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)
