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
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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
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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
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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)
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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
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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%,
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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
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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
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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
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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
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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
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1 min
Age 2 Months - Developmental Milestones
Gross Motor
Holds Head Up, But Unsteady
Fine Motor
Tracks Objects to the Midline
Language
Coos
Social / Cognitive
Social Smile
Recognizes Parents
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1 min
Age 4 Months - Developmental Milestones
Gross Motor
Sits With Support
Rooting Reflex Disappears
Moro Reflex Disappears
Fine Motor
Reaches Across Midline
Language
Turns to Voice
Laughs
Social / Cognitive
Enjoys Looking Around
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2 mins
Age 6 Months - Developmental Milestones
Gross Motor
Palmar Reflex Disappears
Sits Propped Up On Hands
Rolls
Fine Motor
Transfers Objects Hands to Hands
Raking Grasp
Language
Babbles
Responds to Name
Social / Cognitive
Stranger Anxiety Develops
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2 mins
Age 9 Months - Developmental Milestones
Gross Motor
Pulls to Stand
Starts Cruising
Fine Motor
Three-Finger Pincer Grasp
Holds Bottle or Cup
Language
Starts Sounding "Mama" or "Dada"
Social / Cognitive
Waves Bye
Separation Anxiety
Plays Pat-A-Cake
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2 mins
Age 1 Year - Developmental Milestones
Gross Motor
Stands Well
First Steps
Throws Ball
Points to Objects
Babinski Reflex Disappears
Fine Motor
Two-Finger Pincer Grasp
Language
"Mama & Dada"
Social / Cognitive
One-Step Commands with Gesture
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2 mins
Age 2 Years - Developmental Milestones
Gross Motor
Jumps
Fine Motor
Copies a Line
Stacks Six Blocks
Turns Pages
Language
Two-Word Phrases
Half of Speech is Understandable
200 Words by Age 2
Social / Cognitive
Parallel Play
Begins Toilet Training
Rapprochement
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2 mins
Age 3 Years - Developmental Milestones
Gross Motor
Walks Up/Down Steps with Alternating Feet
Rides Tricycle
Fine Motor
Nine Block Tower
Copies Circle
Uses Utensils
Language
Three-Word Sentences
75% Speech Understood by Stranger
Social / Cognitive
Knows Gender / Age
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2 mins
Age 4 Years - Developmental Milestones
Gross Motor
Hop on One Foot
Fine Motor
Copies Square
Uses Fork Well
Language
100% Speech Understandable
Identifies Colors
Social/ Cognitive
Cooperative Play
Imaginary Friends
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2 mins
Age 5 Years - Developmental Milestones
Gross Motor
Skips
Walk Backward
Fine Motor
Copies Triangle
Ties Shoelaces
Independent Dressing / Bathing
Prints Letters
Language
Counts to 10
Five-word sentences
Friends
Social / Cognitive
Completes Toilet Training
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2 mins

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