SECRETS Flashcards
Common cause of wheezing in children
RSV, which classically occurs in winter and causes a fever. Asthma may be cause but usually associated with chronic hx.
When should you intubate
CO2>50 or O2
Best way to reduce pulmonary complications post op
STOP SMOKING (especially when at least 8 weeks before surgery)
Classic cause of PNA in TB pt
Pulmonary cavitation – > Aspergillus sp
Classic cause of PNA in child
RSV
Classic cause of PNA in child 2-5
Parainfluenza (croup)
Why should you get a follow up CXR in all pts >40 who develop PNA
Make sure it clears after appropriate abx treatment. If it doesn’t clear by 4-6 weeks, suspect malignancy, specifically BRONCHOALVEOLAR CA.
Complications of infant RDS
Intraventricular hemorrhage and pneumothorax or bronchopulmonary dysplasia (complications of acute or chronic mechanical ventilation)
What is the fluorescence polarization test?
Reflects ratio of surfactant to albumin in amniotic fluid and is direct measurement of surfactant concentration.
Cyanosis with attempted feedings in a neonate
TE fistula
Triglycerides in a pleural effusion
Chylous effusion
Screening for aortic aneurysm
Abdominal US
Confirmatory for aortic aneurysm
CT with contrast
Screening for aortic aneurysm should occur in?
Male smokers 65-75
Screening for aortic trauma/tear
CT with contrast
Confirmatory for aortic trauma/tear
MRA or TEE
Screening for appendicitis
US (partic in prig and children)
Confirmatory for appendicitis
CT with contrast
Screening for bowel obstruction
Abdom Xray
Confirmatory for bowel obstruction
CT with contrast
Screening for cholecystitis
US
Confirmatory for cholecystitis
HIDA
Screen for choledocholithiasis
US
Confirmatory for choledocholithiasis
ERCP or MRCP
Screen for diverticulitis
CT with contrast. No endscopy acutely as there is a risk of perforation
Screen for esophageal disease
Gastrografin or barium xray
Confirmatory test for esophageal rupture
CT with contrast.
Screen for PUD
Endoscopy
Screen for pyloric stenosis
US
Confiramtory for pyloric stenosis
Barium Xray
Confirmatory for fibroids
MRI
Confiramtory for ovarian disease
MRI
Screen for brain tumor
CT with contrast
Confirmatory for brain tumor
MRI with contrast
Screen for ICH
Non contrast CT
Screen for head trauma
Non contrast CT
Screen for acute stroke
Non contrast CT
Screen for bone mets
Bone scan
Confirmatory test for bone mets
PET scan
Screen for multiple myeloma
Plain xrays
Confirmatory test for fracture
Non contrast CT. CT can pick up many fractures not seen on X-ray.
Confirmatory test for osteomyelitis
Secrets says bone scan. NBOME said MRI.
Confirmatory test for plevic trauma
Non contrast CT
Confirmatory test for scaphoid fracture
MRI
What to do if pt with PE cannot tolerate radiation (prego) or contrast
v/q scan
Persistent and painful hematuria: screen ?
CT scan withOUT contrast
Persistent and painLESS hematuria: screen?
CT scan with contrast.
Screen for hydronephrosis
US
Screen for suspected urethral trauma
Retrograde urethrogram
3 leading causes of death in adolescents
Accidents
Homicide
Suicide
Which anti-psychotics treat positive sx of schizophrenia
Respond well to all currently used.
Which anti psychotics treat negative sx of schizophrenia
Atypical agents
Most important prognostic factor in schizophrenia
Premorbid functioning
Most schizophrenic patients in US are born in the ..
winter months.
ANS side effects are seen most in which antipsychotics?
Low potency antipsychotics like chlorpromazine
Tx of acute dystonia
Antihistamines or anticholinergics (benztropine, trihexyphenidyl)
Tx of akithisia
Beta blockers
Tx of parkinsonism in antipsychotic use
Antihistamines (diphenydramine) or anticholinergics (benztropine, trihexyphenidyl)
Neuroleptic malignant syndrome shows very high levels of what?
Creatine phosphokinase (CPK) .. more than 10x normal range.
Classic SE of thioridazine
Retinal pigment deposits, cardiac tox
Classic SE of chlorpromazine
Jaundice and photosensitivity
Antipsychotic classically associated with parkinsonism
Paliperidone
QT prolongation occurs most with which 2 antipsychotics
Paliperidone > ziprasidone
SE of valproic acid
Liver dysfunction
SE of carbamazepine
BM suppression
SE of lithium
Renal dysfunction
THYROID dysfunction
Tremor
CNS effects.
Encopresis is normal until what age
4 years
Which hallucinations are seen due to CNS issues
Visual
Which hallucinations are seen due to psych issues
Auditory
Pupils in LSD intox
Mydriasis
Start DRE exams at what age
> 40
Start PSA tests at what age in AA male
45 yr
Start PSA tests at what age
50
How often for conventional pap smears in women 30 yr or older who have had 3 negative cytology test results
every 2-3 years
how often for pelvic exam in 21-64 yr old
annually; every 2-3 yr after 3 normal exams
Breast exam by doctor in women 20-40 yrs
Every 3 years
Breast exam by doctor in women >40
Annually
Tdap recommendations
Adults 11 yrs old and older should receive single dose of Tdap to replace single dose of Td if they received last dose of Td 10 or more years earlier. Adults who anticipate having close contact with an infant
Tdap vs Td in wound ppx
Tdap
When can Tdap be given to pregos
Given to women with EVERY preg regardless of prior immunization hx, preferably in late 2nd or in 3rd trimester
Define neonatal mortality rate
Neonatal deaths (first 28 days of life)/1000 live births
Define perinatal mortality rate
Neonatal deaths + stillbirths/1000 total births
Define infant mortality rate
Deaths (0-1 y.o.)/1000 LIVE births
Maternal mortality rate definition
Maternal pregnancy-related deaths (deaths while preg or first 42 days after delivery)/100000 live births.
SE of cyclosporine
Renal toxicity