Test 19 Flashcards
Patient autonomy
Patients have a right to make their own end-of-life decisions even if the treating physician does not agree. With the exception of requests for treatment that are clearly medically futile, a patient’s autonomy in end-of-life decisions must be upheld.
Mitral regurgitation
Chronic primary mitral valve regurgitation (MR) is defined as mitral valve insufficiency that results from an intrinsic defect of the mitral valve apparatus (leaflets, chordae tendineae). Patients with severe, chronic primary MR and left ventricular (LV) ejection fraction less than or equal to 60% are considered to have impaired LV systolic function, and mitral valve surgery is typically indicated.
Physician misconduct
Physicians are ethically obligated to report colleagues who subject patients to potentially harmful txs. State medical boards are authorized to conduct investigations of possible misconduct and institute disciplinary actions if indicated.
ALS
Diaphragmatic paralysis can lead to orthopnea, which can be easily confused with CHF. The most common causes of bilateral diaphragmatic paralysis are neurologic diseases such as ALS. Therefore, in patients with this presumed dx, the presence of neurologic signs and dxs should be sought elsewhere in the body.
Aortic dissection
IV beta blockers are the preferred initial therapy for lower HR and BP and reducing left ventricular contractility in patients with acute aortic dissection. Sodium nitroprusside should be used only in addition to beta blockers if systolic blood pressure remains >100-120 mm Hg after adequate beta blockade.
Pancreatic cancer
Endoscopic ultrasound with aspiration is the best test to evaluate a pancreatic cyst to different malignancy from nonmalignant causes.
Pelvic organ prolapse
Severe or prolonged pelvic organ prolapse can cause vaginal erosions that lead to abnormal vaginal bleeding (post menopausal bleeding, postcoital spotting). Tx of prolapse is via pessary or surgical correction; erosions can be treated with vaginal estrogen.
