Test 57 Flashcards
Substance use disorders
Taking a thorough history can effectively identify substance abuse in the primary care setting. Once it is identified, the initial approach consists of engaging the patient in a brief counseling session to discuss personal risk and develop collaborative goals and a treatment plan.
Thermal burn
Bladder pressure measurement is the standard method for estimating intraabdominal pressure (IAP) and diagnosing abdominal compartment syndrome (ACS). Surgical decompression is the definitive treatment. If increased IAP is recognized early, nonsurgical measures (gastrointestinal drainage, sedation) can potentially prevent progression to ACS.
Intention-to-treat analysis (ITT)
ITT analyzes each subject based on randomization group (even if subjects stop the intervention or shift to a different intervention). This tends to provide a conservative but more valid estimate of the intervention effect. ITT is used to help preserve the benefits of randomization in superiority trials.
Prenatal care
All pregnant women should be screened for anemia and gestational diabetes mellitus at 24-28 weeks gestation secondary to physiologic changes occurring at this time. Testing is performed due to expanding red blood cell mass and relative insulin resistance from secretion of human placental lactogen.
Cardiac arrest
Anomalous aortic origin of a coronary artery is a common cause of sudden cardiac death in young athletes. Patients may have premonitory symptoms of exertional angina, lightheadedness, or syncope. ECG is typically unremarkable and Transthoracic echocardiography or coronary angiographic imaging is required for diagnosis.
Adhesive capsulitis
Mild adhesive capsulitis may be managed with rest and gentle range of motion exercises. Glucocorticoid injection is recommended for patients with more severe symptoms and those who do not improve with conservative measures.
Diabetic neuropathy
Aggressive glycemic control is the most important aspect of treatment for diabetic neuropathy. However, for patients with severe associated pain, treatment with medications like tricyclic antidepressants, duloxetine, or certain anticonvulsant medications (gabapentin, pregabalin) can alter neuronal transmission and decrease pain. While tricyclic antidepressants are effective pain control agents for diabetic neuropathy, SSRIs are not.
Cushing syndrome
Young patients with diabetes, osteoporosis, hypertension, and hypokalemia should be screened for Cushing syndrome. Screening for Cushing syndrome can be performed by an overnight dexamethasone suppression test or measurement of 24-hour urinary free cortisol level.
Head and neck cancers
About 60% of head and neck cancers are locally advanced at the time of diagnosis and are inoperable. Chemoradiotherapy (CRT) promises superior results than chemotherapy or radiotherapy alone.
Poststreptococcal Glomerulonephritis
Poststreptococcal Glomerulonephritis, a complication of group A Streptococcus species, presents with nephritic syndrome (renal failure, HTN, hematuria, red blood cell casts) 2-4 weeks after infection. It is most common in children and has an excellent prognosis in this age group; however, adults and those with a history of chronic kidney disease, metabolic syndrome, or diabetes have a worse prognosis and may develop end-stage renal disease.
Principles and methods of epidemiology
Ecological studies give population-level information, not individual-level information.
Morbidity and mortality rates
The net clinical benefit of a medication is a measure of its possible benefit minus its possible harm.
Pituitary adenoma
Nonfunctioning pituitary adenomas generally arise from gonadotropin-secreting cells of the pituitary gland. Patients usually present with hypogonadism and low gonadotropin levels, serum alpha-subunit levels are characteristically increased. Large tumors may cause symptoms directly through mass effect on local tissues. The primary treatment modality is trans-sphenoidal surgery.
Warts
Plantar warts usually present as single or multiple hyperkeratotic papules on the sole of the foot. Topical salicylic acid is the first-line therapy for plantar warts. Other options include liquid nitrogen cryotherapy.
The initial response to salicylic acid treatment for plantar warts may take 2-3 weeks to become apparent. Patients are usually assessed at 2-3 week intervals and treatment is continued for 1-2 weeks after clinical resolution to eradicate the virus and prevent recurrence.
Paralytic ileus
Diuretic-induced hypokalemia is a common complication of antihypertensive/congestive heart failure therapy, especially with loop diuretics. Dysfunctional bowel, as in paralytic ileus, and cardiac and neurologic complications are indications for prompt parenteral potassium replacement.
