deck 23 Flashcards
problem with thyroid sonograms
pick up a ton of incidentalomas (small thyroid nodules with low risk of malignancy)
- If TSH is normal, repeat US in 6-12 months
anemia with normal RDW
beta-thalassemia
TMJ disorder
Temporomandibular joint (TMJ) disorders occur in a large number of adults. The etiology is varied, but includes dental malocclusion, bruxism (teeth grinding), anxiety, stress disorders, and, rarely, rheumatoid arthritis. Dental occlusion problems, once thought to be the primary etiology, are not more common in persons with TMJ disorder. While dental splints have been commonly recommended, the evidence for and against their use is insufficient to make a recommendation either way. Physical therapy modalities such as iontophoresis or phonophoresis may benefit some patients, but there is no clearly preferred treatment. Radiologic imaging is unnecessary in the vast majority of patients, and should therefore be reserved for chronic or severe cases. In fact, the majority of patients with TMJ disorders have spontaneous resolution of symptoms, so noninvasive symptomatic treatments and tincture of time are the best approach for most.
AIN natural course
With discontinuation of med, most patients recover normal renal function.
AIN mes
all NSAIDs are known to be associated with AIN. Development of AIN usually becomes evident approximately 2 weeks after starting a medication and is not dose-related. Other medications strongly associated with AIN include various antibiotics (particularly cephalosporins, penicillins, sulfonamides, aminoglycosides, and rifampin), diuretics, and miscellaneous medications such as allopurinol.
preferred pressors when fluid resuscitation is inadequate
NE + dopamine
treatment of chronic orthostatic hypotension
fludrocortisone, midodrine, physostigmine
recommended med to reduce mortality in symptomatic patients with HF
beta-blockers
catch about PTH with hyperparathyroidism
normal PTH + hypercalcemia in a patient is diagnostic for hyperparathyroidism since PTH should be suppressed in the presence of elevated calcium
renal failure affect on calcium
causes hypocalcemia
milk alkali syndrome
hypercalcemia resulting from a chronic overdose of calcium carbonate
antivirals for hep B?
Now available ($20/day) - some AIDS drugs are also active against hep B
hemoglobin level in patients with kidney failure
10-12 (levels in normal range associated with death and serious CV events)
characteristic lab finding in pt with intrahepatic cholestasis of pregnancy
elevated serum total bile acids
other conservative treatment for plantar fasciitis
stretching exercises for the achilles tendon
microscopic hematuria management
Ultrasonography of the kidneys, urine cytology, and cystoscopy
valvular abnormalities most common in marfan’s
MVP + aortic insufficiency
long term PPI effects
- The three main concerns regarding the long-term safety of proton pump inhibitors (PPIs) include the effects of prolonged hypochlorhydria and hypergastrinemia, and the possible association of PPIs with gastric atrophy. In particular, hypochlorhydria is of concern since it may predispose to infections and malabsorption.
- studies subsequent to that guideline continue to raise concerns about possible infectious complications, electrolyte disturbances, and metabolic bone disease associated with PPI use
Chads O and 2
CHADS of 2 –> oral anticoagulant
CHADS O –> nothing
BP management/HTN goals
Goal blood pressure is <140/90 mmHg for the general hypertensive population under the age of 60 years, and for patients with diabetes or chronic kidney disease, regardless of age.
•Goal blood pressure is <150/90 mmHg for the general hypertensive population aged 80 years and older.
•Goal blood pressure is <150/90 mmHg for most of the general hypertensive population aged 60 to 79 years, but a goal of <140/90 mmHg may be appropriate for some patients. The choice between these two goal blood pressures depends upon the patient’s general health, comorbid conditions, postural blood pressure changes, the number of medications needed to reach the goal, and upon individual values and preferences.
most common cause of hearing loss in newborns
genetic disorders
side effects of testosterone
- increases hematocrit and can cause polycythemia
- need to monitor hematocrit q 6 months
- may increase bone density
to know about oral iron replacement
1) absorbed better in acidic environment so can give vitamin C and need to avoid PPIs/H2 blockers
2) improved if taken on empty stomach but commonly irritates gastric lining
3) causes constipation
APA treatment during pregnancy
aspirin + heparin
dizziness most concerning when associated with…
diplopia, which suggests a central cause
use of amylase for pancreatitis
less likely to be elevated in alcoholics
lab pattern of hemolytic anemia
reticulocytosis, increased unconjugated bilirubin, elevated lactate dehydrogenase (LDH), decreased haptoglobin
management of nipple pain with feeding
education on positioning
Rome criteria for IBS
3 days per month of abdominal pain for the past 3 months, a change in the frequency of stool, and improvement with defecation
management of diarrheal symptoms in IBS
loperamide
ankle sprain management
semi-rigid stirrup brace (Air-Stirrup, “Aircast”)
standrad therapy for meth dependence
outpatient behavioral therapies, especially with case management included
what confounds B12 testing
renal failure. patients with renal failure often have normal B12 despite actual deficiency. this is when you need to order a MMA level to confirm the diagnosis
patellofemoral pain complaints
Patients complain of popping, catching, stiffness, and giving way. On examination there will be a positive J sign, with the patella moving from a medial to a lateral location when the knee is fully extended from the 90° position. This is caused by an imbalance in the medial and lateral forces acting on the patella. Locking is not characteristic of patellofemoral pain syndrome, so a loose body or meniscal tear should be considered if this is reported.
med dosing in CKD
A reduction of dose, an increase in dosing interval, or both may be necessary
management of rotator cuff tears/any tendon tears
surgical management quickly
preferred cervical cancer screening for women 30-64
Pap test + cotesting for HPV. This is because despite negative cytology, women with oncogenic HPV are at higher risk for later CIN 3+ than women with negative HPV tests. So if pap negative but HPV positive, need o return for cotesting in 1 year.
imiquimod (aldara) used for…
genital warts
severe hyperkalemia
greater than 7.0
hyperkalemia acute management
1) give calcium chloride or gluconate (no effect on plasma potassium but should be given first since it stabilizes the membranes of cardiac myocytes)
2) then give sodium bicarb + glucose with insulin + albuterol. These will translocate potassium from serum to intracellular space.
3) hemodialysis for most severe cases
when to combine NRT
relapsed smoker on next quit attempt
efficacy of NRT for quitting smoking
usually doubles a smokers chance of quitting
