deck 28 Flashcards
high risk areas for basal cell recurrence
High-risk locations include the “mask” areas of the face, which include the central face, eyelids, eyebrows, periorbital area, nose, lips (cutaneous and vermilion), chin, mandible, preauricular and postauricular skin/sulci, temple, and ear. Other high-risk sites include the genitalia, hands, and feet. Moderate-risk locations include the cheeks, forehead, scalp, and neck. All other areas, including the trunk and extremities, are low-risk areas.
how to figure out infection in intertrigo not responding to conservative measures
Wood’s light examination, KOH preparation, and exudate culture
how enhance healing in acute anal fissure
-diltiazem, nifedipine, nitroglycerin ointment
drugs that dilate the internal sphincter
best med for treating resistant HTN
- spironolactone
- longer-acting diuretic such as chlorthalidone also recommended, particularly in cases with normal renal function.
differentiating between severity of alcohol withdrawal
Withdrawal can be divided into four levels of severity: minor, major, seizures, and delirium tremens. Minor alcohol withdrawal is characterized by tremor, anxiety, nausea, vomiting, and/or insomnia 6–24 hours after the patient’s last drink. Major withdrawal occurs 10–72 hours after the last drink and can include the signs and symptoms of minor withdrawal, as well as visual and auditory hallucinations, diaphoresis, tachycardia, and elevated blood pressure. Alcoholic seizure generally occurs within 2 days of the last drink and may be the only sign of withdrawal, although approximately one-third of these patients will progress to delirium tremens.
defining clinical feature of delirium tremens
delirium
feature of delirium tremens not commonly seen with other forms of withdrawal
fever
best meds for treatment of HF when standard treatment with diuretics, beta blockers, and an ACE inhibitor are insufficient to control symptoms
hydralazine + isosorbide denigrate (particularly effective in African Americans with Class III or IV HF)
main use of atropine in ACS
sinus bradycardia with hypotension
best initial choice for chronic opioid therapy
Morphine is the best first choice for chronic potent opioid therapy (SOR B). It is reliable and inexpensive,
and equivalent doses can be easily calculated if the patient must later be switched to another medication.
Transdermal fentanyl and hydromorphone are reasonable second-line choices; however, they are not
recommended as first-line therapy because they are expensive and can produce tolerance relatively quickly
(SOR B). Methadone is another second-line option and tolerance is usually less of a problem. It is
inexpensive and long-acting but also has unique pharmacokinetics. It has a very long elimination half-life,
and its morphine-equivalent equianalgesic conversion ratio increases as dosages increase.
therapies for moderate carpal tunnel syndrome with the longest symptom relief
local corticosteroid injections
typical diastolic HF patient
elderly person who has systolic HTN, LVH, and normal EF
only FDA-approved oral treatment for acne rosacea
doxycycline
principles of patient-centered medical home
Comprehensiveness: Most preventive, acute, and chronic care for individual patients can be performed
at the PCMH. Patient Centered: The PCMH provides care that is relationship-based, with an orientation toward the whole
person. Coordination: The PCMH coordinates care for patients across all elements of the health care system. Accessibility: The PCMH works to provide patients with timely access to providers. Quality: The PCMH continuously works to improve care quality and safety.
target uric acid level to prevent gout
5 to 6 mg/dL
management of ICD when patient doesn’t want intense healthcare
- deactivate it (shocks can be painful and distressing to caregivers/family members)
long QT associated with
polymorphic ventricular tachycardia, including torsades de pointes, and sudden cardiac death
treatment of long QT
p-blockers and implanted cardioverter defibrillators
treatment of mild plaque psoriasis
Topical corticosteroids, vitamin D analogs, and tazarotene are
effective treatments for mild psoriasis (SOR A).
med that can be used for IBS
citalopram
highest risk groups for influenza complications
highest risk include children under the age of 2 years, pregnant women (including women less than 2 weeks post partum), adults over the age of 65, the morbidly obese (BMI >40 kg/m2), and Native or Alaskan Americans
opioid to avoid in patients with renal insufficiency
morphine (toxic metabolites are not eliminated by kidneys. Accumulation of metabolites causes neuroexcitatory effects, including confusion, sedation, respiratory depression, and myoclonus)
indications for indwelling catheter
critical illness, obstruction, hospice care, preoperatively for urologic procedures
management of adrenal crisis
IV hydrocortisone
features of adrenal insufficiency
Common features of acute adrenal insufficiency include fatigue and lack of energy, weight loss, hypotension, loss of appetite, nausea, and vomiting. Other features such as dry skin, hyperpigmentation, and abdominal pain are seen to varying degrees. Common laboratory findings include electrolyte disturbances, hyponatremia, hyperkalemia, hypercalcemia, azotemia, anemia, and eosinophilia. Patients can also have unexplained hypoglycemia.
initial testing of suspected hereditary hemochromatosis
serum iron panel, including a serum ferritin level and transferrin saturation
PFTs with restrictive lung disease
reduced FVC with either a normal or increased FEV1/FVC ratio is consistent with restrictive lung disease.
lichen simplex chronicus presentation
- lichenified plaques and excoriations resulting from excessive scratching
- generalized pruritus that patient scratches frequently
lichen simplex chronicus treatment
topical corticosteroids under occlusive dresses (need to stop itching)
scabies presentation
small, erythematous papule that are frequently excoriated
- https://www.google.com/search?q=scabies&source=lnms&tbm=isch&sa=X&ved=0ahUKEwi-nIrmkpDSAhUCh1QKHbtCCeUQ_AUICCgB&biw=1037&bih=653#imgrc=6sPbXbFpzV5MqM:
antihypertensive metabolized by CYP3A4
amlodipine
treatment of basal cell carcinoma
moh’s micrographic surgery
major issue with azithromycin
- fatal arrhythmias in at-risk patients (prolongs QT. RF’s = hypokalemia, hypomagnesemia, use of antiarrhythmics)
management of bedtime hyperglycemia
add rapid-acting insulin at dinner
initial management of sepsis
1) respiratory stabilization (ventilator if no response to oxygen)
2) fluid resuscitation with IV fluid bolus
RF’s for diverticulitis
NSAIDs
sesamoid fracture presentation
tenderness + swelling of medial plantar aspect of left first MTP
- pain with passive dorsiflexion of toe. no pain with plantar flexion
red flags for elder abuse
unexplained weight loss, reliance on a caregiver, a disheveled appearance, a pressure ulcer, and bruising in locations that are not typically associated with unintentional trauma from falls
five P’s of compartment syndrome
pain, paresthesia, pallor, pulselessness, and paralysis
early presentation of compartment syndrome
Tenderness out of proportion to physical appearance of injury + *severe pain in the involved compartment with passive stretching of involved muscles
USPSTF dysplipidemia recommendation
all men 35 years of age and older be screened for dyslipidemia (evidence rating A). Men who are 20–35 years of age should be screened only if they have cardiovascular risk factors (evidence rating B).
USPSTF prostate recommendation
never
USPSTF testicular exam recommendation
should not be performed
benefits of postmenopausal hormone therapy?
1) decrease in fractures
2) reduced risk of endometrial cancer
problems of postmenopausal hormone therapy
coronary heart disease, stroke, breast cancer, gallbladder disease, dementia, and venous thrombosis
RF’s for prolonged recovery from concussion
- HA’s lasting 60 hours or more, self-reported fatigue or fogginess
initial diagnostic test of choice for patients at intermediate to high risk for DVT
compression US
contraindication to bisphosphonates and what to do
renal dysfunction (switch to denosumab)
SE that commonly occurs with long term opioid therapy
hypogonadism (manifesting as decreased libido, erectile dysfunction, amenorrhea, or fatigue)
management of trace valvular regurgitation detected on initial echo
nothing. don’t order follow-up.
possible pain presentation of constipation
intermittent colicky abdominal pain.
Rome criteria for constipation
straining on defecation, hard stools, incomplete evacuation, or less than three bowel movements per week.
management of severe eclampsia (high blood pressure and proteinuria) near term
mag sulfate + induce labor
other GI complaint suggesting possible malignancy
chronic vomiting