Test 52 Flashcards
Heat related illness
Heat stroke should be treated with augmentation of evaporative cooling, and the naked patient should be sprayed with a tepid water mist or covered with a wet sheet while large fans circulate air to maximize evaporative heat loss. Other cooling methods such as ice packs, ice water lavage, or cold intravenous fluids are helpful adjuncts, but not first-line treatment.
Breastfeeding
HIV-positive women in resource-rich countries are advised to feed their infants with formula rather than breast milk, regardless of maternal or infant antiretroviral therapy. In contrast, women in resource-poor countries are recommended to breastfeed due to high rates of infant morbidity and mortality from water-borne infectious diseases associated with formula feeding.
Asymptomatic bacteriuria
Asymptomatic bacteriuria is common in elderly women. Most cases resolve spontaneously within weeks, so no additional testing or treatment is usually required. Treatment is generally recommended only for patients who are pregnant, undergoing urologic procedures, or within 3 months of kidney transplantation.
Substance induced mood disorder
Psychiatric symptoms are commonly seen in patients taking corticosteroids and can include mood changes, psychosis, and anxiety. The symptoms occur more commonly in patients taking high doses for prolonged periods, but they can occur at any time. The first step in treatment is dose reduction of the offending corticosteroid.
Coronary artery disease
Stress testing is the initial evaluation of choice for patients with suspected coronary artery disease. Patients with positive stress testing results should be started on medical therapy, and those with high-risk stress testing features should undergo coronary angiography to evaluate for revascularization.
Osteoporosis
Chronic glucocorticoid therapy increases the risk of osteoporosis. For this reason, it is important to provide the lowest dose of steroids for the shortest duration, and to add vitamin D as well as calcium supplementation to the patient’s therapy. Based on the duration of therapy, bone densitometry is indicated for every year.
Rib fracture
Flail chest is the result of double rib fractures in more than one site, resulting in paradoxical movements of the flail segment during inspiration. The diagnosis may be obvious on examination, but many cases are occult. Management includes supplemental oxygen, pain control (invasive or noninvasive), positive-pressure ventilation, and surgical stabilization.
Tuberculosis
Children with latent tuberculosis (positive IGRA but normal CXR) infection require treatment to prevent conversion to active disease. Daily isoniazid for 9 months is the standard of care. If isoniazid resistance is suspected, the best alternate therapy is daily rifampin for 4-6 months.
Infectious mononucleosis
Infectious mononucleosis, a systemic viral illness most frequently due to the Epstein-Barr virus, should be suspected in any adolescent with fever, fatigue, exudative pharyngitis or tonsillitis, lymphadenopathy, and hepatosplenomegaly. The presence of atypical lymphocytes in the peripheral smear can be a clue to its identification, although these cells may appear in other inflammatory conditions.
Diabetic kidney disease
Patients with diabetes should be examined yearly for diabetic kidney disease with a urine albumin/creatinine ratio (type 2 right away, 1 is 5 years after dx). Serum creatinine and dipstick urine protein testing have low sensitivity and are not recommended for screening.
Endophthalmitis
Patients with neutropenia or severe conditions requiring the intensive care unit are at risk for invasive Candida infections. Risk is greatest in those with central venous access, particularly if the patient is in total parental nutrition. Endophthalmitis is a a common finding in disseminated disease, and manifestations include fever, eye pain, decreased visual acuity, and funduscopic evidence of focal, glistening, white, mound-like lesions that may extend into the vitreous and cause vitreous haze.
Candida Endophthalmitis with virtual involvement is typically treated with systemic antifungal medication (amphotericin B), intravitreal antifungal injection, and vitrectomy.
