Test 64 Flashcards
Osteonecrosis
MRI scanning is the most sensitive imaging modality for diagnosing osteonecrosis of the femoral head. Early diagnosis and treatment is important to prevent joint destruction.
Antiepileptics
The use of antiepileptics, especially valproate, is associated with an increased risk of congenital anomalies. However, changes should not be made to a patient’s AED regimen after confirmation of pregnancy. Patients are started on high-dose folic acid and screened for congenital anomalies with serum alpha-fetoprotein and an anatomy US.
Incompetent cervix
Cerclage placement decreases the risk of second-trimester loss and preterm delivery in patients with cervical insufficiency. However, previable prolapsing amniotic membranes are associated with imminent delivery and a high risk of previable or preterm delivery and are a relative contraindication to cerclage placement.
Hepatitis C
A positive serologic test for hepatitis C virus (HCV) requires further investigation to evaluate for chronic infection. In asymptomatic patients, 3 potential explanations should be considered: persistent infection, cleared infection, or false-positive antibody test. Diagnosis of chronic HCV requires both a positive serologic test and a confirmatory nucleic acid test to confirm HCV RNA in the blood.
Research ethics
The physician’s personal issues should never enter the interaction between doctor and patient during a clinical visit unless specifically solicited by the patient. A physician should never solicit for funds or other support, even for medically-related issues, during clinical visits because such efforts may alienate patients or make them feel that their care will be affected if they do or do not participate.
Tuberculosis
Patients with HIV are at higher risk for active tuberculosis. Cavitary, apical lung disease is common at higher CD4 counts, but patients with advanced HIV are at greater risk for lobar, pleural, or disseminated disease. Tuberculosis pleural effusions are typically lymphocytic and exudative with an elevated adenosine deaminase level. Smears are often negative for acid-fast bacilli; diagnosis usually requires pleural biopsy with histopathologic demonstration of pleural granulomas.
Mitral stenosis
The physiologic changes of pregnancy (increased plasma volume and heart rate) cause an increase in flow gradient across the mitral valve, and can lead to worsening symptoms in previously stable patients with mitral stenosis.
Hyperglycemic hyperosmolar nonketotic syndrome
Hyperglycemic hyperosmolar nonketotic state is characterized by severe hyperglycemia, acute mental status changes, and absence of ketoacidosis. Initial management includes intravenous fluids and continuous insulin infusion. Stabilized patients can transition to subcutaneous insulin with a basal-bolus regimen.
Complementary and alternative medicine
Ginkgo biloba leaf extract is used by many patients as a “memory booster” because of its suggested propensity for increasing cerebral blood flow. It is most notorious for an increased risk of bleeding and a potentiation of the effects of anticoagulation therapy through various mechanisms, including the inhibition of platelet-activating factor.
Lung cancer
Patients with suspected metastatic cancer should have an initial biopsy of a metastatic site (if possible). Enlarged scalene or supraclavicular LN are generally preferred due to their superficial location.
Depression
Treatment options for pediatric major depressive disorder include pharmacotherapy, psychotherapy, and combination treatment. Selective serotonin reuptake inhibitors, particularly fluoxetine, a first-line pharmacotherapy.
Actinic keratoses
Actinic keratoses is usually treated with excision or destruction of lesions, often with cryotherapy. However, for patients with numerous or widespread lesions, destruction of individual lesions may be impractical and field therapy is recommended. Topical 5-flurouracil cream is the most commonly employed form of field therapy. Other options include imiquimod cream, topical diclofenac, and photodynamic therapy.
Hypertrophic cardiomyopathy
Common ECG findings in hypertrophic cardiomyopathy include criteria for left ventricular hypertrophy (high-voltage QRS complexes) with left axis deviation, depolarization abnormalities (prominent Q waves in the inferior and lateral leads), and repolarization abnormalities (T-wave inversions in the anterolateral leads). A normal ECG is uncommon.
