Test 5 Flashcards
Actinic keratoses
Actinic keratosis typically presents as scaly, erythematous papules on sun-exposed skin. Lesions that are greater than or equal to 1 cm, are tender/indurated, exhibit rapid growth, or fail to respond to treatment should be bx to rule out squamous cell Ca.
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Ocular trauma
The presence of orbital fat tissue in the wound indicates a high probability of septum injury and a possible levator palpebrae injury.
OCD
Exposure and response prevention, a form of cognitive-behavioral therapy is considered a first-line nonpharmacologic intervention for obsessive-compulsive disorder. SSRIs are first line medications for OCD. High doses and prolonged trials are typically required and gradual uptitration is necessary to enhance tolerability. The TCA clomipramine or antipsychotic augmentation can be used in patients who do not respond to SSRIs.
SSRIs cause delayed ejaculation can tx premature ejaculation.
Postpartum endometritis
Is a polymicrobial infection characterized by fever, uterine tenderness, and purulent vaginal discharge. The first-line treatment regimen is clindamycin plus gentamicin, which provides broad-spectrum abx coverage for gram+, gram-, and anaerobic bacteria. Ampicillin-sulbactam is an acceptable alternate regimen.
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HPV
The HPV vaccine series should be offered to all patients age 11-26. The vaccine reduces the risk of genital warts and anogenital and oropharyngeal cancers in both sexes.
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CF
In patients with CF, pulmonary exacerbations are typically due to Pseudomonas aeruginosa or Staphylococcus aureus. Empiric therapy should include methicillin-resistant S aureus coverage (eg, vancomycin) and 2 drugs active against P aeruginosa ( eg, cefepime, amikacin). Other effective agents include carbapenems, certain fluoroquinolones, aztreonam, and colistin.
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Neonatal evaluation
Well-appearing neonates of gestational age greater than or equal to 35 weeks born to mothers who received inadequate (eg, not administered greater than or equal to 4 hr before delivery) but indicated px against group B Streptococcus should be observed for signs of sepsis over 36-48 hours. Blood culture and abx are indicated for clinical signs of neonatal infection, intrapartum maternal fever, or preterm delivery prompted by potential infection.
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Long QT syndrome
The presence of bradyarrhythmias (sinus bradycardia or pauses) is associated with an increased risk of developing torsades de pointed in patients with drug-induced acquired long QT syndrome (LQTS). Common medications implicated in LQTS include antipsychotics, antidepressants, macrolides, fluoroquinolones, and antifungals.
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Influenza
Influenza tx with antiviral medications (oseltamivir) is recommended for patients who require hospitalization, have severe or progressive illness, or have underlying high-risk medical conditions. Oseltamivir is also recommended for low-risk patients with mild dx who present <48 hours after sx onset. Previously healthy patients with >48 hours of sx should receive sx care (acetaminophen) alone.
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Metabolic acidosis
Alcoholic ketoacidosis is characterized by anion gap acidosis, increased osmolal gap, ketonemia or ketonuria and variable blood glucose levels. Blood glucose levels are generally higher than 250 mg/dL in patients with DKA.
Most patients with alcoholic ketoacidosis will respond to an administration of IV dextrose containing normal NS and thiamine. Insulin is generally not required. All patients need to be hospitalized for tx.
Metoclopramide
Metoclopramide is a central and peripheral D2-receptor blocker. It’s use can result in drug-induced extrapyramidal sx such as akathisia, dystonia, and parkinsonian-like sx.
HIV
Patients at high risk of HIV exposure should receive a screening test that combines detection of HIV antigen (p24) and HIV-1/HIV-2 antibody. False-negative results may occur during the first 4 weeks of infection due to low titers of antigen and antibody (window period).
Patients newly diagnosed with HIV require laboratory testing to the stage the disease, determine appropriate antiretroviral therapy, and identify coinfections and comorbidities. Prior to initiation of antiretroviral therapy, testing for hepatitis B virus is required as some treatment regimens can target both infections. Patients are also typically screened for tuberculosis, hepatitis C virus, and sexually transmitted pathogens (eg, Treponema pallidum, Neisseria gonorrhoeae).
Perioperative medical management
Contrast- induced renal vasoconstriction is thought to cause contrast-induced nephropathy (CIN). Patients at high risk of CIN should receive intravenous sodium chloride or sodium bicarbonate infusion before and after contrast exposure to prevent renal hypoperfusion.
N-acetylcysteine has also been used to prevent CIN but has has not been shown to be superior to IV saline or sodium bicarbonate.
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