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Rocky mountain spotted fever caused by:
Tick infected by parasite rickettsia rickettsii
Diagnosis of glaucoma
Tonometry. Normal intraocular pressure is 10-22
Covers outpatient, medical equipment, rehab, screenings.
Will have s3
G6PD deficiency anemia
Hereditary hemolysis of RBCs. Certain foods and meds can trigger:!ASA, nitrofurantoin, NSAID, quinidine, quinine, sulfa meds and antimalarial
Can be caused by sickle cell, leukemia and spinal cord injury.
If rh negative women:
Like Blood type A or B negative
If coombs test is positive- give rhod immune globulin (rhogam) administers at 28 wks and again after birth of baby rh positive
Adrenal gland tumor that can cause long term elevation of BP
Fitz Hugh curtis
Complication of chlamydia that can affect liver and abdomen
Considered positive at 5 mm in high risk populations such as those that may have been exposed. 10 is standard.
Used to screen color blindness
Migraine causing foods
Food that increase blood flow to the heart: aspartame, tyramine, nitrites, MSG, red wine.
Dental procedure prophylaxis
Only recommended for prosthetic heart valves, previous bacterial endocarditis, or congenital heart defects
On buccal mucosa- means measles, along with fever >101, coryza, cough, conjunctivitis, rash
What produces HCG?
If needle stick injury
Order elisa test right away for HIV
Apply acetic acid to HPV warts and look for acetowhite - lesions turn white in HPV
Elevated cortisol levels
Folic acid fooda
Spinach, liver, whole bread.
Presumptive signs of pregnancy
Those experienced by women- n,v, fatigue, increased urine, breast tenderness
Triangular growth on white of eye(conjunctiva) that extends to the cornea.
If you test positive for Hep C antibody
Still need to do hep c PCR to check for active infection. If negative then it is immunity from past infection.
Rebound tenderness on opposite side than palpated
Epstein Barr virus (mono)
Will have abnormal lymphocytes
Breast ca rash
A red scaly rash on breasts that doesn't go away with topical steroid, refer for mammo and breast surgeon cuz could be ca.
Risk factors for complications of UTI tx
DM, pregnancy, steroids
Nocturnal hypoglycemia 2-3am stimulates liver to produce glucagon to raise blood sugar in AM
Not caused by low blood sugars. Cause is normal hormones circulation in AM that causes Blood sugar levels to rise. Most ppl have insulin to deal with this, but diabetics don't.
Evaluation intermittent claudication
Starts with ABI before and after exercise
Peak exploratory flow volume
Determined by height, gender, and age
Can cause induration
Don't give DPT or DT beyond 7 years old.
Normal vagina PH
4-5 (acid) can be lower 3.5-4 in yeast infection (more basic) higher ph >4.5 seen in BV
abnormal shape of nail from IDA - pitted nails
Can be a normal finding in young adults, children or athletes but in older often indicates CHF
Extremely high levels- tx with niacin
Should avoid pregnancy for 4 wks after getting vaccine. Rubella teratogenic.
Can cause microcytic anemia. Abd pain, constipation, v, blue black line in gums.
Can result in hypovolemic shock
Pain in joint of great toe due to gout
Grade IV murmur
A thrill can be palpate day this point
Harsh high pitched mid systolic murmur at R 2nd ICS radiating to carotids
Hep B and C
Only hepatitis associated with hepatocellular ca
Breast milk and baby formula
20 kcal/ 30 ml
Count apical and radial pulse at same time then minus the two.
Barking cough, runny nose, usually no fever.
Dry nonproductive cough, later coughing up phlegm. Cause RSV- winter spring months in young children. Inspiratory/expiratory wheezing with clear drainage.
Test in immunocompromised. Apply candida or mumps antigen to to R forearm and PPD on left and read results in 48-72 hours
Pinworms. Test with scotch tape test- worms come out at night and will stick to tape if places on anus in the morning after sleep.
Atrophic macular degeneration
Leading cause of blindness in elderly. It is a slow or sudden painless loss of central vision
FEV >80% intermittent
FEV> 80% mild persistent
FEV 60-80 moderate persistent
FEV <60 severe persistent
Kernigs and brudzinski for meningitis
Kernig- flex hip and legs and tell pt to straighten against resistance
Brudzinski - pts hands behind head then chin to chest
Given to prevent the destruction of rh positive fetal RBCs that are present in the mothers circulation
Trachial- heard over trachea
Bronchial- heard over bronchi in anterior chest
Vesicular- base of lungs
Hairy patch of leukoplakia on tongue
Early sign of HIV
Mitral stenosis- diastolic
Mitral regurg- pan systolic
Aortic regurg- high pitch diastolic
Aortic stenosis- high pitch midsystolic
Bag of worms in scrotum. Diagnose with U/S. Can cause male infertility. Usually painless. Can have surgical correction.
Likely to have congenital heart defects, early onset Alzheimer's, and atlantoaxial instability- cervical nerve root compression can occur
Due to risk of cervical spine injury, contact sports aren't advised
Fracture of wrist
When trying to break a fall resulting in hyper extension of wrist- fracture of navicular area occurs. Fracture might not show on X-ray until 2 wks, so repeat X-ray in 2 wks. May or May not need surgery
Initial lab tests amylase, lipase and serum electrolytes
Fetal alcohol syndrome
Small palpebral fissures, microcephaly, small jaw
Most common cause of sudden death in athletes. Pre athletic physicals need to include screening for this murmur in supine and standing positions. Unique to this condition is a murmur that is more apparent when standing
Oral penicillin is drug of choice
First line is amox w/ clav or augmentin (if no risk of bacterial resistance)
For those with beta lactam or PCN allergy: levofloxacin or clindamycin plus cefixime
Normal liver span
15-18 cm in midclavicular line
If no testicular development or tanner 2 by 14, refer. If no tanner 2 by 16 definitely refer.
Basal cell ca
Most common skin ca
Pearly gray raised border with central clearing, telangieectasias.
Red, scaly wartlike, depressed border- AK can turn into this
Primary and secondary encopresis
No bowel movements. Primary is due to holding or not having BM. Tx is establishment of regular bowel regimes.
Secondary due to constipation of impaction-meds can be helpful
All partners within 30 days
Also tx for chlamydia- doxy or azithromycin
Not indicated when baby is born RH negative too.
Is indicated when mom rh negative and:
Within 72 hours of rh+ baby, or after molar pregnancy evacuation, and at 28-30 wks gestation.
Posterior closes by 3 mos, anterior closes by 12-18 mos.
Skin infection caused by strep
Veins larger than arterioles
Congenital cancerous tumor of kidney, most frequent sign is palpable abdominal mass, may have microscopic or gross hematuria. Once diagnoses- should never be palpated to prevent spread of tumor cells
Begins at 2 and can last 2 years. Normal not be toilet trained by 3
Usually resolve by first 2 years, or at least by age 5, laser usually not needed.
Tumors in intestines, pancreas, or lymph nodes produce excessive gastrin and can lead to severe ulceration of stomach and duodenum.
And irregular shape of nail- associated with psoriasis
Metronidazole or flagyl
Antabuse effect- avoid alcohol 1 day before, during and 3 days after tx
MMR and varicella vaccines
MMR can result in a diffuse macular rash 2 wks after vaccination
Varicella vaccine can result in chicken pox like blisters
Visual acuity testing
Should begin at 3 years
Webber and rinne
Weber- W on the forehead- lateralizes (heard better) in defective ear.
Rinne- mastoid bone then air. AC>BC
Hep b vaccine
Contraindicated in bakers yeast allergy
BNP >80 usually diagnostic, <80 means no CHF
Ejection fraction 35-40% is CHF
Tibial stress fracture
There is usually extreme point tenderness, X-ray may not show fracture especially early on, and bone scans are definitive but expensive
Stage 2 HTN
>160/110 should start meds right away
Should resolve by 12 mos, if not, refer to urologist for surgical repair
Tracks object with both eyes simultaneously, babbles, coos, smiles, reaches for objects, controls head well.
Remove offending item
ATB ointment, eye patch to prevent continuous blinking, and IBU
Defined as having no period and secondary sex characteristics by age 14 OR normal sex characteristics and no period by age 16
Always refers to endocrinology for primary amenorrhea
Used to diagnose herpes simplex
KOH used to diagnose candida and BV
Polio vaccine (IPV)
Contraindicated in anaphylactic reactions to streptomycin, polymixin B, or neomycin
Tetracycline use in children
Acceptable after 8 years of age- tooth enamel formed
Danger signs of OCP use: ACHES
Abdominal pain, chest pain, headache, eye problems, severe leg pain
The mononuclear spot test or monospot test, a form of the heterophile antibody test, is a rapid test for infectious mononucleosis due to Epstein-Barr virus (EBV
Early sign of CHF
Wt gain and fatigue
SOB and nocturnal dyspnea are late findings
Home care consists of cool mist vaporizer..hot steam aggravates pulmonary inflammation
Diarrhea, n, v, HA, low grade fever for over a day. Get blood or stool culture- could be salmonella
Folic acid def
Cheilitis- swollen lips and inflamed tongue, Pallor and or jaundice
Depression and listlessness
Nursemaid elbow or subluxation of the proximal radial head
Dislocation of radius from elbow from extreme extension of elbow- yanking on arm, etc. can't supinate hand, no bony deformity, can be reduced clinically
HA due to HTN
Occurs upon waking in morning, occipital
If mild- hydrocortisone-bacitracin-polymyxin B otic suspension. Usually bacterial or fungal.
Smooth beefy red tongue
Cheilosis is different- cracked corners of mouth
Chronic bact prostatitis
Daily Bactrim, doxy and nitrofurantoin are acceptable
Goal of tx: avoid intestinal obstruction(meconium ileus), promote clearance of secretions, adequate nutrition and replacement of fat soluble vitamins- A, D, E, K
Toddler mile stones
24 mos- able to speak 50 words
30 mos- 400 words and 75% intelligible
Anything >1 cm is concerning
Malignant lymphatic are usually larger, non tender and stone like
Christmas tree like lesion on trunk lesions last 4-8 wks, no tx. Unknown cause.
Opposite of Cushings(high ACTH usually caused by glucocorticoids- hyperglycemia, wt gain, hypernatremia, hypokalemia
Addisons-low ACTH- dehydration, hypoglycemia, hyponatremia, hyperkalemia. Usually autoimmune but can be from tumor, rapid discontinuation of glucocorticoids or infection
Feet that are adducted (rotates inward)
Type I and II are usually flexible and only require corrective shoes or nothing at all.
Type III is very rigid and doesn't correct to neutral and requires serial plaster casts.
If 4 years or older- require surgery and casting after.
Absolute contraindications for combined OCP
Hepatoma of liver, hx embolic episode, history TIA, undiagnosed vaginal bleed, 35 and older who smoke, migraine With aura, obese or known clotting or cardiovascular disease.
Relative contraindication is depression.
Benign skin growth in inner ear after several infections. Needs to be removed.
Dtap, IPV, MMR, varicella
3 ways: marriage, court order, military
Requires referral to orthopedic surgeon
Virchows nodes or sentinel nodes
Located at supraclavicular area of chest. They are 1st lymph nodes that a cancer lesion will drain into. So when ca is diagnosed, they biopsy these nodes to check if CA is spread to lymph system.
Fungal infection of groin area.
Interacts with coumadin- increases bleeding risk
A decrease in systolic BP on inspiration
High fever and sandpaper rash neck and trunk spreading to extremities following strep infection
Maculopapular rash after high fever breaks.
Fifths disease or erythema infectiosum
Lacy rash slapped cheek begins in face and moves to extremities and trunk 3 stages: URI, 2nd slapped cheeks, 3rd lacy rash spreads to arms and legs and is purple and flat
Rocky Mountain spotted fever
Rash on ankles wrists moves to palms of hands and trunk. Tickborne. Rickettsia
First permanent teeth to erupt at 6 years of age
Due to inflammation of median nerve
Prisoners, pregnant women, fetuses, children, and mentally incompetent individuals
Are considered vulnerable populations with additional protection
Frail elders is not part of this
Rule of 9s
4.5 for face, arms. 9 for back and front of face, arms, etc.
9 for legs. 18 for entire leg. 18 for front.
Cancer of plasma cells or lymphocytes in bone marrow.
Fracture with break in skin
Systemic ATB and tetanus of last dose >5 years
Start with anticholinergic or SABA then progress to LA antichol or LABA. The add ICS.
Primary adrenal insufficiency
Low serum cortisol and aldosterone and high ACTH.
So high potassium and low sodium.
Skin hyperpigmentation, n, v, diarrhea, low BP
For PAD. Divide systolic ankle by systolic of arm.
Score of 1-1.4 is normal. Score <1 is abnormal and <0.5 is severe PAD
Can have rice, oats
Avoid wheat, barley, rye
Augmentin 500 BID x10 days
Fovea of macula
Responsible for sharpest vision 20/20
Heart changes in preg
Systolic ejection murmur, displaced apical pulse, louder S1 and S2
Bruising around umbilical area- sign of ectopic pregnancy
Basal cell ca
Most common skin CA
Grey turners sign
Acute onset of bruising on flank area from acute pancreatitis or rupture ectopic preg
Polymixin and neomycin combo ear drops first line
Most common cause is pseudomonas and 2nd is staph
Normal- bluish spot on lower back on darker skin babies. Usually spontaneously resolves by age 4
Sacrum dimple or tufts of hair
Can represent spina bifida- get u/s of lower spine
Can be given as young as 9 but often in 11-12 years. 3 step series until 26.
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