An ounce of prevention..
What are you required by law to provide a patient when administering a vaccine?
The VIS (Vaccine information statement) for each vaccine
(and document the date/version of the VIS)
How many RBCs on a UA are considered abnormal and deserve a workup?
What are 3 or more RBCs noted when there is no infection
A high exhaled nitric oxide level is indicative of what?
Asthma, non-compliance with inhaled corticosteroids
very high suggests eosinophilic inflammation
At what ages is the Developmental Screening recommended by AAP and CHDP?
What is 9, 18 and 30 months
What MME does the CDC recommend attempting to stay below?
What is 50 MME/day
How early can you give a child an MMR vaccine during an outbreak?
What is age 6 months; that dose "doesn't count" = restart series at age 12 months
What is the difference in treatment for PMR vs Giant Cell Arteritis?
PMR - low dose prednisone (15mg per day then taper)
GCA - high dose - 40-60mg/day
What three things can you buy without a prescription that have decent evidence in treating acute cough?
Honey over age 1
Dextromethorphan over age 2
Zinc
What disease should all children with a lead level of 4.5 or higher be screened for?
What is iron deficiency anemia
According to California law, who must be offered Naloxone
Those taking opiates over 89 MME/day (>90)
Those taking a benzo and opiate
Those at risk of overdose
True or false... Aluminum is no longer used in vaccines.
False - it is still found in hepatitis A and B, Diptheria-tetanus containing vaccines, Hib and Pneumococcal vaccines
What is a normal ESR for an 80 year old male and an 80 year old female?
What is 40 for male, 45 for female
Normal is calculated at Age/2 for men, and Age+10/2 for women
What pharmaceutical MAT agent is the drug of choice for treating alcoholism during pregnancy?
What is naltrexone.
(Disulfuram may be associated with fetal malformations and the disulfuram rxn can cause risk to the fetus; Campral - some teratogenicity in animal studies)
At what age should children be screened for lead toxicity?
Screening should occur at 12 and 24 months of age or at 36-72 months if they have not previously been screened. Those children who immigrate here should be screened upon arrival
How many morphine milligram equivalents is Vicodin (hydrocodone/acetaminophen) 10/325 four per day?
40MME
Patients who received the MMR during what time period should be re-vaccinated?
What are adults given the vaccine between 1963 and 1967 when the vaccines was killed and ineffective (typically those born between 1957 and 1968)
[usually one dose -
should get 2 if 1) students at college, 2) healthcare personnel 3) international travelers 4) those at risk during an outbreak]
What two over the counter supplements are helpful in treating PMS (and have decent evidence to support their use)?
What are calcium 1200mg/day and B6 50-100mg per day
Weaker evidence for chasteberry, magnesium
What conflict style does Dr. Duong exhibit?
Accommodating..
What deficiency is a risk factor for increase susceptibility to measles infection?
Vitamin A deficiency
Per California law, how often do you need to check CURES reports for a patient on chronic controlled substances?
At least quarterly
(And within 24 hours of starting a controlled substance)
What dose of prednisone is considered acceptable when giving an MMR vaccine?
What is <20 mg per day (or equivalent)
What imaging study should be ordered for patients with unexplained hematuria?
A CT urogram -
CT scan with three phases (significant radiation exposure – avoid in pregnancy)
o Noncontrast phase – hydronephrosis, stones
o Nephrogenic phase – renal parenchyma for pyelonephritis and neoplastic lesions
o Excretory phase – urothelial disease, filling defects
What are Dennie-Morgan lines?
creases in the lower eyelid caused by edema in atopic dermatitis;
infraorbital fold, is a fold or line in the skin below the lower eyelid caused by edema inatopic dermatitis. The presence of Dennie–Morgan folds is used as a diagnostic marker for allergy with a sensitivity of 78% and specificity of 76%.
What are the ages and intervals recommended by CHDP for fluoride varnish?
3 times a year from the time teeth erupt til age 6 years
What is the Holy Trinity?
Soma, Benzo + Opiate