deck 14 Flashcards
Problem with infliximab/adalimumab/TNF inhibitors
Increased risk of infections, including TB
- Need to screen for TB, hep B and C
Patient with MRSA in nursing home management
- strict handwashing
- barrier precautions for wounds and medical devices
procedure before which metformin must be stopped
CT angio (contract can cause lactic acidosis in patients taking metformin)
abx for nursing-home acquired pneumonia
Need empiric coverage for MRSA and pseudomonas
- Ceftaz + levo + vancomycin
benzos and pregnancy?
possible link to cleft lip/palate
only SSRI with pregnancy concern
paroxetine
drug for management of severe osteoporosis OR multiple risk factors OR patients who fail bisphosphonate therapy
2 yrs of teriparatide
1st line for anorexia nervosa
family-based treatment
problem with rapid influenza tests
Produce false-negative results
When to initiate treatment for influenza according to the CDC
- Treat based on symptoms, even if rapid test is negative.
- Treat ASAP (earlier the better)
USPSTF aspirin recommendations
The USPSTF recommends the use of aspirin for men 45–79 years of age when the potential benefit from a reduction in myocardial infarctions outweighs the potential harm from an increase in gastrointestinal hemorrhage (Grade A recommendation)
The USPSTF recommends the use of aspirin for women 55–79 years of age when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage (Grade A recommendation)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years of age or older (Grade I statement)
The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 and for myocardial infarction prevention in men younger than 45 (Grade D recommendation)
In summary, consistent evidence from randomized clinical trials indicates that aspirin use reduces the risk for cardiovascular disease events in adults without a history of cardiovascular disease. It reduces the risk for myocardial infarction in men, and ischemic stroke in women. Consistent evidence shows that aspirin use increases the risk for gastrointestinal bleeding, and limited evidence shows that aspirin use increases the risk for hemorrhagic strokes. The overall benefit in the reduction of cardiovascular disease events with aspirin use depends on baseline risk and the risk for gastrointestinal bleeding.
what asthma med can you never use as monotherapy
- LABA –> increased risk of asthma exacerbation or asthma-related death.
preliminary evaluation for IBD
CBC w/ platelets, BMP, ESR
If abnormal then proceed to endoscopy
followup for hyper plastic polyp
10 yrs, not neoplastic
Indications for shorter interval between colonoscopies
Reductions
in this interval are recommended for patients with one or two small tubular adenomas (5–10 years) or those
with three or more tubular adenomas (3 years);
treatment for symptomatic MVP
b-blockers
contraindication for acetazolamide
sulfa allergy
prophylaxis and treatment of latitude sickness
dexamethasone or acetazolamide
most common drug causing AIN
antibiotics (especially penicillins, cephalosporins, sulfonamides)
alternative medication that has been shown to treat chronic venous insufficiency
Horse chestnut seed extract
most common cause of erythema multiforme
HSV
greatest RF for AAA
cigarette smoking
protective factor for AAA
diabetes mellitus
subclinical hypothyroidism
slightly elevated TSH and normal T4 in asymptomatic patient
tinea infection that requires systemic therapy
tinea capitis (need to penetrate affected hair shafts)
BNP specificity
very low
- also elevated with renal failure (reduced clearance), PE, pulmonary HTN, chronic hypoxia
Problem with long term PPI therapy
- increased risk of CAP and c diff colitis
- decreases absorption of B12
- decreases calcium absorption, leading to an increased risk of hip fracture
management of a flutter in patient with heart failure
- electrical cardioversion
management of A flutter in hemodynamically stable patients
digoxin and verapamil
BP management in patient with stroke history
combination therapy with diuretic + ACE inhibitor
management of patient not responding to antidepressants
lithium OR low-dose T3
management of patients with acute cervical radiculopathy
- NSAIDS
cutaneous erythrasma
- infection that often complicates intertrigo
- caused by corynebacterium minutissimum
treatment for cutaneous erythrasma
erythromycin
management of thrombosed hemorrhoid
- excision thrombosed tissue under local anesthesia
classic patellofemoral pain syndrome pt
adolescent girl
cause of patellofemoral pain
- inadequate hip abductor and core strength
patellofemoral pain management
PT
most likely polyp to develop into adenocarcinoma
villous adenoma
polyps that can become malignant
adenomas
insulin drug class that reduces insulin resistance
thiazolidinedione
most effective intervention for smokeless tobacco
behavioral interventions (telephone counseling and/or dental exam)
problem with vacuum delivery
increased incidence of shoulder dystocia
USPSTF chlamydia screening recommendation
- all sexually active, non pregnant young women younger than 25
testicular cancer screening?
not recommended
