[1] Common Ambulatory Care Cases Flashcards
A diagnosis of Dyspepsia requires at least this duration of time
2 weeks
Alarm Features of Dyspepsia (14)
- Age at Onset > 55
- Weight Loss
- Anemia
- Hematemesis
- Melena
- Hematochezia
- Dysphagia
- Odynophagia
- Persistent Vomiting
- Abdominal Mass
- Jaundice
- Chronic NSAID Intake
- Chronic Alcohol Intake
- Previous History of Ulcer
[Treatment]
Dyspepsia
2-4 weeks PPI, 1 tab OD before breakfast
[Watch Out For]
Dyspepsia
- Increased abdominal pain
- Alarm symptoms
- Absence of improvement after >7 days of treatment
[Alternative Medical Treatments]
Dyspepsia
- H2-RA Antagonists (e.g. Ranitidine)
2. Antacids (e.g. Aluminum + Magnesium Hydroxide or Alginates)
[Non-Pharmacologic Treatment]
Dyspepsia
- Small frequent feedings
- Avoid skipping meals
- Avoid alcohol, milk, tea, carbonated drinks, coffee, acidic food/beverages
- Avoid smoking
- Head elevation at bedtime
- Last meal 2 hours before bedtime
How much zinc supplementation should you give to a patient suffering from diarrhea who is 2-6 months old?
1/2 tablet daily for 14 days
Zinc = 20mg/tab
How much zinc supplementation should you give to a patient suffering from diarrhea who is 6 months or older?
1 tablet daily for 14 days
Zinc = 20mg/tab
Based off JNC7/8 Guidelines, how do you differentiate Hypertensive Urgency from Hypertensive Emergency?
Urgency: BP > 180/120 without end organ damage
Emergency: BP > 180/120 with evidence of impending or progressive target organ damage
How quickly should you lower a patients BP if he is experiencing Hypertensive Urgency?
Lower BP within 2-3 days
How quickly should you lower a patients BP if he is experiencing Hypertensive Emergency?
Lower BP no more than 25% of MAP in minutes to 1 hour
Acute Uncomplicated Cystitis is probable with a CFU/mL count of?
> 100 CFU/mL
Acute Uncomplicated Cystitis is probable with a wbc/hpf count of?
> = 5 wbc/hpf
[Treatment]
Acute Uncomplicated Cystitis
Nitrofurantoin 100mg tab BID for 5 days
Fosfomycin 3g sachet in 1/2 glass water SD
[Dosage]
Cotrimoxazole for AUC
160/800mg BID for 3 days
[Symptoms]
Acute Pyelonephritis
Fever (>38C) Chills Flank Pain CVA Tenderness Nausea Vomiting \+/- Lower UTI Symptoms
Acute Pyelonephritis is probable with a CFU/mL count of?
> 10,000 CFU/mL
Acute Pyelonephritis is probable with a wbc/hpf count of?
> 5 wbc/hpf
[Indications for Admission]
Acute Pyelonephritis
- Inability to maintain oral hydration or take medications
- Concern about compliance
- Uncertainty about diagnosis
- Severe illness with high fever, severe pain, marked debility
- Signs of Sepsis
[Pharmacologic Treatment]
Acute Pyelonephritis
Ceftriaxone 1g IM/IV SD
How do you diagnose Asymptomatic Bacteriuria in Adults?
> 100,000 CFU/mL of one or more uropathogens in two consecutive midstream urine specimen or in one catheterized urine specimen in the absence of symptoms attributable to UTI
[UTI in Pregnancy]
When must pregnant women be screened?
First prenatal visit between 9 - 17 weeks AOG
[UTI in Pregnancy]
Test of choice to diagnose UTI in Pregnancy
Clean catch midstream urine
[Pharmacologic Treatment]
UTI in Pregnancy
Co-amoxiclav
Cephalexin
Nitrofurantoin (not for those near term)
Cotrimoxazole (not in 1st and 3rd trimester)
What is the definition of Recurrent UTI?
Episodes of acute uncomplicated UTI documented by urine culture occurring >2x/year in a non-pregnant woman with no known urinary tract abnormality
Complicated UTI
- Presence of Indwelling Catheter/Intermittent Catheterization
- Incomplete emptying of bladder with >100mL retained urine post-voiding
- Obstructive Uropathy due to bladder outlet obstruction, calculus and other causes
- Renal Transplant
- Diabetes Mellitus
- UTI in Males, except in young males presenting exclusively with lower UTI symptoms
Significant Bacteruria in Complicated UTI is defined as?
> 100,000 CFU/mL
[Pharmacologic Treatment]
Complicated UTI
Oral Fluoroquinolones for 7-14 days
UTI in males is generally considered to be complicated, when is it NOT considered complicated UTI?
1st episode of symptomatic LUTS occurring in young (15-40 y/o) healthy sexually active men with no clinical/historical evidence of structural/functional urologic abnormality
[Pharmacologic Treatment]
UTI in Males
TMP-SMZ/Fluoroquinolones 7 day regimen
What are the different criteria for Moderate-Risk CAP
- RR >= 30
- PR >= 125
- Temp >= 40 or
What are the different criteria for High Risk CAP
Any of the criteria under moderate risk CAP + Severe Sepsis/Septic Shock
[Pharmacologic Therapy]
Low Risk CAP w/o Comorbidities
Amoxicillin or Extended Macrolides (Suspected atypical pathogen)
[Pharmacologic Therapy]
Low Risk CAP w/ Comorbidities
B-lactam/B-lactamase Inhibitor (BLIC) or Second-Generation Oral Cephalosphorins +/- Extended Macrolides
[Pharmacologic Therapy]
Moderate Risk CAP
IV Non-Antipseudomonal BLIC + Extended Macrolide
or
IV Non-Antipseudomonal BLIC + Respiratory Fluoroquinolones
[Pharmacologic Therapy]
High Risk CAP w/o Risk for P. aeruginosa
IV Non-Antipseudomonal BLIC + IV Extended Macrolide/IV Respiratory Fluoroquinolone
[Pharmacologic Therapy]
High Risk CAP w/ Risk for P. aeruginosa
IV Antipneumococcal Antipseudomonal BLIC + IV Extended Macrolide + Aminoglycoside
or
IV Antipneumococcal Antipseudomonal BLIC + IV Ciprofloxacin/Levofloxacin (High Dose)
