Vaccinations and immunosuppression. 2 keypoints - ANSWER - - give inactive agents instead of live agents - might not work as effectively live virus vaccine types - ANSWER - Virus: - measles - mumps - polio (oral) - rubella - varicella - yellow fever - herpes zoster Bacteria: - typhoid inactive vaccine virus - ANSWER - Virus: - Hep A and B - HPV - influenza - polio (subq) - rabies Bacteria: - anthrax - cholera - diphteria - Lyme - meningococcus - pertussis - plague - pneumococcus - tetanus Immunization recommendation influenza - ANSWER - all ages, all types (pregnant, diabetes, immunocompromised, etc) Immunization recommendation pregnancy and weakened immune system - ANSWER - - 1 dose Tdap - no varicella, zoster, MMR HIV and vaccinations - ANSWER - Give inactive agents when CD4 count is greater than 200 cells/ mm3 health screening 18 - 45 years - ANSWER - - BMI - BP (q2years) - at age 20: fasting lipid profile: total cholesterol, LDL, HDL, triglycerides (cardiac testing if LDL greater than 200 or HDL lower than 40) - annual breast exam, females - Pap-smear annually health screening 45 and up - ANSWER - - blood glucose q3years - 50 and up: colorectal screening (digital exam annually, sigmoidscopy q5years, colonoscopy q10yrs) - PSA with digital exam annually for males - mammography q1 -2 yrs - women 65 and up: screen for osteoporosis top 5 leading causes of death - ANSWER - 1. heart disease 2. cancer 3. respiratory disease 4. stroke 5. accidents Conjunctivitis; definition - ANSWER - -Pink eyey - Inflammation of conjuctiva (outer layer of eye) Conjunctivitis: causes - ANSWER - Chemical, bacterial, viral, allergic, herpetic. Adenovirus is the most common cause, but bacteria (Haemophilus influenzae and Streptococcus pneumoniae) are also common causes in children. Conjunctivitis: findings - ANSWER - - redness - itching - discharge - edema eyelid - may find gonorrhea or chlamydia in eye discharge Conjunctivitis: management - ANSWER - - cooling - rule out corneal abrasion - bacteria: antibiotic solution (gentamicin, neomycin) - chlamydia: oral tetracycline or erythromycin - gonorrhea: single dose ceftriaxone - herpes: refer to opthalmologist Corneal abrasion: definition, cause, findings, treatment - ANSWER - - disruption of cornea (clear covering of eye) - foreign body/ trauma - pain, redness, photophobia, decreased visual acuity - ab ointment: gentamicin, sulfacetamide, eye-patch, ophthalmologist diabetic retinopathy: definition, cause, findings, treatment - ANSWER - - ocular retinal disease due to DM - DM, exac by smoking and HTN (macular edema) - flashing lights in vision, blurred vision, black spots, loss of vision, sustained glucose greater than 130 - Laser therapy for macular edema, smoking cessation, glucose control, BP control retinal detachment: definition, cause, findings, treatment - ANSWER - - separation of retina and choroid - trauma, intraocular mass, iris inflammation, cataract surgery, DM, sickle cell - painless vision changes, blurred vision, light flashes, "curtain" over visual field, bullous elevation without tears - ophthalmologist for cryotherapy, laser therapy, vitrectomy. If from trauma: eye patch Central & Branch Retinal Artery Occlusion: definition, cause, findings, treatment - ANSWER - - abrupt blockage of retinal artery causing sudden vision loss> will become permanent without intervention - thrombosis/ embolism, arteritis (migraine, older age, afib, DM, HTN, coagulopathies) - sudden, painless vision loss, sluggish pupil, cherry-red spot at fovea - EMERGENCY. Put pressure on eyelid, heparin, immediate consult opthalmolohgist. check coagulopathies, check labs for artherosclerotic disease, blood cultures (endocarditis?), Glaucoma: definition, cause, findings, treatment - ANSWER - - progressive visual loss, first peripherally then centrally: chronic open angle or actute closed angle. Optic neuropathy. - open: too much intraocular fluid production without removal. Secondary from trauma, tumor, or cataracts. Causes: age, steroids, trauma, family history - Photophobia, visual blurring, unilateral headache. Increased intraocular pressure.Acute closed: eye pain and visual disturbance with N/V. - Acute: Emergency. immediate medication and surgery. Chronic: consult opthalmologist and monitor. Bimatropost, and beta-blockers. Laser-therapy Bell's Palsy: definition, cause, findings, treatment - ANSWER - - sudden self-limited unilateral facial paralysis - Idiopathic. Cranial nerve VII (7), sometimes viral cause (herpes), HTN, DM, Lyme's - Unilateral paralysis of face (can't close eye, upper and lower face involved), herpetic lesions, taste disturbances - artificial tears, steroids (to treat CN 7 inflammation), antivirals otitis externa: definition, cause, findings, treatment - ANSWER - - inflammation of the outer ear (swimmers ear) - water, fungi, bacterial, trauma, viral - pain with fullnes of ear, itching, edema, otorrhea - suction of debris, ab and steroid solution in ear, oral ab's (based on bld culture) otitis media: definition, cause, findings, treatment - ANSWER - - inflammation of middle ear - congestion in eustachian tube, respiratory bacteria, neoplasm - pain, hearing loss, vertigo, nausea, pulsatile otorrhea, red and bulging tympanic membrane, hole in tympanic membrane with rupture - ab's (amoxi - 10 days), analgesic for pain, ENT for recurrent vertigo: definition, cause, findings, treatment - ANSWER - - dizziness - vestibular neuronitis, meniere disease, damage to CN 8 (meningitis, trauma), damage to brain stem nuclei, syphilis, drugs, dm, TIA/ CVA - dizziness, tinitis, N/V, "full" ear, Romberg sign (sways/ falls with eyes closed) - TSH (to rule out hypothyroidism), CT/ MRI, glucose, treat symptoms/ bedrest, vestibular suppressants (meclizine, diazepam, scopalamine), antiemetics. low salt and diuretic with meniere epistaxis: definition, cause, findings, treatment - ANSWER - - nosebleed - forceful expiration, winter, trauma, sinusitis, HTN, coagulopathies - bleeding from nose - head erect and elevated, cotton ball with Afrin, topical lidocaine, nasal packing sinusitis: definition, cause, findings, treatment - ANSWER - - inflammation of the sinuses - upper respiratory infections, neoplasms - pain, headache, congestion - ab's (amoxi, doxycycl), analgesics pharyngitis: definition, cause, findings, treatment - ANSWER - - inflammation of pharynx, often with tonsillitis - viral (influenza A & B, Adeno) (most common), bacterial (streptococcus), fungal - pain, fever. Viral: ulcers in oral cavity, edema of lymphoid tissue. Bacterial: white/ yellow exudate, swollen tonsils, bright red mucosa, high fever. Fungal: white spots - rapid strep test, throat culture, mono spot, chlamydia testing, pain relief. Strep: AB's (Bicillin, Cephalxein, azithromycin. Candida/ fungal: Nystatin, fluconazole Epiglottitis (Supraglottitis): definition, cause, findings, treatment - ANSWER - - inflammation of mucous membrane resulting in airway obstruction because of swelling - bacterial (H. influenza, streptococcus, S. aureus) - voice change, dyspnea, anxiety, hoarse voice, drooling, don't examine pharync till x-ray done - xr-neck, CT neck, xr chest, CBC, bld cult, monitor vitals, ER, protect airway (nasotracheal intubation), ab's (3rd cephalo: ceftriaxone or vanco, or clinda) temporomandibular joint (TMJ) disorder: definition, cause, findings, treatment - ANSWER - - pain in joint - rheumatoid arthritis, trauma, dentures, dental work - pain, jaw clicking, earache - NSAIDS, local heat, soft diet