deck 8 Flashcards
USPSTF aspirin primary prevention recommendation
Low-dose recommended for individuals 50-59 who have a 10% or greater 10 year CVD risk + are not at increased risk for bleeding + life expectancy of 10 years.
Interpreting PPD
1) 5 or more induration positive in HIV, recent contact w/ TB, imaging evidence of prior TB, organ transplant, immunosuppressed for other reason
2) 10 or more positive if recent immigrant from high prevalence country, injection drug use, employee of high risk setting, lab personnel, children under 4, exposed to adults in high-risk categories
3) 15 or more for normal people
rapid effusion post knee injury suggests…
ACL or tibial fracture
indications for arthrocentesis
1) unexplained mono arthritis
2) suspected infection
3) unexplained effusion
4) suspected crystal-induced arthritis
5) suspected hemarthrosis
6) symptomatic relief from large painful effusion
most common cause of knee pain in people younger than 45
patellofemoral syndrome
patellofemoral syndrome presentation
1) peripatellar pain
2) exacerbated by overuse
confirming patellofemoral syndrome
compress patella against femur and move it up and down along groove, reproducing pain or crepitation
patellofemoral syndrome treatment
NSAIDS
minimize high-impact activity
pre patellar bursitis presentation
1) anterior knee pain
2) swelling anterior to the patella
Ottawa knee rules for obtaining knee radiograph
Get film if 1 or more is satisfied…
1) Age >55 years
2) isolated tenderness of the patella
3) tenderness at the head of the fibula
4) inability to flex knee to 90 degrees
5) inability to bear weight immediately after injury or in the ED
MOA of ACL injury
twisting resulting in valgus stress
hyperextension
MOA of PCL injury
trauma to flexed knee
arthroscopic surgery for non-OA related knee pain?
Not been shown to improve outcomes as compared with medicine + physical therapy
rotator cuff tendonitis presentation
- Lateral shoulder pain aggravated by reaching, raising the arm overhead, or lying on the side.
- Subacromial pain to palpation and with passive/resisted abduction.
rotator cuff tear presentation
- Shouldr weakness, loss of function, tendonitis symptoms, and nocturnal pain.
- similar to tendonitis exam + weakness with abduction and external rotation
- positive drop arm test
Exam finding specific for rotator cuff tear
- Inability to lower the affected arm smoothly
bicipital tendonitis/rupture presentation
Anterior shoulder pain with lifting, overhead reaching, and flexion; reduced pain after rupture. Bicipital groove tenderness and pain with resisted elbow flexion.
Adhesive capsulitis
Progressive decrease in range of motion, more from stiffness than from pain.
Loss of external rotation and abduction (unable to scratch lower back or fully lift arm straight overhead)
AC syndromers
- anterior shoulder pain and deformity, usually from trauma or overuse.
- localized joint tenderness and deformity (osteophytes, separation); pain with adduction.
Glenohumeral arthritis
- gradual onset of anterior pain and stiffness.
- anterior joint-line tenderness, decreased range of motion, and crepitation
shoulder asymmetry suggests
dislocation
radiography for shoulder pain?
limited usefulness. primary indication is rotator cuff tear (MRI)
initial management of shoulder tenditis or bursitis
- 2-week trial of an NSAID + rest
- if no improvement with 4-6 weeks, PT, subacrominal glucocorticoid injection or (rarely) surgery
- no response to conservative therapy in 6-12 weeks, then consultation with rheumatologist or orthopedist
other exam findings in asthma
- chest hyper expansion, prolonged expiratory phase, nasal mucosal thickening, nasal polyps, rhinitis manifested by cobblestoning of the oropharynx
CXR for asthma?
- may be needed to exclude other diagnoses but is not recommended as a routine test in the initial evaluation of asthma.
how to differentiate COPD vs. asthma in patients w/ smoking history
- DLCO (diffusing capacity for carbon monoxide)
- normal or increased in asthma, and decreased in COPD
bronchiectasis vs. asthma
think bronchiectasis if heavy sputum production and blood, or crackles + wheezing and peribronchial thickening on CXR
mgmt of asthma attack
- short course of systemic glucocorticoids + SABA
- can also give an anticholinergic to enhance bronchidaltor effect of SABA
how to monitor asthma attack severity
spirometry and/or Peak Expiratory Flow Rate (PEFR)
interpreting PEFR
- 40-69% = moderate
- < 40% = severe
drug asthmatics often have a bad response to
bronchoconstriction after taking NSAIDS
- beta-blockers
treatment of mild persistent asthma
- low-dose inhaled GC
treatment of moderate persistent asthma
- 1 or 2 long-term controllers (low dose inhaled GC + LABA)
indication for omalizumab
- reduces exacerbations in patients with severe persistent asthma who have evidence of allergies.
complications of poorly controlled asthma during pregnancy
- low birth weight, preeclampsia, premature labor, increased infant mortality
mgmt of acute severe asthma exacerbations during pregnancy
oral GCs
mgmt of exercise induced asthma
use SABA 15-30 minutes before start of exercise
what to tell obese patient with asthma?
lose weight
sunscreen and melanoma
no clear association
melanoma RFs
- much higher in men
concerning melanoma diameter
6 mm
melanoma mgmt
wide margin excision biopsy + adjuvant interferon for node positive or very deep
Flu vs. URI
- sudden onset of high fever (greater than 102) + sever myalgia + headache.
- severity of symptoms associated with high fever + myalgia suggest influenza
sinusitis features
- purulent nasal discharge
- UNILATERAL sinus pain/tendenress
- maxillary toothache
- poor response to decongestants
- worsening illness after initial improvement
mono presentation
- 1-2 week prodrome of fatigue, malaise, and myalgia followed by adenopathy + sore throat + fever + HSM + lymphocytosis
features of ear suggesting ear ache
red, opaque, bulging, or retracted
symptomatic measures for URIs
1) heated vapor (steam from a hot shower)
2) increase fluids
3) salt water gargles
4) relieve congestion with pseudophed or phenylephrine
rhinorrhea + sneezing symptomatic management
antihistamine or intranasal ipratropium
cough + wheezing management
inhaled beta-agonist
HA, myalgia, malaise management
NSAID or acetaminophen
codeine and over the counter antitussives evidence?
not shown to improve cough with URIs
group a strep throat vs. non group a strep throat
- INDISTINGUISHABLE.
- must use clinical prediction tool (Centor score)
rapid strep test vs. culture
comparable sensitivity and specificity
treatment of choice for strep throat
10 day course of penicillin
viral vs. bacterial sinusitis
bacterial more likely to be accompanied by facial pain, purulent nasal discharge, and long symptom duration
symptomatic therapy of rhinosinusitis
None proven, but often prescribed
- intranasal steroids to reduce inflammation
- mucolytic agents (guaifenesin) to reduce viscosity of nasal secretions
- topical decongestants to reduce mucosal inflammation and improve drainage
management of adults with AOM
Amoxicillin
