Breast cancer screening guidelines
Start mammograms at 50, end at 74 q2-3y
Lung cancer screening
- Start at 55, end at 74 in adults with > 30 pack year smoking history if currently smoking or quit within 15 years annual LDCT up to 3 consecutive times
- For all others do not need to screen
Colorectal cancer screening
- Start at 50, end at 74 with FOBT or FIT q2y or flex sig q10y
- If first degree relative < 60 when diagnosed or two or more family members diagnosed then begin at 40 or 10 years younger than the earliest case and do colonoscopy every 5 years
- If first degree relative > 60 or two or more second degree family members diagnosed then begin at 40 with FIT q2y (if positive then colonoscopy, if negative then do next FIT in 10 y)
When caring for a child with learning disability what is important to remember in counselling and follow up?
- Regularly assess the impact on the child and family
- Ensure the patient and family have access to community resources
- Match the complexity and amount of information with the patient’s ability to understand
What types of meningitis should be considered if lymphocytes are high? Neutrophils?
High lymphocytes think viral or TB
High neutrophils think bacterial
BUT BE AWARE OF RECENT ANTIBIOTIC USE
Treatment for bacterial meningitis
If baby < 28 days ampicillin + cefotaxime
If 29-3 months ceftriaxone/cefotaxime + vanco + amp
If 3 months to 50 yo ceftriaxone and vanco
If over 50 ceftriaxone + ampicillin + vancomycin ± acyclovir ± steroid therapy
Initiate empiric IV AB before LP complete
Add the ampicillin bc you are trying to cover for L monocytogenes in the elderly but also consider in alcoholics or immnocompromised
Add dexamethaone IV if pneumococcal meningitis but NOT for neonates
What are the typical CSF findings for bacterial meningitis?
High protein and neutrophils
Low glucose
Bacteria eat the sugar
WHat are the typical CSF findings for viral meningitis?
High protein and lymphocytes
Normal glucose
What is the prophylaxis for meningitis contacts?
Close contacts of pts with HiB treat with rifampin if live with inadequately immunized or immunocompromised child
Close contacts of N meningitidis give cipro/rifampin/cefrixone AND meningococcal vaccines for outbreak control
Treament for tetanus exposure
Wound debridement
IV metronidazole or IV penicillin G
Neutralize toxins with tetanus immunoglobulin
May need to consider intubation, spasmolytic meds like benzos, cooling blankets
MEDS MAY FAIL TO TREAT UNLESS ADEQUATE WOUND DEBRIDEMENT IS PERFORMED
Infection does not produce immunity - VACCINATE PATIENTS ON DIAGNOSIS
Confusion Assessment Method for delirium
Likely if 1+2 and 3 or 4 are present
- Acute onset and fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
Common in post op and mechnically ventilated patients
1/3 of general medical patients > 70 have delirium
What are some major ways to differentiate delirium and dementia?
- Delirium is quick, dementia is gradual or step wise
- Delirium is reversible, dementia is usually irreversible
- Delirium has fluctuating level of consciousness, dementia has normal level of consciousness
- Delirium has severe agitation/retardation, dementia has disinhibition and loss of ADLs with personality changes
- Delirium has reversed sleep wake, dementia has fragmented sleep
- Delirium has marked short term memory loss, dementia has working and long term memory loss
Can clear C spine if:
- Oriented to person, place, time, event
- No evidence of intoxication
- No posterior midline cervical tenderness
- No focal neurological deficits
- No painful distracting injuries (ie long bone fractures)
If not then do 3 view C spine series (lateral, odontoid, AP)
What are signs of neurogenic shock in C spine injury?
Hypotension, bradycardia, poikilothermia
Occurs within 30 minutes of spinal cord injury at T6 or above
Lasts up to 6 weeks
Provide airway support, fluids, atropine for bradycardia, vasopressors for BP
Which are the live vaccines?
MMR
MMRV
univalent varicella
herpes zoster
BCG
All travelers with fever should undergo which tests?
fever in a returned traveler from a malaria endemic area is malaria until disproven
- CBC and diff, LFT, electrolytes, creatinine, blood C&S
- Thick and thin blood smears x 3 (MALARIA)
- Urinalysis, C&S
- Can consider (regional): stool C&S/O&P, CXR, viral serology, dengue serology or PCR
What empiric treatment is given in a patient with ongoing fever for 2-3d post travel and negative malaria smears with cultures pending?
Name for India/Southeast Asia and all other
India/Southeast Asia: Azithromycin ± Doxycycline
Other: Ciprofloxacin ± Doxycycline
A for Asia for Azithro
How do you test for TB?
CXR
Sputum culture and acid fast stain
NAAT test
How to treat traveler’s diarrhea?
Fluoroquinolone (ie ciprofloxacin 750 mg qd po x 3d)
Azithromycin 1000 mg po once
Rifaximin 200 mg po tid x 3d
Yersinia
Edematous auditory cancel with increased pain when pushing on the tragus or pulling on the pinna suggests?
Otitis externa
Erythematous and bulging tympanic membrane suggests?
Acute otitis media
MC pediatric cause of otalgia
MCC S pneumo, H flu, M cat, viral
Negative middle ear pressure causes influx of pathogens from nasopharynx
Otitis media treatment
- Usually just symptomatic
- If less than 6 months old, immunodeficient, severe symptoms or treatemtne failure or you don’t think they will have regular follow up then treat with high dose amoxicillin or amoxicillin-clavulanate
- If infection persists then may need myringotomy and tube insertion
Otitis externa treatment
- Antipseudomonal ear drops ie Ciprodex
- Often requires manual debridement or ear wick insertion if canal is edematous or obstructed
