RUHS Clinical Pearls

Question 1

Elastography

Answer 1

• Elastography is a non-invasive medical imaging that helps to determine the stiffness of organs and other structures in the body
• Avoid eating 6-8 hrs before exam — This allows visualization of gallbladder

Question 2

Electromyography/Nerve Conduction Velocity Study (EMG/NCV)

Answer 2

1. Used to diagnose carpal tunnnel correctly and develop a list of possible causes
2. Most accurate and correct test
3. Can be used for Upper or Lower extremity ( burning pain, nerve pain)**

Question 3

IUD String Assessment?

Answer 3

1. Make sure you can see the IUD strings on a PAP test. If strings are not in place, pt is at risk of pregnancy
2. Ultrasound if unable to see strings so you can see if IUD is in place.
3. Copper IUD can stay in for 10 years

Question 4

CADAC Certification

Answer 4

1. Matrix model- Adiction to treat addiction

Question 5

US follow up

Answer 5

If you are watching something like carotid stenosis or cervical changes REPEAT US in 6 months**

Question 6

Diabetes & Gastroporesis

Answer 6

1. Diabetes is the most common cause of gastroporesis
2. Gastroparesis is a condition in which the muscles in the wall of the stomach work poorly or don’t work at all, slowing or delaying the rate at which food empties from the stomach to the intestine
3. Sx’s such as abdominal pain, nausea, bloating, vomiting, heartburn, and a lack of appetite

Question 7

Diabetes Medication to be familiar.

Answer 7

1. Actos (TZDs) — Start dose 15-30mg and MAX dose 45mg/day
2. Glipizide (Sulfonylureas) — Start 5 mg; MAX dose 40 mg/day
3. Lantus — Start 0.2 units/kg/dose up to 10 Units/Day
4. Humulin 70/30 (NPH/Insulin regular)
5. Humulog (Insulin Lispro)
6. New medication is Ozempic** (Semaglutide)

Question 8

Toenail fungus

Answer 8

1. Terbinifine (Lamisil)
2. Check liver enzymes when giving medication and repeat in 2 months
3. DO NOT put them on medication if they drink alcohol

Question 9

Baker Cyst

Answer 9

1. Look behind the knees in OBESE patients. Common finding in these patients.
2. 3 view X-ray for diagnosis

Question 10

Routine Labs for Physical

Answer 10

1. CBC
2. CMP
3. TSH and T4
4. Vitamin D
5. PSA if pt has Urinary Sx’s

Question 11

Amlactin Lotion**

Answer 11

1. Ictiousis skin.. Urea based lotion that is great for dry skin.

Question 12

Flonase - Fluticasone

Answer 12

1. Fluticasone Proprionae (Flonase) 50mcg/acuation nasal spray
2. BEST treatment for allergies

Question 13

Debrox - peroxide otic

Answer 13

1. Put drops in ear and lay on side for 30 minutes watching tv then switch over to the other side.
2. Repeat every 10 days if needed

Question 14

Plantar Warts

Answer 14

1. Definitive treatment is referral to Podiatry and tx w/ cryotherapy

Question 15

Psoriatic Arthritis

Answer 15

1. Seronegative spondyloarthroapthy characterized by inflammatory arthritis and enthesitis
2. Symmetric polyarthritis — Typically milder than RA
3. Gernally pt will have long history of psoriasis
4. Morning stiffness of hands, feet, or low back for > 30 minutes

Question 16

HeartBurn Treatment -Gastritis?

Answer 16

1. Put patient on a PPI - pantoprozole. It they are still having break through heartburn, try carafate as a medication
2. If sx’s progress, think about referring to GI

Question 17

TB Treatment

Answer 17

1. Vitamin B-6. Helps the neuropathy from the side effects of Isoniazid for TB treatment. Pain is in the hands and feet.
2. Serial liver and renal labs q3 months
3. Isoniazid INH — 300mg daily
4. Quantaferon Gold is the GOLD Standard — NO Chest xray

Question 18

Nausea

Answer 18

1. Reglan works better in pregnant women

2. Doxylamine and pyridoxine (Vit B6)

Question 19

Morton’s Neuroma

Answer 19

1. Pain between the webbing of the 3rd and 4th toes.

Question 20

ACE inhibitors

Answer 20

1. Lisinipril

2. Know

Question 21

Encoperisis

Answer 21

1. What is it called when a peds soils their pants? Encoperisis

Question 22

Boards Questions

Answer 22

1. Thyroxide — Cydomel Vs Thyroxine or desicated T3 (Armorthyroid) When do you treat with each of these?
   - If you treat with Synthroid and NO results, try Cytomel next. Or Armorthyroid**
2. Beta blocker S/Es
3. ACE inhibitor S/Es — Cough

Question 23

Hepatitis Info

Answer 23

1. HepB - (s) stands for surface and AB stands for antibody — This means the patient is immune to the disease and immunized
2. Hep B (c) stands for core and means that the person has the disease**
3. IgM — Good morning” You have the disease
4. IgG — Gone — This is an old infection

Study for boards **

Question 24

Oral Contraceptives PEARLS

Answer 24

1. DO NOT Put a woman who is over 220 on birth control EVER. They are sedentary and will either stroke out or have an MI
2. A large woman will sometimes still get pregnant when on contraceptives.
3. NEVER NEVER remove an IUD from a woman who is pregnant. You can cause a spontaneous abortion

Question 25

Sjogren’s Syndrome?

Answer 25

Sjogren’s syndrome is a disorder of your immune system identified by it’s two most common sx’s — Dry eyes and a dry mouth
-Can accompany RA and lupus

Question 26

Allergies or sinus cold

Answer 26

1. Start with flonase
2. Consider Certrazine zyrtec 10 mg at bedtime d/t drowsiness 2nd generation antihistamine
3. Assess for allergic shiners, boggy terbunates

Question 27

Nexplanon Placement

Answer 27

1. 4.0 Nylon — for closing anything on the body.
2. 2.5-3 ml’s of lidocaine for pain
3. Make small insicion site with scalpel and use the forecepts to open the skin.
4. One small stitch to close the wound and tripple knot the tie.

Place nexplanon directly under the skin and not too deep