deck 26 Flashcards
How to reduce HF admissions
good evidence that case management interventions led by a heart failure specialist nurse reduce heart failure readmissions, all-cause readmissions, and all-cause mortality. Case management interventions include home care, telephone calls, patient education, self-management, and face-to-face visits. It is not possible to say which specific interventions were optimal, but telephone follow-up was a common component in most of these trials. Multidisciplinary interventions may also be effective.
management of acute low back pain
Nonbenzodiazepine muscle relaxants such as cyclobenzaprine are beneficial for the relief of acute low back pain for the first 7–14 days after the onset of symptoms. Patient education, physical therapy, and the application of ice or heat may also help.
respiratory infection in which antibiotic therapy be initiated immediately upon diagnosis
Epiglottitis
intrapartum prophylaxis of GBS in penicillin-allergic patients
cefazolin
initial treatment of crohn’s
prednisone
when to use TNF agents for Crohn’s
Anti-TNF agents such as infliximab should be considered in patients with moderate to severe Crohn’s disease who do not respond to initial corticosteroid or immunosuppressive therapy, but these are not recommended for initial treatment.
how to differentiate grief from depression in terminally ill patients
The key clinical feature in distinguishing the two conditions is in the pervasiveness of symptoms in depression, particularly the loss of pleasure or interest in all activities. Episodic feelings of guilt, anxiety, and helplessness, and even thoughts of wanting to die can and do occur with grief reactions, but these feelings are not constant and over time the symptoms gradually wane. Terminally ill patients with major depression feel helplessly hopeless all the time, but they often respond to and significantly benefit from antidepressant medication (SOR A).
NSAIDS and liver disease
- fine for mild liver disease, but should be avoided in all patients with cirrhosis (due to risk of precipitating hepatorenal syndrome)
acetaminophen and liver disease
toxic in high doses, but can be used safely in dosages o 2-3 g/day
USPSTF HIV recommendation
all adults age 65 years and under be screened for HIV regardless of RFs
next step if ABI’s don’t correlate with clinical evidence of peripheral vascular disease
vascular imaging with MR or CT arteriography
high risk exposure areas to asbestos
individuals who worked in construction trades or as boilermakers, shipyard workers, or railroad workers, as well as U.S. Navy veterans.
silicosis exposures
sandblasters, miners, persons who have worked with abrasives, and several other occupations.
phenazopyridine
Chemical which, when excreted into the urine, has a local analgesic effect. It is often used to alleviate the pain, irritation, discomfort, or urgency caused by urinary tract infections, surgery, or injury to the urinary tract.
- Phenazopyridine is prescribed for its local analgesic effects on the urinary tract. It is sometimes used in conjunction with an antibiotic or other anti-infective medication at the beginning of treatment to help provide immediate symptomatic relief.
signs of infection in wounds
- periwound induration, cellulitis extending greater than 2 cm beyond margin, increased temp, pain on palpation, drainage from site,
- lymphangitis
- increase in ulcer size
- odor
- pain intensity
treatment of ankle sprain
Lace-up ankle support
most effective prevention of acute mountain sickness
- slow ascent
- acetazolamide or dexamethasone can also be used for prevention and treatment
signs of end-stage acute mountain sickness
ataxia + altered mental status
what to avoid with AMS
alcohol consumption
myocardial changes with age
- collagen and mass both increase with age (increase in collagen may play a role in decreasing LV compliance)
how to improve EF in systolic HF
spironolactone (reduces all cause mortality and improves EF)
med contraindicated with systolic HF
Verapamil (negative inotrope, associated with worsening HF + increased risk of adverse cardiovascular events)
term for gynecomastia in fat people + presentation
- pseudogynecomastia (just due to increased fat deposition secondary to obesity)
gynecomastia presentation
palpable glandular tissue in nipple/areolar region in a concentric mass.
sulfonylurea most likely to cause hypoglycemia
glyburide
for what condition is extracorporeal shock wave therapy used for for shoulder pain?
calcific tendinitis of the rotator cuff
pharmacotherapy for BPD?
nothing available
beta blocker contraindicated in pregnancy
- metoprolol (associated with fetal growth restriction)
drug generally used for HTN in pregnancy
labetalol
most common cause of acute infectious endocarditis
staphylococcus aureus
treatment of hypoactive sexual desire disorder in women (not interested in sex and it bothers them)
- topical testosterone, in either patch or gel form)
treatment for diarrhea-predominant IBS
SSRIs or TCAs
treatment of jarisch-herxheimer reaction
reassurance + antipyretics
ADA recommendation on diabetes screening
Testing for diabetes mellitus should be considered in all asymptomatic adults who have a BMI ≥25 kg/m2 and have one or more additional risk factors such as physical inactivity, a first degree relative with diabetes, a high-risk ethnicity, hypertension, hyperlipidemia, or polycystic ovary syndrome. In asymptomatic patients with no risk factors, screening should begin at age 45.
side effect more likely with aromatase inhibitors than tamoxifen
myalgais and noninflammatory arthralgia
myelodysplastic syndrome labs
Myelodysplastic syndrome is a hematologic malignancy with a predisposition to leukemic transformation. It can present with findings of anemia, thrombocytopenia, neutropenia, or any combination of these. Anemia occurs in 80%–85% of patients and is typically macrocytic.
management of hospitalized pt with low-risk peptic ulcer bleeding
d/c same day as endoscopy and on oral PPI
initial imaging modality to diagnose stress fractures
plain radiograph
treatment of mallet fracture
splint DIP joint in extension for 8 weeks
first line therapy for stress and urge urinary incontinence
Conservative therapies such as behavioral therapy, including bladder training and lifestyle
modification
antidepressant of choice for patient with limited lifespan
methylphenidate (ritalin)
treatment of bell’s palsy
corticosteroids
entity legally responsible for notifying patient results of mammogram
facility
heatstroke vs. heat exhaustion
Heatstroke is a much
more severe condition than heat exhaustion. Evidence of central nervous system dysfunction is evidence of heatstroke rather than heat exhaustion, even if other symptoms are not severe and point to heat exhaustion. Heatstroke is a medical emergency.
caveat about GERD cough
can be otherwise asymptomatic
management of cerebellar hemorrhage
neurosurgery consult
BNP level that rules out HF
less than 100
treatment of choice for menorrhagia due to endometrial hyperplasia without atypia
medical therapy with pro gestational drugs (progestins convert the proliferative endometrium to a secretory one, causing withdrawal bleeding and regression of hyperplasia) - usually with cyclic oral medroxyprogesterone or levonorgestrel IUD
treatment of traveler’s diarrhea
cipro
