GIM Flashcards
(33 cards)
Medications causing Lower limb edema
• The drugs most commonly implicated in edema formation are calcium channel blockers, gabapentin, NSAIDS, oral contraceptives, glucocorticoids, and thiazolidinedi- ones.
• If scaphoid fracture is suspected and radiographs are normal, thumb splinting and repeat radiography in 1 to 2 weeks or immediate advanced imaging (MRI or CT) (the latter is the preferred approach)
Binge eating disorder management
• Cognitive behavioral therapy is the cornerstone of treatment for binge eating disorder.
• Lisdexamfetamine reduces the frequency of binge eating days and can be added as an adjunctive treatment for patients with persistent symptoms of binge eating disorder.
SSRIs will cause weight gain
Venous ulcer treatment
🔴Treatment of venous stasis ulcers consists of local wound care and compression therapy.
🔴Infection should be eliminated as a contributing cause of nonheal- ing venous ulceration.
🔴Necrotic tissue should be debrided, and the wound should be covered with a dressing.
🔴Various dressings are available, and none stand out as superior in direct comparisons; however, dry gauze should be avoided because it disrupts the formation of granulation tissue when removed.
🔴Compression therapy is an essential component of the treatment of venous stasis ulcers. Before application, measurement of the (ABI) is recommended to avoid inappropriate application of lower extremity compression in a patient with peripheral artery disease. An absolute contraindication to compression therapy is an ABI of 0.5 or less,
PTSD Management
Cognitive behavioral therapy is the cornerstone of therapy for patients with posttraumatic stress disorder.
• Sertraline, paroxetine, and venlafaxine, in conjunction with cognitive behavioral therapy, may help relieve posttraumatic stress disorder symptoms.
Premenstrual dysphoric disorder
• Premenstrual dysphoric disorder consists of symptoms of mood disturbance that develop the week before menses, remit within a week after menses, and occur with most menstrual cycles during a given year.
• First-line therapy for premenstrual dysphoric disorder includes second-generation antidepressants with special emphasis on safety in pregnancy
Opioid overdose risk
• Major risk factors for opioid overdose include receiving more than 50 morphine milligram equivalents per day and receiving opioids and benzodiazepines concurrently.
Alcohol withdrawal management
• The treatment of severe alcohol withdrawal symptoms is best managed by symptom-triggered administration of benzodiazepines.
• In the treatment of severe alcohol withdrawal symp- toms, short-acting benzodiazepines are preferred to long-acting benzodiazepines in patients with severe alcoholic hepatitis or cirrhosis.
Thoracic outlets syndrome keywords
Neurogenic: Weakness and numbness and parsthesia with widespread (overhead movements)
Chronic insomnia management
• For patients with chronic insomnia refractory to cognitive behavioral therapy for insomnia (CBT-I) or who decline to participate in CBT-I, either low-dose doxepin or a nonbenzodiazepine benzodiazepine receptor agonist (e.g., zolpidem, zaleplon, eszopi- clone) is recommended after a discussion of risks and benefits
Chronic cough approach
• The initial management of chronic cough includes tobacco cessation and discontinuation of ACE inhibi- tor therapy, followed by chest radiography if cough persists.
• In patients with negative findings on chest radiograph and persistence of cough after discontinuation of ACE inhibitor therapy and tobacco, additional evaluation proceeds in a stepwise fashion: (1) empiric treatment for upper airway cough syndrome; (2) spirometry or empiric treatment for asthma; (3) sputum analysis for eosinophils or empiric treatment with inhaled glucocorticoids; and (4) empiric treatment for gastroesoph- ageal reflux disease.
Post menopausal Vaginal atrophy management
• The North American Menopause Society recommends initiating nonhormonal therapies, such as daily vaginal moisturizer and vaginal lubricants, as first-line treatments for genitourinary syndrome of menopause before considering topical vagínal estrogen therapy
If nonhormonal treatments are not effective in the treatment of genitourinary syndrome of menopause, guidelines recommend the use of low-dose topical vaginal estrogen therapy rather than systemic estrogen therapy for patients whose only symptoms are related to vaginal atrophy.
Suspected melanoma work up
• For suspected malignant melanoma, excisional biopsy, a technique in which the entire lesion is removed using 1- to 2-mm peripheral margins, is used for both diagnosis and determination of Breslow depth
Recombinant herpes zoster vaccine
• Adults aged 50 years or older should receive the recombinant herpes zoster vaccine regardless of a his- tory of herpes zoster vaccination with the live attenuated vaccine or a previous episode of herpes zoster.
Pre-op management of biologics and DMARDs
• All nonbiologic disease-modifying antirheumatic drugs should be continued throughout the periopera- tive period in patients with rheumatologic disease undergoing elective arthroplasty.
• Biologic agents should be withheld for one dosing cycle preoperatively, before arthroplasty, with surgery performed at the end of the cycle and resumed when the wound shows evidence of healing.
Seborrheic keratosis treatment
Topical antifungal treatments are first- line treatment. Over-the-counter medications, such as zinc pyrithione and selenium sulfide shampoos, are the most cost-effective treatment options to use first. Ketoconazole shampoo and cream are also effective. Patients should apply the shampoo on the skin and allow it to sit for 5 minutes before rinsing it off.
Contraindications for estrogen containing contraception
• Contraindications to estrogen-containing contracep- tives include migraine with aura, history of breast cancer, venous thromboembolic disease, uncontrolled hypertension, or smoking more than 15 cigarettes a day for women older than 35 years
Women with contraindications to estrogen should be prescribed either a progesterone-only or a non- hormonal contraceptive option
Acute bacterial conjunctivitis treatment
. Trimethoprim- polymyxin ophthalmic solution is an appropriate antibiotic option. Other reasonable options are erythromycin or bacitracin-polymyxin ophthalmic ointments.
Because of concern about antibiotic resistance and higher cost, ofloxacin ophthalmic solution should be reserved for patients who wear contact lenses. which increases the risk for pseudomonal infection
Erythroderma
• Erythroderma describes the condition of erythema covering greater than 80% body surface area.
• Up to 40% of cases of erythroderma are idiopathic; exacerbation of a preexisting rash (e.g., psoriasis, atopic dermatitis) and medication reaction are other common etiologies.
Pregnancy and vaccination
🔴All women considering pregnancy should be assessed for immunity to varicella and rubella.
🔴If an already pregnant woman is not immune to either varicella or rubella, these vaccines should be administered after delivery and before hospital discharge
🔴Reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine between 27 weeks’ and 36 weeks’ gesta- tion with each pregnancy, helping to ensure immunity to the child upon birth. Administering Tdap during pregnancy is recommended regardless of when a patient received her last tetanus vaccination.
🔴Immunizations to be avoided during pregnancy include live vaccines (varicella, rubella, measles, mumps, live attenuated influenza, live attenuated herpes zoster) and human papillomavirus (HPV) vaccine.
Pemphigus vulgaris vs bullous pemphigoid
• Pemphigoid vulgaris is an autoimmune blistering disorder that presents with flaccid oral or other mucosal bullae that rupture easily and leave erosions.
• Bullous pemphigoid is an autoimmune blistering disease that features tense bullae with pruritus as the predominant symptom
Cervical cancer screening
Women aged 21-65 y with
#cytology (Pap smear) every 3 years
#HPV every 5 years (women older >25)
#HPV + cytology every 5 Years
Cervical cancer screening when to discontinue
• Routine screening for cervical cancer can be discon- tinued at age 65 years in non-high-risk women, pro vided that the patient has undergone adequate prior screening.
• The U.S. Preventive Services Task Force defines ade- quate prior screening as three consecutive negative cytology results or two consecutive negative cytology tests plus human papillomavirus test results within the past 10 years, with the most recent test occurring within 5 years.
Endometrial cancer
• Risk factors for endometrial cancer include obesity (BMI ≥30); a history of unopposed estrogen (e.g., poly- cystic ovary syndrome, obesity); or genetic syndromes, such as Lynch or Cowden syndrome.
• When presenting with abnormal uterine bleeding, women aged 45 years and older or those younger than 45 years who are at increased risk for endometrial cancer should undergo endometrial biopsy.
