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139 Cards in this Set
- Front
- Back
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Empiric TX for presumed meningitis in infants less than 30 days old?
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Amp and gent
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Empiric TX for presumed meningitis for adults?
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Vancomycin and Ceftriaxone
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DOC for proven meningococcal meningitis?
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Penicillin G
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Prophylaxis for close contacts of someone with meningococcal infection?
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Ciproflocacin
or Rifampin |
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1 DOC for GAS infections?
2 Alt a/b for GAS infections? |
1 PCN
2 Cephalosporin or macrolide as alternatives in PCN allergic pts |
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GAS
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Group a Beta hemolytic streptococcus
|
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typhoid fever
organism? tx? |
Salmonella enterica
Cephalosporin & Bactrim |
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Lyme Dx
organism? tx? |
Borrelia Burgdorferi
Doxy |
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Rocky Mountain Spotted Fever
organism? tx? |
Rickettsia ricketsii
Doxy |
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With herpes/ herpetic keratitis can steroids be used?
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NO STEROIDS
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Tx for chlamydia conjunctivitis?
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1 Doxy
2 EES (Erythromycin Ethylsuccinate) |
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Tx for Keratitis?
Keratitis assoc. w/? |
Referral
Herpes Shingles |
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Tx for Iritis/ Uveitis?
Keratitis assoc. w/? |
Referral
immunological disorders |
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Management for chronic open < Glaucoma?
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1 Enhance aqueous outflow
2 Decrease production of aqueous humor |
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What meds enhance aqueous outflow?
Ex? |
Parasympathomimetics
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What meds decrease production of aqueous humor?
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Beta Blockers & Carbonic Anhydrase Inhibitors
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Ex of Optic Beta Blocker?
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Timolol (Timoptic)
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Ex of Optic Carbonic Anhydrase Inhibitor?
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Acetazolamide (Diamox)
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Organisms typically responsible for AOM?
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1 Streptococcus Pneumoniae
2 H influenza 3 Moraxella catarrhalis Also Group A b hemolytic Step, S aureus and Enterobacteriaceae |
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Tx for AOM?
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Amoxicillin or Augmentin 90 mg/kg/day
Macrolides Rocephin |
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Other name for swimmer's ear?
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Otitis Externa
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Tx for Allergic Rhinitis
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Antihistamines
Topical Steroids |
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Ex of antihistamine tx for Allergic Rhinitis?
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Zyrtec 10 mg daily
Remember 1st generation: sedation, dry mouth |
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Ex of Topical Steroid tx for Allergic Rhinitis?
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Flonase daily
No effect on plasma cortisol levels, osteocalcin or bone growth long term |
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Tx for Allergic Rhinitis for kids?
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Nedocromil Sodium (intal) spray QID
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Organisms typically responsible for sinusitis?
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1 Streptococcus Pneumoniae
2 H influenza 3 Moraxella catarrhalis |
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With Pharyngitis/ tonsilitis, which organism is of concern due to sequelae?
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Group A beta hemolytic Strep
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Viral infection accounts for 90% of pharyngitis, which bacterial agents are most commonly found?
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1 Strep pyogenes Group A,C,G
2 Strep 3 Arcanobacterium haemolyticum 4 Gonococcal |
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Other etologies for pharyngitis or tonsillitis?
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Coxsackie
Epstein Barr Group A Strep Peritonsillar abscess |
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Herpangina is caused by?
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coxsackie virus
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Herpetic gingivostomatitis is caused by?
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HSV 1
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Before prescribing any meds, you ask?
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ANY ALLERGIES!!
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With pharyngitis, you don't have to swab or give a/b if?
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1 Fever <100
2 no exudate or nodes |
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a/b for Pharyngitis?
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Pen VK rec
Amox 500 mg po bid/tid x10 days Benzathine Pen G over 60 lbs=600,000U under 60 lbs 1.2 m U ALT: EES 20-40 mg/kg Cefadroxil 30 mg/kg |
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F/U for Pharyngitis needed if?
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If not better after 3-4 days of a/b for Pharyngitis
do f/u culture |
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Avoid use of strong steroids on what body parts?
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1 face
2 flexures 3 scrotum 4 infants and young children with strong steroids as far as possible. |
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Some topical medications come in a variety of formulations such as?
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1 ointment
2 cream 3 gel 4 lotion 5 solution 6 foam 7 mousse |
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Which topical formulation is the most effective?
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Ointments
the most effective b/c they allow the best penetrations of the medication; however, they are also the greasiest |
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Which formulation is good to use on the scalp?
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1 Gels
2 lotions 3 solutions 4 foams/mousses |
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Corticosteroids are used to treat many conditions that are caused or worsened by inflammation, including?
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1 arthritis
2 asthma 3 Crohn’s disease 4 psoriasis |
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Corticosteroids are graded on a scale of 1-7 according to how potent they are with Class 1 being the most potent and Class 7 the least.
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Class 1 = most potent
Class 7 = least potent |
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Bringing psoriasis under control often requires short-term treatment with a Class?
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1 or Class 2 corticosteroid. Less potent corticosteroids can be used to maintain improvement.
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Weak corticosteroids (Class 6 or 7) are best for sensitive areas of the body such as the?
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groin or face
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The potency of a given medication can vary depending on the formulation. Which are generally the most powerful?
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Ointments
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To control a psorias flare, patients typically use what class steroid and for how long?
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Class 1 or 2 corticosteroid twice daily for 2-4 weeks.
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In between psoriasis flares, patients can use a _________corticosteroid less frequently (for example, only on weekends) or a less powerful corticosteroid daily. [Note: some dermatologists also offer cortisone shots directly into psoriasis patches, or plaques (and sometimes into specific joints targeted by psoriatic arthritis).
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powerful
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Topical anti-psoriasis agents in use today include: corticosteroids, vitamin D3 analogs, the retinoid tazarotene, coal tar, anthralin (aka dithranol), and salicylic acid. Examples include?
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clobetasol propionate (Class 1; Brand names: Cormax and Temovate), betamethasone dipropionate (Class 2; Brand name: Diprosone)
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Emollient
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-Occlusive film
-Prevents drying |
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Lotion?
Ex of Lotion? |
H2O and medicated powder
-cooling, soothing, leaves powder behind to protect skin, contain oil and enhance drying Alpha-Keri Lubriderm |
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Ointment?
Examples? |
-H2O and oil
-film protects skin, decreased allergenic; avoid b/t toes |
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Cream?
Ex? |
-Oil droplets in H2O carry tx into skin
-Use intertriginous, can |
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Nonpharmacological tx for Atopic Dermatitis?
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- Humidify environment
- Take long soaking baths - Liberal use of emollients - Relaxation techniques |
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Pharmacological tx for Atopic Dermatitis?
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-Nonsedating antihistamine
-Topical steroids bid |
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Avoid fluorinated on___ due to skin thinning and telangtectesia risk
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face
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Use what kind of steroids for acute flares?
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Systemic flares
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Avoid drying the skin with?
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1 hot H2O baths
2 harsh detergents 3 wool |
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Tx for recalcitrant cases of atopic dermatitis?
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UVB-UVA and PUVA
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Other name for cradle cap?
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seborrheic dermatitis
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Tx for seborrheic dermatitis?
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1 Avoid mositurizers that plug glands
2 Use Selenium sulfide, tar or zinc shampoo 3 Use baby shampoo to remove scale then apply the topical corticosteroids |
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Tx for fungal skin infection?
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topical antifungals
|
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Tx for fungal nail infection?
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Depends on severity
1 topical antifungals 2 oral antifungals |
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Tx for tinea versicolor?
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Selenium sulfide shampoo
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Tx for tinea pedis?
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oral antifungals
|
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Tx for fungal hair infection?
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oral antifungals
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What can be used to diagnose fungal infections?
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KOH or Wood's Lamp
spaghetti and meatball appearance |
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Squamous cell cancer tx?
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5% fluorouracil cream
Cryotherapy |
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Uticaria tx?
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Steroids
Antihistamines Epinepherine if needed |
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Acne tx?
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1 Less androgenic OCPs
2 Keratolytic agents 3 a/b 4 Retin A 5 Accutane (No pregnancy) |
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Rosacea tx?
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Metrogel or a/b
Avoid hot drinks and ETOH |
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Pityriasis Rosea tx?
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antihistamine
Check VDRL to r/o secondary syphillis |
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Scabies tx?
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antihistamines, steroids, Kwell
Retreat in 1 week |
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Don't use Kwell for?
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Children under 3 yrs-No KWELL
|
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Diaper dermatitis from Monilia?
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topical antifungal, protectants
moniliasis or candidiasis would be names for infections by the yeasts. |
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Impetigo tx?
organism? |
Bactroban or PCN
Staph/ Strep |
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Erythema Multiforme
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Milder form of SJS
|
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Bites in order order of possible contamination?
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Human bite
Cat bite Dog bite |
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Tx for bites?
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Td VACCINE?? plus
Augmentin Clindmycin+ quinolone |
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Rabies risk for Bites from?
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Bats
Raccoon Skunks |
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Dog and cat bites contain?
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Pasteurella multocida (gram-)
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Organisms that usually cause acute cellulitis?
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gram +
cause usually staph aureus or Strep pyogenes |
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Tx for acute Cellulitis?
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Td plus
1 Dicloxacillin 2 Keflex 3 Quinolone |
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Subtype of cellulitis?
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Erysipelas
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Breast fed infants up to 6 months of age should receive?
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Vitamin D 200 IU
|
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Pre term and breast fed infants should receive?
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Ferrous Sulfate 2-3 mg/kg/day
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Beginning at 6 months of age, infants should receive?
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Iron fortified cereal
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Fat calories should not be restricted in the ______yrs of life.
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Fat calories should not be restricted in the first 2 yrs of life.
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In the first year of life, infants should not receive?
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cow's milk or honey
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For neural tube defects, infants should receive?
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folic acid
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For hemorrhagic dx of newbons, newborns should receive?
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Vitamin K
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For opthalmia neonatorium, newborns should receive?
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1% silver nitrate at birth
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For dental caries, infants should receive?
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fluoridate water
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Tx for infective endocarditis?
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Amoxicillin
PCN |
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Tx for acute rheumatic fever?
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PCN
Erythromycin |
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Screen pregnant women for what infection?
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Group B Strep
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First line drugs for anxiety?
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SSRI and SNRI's
|
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Tx for Anxiety before SSRI/ SNRI kicks in?
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Benzodiazepines
Aprazolam (Xanax) Lorazepam (Ativan) are effective short term. Use until SSRI's kick in, though limit to 1 month due to high risk of dependency. |
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How long does it take for SSRI/ SNRI to kick in?
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Takes 2-4 weeks for SNRI/SSRI to be effective so need short term benzodiazepine or Buspirone initally
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Name for acronym SSRI?
Examples? |
Selective serotonin reuptake inhibitor
or serotonin-specific reuptake inhibitor 1 Citalopram (Celexa) 2 Escitalopram (Lexapro) 3 Fluoxetine (Prozac) 4 Paroxetine (Paxil) 5 Sertraline (Zoloft) |
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Name for acronym SNRI?
Examples? |
Serotonin–norepinephrine reuptake inhibitors (SNRIs)
Venlafaxine (Effexor) – The first and most commonly used SNRI. Duloxetine (Cymbalta) |
|
One major contraindication of SSRIs is the concomitant use of?
Why? |
MAOIs (monoamine oxidase inhibitors). This is likely to cause severe serotonin syndrome/toxidrome.
|
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Serotonin–norepinephrine reuptake inhibitors (SNRIs)used in the treatment of
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1 major depression & mood dx
2 anxiety disorders 3 obsessive-compulsive disorder (OCD) 4 attention deficit hyperactivity disorder (ADHD) 5 chronic neuropathic pain 6 fibromyalgia syndrome (FMS), 7 relief of menopausal sympt |
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Hordeolum tx?
|
warm compresses
Topical Bacitracin or Erytromycin opth ointment Refer to opthalmologist for possible I& D if no resolution in 48 hrs |
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Chalazion tx?
|
Warm compresses
Referral for surgical removal |
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Bacterial conjuntivitis tx?
|
1 Ertyhromicin 0.5% opt ointment
2 Tetracyline 1% 3 Polymixin B opth sol'n or oint |
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Gonococcal conjuntivitis tx?
|
PCN G
Ceftriaxone 250 IM |
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Chlamydia conjuntivitis tx?
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1 Erythromycin opthal oint.
Oral 1 tetracycline 2 Erythromycin 3 Clarithromycin 4 Azithromycin 5 Doxycycline |
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allergic conjuntivitis tx?
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1 oral antihistamines
Refer to allergist/opthalmologist May need steroids |
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viral adenovirus conjuntivitis tx?
|
sympt care
Mild: saline gtts/ art tears coolness best Moderate: 1 decongestants 2 antihistamines 3 mast cell stabilizers 4 NSAIDS |
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viral herpetic conjuntivitis tx?
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refer to opthalmologist
|
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Bacterial Otitis externa tx?
|
Acetic acid w/ or w/o hydrocortisone
Cortisporin (Neomycin, polymyxin B, HC) Cipro or Ofloxacin |
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Fungal Otitis externa tx?
|
Antifungal gtts
eg clotrimazole 1% soln) |
Name the Bones of the ears?
|
1 Incus
2 Stapes 3 Malleus |
|
Do not use Steroids with?
|
fungal infection (exacerbate it)
herpes |
Name the Bones of the ears?
|
1 Incus
2 Stapes 3 Malleus |
|
Pain management for AOM?
|
1 Acetminophen
2 Ibuprofen 3 Benzocaine otic gtts > 5yrs |
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Tx for AOM
|
1 Amox 80=90 mg/kgday if .6 yrs of age
if alllergic use 1 Cefdinir (ominicef), 2 cefpodoxime (vantin) or 3 cefuroxime (Ceftin/Zinacef) |
|
Serous OM/ OM with effusion (OME)
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Watchful monitoring (3 mo)
A/b tx- no long term efficacy 3 antihistamine/ decongestants (ineffective) 4 re eval in 3-6 mo |
|
other name for pinna
|
auricle
|
|
tragus
|
pict
|
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AOM?
|
fluid in the middle ear with s/s acute local or systemic illness
follows an upper resp infection |
|
Typical organisms that cause AOM?
|
1Strep Pneum
2 H influ 3 Moraxella catarrhalis 4 GAS 5 S aureus 6 Enterobacteriaceae |
|
OM with effusion?
|
residual fluid in middle ear following AOM
decreased hearing, balance problems eustachian tube dysfunction No acute infection, can last 2-3 months |
|
clinical symptoms of AOM
|
1 Rapid onset
2 Otalgia 3 ear pulling 4 fever 5 Irritability 6 Otorrhea 7 Sleeplesness 8 balance prob 9 anorexia 10 vomiting 11 diarrhea 12 hearing loss 13 tinnitus 14 vertigo |
|
PE findings with AOM?
|
1 Decreased TM mobility
2 Discoloration of TM (white, yellow) 3 Fullness of bulging of TM |
|
OME s/s?
|
1 variable
2 Fullness 3 decreased hearing 4 crackling |
|
PE findings with OME?
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1 TM retracted w/ blunting of land marks
2 diffuse light reflex on inspectinon 3 Decreased movement of TM TM opaque, dull, pale golden, yellowish color (not red) with or w/o air bubbles |
|
AOM Tx?
|
Amoxicillin/ Augmentin 90 mg/kg/day
Macrolides or Rocephin call for f/u, may need rx change, hearing screen. |
|
Typical organisms that cause Sinusitis?
|
1Strep Pneum
2 H influ 3 Moraxella catarrhalis 4 GAS |
|
Evaluate hearing if?
|
not speaking @ 18-24 months
|
|
Consult, refer, hospitalize for?
|
1 recurrent AOM
2 Complications 3 Chronic middle ear effusion 4 Peforation of the TM, nonrepsonsive to tx w/i 48-72 hrs, hearing loss |
|
Recurrent AOM?
|
3-4 episodes in 6 monyhd ot 4-6 in 12 months
|
|
Complications of AOM?
|
Mastoiditis or cholesteatoma
|
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Chronic middle ear effusion?
|
3 months or greater in both ears
6 months or greater in 1 ear |
|
Swimmers ear=?
|
Otitis Externa
|
|
S/s of OE?
|
Auricle tenderness with pinna movement
External auditory canal narrowed by edema, accumulation of cellular debris and discharge |
|
OE tx?
|
topical a/b
steroid analgesic |
|
Tx for Pharyngitis
|
PCN VK rec
Amox 500 mg bid-tid x 10 days Benzathine Pcn G Alt EES 20-40 mg/kg, Cefadroxil |
|
When should one f/u for Pharyngitis?
|
if not better in 3-4 days
|
|
Azithromycin is a a concentration dependent killer, so it's best to prescribe?
|
500 mg/ day x 3 days not Z pack
Higher doses=Higher concentrations Z max 2 gms as a single dose 3 days by po is 6 days at the tissue. |
