Purulent Bones
This is the most sensitive and specific imaging modality to evaluate osteomyelitis
MRI with contrast
Ladies with a singleton pregnancy: don't fly past this gestational age.
Ladies with a singleton pregnancy: don't fly past this gestational age.
Name the first line treatment (drug and duration) for onychomycosis
Terbinafine x 12 wks (250mg daily)
A healthy 40 yo M with no significant PMH comes to you before he plans a medical mission trip to Haiti. He is worried about the risk of Hep A there and doesn't think he has been vaccinated. What is your recommended pre-exposure prophylaxis?
one dose of the hep A vaccine before travel (recommend 2nd dose upon return for lifelong immunity)
This is the deliberate release of viruses, bacteria, toxins, or fungi with the goal fo causing panic, mass casualties, or severe economic disruption.
What is bioterrorism?
At 7 and 12 months, maintenance therapy with ____ in patients with schizophrenia is associated with relapse prevention w/ a NNT of 3.
antipsychotic medications
Hospitalizations less likely, NNT 8
movement disorders, NNH 20
weight gain, NNH 25
According to the article, approximately ____ % of patients with neuropathy are asymptomatic.
50
Was there any difference in cognitive decline between older adults with CAD whom underwent revascularization with CABG vs PCI?
nope
This is the most frequent organism isolated from osteomyelitis.
Methicillin sensitive staph aureus (MSSA). (pseudomonas and MRSA are #2 and #3)
This should be prescribed for pregnant or obese patients to prevent DVTs on a plane
compression stockings.
This italian herb has demonstrated antifungal activity in small studies
oregano.
Also cited by the article: tea tree oil, vitamin E, oil of bitter orange, vinegar sock soaks (yuck), and Vicks Vaporub. Very small scale studies.
What is the recommended vaccine regimen for pediatric patients for Hep A? (how many doses, when to give)
-2 doses
-0 and 6 to 12 months.
Name 3 of at least 5 universal precautions that are taken for infection control when interacting with patients whom are infected or exposed to biological agents.
1. hand hygeine
2. gown
3. gloves
4. eye protection
5. make (+/- N95 depending on whether airborne transmission is possible)
6. for both droplet and airborne transmission, private rooms or rooms in which others w/ same infection. For airborne patient's they should be placed in negative pressure rooms.
This appears to be mildly helpful in treating depression in older adults without seasonal depressive disorder.
light therapy
ideal wavelength, intensity, and length of treatment are unknown, but general recommendation is to treat w/ light for <60 m/d
Given a grade B rating, the initial testing of patients with diabetes mellitus and suspected osteomyelitis should receive these 3 tests (name them all).
1. plain radiography
2. CRP
3. probe-to-bone testing
Does screening for ovarian cancer using an algorithm that customized interpretation and follow-up of cancer antigen 125 (CA 125) testing reduce ovarian cancer mortalitiy in average-risk women?
nope
This is the recommended duration of antibiotic therapy for osteomyelitis.
4 to 6 weeks.
These recommendations should be given to all travelers to prevent DVTs on flights of 5 hours or longer. (name 3 out of 4)
-stay hydrated
-avoid ETOH
-walk 10-15 min for every 2 hours of flight
-perform isometric exercises when seated.
Name 2 out of the 5 medication classes cited by the article which may interact with Terbinafine
TCAs
SSRIs
Beta blockers
atypical antipsychotics
tamoxifen
Remember, terbinafine is a CYP2D6 inhibitor and may affect metabolism of other drug classes as well.
This is the preferred diagnostic test for acute Hep A
Anti-Hep A IgM
T/F
Isolation is recommended for patients presenting with pleuropneumonia from Tularemia infection.
False, person-to-person transmission does not occur.
When deciding on treatment setting for patient's diagnosed with VTE, outcomes are generally considered to be better when treating a stable patient in this setting compared to this other setting.
Better at home compared to hospital.
Treatment at home reduces liklihood of PE formation. Risk of subsequent DVT is less (NNT 29). Mortality and bleeding rates are similar between the two settings. For pt's w/ clinically stable PE, home vs hospital treatment produces similar outcomes.
Given an evidence rating of B, antibiotic coverage for MRSA may be discontinued in a patient with a diabetes-related foot infection after a negative MRSA _____ culture.
nares
very high negative predictive value
Is high dose Augmentin any better at treating acute sinusitis than standard-dose Augmentin in adults?
no difference
both doses are minimally superior to placebo
Interesting note: some patient's who get "sinus infections" may actually have a variant of migraine and a trial of a migraine abortive med may be the ticket.
See Curbsiders episode:
#215 Medical Myths: Challenge Dogma with Dr. Douglas Paauw
T/F: Oral antibiotics have similar cure rates for osteomyelitis compared to IV antibiotics.
TRUE!!!
Also, lower risks / costs.
Consider transitioning to oral antibiotics on discharge for your osteomyelitis patients.
Ladies with a multiple gestation pregnancy: don't fly past this gestational age.
32 wks.
T/F: Newer topical medications have similar efficacy to oral terbinafine for treatment of onychomycosis
FALSE. nope, not even close. (5 to 20% efficacy compared to 75% efficacy)
T/F: Supportive care is the mainstay of treatment for Hep A.
True
These are the most concerning agents to national security and public health according to the article (name 3, there are 6).
1. anthrax
2. smallpox
3. plague
4. tularemia
5. botulism
6. viral hemorrhagic fevers
(descending order of liklihood)
These are not recommended to be used together with anticoagulation because they do not reduce PE or mortality and commonly cause adverse effects in pt's w/ DVT.
inferior vena cava filters
According to the International Working Group on the Diabetic Foot Classification System for Defining the Presence and Severity of an Infection of the Foot in a Patient with Diabetes, a grade of "4", the highest severity grade, is applied when the patient presents with a diabetic foot infection and associated _____.
Systemic manifestations, i.e. SIRS.
>=2 of the following:
1. Temp >38 or <36
2. HR > 90
3. RR >20 or PaCO2 of <32mmHg
4. WBC >12k or <4k or >10% bands
Implication is that high graded infections deem broader empiric coverage.
In patient's already on a GLP-1 receptor agonist for DM2, adding on an SGLT-2 inhibitor compared to a sulfonylurea will reduce the patient's risk for hospitalization for ___ and ____, and will also reduce the patient's _______. (name 2 of the 3)
1. MI
2. heart failure
3. all cause mortalitiy
this is the gold standard for diagnosis of osteomyelitis (but may not always be necessary).
positive bacterial culture from bone biopsy.
Name BOTH of the two criteria cited by the article, which should prevent a patient with pulmonary disease from flying
Pt with pulmonary disease who:
-cannot walk 50 m,
OR:
-O2 requirement >4L
It is important to counsel your patients that it may take up to this long for your toenails to grow out and clear after a course of terbinafine.
18 months!
HIV
Chronic liver disease
Alcoholic liver disease
Autoimmune hepatitis
cirrhosis
fatty liver disease
https://www.aafp.org/afp/2021/1000/hi-res/afp20211000p368-t1.gif
This is the only FDA approved inpatient treatment for smallpox infection.
Tecovirimat (TPOXX)
Dosing (not needed for credit)
600mg PO BID for 14d
7.5% or greater
Calculate at: https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/
Give 2 of the 8 "Proper Foot Care Education" counseling topics provided in the article.
1. Apply moisturizers after bathing to prevent blisters, cracks, and calluses, although avoid applying moisturizers between the toes.
2. Avoid walking barefoot even when indoors.
3. Check daily for foot pain, redness, abrasions, or infections of the plantar foot and between toes (may require use of a mirror or caregiver).
4. Contact a primary care physician or podiatrist if finding a foot abnormality.
5. Debride calluses to improve foot sensation and prevent ulcer formations under a callus.
6. Trim nails straight across, then smooth with a nail file (avoid cutting into the corners of toes).
7. Wash feet regularly and dry feet after a bath or exercise.
8. Wear comfortable shoes and check the inside of shoes before use.
FPIN Help Desk Answer article.
Does community vision screening in patients 65 years and older reduce teh prevalence of visual impairment?
No.
Strength of recommendation: A, based on systematic review of RCTs
Excluded patients: those too ill for screening and those living in a long-term residential care facility