Test 6 Flashcards
Pneumothorax
Pulmonary barotrauma is a risk of mechanical ventilation and can lead to pneumothorax. Placement of a chest tube is the preferred initial tx of a large pneumothorax in a patient who has not developed tension physiology.
Insomnia
CBT is the preferred initial therapy for insomnia. Elderly patients have an increased risk for adverse effects of hypnotic medications, including daytime sedation, cognitive impairment, delirium, night wandering, agitation, balance problems, falls, and fractures. If medications are necessary, they should be prescribed with caution and in the smallest possible dose.
Intussusception
Intussusception occurs in children age 6 months to 3 years and presents with severe, episodic, crampy abdominal pain; emesis; and “currant jelly” stools. Air or water-soluble contrast enema is the gold standard for dx and tx of this condition.
Intestinal perforation is a potential complication of enema reduction and of intussusception. Patients with acute pain after reduction should undergo radiographs of the abdomen to rule out intestinal perforation.
See table
Sjogren syndrome
The combination of ocular sx consistent with keratoconjunctivitis sicca and oral sx consistent with xerostomia should lead one to suspect a dx of Sjögren’s syndrome. Anti-Ro-SSA and anti-La/SSB antibodies are commonly present and can be helpful to confirm one’s clinical suspicion of Sjögren’s syndrome, as no true diagnostic test is available.
B lymphocyte activation occurs as a component of the chronic inflammation in patients with Sjögren’s syndrome. This activation results in an increased risk of B cell lymphoma. Metastatic squamous cell Ca frequently spreads to LN in the head and neck but is usually associated with a hx of tobacco or alcohol use.
Confounding, effect modification, bias, error
Confounding bias results when an exposure-disease relationship is obscured by the effect of an extraneous factor that is associated with both the exposure and the dx. If there is a confounding variable and the analysis is stratified by this variable, there will be no significant difference in risk between the groups because the confounding effects have been removed. CI includes 1 RR not statistically significant. Confounding threatens the internal validity of a study.
Vulvovaginitis
Trichomoniasis is characterized by vulvovaginal pruritic and erythema; a frothy, yellow-green discharge; and punctate hemorrhages in the vagina or on the cervix. Single-dose oral metronidazole is the preferred tx. To avoid infant exposure, breast milk should be expressed and discarded for 24 hours after dose administration.
Diverticular dx
When diverticulitis does not improve after 2-3 days of abx therapy, repeat abdominopelvic CT scan is required to evaluate for complications (eg, abscess, perforation, obstruction). Colonoscopy is contraindicated in patients with acute diverticulitis.
Pseudofolliculitis barbae
Pseudofolliculitis barbae presents with small, painful papules in the beard area. It is caused by penetration of the hair shaft into interfollicular skin, often due to shaving of tightly curled hair. Complications include hyperpigmentation, secondary bacterial infection, and keloid formation. Management includes discontinuation of shaving or using clippers to cut hair farther from the skin surface.
Depression
Identifying underlying depression in patients with PD is often difficult as psychomotor slowing and blunted affect can resemble bradykineisa and masked facies, respectively. Pharmacological tx consists of antidepressant medications, specifically SSRIs.
