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241

Mammograms

Starting at 50: every 2 years

D/c after 75

242

Pap smears

Begin at 21 and do every 3 years

For women over 30, can do every 5 years by co-testing with HPV cytology

Stop at 65 if had 3 consecutive negative Paps or two consecutive negative HPV results within the last 10 years

If cervix has been removed, testing is no longer necessary

243

Osteoporosis diagnosis

DXA T-score at or below -2.5

Osteopenia: -1 - -2.5

244

DXA scan

65 and over, and under 65 with high risk

245

Calcium and vitamin D for primary prevention of fractures in osteoporosis

Level D

246

Ottowa knee rules

Perform X-ray if any one:
1. >55
2. isolated patella tenderness
3. tenderness of the head of the fibula
4. inability to flex the knee to 90 degrees
5. inability to bear weight for 4 steps immediately and in the exam room (regardless of limping)

247

Management of most acute sprains

PRICE
-protection
-rest
-ice
-compression
-elevation

NSAIDs or acetaminophen for pain control

Early mobilization of injured ligaments promotes healing and recovery
-begin ROM exercises 48-72 hours after injury

248

Excision borders of melanoma in situ

5mm

249

Superficial spreading melanoma location

Men: torso
Women: legs

250

Acral lentiginous melanoma

More common in blacks and Asian

Under nails, soles of feet, palms

251

ABCDEs of melanoma

Asymmetry
Borders (irregular)
Color (variegated)
Diameter (>6 mm)
Elevation/Evolving

252

Excision margins for lesion concerning for melanoma

2-3mm

If biopsy confirms malignancy, want 5mm margins

253

What factor is most important in the prognosis of melanoma?

Breslow factor (depth): <1 mm thick have a low rate of metastasis

254

First-time microscopic hematuria

Follow up with repeat UA and microscopy in 6 weeks before any other management is done

255

Graves disease finding on radionucleotide scan

Diffuse increased uptake

256

Graves disease treatment

Radioactive iodine (in non-pregnant patients- don't use in children or breastfeeding mothers)

In adolescents:
-antithyroid drugs: PTU, methimazole, carbimazole (inhibit organification of iodine; PTU also inhibits peripheral conversion)
-may go into spontaneous remission after 6-18 months of therapy

257

PTU vs. methimazole

Methimazole is first-line unless pregnant (PTU preferred for 1st trimester)

PTU: black box warning for HEPATOTOXICITY

Watch for agranulocytosis

258

Evaluation of thyroid nodule

TSH and ultrasound

Nodules >1 cm on US require biopsy (FNA)

259

Stages of labor

1. onset of labor until cervix is completely dilated
-latent phase: contractions become stronger, longer lasting, and more coordinated
-active phase: usually starts at 3-4 cm of dilation; rate of cervical dilation at its maximum; contractions usually strong and regular [INDICATION FOR ADMISSION TO BIRTHING UNIT]

2. complete cervical dilation (10 cm) through delivery of fetus
-normal < 2 hrs in nulliparous woman and < 1 hr in parious woman
-epidural can prolong by up to 1 hr

3. delivery of baby until delivery of placenta and membranes
-prolonged if > 30 min

260

Determinants of the progress of labor

1. Power
-strength of uterine contractions
-strength of maternal pushing efforts

2. Passenger
-fetus size, lie, presentation, position within birth canal

3. Pelvis
-size, shape

261

Confirm rupture of membranes

Exam:
-fluid leaking from cervical os (either spontaneously or w/ Valsalva)
-presence of amniotic fluid pooling in the posterior vaginal fornix

Amniotic fluid:
-Nitrazine test: pH > 6.5 (normal vaginal secretions < 5.5)
-ferning (under microscope)

262

Fetal cardinal movements

1. Flexion
2. Internal rotation
3. Extension
4. External rotation

263

Treatment of maternal GBS

penicillin (or ampicillin)

264

Hypovolemic hyponatremia etiologies and treatment

Cerebral salt wasting, skin loss, diuretic use, GI losses, mineralocorticoid deficiency, third-spacing

See signs of volume depletion

Tx: normal saline and treat underlying condition

Severe symptomatic: <125
-confusion, seizures, coma
-urgent treatment with 3% (hypertonic saline)
-but go slow d/t risk of osmotic demyelination ("from low to high your pons will die")

265

Hypervolenic hyponatremia etiologies and treatment

Heart failure, cirrhosis, nephrosis

Exhibit signs of volume overload

Tx: diuretics and restriction of sodium and water intake

266

Euvolemic hyponatremia etiologies and treatment

SIADH (d/t infections, malignancy, drugs, CNS disorders), primary polydipsia, water intoxication, hypothyroidism, low solute intake ("tea and toast syndrome")

Tx: fluid restriction and treat underlying cause

267

Pseudohyponatremia

Low plasma [Na+] in the setting of hyperglycemia, hypertriglyceridemia, hyperproteinemia, laboratory errors, or mannitol use

Usually have normal volume status with normal osmolality

268

Management plan for hyperkalemia

1. stabilize myocardium w/ IV calcium gluconate
2. shift K+ intracellularly with insulin and glucose
3. lower total body K+ with Kayexalate, loop diuretics, or dialysis
4. Address underlying cause

269

Centor criteria

For suspicion of GAS

Points given for:
-absence of cough
-enlarged/tender anterior cervical adenopathy
-fever of 100.4 or higher
-tonsillar swelling/exudates

0-1: no further testing or abx warranted
2-3: perform rapid strep or throat culture and treat w/ abx if positive
4+: consider empiric abx treatment


270

GAS treatment

Penicillin

(IM penicillin G or 10-day course of po penicillin V)