Test 4 Flashcards
Perioperative medical management
Selective estrogen receptor modulators, such as raloxifene, are associated with an increased risk of venous thromboembolism and should be discontinued 4 weeks prior to any surgical procedure associated with a moderate to high risk of venous thromboembolism.
See table
Dyspareunia
Sexual hx should be obtained routinely in health visits. Physicians should normalize sexual health concerns and provide patients with the opportunity to openly discuss these issues.
Contact dermatitis
Poison ivy contact dermatitis presents as pruritic, linear papules and/or vesicles on exposed areas. Reduction of spread is achieved by avoiding both direct (eg, skin-to-plant contact) and indirect (eg, clothing) exposure to the allergen.
Tx is supportive (eg, cool compress, topical corticosteroids). Oral corticosteroids are indicated in severe dermatitis or dermatitis involving the face or genitalia to reduce inflammation. Antihistamine (eg, diphenhydramine) are not effective as the pruritus in poison ivy dermatitis is not histamine-mediated.
Informed consent
Consent for tx is generally obtained from a parent or legal guardian prior to initiating medical tx for a minor except in specific circumstances. These circumstances include emergency care, STIs, and emancipated minors.
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RA
Patients with active RA should be started on a disease-modifying antirheumatic drug to slow the progression of bony erosions and cartilage loss. Methotrexate is the initial drug of choice for most patients. Others: methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, azathioprine.
+ RF and CCP is accelerated joint destruction, negative is less aggressive course
Fail first line use TNF inhibitors
Folic acid supplementation is recommended for patients on methotrexate therapy and reduces the risk of adverse effects without the loss of efficacy.
CAP
Patients with CAP require risk stratification with the pneumonia severity index or CURB-65 score to determine if hospitalization is needed. Patients hospitalized on the medical floor should be initiated on empiric IV abx with a beta lactam that targets Streptococcus pneumoniae (eg, ceftriaxone) and a macrolide (eg, azithromycin) to cover for atypical organisms. Respiratory fluoroquinolones (eg, levofloxacin) are also effective.
See table
Herpes zoster
Herpes zoster is due to the reactivation of varicella-zoster virus and is most commonly seen in elderly patients. Manifestations typically include a unilateral, dermatomal, vesicular rash and pain. Patients with typical lesions are usually diagnosed clinically (without testing) and treated with oral antiviral medication (eg, valacyclovir).
Hospitalized patients with herpes zoster require lesion covering and standard precautions if they have localized disease (one dermatome or immediately adjacent dermatomes). Those with disseminated dx also require contact and airborne isolation.
Urticaria
Chronic spontaneous urticaria presents with pruritic wheals that occur episodically over >6 weeks. A total of 80-90% of cases are idiopathic, but some are associated with atopic or rheumatologic disorders. A limited laboratory work up (eg, CBC, inflammatory markers, liver function studies, urinalysis) is recommended to assess for potential underlying disorders.
Chronic spontaneous urticaria is a self-limited condition that usually responds to standard therapy and resolves within 2-5 years in most cases.
Multiple pruritic SKs (Leser-Trelat sign)
Associated with malignancies (especially lung and gastrointestinal tumors)
CAD
Initial hx and ECG are often insufficient to dx or r/out acute coronary syndrome in patients with acute chest pain. Such patients should be evaluated with troponin levels and serial ECGs to evaluate for ACS and determine appropriate management.
