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TWU FHN 1

Family Health Final

QuestionAnswer
What is the key organism that causes otitis externa? PSEUDOMONAS
what is the second most common disease of childhood after URI? Otitis Media
• The peak incidence of AOM is between 6 and 15 months of age
• OM is more common in boys and those of lower socioeconomic status
• There is increased incidence of OM in: in Native Americans and Alaskan natives and in certain high risk populations such as those children with HIV, cleft palate and trisomy 21
• The major risk factors for AOM are young age, bottle-feeding bottle in bed, parental history of frequent ear infections, presence of a sibling in the home, sharing room w/ sibling w/ history of ear infection, passive exposure to tobacco smoke and daycare exposure to infectious agents
I. Know which antibiotics to use when treating for susceptible to intermediate penicillin resistant strains of S. pneumoniae (initial therapy) Amoxicillin high dose 80-90 mg/kg/day
which antibiotics to use when highly penicillin resistant strains of S. pneumoniae. Rocephin or clindamycin
which antibiotics to use when failure on initial therapy occurs--this is usually caused by presence of M. catarrhallis or H. influenzae (these are beta-lactamase producing bugs so will nullify any beta lactam drugs--the penicillin group) : Amoxicillin hi-dose with clavulanic acid brand name Augmentin
substitute drugs in case of penicillin allergy. First-line treatment Amoxicillin 80-90 mg/kg/day PO (maximum 3 g/24h) divided BID for 5-7d; 10d may be required Ceftriaxone 50 mg/kg IM × 1 dose (maximum 1 g); recommended for children unable to take antibiotics PO and for patients with compliance issues
Children with acute otitis media with tympanostomy tubes: substitute drugs in case of penicillin allergy. • Ciprofloxacin 0.3%/dexamethasone 0.1% otic solution 4 drops BID × 7d or • Ofloxacin otic solution 5 drops BID × 10d
substitute drugs in case of penicillin allergy. Second-line treatment Penicillin allergic: Non – type-1 hypersensitivity: • Cefdinir 14 mg/kg/day (maximum 600 mg/24h) PO qd or divided BID for 5-10d or • Cefpodoxime 10 mg/kg/day (maximum 400 mg/24h) PO qd or divided BID for 5-10d or • Cefuroxime 30 mg/kg/day PO (maximum 1 g/24h) divided BID for 5-10d
substitute drugs in case of penicillin allergy. Second-line treatment Type-1 hypersensitivity: • Azithromycin 10 mg/kg/day (maximum 500 mg) PO × 1 dose, then 5 mg/kg/day (maximum 250 mg/24h) PO qd × 4d or • Azithromycin 10 mg/kg/day (maximum 500 mg/24h) PO qd × 3d or • Clarithromycin 15 mg/kg/day (maximum 1 g/24h) PO divided BID for 5-10d
Recurrent acute otitis media/treatment failure Amoxicillin-clavulanate 90 mg/kg/day (based on amoxicillin component using ES formulation; maximum 4 g/24h) PO divided BID for 5-7d or Cefdinir 7 mg/kg Cefpodoxime 10 mg/kg/day Cefprozil 15 mg/kg Cefuroxime 30 mg/kg/day Ceftriaxone 50 mg/kg
Persistent treatment failure Acute otitis media • Ceftriaxone 50 mg/kg qd IM (maximum 1 g/24h) for 3d or • Clindamycin 20-30 mg/kg/day divided QID for 5-7d
CHOLESTEATOMA The hallmark symptom is a painless otorrhea
BULGING • When the middle ear space contains a large amount of fluid, the membrane is forced outward. Note that the membrane seems to bulge around the umbo creating a donut like appearance. The bulging often impairs the visibility of the bony landmarks.
EFFUSION • Fluid present from 3 to 16 weeks following the diagnosis of acute otitis media without otoscopic signs of inflammation is a residual effusion. After 16 weeks the fluid can be classified as a persistent effusion
Hives (urticaria) are raised, red, itchy welts. The majority of urticaria develop as a result of allergic reactions. Occasionally, they may be associated with autoimmune diseases, infections (parasitosis), drugs, malignancy, or other causes.
Impetigo is a common skin infection. A single or possibly many blisters filled with pus; easy to pop and -- when broken -- leave a reddish raw-looking base (in infants)
Impetigo Treatment A mild infection may be treated with a prescription antibacterial cream. More severe cases may require antibiotics, taken by mouth. Wash the skin several times a day, preferably with an antibacterial soap, to remove crusts and drainage.
Impetigo Causes streptococcus (strep) or staphylococcus (staph) bacteria. injury or trauma to the skin In adults, it may follow other skin disorders or a recent upper respiratory infection such as a cold or other virus.
Acanthosis nigricans is a brown to black, poorly defined velvety, hyperpigmented plaques and warty-papules in the axillae, groin, neck, and/or anogenital region.
The adult form of acanthosis nigricans may be associated with diabetes mellitus or insulin resistance (normal glucose, elevated insulin), obesity, medications, and internal malignancies.
BROWN RECLUSE SPIDER BITES: pruritus, burning pain, erythema, and swelling at the bite site within 2 to 6 hours. bluish necrotic depression
Treat brown recluse spider bites standard local wound care. Consider antibiotic therapy only if secondary infection develops.
Tinea versicolor (pityriasis versicolor) is a common dermatophyte skin infection caused by the yeast infection (Pityrosporum ovale). The yeast interferes with the normal tanning of the skin. This results in small areas that are lighter than surrounding skin.
TINEA CAPTIS • Inflammatory tinea capitis produces pain, tenderness and may or may not have hair loss (alopecia) • Noninflammatory types produce scaling pruritis, and either a diffuse or circumscribed alopecia; can produce occipital or auricular adenopathy
Eczema (Hallmark= pruritis) flexural areas usually caused by allergies Topical steroids until skin clears Group V corticosteroids for red, scaling skin Group I or II for lichenfied skin Face- 1 to 2 % hydrocortisone or Elocon 0.1%
Psoriasis (Auspitz’s sign) Silvery scale on erythematous base Autoimmune Drugs which exacerbate: Lithium Beta Blockers Antimalarials Systemic Steroids Ultraviolet Light B Topical steroids- long term use causes atrophy and telangiectasia: Group I-V UVB and tar Methotrexate Dovonex
Seborrheic Dermatitis Example of seborrheic dermatitis is cradle cap Shampoos Oral Griseofulin- better absorbed with fatty meal Topicals
Fifth disease (Erythema Infectiousum) Low grade fever, malaise, and sore throat “slapped check erythema”- may spread to extremities NO NEED TO STAY OUT OF SCHOOL No tx
Impetigo (lesions with golden serous crest) Children: usually on face Adults: can occur after viral URI Anywhere there was open skin: Animal Bite Human Bite Insect Bite Injury/trauma to skin Oral antibiotics: Cephalosporins Tetracyclines Bactrim (TMP-SMX) Topical: Bactroban
Hand-foot-mouth disease (Coxsackie’s) Vesicle like glove on hands, feet, and mouth AND Low grade fever tx -None- usually resolves in 1 week
Tinea Corporis Flat, scaly, variably pruritic, annular lesions with active raised, advancing papulovesicular border & central clearing Wet dressing with Burow’s solution Topical imidazole bid Griseofulvin for 1 wk for extensive tinea corporis
Tinea Capitis Adults: Griseofulvin 500 mg Po for 4-8 weeks Children: Griseofulvin 10-20 mg/kg/day for 4-8 weeks Ketoconazole
with scales Tinea versicolor (pitryriasis) Hypo/hyperpigmented macules Dx- Woods Lamp/KOH= Spaghetti and Meatballs TX: Selenium shampoo Selenium sulfide 2.5 % mixed with water applied to affected areas, left on over night, and washed off in am 1 week later Imidazole, clotrimazole, miconazole cream applied bid for 2 weeks
Shingles Follows dermatome- will usually not cross midline Usually resolves in 2 weeks Zostavax Warm soaks of Burow’s solution tid Inform pregnant contacts Avoid touching shingles lesions
Rash on palms and soles Syphillis Conical papules-reddish brown in color Benzathine PCN G 2.4 million units IM- single dose *Teach patient about Jarisch Herheimer reaction- fever, headache, myalgia- this can occur within first 24 hours of starting treatment
Herpes Simplex Virus Vesicles appear red on base, center depressed (umbilicated) and crusts form Lesions heal with or without scarring Oral: carmex, blistex, zovirax 5% qid Genital: Valtrex, Zovirax, Famir
Scabies Papules, itchy- esp. at nightAdult: Axilla, waist band, antecubital, wrists, knees, buttocks Infants: Palms, soles Elderly: Few lesions- itch severely scaling Permethrin 5% dermal cream Apply neck down to toes, leave on for 8-12 hours and wash off Teach: Wash linens and bed cloths in hot water Live 3 days off body Will itch for 6 weeks after tx.
Pediculosis (LICE) Capitus Corporis Pubis Permethrin 1% Teach: Retreat- 2nd dose kills embryos
Potency of Corticosteroid medications 1. Eczema -low potency 2. Psoriasis – high potency 1. Super Potent: Class I 2. Potent: Class II and III 3. Intermediate: Class IV and V 4. Mild: Class VI and VII *****Note: Class I is about 1000 times more potent than 1% hydrocortisone.
ABCDE mnemonic of signs/symptoms of Melanoma a. A (asymmetry) b. B (border)- irregular c. C (color)- change in color d. D (diameter)- > 6 mm (size of pencil eraser) e. E (elevation)- Elevation from flat to a raised one or evolving lesion
Comedones the skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne.
 Open comedones are blackheads; black because of surface pigment (melanin) rather than dirt
 Closed comedones are whiteheads; the follicle is completely blocked
 Macrocomedones facial closed comedones that are larger than 2-3 mm in diameter
EYES HTN: 1. Routine fundoscopy recommended 2. Carotid disease increases the risk of Amaurosis fugax- “fleeting blindness”- these patient require a carotid endarectomy
EYES DM: 1. Diabetic retinopathy is the most common cause of blindness in Americans 20-77 2. Should have annual exams with dilation 3. Routine fundoscopy recommended
EYES Clients with a family history of Glaucoma: 1. Should have annual exams
Downs Syndrome: EYES 1. Increased ear and eye risk
Ophthalmologic Referrals 1 Sudden loss of vision--emergent 2. In uninflamed or inflamed eye 3. Gradual loss of vision 4. Cataract, macular degeneration, chronic glaucoma, tumors, chronic uveitis 5. Orbital cellulitis 6. Gonococcal keratoconjunctivitis Major ocular trauma
Colic • Defined by the rule of three 1) Crying for > 3 hours per day 2) Crying for > 3 days per week 3) Crying for > 3 weeks in a child who is well fed and otherwise healthy
Target Lesions – listen carefully about those • Red (erythema), white and black (necrosis) lesions • White on edges, then red closer in, and then black in the middle • Usually occur when patient tries to self-treat • Can’t treat in clinic The black areas have no vascular supply
All Prescriptions require: Name (address) Date of birth of patient Prescribers full name, title, address of business, telephone number, and requirement as required specific to the prescription EX:DEA/ DPS/ RX number Date of issuance Signature of prescriber with title Directions
Mononucleosis is caused mainly by which virus? Epstein-Barr virus (EBV)
Diagnosis of pediculosis in humans diagnosis is made when a live louse is detected in the hair of a host.
A person should not seek treatment for scabies when: C. They visited grandma and she mentioned that her bridge partner’s husband Lou has scabies.
Blepharitis (BLEH-fuh-REYE-tis) dryness and flaking of the eyelashes, resulting in an inflammatory response.
Hordeolum (hawr-dee-uh-luhm) is an acute infection of the Zeis’s gland or the Moll gland (external hordeolum or stye) or meibomian gland (internal hordeolum). Usual causes: Staphylococcus aureus or Staphylococcus epidermidis
Chalazion (kuh-ley-zee-uhn)  Caused by an obstruction of the meibomian gland.  More common in adults than children.
Name an eyelid condition which is caused by an obstruction- not by an infection. Chalazion
. The nurse practitioner is developing a teaching plan for the client with hordeolum. Which of the following instructions would the nurse include in the plan of care? Do not share wash clothes, towels, and makeup.
The nurse is performing an assessment in a client with a suspected diagnosis of blepharitis. The subjective findings that the nurse would expect to note is: “My eye burns and itches. When I go out in the sun, I have to put on sunglasses because my eyes are so sensitive. When I wake up, my eyelids are crusted together.”
What is the most effective treatment for enuresis? Bedwetting alarm
All of the following are expected clinical findings in encopresis a) Lax and patulous anal sphincter b) Enlarged rectum c) Stool impaction
What is the drug of choice for bacterial conjunctivitis? Erythromycin ophthalmic ointment
What symptoms may be present on your assessment of a patient with viral conjunctivitis? )Sore throat and fever  b)Photophobia, visual impairments  c)Sneezing and runny nose
) When differentiating between allergic conjunctivitis and bacterial conjunctivitis, allergic conjunctivitis is most often associated with: Thin, watery discharge
Which of the four choices represents the classic sign associated with otitis externa that is not noted in otitis media? Pain with manipulation of the pinnae, especially the tragus.
Which group is most likely to develop cerumen impactions? nursing home patients
Auspitz sign: Punctuate bleeding points with removal of scales.
clinical presentation of Eczema . Pruritus Late stage lesions are crusted, scaly, thickened, & lichenified D. Lesions are located in hot moist areas & areas where rubbing and scratching occur
58 year old man presented to the clinic with punctuate bleeding spots while removing the psoriatic scales. This sign is _________ sign. Auspitz sign
Mild acne—few papules/pustules, no nodules Antibiotic gels and creams Benzoyl peroxide (2%, 5%, or 10%)—graduate to twice daily if needed, as tolerated Erythromycin (2%)—twice daily Retinoids (creams and gels) Tretinoin (0.01% to 0.05%)—twice daily, graduate if needed, as tolerated
Moderate acne—several papules/pustules, rare nodules Add oral antibiotics to mild acne topical regimen Tetracyline—500mg Minocycline—100mg Doxycycline—50-100mg twice daily, taper to 50 mg daily Counsel point—these antibiotics are teratogenic Bactrim—single strength, bid if above antibiotics dont work. Effective against gram-negative folliculitis.
Severe acne—many papules/pustules with many nodules Topicals used for mild acne plus: Oral isotretinoin—0.5-1 mg/kg given in divided doses taken with food Adjunct systemic glucocorticoids Intralesional triamcinolone—for inflammatory cysts and nodules 0.05ml of a 3-5mg/ml solution
Which of the following skin disorders have signs that include comedones, papules, and pustules? C. Acne vulgaris
Patients with rosacea should be assessed for the following potentially serious problem: Patients with rosacea should be assessed for eye involvement, as rosacea keratitis may cause ulceration of the cornea and blindness.
Ideal Candidate for BRACA 2 family members diagnosed early
at risk for testicular cancer Men with undecended testes
Prostrate cancer African male has 2x the risk of a Caucasian male
Created by: kcorkinsnctc