05-16-2007, 07:01 AM
active tb.....if pt is well complient and can b reached u dont have to admit him.... give 4 meds for 2 months and then 2 for 4 months at home.
if pt is homeless or infecting others on streets or in institusions then u have to admit,,otr if having hiv orany underlying medical prob
in nursing home pts always check ppd ist and then recheck after 3 wks..(.booster checking) to make sure that ist ppd is true positive or tru enegative
as long as stool is well contained in the diapers the kid can come to day care center..
alll kids need prophylaxis along with the day care stafff if 2 or more cases of h-influenza r there..
when kid is not febrile or after 24 h of abx he can go back to school with sorethraot or conjuntivitis...if no purelent discharge..
all kids need prevnar vaccine (congugated vac) which is covering 7 capsule of the infected org for pnumococal protecton
egg allergy is a contraindiation to yellowfever and influenza vaccine not mmr any more..
kid with or adult with hiv need mmrif his cd is above 200 if below its contraindicated
no opv and no bcg to hiv...
ifpt has hiv dont give rifampin it will interact with th e pis..
all pis cause hypertriglycerides no matter what they called.
give hiv pt refabutininstead
all babies who born to hiv mom need 6 wks of azt
give azt for PHAT..which is simmilar to itp but doesnt respond to steroids,,
negativ eppd doesnt mean its negative in aids due to
anergy..
drowning....
Bad prognostic factors:
Duration of submersion >10 minutes
Hypothermia, with a core temperature <33؛C (92؛F)
Age <3 years
Arterial blood pH <7.1 upon presentation
Water temperature >10؛C (50؛F); cold water is beneficial in that it tends to decrease the metabolic demands of the body (helping to attenuate the effects of hypoxemia) and activates the diving reflex, a primitive reflex with bradycardia and breath-holding often seen in children that also shunts blood to the vital organs
There had been a big controversy over whether abduction therapy with double diaper should be used in newborn CDH or not.People have used it for a long tome. But evidence suggest that there is no place for it in rx of CDH. Treatment with double or triple diapers is to be con-demned due to its expense and ineffectiveness.
First RX is observe for 5 days.If does not resolve use pavlik harness.For typi-cal DDH, contra-indications for Pavlik use include: in-fant greater than 8 months of age, irreducible.
No improvement with pavlik---refer to ortho consult!!!
so, the Q` must be having some other choices!! because we are tested as an FP physician and we do not directly refer to ortho consult.
Ref: www.fpnotebook.com
.
both B-HCG and AFP are elevated in nonseminomatous tumors. Remember increased AFP rules out seminoma.
To differentiate between Crohns and UC:Serologic test .pANCA and ASCA
Antibiotics for bites:1."HUMAN BITES". Antibiotics should be given prophylactically for all human bites: amoxicillin/clavulanate 20 to 40 mg/kg/day divided TID; cefixime is an alternative.
Consider IV antibiotics if infection has already occurred, especially on the hand.
If a joint may be involved (e.g., MP joint after an altercation), surgical exploration is indicated.
2."CAT BITES". Antibiotics are routinely given for cat bites. The drug of choice is amoxicillin/clavulanate 20 to 40 mg/kg/day divided TID x 7 days. Doxycycline or ceftriaxone are acceptable alternatives.3.
c ANCA ,,IS PRESENT IN POLYARTRITIS NODOSA AND ASSOCIATED WITHHEP B
ALL HEP C PT NEED HEP A--B VACCINE BUT HEP B PT DOESNTNEED HEP A..
"DOG BITES". Only 5% become infected (the same rate as most wounds), and routine prophylaxis is not recommended. If need to treat, amoxicillin/clavulanate is the drug of choice with doxycycline, clindamycin, plus a fluoroquinolone or TMP/SMX, being good alternatives. Wounds can be closed if not extensive and not a lot of tissue crushed
anti-Ro Antibody titers are most closely associated with Sjogren's syndrome.
- anti-Smith Antibody titers are most closely associated with SLE.
ifu wana know if disease of sle has worse prog ornot responsingto treatment uhav eto check compliment c2-c6 willb dec...in disease notresponding...
disease activity is checked by ds dna antibodies and compliments....
if only rash or arthralgia giv e hydroxycholroquin but if kidney or other system involved steroid ..
if steroids not helping then do th e kidney biopsy to chooose a rt tretament to see which stage pt is at kidney wise
cause of death in sle is always nephritis so once pt has this its already worse prognostic .....level
sle will flare upin preg and warn the pt about baby havingcon 3degree herat block if ro la is positive
check for lupus anticogluant too bcz leads to miscarriag eand also cause thrombosis stroke need prophylaxis...if symptomatic.....with asp and heparin..
- anti-Centromere Antibody titers are most closely associated with CREST or limited scleroderma.
- anti-Jo Antibody titers are most closely associated with dermatomyositis/polymyositis.
- anti-Scl70 Antibody titers are most closely associated with diffuse scleroderma.
antiendomyseal antibodies r with celic sprue
leukemic retinopathy...
When definite intraocular leukemic infiltrates fail to respond to systemic chemotherapy, direct radiation therapy is recommended.
Relapse, manifested by anterior segment involvement should be treated by radiation.
Optic nerve head infiltration in patients with ALL is an emergency and requires prompt radiation therapy to try to salvage some vision.
CMLwith leukemic retinopathy-Retinal vein tortuosity and dilation are thought to be secondary to hyperviscosity.
-Peripheral retinal microaneurysms and retinal neovascularization may be seen particularly in patients with CML. They are thought to occur as a result of peripheral nonperfusion and ischemia from hyperviscosity.
-Retinal hemorrhages are the most common finding in most series and are thought to be secondary to anemia and thrombocytopenia. These hemorrhages may be dot-shaped, flame-shaped, intraretinal, subretinal, or subhyaloid.
-Cotton-wool spots are known to represent nerve fiber layer infarcts. However, they are not correlated with hematological parameters of anemia or blood viscosity.
-Emergent treatment with leukopheresis sometimes is necessary when leukostastic complications are present.
Leukemic retinopathy usually is not treated directly. As the hematological parameters normalize with systemic treatment, many of the ophthalmic signs resolve. There are reports that leukopheresis for hyperviscosity also may alleviate intraocular manifestations.
cyanide poisoning
One potentially useful finding is manifested by bright red retinal veins and arteries, which are caused by absent tissue oxygen extraction.
Cyanosis is uncommon, even in cardiovascular collapse or arrest.
Despite poor perfusion, skin color may remain pink from high arterial and venous oxygen saturation and the reddish pigmentation of cyanhemoglobin (small contribution).
Neurologic findings may range from confusion or drunken behavior to coma and generalized convulsion
Varicella and smallpox generally can be differentiated clinically by the nature of the rash.
In variola, all the skin lesions are at the same stage of development (ie, vesicle, pustule, scab). In contrast, the rash of varicella occurs in waves, so that all stages of rash are present at the same time.
Zidovudine to the mother during the pregnancy orally, then intravenously during the labor and delivery, and finally orally to the infant for six weeks
if pt is homeless or infecting others on streets or in institusions then u have to admit,,otr if having hiv orany underlying medical prob
in nursing home pts always check ppd ist and then recheck after 3 wks..(.booster checking) to make sure that ist ppd is true positive or tru enegative
as long as stool is well contained in the diapers the kid can come to day care center..
alll kids need prophylaxis along with the day care stafff if 2 or more cases of h-influenza r there..
when kid is not febrile or after 24 h of abx he can go back to school with sorethraot or conjuntivitis...if no purelent discharge..
all kids need prevnar vaccine (congugated vac) which is covering 7 capsule of the infected org for pnumococal protecton
egg allergy is a contraindiation to yellowfever and influenza vaccine not mmr any more..
kid with or adult with hiv need mmrif his cd is above 200 if below its contraindicated
no opv and no bcg to hiv...
ifpt has hiv dont give rifampin it will interact with th e pis..
all pis cause hypertriglycerides no matter what they called.
give hiv pt refabutininstead
all babies who born to hiv mom need 6 wks of azt
give azt for PHAT..which is simmilar to itp but doesnt respond to steroids,,
negativ eppd doesnt mean its negative in aids due to
anergy..
drowning....
Bad prognostic factors:
Duration of submersion >10 minutes
Hypothermia, with a core temperature <33؛C (92؛F)
Age <3 years
Arterial blood pH <7.1 upon presentation
Water temperature >10؛C (50؛F); cold water is beneficial in that it tends to decrease the metabolic demands of the body (helping to attenuate the effects of hypoxemia) and activates the diving reflex, a primitive reflex with bradycardia and breath-holding often seen in children that also shunts blood to the vital organs
There had been a big controversy over whether abduction therapy with double diaper should be used in newborn CDH or not.People have used it for a long tome. But evidence suggest that there is no place for it in rx of CDH. Treatment with double or triple diapers is to be con-demned due to its expense and ineffectiveness.
First RX is observe for 5 days.If does not resolve use pavlik harness.For typi-cal DDH, contra-indications for Pavlik use include: in-fant greater than 8 months of age, irreducible.
No improvement with pavlik---refer to ortho consult!!!
so, the Q` must be having some other choices!! because we are tested as an FP physician and we do not directly refer to ortho consult.
Ref: www.fpnotebook.com
.
both B-HCG and AFP are elevated in nonseminomatous tumors. Remember increased AFP rules out seminoma.
To differentiate between Crohns and UC:Serologic test .pANCA and ASCA
Antibiotics for bites:1."HUMAN BITES". Antibiotics should be given prophylactically for all human bites: amoxicillin/clavulanate 20 to 40 mg/kg/day divided TID; cefixime is an alternative.
Consider IV antibiotics if infection has already occurred, especially on the hand.
If a joint may be involved (e.g., MP joint after an altercation), surgical exploration is indicated.
2."CAT BITES". Antibiotics are routinely given for cat bites. The drug of choice is amoxicillin/clavulanate 20 to 40 mg/kg/day divided TID x 7 days. Doxycycline or ceftriaxone are acceptable alternatives.3.
c ANCA ,,IS PRESENT IN POLYARTRITIS NODOSA AND ASSOCIATED WITHHEP B
ALL HEP C PT NEED HEP A--B VACCINE BUT HEP B PT DOESNTNEED HEP A..
"DOG BITES". Only 5% become infected (the same rate as most wounds), and routine prophylaxis is not recommended. If need to treat, amoxicillin/clavulanate is the drug of choice with doxycycline, clindamycin, plus a fluoroquinolone or TMP/SMX, being good alternatives. Wounds can be closed if not extensive and not a lot of tissue crushed
anti-Ro Antibody titers are most closely associated with Sjogren's syndrome.
- anti-Smith Antibody titers are most closely associated with SLE.
ifu wana know if disease of sle has worse prog ornot responsingto treatment uhav eto check compliment c2-c6 willb dec...in disease notresponding...
disease activity is checked by ds dna antibodies and compliments....
if only rash or arthralgia giv e hydroxycholroquin but if kidney or other system involved steroid ..
if steroids not helping then do th e kidney biopsy to chooose a rt tretament to see which stage pt is at kidney wise
cause of death in sle is always nephritis so once pt has this its already worse prognostic .....level
sle will flare upin preg and warn the pt about baby havingcon 3degree herat block if ro la is positive
check for lupus anticogluant too bcz leads to miscarriag eand also cause thrombosis stroke need prophylaxis...if symptomatic.....with asp and heparin..
- anti-Centromere Antibody titers are most closely associated with CREST or limited scleroderma.
- anti-Jo Antibody titers are most closely associated with dermatomyositis/polymyositis.
- anti-Scl70 Antibody titers are most closely associated with diffuse scleroderma.
antiendomyseal antibodies r with celic sprue
leukemic retinopathy...
When definite intraocular leukemic infiltrates fail to respond to systemic chemotherapy, direct radiation therapy is recommended.
Relapse, manifested by anterior segment involvement should be treated by radiation.
Optic nerve head infiltration in patients with ALL is an emergency and requires prompt radiation therapy to try to salvage some vision.
CMLwith leukemic retinopathy-Retinal vein tortuosity and dilation are thought to be secondary to hyperviscosity.
-Peripheral retinal microaneurysms and retinal neovascularization may be seen particularly in patients with CML. They are thought to occur as a result of peripheral nonperfusion and ischemia from hyperviscosity.
-Retinal hemorrhages are the most common finding in most series and are thought to be secondary to anemia and thrombocytopenia. These hemorrhages may be dot-shaped, flame-shaped, intraretinal, subretinal, or subhyaloid.
-Cotton-wool spots are known to represent nerve fiber layer infarcts. However, they are not correlated with hematological parameters of anemia or blood viscosity.
-Emergent treatment with leukopheresis sometimes is necessary when leukostastic complications are present.
Leukemic retinopathy usually is not treated directly. As the hematological parameters normalize with systemic treatment, many of the ophthalmic signs resolve. There are reports that leukopheresis for hyperviscosity also may alleviate intraocular manifestations.
cyanide poisoning
One potentially useful finding is manifested by bright red retinal veins and arteries, which are caused by absent tissue oxygen extraction.
Cyanosis is uncommon, even in cardiovascular collapse or arrest.
Despite poor perfusion, skin color may remain pink from high arterial and venous oxygen saturation and the reddish pigmentation of cyanhemoglobin (small contribution).
Neurologic findings may range from confusion or drunken behavior to coma and generalized convulsion
Varicella and smallpox generally can be differentiated clinically by the nature of the rash.
In variola, all the skin lesions are at the same stage of development (ie, vesicle, pustule, scab). In contrast, the rash of varicella occurs in waves, so that all stages of rash are present at the same time.
Zidovudine to the mother during the pregnancy orally, then intravenously during the labor and delivery, and finally orally to the infant for six weeks