step 3 26 Flashcards
how to tell people to take levothyroxine
on an empty stomach with water 30-60 minutes before breakfast. Common medications, such as calcium and iron supplements, can impair the absorption of levothyroxine and should be separated from it by 3-4 hours (Levothyroxine has a narrow therapeutic index)
comorbidities of late life depression
higher risk for developing Alzheimer disease and vascular dementia
how to tell whether distribution is normal or positively or negatively skewed
normal = mean = median = mode positive = mean greater than median greater than mode negative = mode greater than median greater than mean
ecythma gangrenosum presentation
immunocompromised patient + RAPID EVOLUTION of >1 skin lesion from an erythematous macule to a pustule or bullae and then into a nonpainful gangrenous ulcer. Fever and systemic signs of illness are common.
Bacterial conjunctivitis management
erythromycin ointment or polymyxin-trimethoprim drops. However, fluoroquinolones are preferred for contact wearers due to higher risk for pseudomonal infection.
keratitis presentation
photophobia, blurred or impaired vision, and a foreign body sensation with difficulty opening the affected eye
test of choice to work up femoral head avascularnecrosis
MRI
UC orders
1) mesalamine
2) antidiarrheals
3) antispasmodics
4) dietary consult
IBD orders
ESR CBC CMP Ova and parasites Fecal leukocytes stool culture LFTS PTT PT/INR
licorice effects
hypokalemia
hypotension
(suppresses RAAS. Looks like primary hyperaldosteronism but aldosterone is low due to RAAS suppression)
patellofemoral pain syndrome
young woman with new pain + poorly localized + reproduced pain with extension of the knee with anterior pressure on the patella (patellofemoral compression test).
pes anserine bursitis presentation
medial knee pain distal to the joint line.
osgood schlatter presentation
pain at the insertion of the patellar tendon at the anterior tibial tubercle + adolescent and preadolescent patients + following a rapid growth spurt. Patients will have localized tenderness at the tibial tubercle.
kava kava use
anxiety and insomnia
st John’s wort use
depression
gingko use
Memory enhancement
black cohosh use
Postmenopausal symptoms (hot flashes & vaginal dryness)
ginseng SE
Increased bleeding risk
patients at increased risk for colon cancer
First-degree relative age <60 with colon cancer or adenomatous polyps
>2 first-degree relatives with colon cancer or adenomatous polyps at any age
colon cancer screening for patients at increased risk
- Colonoscopy at age 40 or 10 years before the age of cancer diagnosis in a relative (whichever comes first)
- Repeat every 3-5 years
FOOSH fracture and mechanism + comorbid condition
- distal radius fracture
- tripping and falling forward
- often fracture ulnar styloid too + risk for acute carpal tunnel syndrome
other effects of endocarditis
- common in HIV patients
- pleuritic chest pain and cough due to septic pulmonary emboli (common complication of right sided IE)
- emboli appear on chest x-ray as multiple nodular opacities that may have evidence of cavitation
amiodarone affect on thyroid metabolism
decreases the peripheral conversion of T4 to T3, causing increased serum T4 and decreased serum T3 levels with normal to borderline elevated TSH.
propranolol affect on thyroid hormones
decreases conversion of T4 to T3 and is therefore useful in thyrotoxic emergencies.
