deck 29 Flashcards
management of engorged tick bite
if in area where there is at least a 20% rate of tick infection then (Northeast + upper midwest) single dose of doxycycline
most common cause of thyroid pain
Subacute granulomatous thyroiditis
How to differentiate Subacute granulomatous thyroiditis
low radioactive iodine uptake (RAIU) at 24 hours
DM drug associated with weight loss
Exenatide (injectable GLP-1 agonist)
best exercise for older adults in NH’s
resistance training
acute diverticulitis management
can be treated using oral antibiotics on an outpatient basis in 90% of cases. In fact, there is good evidence that those with uncomplicated diverticulitis (no signs of abscess, fistula, phlegmon, obstruction, bleeding, or perforation) can be treated without the use of antibiotics, using only bowel rest and close follow-up. Among patients who require hospitalization, it is estimated that <10% of cases will require surgical intervention. Thus, the majority of patients hospitalized with this condition, even those with complicated diverticulitis, will respond well to bowel rest and intravenous antibiotics.
indications for surgery with acute diverticulitis
- generalized peritonitis, unconfined perforation, uncontrolled sepsis, untrainable abscess
- abscesses usually drained using CT-guided percutaneous drainage
lichen planus associated with what systemic disease?
hep C
lichen planus presentation
can cause mouth ulcers too
- can be intensely itchy
glycemic treatment goal for patients with complex health problems or poor health
below 8.5
when to screen for DM2
asymptomatic adults with sustained BP over 135/80
opioids with active metabolites that can accumulate in patients with renal failure
codeine, hydrocodone, morphine
opioid metabolized in the liver with no active metabolites
fentanyl
vasopressor of choice
NE
chronic pulmonary thromboembolism presentation
reduced diffusion capacity + normal PFTs
oral antibiotic for acne
minocycline (minocin)
first line prophylactic agent for cluster HA’s
verapamil
bowel ischemia on CT
air within wall of dilated loops of small bowel (pneumatosis intestinal)
presentation of appendicitis in older patients
often vague without fever and not localizing to the right lower quadrant
medical conditions that decrease responsiveness to warfarin and reduce INR
hypothyroidism, DM, hyperlipidemia
high risk unstable angina
- Angina at rest with dynamic ST-segment changes 1 mm
- Angina with hypotension
- Angina with a new or worsening mitral regurgitation murmur
- Angina with an S3 or new or worsening crackles
- Prolonged (>20 min) anginal pain at rest
- Pulmonary edema most likely related to ischemia
virchow’s node suggests
GI system malignancy (pancreatic or stomach cancer)
conditions shown to benefit from hyperbaric oxygen
Decompression sickness + crush injury wounds
beta blocker you can’t use for pregnant women
atenolol
workup of asymptomatic microscopic hematuria
Patients with microscopic hematuria should initially be assessed for benign causes such as urinary tract infection, vigorous exercise, menstruation, and recent urologic procedures. If none of these is found, the next step would be assessing for renal disease using urine microscopy to look for casts or dysmorphic blood cells, and checking renal function. If the results are negative, CT urography and cystoscopy should be performed. CT evaluates the upper urinary tract for nephrolithiasis and renal cancer, while cystoscopy evaluates the bladder for bladder cancer, urethral strictures, and prostatic problems.
rash that is indistinguishable from pityriasis rosea except for herald patch
syphilis rash
IBD diagnosis
colonoscopy with biopsies
TDAP for pregnant patients?
should receive Tdap during every pregnancy
other associations of long term PPI
c diff diarrhea + CAP
indication for stress ulcer prophylaxis
prolonged mechanical ventilation for more than 48 hours
relatively common cause of isolated thrombocytopenia
ITP (not always preceded by infection)
treatment of chronic achilles tendinopathy
the preferred first-line treatment is an intense eccentric strengthening program of the gastrocnemius/soleus complex (SOR A). In randomized, controlled trials, eccentric strengthening programs have provided 60%–90% improvement in pain and function.
how to elicit discomfort with plantar fasciitis
passive ankle/first toe dorsiflexion
cross reaction between penicillin and cephalosporins?
almost nil risk of serious allergic reaction
somatic complaints more common in what depressed group?
elderly, pregnant women, children
EKG abnormality dictating pharmacologic stress test rather than exercise?
LBB
- Left bundle branch block makes the EKG uninterpretable during an exercise stress test, and can also interfere with nuclear imaging performed during the test. It is associated with transient positive defects in the anteroseptal and septal regions in the absence of a lesion within the left anterior descending coronary artery. This leads to a high rate of false-positive tests and low specificity. Pharmacologic stress tests using vasodilators such as adenosine with nuclear imaging have a much higher specificity and positive predictive value for LAD lesions, and the same is true for dobutamine stress echocardiography, which is why these are the preferred methods for evaluating patients with left bundle branch block.
what drug can cause resistance to treatment with epinephrine?
beta-blockers
greatest RF for GBS infection
prematurity
feeding for patients with advanced dementia?
careful hand feeding. no change in aspiration pneumonia or other outcomes with tube feedings.
treatment of CAP
For previously healthy individuals who have not taken antibiotics in the previous 3 months the most appropriate treatment for CAP is empiric treatment with an oral macrolide such as azithromycin, clarithromycin, or erythromycin (level I evidence) or doxycycline (level III evidence). In the presence of comorbidities such as diabetes, alcoholism, or chronic heart, lung, liver, or renal diseases, the treatment of CAP should provide broader coverage with dual antibiotic treatment regimens including combinations of fluoroquinolones, p-lactam drugs, and macrolide options, and hospitalization is often indicated.
differentiating type 1 DM vs. type 2 DM
The gradual onset of symptoms is more consistent with type 2 diabetes mellitus, whereas type 1 diabetes typically has a more rapid onset. Patients with type 1 diabetes typically need lower doses of insulin to correct hyperglycemia, as they lack the insulin insensitivity that is the hallmark of type 2 diabetes. Positive anti-GAD antibodies and low C-peptide at the time of the initial diagnosis are also consistent with type 1 diabetes, although C-peptide levels can also be low in long-standing type 2 diabetes. Weight loss occurs in both types of diabetes mellitus when glucose is profoundly elevated.
hospital use of atypical antipsychotics
ICU delirium
indication for spironolactone use
Spironolactone is an aldosterone antagonist. This class of drugs has been found to reduce all-cause mortality and cardiac death when initiated after a myocardial infarction in patients with a low left ventricular ejection fraction (LVEF) and signs of heart failure. Guidelines from the American College of Cardiology and the American Heart Association recommend the use of aldosterone blockers in patients who have heart failure or diabetes mellitus, have an LVEF :40%, are receiving ACE inhibitors and p-blockers, and have a serum potassium level <5.0 mEq/L (5.0 mmol/L) and a creatinine level >2.5 mg/dL in men or >2.0 mg/dL in women. None of the other medications listed has this level of evidence to support its use.
UC management
- once remission achieved with a certain med, that med is continued indefinitely
- screening colonoscopy 10 years after initial diagnosis and continuing q2-5 years
tramadol contraindication
seizure history (lowers seizure threshold)
cutoff for diagnosing COPD on spirometry
postbronchodilator FEV1/FVC ratio <70% of predicted (SOR C).
dipstick validity for UTI
low sensitivity and specificity
management of asymptomatic thyroid nodule
The first step in the evaluation of a thyroid nodule is to order a TSH level. If the TSH level is suppressed, radionuclide scintigraphy should be ordered to rule out a hyperfunctioning nodule. If the TSH level is either normal or high, the current recommendation is to biopsy only nodules >1 cm. Clinical follow-up is recommended for nodules :1 cm.
drugs of choice to reduce perioperative cardiovascular risks for patients undergoing cardiac surgery
- statins (also reduce vascular inflammation, improve endothelial function, and stabilize atherosclerotic plaques)
- should be started 4 weeks prior to the procedure and continued after surgery
presentation of hyperventilation
anxiety + SOB + paresthesia + carpopedal spasm
distinguishing starvation vs. cachexia
- appetite is decreased early in cases of cachexia but remains normal in the early stages of starvation
- albumin decreases early in cases of cachexia and later in starvation
- due to inflammatory changes, cachexia is resistant to referring
