Ambulatory Medicine Flashcards
(15 cards)
Back pain pharmacologic treatment comments:
Tylenol
Duloxetine
NSAID
Tylenol not helps: cochrane review
Duloxetine: chronic back pain >12 weeks
First line pharmacologic therapy is nsaid, second line duloxetine and tramadol
Back pain gets better after 4 weeks (if it has to improve) on non-pharm therapies regardless of what u choose
Cervical sprain-spurling test
Bends patients head to either side elicits pain and extending the neck and applyinh a downward axial load-also positive for radiculopathy
Neuro exam normal
Not radiates to arm, radiates to posterior head
Acute cervical spasm: nsaid first line-cyclobenzaprine >15mg/d helps but caution in older
Shoulder abduction test:
in cervical radiculopathy, symptoms improve if u hold patient hand on the affected side above patient head
Improves in 2-3 mnths with conservative therapy-ask them for stretching exercise
Myelopathy findings: difficulty writing, gait problems, hypertonia, hyperreflexia, fine manipulation problems-do MRI
Thoracic outlet syndrome
Compression of brachial plexus, subclavianartry or subclavian vein
Neurogenic TOS: brachial plexus compressed: neurogenic symptoms with persistent activties overhead , EMG may be negative
May look for anomalous first rib on imaging
Treat with PT: strengthening
Adhesive capsulitis
Poorly localized progressive insidious onset pain
Worse at night cold weather
Both active and passive ROM decreased
Look for clues for secondary: DM, hypothyroid, prior sugery, trauma, immobilized, autoimmune disorder,stroke
Tests for shoulder:
Cross arm test
Yergason test
Pain with passive shoulder adduction positive in AC joint
Place patient ipsilateral arm at his side while flexing elbow to 90 degrees and supinating against resistances: in biceps tendinitis
Diagnose:
Runner, diffuse lateral knee and distal thigh pain, tenderness to2-3 cm proximal to lateral femoral condyle, weakness with hip abduction
IT band syndrome
NOBLE test:
Reproduction of pain with knee extension from 90 deg to 30 deg with examiner thimb exrting pressure on lateral femoral epicondyle
High ankle sprain versus lateral ankle sprain
Hi ankle sprain – excessive dorsiflexion or eversion, injury to tibiofibular Sendesmotic ligamentsu connecting the distal tibia and fibula
-Squeeze test compressing the leg admit cough
-Crossed leg test-cross legs with lateral malleolus of the injured leg resting on the other knee
-dorsiflexion external rotation test-dorsiflexing and externally rotating the foot with the knee flexed
Associated with swelling and ecchymosis
Lateral ankle sprain, from inversion injuries for the lateral ankle ligaments, interior and posterior talofibular ligaments and calcaneofibular ligament. Exam shows Ecchymosis, lateral ankle tenderness and swelling
Achilles tendon rupture test?
Thompson test, absent plantar flexion with calf squeezing
Patient report Sudden he pain and popping soundat the time of injury
Ottawa ankle and foot rules
Radiography order when
Unable to walk for steps forward immediately after the injury and during evaluation, focal tenderness at posterior aspect of malleolus the navicular bone or fifth metatarsal base
Duration on the VTE prophylaxis after major orthopedic surgery
35 days
For hip fracture, arthroplasty and knee arthroplasty
LMWH first choice
Then dabigatran, or factor Xa inhibitors or warfarin
Post op venous thromboembolism score
Caprini score
For
General surgery, GI, urologic, gyne, bariatric, vascular, plastic/reconstructive
0-very low
1-2 low
3-4 moderate
>5 high: do LMWH with mechanical (int pneumatic compression)
Anti platelet after ACS perioperative managemnt:
1 year DAPT after ACS
at least 30 days after BMS
6 mnths after DES
if surgical delay risk is higher than stent re theombosis: P2Y12 inhibitor stopped after min of 30 days after BMS AND 3 mnths after DES
continue aspirin, if below these time thresholds, continue
Indications of preop echo:
Dyspnea of unknown origion
Heart failure wihh th change
Known left vent dysfunction with no assesment in past 12 months
Also, AS
How to dc factor Xa inibitor when cr clearance is less than 30
Get anti xa level or dc anticoagulation 72 hours earlier
