Set 1 Flashcards
Temporal arteritis labs/tx
ESR elevated; needs biopsy; ophtho for mgmt
Elevated WBC >12,000
Neutrophilia
Neutrophilia with bands
Left shift
Avulsed tooth
Transport in cold milk or commercial “Save-a-tooth”
Sensitivity
Ability of a test to detect a person with a disease
Specificity
Ability of a test to detect a person who is healthy
Cohort study
Follows a group who share some common characteristics: try to observe development of disease over time
Keisselbach’s plexus
Anterior epistaxis
Initial action
Interview
Gold standard test: sickle cell, thalasemia, G6PD
Hemoglobin electrophoresis
Allergy to PCNs: gram+ infection
Macrolide or clindamycin
Acute mononucleosis
usually teen with fatigue, sore throat, cervical LAD; if older patient may be mono reactitvation
Alpha thalasemia
Southeast Asians Filipinos
Iron deficiency anemia
Pica or spoon shaped nails
SLE
butterfly or malar rash
Polymyalgia rheumatica (PMR) tx
1st: long term steroids *long term risk for temporal arteritis
Finkelsteins
de Quervain’s tenosynovitis: pain aggravatted by passively stretching thumb tendons over the radial styloid in the flexion
Anterior drawer
+in ACL tear
McMurrays
Checks for meniscal injury: with patient lying flat (supine), knee fully flexed; grasp heel; leg is rotated on the thigh with the knee in full flexion and out of flexion; internally and externally rotate checking for a click
Diabetic retinopathy eye sx
neovascularization, hard exudates, cotton wool spots, microaneurysms
HTN retinopathy
AV nicking, silver wire/copper wire arterioles
DTR grading
0=absent; 1=hypoactive; 2=normal; 3=hyperactive; 4=clonus
S4
Benign in some elderly
Cutaneous anthrax
Cipro 500mg PO BID x 60 days or doxy 100 PO BID
Primary prevention
“prevention” performing actions to prevent a condition from occuring
Secondary
“detection” screenings: breast exam; genital self-exam
tertiary
“rehab” preventing complications, education, support groups, med side effects, limiting further harm
Bacterial vaginosis
alkaline ph (normal vag ph =4.0)-BV only vag condition with alkaline ph
Clue cells
BV: “mature squamous epithelial cells with numerous bacteria noted on cell borders”
Candida
Yeast: DC white curdlike with redness and itching; see WBCs, psseudohyphae, spores “spaghetti and meatballs”
Trichomonas
copious discharge, bubbly, green; +inflammation, itching, redness; considered STI–> treat partner
HCTZ side effect
hyperuricemia and hyperglycemia
CAP 1st line tx
macrolides
mortality
most common cause of death
morbidity
most common cause of disease
most common cancer death
lung cancer
most common cancer
skin
CDC mortality: dz most deaths
CVD
cancer highest mortality
lung
most common cause death adolescents
MVA
Cancer prevalence: female
breast; not considered a gyn cancer
cancer prevalence male
prostate
most common skin cancer
basal cell
highest skin cancer mortality
melanoma
GYN cancers
vulva, vaginal, cervix, uterine, ovary
most common gyn cancer
uterine; ovarian #2
torus palatinus
bony growth midline at hard palate of mouth, covered with normal oral skin; painless; does not affect function
geographic tongue
multiple fissures; irregular smoother area on surface; looks like topo map; benign
leukoplakia
not benign: slow growing white plaque that has a firm hard surface—> precancerous lesion requires biopsy: cause poorly fitting denturs or chewing tobacco
oral/hair leukoplakia
painless white patch: appears corrugated on lateral tongue: HIV/AIDS, EBV of tongue
breast screening
mammo w/wo CBE start age 50, then every 2 years until age 75; women 40-49 mammo based on individual risk factors and history
ovarian cancer screening
no recommended regular screening
ovarian cancer
older female c/o abd or pelvic symptoms, stomach bloating, low back ache, constipation: palpate ovary; must r/o ovarian cancer in any woman with palpable ovary
population for ovarian cancer workup
early menarche, late menopause, endometriosis, PCOS, fam hx, +BRCA 1/2; initial CA125; intravag US
AAA screenign
1 time (male 65-75) with 30+ pack year smoking history
Barretts esophagitis
precancerous lesion of esophagus
Tanner stage 1 male and female
pre-puberty
Tanner stage 2 female
breast bud/areola start to develop
Tanner stage 3 female
breast bud/areola continue to grow (one mound no separation)
Tanner stage 4 female
nipples/areola become elevated from breast (secondary mound)
Tanner stage 5 male and female
adult characteristics
Tanner stage 2 male
testes with scrotum enlargement (scrotal skin starts to darken with more ruggae)
Tanner stage 3 male
penis grows larger (length) scrotum continues to enlarge
Tanner stage 4 male
penis wider
physiologic gynecosmastia
disc-like breast tissue, mastitis, asymetrical,
pseudogynecomastia
increased risk with overweight/obese
high potassium foods
potatoes, apricots, brussel sprouts
high tyramine foods
aged cheese, red wine, chocolate (increased reactions with MAOIs)
Gluten
avoid in celiac disease (wheat, rye, barley, oats)
Gluten free
corn, rice, potato, soy, tapioca
High mag foods
(decrease BP, dilates blood vessels): some nuts, beans, whole wheat
asthma child outcome
ability to attend school full-time and to play normally every day
Anaphylaxis tx primary care
epi 1:1000 o.3mg IM then 911
anaphylaxis in ED
oxygen, IV, epi, H2 blockers, H1 blockers, bronchodilator, systemic glucocorticoids
anaphylaxis
type 1 IgE mediated; may have biphasic reaction–>reoccurs within 8-10 hours. prescribe medrol dose pack
Elderly patient with weight loss
high rate of complications and increased risk death
Pathologic weight loss
unintentional weight loss >10%
maculopapular
has color and texture-small papules on red or raised skin lesions
varicella
maculaopapular with papules, vesicles, and crusts
fifth dz
maculopapular rash in lace-like pattern
pityriasis rosea (PR)
herald pathc; christmas tree pattern
vesicular rash on erythematous base
herpes simplex, genital herpes
scabies
nighttime pruritic rash, family members with similar symptoms, finger wens, waist, penis; treat all family members same time, wash all clothing, linen in hot water; high heat
S3 heart sound best heard
pulmonic area; pathognomic for heart failure
PPD
measure induration
pulmonary tb gold standard
sputum cx; treat with 3 drug regimin; reportable
INH therapy (isoniazid)
baseline lft and repeat monitoring
DJD
OA
atopic dermatitis
eczema
senile arcus
arcus senilis
acute otitis media (AOM)
purulent OM
serous OM
OME
group A beta strept
strept pyogenes
tinea corporis
ringworm
enterobiasis
pinworms
vitamin B12
cobalamin; cyanocobalamin
vitamin b1
thiamine
scarlet fever
scarletina
otitis externa
swimmer’s ear
condyloma acuminata
genital warts
tic doloureaux
trigeminal neuralgia
tinea cruris
jock itch
thalassemia minor
thalassemia trait (alpha/beta)
giant cell arteritis
temporal arteritis
psoas sign
ilipsoas sign
tinea capitas
ringworm of scalp
light reflex
Hirscberg test
sentinel nodes
Virchow’s nodes: left supraclavicular fossa
erythema migrans
early stage of lyme disease
SSRI
1st line MDD/OCD
benzos
anxiety/insomnia
mood stabilizer (lithium)
bipolar
TCAs
2nd line for depression; prophylactic for migraines, chronic pain, neuropathic pain *no TCA for SI–OD risk
carbamazepine
tegretol: anticonvulsant also used for chronic pain and trigeminal neuralgia
CAGE
screening for ETOH; cut down. annoyed by comments, guilt about drinking, early AM drinking
HTN JNC7 Stage 1 treatment
THiazide: good for osteopenia/osteoporosis: decreases calcium excretion by kidneys and stimulates osteoclast activity resulting in bone formation
ACEI
HTN with DM
HTN with migrains
beta blockers (without lung diseases)
Diverticula
usually asymptomatic, small polyps on colon wall diagnosed via colonoscopy, cause low intake of fiber, rare for those less than 50. mild cases managed OP: ABX cipro 500mg PO BID with flagyl 500mg PO TID x 10-14 days; recommend fiber and psyllium; diverticulitis if develops can be life-threatening
Rocky Mountain Spotted Fever
Emergent condition (Rickettsia Rickettsia): south central US, outdoor activities; presents classic rash wrists/ankles spreading centrally with involvement of palms/soles. systemic sx high feverm HA, myalgia, nausea. treat w/in forst 8 days or fatal. refer to ED. may be difficult to distinguish between meningococcemia and RMSF before BCx and LP. Doxycycline 100mg PO /IV x 7days
Lyme disease
Mid atlantic/new england states; erythema migrans rash; ixodes-deer tick bite; Spirochette Borrelia; doxycycline x 21 days
Menarche
cycle is irregular: months -2 years before
Leading causes of death in teens
1 cause of death in teens MVA; Homicide #2
Emancipated minor
<18: has full legal rights of adult; minors who are parents are not emancipated unless married. Criteria for emancipation: married, enlisted, legal emancipation
Angina
classic presentation CP precip by exertion, relieved by rest; history: several episodes of the same plus risk factors age, gender, lipids
AAA
pulsatile mass mid abd with bruit; older white male with hx smoking; rupture is abrupt, severe abd pain with low back pain, abd distension and shock sx
Tay-Sachs
Ashkanazi Jewish: progressive fatal disease, inherited, build up of plaques in brain-fatal
eGFR
sensitive indicator of renal function: <60 =kidney damage; affected by age, less sensitive in elderly; males higher; increased in african americans
BUN
waste products of protein intake: increased intake=increased levels; dehydration =increased BUN
Warfarin interaction
Bactrim; sulfa drugs interact with warfarin (increased levels=increased INR=inreased bleeding risk)
oral drugs 1st pass metabolism
drug swallowed-gi tract absorbs-portal circulation-liver metabolizes/biotransforms-releases systemic circ
1st pass metab
lowers amount of active drug available to body; drugs with high first pass effect-mostly deactivated and cannot be used by body; example is swallowed insulin-broken down in GI tract-bypassed by injection
drug metabolism
biotransformation: most active in liver (cytochrome p450 enzyme system) kidneys, gi, liver
drug excretion
liver-excreted in bile, urine, feces, resp gas (CO2), and sweat, most drugs are excreted in 2 or more systems
1/2 life
amount of time drug content decreased by 50%
area under curve
average amount of drug in blood after a dose given-measure of bioavailability after drug administered
minimum inhibitory concentration
lowest concentration of antibiotic that will inhibit growth of organisms
max concentration
highest concentration of drug after dose
trough
minimum concentration of drug after dose
problematic drugs-potent inhibitors of cytochrome p450
inhibits or slows drug clearance: increased risk of OD; macrolides, antifungals, cisapride, cimetidine, citalopram
narrow therapeutic index drugs
warfarin, digoxin, theophylline, carbamazepine, phenytoin, levothyroxine, lithium (check blood levels and TSH)
Pioglitazone (Actos)
a TZD: exacerbates CHF; do not use if CHF class 3 or 4, stop if develops SOB, weight gain, cough
atypical antipsychotics
resperidal, olanzapine, quietipine: increased weight gain, dm; monitorweight; black box for increased mortality in elderly; monitor tsh, lipids, bmi
bisphosphonates
alendronate; jaw pain/necrosis, CP diff swallowing, burning back pain; perfed viscous; take solo upon awakening with 8oz water (no juice), remain upright for 30 min
Statins
no mixing with grapefruit juice, drug induced hepatitis/rhabdo, high dose zocor highest risk rhabdo,
digoxin
ti 0.5-2; dig toxic/od anorexia, nausea, vomiting, arrythmias, confusion, visual changes (yellow-green)-digibind for severe toxicity
coumadin od
inr 5-9 w/o bleeding: hold warfarin 1-2 doses, recheck inr in 2-3 days until stable 2-3, once stable recheck monthly
coumadin and inr <2
stroke risk increased 6x;
thiazide diuretics
uncomp 1st line HTN agent; avoid with sulfa allergies; beneficial in osteoporosis; advers hyperglycemia, increased trigs, increased uric acid, hypokalemia
potassium sparing diuretics
alt to thiazides if sulfa allergic; black box warning for hyperkalemia; increased risk if renal impariment, dm, elderly; monitor serum k. advise no salt substitutes or k supplements, caution with ACEI/ARB increased risk hyperkalemia
Loop diuretics
Lasix/Bumex; indication for edema 2/2 chf; cirrhosis, renal disease, htn; excreted via loop of henle; more potent than hctz; adverse electrolyte changes hypokalemia, hyponatremia, decreased chloride; hypovolemia; hyponatremia; pancreatitis, jaundice, rash, ototoxic
Aldosterone antagonists
spironolactoneL indicatedhirsutism, htn, severe chf; advers galactorrhea, hyperkalemia; rare use in primary care 2/2 adverse affects; increased risk of cancers; black box increased risk of benign and malignant tumors
Beta blockers (beta antagonists)
indication: htn, post mi, angina, arrythmias, migraine prophylaxis; adjunct hyperthyroid, thyrotoxicosis; glaucoma=timolol; cardioselective =B1 only; adverse =bronchospasm, bradycardia, depression, fatigue, ercetile dysfunction, blunts hypoglycemic response (caution with DM patients)
ACEI/ARB
indication: HTN, DM, CKDavoid in pregnancy; adverse angioedema and anaphylaxis; ACEI=cough, hyperkalemia; cough usually in the first few months dry and hacking
CCB
indications: HTN, raynauds phenom; DHP vs non-dhp; do not give verapamil with erythromycin or clarithromycin; avoid with grapefruit juice; adverse is headache, peripheral edema, bradycardia, heart block, hypotension, qt prolongationconstipation most common side effect
Alpha blockers
indication: htn with coexisting BPH; terazosin (hytrin) 1mg PO qHS, not first line treatment except htn with bph; potent vasodilator; side effect dizzy/hypotension; severe fall risk at night–advise elderly
pharyngitis
Group A beta strept (pyogenes) 1st line=amoxicillin or pcn vk; if allergic give clarithromycin 250mg PO BID x10days (alternative to pcns is macrolides=azithromycin or clarithromycin)
Mono with strept throat
+mono spot and +cx GAS; avoid using amoxicilin or ampicillin 2/2 rash; use pcn vk or macrolide
atypical pneumonia
erythromycin-n/v common-not an allergy–>switch to azithromycin (z-pack); if allergic to macrolides swiitch to doxycycline; consider macrolide resistant strept pneumo if patient on macrolide within last 90 days
pneumovax
primary prevention in all COPD patients
bacteriocidal
kills bacteria
bacteriostatic
inhibits bacterial growth and replication
tetracycline
preg cat D; permanent discoloration of teeth (yellow-brown) and skeletal defects; treats acne age 13-14; doxycycline 1st line chlamydia/atypical bacteria; minocycline (more se and ae),
acne
tetracycline 1st line mod severe acne/rosacea; adverse=photosensitivity; esophageal ulceration; ci pregnancy or children <8; do not give tetracycline for mild acne (comedomes) only topicals; mild-mode not responsive to topicals then topicla prescription agents like retin-a or benzamycin; consider adding tetracycline if moderate acne not responsive to topical prescription; tetracycline binds to some minerals (calcium, dairy products, iron, mg, zinc) best taken on empty stomach; may decrease OCP
Doxycycline
1st line chlamydia (cervicitis, PID, atypical pneumonia); atypicals include mycoplasma
side effects minocycline
dizziness and vertigo-advise patient to discard all expired tetracycline-degrades and becomes nephrotoxic or Fanconi’s syndrome
Macrolides
cat B; associated with more drug interactions; erythromycin and clarithromycin-potent cyp34A inhibitors-increased interactions; erythromycin is not cyp34a therefore less interactions; carfeul using with MG, coumadin, ccb, benzos, salmeterol, anticonvulsants, or statins; adverse effects: GI distress, ototoxic, cholestasis, jaundice, qt prolongation
cephalosporins
cat B: beta lactam family; bacteriocidal inhibists cell wall synthesis
1st gen cephalo
gram + cellulitis/mastitis
2nd gen cephalo
more broad spectrum_gram +and neg (sinusitis.OM
3rd gener cephal
decreased against gram +, but increased gram -; n.gonorrhea, enteric bacteria
rocephin
1st line gonorrhea
mrsa skin
bactrim or clida 5-10 days
anaphylaxis
type 1 ige mediated response
penicillins
cat b: risk of cross-reactivity with cephalosporins; amoxicillin and ampicillin extended spectrum; gram + and some gram - (h.influenzae, e.coli, proteus mirabilis) advers=diarrhea, c diff, vaginitis; amoxicillin given to mono–>rash; use pcn vk
fluorquinolones
gram neg and some atypicals (chlamydia, mycoplasma, legionella) newer gerations cipro, moxi, gata; levo and moxi are resp:strept pneumo**increased risk of achilles tendon ruptures); interacts with other qt prolonging drugs (amio, macrolides, TCA, antipsychotics); avoid with electrolyte disturbances (mag/K)–>increased risk of torsades; if admin with antacids/sucralfate decreased absorption; CI <18-reduces cartilage formation; MG; pregnant or breastfeeding; advers: CBS dizziness HA insomnia mood changes, qt prolong
anthrax inhalation
cipro 500mg PO BID x 60 days
cutaneous anthrax
cipro 500mg PO BID x 7-10 days
travelers diarrhea
cipro 500mg PO BID x 3 days
drug with hishest risk tendon rupture
steroid if older than 60
Sulfonomides
cat c: gram neg (e. coli, klebsiella, h. influ); bacteriostatic-bactrim; other sulfa medications: diuretics (furosemide/hctz); sulfonylureas ( glyburide/glipizide); cox-2 inhibitors (celecoxib/celebrex); dapsone -for HIV
CI: G6PD anemia-hemolysis; newborns/infants <2months old; pregnancy late 3rd trimester-increased risk of hyperbili and kernicterus
interactions: warfarin increased INR
adverse: skin rash, stevens-johnsons
note: uti on coumadin do not give bactrim
HIV: high risk for sulfa related stevens-johnson
G6PF: AA with presenting hemolysis and jaundice 2/2 treatment with sulfa=decreased H/H and jaundice
topical nasal congestants
oxymetazoline (afrin); phenyephrine (neo-synephrine)-short term use BID pRN 3 days max; rhinitis medicamentosa -chronic use >3 days
antihistamines
avoid benadryl in elderly
elderly-use loratadine (claritin) decreased incidence of sedation
zyrtec: more potent and longer acting
ketoralac
maintain 5 days or less
salicylate
aspirin post MI=tertiary prevention
ASA IRREVERSIBLY inhibits platelet function for 7 days
DC ASA of c/o tinnitus; long term =81mg/day
not for use if less than 16: reyes syndrome
acetaminophen
max 1g/4hours or 4g/day; avoid in chronic hepatitis; dehydration, cirrhosis; 1st line in OA; antidote is acetylcysteine
Glucocorticoids
steroids: RA, autoimmune, polymyalgia rheumatica, asthma, temporal arteritis, uveitis, skin (eczema, psoriasis, contact derm); if PO and short term (<3weeks) no need for taper
Topical steroids
class 1-7; low potency face, genitals, children; mod thicker skin (scalp, soles, palms) plaques-still need to taper topicals if long term
acute inflamed joints
intraarticluar triamcinilone (kenalog); max 3xper year; SE HPA suppression, cushings dz, osteoporosis, immune suppression, chronic skin changes (atrophy, striae, teleangist, acne
poison oak/ivy
may require 14-21 days of oral steroids
drugs requiring eye exam
digoxin, corticosteroids, fluorquinolones, ED drugs, accutane, topamax, plaquenil
DEA schedules
1-5; 1 is heroin, ecstasy, PCP, etc-illicit; 5 is cough meds with less than 200mg codeine
FDA category X drugs
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.- finasteride, isotretinoin, warfarin, misoprostol, androgenic hormones, live virus vaccines (MMR, varicella, flu mist, rotavirus), thalidomide (DES)
FDA category A drugs
Category A
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
FDA category B drugs
Category B
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
FDA category C drugs
Category C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
FDA category D drugs
Category D
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
FDA category N drugs
not studied
OA CAM med
glucosamine with or without chondroitin; no evidence to support use
CAM PMS sx
black cohosh, wild yam root
isoflavones
soy beans-estrogen like effect
saw palmetto
BPH sx; no better than placebo
kava kava; valerian root
anxiety/insomnia
St John’s wort
mild depression: do not use concurrently with SSRI, triptans, or HIV protease inhibitors
homeopathy
law of similars; substances diluted
Leading causes of death US
heart dz, cancer, chronic lung
cancer mortality
leading cause of cancer death: lung
teen leading causes of death
male rate>female rate in teens; accidents and injuries #1; homicide#2; suicide#3; unintentional injuries (accidents) #1 in 1-19 yr olds
Life expectancy
78.5 yrs
most common cancer
skin; most common skin cancer basal cell; melanoma causes 75% of deaths from skin cancer
cancer by gender
male: prostate
female: breast
sensitivity
highly sensitive test have increased risk of false positives. example HIV Elisa has 99% sensitivity–too sensitive with high rate of false positives-must confirm with Western blot
specificity
detects individuals who do not have the disease: HIV Elisa has high specificity (99%) which increases risk for false positive; confirm with western blot which has high specificty -r/o people who do not have the disease
primary prevention
preventing disease and injury: individual actions of healthy individuals: nutrition, diet, exercise, seatbelts, helmets, gun safety, national programs (immunization, safety laws, environmental), youth centers, habitat for humanity
secondary prevention
early detection of disease to minimize bodilty injury: screening tests -pap. mammo, cbc for anemia, screening for depression, sti/etoh screening
tertiary prevention
rehab, support groups, education of equipment, breast cancer support, hiv support, alcoholics anonymous; education for patient with preexisting disease (DM/HTN); education to avoid drug interactions; cardiac/pulm rehab, PT/OT, exercise program for obesity
USPSTF breast cancer
baseline mammo age 50 and then every 2 years; age 40-49 individualize based on risk factors-ACS recommends starting age 40; age 75 stop unless life expectancy >10 years
HPV testing
not for less than 30 years old
cervical cancer screening
pap/cytology age 21 then every 3 years until age 65; or after age 30 Pap with HPV every 5 years; no screening after age 65
colorectal screening
baseline age 50 thru 75; 76-85 based on individual risk factors; >85 none; options include FOBT x3 every year or flex sig every 5 years or colonoscopy every 10 years
lipid profile
9 hour fasting; male at 35 and oldre; 20-35 if increased risk; female start age 45 or 20-45 if risk factors; increased risk is htn, fam hx, +stroke
prostate
USPSTF recommends against PSA based screening except diagnosed or undergoing treatment for prostate cancer (surveillance)
skin cancer counseling
children, adolescnet, young adults, with fair skin; avoid sunlight 1000-1600; spf 15 or higher, protective clothing, hats
no routine screenings
lung cancer, ovarian cancer, oral, prostate, testicular
breast cancer risk factors
older age >50 (most common RF) previous hx breast cancer 2 or more first degree relatives with BC early menarche, late menopause, nulliparity (increased exposure to estrogen) obesity:adipose synthesizes estrogen
cervical cancer
multiple sex partners (>4 lifetime)
younger age 1st sex (immature cervix easy to infect)
immunosuppression/smoking
colorectal cancer risk factor
familial history polyposis; first degree relative; crohns or ulcerative colitis
prostate cancer risk factor
increased age >45, african american, +FH, +BRCA1/2
STI risk factors
multiple sex partners/new partners (<3months)
early age onset sex
STI hx
homeless
Hep B vaccine
3 doses: if not completed don’t restart entire series; catch up until all 3 doses complete
Influenza vaccine
start oct/november to cover fall/winter;
live attenuated vaccine intranasal 2-49 years
safety: no aspirin for children w/i 4 weeks
avoid antivirals 48 hours before and 14 days after
LAIV contraindications
pregnancy, chronic disease (asthma, COPD, RF, DM, immunocompromised)
Flu injectable
trivalent inactivated (IM), fluzone (intradermal) CI: severe anaphylaxis (allergy to previous dose or egg protein) youngest age for flu vaccine is 6 months (IM); flu mist 2-49 years
tetanus vaccine
q 10 years; booster give for wounds sustained if last booster >5years
CI: severe allergy previous dose
pertussis may cause encephalopathy
precaution if mod/severe illness w or wo fever; GBS w/in 6 wks of last dose
unknown tetanus vaccine
if patient wound give immediate Td with tetanus immune globulin
pneumococcal vaccine
pneumovax 23-IM; 65 and older (1 dose lifetime); if vaccinated before 65 then give booster dose 5 years after initial dose
pneumoccocal infection risk
highest fatality for alcoholics, Dm, CSF leak, asthma, chronic hep, asplenial, immunocompromised, malignancies, CA blood, renal dz, organ/bone marrow transplant
zoster vaccine
one time age 60; SC; earliest at age 50; can give even if hx of chickenpox or shingles; may increase risk of asthma or polymyalgia rheumatica;
CI: pregnancy and breast feeding; cancer; immunocompromised or on meds for a condition
varicella vaccine
2 doses; 4-8 weeks between; live attenuated; SC for exposure to chickenpox (post exposure prohylaxis) give within 5 days; if born before 1980 then no vaccine
health care personnel vaccine
Td/Tdap; MMR; Varicella; Hep B; Influenza
BCG vaccine
TB-live attenuated used in asia and africa; follow up for clinical sx; r/o latent infx with chest xray; symptoms: chronic cough, wt loss, night sweats
herpes keratitis
acute onset severe eye pain, photophobia, blurred vision in affected eye;
dx: fluorscein dye =ferning pattern versus corneal abrasion which is linear
infection will permanently damage corneal epithelium
acute-angle closure glaucoma
emergency elderly, acute onset severe eye pain with headache, nasua, vomiting, “halos”, decreased vision. mildly dilated pupil-oval shaped; “cloudy cornea”–cupping of optic nerve
scotoma
retinal detachment
eye pain
uveitis, glaucoma
cholesteatoma
hx chronic otitis media; cauliflowerlike growth-not ca-can erode bones and damage cn7; foul smelling DC; PE: no visible TM/ossicles 2/2 destruction by tumor; tx abx and surgical debridement…refer ENT
Battle sign
bruise behind ear over mastoid; fracture basilar skull
Clear golden fluid DC from nose or ear
basilar skull fracture CSF leak; test with urine dipstick (+glucose if CSF); mucous = neg glucose
Cavernous sinus thrombosis
rare but life-threatening; h/o sinus/facial infection; severe HA with high temp; rapid decline in LOC-coma-death**refer to ED
Peritonsilar abscess
PTA: one sided swelling of peritonsilar area and soft palate; severe sore throat/dysphagia;odonophagia; trismus; “hot potato voice”; +malaise, fevers, chills, marked swelling, uvular displacement
ED for I/D
HMO and PPO are
Managed care systems. Managed care systems integrate delivery of health care with financing of health care. Typically done through a series of contracts with health care providers, diagnostic groups, and other support services
Diptheria
“Corynebacterium Diptheriae”: sore throat, fever, swollen neck “Bull neck”; hoarseness, dysphagia
Post pharynx coated with **pseudomembrane” =tissue necrosis; incubation 2-7 days
systemic manifest: resp, neuro, cardiovasc collapse, death
need antitoxin
resp and/or contact isolation
Mononucleosis cbc
Increased lymphocytes and decreased total wbc; viral infx increased lymphocytes and decreased neutrophils; atypical lymphocytes
Normal eye fundoscopy
viens>arteries; macula is central area for central vision; fovea is set in middle (has cones) responsible for sharpness (20/20)
cones: for color vision and sharpness
rods: light/shadow, night vision, depth perception
Sexual development female
By 16 years with or without secondary sexual characteristics should begin menses especially if tanner 5; refer if not
presbyopia
age related visual changes; decreased ability to accomodate; stiffening lens; starts age 40; difficulty focusing and decreased ability to read close print
Hormone replacement therapy
3 leading causes of morbidity and mortality in women influenced by female hormones. HRt may not be beneficial to many, it is not recommended for all postmenopausal women.
Ears normal exam
TM: off-white to grey= “cone of light”
tympanogram: most objective measure of fluid in middle ear
auricle: external portion (high in cartilage) does not regenerate
Ulcerative colitis
Amenable to surgical resection, usually a total colectomy. Surgery for crowns is not curable, but may be indicated in some situations.
Nose normal exam
inferior turbinate is visible: upper and mid need equipment
bluish, pale, or boggy=allergic rhinitis
Innocent murmur in pediatrics
Innocent or functional murmurs are common clinical findings esp in 3-7 year olds. Functional murmurs are audible when the child is supine, are diminished or absent when the child is sitting or standing. Grade 1-3, brief, blowing, with medium pitch, and auscultation in systole at left eternal border 2nd ics. Patient gender has no bearing on whether murmur is functional or not
leukoplakia
leukoplakia: white, raised, feathery area usually on side =HIV, AIDS, tobacco: increased risk oral cancer
Heberdens and Bouchard
Osteoarthritis: heberdens DIP; Bouchards PIP
apthous stomatitis
canker sores: shallow ulcers of soft tissues
Ida assessment of adequacy if supplementation
Check hemoglobin and hct one month after starting iron; if not improved consider other sources of bleeding like gi or menstrual. Serum ferritin is an indicator of tissue iron stores and should be near normal 4-6 months after supplements
avulsed tooth
store in cold milk-no ice: see dentist asap
Chronic bacterial prostatitis tx
Fluoroquinolone daily x3-4 months. Bactrim cure rate too low for use 30-40%
tonsils
butterfly shaped porous glands: purulent exudate=tonsillitis
Complications of gestation dm
Cephalopelvic disproportion, microsomia, hypoglycemia
Does not increase risk of placenta previa
post pharynx
postnasal drip (acute sinusitis;allergic rhinitis) posterior pharyngeal LAD-allergic rhinitis cobblestoning: inner conjunctiva with mildly elevated lymphoid tissue=atopy
Antifungal safe during pregnancy
Miconazole “Monistat”cream not absorbed systemically
geographic tongue
benign: map-like appearance; patches may move
Findings to warrant np investigation of child abuse
Overly compliant, withdrawn, or apathetic behavior should be investigated for possible abuse. Small teeth marks often from other children. Multiple bruises on child’s knees and elbows are typically associated with unintentional injuries that occur during break childhood activities. Nocturnal enuresis is normal in 2 yr old
torus palatinus
benign: painless bony protuberance midline hard palate; asymmetrical, skin should be normal
2 year old with uncircumcised unable retract foreskin over glans
Reassure mother normal. Phimosis unable to retract over foreskin. Normal in uncircumcised usually resolves by 5 years.
Fishtail, split uvula
benign: may be sign of occult cleft palate
Alzheimer’s disease influences
Environmental and genetic. One treatable factor is estrogen deficiency. Because women live longer than men more women develop Alzheimer’s disease. Some experts believe that women have higher risk of Alzheimer’s related to estrogen production stoppage while men keep producing testosterone
Nystagmus
a few lateral is normal;
**vertical always abnormal
papilledema
optic disc swelling; increased ICP 2/2 bleeding, tumor, abscess, pseudotumor cerebri
htn retinopathy
copper or silver wire arterioles
diabetic retinopathy
microaneurysms 2/2 neovascularization
cotton wool spots
cataracts
opacity of corneas
can result from chronic steroid use
Koplik’s spots
measles; small red papules with blue-white centers inside cheek by lower molars
hairy leukoplakia
elongated papilla=lateral
EBV, HIV
palpebral conjunctiva
mucosal lining inside eyelid
bulbar conjunctiva
mucosal lining covering eye
soft palate
uvula, tonsils, ant throat
snellen
test vision; test with and without glasses
abnormal-2 line difference between eyes
ou=both; os: left; od: right
line counts if gets 1 more than 1/2 of line; ex (out of 6 ust get 4)
peripheral confrontation
checks for blind spots (scotomas)
color blindness test
Ishihara chart
legal blindness
best corrected vision >20/200 or visual field <20 degrees (tunnel vision)
Weber
tuning fork to forehead
normal =NO lateralization; +lateralization=abnormal
CHL
Weber will lateralize to imparied
SHL
Weber will lateralize to good
Rinne
tuning fork to mastoid
Rinne CHL
BC greater or equal to AC
Rinne SHL
AC greater or equal to BC
herpes keratitis
emergent, damages corneal epithelium 2/2 herpes virus (shingles); acute onset eye pain, photophobic, blurred vision; affected side check for herpetic rash; fernlike pattern on fluorescien; zovirax and valtrex-avoid steroids
corneal abrasion
acute, foreign body sensation, increased tearing, contact lens increased risk bacterial infx; topical ophthalmic abx -erythromycin/polytrim
hordeolum
stye; pain, bacterial infection of hair follicale; pustule; treatment warm moist compresses; can give abx drops or ointment
chalazion
chronic inflammation of hte mebomian gland of eyelid; gradual onset of small superficial nodule, discrete and movable on upper eyelid, feels like bead; painless, benign; treatment is surgical removal r/o SCC
pinguecula
yellow triangular thinckiening of bulbar conjunctiva-inner and outer margins of cornea; caused by UV damageof collagen; tx: if inflames weak steroids; sunglasses/surgery
pterygium
yellow triangular (wedge-shaped) thickening of conjunctiva extending to cornea-UV damaged cornea; tx: if inflamed weak steroid; sunglasses/surgery
primary open angle glaucoma
gradual increased IOP >22mm hg 2/2 blocked drainage of aqueous humor inside eye; retina and optic nerves (CN 2) show ischemic changes and permanent damage
**most common 60-70% of cases
usu elderly african american with DM; usu asympto; gradual visual changes
LOSE PERIPHERAL VISION FIRST!
fundo: CUPPING
meds: timolol (beta blocker)
normal IOP
10-22
primary angle closure glaucoma
sudden blockage of aqueous humor resulting increased IOP and ischemia/permanent damage to CN2
Case: elderly acute frontal headache; eye pain; tearing; blurred vision; nausea/vomiting
HALOS AROUND LIGHTS
PE: fixed, dilated cloudy pupil-may be oval shaped-conjunctival injection with increased tearing
REFER TO ED
Anterior uveitis
Iritis: increased with autoimmune disorders; c/o red, sore eyes, increased tearing
**no purulent discharge–>refer to ophtho
Age-related macular degeneration
atrophic (dry) versus exudative (wet); atrophic less severe-more common; exudative usu vision loss; caused by gradual damage to pigment of macula
- *LEDING CAUSE OF BLINDNESS IN OLDER ADULTS** higher rate in smokers
- *PAINLESS, CENTRAL VISION LOSS; starts with distorted lines in vision
Sjogren’s syndrome
chronic autoimmune; decreased function of lacrimal and salivary; may occur alone or with other disorder
Sx: dry eyes, mouth >3 months
PE: swollen and inflamed salivary glands
Tx: OTC tear substitutes; refer rheum and ophtho
Blepharitis
chronic, bare eyelashes/inflammation; c/o pruritus, inflammation, redness, crusting,
tx: baby shampoo/warm water scrub
ABX ointment
epistaxis
posterior worse than anterior; tilt head forward-pressure; use afrin pledgette to shrink tissue and then place packing
Group A beta strept
strept pyogenes; sequalae=scarlet fever, rheumatic fever, post strept glomerulonephritis
treatment: pcn vk 250 mg PO QID x 10 days; if pcn allergic give zpackx5days
strept throat complications
scarlet fever: sandpaper like rash
rheumatic fever: may affect heart valves, joints, brain
Peritonsillar abscess
AOM organisms
strept pneumo (gram +)-high beta lactam resistance
H. influenzae (gram -)
M. catarhalis (gram -)
AOM complications
cholesteatoma; mastoiditis; preorbital/orbital cellulitis; meningitis, cavernous sinus thrombosis
OME
follows AOM; chronic; tm may bulge or retract but not red; fluid level with bubbles.
Tx: oral decongestant; steroid nasal spray
OE
usually bacterial but can be fungal; warm humid weather; pseudomonas vs staph; pain with manipulation of tragus
Tx: cortisporin otic QIDx7 days
complications: if diabetic can spread into cellulitis or osteo
Infectious mono
epstein barr virus: peak 15-24 years; after acut einfection can lay dormant in tissue and reactivate
TRIAD fatigue, pharyngitis, LAD; fatigue can last months
-may have abd pain with +HSM
CBC–>lymphocytosis with atypical lymphs>50%
Heterophile Ab test: MONOSPOT +
Tx: abdominal US if +HSM; avoid sports 4-6 weeks otherwise symptomatic treatment
**avoid amoxicillin and ampicillin (rash)
Complications: splenic rupture; ariway obstruction (ED high dose steroids); neuro: GBS; aseptic meningitis; optic neuritis; blood dyscrasias (atypical lympho)
Ceilosis
skin fissures/macerations corners of mouth
causes: oversalivation, IDA, secondary bacterial infx; vitamin deficiency
TX: apply triple antibiotic ointment BID-TID until healed; treat underlying cause
Rocky mountain spotted fever
classic rash: petechiae hands/feet/palms/soles progressing to trunk-generlized
rash on 3rd day after abrupt high fever (103-105) leading to HA, myalgias, conjunctival injection, N/V, arthralgia
FATAL
US: southeast southcentral, spring early summer
aK
actinic keratosis: elderly, sun exposed area-rough, scaly, precancerous
meningococcemia
sore throat, cough, fever, HA, stiff neck, photophobia, change in LOC, toxic, petechial rash
fulminant death within 48 hours; increased risk college dorms–vaccine
rimfampin as prophylaxis
erythema migrans
early lyme disease: expanding red rash with central clearing; 7-14 days after bite
deer tick; lesion resolves after a few weeks; flu like sx
Herpes zoster ophthalm
shingles of trigeminal nerve CN5
if herpetic rash on tip of nose assume shinglesREFER TO ED
Melanoma
> 6mm; uneven, irregular, multiple colors
BCC
most common; supperficial pealry domed, waxy
atrophic: ulcerated center
may be multiple colors
acral lentiginous melanoma
most common melanoma in AA asians, dark brown/black, nailbeds, palmar, plantar surfaces
subungal hematoma
direct trauma to nailbed-trapped blood; if >25% of nail area, risk permanent ischemic damage to nail matrix–>drain
Stevens-Johnsons Syndrome
Erythema multiforme major; classic lesions target-like or bulls-eye, abrupt eruption, multiple, blisters, petechiae, purpura, hemorrhagic; prodrom fever and flu-like symptoms
-rare hypersensitivity to meds: pcn, sulfa, phenytoin, barbituates; high mortality 25030; increased risk HIV with bactrim
vitamin D
darker skin requires more sun exposure for vitamin D; def of vit D in pregnancy results in infantile rickets, brittle bones, skeletal abnormalities
bulla
elevated superficial blister>1cm; fluid filled
Ex: impetigo, 2degree burn, SJS
vesicle
elevated, superficial, <1cm, fluid filled
Ex: herpetic lesion
pustule
elevated, superficial <1cm, purulent filled
Ex: acne pustules
macule
flat, nonpalpable, <1cm
Ex: freckles, small cherry hemangiomas
papule
palpable solitary, <0.5cm
Ex: nevi, acne
plaque
flattened, elevated lesions, variable shape >1cm diameter
Ex: psoriatic lesions
seborrjeic keratoses
soft, round, wart-like fleshy growths
xanthelasma
yellow-like plaques-eyelids; hyperlipid if <40
melasma
mask of pregnancy; brown tar stain cheeks and forehead pregnancy or on estrogen OCP; usu permanent but can lighten
vitiligo
hypopigmented patches of skin
cherry angioma
1-4mm small, red, smooth papule; nest of multiformed arterioles
nevi
moles
xerosis
inherited skin disorder, extreme dry skin
topical steroids
infants, children, or adults with thin facial skin; no fluorinated topicals -use 0.5-1% hydrocortisone
Prolonged use: HPA axis suppression-striae, atrohpy, telangietasia, acne, hypopigmentation
psoriasis
inherited, squamous, epitelial cells undergo rapid mitotic division/abnormal maturation
**KOEBNER Phemom: new psoriatic plaques over skin trauma
AUSPITZ signL pinpoint areas of bleeding remain in skin where plaque removed
Sx: classic pruritic erythematous plaques, fine silvery, white scabs, pitted nails; scalp, elbows, knees, sacrum, intergluteal folds
psoriatic arthirits
includes joint manifestations
AK treatment
5FU or chryotherapy
tinea versicolor
superficial skin infection; yeasts P. Tyrosporium
c/o multiiple hypopigmented round macules on chest, shoulders, or back appearing after sun exposure
LABS: KOH; +hyphae and spores; spaghetti and meatballs
MEDS: selenium sulfide or ketoconazole (nizoral) topical BID x 2 weeks
atopic dermatitis
eczema: chronic inherited, pruritus; hand, flexural folds, neck; increased with stress, environmental (winter); associated with atopic conditions
rash: start multiple small vasicles; can be lichenified from chronic itching-fissures; may develop secondary bacterial infx
meds: topical steroids; lubricnats
superficial candidiasis
yeast candida albicans; external sx: bright red/shiny lesion with itch
intertriginous areas: uner breast, axilla, abd, groin, may have satellite lesions
-if oral=thrush
Nystatin – HIV esophageal Candida-need sytemic antifungal (fluconozole)
cellulitis
skin infection deep dermis or underlying tissues-usu gram+; 2 forms purulent or nonpurulent
clenched fist injury
send to ED; check for foreign body; nec fascititis; group A strept; reddened/purple lesion will increase rapidly
furuncle
boil: infx of hair follicle filled with pus
carbuncle
coalesced boil
erysipelas
dermis/lymph-CLEAR DEMARKATED AREA strept
Bites
augmentin x10days; no suturing of punctures, wound>12 hours or 24 hours to face
rabies
rabies IG and and vaccine; quarantine animal for 10 days checking for rabies symptoms
hidradenitis suppurativa
bacterial infx (staph) of axilla and groin, chronic, eventually leaves scars, tracts, with scarring tx: augmentin; mupoirocin ointment-nares, fingernails BID x 14 days-no deodorants; antibiotic soap
impetigo
superficial skin infection: gram +; staph/strept; very contagious; common in humid weather; “honey colored crusts”; keflex; clinda
meningococcemia
neisseria meningitides-gram neg; resp droplets; refer to ED
Labs: LP, CSF, BCx, throat cx, CT/MRI brain
tx: rocephin2 grams IVx12 hours +vanco IV q 8-12 hours
isolation
complications: tissue infarction, necorsis
brudzonski’s
meningeal irritation: With patient supine, flex head and neck toward chest. Note resistance or pain, and watch for flexion of hips and knees B=BEND the neck
kernigs
flex one of the patients legs at hip and knee, then straighten leg. note resistance or pain
Lyme disease
Borrelia Burgdorfori
labs: serum Ab, Igm, Igg
Doxycycline
comp GBS, arthritis, fatigue
rocky mountain spotted fever
Rickettsia Rickettsii (parasite) Labs: Ab titer to R. Rickettsii biopsy skin lesion, CBC, LFT, CSF Med: Doxy Comp: death, neuro sx, hearing loss, neuropathy
varicella zoster
chickenpox: prodrome fever, pharyngitis, malaise
rash in different stages starting head/face-trunk-extrem; 1-2 weeks crusting- fall off
varicella vaccine
no pregnancy w/in 3 months
CI: AIDS, high-dose steroids, radition, chemo, immunocompromised
-only a person who has had chickenpox can get shingles
herpetic whitlow
viral skin infection of finger (herpes simplex 1/2) from direct contact with cold sore or genital herpes lesion
c/o red lesions side of finger/cuticles/terminal phalanx; may have recurrent outbreaks
mgmt: self-limiting, NSAIDs, if severe give acyclovir
pityriasis rosea
cause unknown; self-limiting 4-8 weeks; asymptomatic
c/o “Herald Patch” 1st lesion is largest 2 weeks before full rash
oval lesions with fine scales follow skin lines “Christmas Tree Pattern”; salmon pink color
no meds
r/o syphillis with RPR, check STD
scabies
infestation by mite; female burrows and lays eggs; asymptomatic first 2-6 weeks; close contact transmission; may remain pruritic even after treatment for 2-4 weeks
sx: interdigital pruritus, worse at night, serpenginous (snakelike) in linear patterns; labs wet mount-mites/egg;
meds: permethrin 5% (Elimite)-apply cream head to toe wash 8-14 hours; treat all family members; wash laundry in hot water; pruritus should improve in 48 hours; benadryl or topical steroids for severe itch
tinea infections
dermatophytes-yeast
infection of superficial keratinized tissue
gold standard is fungal culture; KOH slide-pseudohyphae/spores
Meds: OTC topical azoles/allylamines
tinea capitas
ringworm of the scalp;
black dot sign-broken hair shaft leaves dot like pattern on scalp
meds: baseline LFTs 2 weeks after systemic griseofulvin
complication: kerion (inflammation/indurated lesion that permanently damages hair follicle)
impetigo
“honey colored” crusts, fragile bullae
measles
“kopliks spots”
scabies
Increased night, intersigital webs, waist, axilla, penis
scarlet fever
“sandpaper rash” sore thraot. strept
tinea versicolor
hypopigmented round-oval macular rashes; mostly upper shoulders/back-not pruritic
pityriasis rosea
“christmas tree” pattern rash on linear skin lines; HERALD PATCH 2 weeks before rash
molluscum contagiosum
smooth papular 5mm dome shaped, central umbilication with a white plug
erythema migrans
red target-like lesion, grow is size with some central clearing; early lyme
meningococcemia
purple to red painful skin lesions, acute onset high fever, HA, LOC changes
rocky mountain spotted fever
hand/palm/soles
tinea pedis
athletes foot; 2 types; scaly dry or moist (odorous)
tinea corporis
ringworm of body
ringlike with collatrette of fine scales; slowly enlarges with central clearing; if large number give oral antifungal
tinea cruris
jock itch
tinea barbae
beard
onychomycosis
nails, yellow, thickened, opaque; great toe most common
antifungal meds
pulse therapy-systemic AF; baseline LFT; oral fluconazole 150-300mg weekly
acne vulgaris
inflammation or infection sebaceous glands; multifactorial high androgen, bacterial (propionbacterium acnes); genetics, face, shoulders, chest, back; puberty and adolecents
mild acne
open comedones (blackheads), closed/small papules, small pustules: prescription isotretinoin (retin-a); benzoyl peroxide with erythromycin (benzamycin), clindamycin topical
moderate acne
increased papules/pustules) prescription topicals (benzamycin) plus PO tetracycline or minocycline
tetracyclines can start age 13; after permanent teeth except wisdom-may decrease effect of OCP (use 2 methods)
severe cystic acne
all of the mild and moderate plus painful indurated nodules and cysts over face, shoulders, chest
meds: isotrtinoin (Acutane) plus cat x (tetracycline)
must enroll in ipledge program to prevent pregnancy-2 forms contraception; prescribe one month at a time-monthly preg testing and 1 month after discontinuing
DC if depression, visual disturbance, hearing loss, tinnitus, GI pain, rectal bleed, uncontrolled hypertrig, pancreatitis, hepatitis
rosacea
(acne rosacea)-chronic relapsing skin inflammatory disorder; no cure; symptom control and avoid triggers; usually light-skinned, chronic/small acne like papule patches around nose, mouth, chin
metronidazole topical, low dose tetracycline/minocycline
complications: rhinoplyura-hyperplasia of tip of nose; ocular rosaacea
The most common place for indirect inguinal hernias to develop is:
The internal inguinal ring is the most common site for development of an indirect inguinal hernia. These can occur in men and women. Though most are probably congenital, symptoms may not be obvious until later in life. Indirect hernias are more common on the right side. Direct inguinal hernias occur through Hesselbach’s triangle.
Ankle sprains
Ankle sprains are generally graded based on clinical signs. A grade I sprain results from minimal stretching or small tears in the ligament. There is mild tenderness and edema, and the patient is able to bear weight. A grade II sprain is more significant. The clinical signs are more severe stretching and tearing of ligament(s) with moderate pain, edema, tenderness, and ecchymosis. Weight bearing is painful, but the patient can walk. A grade III sprain is the most severe. It involves complete tear of a ligament. There is joint instability, severe pain, edema, tenderness, and ecchymosis. Patients usually are unable to bear weight due to pain. An avulsion fracture could produce the same symptoms described above. This patient needs an x-ray to rule out fracture.
bipolar mania
During a period of mania, common symptoms are inflated self-esteem and grandiosity (like a buying a baby grand piano), decreased need for sleep, hyper verbosity (excessive talking), racing thoughts and flight of ideas, distractibility, and excessive involvement in pleasurable activities that can be associated with very painful consequences later.
therapeutic relationship
A therapeutic relationship with a patient can be established in many different ways. One way is to ask open-ended questions. This allows the patient to discuss what is most important to him; personal concerns may be vocalized by the patient. Telling the patient that he can trust you probably does little to establish trust. Actions that establish trust are more therapeutic than this statement. Touching the patient during the interview may be perceived as inappropriate by many patients. In contrast, touching the patient during the exam is different. Finally, telling the patient that you enjoyed taking care of him (if this was true) does little to establish trust.
Question:
Which reflexes might a one month-old infant be expected to exhibit?
Your Answer is Correct
Moro, stepping, rooting Stepping, rooting, tonic neck Babinski, Moro only Fencing, stepping, rooting Explanation: A one month old infant would be expected to exhibit the Moro, stepping, rooting, and Babinski reflexes. The tonic neck, or “fencing” reflex isn’t exhibited until about 2-3 months of age. This is assessed by lying the baby on his back and turning his head to one side. If the reflex is present, he should extend his arm on the side that his head is turned. The opposite arm assumes a flexed position. This pose mimics a fencer and thus, the name.
