Newly onset......ah, I forget
This is the term used to describe the inability to carry out motor tasks; deficits may exist in motor or sensory systems, comprehension, or cooperation.
apraxia
These three diseases were mentioned repeatedly throughout the article as needing treatment when co-existing with vocal cord dysfunction. (name 2)
Asthma, post-nasal drip, and GERD
**Data are limited on whether treating any comorbid psychiatric condition may help.
Because dentists regularly manage bleeding with topical agents, pressure packs, and sutures, the recommendation is to continue these medication classes at therapeutic doses in patients undergoing common dental procedures.
Antiplatelet and anticoagulants
This life-threatening complication of ESRD often presents as painful, necrotic skin lesions.
Calciphylaxis
True
According to the POEMS in this edition, a limited study showed comparable cure rates in children treated for CAP with amoxicillin for this many days compared to the standard 10 day treatment course.
5
This is the rating applied by the USPSTF regarding the balance of risks/benefits from screening for vitamin D deficiency.
I: insuffient evidence for screenign for vitamin D deficiency
Name 2 clinical indications cited by the arti for breast implants, aside from purely cosmetic breast augmentation.
-male-to-female top surgery (gender dysphoria)
-post-mastectomy breast reconstruction
-correction of breast or chest wall anomalies, congenital or otherwise
Happening in 8 to 30% of patients presenting with AMS, this test is an important study to rule out nonconvulsive seizures.
EEG
Injection of the vocal folds with this is sometimes performed when other more conservative treatment options have failed.
Botox, onabotulinumtoxinA
According to the article, the preferred analgesia is a combination of these two medications.
APAP and NSAIDS taken together at the same time.
Which demonstrates improved mortality in ESRD? Kidney transplant or dialysis.
Kidney transplant.
True / False: Nutritional /dietary supplements can help prevent fetal growth restriction.
False. Multiple RCTs showing no benefit of nutritional treatments/dietary supplements. Reassure moms it is not happening because they are "not eating right"
One of the POEMS found that adults with idiopathic pulmonary fibrosis had an increased number of adverse events without any significant benefit when treated with this type of therapy.
Antimicrobial
When evaluating for obstructive sleep apnea, this shorter tool has been shown to be easier to use and equally sensitive as the longer, more cumbersome STOP-BANG criteria.
STOP: snoring, tiredness, observed apneas, “pressure”/HTN treatment
Even though the article says this, I was able to find a study online stating that sensitivities were increased by expanding the STOP criteria to STOP-BANG. I am going to continue using STOP-BANG.
Diagnosis of OSA is based on 15 or more events/hr on the respiratory disturbance index, respiratory event index, or apnea/hypopnea index. Most effective treatment is CPAP.
T/F: Breastfeeding is contraindicated in women with silicone implants due to risk of silicone ingestion by the infant.
False.
There is a higher risk of exclusive breastfeeding in women with implants, but it is still possible, not contraindicated.
As part of the Choosing Wisely Campaign, the American Geriatrics Society recommends against the use of this medication class as the first choice in treatment of the behavioral and psychological symptoms of dementia.
antipsychotics
Name at least 2 of the alternative diagnoses on the differential provided in the vocal cord dysfunction article.
amyotropic lateral sclerosis
anaphylaxis
anatomic defects (such as langomalacia, subglottic stenosis, tracheal masses, volcal cord polyps)
foreign body
laryngeal edema (croup, epiglottitis)
poorly controlled asthma
vagus or recurrent laryngeal nerve injury
Routine dental care should be postponed in patients undergoing radiation therapy to these regions of the body.
Head and neck
If patient's GFR is less than __, you should refer them to a kidney transplantation program. (must be within 5)
30.
There are several benefits of early referral:
-allows for thorough medical and psychosocial evaluation
-identification of living donor takes time
-accrues time on the transplant waiting list, making it more likely pt will get transplant
Even if Estimated Fetal Weight is normal, this biometric measurement may also be used to diagnose FGR.
Abdominal Circumference (<10%)
Which two drug classes were recommended as first line treatments for chronic neuropathic pain in this month’s POEMS section?
SNRIs (both duloxetine and venlafaxine were found to have similar benefit) and anticonvulsants (specifically pregabalin and gabapentin)
Here are some numbers needed to treat and harm
Anticonvulsants: NNT = 7; NNH = 17-22
SNRI: NNT = 7; NNH = 13
Rubefacients: NNT = 7; NNH = 25
Opioids: NNT = 8; NNH = 12
According to the Cochrane article, which treatment for basal cell carcinoma has the lowest recurrence rate?
Surgical excision / Mohs
All rates reported are recurrence rates
Surgerical excision (including Mohs): 5.2% at 5 years
Imiquimod: 17.5% a 5 years, may have a more favorable cosmetic outcome
Photodynamic therapy: 36.4% at 3 years
Radiation: 6.4% at 4 years
Note cryotherapy is not listed!!
T/F: patients with silicone breast implants should be screened for implant rupture with breast MRI.
True! (US is alternate modality)
recommend starting at 5-6 yrs postop, and screening q2-3yrs.
When using medications to treat acute changes in mental status, use the ___ effective dose for the _____ amount of time necessary.
Lowest, least/minimum
Describe the therapeutic breathing maneuver / vocal cord relaxation technique outlined in the article (it was in the video provided.)
During an attack, instead of taking a deep breath through the mouth, instead exhale through pursed lips. Then, take two small inhalations through the nose, and again exhale through pursed lips. Repeat until the attack has passed.
The article recommends optimizing this before initiating bisphosphonate therapy.
Oral health. There is an increased risk of osteonecrosis of the jaw in patients undergoing dental procedures while on bisphosphonates that’s higher than the risk of osteonecrosis of the jaw in patients on bisphosphonates who are not undergoing dental procedures.
treating this common primary care condition in ESRD patients improves mortality.
Hypertension
This medication has been shown to reduce the incidence of fetal growth restriction, when given to a certain subset of patients.
Aspirin - when given to women at high risk of developing preE. It does not reduce FGR if there is no indication for preE prophylaxis
With a trade off of increased bleeding, this POEM found that administering dual antiplatelet therapy within this time frame after a mild to moderate stroke or TIA was more effective than ASA alone at decreasing recurrent stroke over the next 90 days.
Within 24 hours of the event; NNT = 53; NNH = 256 for major bleeding
In pateints 12 years and older with inadequate asthma control with ICS/LABA the addition of a long-acting _____ agent is recommended
Muscarinic (i.e. montelukast)
False. Mammography is still indicated! Do not change frequency of mammography or when to initiate, but additional radiographic views are recommended, as breast tissue is often obscured by implants, decreasing sensitivity.
Many measures were presented in table 6 of the article for the prevention of delirium. Name 4.
Adequate hydration
adequate nutrition
adequate oxygenation
avoid constipation
avoid tethering (IV lines, monitors, Foley)
provide cognitively stimulating activities
early mobilization
ensure patient has assistive devices such as glasses hearing aids, mobilitiy aids
infection prevention
limit psychoactive meds
pain management
presence of family and caretakers
orientation (accurate calendars and clocks, and appropriate lighting; reorientation by staff and family)
sleep enhancement (avoid nighttime disturbances, use appropriate lighting, reduce noise at night)
Once diagnosed with vocal cord dysfunction, referral to this medical professional is considered first line therapy.
Speech. They’ll get therapeutic breathing maneuvers, vocal cord relaxation techniques, and speech therapy.
According to the article, the use of this intervention does not affect the incidence of prosthetic knee or hip infections
Periprocedural abx ppx
Name 3 out of the 5 labs cited by the article that should be obtained at least yearly in patients with ESRD. (other than GFR /basic metabolic panel/electrolytes)
-Ca (q3mo)
-Phos (q3mo)
-PTH (q3-6mo)
-Vit D
-Alk Phos (q12mo)
How frequently are umbilical artery dopplers typically recommended in FGR pregnancies?
q1-2wks.
According to this month's journal, which two drug classes are superior for treatment of episodic migraine in adults?
NSAIDs and triptans
According to the GINA guidelines, when treating intermittent asthma in children 6 to 11 years of age these two medications are recommended to be used together PRN.
ICS and SABA
***For adults the recommendation is PRN ICS/formoterol
Breast implant associated anaplastic large cell lymphoma (ALCL) is mainly associated with which type of breast implant?
Textured implants.