deck 1 Flashcards
most common cause of pancreatitis
gallstones
IBS diagnostic features
The criteria include symptoms that are present for at least 12 weeks (not necessarily consecutive) in the previous 12 months, and pain that is characterized by two of the following three features: (1) relieved by defecation, (2) onset is associated with a change in stool frequency, or (3) onset is associated with a change in the form or appearance of stool.
dyspepsia etiology
- no specific etiology found for 50-60% of patients
- 15-25% have peptic ulcer disease
- 5-15% have GERD
dyspepsia
chronic or recurrent discomfort centered around the upper abdomen
ASCUS with negative HPV….
repeat Pap in 1 year
Most common cause of IDA
blood loss
head lice treatment
1% permethrin ointment
cat bite treatment as oupatient
amoxicillin/clavulanic acid
cat bite management
hospitalization, unless superficial and doesn’t appear to be infected
discharge concerning for breast cancer
spontaneous, unilateral
pulmonary complication of RA
interstitial lung disease
polypharmacy defined as…
5 or more
cause of hyperglycemia in diabetic patients
4 I’s, infection/impregnation/ischemia. INFECTION, INFECTION, INFECTION
feature with highest likelihood of MI on ECG
ST-segment elevation
cardiac workup of patient with angina and low-risk
exercise ECG (cheaper and more convenient than stress testing)
labs to order for constipation workup
none, just thorough history unless alarm symptoms present (hematochezia, family history of colon cancer/IBD, positive FOBT, weight loss)
first line for constipation
- non pharmacologic, then bulk-forming agents (like psyllium)
treatment of choice for impaction
enema
first line for pertussis
5 day course of azithromycin or 14 day course of erythromycin
supportive care for acute viral diarrhea
- eat potatoes, rice, when, noodles, crackers, banana, yogurt, soup.
foods to avoid with viral diarrhea
dairy, alcohol, caffeine
1st line for peripheral vestibular disorder
antihistamines
predictive value of BNP for CHF
very high. if normal, chance is near zero.
mgmt of recurrent UTI post-coitus
1st line = single dose postcoital antibiotic use
2nd line = daily single-dose antibiotic prophylaxis for 3-6 months
dysuria + absent pyuria in postmenopausal woman cause or in younger woman
atrophy in older women, bladder irritant in younger women (caffeine, acidic foods)
hematuria + dysuria + no pyuria
suspect interstitial cystitis
interstitial cystitis workup
cystoscopy
cystitis and pyelonephritis in men?
very uncommon
acute prostatitis presentation
30-50 year old men, symptoms = frequency, urgency, back pain, acutely ill, pyuria
TMJ dysfunction treatment
NSAIDS, heat, mechanical soft diet.
finding insufficient to diagnose otitis media
reddened tympanic membrane (can be caused by increased intravascular pressure associated with crying)
reliable findings for otitis media
- opaque tympanic membrane
- bulging tympanic membrane
- impaired tympanic membrane mobility
purulent discharge in ear canal suggests….
tympanic membrane perforation
mgmt of kid with otitis that is treated and persistent effusions
- monitor (can take up to 3 months to resolve)
external otitis media treatment
Fundamental to the treatment of external otitis is protection from additional moisture and avoidance of further mechanical injury from scratching. Otic drops containing antibiotics and corticosteroids are very effective.
meds that can cause peripheral edema
Antihypertensives, such as calcium channel blockers are well known to cause this, but direct vasodilators, β-blockers, centrally acting agents, and antisympathetics also can cause edema. Of the diabetic medications, insulin sensitizers, such as rosiglitazone often cause edema.
edema workup
First thing to note is if the edema is bilateral or unilateral. Bilateral edema associated with signs and symptoms of CHF (dyspnea, rales, or JVD) would necessitate a chest x-ray to rule in the diagnosis, followed by an echocardiogram. If ascites is present, liver function studies are needed. If these are absent, the clinician should check an urinalysis. If the sediment is abnormal, nephritic syndrome or acute tubular necrosis (ATN) is the likely diagnosis.
mgmt of chronic venous insufficiency
elastic stockings
caveat about unilateral edema
usually does not respond to diuresis, sodium restore
tion, or an ACE inhibitor
fatigue workup
1) screen for depression
2) if depression screen negative, screen for sleep apnea, anemia, hypothyroidism, and pregnancy
mgmt of external hemorrhoid
local anesthesia and excision
mgmt of internal hemorrhoids
rubber-band ligation and sclerotherapy
anal fissure presentation
pain on defecation + hematochezia + complaint of ache or spasm that resolves after a couple of hours
strongest evidence base for prophylactic migraine therapy
TCA’s (amitriptyline)
HA warning signs
- sudden onset, increase in severity or frequency with signs of systemic disease, focal neurologic symptoms, papilledema, onset after age of 50
only CCB that works for migraines
verapamil
cluster HA acute management
Oxygen should be tried first if available (eg, in a hospital or emergency clinic setting) since it is without side effects. Otherwise, subcutaneous sumatriptan 6 mg can be used as initial therapy.
hematuria workup
In patients younger than 40 years with hematuria, but a normal IV pyelogram, urine culture and cytology, periodic
monitoring, and reassurance are appropriate. In a patient older than 40 years, cystoscopy would be appropriate.
