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Tanner Stage 2 - correct answer>>Increased rugae of scrotum, testes enlarge. Breast bud. Straight sparse hair. Tanner Stage 3 - correct answer>>Penis elongates. Pencil penis. Scrotal color darkens. Breast tissue and areola are one mound. Darkened hair, starts to curl. Tanner 4 - correct answer>>Penis thickens and increases in size. Areola/nipple separate for secondary mound. Curly hair, not on medial thigh. When does menarche begin? - correct answer>>After Tanner stage 2, within 1-2 years. Delayed puberty if no secondary sexual characteristics by 12-13 in girls and 14 in boys. Trisomy 21 - correct answer>>Down Syndrome. Risk with advanced maternal age. Microcephaly, flat nose, hypotonia, simian crease. Marfan's Syndrome - correct answer>>Pectus excavatum. Tall, wide arm span. Risk of MVP, aneurysm, aortic regurgitation. Do not clear for sports. Turner's Syndrome - correct answer>>FEMALE.
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Tanner Stage 2 - correct answer>>Increased rugae of scrotum, testes enlarge. Breast bud. Straight sparse hair. Tanner Stage 3 - correct answer>>Penis elongates. Pencil penis. Scrotal color darkens. Breast tissue and areola are one mound. Darkened hair, starts to curl. Tanner 4 - correct answer>>Penis thickens and increases in size. Areola/nipple separate for secondary mound. Curly hair, not on medial thigh. When does menarche begin? - correct answer>>After Tanner stage 2, within 1-2 years. Delayed puberty if no secondary sexual characteristics by 12-13 in girls and 14 in boys. Trisomy 21 - correct answer>>Down Syndrome. Risk with advanced maternal age. Microcephaly, flat nose, hypotonia, simian crease. Marfan's Syndrome - correct answer>>Pectus excavatum. Tall, wide arm span. Risk of MVP, aneurysm, aortic regurgitation. Do not clear for sports. Turner's Syndrome - correct answer>>FEMALE. Lymphedema in utero, webbed neck, LD, widely spaced nipples, HTN coarctation of aorta. Klienfelter's Syndrome - correct answer>>Extra X in males. More feminine. Will see in puberty. Infertile, hypogonadism, low testosterone. Tall, lanky, underdeveloped sexually. Caput succadeum - correct answer>>Sutures cross midline, spreads. Caphalohematoma - correct answer>>Sutures do not cross midline, more significant. When does anterior fontanelle close? - correct answer>>18 months When does posterior fontanelle close? - correct answer>> 2 - 3 months Abrnomal red reflex - correct answer>>Black or white. Retinoblastoma, cataracts, osteogenesis perfecta. White specks in down syndrome. Edward's Syndrome - correct answer>>Trisomy 18. Small mouth. High pitched cry.
Newborn screening tests - correct answer>>PKU (phenylalanine), can lead to hyperactivity and mental retardation. Hypothyroid. If not treated, mental retardation. Sickle cell. Galactessemia, maple smell to urine, septic. Hordeolum - correct answer>>Stye. Pain, edema. Bacitracin ophthalmic ointment. STD conjunctivitis. - correct answer>>Emergency. Rocephin for gonorrhea. Gonococcola Ophthamlia Neonatorum - correct answer>> 2 - 4 days after birth. Red eye, purulent discharge, swollen eyelids. GC culture, Thayer Martin, ROCEPHIN. Chalmydial Ophthalmia Trachoma - correct answer>> 4 - 10 days after birth. Edematous, red, profuse WATERY discharge that becomes purulent. Azithromycin, erythmocycin. Otitis externa - correct answer>>Fungal. Odor, black specks. Clotramizole. Pain with tragus/pinna. Corticosporin Sensorineuro hearing loss in PEDS - correct answer>>Syphilis, acoustic neuroma, aminoglycoside (gentamycin) Epiglottitis - correct answer>>Bacterial. Thumb sign on x-ray. Croup - correct answer>>Viral. Steeple sign on x-ray. Bronchioloitis - correct answer>>RSV, adenovirus. Under 3. Lower respi. URI, fever, nasal flaring, stridor.If a preemie, synegis. Intermittent Asthma peds - correct answer>>SABA, 2 puffs q 4-6 hours. Peak 30 min- 2 hours, lasts 4-6. Mild persistent - correct answer>>Add low dose ICS S. pneumonia (CAP) peds - correct answer>>Lobar consolidation. Tx with penicillin. H. influenza pneumonia peds - correct answer>>Lobar consolidation. Amoxicillin or cephalosporin. M. cataralis or mycoplasma - correct answer>>Linear. Azithromycin.
Bacterial vaginosis - correct answer>>Milky foul discharge, itching, no CMT. Wet mount with clue cells. Tx with flagyl or clinda. HIV testing - correct answer>>ELISA in older child. PCR in infant. Western blot confirms. More than 800 CD4 count normal, viral load less than 5000 or 0/undetectable. Cause of fever in less than 2 month old - correct answer>>Group B strep, e coli common cause of fever in 2 months and up - correct answer>>Strep. pneumoniae, and h. influenza Preoperational phase, preconceptual - correct answer>> 2 - 4 years old Causation, intuitive - correct answer>> 4 - 7 years old When is vision 20/20? - correct answer>>Age 6 Concrete thinking, cognitive tasks, capable - correct answer>>School age What can be confused as child abuse in younger children? - correct answer>>Osteogenesis imperfecta VSD - correct answer>>Thrill felt at LL sternal border. Most common heart defect in babies. Opening between septum. Holosystolic murmur. Transposition of great arteries - correct answer>>RVH. L. lower sternal border. Egg on a string on x-ray. Tetralogy of fallot - correct answer>>VSD. Pulmonary stenosis. Overriding aorta. R. sided hypertrophy. Systolic ejection murmur and thrill. Squat to slow return of blood to heart. Aortic stenosis - correct answer>>Systolic thrill. R. upper sternal border. Ejection click. LVH. X-ray, severe HF. Coarctation of aorta - correct answer>>Ejection murmur. RVH to LVH. Rib notching. Pressures different in upper and lower extremities. Still's Murmur - correct answer>>Left lower sternal border. Turbulence in left ventricle. Systolic ejection murmur. Innocent
Venous hum - correct answer>>Heard best while sitting, disappears while supine. R. upper sternal border. innocent. HTN in peds - correct answer>>Organ problem or aldosterone. Cushings. Refer to cards Rheumatic heart disease - correct answer>>Joints, CNS, post infectious group a strep. affects mitral valve. Jones criteria (carditis, chorea, erythema marginatum, esr elevated, arthralgia, fever, prolonged PR interval) Kawasaki's - correct answer>>Toxic vasculitis. Fever several days, rash, swelling, peeling, strawberry tongue, prolonged PR or QT. ASA, refer. Pyloric stenosis - correct answer>>Breastfeeding delays. Projectile non-bilious vomiting, peristaltic waves, olive mass. US. Surgery. Intusucception - correct answer>>Surgical emergency. Lethargy, vomiting, jelly stool, mass in RUQ. Can be from rotavirus? Neuroblastoma - correct answer>>Adrenal gland tumor, before age 5. Mass in abdomen. Catecholamines elevated. Painful, fixed, crosses midline. Progestin effects of BC - correct answer>>Thicken cervical mucus, ovum transport slowed, sperm transport blocked Fetal alcohol syndrome - correct answer>>Small head, shortened palpebral fissures (narrow eyes), flat nasal bridge. Thin upper lip. Port wine stain - correct answer>>Trigeminal nerve, refer to opthlamology to rule out congeital glaucoma. Can be a sign of Sturge-Weber syndrome. Hirschberg Test - correct answer>>Corneal light reflex, tests for strabismus. Anal wink - correct answer>>Absence is indicitave of spina bifida Plantar (babinski) - correct answer>>Fanning of toes Palmar reflex - correct answer>>Grasp Moro reflex - correct answer>>Startle. Disappears by 3-4 months. If unilateral or does not disappear, refer to neuro or r/o shoulder injury
Epiglottitis signs - correct answer>>Rapid onset of fever, chills, severe sore throat, "hot potato voice". Common between age 2-6. 2 year development - correct answer>> 2 - 3 word setences. Simple commands. Knows first name. Copy straight line. 3 year development - correct answer>>Copies circle. 9 cupes. Knows 3 numbers and 3 colors. Speech understood by strangers. Phallic stage. Group play. 5 year development - correct answer>>Copies square. Dresses self. Skipping, hopping. 6 year development - correct answer>>Copies trinagle, diamond (7). Ties shoes. Preschool vaccines - correct answer>>MMR, varicella, IPV, dtap Middle School Vaccines - correct answer>>Tdap, MCV4, HPV. (3 total doses of HPV). Fragile X Syndrome - correct answer>>Large head circumference, mental retardation, autism, avoids eye contact. Prominent long face, forehead, large ears, flat face. Hodgkin's Lymphoma - correct answer>>Enlarged, painless cervical and supraclavicular adenopathy, fever a nd night sweats. Common 15-19. ALK phos - correct answer>>normally elevated in puberty due to growth spurts. Primary amenorrhea - correct answer>>Lack of menarche before age 15. Secondary amenorrhea - correct answer>>Most common cause pregnancy, anorexia, PCOS. CRAFFT questions - correct answer>>Screening for adolescent substance abuse. Car, relax, alone, forget, friends, trouble When to screen for type 2 diabetes in children? - correct answer>>Overweight (BMI
85th percentile), plus 2 risk factors. Family hx, race, signs of diabetes, maternal history of DM or gestational Diagnosing ADD - correct answer>>Symptoms present before age 12, impairment present in 2 settings, functional interference
Peritonsillar abscess - correct answer>>Bacterial, hot potato voice, lock jaw (trismus) ICS for children 0- 4 - correct answer>>Budesonide, fluticasone ICS 5- 11 - correct answer>>budeonide, beclomethasone, fluticasone When to tx AOM? - correct answer>>Children younger than 6 months, severe with unilateral or bilateral, non severe with bilateral in children 6-23 months Abx for AOM - correct answer>>Amoxicillin or if PCN allergic, cefdinir/cefuroxine Moderate dehydration Oral rehydration therapy - correct answer>> 50 - 100 ml/kg over 3- 4 hours, frequent small volumes CAP in children less than 5 - correct answer>>Common: Amoxillin or augmentin, atypical: azithromycin CAP in children older than 5 - correct answer>>Amoxicillin, atypical" azithromycin/clarithyromycin. Doxy for children over 7 UTI treatment in children 2-24 months - correct answer>> 7 - 14 days. Amoxicillin, bactrim, ceficime, cephalexin, cefpodoxine Ectopic pregnancy - correct answer>>Abdominal pain, dark, tarry bleeding. Get HCG. Tender adnexa, positive CMT Goodell's sign - correct answer>>softening of cervix Chadwick's sign - correct answer>>blue color to cervix Hager's sign - correct answer>>Softening of cervical uterine junction Alpha Fetal Protein - correct answer>>Should not be elevated in single uterine pregnancy When is viability? - correct answer>>24 weeks Treatment for PIH - correct answer>>Rest, fetal surveillance, kick counts, left lateral position
PAP smear: endometrial cells - correct answer>>endometrial biopsy PAP: Low grade squamous intraepithelial lesions, high grade squamous - correct answer>>HPV testing, colposcopy, biopsy How long to use Depo shot? - correct answer>>2 years. increased risk of osteoporosis Biphosphonates - correct answer>>Aldendronate, risedronate. Take in morning with full glass of water, wait at least 30 minutes before laying down. Do no take with other meds. Low AFP - correct answer>>Down's syndrome; order triple screen or quadruple screen High AFP - correct answer>>R/o neural tube defect or multiple gestation. order triple or quad screen. Positive signs of pregnancy - correct answer>>Palpation of fetus, US, heart tones Probable signs of pregnancy - correct answer>>HCG, quickening, all of the "signs" Presumptive signs of pregnancy - correct answer>>N/V, fatigue, amenorrhea Naegle's Rule - correct answer>>Subtract 3 months and add 7 days What does rhogam do? - correct answer>>Destroys fetal Rh-positive RBCs that have crossed the placenta Tx for asymptomatic bacteruria in pregnancy - correct answer>>Always treat. Nitrofurantoin, Amoxicillin. Abx to avoid late in pregnancy - correct answer>>tetracyclines, nitrofurantoin (very end/also do not use in G^PD anemia)), sulfa drugs. How to treat mastitis? - correct answer>>Non-MRSA: Dicloxacillin MRSA: Bactrim, clinda Normal cup to disc ratio in eye - correct answer>>Cup should not be more than 1/2 the size of diameter of disc. If it is, glaucoma. Arcus stenosis - correct answer>>Order lipid panel.
Ptergyum - correct answer>>Wedge shaped growth of non cancerous skin Hordeoleum - correct answer>>Staph infection, stye. Warm compresses. Chalazion - correct answer>>Beady nodule, painless. Blepharitis - correct answer>>Staph. Sebhorreic dermatitis of lid edge. Hot compresses, topical, scrub. Signs of glaucoma - correct answer>>Increased ICP. Cupping of disc Open angle glaucoma - correct answer>>Peripheral vision loss. Alpha 2 adrenergic. Tinolol, pilocarpine. Closed angle glaucoma - correct answer>>Immediate referral. Eye pain when closed, halos around lights. Mannitol, xolimide. What is leading cause of treatable blindness? - correct answer>>Cataracts. Painless, clouded, blurred vision. Diplopia, opacity of lens. Cholesteatoma - correct answer>>Chronic OM, scaling, erode middle ear, deafness. Squamous epithelial lining. TM perforates.Cauliflower like. Sensorineural hearing loss - correct answer>>Meneire's disease, acoustic trauma, ototoxic drugs Fernlike lines on corneal surface - correct answer>>Herpes keratitis. severe eye pain, photophobia, blurred vision. Bruise behind ear - correct answer>>Battle's sign. clear, golden serous discharge. sign of basilar skull fracture Cones in eyes - correct answer>>Color perception, 20/20 vision Rods in eyes - correct answer>>Detects lights and shadows, depth perception Presbyopia - correct answer>>Normal changes in vision after age 40. AV ratio - correct answer>>2:3, veins larger than arteries
Cranial nerve 10 - correct answer>>Vagus. Slowed HR, defecation Cranial Nerve 11 - correct answer>>Spinal accesory, shoulder shrug Cranial nerve 12 - correct answer>>Hypoglossal. Tongue movement Eye exam for macular degeration - correct answer>>Soft yellow deposits in macular region. Risk factor for AAA? - correct answer>>Smoking What drug do you use for isolated systolic HTN in elderly? - correct answer>>Thiazide or CCB Symptoms of Aortic stenosis - correct answer>>Angina, syncope, HF Symptoms of aortic regurgitation - correct answer>>Long period of being symptomatic, leading to SOB with exertion, to SOB at rest What area of the heart does rheumatic HD affect? - correct answer>>Mitral valve How to treat MVP? - correct answer>>Beta-blocker. Usually asymptomatic/benign. Differential to consider if child complains of bone pain all day while playing? - correct answer>>ALL Vaccines to avoid if gelatin allergy - correct answer>>MMR, varicella How long does rooting last? - correct answer>> 2 - 3 months usually, can appear at night for 1 year Chest/head difference in babies - correct answer>>Head larger than chest up to 18 months old What is Hirschsprung's disease? - correct answer>>Failure to pass meconium Examples of high intensity statins - correct answer>>Atorvastatin 40-80, Rosuvastatin 20 - 40. For patients with ASCVD, younger than 75, or 190 or higher LDL
Examples of moderate intensity statins - correct answer>>Atorvastatin 10-20, Rosuvastatin 5-10, Simvastatin 20-40, Pravastatin 40- 80 Signs of duodenal ulcer - correct answer>>Younger adults, H. pylori, food improves symptoms--gnawing pain Signs of gastric ulcer - correct answer>>Older patients, food makes it worse How to treat h. pylori - correct answer>>2 antibiotics, PPI, pepto. MOC. AOC. Active Hep. A. - correct answer>>Anti-HAV, IgM (IgM--immediate). Fecal/oral Recoveredhep. a - correct answer>>Anti-HAV, IgG (IgG-gone) Active hep. B - correct answer>>HBsAg, HBeAg, Anti-HCc, IgM Chronic Hep B - correct answer>>HBsAg, Anti-HBc, Anti-Hbe, Igm, IgG Recovered Hep. B - correct answer>>Anti-HBc, Anti-HBsAg Acute Hep. C - correct answer>>Anti-HCV, HCV RNA Chronic Hep. C - correct answer>>Anti-HCV, HCV RNA Immune from Hep. B - correct answer>>HBsab, Anti-HBs Diverticulitis - correct answer>>Low fiber diet, women, LLQ pain. Plain films to check for air. Broad spectrum abx. Bowel sounds with obstruction - correct answer>>High pitched Bowel sounds with perforation - correct answer>>Quiet, ominous Changes with older adults GI - correct answer>>Decreased thirst-risk for dehydration, delayed gastric emptying, dysphagia Treatment for presumptive gerd - correct answer>>PPI once a day before first meal Immune to Hep. A - correct answer>>Anti-HAV+, IgG
How to calculate thyroid dosese - correct answer>>Body weight 4.0 mcg/kg/day children, 1.0 mcg/kg/day in elderly, 1.6 mcg/kg/day adults...increases by 50% in pregnancy. How soon do you recheck TSH after dose changes? - correct answer>> 6 - 8 weeks. Biguanides - correct answer>>Insulin sensitizer, reduces glucose prduction from liver and increases absorption in intestines. Metformin. First line. Risk of lactic acidosis. Do not use if GFR less than 45. Increases risk of B12 deficiency TZD - correct answer>>glitazone---Actos. Works with fasting and post prandial levels. Insulin sensitizer. Don't use with heart failure. Risk of edema. Sulfonyureas - correct answer>>Glipizide. Increases insulin release from pancreatic cells. Hypoglycemia risk. DPP-4s - correct answer>>SitaGLIPTIN. Increases insulin release, largely on post prandial glucose. Risk of pancreatitis GLP- 1 - correct answer>>Injection. Exenatide, liraglutide. Increases insulin release. Nausea, vomiting, pancreatitis risk. Do not use in ESRD. SGLT2 - correct answer>>Flozins. Increases glucose excreted in urine. UTI risk. Do not use in renal impairment. Risk of urosepsis. Peak of short acting insulin (aspart, lispro, glulisine) - correct answer>>1 hour. Onset is 15 min. Lasts 4 hours Short acting insulin (regular) - correct answer>>Peaks 2-3 hours, onset 30 min, lasts 3- 6 hours Peak of long acting, lantus, determir, glargine - correct answer>>Peak --no peak, onset - 2 hours, lasts 24 hours Intermediate acting insulin - correct answer>>Onset 1-2 hours, peak 6-14 hours, lasts 16 - 24 hours What is motivational interviewing? - correct answer>>Partner with patient. Empathy, self-efficacy, change talk, open-ended, affirming statements. Ask-provide-ask
What med for hyperthyroidism is preferred in pregnant women? - correct answer>>PTU What diabetes meds cause weight loss? - correct answer>>Metformin, Byetta What diabetes meds cause weight gain? - correct answer>>TZD, sulfonyureas, insulin IDA - correct answer>>Microcytic, hypochromic elevated RDW.Blood loss, inadequate intake, absorption problem. PICA. Ferritin LOW, TIBC High Thalassemia - correct answer>>Microcytic, hypochromic NORMAL rdw. Medeterranian, Asian. Ferritin and TIBC normal. Folate deficiency - correct answer>>MCV HIGH. Beefy red tongue, no neuro symptoms. Common in alcoholic. Tx by diet changes, 1 mg PO folate B12 deficiency - correct answer>>MCV high. Beefy red tongue and neuro signs (parasthesias, fine motor, tremors). B12 injections (cyanacobalmin) daily for 1 week then monthly. Sickle Cell - correct answer>>Normocytic. Hemolytic. Worse in high altitudes, stress, dehydration, joint pain. Anemia of chronic disease - correct answer>>Normocytic. Ferritin High, TIBC low. AML - correct answer>>Most common acute leukemia ALL - correct answer>>Pacytopenia with circulating blasts, all lab values down. CLL - correct answer>>Most common leukemia in adults, lymphocytosis, 10 year survival. CML - correct answer>>40 years and over, 3-4 year survival, philadelphia chromosome. Staging of lymphoma - correct answer>>Stage 1-1 node. Stage 2-more than one place but on one side of diaphragm. stage 3 both sides of diaphragm. Stage 4 everywhere Hodgkin's Lymphoma - correct answer>>Young adults 32. Cervical adenopathy then spreads down. Reed Sternberg cells. Night sweats.
When does masturbation start? - correct answer>>Tanner 3 Tx for epididymitis in men under 35 - correct answer>>Ceftriaxone plus doxy Tx epididymitis in men over 35 - correct answer>>bactrim plus cipro Positive phren's sign - correct answer>>Pain relief when scrotum is lifted. Positive in epid....negative in torsion Acute bacterial prostatitis - correct answer>>STD. Frequency, dribbling, fever, chills. DRE, painful, boggy. Bactrim, levaquin BPH - correct answer>>Enlarged, non-tender, smooth, rubbery. Prostate cancer - correct answer>>Adenopathy, prostate harder than normal, nodules, obscure borders Normal PSA - correct answer>>Under 4 HIV tests - correct answer>>ELISA-early screening. Confirmatory: Western Blot. If positive--CD4, Viral load. AIDS - correct answer>>T cells over 800, CD4 less than 200, viral load high. Prophylaxis for Pneumocysitis jarin... - correct answer>>Bactrim daily Chancroid - correct answer>>Single, painful ulcer. Swollen lymph node.Tx: azithro/ceftriaxone Chlamydia - correct answer>>Asymptomatic. If sx: thick, cloudy dicharge, dysuria. Tx with azithro or doxy Gonorrhea - correct answer>>Report to health department. Also treat for chlamydia. Green/yellow discharge, dysuria. Ceftriaxone HPV - correct answer>>Condyloma acumilata. painless growth. Tx: podophylin, TCA, BCA< cautery
Lymphogranuloma verenium - correct answer>>painless vesicle, adenopathy. doxycycline 21 days bid Normal GFR - correct answer>>greater than 90. Renal failure: less than 15. What is a complicated uti? - correct answer>>Males, pregnant women, diabetics, children/elderly, recurrent UTIs, immunocompromised, structure changes High oxalate foods - correct answer>>Avoid with stones: rhubarb, spinach, beets, chocolate, tea, meat. Meds for BPH - correct answer>>Terazosin, tamsulosin--A.A.A. Finasteride shrinks prostate. Avoid cold meds. Saw Palmetto can help symptoms. How to treat chronic bacterial prostatitsi - correct answer>>Elderly, perineal discomfort, voiding symptoms. Boggy, non-tender. UA normla. Treat with bactrim or oflaxin for 4- 6 weeks Balanitis - correct answer>>Candida of penis. Topic OTC azole. Disseminated gonoccocal disease - correct answer>>Untreated gonorrhea. petechial rash, arthritis, pharyngitis, signs of std Fitz-hugh-curtis syndrome - correct answer>>Infection of liver capsule, STD, violin strings. Complication of GC Jarish-Herxheimer Reaction - correct answer>>Febrile reaction 24 hours after treatment for STD What is RPR and VDRL - correct answer>>Screening test for Syphylis. FTA-ABS confirmatory When do you start antivirals in pregnant women? - correct answer>>Second trimester Prophylaxis for migraines - correct answer>>Amitriptyline, propanolol, topamax Acute tx for migraine - correct answer>>Sumatriptan, triptans, NSAIDS. Class and common migraine - correct answer>>Classic with aura, common without aura