Term
| What are the major reasons for the increase in reported cases of pertussis from 1000 in '76 to 26000 in '04? |
|
Definition
- genetic changes in B. pertussis
- decreased potency of vaccines
- greater awareness of pertussis
- improved dx tests
- WANING IMMUNITY/INADEQUATE IMMUNIZATION |
|
|
Term
| What is the major systems barrier to immunization? |
|
Definition
- lack of manufacturing capacity
- misdistribution of vaccines |
|
|
Term
| What are major provider barriers to complete immunization of pts? |
|
Definition
1) continuous, updates on immunization schedules
2) need for combination vaccines
- cost/storage capacity/lack of access to prior records
- lack of adequate reminder/recall systems
- need for immunization registries |
|
|
Term
| What are major barriers to immunization by patients and parents? |
|
Definition
1) lack of knowledge
- fearful of safety
- lack transportation
- inconvenience
- cost |
|
|
Term
| what are good examples of educational resources for parents w antivaccine misinformation |
|
Definition
1) ImmunizationEd.org
2) vaccineinformation.org
*may be opposed to "official" sources* |
|
|
Term
| What are suggested measures for increased immunization rates? |
|
Definition
- reminder/recall systems for all parties involved in pt healthcare
- requirement as pre-req for enrollment in school and childcare
- decreases out-of-pocket costs
- standing orders for adult immunization |
|
|
Term
| Why have vaccines "become victims of their own success"? |
|
Definition
1) attention shifts to the occasionally serious adverse events
2) physicians reluctant to admin immun b/c liability concerns |
|
|
Term
| What are common misconceptions about vaccines |
|
Definition
- too many immunizations will weaken immune sx
- vaccine-preventable dz already were disappearing prior to vaccines
- vaccines are not "natural"
- reliance on herd immunity |
|
|
Term
| What are the most common local reactions caused by vaccines? |
|
Definition
1) redness
2) swelling
3) soreness at injection site |
|
|
Term
| Define (in relation to vaccines): Compression |
|
Definition
| - overestimate frequency of rare risks and underestimate frequency of common risks |
|
|
Term
| Define (in relation to vaccines): omission bias versus commission bias |
|
Definition
| 1) may lead to vaccine refusal by parent who thinks "if my child gets a vaccine reaction, it's my fault; if my child gets a disease, it's an act of God or Nature" The parent feels less liable for guilty from an act of omission than from an act of commission |
|
|
Term
| Define (in relation to vaccines): ambiguity aversion |
|
Definition
| - known risks may be more acceptable than unkown risks of lesser magnitude |
|
|
Term
| Define (in relation to vaccines): natural risks |
|
Definition
| - more acceptable than man-made risks |
|
|
Term
| Define (in relation to vaccines): availability heuristic |
|
Definition
| - an event that is available can lead to overestimation of its frequency |
|
|
Term
| Define (in relation to vaccines): freeloading |
|
Definition
| - vaccine refusers rely on high vaccination rate and herd immunity to protect their unvaccinated loved ones. However, this increases the risk for everyone |
|
|
Term
| Define (in relation to vaccines): bandwagoning |
|
Definition
| - vaccinate because everyone else is |
|
|
Term
| Define (in relation to vaccines): altruism |
|
Definition
| - accept personal risk to benefit community or society |
|
|
Term
| How can omission bias be overcome? |
|
Definition
1) reframe the issue from the child's point of view
- from the child's point of view, it would not matter whether injury resulted from a naturally occurring disease or a vaccine injury |
|
|
Term
| What are common vaccine risks |
|
Definition
- pain
- swelling
- redness
- sterile abscesses
- fever and irritability |
|
|
Term
| What is the important fact regarding the temporal relation of adverse events to vaccine administration |
|
Definition
- this does not prove causation
- e.g.: vaccine given at a time when sisx of autism first become apparent |
|
|
Term
What are the major allegations regarding each of the following vaccines:
MMR
HepB
thiomersal containing vaccines |
|
Definition
1) autism; no causation re: Madsen et al
2) chronic fatigue syndrome, MS, AI dz
3) autism; IoM "no causation", but reduced thiomersal is common. |
|
|
Term
| What are the components of the routine newborn assessment? |
|
Definition
- size
- macrocephaly/microcephaly
- changes in skin color
- signs of birth trauma
- malformations
- evidence of Resp distress
- level of arousal
- posture
- tone
- presence of spontaneous movements
- symmetry of movements |
|
|
Term
| When in gestation would an insult cause symmemtric vs asymmetric decrease in size for gestational age? |
|
Definition
1) onset early in gestation, brain size corresponding w body size
2) onset late in gestation: no effect on fetal brain growth |
|
|
Term
| Why should congenital exophytic scalp nodules always be evaluated further? |
|
Definition
| - 20-37% connect to underlying central nervous system |
|
|
Term
| What are major causes of unconjugated hyperbilirubinemia |
|
Definition
- physiologic hyperbilirubinemia (most common)
- breastfeeding
- increased production of bilirubin ?(hemolysis, sequestered blood, polycythemia, sepsis)
- decreased hepatic uptake (hypothyroidism, Crigler-Najjar, Gilbert) |
|
|
Term
| What are major causes of conjugated hyperbilirubinemia |
|
Definition
- hepatobiliary disorders: idiopathic hepatitis, TORCH, prolonged parenteral nutrition, metabolic d/o
- ductal disturbances in biliruin excretion (biliary atresia, choledochal cyst) |
|
|
Term
| What is the major causes of large fontanelles? |
|
Definition
- hypothyroidism
- trisomy 13, 18, 21
- bone d/o (cleidocranial dysostosis) |
|
|
Term
| What is the effect of craniosyntosis on growth? |
|
Definition
| 1) premature fusion of cranial sutures resulting in growth restriction perpendicular to affected suture and compensatory overgrowth in urestricted regions |
|
|
Term
| Describe caput succedaneum |
|
Definition
- after prolonged labor
- sec to accumulation of blood above the periosteum
- poorly demarcated soft tissue swelling crossing suture lines
- no tx required |
|
|
Term
|
Definition
- less common than caput succedaneum
- rupture of blood vessel that traverse skull to periosteum
- well-demarcated, fluctuant swelling that does not cross suture lines
- no tx required for uncomplicated lesions |
|
|
Term
| What are the most common causes of neck masses in newborns? |
|
Definition
- vascular malformations
- abnl lymphatic tissue
- teratomas
- dermoids cysts
*e.g. thyroglossal duct cysts* |
|
|
Term
| What are the more common locations for branchial cleft cysts? |
|
Definition
1) postauricular area
- jugulodigastric area
- anterior border of SCM mid-neck |
|
|
Term
| Where are lipomas most commonly found as congenital neck lesions in newborns? |
|
Definition
1) supraclavicular area
- suprasternal area |
|
|
Term
| What are hte most common broken bones in newborns? Tx if in pain? |
|
Definition
- clavicular bones
2) affected arm immobilized abducted to 60deg and elbow flexed 90deg |
|
|
Term
| What congenital condition may simulate facial nerve palsy in newborns? |
|
Definition
| 1) congenital absence or hypoplasia of depressor anguli oris muscle |
|
|
Term
| What are the components of CHARGE association? |
|
Definition
- Coloboma
- Heart disease
- choanal Atresia
- postnatal growth Retardation
- Genital hypoplasia
- Ear anomalies |
|
|
Term
| What are major causes of conjunctivitis in newborns? |
|
Definition
- chemical conjunctivitis (after instillation)
- conorrheal conjunctivitis (1-2d postnatal; ceftriaxone)
- chlamydial conjuncitivits (7-14d postnatal; erythromycin)
- HSV conjunctivitis (14+d postnatal; acyclovir) |
|
|
Term
| What disease is suggested by unilateral absence or hypoplasia of pectoralis major muscle? What are common findings in this disease? |
|
Definition
- poland's syndrome
- rib defects, hypoplasia of UE, syndactyly
- occ: hemivertebrae, renal anomalies, dextrocardia |
|
|
Term
| Disease: cyanosis relieved by crying in newborn |
|
Definition
|
|
Term
| What is the normal heart rate in newborns? |
|
Definition
|
|
Term
| Disease: scaphoid abd in newborn |
|
Definition
| - presence of diaphragmatic hernia |
|
|
Term
| What is the appropriate therapy for a newborn with hip dysplasia? |
|
Definition
|
|
Term
| What is thge difference between metatarsus adductus and talipes equinovarus |
|
Definition
1) C curve of the lateral border of the foot
2) adduction/inversion of the forefoot, inversion at the ankle, and equinus posturing |
|
|
Term
| What population is supernumerary digits more common in? |
|
Definition
|
|
Term
| What is the first step in management of an abdominal mass in a newborn? |
|
Definition
|
|
Term
| What are the associated anomalies in omphalocele vs gastroschisis and what is the mgmt of these defects? |
|
Definition
1) 67% have trisomy 13, 18, 21, congenital heart disease, GI anomalies, neurologic and renal anomalies:: 30% mortality
2) primarily intenstinal atresia:: 10% mortality
3) application of warm, fluid-permeable dressing
- placement of orogastric tube to decompress
- aggressive fluid mgmt
- culture w broad-spectrum abx |
|
|
Term
| What glands must be assessed in the medical emergency of ambiguous genitalia? |
|
Definition
| 1) adrenal and pituitary integrity must be established |
|
|
Term
| What is the incidence of cryptorchidism in term infants? premature infants? |
|
Definition
1) 2.7-5.9%
2) 27-59% (10 times higher than term) |
|
|
Term
| Is milk, bloody secretions from vagina normal in term infants? |
|
Definition
| - it may benormal if there is significant withdrawal of maternal hormones in normal newborns |
|
|
Term
| What are the major benefits of breastfeeding to the mother after pregnancy? |
|
Definition
1) weight loss
- mother-infant bonding
- accelerated uterine involution
- contraception via prolongation of anovulation
- decreased risk of breast/ovarian ca
- decreased risk of osteoporosis |
|
|
Term
| What are the major benefits of breast-feeding to the infant |
|
Definition
- reduces incidence of obesity/ca/HDz/allergies/T1DM/IBD
- decreased Respiratory tract illnesses
- lower rates of diarrhea
- decreased risk of UTI
- increased IQ
- decreased risk of necrotizing enterocolitis and other GI infections |
|
|
Term
| What should be inital antiretrovial regimen for HIV infection? |
|
Definition
- three agents
- two NRTI
- one NNRTI/protease inhibitor
- ritonavir does not count
*goal is undetectable viral load* |
|
|
Term
| What is the acute retroviral syndrome associated with HIV? |
|
Definition
- low-grade fever
- rash
- diarrhea
- nausea and vomiting
- pharyngitis
- aseptic meningitis
- headache |
|
|
Term
| Rank the risk of HIV transmission for population (1) and activity (2) |
|
Definition
(1)
- MSM
- heterosexual contact (high-risk)
- IVDU
- 0-20y/o, ethnic minorities, metropolitan areas
(2)
- receptive anal intercourse
- insertive anal intercourse
- receptive vaginal intercourse |
|
|
Term
| What are the major AIDS defining illnesses |
|
Definition
- candidiasis
- cervical cancer (invasive)
- coccidiodomycosis, disseminated
- cryptococcosis, extrapulm
- cryptosporidiosis, chronic intestinal
- CMV and retinitis w vision loss
- encephalopathy, HIV-related
- herpes simplex virus
- histoplasmosis, disseminated/extrapulm
- isosporiasis, chronic intestinal
- kaposi sarcoma
- lymphoma
- MAC
- TB
- pneumonia, bacterial/recurrent (P. jiroveci)
- PML
- salmonella septicemia, recurrent
- toxoplasmosis of brain
- wasting syndrome, HIV-related |
|
|
Term
| What is the recommendation for HIV screening by physicians? |
|
Definition
1) routinely in pts 13-64yrso
2) screening unless prevalance of undaignosed HIV infection has been documented to be less than 0.1%
- separate consent for HIV screening should not be required
- all patients seeking tx for STI should be screened
- all pregnant women should be screened in both 1st (and 3rd if high prevalence) |
|
|
Term
|
Definition
| - HIV-seropositive pts who have a CD4 count less than 200cells/mm3 or 1 AIDS defining illness |
|
|
Term
| When is treatment w antiretrovirals indicated in HIV positive patients? |
|
Definition
- when CD4 count is less than 350cells/mm3
- should genotype/phenotype these patients prior to initiation |
|
|
Term
| Define: treatment failure of HIV |
|
Definition
- failure to achieve undetecable viral load within 12-24 weeks of therapy OR development of viremia in pts who previously had an undetectable viral load
- modifiable factors (nonadherence, ahem) should be evaluated first |
|
|
Term
| When can antimicrobial prhphylaxis be d/c'd? |
|
Definition
| 1) when the patient has had a CD4 count above the threshold for 3+mo in concordance w undetectable viral load |
|
|
Term
What is the phophylaxis regimen and CD4 cell count cutoff for the following opportunistic infection:
P. jiroveci pneumonia |
|
Definition
1) TMP/SMX double strength tab QD; alt: Dapsone 100mg PO QD
2) 200cells/mm3 |
|
|
Term
What is the phophylaxis regimen and CD4 cell count cutoff for the following opportunistic infection:
toxoplasmosis |
|
Definition
1) TMP/SMX double strength tab QD
2) 100cells/mm3 |
|
|
Term
What is the phophylaxis regimen and CD4 cell count cutoff for the following opportunistic infection:
MAC |
|
Definition
- azithromycin 1200mg PO per week
- 50cells/mm3 |
|
|
Term
| What is the baseline testing recommended for patients with newly dx HIV infection |
|
Definition
- CBC
- chemistry profile
- BUN/Cr
- AST/ALT
- Hep A,B,C
- fasting glucose
- serum lipids
- U/A
- TB
- CXR
- Pap smear
- HIV antibody testing
- CD4 count
- HIV RNA
- genotypic resistance
- anti-toxo titer
- syph, chlam, gon testing |
|
|
Term
| What type of vaccines may HIV patients receiv |
|
Definition
- killed/inactivated vaccines
- ?what about MMR? |
|
|
Term
| What is the recommended pre-HIV test counseling? |
|
Definition
- obtain written informed consent prior to ordering test
- anonymous and confidential testing options
- difference between HIV and AIDS
- HIV transmission and risk reduction
- defer testing if high risk to self/others
- implications of window period
- appt for delivery of results and post-test counseling
- explain meaning of test results
- reassurance |
|
|
Term
| What is the recommended post-HIV test counseling for pt with negative result |
|
Definition
- discuss meaning of test result
- discuss posibility of HIV exposure during past three months (window period) and advisability of retesting
- emphasize negative result does not imply immunity
- reinforce risk reduction strategies |
|
|
Term
| What is the recommended post-HIV test counseling for pt with positive test results |
|
Definition
1) meaning of result
- possibility of medical care
- notification of sexual/needle-sharing partners
- behavior change to prevent transmission of HIV infection
- refer to appropriate medical and support services |
|
|
Term
| What are the three age groups for treatment stratification in asthma? |
|
Definition
- 0-4yrso
- 5-11yrso
- 12+yrso |
|
|
Term
| What is the difference between asthma severity and asthma control |
|
Definition
1) severity: measure of intrinsic intensity of disease process (assessed before initiating tx)
2) control: minitored over time to guide adjustments to therapy |
|
|
Term
| What is the best tool to use for dx of asthma in patients 5+yrso? |
|
Definition
| - spirometry before and after bronchodilation therapy |
|
|
Term
| What is the preferred tx for Step 1 (intermittent) asthma |
|
Definition
|
|
Term
| What is the recommended treatment for patients in each asthma age bracket for Step 2 |
|
Definition
| 1) Low-dose ICS, or cromolyn for all |
|
|
Term
| What is the recommended treatment for patients in each asthma age bracket for Step 3 |
|
Definition
1) medium dose ICS for all
2) low dose ICS w LABA for 5+yrso |
|
|
Term
| What is the recommended treatment for patients in each asthma age bracket for Step 4 |
|
Definition
| 1) medium-dose ICS w LABA for all |
|
|
Term
| What is the recommended treatment for patients in each asthma age bracket for Step 5 |
|
Definition
| 1) high dose ICS w LABA for all |
|
|
Term
| What is the recommended treatment for patients in each asthma age bracket for Step 6 |
|
Definition
| 1) high dose ICS w LABA w OCS for all |
|
|
Term
| What are the recommendations for quick-relief of asthma exacerbation in all ages? |
|
Definition
1) SABA PRN
*frequent use may suggest need to increase step for tx |
|
|
Term
| Why is spirometry testing important in asthma? |
|
Definition
| - because it frequently results in changes to tx of asthma |
|
|
Term
| What frequency should asthma be reassessed? |
|
Definition
1) 2-6wk intervals until control is achieved
- 1-6mo after control has been achieved |
|
|
Term
| When is it appropriate to consider a step down in asthma treatment? |
|
Definition
1) when asthma is well controlled for 3 months or more
2) ICS should be tapered 25-50% q3mo |
|
|
Term
| What are the important aspects of patient-dr rapport to enhance asthma tx adherence? |
|
Definition
| - give every pt a written asthma actionplan that addressed individual sx and/or PEF measurements and includes instructions for self-management |
|
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