deck 30 Flashcards
treatment of campylobacter diarrhea
azithromycin
abx for salmonella and shigella
ciprofloxacin
only NSAID that doesn’t increase risk of MI
naproxen
first line for keloid scars
intralesional corticosteroid injections
drugs that can cause a false-positive urine drug screen for opioids
Dextromethorphan, diphenhydramine, ibuprofen, and even fluoroquinolones are among the many agents that can cause a false-positive urine drug screen for opioids. Pseudoephedrine can cause a false-positive test for amphetamines
how to diagnose cat scratch fever
IgG testing for Bartonella henselae
treatments that have evidence for IBS
Exercise, probiotics, antibiotics, antispasmodics, antidepressants, psychological treatments, and peppermint oil
problems with stimulants in adults
can aggravate psychosis, tics, or HTN
main SE’s of stimulants
insomnia, dry mouth, weight loss, headaches, and anxiety
antihypertensive that can also slow bone loss in postmenopausal females and reduce incidence of osteoporosis/hip fractures
thiazide diuretics
doxylamine
first generation antihistamine
doxylamine use
(unison) sleep aid
calcium supplement to use for patient on PPI
calcium citrate
rapidly progressing paraparesis and sensory abnormalities in a diabetic patient think…
epidural abscess
how to assess RV dysfunction with PE
1) echo (EKG can be normal)
initial treatment of chronic fatigue syndrome
CBT or graded exercise therapy
hepatorenal syndrome
- renal failure in patients with cirrhosis and elevated pressures in the portal vein system
(elevated portal vein pressure leads to juxtaglomerular apparatus sensing reduced “effective” blood volume and activating RAAS.
labral tear presentation
anterolateral pain, although pain may be deep and poorly localized, and may be associated with instability and a catching sensation
posterior shoulder pain
often rotator cuff tendinopathy from teres minor or infraspinatus
dermatofibroma
- https://www.google.com/search?q=dermatofibroma&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjWvdzfhpDSAhVJiVQKHY6HBQsQ_AUICCgB&biw=1037&bih=653
- dimple elicited on compression
vitals with PE
tachycardia, tachypnea, low-grade fever
classic findings of PE on ECG
prominent S in lead I, Q in lead III, and inverted T in lead III (s1q3t3)
PE findings on CXR
hampton hump, westermark sign
arrhythmia associated with PE
atrial fibrillation (caused by atrial strain from increased right atrial pressure)
pleural fluid with empyema
pH less than 7.2
decreased glucose
WBC less than 50,000
parapneumonic effusion
pleural effusion resulting from effusion, lung abscess, or bronchiectasis
pleural fluid analysis with parapneumonic effusion
pH greater than 7.2
decreased to normal glucose
WBC count greater than 50,000
pleural fluid criteria called
Light criteria
pathophys of empyema
Most parapneumonic effusions are uncomplicated and resolve with abx. However, if bacteria cross into pleural space, a complicated parapneumonic effusion or empyema may develop.
what will CXR show with empyema?
loculation
management of COPD exacerbation
Oxygen
inhaled bronchodilators
systemic glucocorticoids
antibiotics if greater than 2 cardinal symptoms
oseltamivir if evidence of influenza
NPPV if ventilatory failure
tracheal intubation if NPPV failed or contraindicated
duration of abx for COPD exacerbation
3-7 days
pulmonary capillary wedge pressure significance
measure of pulmonary artery pressure, which is a surrogate for R atrial pressure (because of large compliance of pulmonary circulation)
use of pulmonary wedge pressure
- Gold standard for determining the cause of acute pulmonary edema
- elevated also suggests LV failure
clinical features of pulmonary contusion
- usually happens within 24 hours of blunt thoracic trauma
- tachypnea + tachycardia + hypoxia
- pulmonary contusion leads to idntraalveolar hemorrhage
diagnosis of pulmonary contusion
- rales or decreased breath sounds
- CT or CXR with patchy, alveolar infiltrate not restricted by anatomical borders
pulmonary hygiene
nebulizer treatment + chest physiotherapy
why does an exudative pleural effusion happen with pulmonary infection?
Cytokines released during inflammation or infection increase capillary permeability, resulting in translocation of cells and fluid from the vasculature into the pericapillary space, which aids in immune response but can also result in exudative pleural effusion
criteria for initiating long term oxygen therapy in patients with COPD
1) resting arterial oxygen tension less than 55 mm Hg or pulse ox less than 88% on RA
2) PaO2 less than 59 mm Hg or SaO2 less than 89% in patients with for pulmonate, evidence of RH failure or hematocrit greater than 55%
how to determine dose of supplemental oxygen for people on long term oxyen
titrate to 90% on RA during normal walking
scoring system for PE risk
Wells score
Test of choice for clinically stable patients in whom PE is likely
CT angiography
algorithm for suspected PE
stabilize patient with O2 and IV fluids –> evaluate for contraindications to anticoagulation –> if no, then assess clinical suspicion of PE with modified wells –> consider anticoagulation if moderate to severe distress –> obtain diagnostic test and start, continue, or stop anticoagulation
