deck 25 Flashcards
venlafaxine withdrawal?
- much more severe than SSRI withdrawal
- agitation, anorexia, confusion, seizures, sweating, tremor, vomiting
other methods for reducing risk of renal failure induced by contrast material
adequate hydration + use of N-acetylcysteine
pap smears after hysterectomy?
can be discontinued
osteoporotic vertebral compression fracture management
- confirm ddx with plain film
- period of bed rest as short as possible
- bracing
- calcitonin often provides pain relief
cause of heel pain in geriatric patient (versus plantar fasciitis)
fat-pad atrophy
- causes pain as the day progresses
tarsal tunnel syndrome presentation
neuropathic pain in the distribution of the posterior tibial nerve, radiating into the plantar aspect of the foot toward the toes
imaging study of choice for osteomyelitis
MRI
TPN indication
- Patients with poorly functioning GI tracts who can’t tolerate other means of nutritional support
how to manage patients who can’t swallow because of esophageal motility problem
tube feedings
most effective treatment for head lice
malathion
most common lower extremity stress fracture in kids and adults
tibial fractures.
greatest demand for iron during pregnancy
latter half
bariatric surgery indications
BMI >40 or those with a BMI >35 who have serious coexisting medical problems. Examples of such coexisting medical problems include severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy, and severe diabetes mellitus
tocolytic with respiratory depression
magnesium sulfate
impt features of influenza
- very abrupt onset
- nonproductive cough almost always present
- patients say they have never been so ill
“influenza-like illness”
unconfirmed cases of flu
when to give someone normal saline rather than free water restriction for hyponatremia
- if hemodynamically stable then free water restriction
- if rapid onset and neurologic symptoms such as seizures then hypertonic saline
other common false positive on drug tests
poppy seed muffins (eating as little as one seed can produce detectable amounts of morphine and codeine)
head and neck lymph nodes most likely to be malignant
supraclavicular
most common known form of nutritional deficiency in US
iron deficiency
common complications with roux-en-y bypass
iron and B12 deficiency
most sensitive and accurate method of determining a patient’s risk for postoperative bleeding
history of prior bleeding problems
transmission of scabies mite
direct personal contact
contraindications to treatment with electrosugery
use of a pacemaker + treatment of melanoma
meds that can induce hypokalemia
pseudo ephedrine, insulin, potassium, diuretics
only med proven to be effective for cold
- ipratroprium nasal spray (decreases rhinorrhea and sneezing)
DRESS syndrome treatment
stop drug, start steroids
med that can worsen renal failure in patients with HTN secondary to renovascular disease
ACEIs
- thus can be useful diagnostic test since should see creatinine elevation if renovascular
problem with adalimumab and other TNF inhibitors
black-box warning about the potential for developing primary TB or reactivating latent TB
- also increased risk for invasive
max dose of ibuprofen
2,400 (800 TID)
acute hypersensitivity pneumonitis
Hypersensitivity pneumonitis can present in acute, subacute, or chronic forms. The case described includes two episodes of the acute form. The patient was exposed to mold antigens in his flooded home. Within 4–8 hours of exposure, chills, cough, and shortness of breath will be noted, and at times will be dramatic. A chest film can be normal, even with significant hypoxia. Pulmonary function tests will show restrictive changes, as compared to the reversible obstructive changes of acute asthma. Blood tests often show an elevated erythrocyte sedimentation rate. Serum IgG tests for the probable antigen confirm the diagnosis.
Symptoms of acute hypersensitivity pneumonitis resolve over several days, but will suddenly and violently recur with repeated exposure to the offending antigen. The subacute form begins gradually over weeks or months, causing a cough and increasing shortness of breath. The chronic form develops over years of exposure, causing fibrotic changes to the lungs that will be evident on radiographs, as well as chronic crackles on auscultation.
common metabolic abnormality with stage 4 CKD
hyperparathyroidism
only med proven to be effective for cold
- ipratroprium nasal spray (decreases rhinorrhea and sneezing)
management of negative rubella titer in pregnant woman
vaccinate immediately postpartum (can’t while pregnant since live vaccine)
contraindications to bisphosphonates
Hypocalcemia
renal impairment
major contraindication to OCPs
history of migraine (women with migraine history are 2-4 times as likely to have a stroke compared to women without migraines and women who have an aura with migraine are at even higher risk)
treatment of melasma
high-potency broad-spectrum sunscreens can help prevent it or prevent worsening
- postpartum topical retinoids, hydroquinone, or steroids can be used but require months of treatment.
- usually improves spontaneously after delivery but may be prolonged or worsened by OCP use (which can do it too)
otitis externa treatment
- Ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex) topically
(topical corticosteroids may hasten symptom reduction)
urine should be acidified for what type of stones?
calcium phosphate, struvite stones (cranberry juice or betaine can lower urine pH)
PCOS women at increased risk for what malignancy?
endometrial
gonorrhea treatment
Ceftriaxone, 250 mg intramuscularly, plus azithromycin (Zithromax), 1 g orally
treatment of comedonal acne
- topical retinoids
- Comedones are noninflammatory acne lesions. Inflammatory lesions include papules, pustules, and nodules. Grading acne based on the type of lesion and severity helps guide therapy. Topical retinoids prevent the formation of comedones and reduce their number, and are indicated as monotherapy for noninflammatory acne. Topical antibiotics are used primarily for the treatment of mild to moderate inflammatory or mixed acne. Oral antibiotics are effective for the treatment of moderate to severe acne. Oral isotretinoin is reserved for treatment of severe, recalcitrant acne.
major contraindication to OCPs
history of migraine (women with migraine history are 2-4 times as likely to have a stroke compared to women without migraines and women who have an aura with migraine are at even higher risk)
USPSTF recommendation for AAA screening
one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men age 65–75 who have ever smoked (Grade B recommendation)
otitis externa treatment
- Ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex) topically
(topical corticosteroids may hasten symptom reduction)
urine should be acidified for what type of stones?
calcium phosphate, struvite stones (cranberry juice or betaine can lower urine pH)
CHADS 2
warfarin
antidote for magnesium toxicity
calcium infusion
initial management of hypothyroidism
Methimazole and propylthiouracil (PTU) are the two oral antithyroid medications available. However, because of reports of severe hepatocellular damage, methimazole should be used instead of PTU unless it is contraindicated. Radioactive iodine treatment (131I) is an option, especially for patients who do not achieve remission with antithyroid medications. However, worsening of preexisting orbitopathy is a well-recognized potential complication of 131I treatment, as well as a transient increase in thyroid hormone levels that can precipitate thyroid storm. Thus, patients with elevated free T3 or free T4 levels should be treated with methimazole prior to 131I administration. Thyroidectomy is most often recommended for patients with thyroid nodules and those who are suspected of having cancer or who do not tolerate or refuse alternative forms of therapy. However, antithyroid medication should be given to achieve a euthyroid state prior to surgery in most patients.
management of hoarseness
- if doesn’t resolve in 3 months then get laryngoscopy
- if recent history of URI or vocal abuse, then voice rest for 2 weeks
- if history of GERD, ppi
USPSTF recommendation for AAA screening
one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men age 65–75 who have ever smoked (Grade B recommendation)
1st line antihypertensive for patients with CAD
beta-blockers (should also be used for normotensive patients)
classic finding in MM
bone pain
duration of thromboprophylaxis following hip surgery
35 days
antidote for magnesium toxicity
calcium infusion
initial management of hypothyroidism
Methimazole and propylthiouracil (PTU) are the two oral antithyroid medications available. However, because of reports of severe hepatocellular damage, methimazole should be used instead of PTU unless it is contraindicated. Radioactive iodine treatment (131I) is an option, especially for patients who do not achieve remission with antithyroid medications. However, worsening of preexisting orbitopathy is a well-recognized potential complication of 131I treatment, as well as a transient increase in thyroid hormone levels that can precipitate thyroid storm. Thus, patients with elevated free T3 or free T4 levels should be treated with methimazole prior to 131I administration. Thyroidectomy is most often recommended for patients with thyroid nodules and those who are suspected of having cancer or who do not tolerate or refuse alternative forms of therapy. However, antithyroid medication should be given to achieve a euthyroid state prior to surgery in most patients.
management of lateral epicondylitis
Conservative care that includes offloading the involved tendons is the key to improving outcomes at 1 year, which would mean modifying this patient’s work.
- Stop doing whatever it is that is causing the pain.
