Test 1 Flashcards
Patellar tendon tear
After a strong contraction of the quadriceps (eg, pivot, landing), patellar tendon rupture should be suspected in a patient with severe pain, anterior knee swelling, and an inability to actively extend the knee or maintain passive extension of the knee. Tx: surgical repair
Kava kava (Piper methysticum)
It is important to ask patients about the use of herbal dietary supplements as these agents can be associated with adverse effects. Kava kava is a supplement that has been used for anxiety, insomnia, and menopause but may result in hepatoxicity and liver failure several weeks or more after intake. See table
PEA cardiac arrest
Pulseless electrical activity (PEA) describes an organized cardiac rhythm that is unable to generate sufficient cardiac output to create a measurable blood pressure or palpable pulse. Patients with PEA cardiac arrest require immediate and continuous cardiopulmonary resuscitation until, if and when, the cause of the cardiac arrest can be identified and treated and return of spontaneous circulation is achieved. Neither defibrillation nor synchronized cardioversion are performed on patients in PEA cardiac arrest.
Ask clinicians to use a beside scoring system to identify patients who are deteriorating clinically
Clinical Microsystems are frontline health care settings where patients, families, and health care teams interface. They are the building blocks of the larger health care system. Quality improvement measures a targeting micro system components can enhance delivery of high-quality care and improve overall patient outcomes in the system as a whole.
Child abuse
Abusive head trauma, typically caused by repeated acceleration-deceleration forces on the brain often presents in an infant with a reported mechanism of injury inconsistent with the patient’s development. Retinal hemorrhages, intracranial bleeds, and diffuse brain injury are characteristic. Next CT scan of head
LR
The likelihood ratio (LR) is the probability of a patient with the disease having a particular finding (eg, positive or negative test) divided by the probability of a patient without the disease having the same finding. The formula for a positive LR is sensitivity/(1-specificity); the formula for a negative LR is (1-sensitivity)/specificity.
LR <1 indicates a decreased likelihood that the disease is present
LR = 1 indicates no change in the likelihood of disease
LR >1 indicates an increased likelihood that the disease is present
CML
Chronic myeloid leukemia (CML) is caused by a translocation of chromosomes 9 and 22, which produces the Philadelphia chromosome. The presence of the bcr/abl fusion protein is diagnostic of CML and results in unregulated tyrosine kinase activity. Tyrosine kinase inhibitors such as imatinib are the initial treatment of choice in almost all instances. Later BMT, can be offered to patients who are young with stable disease and who have a suitable donor.
Autonomy
Patients have the right not to know genetic information unless it involves a treatable condition in a child. Physicians must be aware of the psychological ramifications of knowing carrier status for a fatal condition such as Huntington disease.
Sickle cell
Early manifestations of sickle cell disease include dactylitis, painful swelling of the hands or feet due to bone infarction, and hemolytic anemia. Predominant hemoglobin S with absent hemoglobin A on hemoglobin electrophoresis is diagnostic.
Central venous catheter
Patients undergoing hemodialysis through a tunneled catheter have high rates of catheter-related bloodstream infection. Empiric treatment typically includes vancomycin plus cefepime (or gentamicin). Catheter removal is indicated for those with severe sepsis, hemodynamic instability, pus from the catheter site, evidence of metastatic infection, or symptoms that do not improve within 72 hours of antibiotic administration. S aureus bacteremia: dx MRI of spine confirmed with open or CT-guided bx
DM
Type 1 diabetes mellitus should be managed with a combination of a longer-acting basal insulin (eg, glargine) and mealtime boluses, a short- or rapid-acting insulin.
Streptococcus agalactiae (Group B Streptococcus)
Asymptomatic GBS bacteriuria immediate abx tx with amoxicillin or cephalexin. Test of cure 1 week later to rule out persistent bacteriuria. PCN prophylaxis during labor
