Adam Shared "Family Medicine" - 104 Picmonics
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Family Medicine
Recommended Vaccines for Adults 4475
- Age 19-64
- T dap once as substitute for T d booster, then T d every 10 years
- Especially true for pregnant women and other adults who are expected to be in close contact with small children
- Influenza annually
- PPSV23 alone:
- Chronic heart, lung, or liver disease
- Diabetes, current smokers , alcoholics
- Sequential PCV13 + PPSV23 (very high risk patients):
- CSF leaks, cochlear implants
- Sickle cell disease, asplenia
- lmmunocompromised (eg, HIV, malignancy)
- Chronic kidney disease
- Age ≥65
- T dap once as substitute for T d booster, then T d every 10 years
- Influenze annually
- Sequential PCV13 + PPSV23: 1 dose of PCV13 followed by PPSV23 at a later time
Features of Septic Arthritis in Children 2447
- Clinical Manifestations
- Acute onset of fever and joint pain
- Fatigue or malaise
- Refusal to bear weight due to pain
- Physical examination
- Erythema of the overlying skin
- Warmth and swelling of the joint
- Pain with active and passive range of motion
- Laboratory findings
- Arthrocentesis is both diagnostic and therapeutic
- Elevated WBC
- Elevated ESR & CRP
- Synovial fluid WBC > 50,000 cells/μL
- Treatment
- Birth to 3 months:
- Organisms - Staphylococcus, group B streptococcus & and Gram-negative bacilli
- Antibiotics - Antistaphylococcal agent (nafcillin or vancomycin), PLUS gentamicin or cefotaxime
- Older than 3 months:
- Organisms - Staphylococcus , group A streptococci & Streptococcus pneumoniae
- Antibiotics - Nafcillin, clindamycin, cefazolin, or vancomycin
- Blood and synovial fluid cultures should be obtained before administering empiric antibiotics
- Often proceeded by seemingly mild infection ie cellulitis and can spread hematogenously (ie why you also do blood cultures)
- Staph aureus is the most common cause
- 90% neutrophils on aspiration
- Emergency surgical drainage or risk of joint necrosis
- Effusion on ultrasound /MRI
- Pseudoparalysis (lack of movement ) and swelling of the affected joint may be present
Lab and Diagnostic Tests During Pregnancy (Other Visits)
- Diagnosis
- 10-13 Weeks
- Offer Chorionic Villus Sampling (CVS)
- 15-18 Weeks
- Quad Screen
- 18-20 Weeks
- Ultrasound
- Anatomic Screening
- 24-28 Weeks
- One-Hour Glucose Challenge Test
- 35-37 Weeks
- Streptococcus Agalactiae
3 mins
Lab and Diagnostic Tests During Pregnancy (1st Visit)
- Diagnosis
- Complete Blood Count (CBC)
- Blood Typing and Rh
- Rubella
- HIV
- Hepatitis B
- Tuberculosis Skin Mantoux Test (PPD)
- Sexually Transmitted Infections
- Chlamydia
- Neisseria gonorrhoeae
- Syphilis
- Pap Smears
- Urinalysis
- Sickle Cell Screening (If Indicated)
2 mins
Vaccines During Pregnancy 3106
- Recommended
- Tdap
- Inactivated influenza
- Safe during every trimester of pregnancy and while breastfeeding
- Rho(D) immunoglobulin
- Indicated for high-risk patients
- Hepatitis B
- Hepatitis A
- Pneumococcus
- Haemophilus influenzae
- Meningococcus
- Varicella-zoster immunoglobulin
- Contraindicated
- HPV
- MMR
- All rubella-nonimmune patients should be vaccinated during the immediate postpartum period
- Live attenuated influenza
- Varicella
Guidelines for Lipid-Lowering Therapy 3822
- Clinically significant atherosclerotic disease:
- ACS, Ml, Stable or unstable angina, Coronary or other arterial revascularization, Stroke, TIA, PAD
- Age ≤75 High-intensity statin
- Age > 75: Moderate-intensity statin
- LDL ≥190 mg/dl
- High-intensity statin
- Age 40-75 with diabetes and LDL 70-189
- 10-year ASCVD risk ≥7.5% High-intensity statin
- 10-year ASCVD risk: Moderate-intensity statin
- Estimated 10-year ASCVD risk ≥7.5% (Pooled Cohort Equations), 40-75 and LDL 70-189
- Moderate- to high-intensity statin*
- Statins
- High-intensity statins: atorvastatin 40-80 mg, rosuvastatin 20-40 mg
- Moderate-intensity statins: atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg, lovastatin 40 mg
- Medium intensity in liver and renal disaease as well
- Tests prior to starting a statin
- Baseline values of Lipids, A1c, CK, and LFTs are required before starting a statin
- Lipids are assessed annually (NOT q3months)
- A1C reassessed q3months
- CK and LFTs are NOT checked routinely
- Assess them only when there’s evidence of disease ie myositis or hepatitis
- If myositis or hepatitis occur then stop and start back up again at a lower dose
- Aspirin for secondary prevention of CV events in established atherosclerotis; considered primary prevention in diabetes with 10-year risk >10%,
Pediatric Vaccinations - Age 2 Months
- 2 B DR HIP
- Hepatitis B
- DTaP - Diphtheria Tetanus acellular Pertussis
- RV - Rotavirus
- HiB - Haemophilus Influenzae Type B
- IPV - Inactivated Polio Vaccine
- PCV - Pneumococcal
1 min
Pediatric Vaccinations - Age 4 Months
- 4 DR HIP
- DTaP - Diphtheria Tetanus acellular pertussis
- RV - Rotavirus
- HiB - Haemophilus Influenzae Type B
- IPV - Inactivated Polio Vaccine
- PCV - Pneumococcal
1 min
Pediatric Vaccinations - Age 6 Months
- B DR HIP In 6 Months
- Hepatitis B
- DTaP - Diphtheria Tetanus acellular pertussis
- RV - Rotavirus
- HiB - Haemophilus Influenzae Type B
- IPV - Inactivated Polio Vaccine
- PCV - Pneumococcal
- Influenza
2 mins
Pediatric Vaccinations - Age 12 to 15 Months
- 1 Very MAD HIP-ster
- Varicella Zoster
- MMR
- Hepatitis A
- DTaP - Diphtheria Tetanus acellular pertussis
- HiB - Haemophilus Influenzae Type B
- IPV - Inactivated Polio Vaccine
- PCV - Pneumococcal
2 mins
Pediatric Vaccinations Age 4-6 Years
- Very DIM between 4-6pm
- Varicella Zoster
- DTaP - Diphtheria Tetanus acellular pertussis
- IPV - Inactivated Polio Vaccine
- MMR
1 min
Age 2 Months - Developmental Milestones
- Gross Motor
- Holds Head Up, But Unsteady
- Moves Both Arms and Both Legs
- Fine Motor
- Opens Hands Briefly
- Tracks Objects to the Midline
- Language/Communication
- Produces Sounds Aside from Crying
- Reacts to Loud Noise
- Social / Cognitive
- Social Smile
- Recognizes Parents
- Soothed When Spoken to or Picked Up
2 mins
Age 4 Months - Developmental Milestones
- Gross Motor
- Keeps Head Steady Without Support
- Pushes Up on Elbows While on Tummy
- Fine Motor
- Holds a Toy in Hands
- Moves Hands Towards Mouth
- Language/Communication
- Cooing
- Turns to Voice
- Social / Cognitive
- Chuckles
- Enjoys Looking Around
- Looks at Hands With Interest
- Opens Mouth When Hungry
2 mins
Age 6 Months - Developmental Milestones
- Gross Motor
- Sits Propped Up On Hands
- Rolls
- Fine Motor
- Raking Grasp
- Language/Communication
- Makes Squealing Noises
- Blows "Raspberries"
- Turn-Taking in Sounds
- Social / Cognitive
- Laughs
- Enjoys Looking at Self in a Mirror
- Recognizes Familiar People
- Closes Lips to Signal Fullness
- Puts Objects in Mouth
- Reaches for Desired Toys
2 mins
Age 9 Months - Developmental Milestones
- Gross Motor
- Sits Up Independently
- Fine Motor
- Transfers Objects Between Hands
- Uses Fingers to Pull Food Toward Self
- Language/Communication
- Produces Various Sounds Like "mamamama" and "bababababa"
- Raises Arms to be Lifted Up
- Social / Cognitive
- Separation Anxiety
- Shows Facial Expressions
- Looks When Calling Name
- Smiles or Laughs at Peek-a-boo
- Looks for Dropped Objects Out of Sight
- Bangs Two Items Together
2 mins
Age 1 Year - Developmental Milestones
- Gross Motor
- Pulls Up to Stand
- First Steps
- Fine Motor
- Drinks From an Open Cup with Assistance
- Two-Finger Pincer Grasp
- Language/Communication
- Understands “No”
- Waves "Bye-Bye"
- "Mama & Dada"
- Social / Cognitive
- Plays Pat-A-Cake
- Puts Block in Cup
- Searches for Hidden Toys
2 mins
Age 2 Years - Developmental Milestones
- Gross Motor
- Kicks a Ball
- Runs
- Walks Up Stairs With Help
- Fine Motor
- Stacks Six Blocks
- Feeds Self With a Spoon
- Language / Communication
- Two-Word Phrases
- Points to Book Items as Prompted
- Demonstrates Varied Gestures
- Identifies Body Parts When Prompted
- Social / Cognitive
- Shows Empathy
- Holds and Manipulates Objects Simultaneously
- Engages With Multiple Toys
2 mins
Age 3 Years - Developmental Milestones
- Gross Motor
- Starts Dressing Independently
- Rides Tricycle
- Fine Motor
- Stack Nine Block Tower
- Threads Items Together
- Copies Circle
- Uses Fork
- Language / Communication
- Engages in Two-way Conversation
- 75% Speech Understood by Stranger
- Says First Name
- Social / Cognitive
- Avoids Hot Objects When Warned
- Joins Other Kids in Play
2 mins
Age 4 Years - Developmental Milestones
- Gross Motor
- Unbuttons Some Buttons
- Catches a Large Ball
- Serves Food or Pours Water With Help
- Fine Motor
- Copies Line, Circle, Stick Figure
- Language / Communication
- 100% Speech Understandable
- Identifies Colors
- Social/ Cognitive
- Cooperative Play
- Imaginary Friends
- Likes Being a “Helper”
- Avoids Danger
2 mins
Age 5 Years - Developmental Milestones
- Gross Motor
- Buttons Some Buttons
- Hops on One Foot
- Fine Motor
- Prints Letters
- Language / Communication
- Counts to 10
- Uses Simple Rhymes
- >3 Back-and-forth Exchanges
- Answers Simple Questions
- Tells a Story
- Social / Cognitive
- Names Some Letters When Pointed
- Follows Rules
- Sings, Dances, Acts
- Does Simple Chores
2 mins
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