal hemorrhage?
non selective beta blockers
symptoms of ectopic pregnancy
bleeding in first trimester, abdominal pain, amenorrhea
what enzyme is elevated in compartment syndrome
creatine kinase
what should be avoided when children present with bloody diarrhea and no stool culture confirmation
DO NOT GIVE ANTIBIOTICS DUE TO INCREASED RISK FOR HUS
contraindication to tetanus shot
encephalopathy after previous tetanus shot
