Random Topics Flashcards
If a patient has erythema, induration, tenderness over a visible vein, what might be occuring?
Superficial Thrombophlebitis
++Check for DVT, occurs in 23% of patients at same time
If a patient has unilateral lower leg swelling and pain, with visible redness on the outside with tenderness, what should be first step in management?
Duplex Ultrasound of the Leg – looking for DVT
What are the most common differential diagnoses of leg pain and swelling?
Superficial Thrombophlebitis Chronic Venous Insufficiency CHF DVT Postphlebitic Syndrome Lymphedema Other reasons -- Cellulitis/Dermatitis, Traumatic
What are the red flag symptoms in a patient who has suspected DVT?
- SOB / Tachypnea
- Chest Pain
- Syncope
- Hypotension
- Fever
- Hypoxia
What elements have the greatest positive predictive value of DVT?
- Recent Surgery
- Immobilization for more than 3 days in 4 weeks
- Venous Dilation
- Swelling / Temperature Difference
What can a D-dimer test add to evaluation of DVT?
Negative Predictive Value
– if positive, doesn’t mean there is a DVT/PE, but if negative means good indication there is none.
What is the best plan of evaluation for a patient suspected of a PE?
Helical Computed Tomography
If you have 2x risk factors for DVT according to Well’s criteria, what is your risk?
Moderate – 17% chance
Low = Zero Risk Factors, High = 2+
If a patient is considered moderate risk for DVT and has a negative ultrasound performed, abnormal D-dimer, what is next in management?
Repeat US in 1 week, or do contrast venograph study
If a patient is started treatment for DVT, what is the management?
Heparin x 5 days
- Start Warfarin at the same time
What is the best way to treat Obstructive Sleep Apnea?
- Losing weight
- avoiding alcohol and sedatives
- avoiding supine sleep
- CPAP at Night
What are red flag symptoms for sleep disorders?
- Depressed Mood
- Substance Abuse
- Falling asleep during activites
- Lower extremity edema
- Polyuria
- Orthopnea
What are good questions to ask a patient screening them for sleep disorder?
- How long it takes to fall asleep?
- Do they nap?
- What is happening when they wake up at night?
- Noise present?
- Medications?
What are key parts of an exam that are important in evaluation for sleep disorder?
- Blood Pressure
- Body Mass Index
- CV - Resp Exam
- Iron Deficiency (conjunctivae and nail bed)
What is the first step in management of a patient with insomnia not easily explained?
Check for TSH and CBC (for Anemia)
- Most effective is Sleep Diary
- Sleep specialist if suspect OSA
For chronic insomnia over 4 weeks, what does the evidence suggest is the best management?
Cognitive behavioral therapy – A
Exercise – B
What are recommendations for the best sleep hygiene?
- Avoid Caffeine/Exercise before bed
- Avoid large meals in evening
- Avoid naps
- Regular sleep schedule each day
- Dark Bedroom
- Relaxation time before bed each night.
If a patient has significant daytime sleepiness, but is not obese or have any history of snoring, tests negative for OSA, what should be evaluated next?
Sleep Latency Testing – looking for Narcolepsy
If Narcolepsy – Modafinil (stimulant for daytime)
What is the single best question to screen for alcohol abuse?
How many times in the past year have you had more than 5 drinks in a day or 4 for women?
- Anything above 0, indicates positive
- Then do CAGE questioning
What are the CAGE questions for alcohol screening?
- Tried to CUT down your use?
- Annoyed by others criticizing you?
- Felt GUILTY because of alcohol use?
- Eye opener in the morning?
What is the common depression screening tool to use while interviewing?
SIG E CAPS S -- Sleeping (too little or too much) I -- interest G -- Guilt E -- Energy C -- Concentration A -- Appetite P -- Psychomotor S -- Suicidal Thoughts
What are the best therapies for depression in elderly?
Exercise
Behavioral Cognitive Therapy
SSRI/SNRI
Who needs antibiotics for otitis media?
Children under the age of 6 months
Children between 6months-2 years who have been observed first
Children below 2 with bilateral otitis media
What is considered orthostatic hypertension?
A drop in systolic blood pressure 20mmHg with change in position
A drop in diastolic blood pressure 10mmHg with change in position
