deck 20 Flashcards
FH of sudden death + recurrent syncope suggests…
long-QT syndrome
Long-QT syndrome diagnosis
resting EKG
other thing to think about with young people and sudden death
long-QT syndrome
long-QT syndrome management
beta-blockers, implantable ICD, no participation in competitive sports
supplement that can reduce symptoms + possibly slow disease progression in patients with knee OA
glucosamine sulfate
atypical antipsychotic associated with least amount of weight gain
aripiprazole
MM confirmatory diagnosis
- bone marrow exam showing greater than 10% of plasma cells
management of small spontaneous pneumothorax
outpatient management with analgesics + followup within 72 hours.
pain reduced when abdominal muscles are tightened suggests..
Garnett’s sign –> abdominal wall pathology such as a hematoma in abdominal wall musculature
current exercise recommendations to delay onset of heart disease and HTN
- 30 minutes of accumulated moderate-intensity exercise 5 or more days per week
diastolic dysfunction pathophys
chronic systolic HTN –> LVH –> limited output
NNT
1/absolute risk reduction
other high risk group that should receive pneumovax
1) all smokers between ages of 19 and 64
2) one-time revaccination after 5 years for patients with chronic renal failure, asplenia.
diverticulitis abx
1) metronidazole
2) amoxicillin/clavulante
common cause of fecal incontinence in institutionalized elderly
Overflow incontinence (due to constipating meds)
cause of fecal incontinece in IBD
reduced storage capacity
cause of fecal incontinence in women
- puborectalis and internal sphincter weakness from vaginal delivery
slipped capital femoral epiphysis pathognomic exam finding
limited internal rotation of flexed hip
campylobacter gastroenteritis
- common in elderly and very young
- very common
- more common during summer
- more common in males
- mostly diarrhea with less N/V
guidelines for BP control in stroke patients
Monitoring with no additional treatment for patients with a systolic blood pressure <220 mm Hg or a diastolic blood pressure <120 mm Hg. The elevated blood pressure is thought to be a protective mechanism that increases cerebral perfusion, and lowering the blood pressure may increase morbidity.
most common cause of constant unilateral nasal obstruction
septal deviation
initial management of hypercalcemic crisis
Volume repletion and hydration. The combination of inadequate fluid intake and the inability of hypercalcemic patients to conserve free water can lead to calcium levels over 14–15 mg/dL. Because patients often have a fluid deficiency of 4–5 liters, delivering 1000 mL of normal saline during the first hour, followed by 250–300 mL/hour, may decrease the hypercalcemia to less than critical levels (<13 mg/dL).
muscle relaxant to avoid
carisoprodol (metabolized to meprobamate, which is a class III controlled substance0
lab finding with very high PPV for acute gallstone pancreatittis
threefold or greater elevation in alkaline transaminase
lab finding with high PPV for pancreatic necrosis
CRP
USPSTF recommendation on vitamin supplements
no rec for vitamin supplements for any condition
behcet’s syndrome
original description of Behçet’s syndrome included recurring genital and oral ulcerations and relapsing uveitis. It is more common in Japan, Korea, and the Eastern Mediterranean area, and affects primarily young adults. The cause is unknown. Two-thirds of patients will develop ocular involvement that may progress to blindness. Patients may develop arthritis, vasculitis, intestinal manifestations, or neurologic manifestations. This disease is also associated with cutaneous hypersensitivity; 60%–70% of patients will develop a sterile pustule with an erythematous margin within 48 hours of an aseptic needle prick.
metatarsal stress fractures
- common in runners
- can be reproduced by having patient jump on affected leg
- localized tenderness and swelling
management of severe hyponatremia (with confusion and seizures)
Warrants urgent management with hypertonic saline.
- Raise serum sodium level by 1-2 mmol/L per hour
- some people recommend concomitant use of furosemide
best initial management for patients in afib
rate control w/ CCB or beta-blocker + warfarin for anticoagulation
best choice for anticoagulation in patients 65 and older with one or more RFs for stroke
warfarin
enoxaparin/LMWH monitoring
only required in severely obese patients, should be monitored with anti-factor Xa levels
management of asymptomatic patient with positive PPD
CXR
management of high risk patient with initial negative PPD
two-step PPD
management of asymptomatic patient with positive PPD + abnormal chest film
sputum culture for TB
therapy for acute pericarditis
NSAIDS (aspirin and ibuprofen)
erythrasma/corynebacterium infection ddx
coral-red fluorescence under a Wood’s light
management of elevated transaminases in patient at risk for NAFLD
- need to rule out hep B and C still (test for viral hepatitis)
most common presenting symptom of OSA
excessive daytime sleepiness
other OSA symptoms
snoring, unrefreshing or restless sleep, witnessed apneas and nocturnal choking, morning headache, nocturia or enuresis, gastroesophageal reflux, and reduced libido
mild cognitive impairment defined as
motor function normal and normal functional activities/adls but objective evidence of memory impairment
when does advance directive take effect
when individual becomes unable to communicate health care wishes
usual management of patient with systolic HF
ACE inhibitor + beta blocker
concern with angioedema and ACEI
ARB will prob do it too if ACEI is
when metolazone is used for HF
volume overload unresponsive to increased doses of furosemide
management of systolic HF for patient who can’t tolerate ACEI
isorbide + hydralazine
concern in women over 65 with hyperthyroidism
increased risk for hip and vertebral fractures
