Test 9 Flashcards
Intraabdominal abscess
Abdominal US is the best dx test for a suspected subphrenic or other abdominal abscess.
Desmoid tumor
Desmoid tumor are slow-growing and locally aggressive benign neoplasms with a high rate of local recurrence, even after surgical excision.
Depression
Sexual dysfunction, including decreased libido, anorgasmia, and delayed ejaculation, is common in patients taking selective reuptake inhibitors (SSRIs). Management include switching to the non-SSRI antidepressants, bupropion or mirtazapine, augmentation with sidenafil or bupropion, and cautious dose reduction in patients taking high-dose SSRIs.
Depression
Tx options for major depression include pharmacotherapy, psychotherapy, or a combination of the two. Initial tx with an antidepressant is indicated for patients with moderate-to-severe depression or if psychotherapy is not accessible or available. CBT and interpersonal psychotherapy have the best evidence among psychotherapies.
Sepsis
Sepsis is associated with high rates of death. Aggressive intravenous fluid resuscitation and the early initiation of antibiotics have been shown to reduce mortality. Empiric broad-spectrum abx should be administered within 1 hour of presentation (ideally after blood cultures have been drawn).
Urinary incontinence
A vesicovaginal fistula is a potential complication of pelvic surgery that presents as painless, continuous leakage of urine (clear, malodorous fluid) into the vagina. Small vesicovaginal fistulas may be subtle on examination (red area of granulation tissue) and require evaluation (bladder dye testing).
Posterior urethral valve
A voiding cystourethrogram is obtained by catheterizing the patient, injecting radiopaque dye, and obtaining images during voiding. It is the test of choice for dx vesicoureteral reflux and posterior urethral valves.
Transmission based precautions
HIV+ positive children should attend school in a normal manner (commingling with other students in the classroom and on the playground) and may play sports. Any disclosure of HIV status by the family is voluntary.
Brain death
Brain death testing can be interpreted only in the absence of confounding factors contributing to central nervous system depression such as metabolic derangements, sedation, and drug intoxication.
Hemoptysis
CXR abnormalities may suggest a variety of specific causes in patients with hemoptysis, including malignancy, focal infection (pulmonary tuberculosis), or heart dx (mitral dx).
COPD
Acute bronchitis is the most common cause of hemoptysis. A trial of abx therapy is warranted in pts with increased dyspnea, increased sputum volume, or increased sputum purulence (any 2 of these).
Vulvovaginitis
Trichomonas vaginalis, a flagellated, motile protozoan, causes trichomoniasis, a common sexually transmitted infection. Infected patients and their sexual partners are treated with oral metronidazole regardless of sx (or lack thereof) as untx Trichomonas infection can increase the rates of HIV transmission.
Sarcoidosis
Sarcoidosis is a multisystem granulomatous disease. The lungs are most commonly affected, but extra pulmonary manifestations of the skin (erythema nodosum), eyes (uveitis), joint (acute polyarthritis), nervous system (facial nerve palsy), and reticuloendothelial system (hepatosplenomegaly, lymphadenopathy) commonly occur. CXR is often the screening test because >90% of patients have bilateral hilar or mediastinal adenopathy.
Patients with clinical and radiographic features consistent with sarcoidosis are usually dx after other diseases with similar sx (tb) have been excluded and bx demonstrates noncaseating granulomas. Bx should be performed in the involved location easiest to access, which is usually a palpable LN or skin lesion. When there is no easily accessible lesion, fiberoptic bronchoscopy with transbronchial lung bx is often performed.
PD
Levodopa or dopamine agonists (pramipexole) can be used as the initial tx of PD sx. Dopamine agonists might be preferred in younger patients with less severe sx due to concerns about the long-term efficacy and side effects of levodopa.
