Unit 6 Q&A Flashcards
What is the best contraceptive for women with seizures disorders?
Depot medroxyprogesterone acetate because its level of progestin raises the
seizure threshold
What is the presenting clinical triad for abruptio placentae?
fetal
distress or death, tetanic uterine activity (contractions), and uterine bleeding
(concealed or external
Your patient walks in with complaint of painless vaginal bleeding and is in her third trimester. What do you suspect?
Placenta previa
Uterine perforation is highest when IUD insertion is performed when after delivery? Is the risk greater in lactating or non-lactating women?
Highest when inserted in the first 1-8 weeks after delivery, greater risk in lactating
women (because of accelerated uterine involution)
Your patient presents with complaints of severe abdominal itching. You note erythematous,
pruritic papules that coalesce into plaques along her stretch marks. What do you diagnose her with and what treatments could you give?
PUPPS (pruritic urticarial papules and plaques of pregnancy). Can treat with topical steroids, Sarna lotion and antihistamine
What is the different between pregnancy induced hypertension vs. pre-eclampsia?
Pre-eclampsia has proteinuria
PUPPS, usually disappear when?
2 weeks postpartum (usually appears during 3rd trimester)
When is ectopic pregnancy usually occur?
rupture normally occurs between 6-12 weeks gestation
what are the risk pregnancy complications for anemia?
preterm labor and intrauterine growth restrictions
define chronic hypertension in pregnancy
BP > 140/90 before pregnancy or before the 20th week of pregnancy / presence of persistent hypertension >12 weeks
what re the 2 BP medications contraindicated in pregnancy?
ACEI
ARBS
what is the diagnoses criteria for pre-eclampsia?
BP>140/90 on 2 occasions + proteinuria of >300mg/24hrs
How can we truly diagnose pre-eclampsia?
2 criteria: elevated BP >140 systolic or >90 diastolic on two occasions 6 hours
apart and proteinuria > 300mg in 24 hour specimen. (
all > are equal to or greater
than)
What are the s/s of sever pre-eclampsia?
BP > 160/110, proteinuria > 5g/d (3+), oliguria, headache, RUQ/epigastric pain,
liver dysfunction, vision changes, thrombocytopenia, & pulmonary edema.
What is the difference between threatened and inevitable abortion?
In threatened the cervix stays closed
Name one the teratogen medication that cause spontaneous abortion
Dilantin (yes, seizure medications)
True or False, Placenta previa, the initial bleeding is usually after 24
wks and it painless
True
What is the color of the bleeding for cervical lesions?
pinkish
What type of discharge is bloody show consist of?
pink to red mixed with mucous
What antibiotic is use common and safe to treat UTI in pregnancy
Cephalosporin like K
eflex. Amoxicillin and nitrofurantoin as well. But do not
use nitrofurantoin in the last weeks of pregnancy. Keflex is safer and cheaper.
Raber mentioned Keflex several times in the lecture. I think she likes that one
What drugs should pregnant
women avoid during the third trimester because they can cause
neonatal jaundice?
sulfonamides
What medication can be used for N/V during pregnancy?
Small frequent meals, dry crackers before getting out of bed.
Doxylamine (Unisom) and B6.
Lastly Zofram ODT
4mg prn nausea and vomiting
What is the most common anemia in pregnancy?
Iron deficiency anemia (hypocromic and microcytic
What are some diet high in iron?
Green leafy vegetables, beans, beef, whole grain, and nuts
What is the treatment for anemia in
pregnancy? How long?
Ferrous sulfate…3 months past normal hgb
What is TORCH? Why important?
Toxoplasmosis, other causes, rubella (German measles), cytomegalovirus, and
herpes simplex virus
When id PUPPS usually appear and disappear?
Appears 3rd trimest
er and resolves 2 weeks postpartum
What is the first line medication for chronic HTN in pregnancy?
Methyldopa
What is the most common UTI pathogen in children?
The organisms most commonly responsible for UTI are fecal flora, most
commonly E. coli (85%)…
E. coli
How many alcoholic beverages put a woman at high risk? Or over the limit…
7 per week puts women at risk (8 for men)
8 yr old male patient comes in for sore throat. Rapid strep comes back positive. Patient is
severely allergic to PCN and says
it closes his throat off when he last took PCN. What is the
best treatment?
Azithromycin
Your patient complains of small shallow sores on the inside of his mouth. He says he tried
gargling with salt water with no relief. What is the best treatment for aph
thous ulcers?
Oral corticosteroids
You have a 30 yr old patient that was treated amoxicillin 28 days ago. She complains of
frontal sinus pain that is unbearable and a bad headache for the last 11 days. What is the best
treatment?
clavalunate (A
ugmentin) and levofloxacin (Levaquin) were what
they originally looked for as answers. Later she accepted doxycycline per shimp
text
Treatment for allergic conjunctvitis includes:
- Mast cell stabilizers (Cromalyn). 2. H2 receptor antagonists (Levocabast
ine) 3.
NSAID (ketorolac tromehamine) 4. combination dropps with mast cell & H2
(Olopatadine). 5. systemic antihistamines are also helpful (Benadryl)
t/f?
we should not put steroid drops in the eye
true
t/f?
Allergic conjunctivitis usually involves hx
of allergies. Discharge is white & stringy
true
How does bacterial conjunctivits present?
redness & purulent discharge, eyes usually matted in morning, can be bilateral or
unilateral
T/F;
Prescribe empiric antibiotics for bacterial conjunctivitis?
t
What is
done differently for bacterial conjunctivitis caused by chlamydia, or gonorrhea?
Culture the eyes of any sexually active teen with conjunctivitis to rule out STD
Treat systemically
What are the 2 most frequent neural tube defects?
Spina Bifida and Anencephaly
When does neural tube closure occur?
By the 4th week of pregnancy/ 28th day after conception (21-28 days post-conception
Recommended daily folic acid intake for non pregnant women with no r/f for neural tube
defect?
0.4mg/day for nonpregnant
with no risk factors. And 4mg/day for women with
history of giving birth to child with neural tube defects or strong fam history.
what are the hallmarks for PROM?
pooling
positive nitrazione
positive ferning
1 cause of infant colic in breastfed babies?
dairy
Women with possible Zika virus exposure are recommended to wait to conceive until ____
weeks after symptom onset or last possible Zika virus exposure
8
Zika virus infection during pregnancy can result in _______ and serious abnormalities of the____?
congenital microcephaly and brain
Zika virus is transmitted from the bite of ____ and also through _____?
mosquito and sex
What parameters are checked at routine pregnancy visits? Blood pressure..
Weight, urine dipstick (nitrates, leukocyte, protein, glucose) and fetal heart tines
starting at 10 or 12 weeks gestation, and fundal height starting at 18 weeks
At her 37 week appointment, your patient’s fundal height is measuring at 34cm. Why
shouldn’t you panic?
At and after 36 weeks the baby is lowering into the birth canal
At 20 weeks, fundal height is measured at the ______
umbilicus
What test is included in the quadruple but not triple aneuploidy screen? What two processes
are you testing for? When
do you test? And who do you test?
Inhibin (and possibly unconjugated estriol – need to look up) Neural tube defect & trisomy. Tests b/w 15 - 20 week; ideally 16 - 18 weeks. Women >35
Which gestational diabetes test uses the fasting method? Ho
w many abnormal results are
needed using this test to diagnose? What are the normal parameters?
ADA, only one abnormal for dx. Fasting >92, 1 hour >180, 2 hour > 153
Using the ACOG method, a level greater than ____in the 1hr test confirms gestational
diabe
tes without using the 3hr method. How many abnormal readings are needed in the 3hr
test to confirm dx? What are the normal parameters?
200.
Fasting >95, 1hr >180, 2hr >155, 3hr >140. Any two abnormal values is
diagnostic for GDM
Wh
at’s the difference between chronic and pregnancy induced HTN?
Chronic: Present prepregnancy or before 20 weeks of pregnancy, Or continues
more than 3 months postpartum. PIH: after 20 wks and resolves PP
A sunny side up fetal position presents how?
a. Head first face up
b. Also known as “op” and are very difficult to get out vaginally
A patient has sudden onset of clear rhinorrhea, nasal congestion, sore throat, cough, and
fever for 2 days. What do they likely have and how do you treat?
Acute viral rhinosinusitis, treat with OTC oral decongestants
t/f?
Croup is usually caused by Parainfluenza. Decadron 0.15-0.6 mg/kg PO
true
A patient has a gradual onset sinus tenderness purulent nasal drainage, cough, headache, and
fever for 10 days. What do they have and how do you treat?
line treatment Amoxicillin (1,000mg PO TID
x10 days
How does treatment for chronic sinusitis differ from acute sinusitis?
4weeks
Allergic rhinitis is part of a triad. What are the
other two diseases these kids normally have?
a.
Asthma and eczema
b.
Triad common in red heads
What’s the definition of recurrent sinusitis? And chronic?
Recurrent - successive episodes lasting less than 30 days and separated by 10 days Chronic - episode lasting m ore than 90 days
Number one treatment for allergic rhinitis?
Avoidance of allergic triggers
What is epistaxis? How do you treat it?
Nosebleed, have pt sit up and lean forward, pinch soft part of nose for at least five minutes up to 15 minutes. Also may use one time administration of Afrin for Neo - Synephrine
90% of sore throat and fever are due to ____ infections
viral
I come in with a sore throat and fever. You find exudative tonsills, generalized cervical
adenitis, and I have a palpable spleen. What do I have?
a.
Mono.
b.
Can’t play contact sports (for 2 weeks?) because risk for ruptured spleen
4 centor criteria in diagnosing GABHS? How many must be present to diagnose?
I remember this one by thinking, look at their FACE. Fever Anterior cervical nodes (tender) Cough (lack of) Exudate
First line treatment for acute bacterial pharyngitis? Also known as gabhs?
a.
Pen VK
b.
If allergic, Azithromyci
I’m an 18 month old that comes in drooling, difficult breathing, high fever, dysphagia, and
gurgling breath sounds. I’m not
sitting in sniffing dog position I’ve had hep b, and when you
look at my throat you can see an obstruction. What do I have and what do you do?
Retropharyngeal abcess
I’m a newborn with continuous yellow drainage and tearing out of my right eye. There is
also swelling. What do I have
Dacrocystitis (clogged duct)
What is esotropia? Hypertropia? Exotropia?
Esotropia - eye points inward Hypertrophic - eye looks upward Exotropia – eye points out ward
What is the most common and serious sequels of strabismus?
Amblyopia
When do you refer visual acuity?
2 line difference between eyes
Acuity less than 20/40 in either eye
How of yo
u treat viral conjunctivitis?
Abx drops to prevent secondary bacterial infection.. there’s a long list of accepted
ones
If you think I have a foreign object in my eye, how do I present and how do you exam me?
Sudden unilateral pain. Numb my eye and look around. Do not send me home with numbing drops. Refer if embedded.
You use fluorescein and woods or cobalt blue lamp to examine an eye for what?
Corneal abrasion
If a patient comes in for eye pain, what will you ALWAYS check??
Visual acuity and pupil reaction
I have a hard, painless nodule on my eyelid. What is it? How do you tx?
chalazion
I have a tender, red, warm papule on my eyelid. What is it?
stye (hordeolum)
I have rapid onset unilateral eye pain. My vision is blurred with halos around lights. You
find my pupil nonreactive and my eye is hard. What’s wrong, and what do we do?
Acute closed angle glaucoma, REFER
I come in with ear pain. You find a red swollen shut external canal with pain when you push
my Tragus. What am I? What do you have to assume?
And how to treat me?
Otitis externa.. assume TM is ruptured if it can’t be visualized.. give ciprodex
drops
What pathogen usually cause ATOM?
Strep pneum, m. Cat, h flu
When is observation ok in ATOM?
> 2 yrs old
<6mo no, 6mo-2yr if unilateral wo otorrhea
first line treatment for ATOM?
90mg/kg/day in 2 divided doses
I’m one week past treatment of aom but I feel fullness in that ear. You find ome. Should I be
worried and if not why?
Don’t worry, it can take up to 3 months to resolve. Recheck at 4 weeks. And yes
worry about little ones for speech reasons
You look in my ear and find a greasy looking mass. What am I?
cholesteatoma
I’m und
er 4 weeks old and my fever is 103. What do you do?
admit to hospital
What criteria makes a fever in an pediatric patient a serious illness?
< 3 months, fever > 40.0 C, Nuchal rigidity, petechial skin rash, seizure activity,
and stidor or increase work
of breathing
Fever >8 days without identifiable source. Could be malignancy, infectious
disease or connective tissue damage. Fever cannot cause serious damage unless it
reaches >107 F
Tylenol dosage in kids? And ibuprofen?
Tylenol - 15mg/kg q4 - 6hrs ibuprofen - 10mg/kg q6 - 8 hrs
Why don’t PEDs pt use aspirin?
Don’t use for risk of Reye’s syndrome
What is the most common pathogen for croup?
Parainfluenza
My 4 year old
had some respiratory systems for the past 3 days. But now she has a bark
cough and strider at rest!! What are we gonna do?
Racemic epi, dexamethasone IM, inhaled budesonide and O2
my 8 weeks old that was born at 34 weeks has a URI. But now she has a fever
, rhinorrhea,
and cough. She also has wheezing, labored breathing, and has been irritable and not eating
well. What would you swab for?
Bronchilitis (likely caused by rsv or flu)
there are three stages of whooping cough. What are they? and how long do each
on last?
Symptoms develop within 5 - 10 days (can take up to 3 weeks) of exposure. 3 stages: #1 Catarrhal - usually 7 - 10 days but can last up to 3 weeks - runny nose, low grade fever, mild cough, looks like a mild URI. #2 Paroxysmal - 1 - 6 week duration - ca n last up to 10 weeks - paroxysms of numerous rapid coughs. Thick secretions make it difficult to clear the bronchial tree. Long inspiration effort followed by the whoop at the end of the cough. Cyanosis, vomiting, exhaustion,
attacks occur more frequently at night. #3 - Convalescent - 7 - 10 days but can last up to 3 weeks - paroxysms gradually lessen - gradual recovery.
What do we use to treat whooping cough? (not the vaccine lol)
a. Macrolide
b. If under 1 month DO NOT use Erythromycin due to risk of intussuscep
tion
(Azithro and Bactrim safer)
I come in with the complaint of high fever, coughing, SOB, tachypnea, crackles and rales in my right lower lobe. What tests do you run and what you do you think i have?
CXR - probably pneumonia
How do you treat influzena?
Can give olsetamvir(tamiflu) or zanamivir (relenza)
Supportive care, fluids, rest, keeping the nose and throat clear, OTCs like
ibuprofen and Tylenol for pain/fever control, decongestants, Flonase, Zyrtec, etc.
How do you treat Community acquire
pneumona?
zpak, clarithromycin 500mg bid, or doxy cyclone 100mg bid
Unless used antibiotics or at risk for antibitoc resistance then:
Fluroquinoline (moxifloxacin, gemifloxacin, or levofloxacon)
OR:
A combo of macrolide plus
1
-
amoxicillin 1 gr
am rid
2
-
augmentin 2gm bid
3 cedopoxime 200mg bid or cefuoxime 500mg bid
you enter your exam room and im a kid sitting in the sniffing dog position, i have a high
fever, drooling, dysphagia, muffled voice, and inspriatory retractions, and soft stidor. Wha
t
do i have? and what do you do
Epiglottitis. Refer.
If im an adult thats over than 65 that drinks often and have COPD. What are the different
ways you can treat my CAP?
a.
Fluoroquinolone
or a combination of a macro life plus:
Augmentim
High dose ampicillin
Or cefpodxime/cefuroxime
b.
Initial treatment for patients with comorbidities, or those who have had abx in last
three months, or those immunosuppressed, or at risk of resistance.
i.
A respiratory fluoroquinolone OR a macrolide PLUS a beta lactam
What is CURB-65 stand for?
confusion, uremia, respiratory rate over 30, sbp less than 90. Add it up and see if
they need to be in icu, go home, or admit
What are two ways to help prevent CAP?
flu and pneumonia vaccines
I come in with stomach pain that is in my RLQ. I ha
ve positive rovsing sign, and cope
obturator test. WHat do i have?
Appendicitis.. can get ct or u/s if woman of child bearing age
What is Rovsing sign? Cope Obturator test, and Iliopsoas sign?
Palpating the LLQ and the pt feels pain in the
RLQ
b.
Cope obturator test
–
the obturator muscle runs along the appendix. When we flex
this muscle in a pt with appendicitis, it causes pain in the RLQ. To flex the muscle
the pt is supine. You would hold the pts leg at a 90 degree angle (knee and ankle
han
d positions) and rotate the hip by moving the pts ankle laterally while allowing
the knee to move only inward. Pain = positive sign
c.
Iliopsoas sign
–
same deal with the muscle irritating the inflamed appendix. Pt is
supine, pt lifts R. leg up and you use r
esistance to push it down. Pain = positive
psoas sign
what is the test most senstive for dx acute abdominal pain?
CT
I come in with pain that is colicky, Pain is worse after eating, and is located in my RUQ.
It is worse when i breathe in. Whats
your dx and what tests would you run?
Cholecystitis and a HIDA scan or US
I went out and drank until i dropped after finals next week. I wake up with severe
epigastric pain that radiates to my shoulder. What do i have and what test will specifically
ran to confirm your dx? Then what do you do with me?
pancreatitis and Amalyse and lipase level are specific for pancreatitis
I have pain in the LLQ, loose stools, and some times nausea and vomiting. You feel a mass in the LLQ, and stool with + occult blood. What do i have and how do we treat it?
Diverticulitis. Could do a CT to confirm?
b.
mild cases respond to a 7
-
10 day course of oral ciprofloxacin 500mg BID, plus
metronidazole 250mg TID.
c.
Pts with vomiting or sepsis require hospitalization, IV abx, fluids and pos
sible
surgery to respect bowel if perforation or obstruction are present.
d.
Dietary restrictions on meats, foods with nuts, seeds, popcorn.
alarm symptoms for GERD?
>
- Anemia, Melina, or hematemsis, dsyphagia, significant weight loss, or
painful/difficulty swallowing
how do you treat mild GERD
Antihistamine 2s and antacids
How long do you continue gerd tx with the pt has good control
8-12 weeks
What are the 2 major causes of PUD?
NSAIDs and H. Pylori
I have a gnawing hunger like pain that goes away when I
eat food. It awakes me in the
middle of the night. What do you think I have and how do you DX?
PUD. Dx with a upper GI study and biopsy
I have a 2 year old. I have notice jelly like stools in my babies diaper, she is also drawing up her knees and screaming. What do you think is wrong? And how do you tx/dx?
Intussusception, treat with air enema
Umbilical hernia affect what race more?
african american
I have a ingunial hernia that is unreducable and looks grey. Is that a problem? What
should I do?
yes - emergency surgery
I am a healthy 3 week infant that suddenly refuses to eat and vomit bile. What in the
world could be wrong with me?
Malrotation
You have a kid come in with abdominal pain but have ruled out everything you can think
of. The kid has normal
growth and development and the pain is usually onset while he is at
school and he has to come home. What is the problem?
Nonspecific abdominal pain
A 4 week infant comes in with projectile vomiting after every feeding. You wrongly dx
formula intolerance (Its okay it happens to all of us
). the infant throws up and acts immediately hungry again. What is wrong?
Pyloric Stenosis
You have a 4 year old that has bloating, increase flatulence, pain, and diarrhea about 2
hours after ingesting mild. What do they have?
Lactose Intolerance
Midcycle pain cause by irritation of the peritoneum due to spillage of fluid from a
ruptured follicular cysts at the time of ovulation. what am i?
Mittelsschmerz
Hematuria in a male always needs to be worked up. True or false?
true (less common in males)
A patient with sharp, acute flank pain that is traveling done to the ipsilateral groin. What
do you think your dx is?
kidney stone
Red flags for headaches in kids?
N/v, pain awakens them in the middle of the night, ha <5 yrs old, wo
rst ha of life,
posterior ha, neuron deficits, worse with postural or straining
Red flags
for headaches in adults?
a. New onset over 50 y.o. Thunder clap. Worst headache of life. No history of migraines. Vision changes. Stroke s/s - speech issues, facial droo p, weakness, etc
Three types of primary headaches?
Migraine, Tension, Cluster
Name some reasons for secondary headaches?
Menstrual headaches, medications, increased ICP
what makes a migraine episodic and chronic?
<15 days, >15 days
Number one way to
prevent a migraine?
know triggers
I’m a middle age man that comes in complaining of these headaches that last about 1
hour log every day for weeks at a time then disappear. Yet they always come back. The
headache is usually behind my eye and there is no fa
mily hx of migraines in my family.
What do i have?
cluster
I have a dull, generalized headache that is worse in the back of my head. I can still do
physical activity and it doesn’t pulsate. what kinda headache am i having?
tension
I have a unilateral heada
che that throbbing. I have had nausea, photophobia and
phonophobia, It is worsen with activity. What kind of headache do i have?
migraine
How do you treat a migraine?
NSAIDs, Cafergot & Triptans
How do you treat cluster headaches?
a. 100% O2 for 15 minutes th rough a non rebreather mask. b. Imitex sub q or intranasally c. Sonic nasal spray d. Viscous lidocaine intranasally e. Dhe IM or IV used in er
How do you prevent a migraine?
a. antiepileptic like Topamax and Depokene b. BB: propranolol or Timolol c. CCB: Verapamil also antide pressant like Elavil (Amitriptyline)
How do you treat tension headaches?
No Triptans. Treating the anxiety or depression is important. Can still take
ergotamines and NSAIDs
