deck 27 Flashcards
primary indication for joint replacement surgery in patients with OA
- intractable pain is primary indication
- significant limitation of joint function
- altered limb alignment
treatment of pharyngeal gonorrhea
cotreat for chlamydia infection
what increases likelihood of dialysis in diabetic patient
combining an ACE with an ARB
initial treatment of mild to moderate allergic rhinitis
The initial treatment of mild to moderate allergic rhinitis should be an intranasal corticosteroid alone, with the use of second-line therapies for moderate to severe disease (SOR A).
subacromial bursitis presentation
- pain on abduction + intense local tenderness
- Acute subacromial bursitis is common and is often associated with calcific deposits in the supraspinatus tendon, pain on abduction, and local tenderness.
evidence for static stretching before running?
no benefit
evidence for low carb diets?
Emerging data on low-carbohydrate diets is mostly encouraging, in that these diets do not seem to cause the expected increases in blood pressure, LDL-cholesterol levels, or triglyceride levels that the medical community had first assumed. Although low-carbohydrate diets have been shown to result in clinically meaningful weight loss, reduced-calorie diets appear to result in similar weight loss regardless of which macronutrients they emphasize. This patient has symptoms of metabolic syndrome and has a higher risk of glucose intolerance or diabetes mellitus. Low-carbohydrate diets have been shown to reduce insulin resistance at least as well as, if not better than, traditional diet plans.
contraceptive for women who are exclusively breastfeeding?
progestin-only pills
contraceptive for women on antiepileptics?
levonorgestrel (progestin only) IUD and copper IUD (certain AEDS induce hepatic metabolism of estrogen and progestin, leading to failure of contraceptive
management of patient on dual anti platelet therapy who requires bypass surgery
continue taking aspirin, stop clopidogrel.
confounding factor for serum sodium?
- hyperglycemia (glucose-related increase in osmolality of extracellular fluid, followed by movement of water from intracellular to extracellular fluid compartments and subsequent loss of excessive extracellular fluid and electrolytes)
- serum sodium concentration also diminished in patients with HLD or hyperproteinuria because of the volume occupied by lipids or proteins.
patellofemoral pain syndrome presentation
- anterior knee pain that is worse with running downhill
- exam usually normal
patellofemoral pain syndrome treatment
exercises to strengthen the quadriceps and hips, and by using a knee sleeve with a doughnut-type cushion that the patella fits into.
asymmetry, symmetry of RA?
most often symmetric at presentation
- *also RF is often negative in early months of the disease
caveat about CXR for pneumonia
delay in presentation of pneumonia, so is often negative early on
manage of abdominal pain secondary to psych issue/other somatization
regular visits, manage like somatoform disorder
USPSTF recommendation on carotid artery US
The U.S. Preventive Services Task Force and the American Heart Association/American Stroke Association recommend not performing carotid artery screening with ultrasonography or other screening tests in patients without neurologic symptoms because the harms outweigh the benefits. In the general population, screening tests for carotid artery stenosis would result in more false-positive results than true-positive results. This would lead to surgical procedures that are not indicated or to confirmatory angiography. As a result of these procedures, some patients would suffer serious harms such as death, stroke, or myocardial infarction, which outweigh the potential benefit surgical treatment may have in preventing stroke.
most common primary immunodeficiency
- common variable immunodeficiency
CVD diagnosis
low serum levels of IgG, IgM, IgA
common variable immunodeficiency presentation
The disorder is associated with recurrent sinus infections, otitis media, bronchiectasis, and chronic gastrointestinal problems.
common variable immunodeficiency treatment
IVIG
Best evidence for vitamin D
prevent falls in community-dwelling adults 65 and older who are at increased risk for falls (grade B recommendation)
normal time required for timed up and go test
10 seconds
methanol poisoning treatment
ethanol administration to inhibit the metabolism of methanol, hemodialysis to remove alcohol and its toxins, and vigorous management of metabolic acidosis with bicarbonate therapy.
management of undescended testis
Treatment for a unilateral undescended testis should be started at 6–12 months of age to avoid testicular damage. It was once thought that delaying descent lowered the incidence of testicular cancer, but it is now believed that orchiopexy allows for early cancer detection. HCG treatment may promote descent into the distal canal, but the testicle often ascends again. Ultrasonography will not show an undescended testis in many cases and is therefore not recommended.
common cause of SIADH
head trauma
management of precipitous drop in serum sodium
- immediate treatment with hypertonic saline
other name of fifth disease
erythema infectious
most effective method of natural family planning
cervical mucus monitoring
most common cause of stillbirth
placental abnormalities and obstetric complications
Essential tremor can be associated with..
head bobbing + voice change
false-negate rates with rapid antigen-based nasal swab
can be as high as 70%
treatment of pneumonia + influenza
oseltamivir + ceftriaxone + azithromycin
antihypertensive for patients with CAD
beta-blocker
exotropia
lateral deviation of gaze
paronychia
bacterial or fungal infection of hand or foot where nail and skin meet at side or base of finger or toenail
management of bipolar II (hypomanic episodes + major depression)
divalproex OR lithium
- given as single agents, not in combination with other drugs.
management of DM patients with advanced CAD
coronary artery bypass graft surgery
only c diff med effective intravenously
metronidazole (biliary excretion and possibly exudation through the colonic mucosa allows it to reach the colon via the bloodstream)
- vancomycin and fidaxomicin are always given orally.
scoring tool to use for DVT risk
Wells score
test to use to rule out DVT in patient with low pretest probability
D-dimer (high negative predictive value)
first-line for patients with recurrent SVT
radiofrequency ablation
SVT presentation
- prolonged period (can be around 2 hours) of chest discomfort, dyspnea, dizziness, and palpitations
- younger patient
- high heat rate
EKG with SVT
regular narrow QRS complex tachycardia with no visible P waves
ventilator setting for ARDS
low tidal volume
first-line treatment for diabetic peripheral neuropathy
TCA’s
2nd line = anticonvulsants
3rd line = opioids
DM kids need to be screened for…
hypothyroidism, nephropathy, hypertension, celiac disease, and retinopathy
patients who need prophylactic cholecystectomy for asymptomatic gallstones
sickle cell patients (high rate of complications and hard to diagnose complications because hard to distinguish between symptomatic cholelithiasis versus abdominal sickling crisis)
- also prevents mortality/morbidity associated with emergency surgery
treatment for chronic fatigue syndrome
cognitive-behavioral therapy and graded exercise therapy have been shown to improve fatigue levels, anxiety, work/social adjustment, and postexertional malaise (SOR A).
chronic fatigue syndrome diagnostic criteria
include fatigue for 6 months and a minimum of four of the following physical symptoms: impaired memory, postexertional malaise, muscle pain, polyarthralgia, tender lymph nodes, sore throat, new headaches, and unrefreshing sleep
treatment for hep A exposure in unimmunized person?
hep A vaccine only (vaccine preferred over immunoglobulin because long-lasting, easy to administer, and efficacious)
recommended prophylactic abx for patients undergoing ortho procedures such as total joint replacement
cefazolin
thessaly test is for…
medial meniscus tear
orthostatic hypotension definition
drop in blood pressure of at least 20 mm Hg systolic or 10 mm Hg diastolic that occurs within 3 minutes of standing.
contraceptive with increased risk of hyperkalemia
drospirenone
management of hypothyroid patient who’s euthyroid on levo and still having symptoms?
continue therapy, no change
