Yellow with envy
Someone walks into your clinic with new onset jaundice. Initial laboratory evaluation should include...
CBC, CMP, PT/INR, direct bili, GGT
What can parents do to encourage school readiness?
Reading with their child!
This treatment can be used for interstitial cystitis.
Pelvic floor PT
Cardinal features of acute bacterial rhinosinusitis are unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages.
72 yo M with HTN and T2DM presents with sudden onset severe painless vision loss in L eye, occurred 2 hours ago. What should you do next?
Call code stroke!
Central retinal artery occlusion
If etiology is unclear after labs and imaging in a pt with jaundice, you should consider ___.
liver biopsy
Tooth brushing can begin when baby teeth first erupt above the gumline; twice a day, with a soft bristled brush and tap water or a rice-sized amount of toothpaste. A pea-sized amount of toothpaste may be used from 3 to 6 years of age.
Name at least 2 bladder irritants
citrus, pineapple, tomato, onion, beans, nuts, yogurt, caffeinated carbonated beverage, vinegar, chocolate, spicy food
When should you get a CT scan and refer to ENT in a pt with rhinosinusitis?
if recurrent or concern about complications
68 yo F presents with several hours of floaters in L eye followed by sudden onset loss of vision in L eye that was like a curtain dropped over her vision. Dx?
retinal detachment
Examination may reveal 20/20 central vision and normal pupils. However, once the retinal detachment progresses to the macula (the anatomic part of the retina responsible for sharp central vision), there may be significant visual acuity loss and, with extensive detachment, possible RAPD. Confrontation testing of visual fields will show a peripheral scotoma. Although funduscopic examination may reveal an area of detachment, peripheral detachments are difficult to identify with a direct ophthalmoscope.
Investigations. Retinal detachment requires urgent referral to ophthalmology. B-scan ocular ultrasonography may help visualize a retinal detachment through opacities, such as significant cataract or vitreous hemorrhage.
First line imaging studies for patients with jaundice include... (name 2/3)
ultrasound
CT w/contrast
MRCP if obstruction suspected
These 2 behavioral modifications are used in infants and children with sleep issues
bedtime fading
modified or graduated extinction
You have a 57yoF come to your office and you dx a UTI and Rx abx after she gives a hx c/w UTI and her UA had positive WBCs, RBCs (confirmed with micro), LE, and nitrites. What followup would you recommend?
repeat UA after tx to confirm resolution of hematuria
Name complications of rhinosinusitis.
orbital cellulitis, meningitis, abscess, cavernous sinus thrombosis, osteomyelitis
kids>adults
Your pt comes into the office with R eye pain, headache, nausea and vomiting x 1 day. The R eye is partially dilated and nonreactive to light on exam. Next, you should...
measure IOP, if elevated start pilocarpine drops and emergent referral to ophtho; IV mannitol, acetazolamide
Etiology of conjugated hyperbilirubinemia can be divided into these 3 categories.
extrahepatic
drug induced liver injury
Thumb sucking or pacifier use is discouraged after this age to reduce risk of AOM
6-12 months
A higher incidence of substantial dental malocclusion has been observed with pacifier use continued after 3 years of age
Consider testing patients with recurrent or persistent cervicitis or urethritis for ___.
mycoplasma genitalium
You prescribe antibiotics for your patient with acute rhinosinusitis when her sxs significantly worsened after DOI#5. She has a beta lactam allergy, so you decide to tx her with ____ or ____.
tudies have shown that amoxicillin is as effective as amoxicillin-clavulanate as a first-line treatment for acute bacterial rhinosinusitis for those without a beta-lactam allergy. For patients with a beta-lactam allergy, appropriate antibiotics include doxycycline or a respiratory fluoroquinolone; clindamycin plus a third-generation cephalosporin is an option for children with non-type I hypersensitivity to beta-lactam antibiotics.
A 58 yo M presents to your office with scalp tenderness, jaw pain, proximal muscle and joint pain, fevers, chills and fatigue. His laboratory evaluation reveals an elevated C-reactive protein level and platelet count. You should...
Rx empiric steroids to prevent vision loss in the unaffected eye (IV initially), as well as refer for a temporal artery biopsy
Name 2 medical conditions to consider if laboratory evaluation in a patient who appears jaundiced is normal.
Carotenemia
Addison disease
anorexia nervosa
In addition to focusing on family mealtime behaviors, these strategies can help with picky eating.
Limiting milk consumption to 16 to 24 oz a day to avoid appetite suppression and only allowing sugary drinks in small quantities can also be helpful.
Name 3/4 risk factors that indicate a pt is at a high risk for genitourinary malignancy when presenting with microhematuria
>60 yo
>30 pack yr hx
>25 RBCs per HPF
hx of gross hematuria
Recent studies show that for every 100 adults treated with antibiotics for acute rhinosinusitis, __ (#) benefitted and __ (#) were harmed.
5, 12
27 yo previously healthy F presents with R eye progressive vision loss over the last 2 days. Her exam is significant for decreased visual acuity, color desaturation and visual field loss in her R eye. She has pain behind the R eye that worsens w/eye movement. She should be admitted to the hospital for __ and __.
IV steroids and MR brain