PEARLS Flashcards
“After warfarin is discontinued, anticoagulant effects persist for”
“2 to 5 days.”
“Asian patients may require lower starting and maintenance doses of”
warfarin
“Some genotypes require lower doses of”
warfarin
“Persons older than 60 years are more likely to have”
“larger increases in INR (after dose is increased) compared with younger patients.”
“INR values lower than 2.0 increase”
stroke risk sixfold
“Mayonnaise, canola oil, and soybean oil also have high levels of”
vitamin K
“patient is already on HCTZ and doing well,”
do not change
“TB blood tests (IGRA) are preferred method of TB testing for people who have received”
the BCG vaccine
“During recent influenza seasons, between 80% and 90% of influenza-related deaths occurred in people aged”
“65 years or older. Remind older patients to get the influenza vaccine starting in the fall season.”
“MEEs can persist for 8 weeks or longer after treatment of”
AOM
“recommended for patients with allergic rhinitis”
“Allergy pillow covers, allergy mattresses, and HEPA allergy filters for air conditioners”
“Many are allergic to dust mites, an indoor allergen.”
“The FDA recommends that health providers avoid prescribing oral ketoconazole (Nizoral PO) for fungal skin and nail infections because”
“the harm (serious liver damage, etc.) outweighs the benefit. Topical ketoconazole shampoo is safe.”
“for rashes near the eyes USE”
“ophthalmic-grade sterile cream and ointments”
“Patients with scarlet fever are at higher risk for developing”
“postglomerular nephritis (compared with “strep” throat).”
“Recurrences of tinea pedis and tinea cruris infection are”
Common
“Patients on anti-TNF biologics are at higher risk for”
“melanoma and squamous cell skin cancer.”
“there is no evidence of tooth staining with short courses of doxycycline.”
“Per the CDC, recent research”
“Only a person who has had chickenpox (rarely the chickenpox vaccine) can get”
Shingles
“A susceptible person (who has never had chickenpox or been vaccinated) can become infected from shingles, but”
“that person’s initial infection will manifest as chickenpox.”
“Major bleeding episodes can occur even with a normal INR. Order an”
“INR with the PT and the PTT if you suspect bleeding.”
“Coumadin is an FDA category”
X drug
“after changing the warfarin dose to see a change in the INR it may take up to”
3 days
“It may take up to 3 days after changing the warfarin dose to see”
“a change in the INR”
“Hypertensive patients who are less than 20/10 mmHg above goal can initially be treated with”
Monotherapy
“Per JNC 8, consider chlorthalidone or indapamide (instead of hydrochlorothiazide)”
“better evidence and longer half-life.”
“may cause memory loss, confusion, etc. (cognitive effects), which are reversible upon discontinuation”
Statins
“Patients on simvastatin and lovastatin should avoid”
“grapefruit juice. Also, they should not mix these two statins with macrolides.”
“Muscle pain (mild to severe) from rhabdomyolysis is usually located on the”
“calves, thighs, lower back, and/or shoulders. Urine will be darker than normal (reddish-brown color). Rule out rhabdomyolysis if patient on a statin complains of muscular pain with dark-colored urine”
“Long-term use of oral corticosteroids increases the risk of”
Pneumonia
“When you are treating a COPD patient, pick an antibiotic that has coverage against”
“Streptococcus pneumoniae and H. influenzae (gram negative).”
“Depending on the stage of the disease and hydration status, the CXR result may be “normal” during the early phase of”
“bacterial pneumonia (lobar pneumonia)”
“a “healthy” adult with no fever who has been coughing for more than 2 to 3 weeks, especially if previously treated with an antibiotic (that was not a macrolide) and is getting worse”
Suspect pertussis, rule out pneumonia first
“best mucolytic, thins out mucus”
“Emphasize importance of adequate fluid intake”
“can present as recurrent pneumonia”
Lung cancer “due to mass blocking bronchioles”
“If S. pneumoniae macrolide resistance greater than 25%,”
“do not use macrolide monotherapy. See CAP treatment guidelines notes.”
“The QuantiFERON-TB Gold in-tube and the T-SPOT TB tests are available at”
public health clinics
“They only require one visit for the patient to be tested”
“one vial of blood”
“Never treat TB with fewer than”
three drugs
“According to the CDC, on the average, about 10 contacts are listed for each index person with”
infectious TB
“Persons with HIV infection with CD4 fewer than 500 or patients who are taking tumor necrosis factor antagonists (or biologics) are at very high risk for”
“active TB disease after initial exposure (primary TB)”
“The tuberculin skin test is considered”
“both valid and safe to use throughout pregnancy.”
“Younger children are more likely than older children to develop”
“life-threatening forms of TB disease”
“If you suspect that the patient has allergic asthma, check”
“serum immunoglobulin G allergy panels (mold allergy, grass allergy panels, others). Refer to allergist for scratch testing and treatment.”
“Consider supplementing with calcium with vitamin D 1,200 mg tabs QD for”
“menopausal women and other high-risk patients (for osteoporosis) such as males who are on medium- to high-dose inhaled steroids long term.”
“Consider bone density testing (in males or females) who are on chronic steroids to rule out”
osteopenia or osteoporosis
“Annual eye exams if on long-term steroids since higher risk of”
cataracts and glaucoma
“Exercise-induced bronchospasm is a marker for”
inadequate asthma control
“Many patients with subclinical hypothyroidism will eventually develop”
overt hypothyroidism
“before swallowing with water for better absorption.”
“Advise patient to crush Synthroid tablets with teeth inside mouth”
“These tablets are synthetic T4 (levothyroxine)”
“Using a small amount of K-Y Jelly to lubricate the tips of the speculum (in patients with atrophic vaginitis to reduce pain and vaginal bleeding) will”
“not affect the Pap test results.”
“In reproductive-age teens or women who present with acute pelvic pain or lower abdominal pain, always”
“perform a pregnancy test (use good-quality urine human chorionic gonadotropin strips).”
“Girls and teenagers have larger”
“ectropions. Some adult women on birth control pills may develop ectropion.”
“Yaz or Yasmin contain”
“estrogen and drospirenone. Has a higher risk of blood clots, stroke, heart attacks, and hyperkalemia.”
“Do not recommend Depo-Provera for women who want to”
“become pregnant in 12 to 18 months because it may cause delayed return of fertility. It can take up to 1 year for some women to start ovulating.”
“Cu-IUD probably has the broadest indication for use as”
“a contraceptive for women with medical conditions (diabetics, smoker for more than 35 years, on anticonvulsant or antiretroviral therapy, ovarian cancer, ischemic heart disease, liver tumors, etc.).”
“Wet smear or microscopy is gold-standard diagnosis”
“bacterial vaginosis, candidal or trichomonal vaginitis”
“Women who have persistent vaginal and urinary tract infections, despite hygiene measures, adequate hydration, and in the absence of sexual exposures from partner(s), should be screened for”
“underlying glucose metabolism disorders and diabetes”
“False-positive RPR can be caused by”
“pregnancy, Lyme disease, autoimmune diseases, chronic or acute disease.”
“Recheck syphilitic chancre in”
“3 to 7 days after injection (should start healing).”
“Nontreponemal titers (RPR or VDRL) usually decline after treatment, but in some persons,”
“nontreponemal antibodies can persist for a long time (serofast reaction). Most patients with reactive nontreponemal tests will be reactive for the rest of their lives (low titers), but 15% to 25% revert to being serologically nonreactive in 2 to 3 years.”
“if both gonorrheal and chlamydial tests are negative”
“treat a sexually active patient who has signs and symptoms of PID combined with a sexual history.”
“PID is a clinical diagnosis.”
“A large study found that adnexal tenderness is the most sensitive physical exam finding for”
“PID (compared with cervical motion tenderness, which may be negative).”
“Probably better to “overtreat” than to miss treating possible PID infections.”
“After treating a patient for PID, follow up within”
“72 hours and perform vaginal bimanual examination to check for improvement of adnexal tenderness and/or cervical motion tenderness.”
“For STDs treated with azithromycin 1 g × one dose (chlamydia),”
“instruct patient and partner not to have sex for at least 7 days.”
“It can take from 3 to 12 weeks for HIV antibody tests to detect”
HIV Infection
“The HIV antibody/antigen test can detect infection in”
“2 to 6 weeks (may be positive within 2 weeks after infection).”
“NAAT can detect HIV infection in”
“7 to 28 days”
“For job-related exposures, contact”
“National Clinician’s Postexposure Prophylaxis Hotline (Pipeline) toll free at (888) 448-4911 for advice (open 24/7).”
“GDM is diagnosed in the”
“second to third trimester”
“A woman with diabetes in the first trimester has”
type 2 diabetes.
“An A1C <6% (second to third trimesters) has the lowest risk for”
“large-for-gestationalage infants”
