ABFM Bank Flashcards
compare influenza to URI, mycoplasma pneumonia, legionnaires disease
Influenza - fever, nonproductive cough, prostrating illness
URI - not so prostrating illness
mycoplasma pneumonia - milder illness, longer incubation period than influenza
legionnaires disease - mild illness to life threatening pneumonia, can cause point source epidemics, longer incubation period, diarrhea prominent sx
compare Henoch-Schonlein purpura to other vasculitis, Takayasu arteritis, Wegener granulomatosis, Polyarteritis nodosa
Henoch-Schonlein purpura - IgA-mediated small-vessel vasculitis. Triad of nonthrombocytopenic palpable purpura, colicky abdominal pain, and arthritis. Also has conjunctival injection, mucosal erythema, rash, and lymphadenopathy
Takayasu arteritis - night sweats, fatigue, weight loss, myalgia, and arthritis. Later findings hypertension, skin lesions, and cardiac disorders
Wegener granulomatosis - weight loss and fatigue, later findings including respiratory problems, ophthalmologic lesions, neuropathies, glomerulonephritis, and skin lesions.
Polyarteritis nodosa - fatigue, fever, and myalgias. Skin lesions, gastrointestinal symptoms such as postprandial abdominal pain, and cardiac lesions.
substances reported to cause false-positive urine drug screens include what
poppy seed - can produce amounts of morphine and codeine
selegiline, Vicks inhalers, NSAIDs, oxaprozin, fluoroquinolones, rifampin, venlafaxine, and dextromethorphan.
What is the Ottawa ankle rules?
To determine if ankle or foot XR needed.
Patients who were able to bear weight immediately following their injury and who can take 4 steps
independently in a clinical setting require radiographic study only when the following criteria are met: pain is present in the malleolar zone and bony tenderness of the posterior edge or tip of either malleolus is elicited (ankle radiograph), or pain is present in the midfoot zone and bony tenderness of either the base of the fifth metatarsal or the navicular region is
https://www.google.com/url?sa=i&url=http%3A%2F%2Fwww.emdocs.net%2Fankle-x-rays%2F&psig=AOvVaw0bVz9NdEcvrhSgniemBcoI&ust=1639453857811000&source=images&cd=vfe&ved=0CAsQjRxqFwoTCIDggtrv3_QCFQAAAAAdAAAAABAJ
When can child return to school once he/she starts treatment for bacterial conjunctivitis?
Once therapy is initiated, children with bacterial conjunctivitis should be allowed to remain in school. Careful hand hygiene is important and behavior must be appropriate to maintain adequate hygiene. No specific length of treatment or evidence of clinical response is required before returning to school.
Which site of head and neck lymphadenopathy is most likely malignant?
supraclavicular
You give Rhogam to Rh negative or positive mother? and how much?
RHO immune globulin (RhoGAM) is recommended in any Rh-negative patient who is unsensitized with fetomaternal hemorrhage. For gestational age is 12 weeks or less, give 50 mcg of RhoGAM. For gestational age is greater than 12 weeks, give 300 µg of RhoGAM.
what is the Rh antigen?
Rh negative means the person does not have type D antigen on their red blood cells. If a woman is exposed to Rh D antigen–positive red blood cells, she can have an immune response of variable strength. This may occur in the setting of pregnancy (transplacental fetomaternal transfusion), or exposure outside of pregnancy (e.g., transfusion with mismatched blood). An antibody titer of 1:4 poses much less risk to the fetus than a titer of 1:64.
What complications occurs most frequently after Roux-en-Y gastric bypass surgery for obesity?
Iron and vitamin B12 deficiencies
what the of anemia is most common in infancy
iron deficiency anemia
The scabies mite is predominantly transmitted by
direct personal contact
Electrosurgical destruction treatment is contraindicated for
use of a pacemaker and the treatment of melanoma
Clinical picture of a when Crohn’s disease affects primarily the distal small intestine (regional enteritis)
A young person, usually in the second or third decade, will present with a period of episodic abdominal pain, largely postprandial and often periumbilical, occasionally with low-grade fever and mild diarrhea. Anorexia, nausea, and vomiting may be present. Weight loss frequent. Some patients may have tenderness in RLQ and even of a palpable mass in RLQ.
When family dynamics lead to conflict during an office visit, it is best for the physician to attempt to remain neutral by avoiding triangulation which is?
When the two sides in conflict each attempt to align with a third party. Priority should be given to the patient’s right to privacy and confidentiality, and the physician should ask permission from the patient to discuss his or her health issues with other people. Physicians should always remember who they are primarily responsible to.
What is DRESS?
DRESS is acronym for Drug Reaction with Eosinophilia and Systemic Symptoms. Hallmark of DRESS syndrome is erythroderma accompanied by fever, LA, elevated LFTs, and eosinophilia. The offending medication should be discontinued immediately and treatment with corticosteroids should be initiated. Seizure medications such as carbamazepine, phenytoin, lamotrigine, and phenobarbital are responsible for approximately one-third of cases. Allopurinol-associated DRESS syndrome has the highest mortality rate.
Described celiac disease (gluten-sensitive enteropathy)
Approximately 7% of type 1 diabetics have celiac disease. A number of other autoimmune syndromes have been associated with celiac disease, including thyroid disease and rheumatoid arthritis. There is no reported association with type 2 diabetes. Gastrointestinal involvement may include diarrhea, constipation, or other symptoms of malabsorption, such as bloating, flatus, or belching. Fatigue, depression, fibromyalgia-like symptoms, aphthous stomatitis, bone pain, dyspepsia, gastroesophageal reflux, and other nonspecific symptoms may be present and can make the diagnosis quite challenging. Dermatitis herpetiformis is seen in 10% of patients with celiac disease. Serum antibody testing, especially IgA antiendomysial antibody, is highly sensitive and specific. Definitive diagnosis generally requires EGD with biopsy of the distal duodenum to detect characteristic villous flattening.
What is secondary hyperaldosteronism
sodium retention and thus decreased urinary sodium excretion, while potassium secretion is normal to increased.
What imaging modalities would be most helpful for confirming a diagnosis of appendicitis?
spiral CT.
Ultrasonography is used in women who are pregnant and women in whom there is a high degree of suspicion of gynecologic disease.
Which drug can be used as part of a test for diagnosing renovascular hypertension, but would also increase the risk for azotemia if used for treatment?
ACE inhibitors can significantly worsen renal failure in patients with hypertension caused by renovascular disease. Hyperkalemia is an associated problem. Captopril renography is a useful diagnostic screening test.
Patients with symptomatic heart failure associated with a reduced systolic ejection fraction or left ventricular remodeling should be initially treated with which one of the following agents?
CHF patients treated with ACE inhibitors survive longer, and all such patients should take ACEi if tolerated.
Adverse effects of these drugs.
Tumor necrosis factor (TNF) inhibitors
Amiodarone
TNF inhibitors (adalimumab) are currently approved by FDA for the treatment of rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and juvenile idiopathic arthritis. All drugs in this class carry an FDA black-box warning for potentially developing primary tuberculosis or reactivating latent tuberculosis.
Amiodarone is associated with a subacute cough and progressive dyspnea due to pulmonary toxicity.
How to switch a patient on dabigatran (direct thrombin inhibitor) to warfarin?
Start warfarin 3 days prior to stopping dabigatran. Bridging with a parenteral agent is not necessary. Dabigatran is known to increase the INR, so the INR will not reflect warfarin’s effect until dabigatran has been withheld for at least 2 days.
Mechanism of action of diabetes meds? Metformin Thiazolidinediones (pioglitazone) Sulfonylureas Meglitinides
Metformin - main effect on serum glucose results from inhibition of gluconeogenesis in the liver
Thiazolidinediones (pioglitazone) - sensitize peripheral tissues to insulin
Sulfonylureas (glipizide) and meglitinides (Repaglinide and nateglinide)- stimulate insulin release from the pancreas
Epidemics of gastroenteritis on cruise ships are consistent with
Norovirus infections due to waterborne or foodborne spread. Common cause of waterborne epidemics of gastroenteritis, and have been shown to be responsible for outbreaks in nursing homes, on cruise ships, at summer camps, and in schools. Symptomatic treatment.
What is treatment for primary hyperparathyroidism for patients <50 years old or symptomatic patients, such as those with a fragility fracture?
Parathyroidectomy. If a patient is older, is a poor surgical candidate, or has asymptomatic disease, long-term monitoring with treatment focused on reducing bony complications can be considered
Venous thrombosis is associated with what conditions
activated protein C resistance (factor V Leiden), trauma, surgery, malignancy, sepsis, and oral contraceptive use.
agents that can induce hypokalemia include
β-Agonists (albuterol), pseudoephedrine, insulin, thiazides diuretics
agents that can induce hypokalemia include
β-Agonists (albuterol), pseudoephedrine, insulin, thiazides diuretics
what is treatment for infantile gonococcal infection
A single dose of 25–50 mg/kg of ceftriaxone IV or IM. Ophthalmia neonatorum and sepsis are the most severe gonococcal infections in newborns
which nasal medication has beneficial effect for symptoms of the common cold in an adult?
Ipratropium (Atrovent) nasal spray is the only nasally inhaled anticholinergic that decreases rhinorrhea and sneezing in the common cold.
Which physical examination findings is pathognomonic for slipped
capital femoral epiphysis?
Slipped capital femoral epiphysis (SCFE) typically occurs in young adolescents during the growth spurt, when the femoral head is displaced posteriorly through the growth plate. Physical activity, obesity, and male sex are predisposing factors. There is pain with physical activity, most commonly in the upper thigh anteriorly, but one-third of patients present with referred lower
thigh or knee pain. Hallmark of SCFE exam is limited internal rotation of the hip. Specific to SCFE is the even greater limitation of internal rotation when the hip is flexed to 90°.
What is the usual reservoir for hantavirus?
Virus is spread by inhalation of dried aerosolized deer mouse urine or droppings
what is the sensitivity, specificity, NPV, and PPV chart?
draw it
Which cardiac rhythm abnormalities is most common in patients with anorexia nervosa?
Sinus bradycardia is almost universally present in patients with anorexia nervosa. Hypothesized that this is due to vagal hyperactivity
A nucleic acid amplification test is performed on a urine sample, and the results are positive for gonorrhea and negative for Chlamydia. Which one of the following is the recommended treatment for this patient?
Ceftriaxone, 250 mg intramuscularly, plus azithromycin (Zithromax), 1 g orally. High incidence of coinfection with Chlamydia, even if testing is negative
Polypharmacy is common in the elderly population. Older antihistamines such as in acetaminophen/diphenhydramine can cause what ADE in elderly?
CNS effects such as cognitive slowing and delirium. Anticholinergic properties of older antihistamines include dry mouth, constipation, blurred vision, drowsiness, and sedation
What are facial dysmorphic features of fragile X syndrome and Prader-Willi syndrome?
Fragile X syndrome - In prepubescent male child, have large ears, an elongated face, macrocephaly, or frontal bossing. After puberty, a prominent jaw and macro-orchidism.
Prader-Willi syndrome - narrow distance between the temples, almond-shaped eyes, and a thin upper lip.
how do phosphate binders work to hypercalcemia in secondary hyperparathyroidism of ESRD?
Phosphate binders (sevelamer, calcium acetate. Decreasing serum phosphate lowers the feedback stimulation of parathyroid hormone secretion by the parathyroid gland. Normalizing parathyroid levels improves serum calcium levels.
11-year-old male is brought to your office for evaluation of bilateral posterior heel pain that has occurred for the past few months. No swelling or tenderness of the heel or Achilles tendon. What is condition?
Calcaneal apophysitis (Sever disease) is the most common etiology of heel pain in children, usually occurring between 5 and 11 years old. Bones grow faster than the muscles and tendons. A tight Achilles tendon then pulls on its insertion site at the posterior calcaneus with repetitive running or jumping activities, causing microtrauma to the area. There may be swelling and tenderness in this area and passive dorsiflexion may increase the pain. Treatment involves decreasing pain-inducing activities, anti-inflammatory or analgesic medication if needed, ice, stretching and strengthening of the gastrocnemius-soleus complex, and the use of orthotic devices.
Differentiate chlamydial pneumonia, Staphylococcal pneumonia, RSV?
Chlamydial pneumonia is usually seen in infants 3–16 weeks of age, and these patients frequently have been sick for several weeks (subacute illness). The infant appears nontoxic, afebrile, tachypneic, prominent cough. PE with diffuse crackles with few wheezes, and conjunctivitis is present in about 50% of cases. CXR will show hyperinflation and diffuse interstitial or patchy infiltrates. There may be eosinophilia.
RSV infections start with rhinorrhea and pharyngitis, followed in 1–3 days by a cough and wheezing. Auscultation of the lungs will reveal diffuse rhonchi, fine crackles, and wheezes. CXR is often normal. If the illness progresses, coughing and wheezing increase, air hunger and intercostal retractions develop, and evidence of hyperexpansion of the chest is seen. In some infants the course of the illness may be similar to that of pneumonia. Rash or conjunctivitis may occur occasionally, and fever is an inconsistent sign. The WBC count will be normal or elevated.
Staphylococcal pneumonia has a sudden onset. Infant appears very ill and has a fever, and initially may have an expiratory wheeze simulating bronchiolitis. Signs of abdominal distress, tachypnea, dyspnea, and localized or diffuse bronchopneumonia or lobar disease may be present. WBC count will show a prominent leukocytosis.
treatment for acute hyperthyroidism
B-blocker and Methimazole first.
Propylthiouracil (PTU) can cause hepatocellular damage so don’t use. Then radioactive iodine.
Symptoms and treatment for epiglottis?
Sx: Hoarseness, dysphagia, stridor, drooling, fever, chills, and respiratory distress
Tx: IV antibiotic should be given immediately, ideally with a B-lactam drug that exhibits activity against MRSA
Signs of streptococcal pharyngitis
Fever over 100.4°F, tonsillar exudates, anterior cervical lymphadenopathy, and absence of cough.
what pain medication is CI in liver cirrhosis?
NSAIDs due to the risk of precipitating hepatorenal syndrome
What is erythrasma
Infection with Corynebacterium minutissimum
Coral-red fluorescence on Wood’s light examination
Erythromycin is treatment
which diabetes drug is the most likely to cause hypoglycemia
Sulfonylureas: Glyburide is more likely to cause hypoglycemia than Glipizide. Glyburide should rarely be used in the elderly.
what is calcitonin-salmon (Miacalcin) used for?
Vertebral fracture risk reduction (labeled use) or osteoporotic vertebral fracture pain relief (off label use)
Extracorporeal shock wave therapy is effective for what condition?
Calcific tendinitis of the rotator cuff.
What is first-line therapy for hypertension in pregnancy?
Labetalol
CI in pregnancy: ACEi, ARB, metoprolol due to adverse effects
Metoprolol: pregnancymetoprolol with fetal growth restriction birth defects and ACEi, ARB: risk of birth defects and fetal or neonatal renal failure
What is criteria for hypoactive sexual desire disorder (HSDD) and treatment?
Diagnosis includes two components:
(1) recurrent deficiency or absence of sexual desire or receptivity to sexual activity, and (2) distress about such a deficiency.
Tx: Topical testosterone, in either patch or gel form, has shown consistent improvements in arousal, desire, fantasy, orgasm, and overall satisfaction in cases of hypoactive sexual desire disorder (HSDD)
what is treatment for thrombosed external hemorrhoid, internal hemorrhoid, or hemorrhoids not in acute stage?
Elliptical excision of the thrombosed external hemorrhoid and overlying skin under local anesthesia.
Rubber band ligation and infrared coagulation are options for internal hemorrhoids.
Sitz baths, bulk laxatives, stool softeners, and local analgesia may be helpful. Avoid precipitating factors such as prolonged standing/sitting, constipation, and delay of defecation.
What class of psych meds have shown beneficial effect on the symptoms of irritable bowel syndrome (IBS)?
SSRIs and tricyclic antidepressants
What is screening guideline for diabetes mellitus
Test for DM in adults who have a BMI ≥25 kg/m2 and have one or more risk factors such as physical inactivity, a first degree relative with diabetes, a high-risk ethnicity, hypertension, hyperlipidemia, or polycystic ovary syndrome.
In patients with no risk factors, test at age 45.
Adverse effect of aromatase inhibitor such as letrozole (Femara) and tamoxifen (Soltamox)?
letrozole (Femara): Myalgias and noninflammatory arthralgias
tamoxifen (Soltamox): Endometrial cancer
what isMyelodysplastic syndrome
Hematologic malignancy with a predisposition to leukemic transformation. It can present with anemia, thrombocytopenia, neutropenia, or any combination of these. Anemia occurs in 80%–85% of patients and is typically macrocytic
What are the asthma classifications?
Intermittent: Symptoms less than or equal to twice weekly, nighttime awakenings ≤2 times/month, short-acting β-agonist usage ≤2 days/week, no interference with daily activities, and normal FEV1 and FEV1/FVC ratio at baseline
Mild Persistent: Symptoms >2 days/week but not daily, nighttime awakenings 3–4 times/month, short-acting β-agonist usage >2 days/week but not more than once daily, minor limitation to daily activities, FEV1 ≥80% predicted, and normal FEV1/FVC ratio
Moderate Persistent: Daily symptoms, nighttime awakenings greater than once weekly but not nightly, daily use of a short-acting β-agonist, some limitation to daily activity, FEV1 >60% but <80% of predicted, and FEV1/FVC ratio reduced by 5%
Severe Persistent: Symptoms throughout the day, nighttime awakenings nightly, short-acting β-agonist usage several times daily, extremely limited daily activities, FEV1 <60% of predicted, and FEV1/FVC ratio reduced by >5%
Status asthmaticus is a medical emergency and requires emergent treatment in a hospital setting.
Treatment for mallet fracture (finger)?
mallet fracture: caused by load to the tip of an extended finger that causes forced flexion at the distal interphalangeal (DIP) joint and leads to dorsal extensor tendon rupture or avulsion fracture (tendon and piece of bone attached).
Tx: splint the finger DIP joint in extension for 8 weeks
what can you give a patient with end stage cancer with few weeks life expectancy and becomes very depressed?
Psychostimulants (i.e. methylphenidate) reduce symptoms of depression within days
signs of heart failure
HF: Fluid overload (edema), JVD, a third heart sound, an elevated BNP level, and a responds to diuretics.
A BNP level <100 pg/mL can help rule out heart failure.
Treatment for Traveler’s diarrhea
Most common cause of traveler’s diarrhea is enterotoxigenic Escherichia coli. Fluoroquinolones such as ciprofloxacin have been shown to significantly reduce the duration and severity of traveler’s diarrhea when given for 1–3 days
Treatment for prevention of constipation in opioid-induced constipation
Constipation is a very common side effect of opioids that does not resolve with time. Start an appropriate bowel regimen with the initiation of opioid therapy to prevent constipation.
Polyethylene glycol, lactulose, magnesium hydroxide, and senna with docusate
Which activities are most likely to be impaired in early dementia?
Basic activities of daily living, such as dressing, eating, toileting, and grooming, are generally intact in early dementia. Instrumental activities of daily living, such as managing money and medications, shopping, cooking, housekeeping, and transportation, which often require calculation or planning, are frequently impaired in early dementia.
Adverse effect of these psych meds: Carbamazepine Aripiprazole and olanzapine Lithium Imipramine
Carbamazepine (Anticonvulsant) - agranulocytosis
Aripiprazole and olanzapine (2nd generation atypical antipsychotics) - black box warnings for an increased risk of death in the elderly.
Lithium (Antimanic - Bipolar d/o, MDD unipolar) - lithium toxicity and thyroid dysfunction
Imipramine (TCA) - cardiac toxicity, EKG monitoring is recommended
These tests for what injury?
Lachman test
Posterior drawer test
McMurray and Thessaly
Lachman test - anterior cruciate ligament
Posterior drawer test - posterior cruciate ligament
McMurray and Thessaly - meniscal tears
Patients with celiac disease are at increased risk of?
Celiac disease - increased risk of osteoporosis due to bone loss from
decreased calcium and vitamin D absorption.
How many days before surgery before surgery should Clopidogrel be stopped?
Patients receiving dual antiplatelet therapy who require bypass surgery should continue taking aspirin. Clopidogrel or prasugrel should be stopped 5 days before the surgery.
Pulmonary hypertension can be due to various causes (left heart failure, chronic thromboembolic disease, etc). When due to left heart failure, you want to do what?
maximize treatment for her heart failure and other comorbidities.
Treatment for methanol poisoning
Depending on its severity, give ethanol to inhibit the metabolism of methanol to toxic metabolites, hemodialysis to remove alcohol and its toxins, and vigorous management of metabolic acidosis with bicarbonate therapy.
Treatment for an infant’s unilateral undescended testis should be started at what age?
at 6–12 months of age to avoid testicular damage.
Human parvovirus B19 is associated with what?
Parvovirus B19 is associated with erythema infectiosum (fifth disease). It is also associated with nonspecific fever, arthropathy, chronic anemia, and transient aplastic crisis.
Causes of stillbirth?
Stillbirth is defined as fetal death occurring at or after 20 weeks gestation, and Causes of stillbirth include placental abnormalities and obstetric complications, which are the two largest category. Others include infection and fetal defects.
Treatment for pneumonia and suspected coinfection with influenza
Treatment should include antiviral and antibacterial agents that include coverage against methicillin-resistant Staphylococcus aureus (MRSA), the most common bacterial pathogen isolated from critically ill patients with coinfection. Oseltamivir, ceftriaxone, azithromycin, and vancomycin should be initiated empirically.
Medications to start treatment for HTN in pts with CAD?
AHA recommends treat hypertension in patients with stable heart failure with ACE inhibitors and/or β-blockers. ACE inhibitors are recommended as antihypertensive agents in patients already on β-blocker therapy (especially following MI), in diabetics, and in pts with left ventricular dysfunction.
Describe symptoms of Meniere’s disease
Multiple episodes of vertigo lasting for 20–120 minutes, accompanied by a fluctuating hearing loss, tinnitus, and a sense of aural fullness. Audiograms will reveal a low-frequency hearing loss.
Monotherapy for bipolar disorder
Divalproex (same names Valproic Acid, Depakote) and lithium are indicated for treating bipolar depression or acute mania, and for maintenance. They should be given as single agents, not in combination with other drugs.
Treatment for patient with diabetes mellitus and advanced coronary artery disease
CABG was superior to percutaneous coronary intervention (PCI) in that it significantly reduced rates of death and myocardial infarction.
In young children with bilious emesis, anorexia, and lack of fever, the most likely diagnosis is:
Intestinal malrotation with volvulus
Diagnosis: upper GI series to evaluate initially (CT too much radiation for young children)
Treatment for Clostridium difficile colitis
Metronidazole, vancomycin, and fidaxomicin are the three medications used for Clostridium difficile colitis. Only metronidazole is effective IV. Treatment with vancomycin and fidaxomicin is PO.
Treatment for Calcaneal apophysitis, also called Sever’s disease
Calcaneal apophysitis (Sever’s disease) is a common cause of heel pain in young athletes, especially those who participate in basketball, soccer, track, and other sports that involve running. Typically the heel apophysis closes by age 15. Treatment options include activity modification, the use of ice packs and/or moist heat, stretching, analgesics, and orthotic devices.
Patients with persistent symptoms carpal tunnel syndrome achieve the best long-term relief with?
surgery
Treatment for SVT?
Vagal maneuvers, IV adenosine or verapamil, IV diltiazem or β-blockade, IV antiarrhythmics, or cardioversion in refractory cases. Radiofrequency ablation is becoming first-line therapy for all patients with recurrent SVT, not just those refractory to suppressive drug therapies.
Mechanical ventilation settings for Acute respiratory distress syndrome (ARDS)
Early recognition and prompt treatment with intubation and mechanical ventilation is necessary to improve chances for survival in ARDS. Patients with ARDS should be started at lower tidal volumes (6 mL/kg) instead of the traditional volumes (10–15 mL/kg) (SOR A). They often require higher positive end-expiratory pressure settings (PEEP) (SOR B).
First-line treatment for diabetic peripheral neuropathy, according to the ADA
TCAs. Among the TCAs, amitriptyline, imipramine, and nortriptyline have been found to be the most effective. Other options include duloxetine, pregabalin, oxycodone, and tramadol.
Features of fetal alcohol syndrome, Down syndrome, and Prader-Willi syndrome
Fetal alcohol syndrome - minor facial anomalies, including a thin upper lip, a smooth philtrum, and a flat nasal bridge. Other physical anomalies include clinodactyly; prenatal and postnatal growth retardation; and functional or structural CNS abnormalities.
Down syndrome - hypotonia, a flat face, upward and slanted palpebral fissures and epicanthic folds, and speckled irises (Brushfield spots); varying degrees of mental and growth retardation; dysplasia of the pelvis; cardiac malformations; a simian crease; short, broad hands; hypoplasia of the middle phalanx of the 5th finger; and a high, arched palate.
Prader-Willi syndrome - severe hypotonia at birth, obesity, short stature (responsive to growth hormone), small hands and feet, hypogonadism, and mental retardation.
Drugs that can cause drug induced SLE
hydralazine, antiarrhythmics
Defined orthostatic hypotension
Drop in blood pressure of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing.
Describe cluster A, B, C type of personality disorders?
Cluster A personality disorder group - odd or eccentric personalities. Group includes paranoid, schizoid, and schizotypal personality disorders.
Cluster B disorders - dramatic, emotional, or erratic personalities. Group includes antisocial, borderline, histrionic, and narcissistic personality disorders.
Cluster C disorders - anxious or fearful behaviors. Group includes obsessive-compulsive and dependent personality disorders.
Describe intertrigo, most common organism in intertrigo, and treatment
Intertrigo is skin inflammation caused by skin-on-skin friction. Due to moisture trapped in deep skinfolds where air circulation is limited. When intertrigo does not respond to usual conservative measures, including keeping the skin clean and dry, evaluation for infection is recommended. A Wood’s light examination, KOH preparation, and exudate culture can assist in identifying causative organisms.
The moist, damaged skin is breeding ground for various microorganisms, and secondary cutaneous infections are common. Candida is organism most commonly associated with intertrigo.
Treatment for acute rectal fissure
Although patients often require an internal sphincterotomy, nonsurgical measures that relax the sphincter have proven helpful. Botulinum toxin injected into the internal sphincter has proven most beneficial, but topical preparations are not yet available and have not been shown to be effective. Drugs that dilate the internal sphincter, including diltiazem, nifedipine, and nitroglycerin ointment, have proven to be beneficial in healing acute fissures
Describe signs of the four levels of alcohol withdrawal severity: minor, major, seizures, and delirium tremens
Chronic excessive alcohol intake produces functional changes in neurotransmitter activity that can lead to a net increase in excitatory neuroreceptor activity when the person stops drinking. Withdrawal can be divided into four levels of severity: minor, major, seizures, and delirium tremens.
- Minor alcohol withdrawal is characterized by tremor, anxiety, nausea, vomiting, and/or insomnia 6–24 hours after the patient’s last drink.
- Major withdrawal occurs 10–72 hours after the last drink and can include the signs and symptoms of minor withdrawal, as well as visual and auditory hallucinations, diaphoresis, tachycardia, and elevated blood pressure.
- Alcoholic seizure generally occurs within 2 days of the last drink and may be the only sign of withdrawal, although approximately one-third of these patients will progress to delirium tremens.
- Delirium tremens can occur anytime within 3–10 days following the last drink. The defining clinical finding is delirium, but the findings seen in milder forms of alcohol withdrawal can also be present, and may be more severe. Fever is most often seen with delirium tremens and is less common with less severe forms of alcohol withdrawal.
Additional heart failure treatment to add when standard treatment is insufficient to control symptoms or cannot be tolerated.
Combination of the vasodilators hydralazine and isosorbide dinitrate has been shown to be effective in the treatment of heart failure when standard treatment with diuretics, β-blockers, and an ACE inhibitor (or ARB) is insufficient to control symptoms or cannot be tolerated. This combination is particularly effective in African-Americans with NYHA class III or IV heart failure, with advantages of reduced mortality rates and improvement in quality-of-life measures.
Signs of heroin overdoses
Heroin overdose is manifested by CNS depression and hypoventilation. Clues include pupillary miosis and a decreasing respiratory rate in the presence of a semi-wakeful state. In addition to hypoventilation, a multifactorial acute lung injury occurs within 2–4 hours of the overdose and is associated with hypoxemia and a hypersensitivity reaction, resulting in noncardiogenic pulmonary edema. Findings include hypoxia, crackles on lung auscultation, and pink, frothy sputum. Treatment must include respiratory support with intubation, mechanical ventilation, oxygen and opiate reversal with naloxone, which may require repeat doses or intravenous infusion.
First choice for chronic potent opioid therapy for chronic pain
Morphine is the best first choice for chronic potent opioid therapy (SOR B). It is reliable and inexpensive, and equivalent doses can be easily calculated if the patient must later be switched to another medication. Transdermal fentanyl and hydromorphone are reasonable second-line choices. They are not recommended as first-line therapy because they are expensive and can produce tolerance relatively quickly
FDA approved antibiotic for acne rosacea
Doxycycline at a subantimicrobial dosage (40 mg daily). This does not contribute to antibiotic resistance, even when used over several months, and is better tolerated than higher dosages.
You suspect that he has asthma. What do you do first?
Do spirometry. The American Academy of Asthma, Allergy, and Immunology recommends that asthma not be diagnosed or treated without spirometry first.
How to differentiate abdominal pain due to visceral vs within the abdominal wall itself
Palpate the tender location of abdomen with patient in supine position. Then have patient raise both legs off table while you palpate abdomen. A reduction of the pain caused by abdominal palpation when the abdominal muscles are tightened is known as Carnett’s sign. If the cause of the pain is visceral, the taut abdominal muscles may protect the locus of pain. Intensification of pain with this maneuver points to a source of pain within the abdominal wall itself.
Mild cognitive impairment is characterized by what
Mild cognitive impairment is an intermediate stage between normal cognitive function and dementia. Motor function remains normal. Patients have normal functional activities but there is objective evidence of memory impairment.
Describe Centor criteria
Centor criteria are the clinical predictors of streptococcal pharyngitis. Include tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough, and history of fever.
Patients with four positive criteria should be treated with antibiotics, those with three positive criteria should be tested and treated if positive, and those with 0–1 positive criteria should be treated with analgesics and supportive care only.
Routine vaccination against which one of the following organisms has significantly reduced the risk of bacterial meningitis among young children?
Conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae have been highly effective in reducing the incidence of bacterial meningitis in young children.
Describe long QT syndrome
Patients with EKGs showing a QTc interval >480 ms with a syncopal episode, or >500 ms in the absence of symptoms, are diagnosed with long QT syndrome if no secondary cause such as medication use is present. Consists of cardiac repolarization defects. Associated with polymorphic ventricular tachycardia, including torsades de pointes, and sudden cardiac death. Treat with p-blockers and implanted cardioverter defibrillators.
When should an antibiotic time-out be scheduled at the time a patient is admitted to the hospital?
For patients started on empiric antibiotic therapy at hospital admission, the CDC recommends an antibiotic time-out 48 hours after the initial order to determine if it can be stopped or needs to be changed.
Treatments that can improve symptoms of Irritable bowel syndrome (IBS) symptoms.
Irritable bowel syndrome (IBS) symptoms improve with several different medications and alternative therapies. Exercise, probiotics, antibiotics, antispasmodics, antidepressants, psychological treatments, and peppermint oil all have evidence that they may improve IBS symptoms (SOR B). Antidepressants can improve pain and overall symptom scores compared to placebo. SSRIs used in these trials included citalopram, fluoxetine, and paroxetine, and tricyclic antidepressants included amitriptyline, desipramine, and imipramine.
Backup contraception after IUD insertion.
Patient does not need to use backup contraception if IUD is inserted within 7 days after menstrual bleeding started. If the levonorgestrel IUD is inserted more than 7 days after menstrual bleeding starts, then patient needs to abstain from sexual intercourse or use additional contraceptive protection for the next
7 days.
PFT for restrictive lung disease vs obstructive lung disease.
A reduced FVC with either a normal or increased FEV1/FVC ratio is consistent with restrictive lung disease. There are three basic categories of restrictive lung disease: intrinsic lung disease, chest wall deformities, and neuromuscular disorders. A reduced FEV1 and decreased FEV1/FVC ratio is seen in obstructive lung disease (asthma, COPD). The DLCO is the measure of the diffusion of carbon monoxide across the alveolar-capillary membrane. Reduced values are obtained when interstitial fibrosis is extensive, or when the capillary surface is compromised by vascular obstruction or nonperfusion, or is destroyed (as in emphysema). A bronchodilator challenge will allow assessment of reversible airway obstruction. A methacholine challenge test looks for airway hyperreactivity.
Two causes of pain at the first metatarsophalangeal (MTP) joint of foot.
Sign of Morton’s neuroma.
The first metatarsophalangeal (MTP) joint has two sesamoid bones that can be injured. Overuse, a sharp blow, and sudden dorsiflexion are the most common mechanisms of injury.
Gout often involves the first MTP joint, but the onset is sudden, with warmth, redness, and swelling, and pain on movement of the joint is common.
Morton’s neuroma causes numbness involving the digital nerve in the area, and usually is caused by the nerve being pinched between metatarsal heads in the center of the foot.
Treatment for Raynaud’s disease
No currently approved treatment for Raynaud’s disease. Patients reportedly experience subjective symptomatic improvement with dihydropyridine calcium channel antagonists, with nifedipine being the calcium channel blocker of choice. (1-Antagonists such as prazosin or terazosin are also effective. B-Blockers can produce arterial insufficiency of the Raynaud type, so propranolol and atenolol are contraindicated.
Treatment for acute epididymo-orchitis
Acute epididymitis is often the result of descending infection caused by urinary tract pathogens. When the infection involves the epididymis and testis (epididymo-orchitis), sonography will frequently show an enlarged heterogeneous testis with increased color flow. Give antibiotics for the treatment of both gonorrhea and Chlamydia infections.
The five Ps of acute compartment syndrome
Typically, compartment pressure can be measured using a needle attached to a manometer, and if the pressure is elevated (usually >40 mm Hg) urgent fasciotomy is necessary to prevent muscle necrosis. If the classic “Five Ps” (pain, paresthesia, pallor, pulselessness, and paralysis) are all present, the outcome will most certainly be bad, even limb-threatening.
Before the classic findings develop, patients will have tenderness out of proportion to the physical appearance of the injury and, most importantly, severe pain in the involved compartment with passive stretching of the involved muscles.
Associated conditions with Crohn’s disease
Crohn’s disease is associated with many extragastrointestinal conditions: erythema nodosum (as with this patient), anemia, inflammatory arthropathies, uveitis, and venous thromboembolism (level of evidence 3).
Adverse effect of being on long term opioid therapy
Hypogonadism is often underrecognized and undertreated side effect of long-term opioid therapy. More often seen in men and in patients receiving larger doses of opioids. Typical symptoms include decreased libido, erectile dysfunction, amenorrhea, or fatigue. Also constipation
Treatment for mild to moderate croup and moderate to severe croup
Croup is a viral infection that results in swelling in the larynx. It rarely is severe enough to cause respiratory collapse or require intubation and must be differentiated from more severe conditions such as epiglottitis, retropharyngeal abscess, or pneumonia. Condition is usually benign and self-limiting, with the worst symptoms occurring at night. Treat mild to moderate croup with a single dose of either an oral or IM corticosteroid. Dexamethasone is recommended due to its 72-hour length of effect. Inhaled racemic epinephrine has been shown to reduce the need for intubation in cases of moderate to severe croup.
fungal disease regions in US
Histoplasmosis - mid US (Iowa, Nebraska, etc)
Coccidioidomycosis - southwest US (California, AZ, NM)
Blastomycosis - east US
Describe lichen planus
Lichen planus is an idiopathic inflammatory disease affecting the skin and oral mucosa. The characteristic violaceous, polygonal papules on skin may be intensely itchy. Can cause oral ulcers. There is a significant association between lichen planus and hepatitis C virus infection.
Describe likelihood ratio (LR)
The likelihood ratio (LR) is the ratio of the probability of a specific test result in people who have a particular disease to the probability in people who do not. LRs correspond to how well a test rules in or rules out a given disease. A test with an LR of 1.0 indicates that it does not change the probability of disease. The higher above 1 the LR is, the more likely it is that the disease is present (an LR >10 is considered good). Conversely, the lower the LR is below 1, the more likely it is that the disease is not present (an LR <0.1 is considered good).
Adverse effects of bisphosphonates
The use of bisphosphonates is associated with a small increase in the risk of atypical femoral shaft fractures. The risk increases with the duration of use (SOR B). Also associated with increased risk of osteonecrosis of the jaw, esophagitis, esophageal ulceration, and hypocalcemia. Bisphosphonates are used as a treatment for hypercalcemia.
What to do if you suspect developmental dysplasia of the hip
Developmental dysplasia of the hip encompasses both subluxation and dislocation of the newborn hip, as well as anatomic abnormalities. It is more common in firstborns, females, breech presentations, oligohydramnios, and patients with a family history of developmental dysplasia.
If there is any question of a hip problem on examination by 2 weeks of age, the recommendation is to refer to a specialist for further testing and treatment. Studies show that these problems disappear by 1 week of age in 60% of cases, and by 2 months of age in 90% of cases.
Closed reduction and immobilization in a Pavlik harness, with ultrasonography of the hip to ensure proper positioning, is the treatment of choice until 6 months of age. The American Academy of Pediatrics recommends ultrasound screening at 6 weeks for breech females, breech males (optional), and females with a positive family history of developmental dysplasia of the hip.
Choice of medication for chronic pain in ESRD
Fentanyl is metabolized in the liver and has no active metabolites. Codeine, hydrocodone, morphine all have active metabolites that can accumulate in patients with renal failure, leading to serious side effects. Avoid in patients on dialysis.
Pattern of low diffusing capacity of the lung for carbon monoxide (DLCO) and PFT in conditions below:
Chronic pulmonary embolism
Emphysema
Interstitial lung disease and hypersensitivity pneumonitis
Asthma
A diffusion capacity test assesses how well a tracer gas in inspired air can cross from the air into the blood. The diffusion capacity provides a general assessment of the air-blood interface. Reduced values are seen with severe interstitial fibrosis, or when the capillary surface has been compromised by vascular obstruction (pulmonary embolism) or is destroyed by emphysema.
Chronic pulmonary embolism - low diffusing capacity of the lung for carbon monoxide (DLCO) and normal PFT
Emphysema - low DLCO and an obstructive PFT
Interstitial lung disease and hypersensitivity pneumonitis - low DLCO and restrictive PFTs.
Asthma - may have an increased DLCO with an obstructive PFT, with reversibility after bronchodilator administration.
Muscle strength score
Muscle strength is scored on a scale of 0 to 5.
0 - The inability to contract a muscle.
1 - Contraction without movement.
2 - Movement with the effect of gravity neutralized
3 - Movement against gravity only
4 - Movement against gravity plus some resistance.
5 - Normal, Movement against substantial resistance.
USPSTF recommendation annual screening for lung cancer with low-dose computed tomography (LDCT)
The U.S. Preventive Services Task Force recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults 55–80 years of age who have a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have lung surgery (B recommendation).
cluster headaches treatment - prevention and abortive tx
Verapamil is first line prophylactic agent for the prevention of cluster headaches (SOR A). Oxygen and sumatriptan are first-line abortive therapies for cluster headaches (SOR A).
What conditions decreases or increases INR when on coumadin?
Medical conditions that decrease responsiveness to warfarin and reduce the INR include hypothyroidism, visceral carcinoma, increased vitamin K intake, diabetes mellitus, and hyperlipidemia. Conditions that increase responsiveness to warfarin, the INR, and the risk of bleeding include vitamin K deficiency caused by decreased dietary intake, malabsorption, scurvy, malnutrition, cachexia, small body size, hepatic dysfunction, moderate to severe renal impairment, hypermetabolic states, fever, hyperthyroidism, infectious disease, heart failure, and biliary obstruction (SOR B, SOR C).
Which class of oral diabetes meds are the most likely to cause hypoglycemia?
Sulfonylureas are the oral hypoglycemic agents most likely to cause hypoglycemia, with glyburide more likely than glipizide due to its longer half-life. The use of these agents should be rare in elderly patients with diabetes mellitus.
If patient received BCG vaccine, what test for TB is best?
Immigrants who received the bacille Calmette-Guérin (BCG) vaccine can have false-positive tests. Interferon-y release assays (QuantiFERON-TB Gold Plus) preferred to tuberculin skin testing in immigrants who have been vaccinated with BCG.
which has the highest specificity for heart failure
Among the constellation of history and physical findings that can be found in patients with heart failure, none provides a proof-positive diagnosis alone, as most are found in other disease states as well. Each of the options listed raises the possibility of heart failure but the only one that has a specificity >90% is the third heart sound, which is 99% specific for the diagnosis of heart failure. Other findings with >90% sensitivity include a displaced point of maximal impulse, interstitial edema or venous congestion on a chest radiograph, jugular vein distention, and hepatojugular reflux. The other options listed here have specificities for heart failure that fall within the range of 65%–80%.
Which cancer is mostly likely seen with Courvoisier’s sign?
The presence of a solitary enlarged left supraclavicular lymph node (Virchow’s node) is associated with a gastrointestinal system malignancy. When combined with painless jaundice and a palpable nontender gallbladder (Courvoisier’s sign), pancreatic cancer is the most likely diagnosis.
What conditions are beneficial with hyperbaric oxygen?
Medical hyperbaric oxygen is considered a reimbursable treatment option by many insurers for a long list of diagnoses. The list of conditions shown to benefit from hyperbaric oxygen is a shorter one, however, and includes decompression sickness and wounds caused by crush injuries.
Duloxetine is what class of antidepressant and what can it treat
Duloxetine (Cymbalta) is SNRI. Treats depression, chronic pain, does not cause weight gain
Next step in microscopic hematuria finding
Initially assess for benign causes such as urinary tract infection, vigorous exercise, menstruation, and recent urologic procedures. If none of these is found, next step would be assessing for renal disease using urine microscopy to look for casts or dysmorphic blood cells, and checking renal function. If the results are negative, CT urography and cystoscopy should be performed. CT evaluates the upper urinary tract for nephrolithiasis and renal cancer, while cystoscopy evaluates the bladder for bladder cancer, urethral strictures, and prostatic problems.
What are differentials for with pink, scaling papules and plaques on the trunk and proximal aspect of the arms and legs in young adult.
Differential diagnosis of multiple small scaling plaques includes drug eruptions, secondary syphilis, guttate psoriasis, and erythema migrans.
Most common extra-articular manifestation of ankylosing spondylitis (AS) and treatment for it
Uveitis is inflammation of the uveal tract and can affect any or all of its components, including the iris. It is the most common extra-articular manifestation of ankylosing spondylitis (AS). Iritis presents with a painful red eye with conjunctival injection, photophobia, and a sluggishly reacting pupil. A hazy-appearing anterior chamber results from the iris producing an inflammatory exudate. Treatment is topical corticosteroids but oral or parenteral corticosteroids and NSAIDs are also effective. Reduced anterior spine flexion results from the skeletal manifestations of AS. A “bamboo spine” is classically seen on lumbar radiographs
Imagining to order for elevated prolactin level
In almost all patients with an elevated prolactin level, MRI of the pituitary is recommended to exclude the possibility of a pituitary adenoma (SOR C).
Alternative antibiotic to penicillin or amoxicillin allergy
Risk of a serious allergic reaction to second-and third-generation cephalosporins in patients with penicillin or amoxicillin allergy appears to be almost nil, and no greater than the risk among patients without such allergies.
Which EKG abnormalities would dictate the use of a pharmacologic stress test as opposed to an exercise stress test?
Left bundle branch block makes the EKG uninterpretable during an exercise stress test, and can also interfere with nuclear imaging performed during the test. It is associated with transient positive defects in the anteroseptal and septal regions in the absence of a lesion within the left anterior descending coronary artery. This leads to a high rate of false-positive tests and low specificity. Pharmacologic stress tests using vasodilators such as adenosine with nuclear imaging have a much higher specificity and positive predictive value for LAD lesions, and the same is true for dobutamine stress echocardiography, which is why these are the preferred methods for evaluating patients with left bundle branch block.
Treatment for poison ivy dermatitis
Poison ivy dermatitis is caused by urushiol, a resin found in poison ivy, poison oak, and poison sumac plants. This is a type IV T cell–mediated allergic reaction, so it typically takes at least 12 hours and often 2–3 days before the reaction is fully manifested. Depending on the degree of contact (i.e., the amount of resin on the skin), the rash often progresses over a couple of days, giving the impression that it is spreading. Also, delayed contact with resin from contaminated clothing, gloves, or pets may result in new lesions appearing over several days. Brushing against the leaves of the plant causes the linear streaking pattern characteristic of poison ivy dermatitis. The resin can be inactivated with any type of soap, thereby preventing the reaction, but the sooner the better. Approximately 50% of the resin can be removed by soap and water within 10 minutes of contact, but after 30 minutes only about 10% can still be removed. Treat with antihistamines for the itching and expert consensus is to use a higher dosage tapered over a longer period, generally 10–14 days, in order to prevent a relapse (such as oral prednisone)
What is important to exclude before undergoing anesthesia for surgery in a patient with long-standing rheumatoid arthritis
Imaging of the patient’s cervical spine to detect atlantoaxial subluxation in a RA would be most important for preventing a catastrophic spinal cord injury during intubation. In many cases cervical fusion must be performed before other elective procedures can be contemplated.
In HIV patients with immunodeficiency, what antibiotics should be given for prophylactic treatment based on CD4 counts?
Patients with HIV infection and severe immunodeficiency are at risk for certain opportunistic infections. Susceptibility to opportunistic infections can be measured by CD4+ T lymphocyte counts. Patients with a CD4+ count <200 cells/mm3 should receive trimethoprim/sulfamethoxazole for prophylaxis against Pneumocystis pneumonia, and prophylaxis against Toxoplasma gondii when CD4+ level is <100 cells/mm3. Azithromycin for prophylaxis against Mycobacterium avium-intracellulare complex when CD4+ counts are <50 cells/mm3. Itraconazole for prophylaxis against Histoplasma capsulatum infection when the CD4+ count is :150 cells/mm3 if the patient is at risk due to occupational exposure or living in a community with a hyperendemic rate of histoplasmosis (>10 cases per 100 patient years).
Describe Legg-Calvé-Perthes disease
Legg-Calvé-Perthes disease results from interruption of the blood supply to the still-growing femoral head. It occurs in children 2–12 years of age and presents with hip pain and an atraumatic limp. Common physical findings include leg-length discrepancies, and limited abduction and internal rotation. Radiographs reveal sclerosis of the proximal femur with joint space widening. MRI confirms osteonecrosis.
First-line therapy for menstrual abnormalities, hirsutism, and acne in polycystic ovary syndrome
Hormonal contraceptives are the first-line therapy for menstrual abnormalities, hirsutism, and acne in polycystic ovary syndrome. Clomiphene is used for infertility. Metformin is beneficial for metabolic/glycemic abnormalities and menstrual irregularities, but does not improve hirsutism or acne.
What is recommendation for feeding for older adults with advanced dementia?
The American Geriatrics Society (AGS) states that percutaneous feeding tubes are not recommended for older adults with advanced dementia, and that careful hand feeding should be offered instead. This is the first recommendation by the AGS in the Choosing Wisely campaign. Careful hand feeding for patients with severe dementia is at least as good as tube feeding with regard to the outcomes of death, aspiration pneumonia, functional status, and patient comfort. Regular food is preferred. Tube feeding is associated with agitation, increased use of physical and chemical restraints, and worsening pressure ulcers.
What do people on the National Weight Control Registry do?
Individuals on the National Weight Control Registry eat a low-fat diet rich in complex carbohydrates, eat breakfast daily, weigh themselves at least once a week, and are physically active for 60–90 minutes a day.
What makes type 1 DM more likely thank type 2 DM
The patient presents with marked hyperglycemia but no evidence of ketoacidosis or nonketotic coma. Differentiating between type 1 and type 2 diabetes mellitus is important for guiding therapy. The gradual onset of symptoms is more consistent with type 2 diabetes mellitus, whereas type 1 diabetes typically has a more rapid onset. Patients with type 1 diabetes typically need lower doses of insulin to correct hyperglycemia, as they lack the insulin insensitivity that is the hallmark of type 2 diabetes. Positive anti-GAD antibodies and low C-peptide at the time of the initial diagnosis are also consistent with type 1 diabetes, although C-peptide levels can also be low in long-standing type 2 diabetes. Weight loss occurs in both types of diabetes mellitus when glucose is profoundly elevated.
Atypical antipsychotics is most appropriate for which condition
Atypical antipsychotics (2nd generation antipsychotics) may reduce the duration of delirium in adult intensive-care patients, and are recommended by the American College of Critical Care Medicine in their clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive-care unit.
The American Geriatrics Society and the American Psychiatric Association (APA) recommend not using antipsychotics as a first choice to treat the behavioral and psychological symptoms associated with dementia, such as aggression and resistance to care. These drugs have limited benefit and can cause serious harm, including stroke and premature death.
Typical antipsychotic is haloperidol (first generation antipsychotic)
Describe polymyositis/dermatomyositis group
Polymyositis/dermatomyositis group is an inflammatory myopathy. Proximal muscle involvement and elevation of serum muscle enzymes such as creatine kinase and aldolase are characteristic. Corticosteroids are the accepted treatment of choice.
Which one of uterotonic agents is CONTRAINDICATED in the management of postpartum hemorrhage if patient has hypertension or asthma?
Methylergonovine, Oxytocin (Pitocin), misoprostol (Cytotec), Carboprost tromethamine (Hemabate)
Uterotonics are the first-line treatment for postpartum hemorrhage in patients with decreased uterine tone. Methylergonovine should be avoided if the patient is hypertensive. It is an ergot alkaloid that causes generalized smooth muscle contraction and can raise blood pressure. Oxytocin (Pitocin) and misoprostol (Cytotec) not have any contraindications. Carboprost tromethamine (Hemabate) be avoided in asthmatic patients and is relatively contraindicated if the patient has hepatic, renal, or cardiac disease.
In a healthy premenopausal women, treatment for UTI is based on what?
In healthy premenopausal women with no history of a urinary tract functional abnormality, current pregnancy, or another underlying condition that may increase the risk of treatment failure, infection can be presumed based on symptoms. Patients with acute uncomplicated cystitis are not febrile and have no vaginal symptoms. Treat based on the symptoms rather than documented evidence of infection (SOR C).
Treatment for moderate osteoarthritis pain in patient with CKD3?
Acetaminophen is the analgesic of choice for short-term treatment of mild to moderate pain in patients with stage 3–5 chronic kidney disease. Chronic nonterminal pain requires initial treatment with nonopioid analgesics. NSAIDs should be avoided because of the risk of nephrotoxicity.
Blood gas for hyperventilation
Anxiety, shortness of breath, paresthesia, and carpopedal spasm are characteristic of hyperventilation. Respiratory alkalosis secondary to hyperventilation characterized by elevated arterial pH and depressed pCO2.
Distinguish starvation from cachexia in elderly patients?
In the frail elderly, it may be difficult to distinguish relative starvation due to decreased or inadequate caloric intake from cachexia, which is due to an inflammatory response with elevated cytokines. Appetite is decreased early in cachexia but remains normal in the early stages of starvation. Albumin decreases early in cases of cachexia and later in starvation. Due to the inflammatory changes, cachexia is resistant to refeeding. A reversal of changes occurs with refeeding in starvation
Which NSAID is safest for patients with a previous history of myocardial infarction?
All oral NSAIDs increase the risk of myocardial infarction (relative risk versus placebo from 1.5 for ibuprofen to 1.7 for celecoxib), with the exception of naproxen. Cardiac risks are greater in older patients, those with a history of cardiac events, and with higher dosages.
Treatment for laryngitis in children less than 3 weeks.
supportive care
What are signs of retinal vein occlusion?
The signs of retinal vein occlusion include sudden painless loss of vision or distortion of vision. Tortuous and dilated retinal veins on funduscopic examination. Patients also often have multiple cotton-wool spots, although these are not specific to retinal vein occlusion. An afferent pupillary defect often occurs on the affected side. Diabetes mellitus and hypertension are both risk factors for retinal vein occlusion. Redness is not typical and should cause the clinician to suspect an alternate diagnosis.
Which drugs can cause a false-positive test for opioids on UDS?
Dextromethorphan, diphenhydramine, ibuprofen, and even fluoroquinolones are among the many agents that can cause a false-positive urine drug screen for opioids. Pseudoephedrine can cause a false-positive test for amphetamines
Stretching has NO demonstrable benefit for which condition?
No benefit: Joint contracture
Benefits: Hamstring strain, Chronic neck pain, Osteoarthritis, Rehabilitation post knee replacement
Which has been shown to be LEAST effective in the treatment of irritable bowel syndrome?
Fiber is ineffective in the treatment of adult irritable bowel syndrome (IBS) (SOR A).
Symptoms do improve with exercise, probiotics, antibiotics, antispasmodics, antidepressants, psychological treatments, and peppermint oil (SOR B). SSRIs used in these trials included citalopram, fluoxetine, and paroxetine, and TCAs included amitriptyline, desipramine, and imipramine.
Adverse effects of stimulant medications for adults with ADHD?
Stimulants are preferred over nonstimulant medications for adults with attention-deficit disorder. Stimulants can aggravate psychosis, tics, or hypertension and are contraindicated in patients with these problems. Main side effects of these drugs include insomnia, dry mouth, weight loss, headaches, and anxiety.
