Test 70 Flashcards
Diabetes mellitus
Dextrose is the first-line treatment for sulfonylurea (glyburide) poisoning. Octreotide is a somatostatin analog that decreases insulin secretion in patients with with severe sulfonylurea overdose.
Scaphoid fracture
Scaphoid fractures that are not treated appropriately or in a timely fashion can result in avascular necrosis and increase the risk of nonunion.
Food protein-induced allergic proctocolitis
Food protein-induced allergic proctocolitis is a non-IgE-mediated food allergy that presents in a well-appearing infant at age 1-4 weeks with blood-streaked stools. Diagnosis is clinical, and treatment in breastfed infants involves elimination of dairy from the maternal diet.
Antiepileptics
Although the frequency is not clear, neutropenia and bone marrow suppression due to carbamazepine use are significant adverse reactions. Elderly patients are also at risk of SIADH. Because of some mild anticholinergic effects, there is a risk of glaucoma, urinary retention or constipation.
Osteoporosis
Bisphosphonate therapy is indicated for postmenopausal women with:
Low bone mass with a history of fragility fracture
Osteoporosis (T-score less than or equal to -2.5 on DXA)
Osteopenia (T-score between -1 and -2.5) and a 10- year probability for major osteoporotic fracture greater than or equal to 20% or hip fracture greater than or equal to 3% based on the fracture assessment tool (FRAX) risk calculator
Conflict of interest
Physicians must consider ethical issues when asked to provide informal treatment for friends. Treating friends should generally be limited to emergency situations when no other care is available.
Toxic megacolon
The first-line treatment for toxic megacolon is medical management to lessen the degree of colitis, with glucocorticoids used for patients with underlying inflammatory bowel disease and appropriate antibiotics used for patients with infectious colitis. 5-ASA compounds and opioids should be avoided in patients with toxic megacolon.
Measles
Measles (rubeola) is a vaccine-preventable viral infection that presents with a prodrome of fever, cough, coryza, and conjunctivitis. A maculopapular rash begins 2-4 days after initial symptoms and spreads in a cephalocaudal pattern. Patients are typically ill-appearing.
Falls
Thorough history taking in a patient with a fall is crucial in order to determine if the underlying cause is syncope, mechanical, or seizure. Additional history taking should clarify number of episodes, presence of a prodrome, surrounding events, associated symptoms, duration of the episode, time until full recovery, witnesses to the event, other medical problems, drug use, and history of seizures.
Slipped capital femoral epiphysis
Slipped capital femoral epiphysis is a common cause of progressive hip pain and altered gait in obese adolescents. It is diagnosed on x-ray with a posteriorly displaced femoral head, and immediate surgical pinning is the treatment of choice.
Aortic stenosis
The presence of a low-intensity, single second heart sound during inspiration is consistent with severe aortic stenosis. Other findings suggestive of severe AS include delayed and diminished carotid pulse and loud and late-peaking systolic murmur.
Peptic ulcer disease
Confirmation of H. Pylori eradication is recommended for patients with ulcers or ongoing dyspepsia. Either urea breath or fecal antigen testing can be used after 4 weeks to confirm H. Pylori eradication. H. Pylori serology should not be used since it may remain positive a year or more after eradication.
Physician patient communication
Encounters with angry, verbally abusive patients are best managed by acknowledging the anger and attempting to preserve the physician-patient relationship with a nondefensive, empathic approach.
