deck 18 Flashcards
best evidence for physical activity in elderly
fall prevention
preferred anticoagulant for venous thrombosis during pregnancy
LMWH (unfractionated heparin requires more monitoring and may increase risk of HIT)
mediastinal widening in MCV crash patient
partial rupture of thoracic aorta
most common presenting symptom of hodgkin’s lymphoma
painless lymphadenopathy
pseudoaddiction
term used to describe patient behaviors that may occur when pain is undertreated.
management of pt on narcotics using alcohol/illicit drugs
- expected that alcohol and illicit drugs not be used concurrently.
OTC cough and cold products cannot be used in infants/childrens younger than…
2
gout triggers
red meat, seafood, alcohol, nuts and beans (high in purines)
food that reduces frequency of gout attacks
dairy products
pharmacokinetic factors that change with age
- volume of distribution (due to increase in ratio of fat to lean body weight)
- liver metabolism, renal excretion
- *transdermal asborption DOES NOT CAHNGE.
CBT for GAD?
Has been shown to be at least as effective as medication.
pertussis diagnosis
nasopharyngeal culture + PCR testing
preferred opioids for use in patients with ESRD
fentanyl (metabolized in liver) and methadone
how to correlate A1C with glucose level
- 6.0 –> 120 mg/dl
- each percentage point corresponds to increase in 30 mg/dl rise in average glucose
ABG with PE
PO2 and PCO2 decreased, pH elevated
management of stable patient with SVT
first line –> vagal maneuvers
second line –> IV adenosone
lab to order for vitamin d deficiency
25-hydroxyvitamin D
ottawa ankle rules for radiographs
According to these guidelines, an ankle radiograph series is required only if there is pain in the malleolar zone and bone tenderness of either the distal 6 cm of the posterior edge or the tip of either the lateral malleolus or the medial malleolus. Inability to bear weight for four steps, both immediately after the injury and in the emergency department, is also an indication for ankle radiographs. Foot radiographs are required only if there is pain in the midfoot zone and bone tenderness at the base of the 5th metatarsal or the navicular, or if the patient is unable to bear weight both immediately after the injury and in the emergency department.
most common cause of incontinence in elderly patients
detrusor instability
- can become worse after TURP
best med for prophylaxis of traveler’s diarrhea
rifaximin
treatment of choice for decontamination of most medication ingestions
- single dose of activated charcoal
- should be used within 1 hour of ingestion
cutoff fasting plasma glucose for managing GDM
start meds if above 100
DM meds for GDM
NPH + lispro BID
asthma diagnosis
Need spirometry to diagnosis
PMS syndrome caveat
symptoms are generally worse prior to menses, but can occur to some degree during menses and throughout the month
PMS symptoms
anxiety, sleep disorder, fatigue, persistent depressed mood, decreased libido
medicare part A covers
(hospital insurance) covers inpatient care in hospitals and skilled nursing facilities, hospice, and home health services.
medicare part B covers
outpatient physician services, including office visits and home health services.
medicare part D
prescription drug coverage.
tetanus booster recommendation
Tdap (Due to waning immunity to pertussis. unless less than 5 years since last booster)
management of isolated, enlarged cervical lymph node
1) Immediate biopsy is warranted if the patient does not have inflammatory symptoms and the lymph node is >3 cm, if the node is in the supraclavicular area, or if the patient has coexistent constitutional symptoms such as night sweats or weight loss. Immediate evaluation is also indicated if the patient has risk factors for malignancy. Treatment with antibiotics is warranted in patients who have inflammatory symptoms such as pain, erythema, fever, or a recent infection.
2) if no malignancy RF’s, monitor node for 4-6 weeks.
STEMI definition
ST-segment elevation of greater than 0.1 mV in at least 2 contiguous precordial or adjacent limb leads.
most important goal in STEMI management
1) begin fibrinolysis less than 30 minutes after contact with health system
- oral clopidogrel + chew large dose aspirin
“enteric” meaning for drugs
coating that prevents dissolution or disintegration in the gastric environment
drug you can’t use anymore for head lice
Lindane (efficacy has waned + neurotoxic)
thyroid nodule management
1) Measure TSH
2) IF suppressed, get a radionuclide thyroid scan –> if hot, FNA not needed. If cold, FNA
3) If TSH normal, get an FNA
HEENT associated with DM
parotid gland enlargement + candidiasis + periodontal bleeding
tooth erosion can also be a feature of…
GERD
management of infected ingrown toenail
- partial avulsion of the medial nail plate and phenolization of the matrix at this visit
if you can’t get IV access then…
IO access. no contraindications. all IV drugs can be given IO.
biguanide mehcanism
decrease hepatic glucose production + increase insulin sensitivity
DPP-4 mechanism
prevent GLP-1 breakdown
elevated LH/FSH with absent menses suggests…
ovarian failure
treatment of hirsutism in premenopausal women
spironolactone
best drug with osteoporotic women w/ breast cancer FH
raloxifine
raloxifine MOA
estrogen agonist in bone, antagonist in uterus and breast
management of benign FNA cytology with firm, fixed breast mass
excisional biopsy (biopsy results don’t match clinical results)
flashing lights + visual field defect
retinal detachment
med that falsely depresses PSA levels
finasteride
onset of somatization disorder
usually before 30
test of choice if endoscopy is unsuccessful due to active bleeding
A technetium-99m blood pool scan to determine site of bleeding
