Test 21 Flashcards
Perioperative medical management
Metformin is contraindicated for patients with renal insufficiency, hepatic dysfunction, alcohol abuse, sepsis, or CHF (especially with estimated GFR <30 mL/min/1.73 m^2). It can increase the risk for lactic acidosis when combined with large-dose IV iodine contrast (during coronary angiography). Metformin is usually held on the day contrast is given and restarted at least 48 hours later after documenting stable renal function.
Wolf-Parkinson-white syndrome
The classic Wolf-Parkinson-white pattern in ECG consists of short PR interval, delta wave, and wide QRS complex. Some patients can become symptomatic with tachyarrhythmias, and syncope can result.
Patients with WPW syndrome are at risk of sudden cardiac death because the accessory pathway can lead to atrial fibrillation that can degenerate into ventricular fibrillation. Catheter ablation to obliterate the accessory pathway is the preferred tx.
Meningitis
Close contacts (household members, roommates or intimate contacts, child care workers, persons having had direct exposure to oral or respiratory secretions) of patients with known meningococcal meningitis should receive chemoprophylaxis. Regimens include rifampin (preferred), ciprofloxacin, and ceftriaxone. Ciprofloxacin and ceftriaxone are acceptable regimens in patients who cannot take rifampin (women taking OCPs).
Polycystic kidney dx
AD polycystic kidney dx is an inherited disorder characterized by multiple bilateral renal cysts. Patients are often asymptomatic, but may develop HTN, hematuria, proteinuria, renal insufficiency, and/or flank pain. Dx is usually made by renal US.
Patients age greater than or equal to 18 with family history of autosomal dominant polycystic kidney dx should be screened for the disorder using renal US. Counseling should be done prior to screening as positive testing can have psychological, insurability, and employment ramifications.
Osteoporosis
Patients with a fracture following minor trauma such as a ground-level fall should be tested for osteoporosis using dual-energy x-ray absorptiometry.
Osteoporosis
Pharmacologic therapy for osteoporosis is indicated for patients with a T-score less than or equal to -2.5 and for those with fragility fractures regardless of bone mineral density. Bisphosphonates are first-line tx in most cases.
