HVAC Excellence - ELECTRICITY Exam
Guide with complete solution
Types of prevention - -primary- car restraints, bicycle helmets,
immunizations
secondary- prevent for those with RF-pap, mammo
tertiary-mgmt of established disease- meds, lifestyle
-Primary - -Preventing the health problem, most cost effective form of
healthcare **IMMUNIZATIONS, ensuring adequate illumination at home
(preventing falls)
-Secondary - -Detecting disease in early asymptomatic stages, screenings
-Early cause finding of asymptomatic disease via the use of a screening test
Ex. highly abnormal mammo not final word
-Tertiary - -Minimizing negative disease induced outcomes, potentially
viewed as a failure of primary prevention
Ex- rehab, PT, OT
-Who should not receive influenza vaccine - -4 mon old born at 32 weeks
gestation
receive flu- 6 mon and older
can give during pregnancy/lactation
give children 2x- 4 months apart
-MMR - -preggers can't receive (no varicella, or zoster, smallpox, flu mist,
rotavirus), but lactation OK!
its live but weakened
give again to those born after 1957
Give to 6-11 month who are travelling outside US
May treat and have an innocent flat pink rash
2 doses ( at 12-15 mon and 4-6 years)
-Tetanus - -can get from soil, a depth of the wound is important
Preggers- get a tdap in her thirst trimester to pass onto the unborn child
(pertusis is a bad outcome!), family members need to be up to date- can
cause lockjaw
T-dap- 1 at 11-64 and then booster every 10
dTap-five doses
,Pertussis- uncontrollable cough, vomitting, fatigue, dx: nasopharyngeal
culture and PCR testing
tx: Azithromycin
-No pap smear - -prior to 21 or in elderly
-Benadryl - -older, cross BBB, can cause sedation, urinary retention (bad for
BPH)
-herpes zoster - -stronger chickenpox vaccine-zoster vaccine
post-herpetic neuralgia- persists after 1 month
Herpes keratitis is damage to the corneal epithelium caused by the herpes
virus, commonly shingles. The patient usually has acute onset of eye pain,
photophobia, and blurred vision in the affected eye.
-primary open angle glaucoma - -peripheral vision loss, elevated intraocular
pressure, deep-cupping of optic disc, tx with beta-adrenergic antag (Timolol),
alpha agonists, prostaglandin analogues
Glaucoma screening test- Tonometry
-Normative aging - -Need for increased illumination
-Macular degeneration - -central vision loss, common cause of new onset
blindness in elderly
More females
Screening tests- Amsler grid test
-Meniere's disease (idio) vs. Meniere's syndrome (secondary) - -dizziness,
tinnitius, nystagmus, vertigo RF: ototoxic drugs, tx: benzos for rest and
corticosteroids for anti-inflam
-oral cancer - -ulcerated lesion with indurated margins, most common SCC,
RF: HPV 16, screening at dental visits
-beta lacatams with allergic reactions - -penecillins, cephalosporins,
carbapenems
rashes with Epstein Barr
-Otitis externa - -Caused by fungus- Candidia or Aspergillus/P. aeruginosa
hallmark is pain on palpating tragus
Tx--> fluoroquinolone
,-AOM - -S.penumoniae (gram pos)-40-50%, tx with amox/cephalo,
macrolides, resistance protein binding sites
H.influenza (gram neg)- can produce beta-lactamase
M.catarrhalis (gram neg)- also produces beta-lactamase, can get better
without antibiotic
Need abnormal ear drum (bulging TM) + pain (otalgia)/rubbing/tugging ear
tx- Acetaminophen and otic drops help with ST
Watchful waiting- 6 months or older, with non-severe illness, unilateral, fever
<102.2, otalgia <48
<6 months-begin antibiotic!! if allergy-Cefdinir], RF: pacifier use for 10
months, feedings in the supine, smoke exposure, day care,
<2- 10 days
2-6 yrs- 7 days
>6 yrs- 5 days
1st line- Amox 90 BID, Amox clav BID
With PCN allergy- **Cefdinir (Cephlosporins)
-Group A strep
(GABHS) - -Streptococcus pyogenes, risk for rheumatic fever and Glomerulo.,
peritonsillar abscess,
tx- amox then try macrolide if doesnt't improve
GOLD STANDARD IS THROAT CULTURE
-indoor allergen - -dust mites (perennial), pets, cockroaches, mold spores
-Acute Bacterial rhinosinusitis - -S.penumoniae**, RF-viral infection,
allergies, tobacco use, 1st line is Augmentin, penicillin allergy-Cefdinir
2nd line- if not better...Clindamycin and Cefixime
-Mono - -30-50 days ago was infected before sxs, give prednisone not amox
(rash), at least 50% present with spleen enlargement, wait 1 month to go
back to sports
Anterior and posterior cervical lymph
Pharyngitis with exudate
right and left upper quadrant abdominal tendernes
Hepatomegaly in 10% of cases
Splenomegaly in 50% of cases
, -Asthma flare - -FEV1/Peak expiratory flow rate- drops early (even before
patient notices) and good indication of severity of asthma
-S3 - -systolic dysfunction or early diastolic, common in HF (dyspnea,
crackles, tachycardia- 3 adject/s3),
marker of ventricular overload- best heard with bell
-S4 - -diastolic dysfunction, common in poorly-controlled hypertension,
recurrent myocardial ischemia, unstable angina
-Systolic Murmurs - -Mitral (rad to axilla) Mitral Benign is- negative hx
Regurgitation Valve lower grade
Physiologic Prolapse no radiation
Aortic (rad to neck) PMI WNL
Stenosis (harsh) softens w. position change
Systolic
-Diastolic Murmurs - -Mitral
Stenosis (Rumble)
Atrial
Regurg (blowing)
Diastolic
-Aortic stenosis - -young man, exercise tolerance, harsh systolic murmur,
softer when changing position, radiation to the neck (assume it came out of
AORTIC VALVE)
LVH, congenital defect
RF- rheumatic fever, older adults-calcification
-Calcific aortic stenosis - -82 y/o woman, dizzy walking up a flight of stairs,
harsh systolic murmur radiation to neck,
-Mitral Regurgitation - -62 y/o male with HTN, HF, PMI displaced (big LV),
accentuated when rolled to the side, louder with hand grip, holosystolic,
blowing murmur
-Mitral Valve Prolapse - -27 y/o woman, runner, oral contraceptive, funnel
chest/pectus excavatum, mid-late systolic murmur which moves forward
upon position change
HONKING (heard best at apex)
Marfan's syndrome, scoliosis
Tx: obtaining an echo is a prudent next step
Guide with complete solution
Types of prevention - -primary- car restraints, bicycle helmets,
immunizations
secondary- prevent for those with RF-pap, mammo
tertiary-mgmt of established disease- meds, lifestyle
-Primary - -Preventing the health problem, most cost effective form of
healthcare **IMMUNIZATIONS, ensuring adequate illumination at home
(preventing falls)
-Secondary - -Detecting disease in early asymptomatic stages, screenings
-Early cause finding of asymptomatic disease via the use of a screening test
Ex. highly abnormal mammo not final word
-Tertiary - -Minimizing negative disease induced outcomes, potentially
viewed as a failure of primary prevention
Ex- rehab, PT, OT
-Who should not receive influenza vaccine - -4 mon old born at 32 weeks
gestation
receive flu- 6 mon and older
can give during pregnancy/lactation
give children 2x- 4 months apart
-MMR - -preggers can't receive (no varicella, or zoster, smallpox, flu mist,
rotavirus), but lactation OK!
its live but weakened
give again to those born after 1957
Give to 6-11 month who are travelling outside US
May treat and have an innocent flat pink rash
2 doses ( at 12-15 mon and 4-6 years)
-Tetanus - -can get from soil, a depth of the wound is important
Preggers- get a tdap in her thirst trimester to pass onto the unborn child
(pertusis is a bad outcome!), family members need to be up to date- can
cause lockjaw
T-dap- 1 at 11-64 and then booster every 10
dTap-five doses
,Pertussis- uncontrollable cough, vomitting, fatigue, dx: nasopharyngeal
culture and PCR testing
tx: Azithromycin
-No pap smear - -prior to 21 or in elderly
-Benadryl - -older, cross BBB, can cause sedation, urinary retention (bad for
BPH)
-herpes zoster - -stronger chickenpox vaccine-zoster vaccine
post-herpetic neuralgia- persists after 1 month
Herpes keratitis is damage to the corneal epithelium caused by the herpes
virus, commonly shingles. The patient usually has acute onset of eye pain,
photophobia, and blurred vision in the affected eye.
-primary open angle glaucoma - -peripheral vision loss, elevated intraocular
pressure, deep-cupping of optic disc, tx with beta-adrenergic antag (Timolol),
alpha agonists, prostaglandin analogues
Glaucoma screening test- Tonometry
-Normative aging - -Need for increased illumination
-Macular degeneration - -central vision loss, common cause of new onset
blindness in elderly
More females
Screening tests- Amsler grid test
-Meniere's disease (idio) vs. Meniere's syndrome (secondary) - -dizziness,
tinnitius, nystagmus, vertigo RF: ototoxic drugs, tx: benzos for rest and
corticosteroids for anti-inflam
-oral cancer - -ulcerated lesion with indurated margins, most common SCC,
RF: HPV 16, screening at dental visits
-beta lacatams with allergic reactions - -penecillins, cephalosporins,
carbapenems
rashes with Epstein Barr
-Otitis externa - -Caused by fungus- Candidia or Aspergillus/P. aeruginosa
hallmark is pain on palpating tragus
Tx--> fluoroquinolone
,-AOM - -S.penumoniae (gram pos)-40-50%, tx with amox/cephalo,
macrolides, resistance protein binding sites
H.influenza (gram neg)- can produce beta-lactamase
M.catarrhalis (gram neg)- also produces beta-lactamase, can get better
without antibiotic
Need abnormal ear drum (bulging TM) + pain (otalgia)/rubbing/tugging ear
tx- Acetaminophen and otic drops help with ST
Watchful waiting- 6 months or older, with non-severe illness, unilateral, fever
<102.2, otalgia <48
<6 months-begin antibiotic!! if allergy-Cefdinir], RF: pacifier use for 10
months, feedings in the supine, smoke exposure, day care,
<2- 10 days
2-6 yrs- 7 days
>6 yrs- 5 days
1st line- Amox 90 BID, Amox clav BID
With PCN allergy- **Cefdinir (Cephlosporins)
-Group A strep
(GABHS) - -Streptococcus pyogenes, risk for rheumatic fever and Glomerulo.,
peritonsillar abscess,
tx- amox then try macrolide if doesnt't improve
GOLD STANDARD IS THROAT CULTURE
-indoor allergen - -dust mites (perennial), pets, cockroaches, mold spores
-Acute Bacterial rhinosinusitis - -S.penumoniae**, RF-viral infection,
allergies, tobacco use, 1st line is Augmentin, penicillin allergy-Cefdinir
2nd line- if not better...Clindamycin and Cefixime
-Mono - -30-50 days ago was infected before sxs, give prednisone not amox
(rash), at least 50% present with spleen enlargement, wait 1 month to go
back to sports
Anterior and posterior cervical lymph
Pharyngitis with exudate
right and left upper quadrant abdominal tendernes
Hepatomegaly in 10% of cases
Splenomegaly in 50% of cases
, -Asthma flare - -FEV1/Peak expiratory flow rate- drops early (even before
patient notices) and good indication of severity of asthma
-S3 - -systolic dysfunction or early diastolic, common in HF (dyspnea,
crackles, tachycardia- 3 adject/s3),
marker of ventricular overload- best heard with bell
-S4 - -diastolic dysfunction, common in poorly-controlled hypertension,
recurrent myocardial ischemia, unstable angina
-Systolic Murmurs - -Mitral (rad to axilla) Mitral Benign is- negative hx
Regurgitation Valve lower grade
Physiologic Prolapse no radiation
Aortic (rad to neck) PMI WNL
Stenosis (harsh) softens w. position change
Systolic
-Diastolic Murmurs - -Mitral
Stenosis (Rumble)
Atrial
Regurg (blowing)
Diastolic
-Aortic stenosis - -young man, exercise tolerance, harsh systolic murmur,
softer when changing position, radiation to the neck (assume it came out of
AORTIC VALVE)
LVH, congenital defect
RF- rheumatic fever, older adults-calcification
-Calcific aortic stenosis - -82 y/o woman, dizzy walking up a flight of stairs,
harsh systolic murmur radiation to neck,
-Mitral Regurgitation - -62 y/o male with HTN, HF, PMI displaced (big LV),
accentuated when rolled to the side, louder with hand grip, holosystolic,
blowing murmur
-Mitral Valve Prolapse - -27 y/o woman, runner, oral contraceptive, funnel
chest/pectus excavatum, mid-late systolic murmur which moves forward
upon position change
HONKING (heard best at apex)
Marfan's syndrome, scoliosis
Tx: obtaining an echo is a prudent next step
