Flashcards in General Information Deck (48):
Best evidence in a study?
1. Systematic reviews
2. Meta analysis
3. Randomized Clinical trials
Geriatric with low Hgb, low serum iron, normal TIBC, Normal Ferritin, low MCV
Give Ferrous Sulfate oral TID and recheck in 1 and 3 months
Patient oriented out come that should be discussed during shared decision making?
A decrease in all cause mortality
True about Live attenuated intranasal influenza vaccine
It is more effective in age 2-6 than inactivated vaccine
Alcohol management option supported by evidence
Confirm DX of Septic Shock?
High Lactate level
Leading cause of death in RA PT
68 y/o male, got PCV 23 at age 65. What vaccine to give now?
Significant risk factor for Esophageal Adenoca
Obesity + GERD
Pleural fluid protein to serum protein >0.5
Pleural fluid LDH to serum protein >0.6
Pleural LDH >.67 time s the limit of normal
Geriatric patient; what will affect pharmacokinetics?
Increase percentage fat!
Decrease lean body mass
Bioterrorism that needs txt with 60 days of continues antibiotic?
TX with Fluroquinolones and Doxy
HIV testing by USPTF?
Age 15 - 65
ABI for Dvt
1-1.4 is normal
<0.9 is abnormal
When to screen for Hepatitis C
If patient was born bet 1945-1965
Test for Hereditary Hemochromatosis?
Ferritin and Transferrin saturation
USPSTF guidelines for 60 y/o Male who smoked for 20 yrs.
What do screen?
- Low dose chest CT!
- for age 55-80
- smoker or quit within 15 yrs
- 30 pack years
- Screen for AAA if 65-75
- screen for Osteoporosis if Female > 65
Hyperplastic Polyp less than 10 mm; when to rpt colonoscopy
In 10 yrs
Labs of Vitamin B12 deficiency
Elevated Methylmalonic acid plus elevated Homocysteine
Most common Carcinoma in the US?
Basal Cell Carcinoma
Painless Ulcer in Labia, RPR negative.
How to confirm?
- test becomes positive after 3 weeks from the appearance of the chancre
Specificity vs Sensitivity
Specificity - ability to identify those who do NOT have the disease (good for screening)
Sensitivity - ability to identify those who have the disease(good for confirmatory)
Patient with Celiac Disease. She is high risk for?
- decrease absorption of Ca and Vit D
Non pruritic rash in the axilla; coral red flurescence on woods light
Erythrasma : Corynebacterium
Tx: Erythromycin or Clindamycin
Best Diagnositic test for Vit D deficiency?
25- hydroxy vitamin D
Best for Excercise induced Bronchospasm?
Albuterol + low dose corticosteroids
Strategy to identify the unrecognized hep c is to screen what?
All born bet 1945-1965. Age 72- 92
Most common neurological complications of Paget's?
Lyme disease. Most common cardiac problems?
HEART BLOCK --> TEMPORARY!
Most common cause of medication related adverse events in the US?
3. DM Meds
Risk factor for Uncomplicated Cystis?
65 y/o female had bone density screening
Low dietary Ca intake
DXA showed -1.8 at hip and -2.1 at spine
10 yr risk of hip fx is 1.3%
-Increase Ca to 1200mg/day and Vit D supplementation 800IU
* if 10 yr risk of hip fx is >20%, may do Alendronate, or Calcitonin-Salmon
CT scan is equivalent to how many CXR?
Patient with menorrhagia
What will be consistent with von Willebrand?
- prolong PTT
*coagulation disorder; decrease protein complex of platelet adhesions, hence Platelets should be normal
36 y/o male with episodic rectal pain
Every 3- 6 months; sharp severe, cramp like
1-15 mins; normal anoscopy and DRE
18 y/o with intensely pruritic papular eruption in the waist after walking in the woods
PE: excoriated papules along the belt line
Cause of rash?
Chiggers - mite larvae - crawl until they reach constrictive clothing like belt and socks
Patient how is 200 lbs ABOVE her ideal wt.
Which wt loss treatment will decrease her cardiac risk?
1. Bariatric surgery! - reduce all cause mortality
*Orlistat and Phentermine will have moderate wt loss but no decrease in morbidity and mortality
Most prevalent form of elderly abuse
Chronic fatigue syndrome
Symptoms that rules it out?
1. 6 months of pathologic fatigue ,unrefresh sleep ,impairment of focus and concentration ,ORTHO static intolerance ,post exertional malaise + tender lymph nodes
2. Not in Chest pain, Neuro deficits, enlarged LN, Joint erythema
What physiologic change do you expect in the elderly in terms of BP?
WIll have widen pulse pressure
The DBP will decline
PP= SBP - DBP
60 y/o male with DDD
Herbal supplement that may be beneficial?
S-adenosine L- Methionine
90 year old schedule for surgery
What test to assess frailty?
Frailty: age related ; multidimensional state of decreased physiologic reserves
Patient with Irritable bowel syndrome
Therapy to reduce abdominal cramping?
Peppermint oil! - has antispasmodic properties
Drug noted to beneficial for a common disease
Cheap, generic, no pharma firm willing to fund a trial
What type of study is good to evaluate this treatment?
A Non -inferiority trial: does not distinguish that a new drug is not inferior or superior
46 y.o male with ADPCKD with HTN.Meds?
Patient wants to manage HTN non pharmacologic.
How much salt?
How much wine?
Monitor home BP
Salt 2400mg/day = 1 tsp of table salt
2 drinks of wine/day for men and 1 drink for women
Greatest benefit of Bariatric surgery
- remission of type 2 dm
- decrease all cause mortality