Choosing Wisely
COVID Updates
To Image or Not to Image
Speciality Delight
100
Inductions of labor should not be scheduled before __ weeks unless medically indicated?
39 weeks
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks and 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.
• American Academy of Family Physicians
• American College of Obstetricians and Gynecologists
• California Department of Public Health
100
Is COVID Still around?
Yup! Although some would argue otherwise.
100
Back pain after car accident without neuro symptoms?
No imaging
Imaging of the lumbar spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits.
100
This program, which provides vouchers for food, requires participants to certify every 1 year or when there is a status change (e.g., moving from Pregnant to Breastfeeding).
WIC!
200
When should you screen for vitamin D deficiency?
Never for the general population!!!!!
Why? We dont know if
- 25OHD is appropriate for all races.
- What the actual normal level is
- that it improves outcomes
Laboratory testing is appropriate in higher risk patients when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections, obese individuals).
200
Where within Unity can you get a covid vaccine and what kind?
UC, Brentwood, EOR, PS, MAHC, ANA - Moderna hours vary. Walk up or Appt or during office visit
SBHC - Pfizer. Tuesdays (Cardozo HS), Wednesdays (Woodson)
HealthCare for the Homelss - Moderna and J&J
200
Screening for osteoporosis in a man under 70 with no risk factors.
No imaging
Don’t use dual energy x-ray absorptiometry (DEXA) to screen for osteoporosis in women younger than 65 years or in men younger than 70 years with no risk factors. note: Risk factors include, but are not limited to, fractures after 50 years of age, prolonged exposure to corticosteroids, diet deficient in calcium or vitamin D, cigarette smoking, alcoholism, and thin/small build.
200
Ouch! Heel pain when you get up in the morning and step on the floor. Arch pain when you walk
during the day.
Plantar fasciitis
300
What class of medication should be avoided in individuals with hypertension or heart failure or chronic kidney disease of all causes, including diabetes?
NSAIDs
The use of NSAIDs, including cyclooxygenase type 2 inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate blood pressure, make antihypertensive drugs less effective, cause fluid retention, and worsen kidney function in these individuals. Other agents such as acetaminophen or tramadol, or short-term use of narcotic analgesics, may be safer than and as effective as NSAIDs.
American Society of Nephrology
• National Kidney Foundation Kidney Disease Outcomes Quality Initiative
300
According to the CDC what are some things you can do if you are fully vaccinated?
Fully vaccinated people can:
- Resume activities without wearing masks or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance
- Resume domestic travel and refrain from testing before or after travel or self-quarantine after travel
- Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States
- Refrain from testing following a known exposure, if asymptomatic, with some exceptions for specific settings
- Refrain from quarantine following a known exposure if asymptomatic
- Refrain from routine screening testing if feasible
300
How often should you order follow up echos for trace valvular regurg?
You shouldn't!
Trace mitral, tricuspid, and pulmonic regurgitation can be detected in 70% to 90% of normal individuals and has no adverse clinical implications. The clinical significance of a small amount of aortic regurgitation with an otherwise normal echocardiographic study is unknown.
American Society of Echocardiography
• ACC/AHA guidelines
300
What GLP-1 Receptor Agonist is preferred on FFS Medicaid and all MCOs?
Trulicity!
400
What medical tests are indicated before eye surgery?
None unless
EKG - heart disease
CMP - if on diuretics or has diabetes
For many, preoperative tests are not necessary and add costs because eye surgeries are not lengthy and don’t pose serious risks. An electrocardiogram should be ordered if patients have heart disease. A blood glucose test should be ordered if patients have diabetes. A potassium test should be ordered if patients are on diuretics. In general, patients scheduled for surgery do not need medical tests unless the history or physical examination indicates the need for a test (e.g., like the existence of conditions noted above, heart disease, diabetes, use of diuretics, etc.). Institutional policies should consider these issues.
• American Academy of Ophthalmology
• Cochrane Database of Systematic Reviews
400
What rare side effects are there from each type of the COVID vaccine and what age group does it affect?
Adenovector - J&J - rare blood clots in the brain - affects women aged high 18-48
mRNA - Pfizer - myo/peri-cardiitis - mostly younger boys/young adults
People with dermal fillers could have associated facial swelling with Pfizer
**Make sure patients are signed up for v-safe to report any potential side effects of getting the vaccine**
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html
400
Ultrasound for patient with Wells Score 1
No!
In patients with low pretest probability of venous thromboembolism as defined by the Wells prediction rules, a negative high-sensitivity D-dimer measurement effectively excludes venous thromboembolism and the need for further imaging studies.
400
What is the treatment for this rash? 
Valacyclovir 1gm PO TID X 7 days as soon as possible (within 72 hrs of outbreak)
500
What age should children have their first dental appointment?
the first dental visit should occur within 6 months of the first baby tooth erupting but not later than 1 year of age.