SNOT
What are the cardinal features of acute BACTERIAL rhinosinusitis
Cardinal features of acute bacterial rhinosinusitis are unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages.
Pain with movement of the eye is concerning for _______. Eye pain at rest is concerning for ________.
Movement = optic neuritis
Rest = Acute angle closure glaucoma, uveitis, endophthalmitis
Which of the following is a first-line conservative treatment for gastroesophageal reflux disease (GERD) in infants who are formula-fed?
A. Acid suppression therapy
B. Thickening agents in formula
C. Maternal elimination of dairy in breastfed infants
D. Proton pump inhibitors
Thickening agents in formula are a first-line conservative treatment for GERD in formula-fed infants.
Which one of the following statements about the use of psychosocial interventions to prevent alcohol use during pregnancy is correct?
A. They reduce the number of drinks consumed per day.
B. They prolong retention in treatment programs.
C. They may increase the rate of sustained alcohol cessation during pregnancy.
D. All of the above
C. They may increase the rate of sustained alcohol cessation during pregnancy.
USPSTF recommends screening for alcohol use in pregnancy
A 65-year-old patient with degenerative joint disease of the hip complains of persistent pain despite physical therapy. You are considering an intra-articular injection. Based on recent evidence, which of the following is the most effective treatment for short-term pain relief?
A. Hyaluronic acid
B. Platelet-rich plasma
C. Steroid injection
D. Anesthetic injection
C. Steroid Injection
meta-analysis found that steroid injections were the only treatment to significantly improve pain after 3 months compared to placebo. However, no injection provided sustained long-term pain relief beyond 6 months.
When do we consider antibiotics for acute rhinosinusitis?
Antibiotics should be considered for patients with 3 or more days of severe symptoms, significant worsening after 3 to 5 days of symptoms, or 7 or more days of symptoms
A 70-year-old patient with a history of temporal arteritis presents with sudden vision loss in one eye. The patient has scalp tenderness, jaw claudication, and muscle aches. What is the most important immediate treatment for this condition?
The most important immediate treatment is the initiation of high-dose corticosteroids (empiric steroids) to prevent further vision loss in the unaffected eye and reduce inflammation.
Empiric steroids (intravenous methylprednisolone pulse therapy, 15 mg/kg per day for 3 days, followed by oral prednisone, 1 mg/kg or more per day) should be initiated immediately to prevent vision loss in the other eye while waiting for temporal artery biopsy.
A 4-month-old infant with persistent vomiting, poor weight gain, and feeding difficulties is suspected to have gastroesophageal reflux disease (GERD). What diagnostic test is most appropriate if alarm symptoms are present, such as bilious vomiting or hematemesis?
Endoscopy or a barium study would be appropriate in the presence of alarm symptoms. These tests help evaluate for complications like esophageal stricture or reflux esophagitis.
What are the major cardiovascular benefits of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in different patient populations?
The benefits (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) were more pronounced in patients with diabetes and chronic kidney disease, while heart failure patients did not show significant results.
This antibiotic is considered first-line treatment for acute bacterial rhinosinusitis in patients without a beta-lactam allergy.
Amoxicillin
A 65-year-old patient presents with sudden, painless loss of vision in one eye. Fundoscopic examination reveals a pale retina with a cherry-red spot at the macula. What is the most likely diagnosis, and what immediate intervention is recommended?
The likely diagnosis is retinal artery occlusion. Immediate intervention to reduce intraocular pressure with medications such as acetazolamide or hyperbaric oxygen therapy may be considered to prevent further vision loss.
A 3-month-old infant presents with frequent spitting up, irritability, and arching of the back. The symptoms are most prominent after feeding. What is the most likely diagnosis, and how should it be managed?
The likely diagnosis is physiologic gastroesophageal reflux (GER). Management involves reassuring the parents that it is self-limited and does not typically require pharmacologic treatment. Conservative measures like positioning changes or thickened feeding may help
Diabetic kidney disease, or diabetic nephropathy, is defined by...
the presence of persistent albuminuria (less than 300 mg/day) on two separate occasions at least 3 months apart in patients with type 1 or 2 diabetes, with or without a reduced estimated glomerular filtration rate.
List 4 clinical findings that favor a diagnosis of bacterial sinusitis
CRP >15, Maxillary tooth pain, purulent nasal discharge, unilateral tender maxillary sinus, preceeding URI, history of rhinosinusitis
These rare but serious complications of rhinosinusitis may require computed tomography and referral to an otolaryngologist.
Orbital cellulitis, meningitis, abscess, Cavernous sinus thrombosis.
MC- preseptal cellulitis
A patient presents with sudden vision loss, accompanied by ocular pain, headache, and nausea. On examination, the intraocular pressure is found to be elevated. What is the most likely cause of this patient's symptoms, and what is the first-line treatment?
The most likely diagnosis is acute angle-closure glaucoma. First-line treatment includes lowering the intraocular pressure using medications like pilocarpine eye drops, acetazolamide, and mannitol.
A 10-month-old infant is brought to the clinic by his parents due to frequent episodes of regurgitation and irritability, especially after feeding. He was born at 39 weeks’ gestation and has no significant medical history. His parents report that he is exclusively fed breast milk. Both parents have a history of gastroesophageal reflux disease (GERD), and the mother has a history of mild, intermittent asthma. Which one of the following is a risk factor for developing GERD in this infant?
A. Prematurity
B. Exclusively feeding with breast milk
C. Parental History of GERD
D. Asthma in mother
C. Parental History of GERD
Although a personal history of prematurity and asthma are factors that may contribute to an increased risk of GERD, this infant was born at term and his mother has been diagnosed with asthma. Exclusively feeding with breast milk is considered protective against GERD. In this infant’s case, parental history of GERD is his most significant risk factor for developing GERD.
Which antibiotic classes should be avoided in treatment of bacterial rhinosinusitis and why?
Macrolides and TMP-SMX due to high resistance from H flu and S pneumo
This class of antibiotics is recommended for patients with a beta-lactam allergy who have acute bacterial rhinosinusitis.
Doxycycline or Respiratory fluoroquinolone
List the 5 common causes of sudden vision loss discussed in the article and their differentiating factors
Acute angle-closure glaucoma presents with ocular pain, nausea, and headache. Treatment involves lowering intraocular pressure.
Retinal detachment causes a curtain-like visual field defect and usually requires surgical intervention.
Retinal artery occlusion leads to painless vision loss, often in patients with vascular risk factors, with management focused on preventing further loss in the other eye.
Giant cell arteritis should be suspected in patients over 50 with symptoms like scalp tenderness and jaw claudication. Immediate steroids are necessary to prevent further vision loss.
Optic neuritis, associated with multiple sclerosis, presents with pain during eye movement and color desaturation. Treatment includes high-dose steroids.
A 6-month-old infant is brought to the clinic due to episodes of inconsolable crying and feeding refusal that have worsened over the past month. Her parents also report that she has experienced occasional coughing and choking during feeding. The infant has had multiple episodes of otitis media over the past few months. Physical examination is unremarkable, but the parents are concerned about the persistent symptoms. Because her reported signs and symptoms indicate that she has likely progressed from gastroesophageal reflux to GERD, which one of the following complications is this infant at risk of developing?
A. Esophageal Stricture
B. Pyloric Stenosis
C. Malrotation
D. Intestinal Atresia
A. Esophageal Stricture
GERD can lead to several complications, including esophagitis and esophageal stricture, which are caused by chronic inflammation and scarring of the esophagus. The infant’s symptoms of feeding refusal and coughing during feeding and history of recurrent otitis media suggest the possibility of GERD, which places her at risk for these complications.
A patient with diabetic nephropathy is treated with an angiotensin receptor blocker (ARB). What is the primary effect of ARB therapy in this patient, according to the evidence?
A. It reduces all-cause mortality.
B. It reduces cardiovascular mortality.
C. It prevents progression to end-stage kidney disease.
D. It improves glycemic control.
C. It prevents progression to ESRD
While ACE inhibitors and ARBs are effective in preventing the progression of diabetic kidney disease to end-stage renal disease, they do not significantly reduce all-cause or cardiovascular mortality.
Your patient with type 2 diabetes has had microalbuminuria (albumin level 30-300 mg per day) on two separate occasions at least 3 months apart. Which one of the following statements regarding the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in patients with diabetic nephropathy is correct?
A. They reduce progression to end-stage kidney disease.
B. They reduce all-cause mortality.
C. They reduce cardiovascular mortality.
D. All of the above
A. They reduce progression to ESRD
ARB therapy prevented doubling of serum creatinine over the course of 3 years and progression from microalbuminuria to macroalbuminuria over the course of 2 years, whereas ACE inhibitor therapy prevented progression from microalbuminuria to macroalbuminuria. Results suggest that they may contribute to regression of microalbuminuria. There was insufficient evidence to determine the comparative superiority of ACE inhibitor or ARB therapy on kidney outcomes,