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57 Cards in this Set

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=== ANORECTAL ===

=== ANORECTAL ===

Anorectal Abscess,management?

Surgical drainage


- Abx if DM, immunocomp, cellulitis

=== MENTAL HEALTH ===

=== MENTAL HEALTH ===

=== MENTAL HEALTH ===

Major depressive episode

5+ SIGECAPS for 2 weeks incl depressed mood

Minor (subsyndromal) depression is characterized by

2-4 SIGECAPS x 2 weeks

dysthymia?

Minor depression sx x 2 years

When to treat grieving patient?

ifbereaved person meets the criteria for major depression 2 months after the loss

psychiatric referral indicated for depression when:

(1) suicidal or homicidal ideation,


(2) bipolar disorder,


(3) psychotic symptoms, or


(4) symptoms refractory to at least two medications.

treatment of depression, the best outcomes are achieved with

combination of medication and psychotherapy

these anti-depressivesmay be especially helpful in patients with concomitant pain syndromes

SNRI

only nonoral antidepressant available

transdermal preparation of selegiline

the most effective nonpharmacologic intervention for generalized anxiety

CBT (equal efficacy for pharmacology)

generalized anxiety disorder

excessive anxiety and worry about various events or activities on most days for at least 6 months, with difficulty controlling worrying

pharamacotherapy for GAD / panic disorder?

-SSRIs and SNRIs


- Buspirone (slow to work)


- Benzo => risk of dependence, avoid if hx of subs abuse

PTSD is characterized by

at least 1 month of symptoms that include intrusive thoughts about the trauma, nightmares or flashbacks, avoidance of reminders of the event, and hypervigilance with sleep disturbance

PTSD tx?

CBT


SSRI / TCA


Prazosin for nightmares


avoid Benzo

Social anxiety d/o tx

Psychotherapy


SSRI / MAOI

OCD tx?

1st line: CBT


also SSRI or clomipramine (a TCA)

Intermittent explosive disorder?

repeated episodes of aggressive violent behaviors grossly out of proportion to the situation. Examples include road rage, severe temper tantrums, and domestic abuse


- after: remorse / embarrassment

Intermittent explosive disorder, tx?

CBT and pharmacotherapy.


- Mood stabilizers and anticonvulsant agents (carbamazepine, phenytoin, and lithium)


- SSRI if depressed

tx for acute manic episodes,

- either lithium or valproate + atypical antipsychotic agent such as olanzapine, quetiapine or aripiprazole


- avoid SSRI

conversion disorder

single pseudoneurologic symptom that is not explained by a medical evaluation and often follows lay understanding of neurology (for example, hemiparesis that does not follow crossed corticospinal tracts

hypochondriasis
patients misinterpret normal bodily sensations and are afraid these symptoms are manifestations of serious illness

malingering vs factitous d/o

Patients with malingering do this for external gain (such as avoidance of work), whereas those with a factitious disorder do so in order to remain in the sick role.

somatoform d/o tx?

- CBT


- primary care visits should focus on the evaluation of new or changed symptoms and functioning with somatic symptoms rather than elimination of symptoms.

bulimia tx?

1st line: CBT


- Fluoxetine or sertraline


- Topiramate has been shown to reduce binge eating and promote weight loss

Length of time for schizo dx?

Diagnosis is based on the presence of signs and symptoms for at least 1 month in duration, with some manifestations of the disease present for at least 6 months

ADHD tx in adults?

- usually shows gradual improvement with age


- verify the ongoing need for medication with periodic “drug holidays” in well controlled patients


- Atomoxetine : SNRI

anorexia, tx

CBT


Avoid TCA / Bupropion


Antidepressants alone don't cause weight gain



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=== GERIATRIC ===

=== GERIATRIC ===

=== GERIATRIC ===

timed “Up & Go” (TUG) test?
– rise from a chair, walk 10 feet, turn around, walk back, and sit down again


– usu < 10 s. If > 14s then incr risk for falls.
The Institute of Medicine recommends a vitamin D intake of
600 units/d for all men and women aged 51 to 70 years old and 800 units/d for men and women older than 70 years.
MMSE scores for dementia?
– 24 to 25 out of 30 => mild impairment–19 to 24 => mild dementia,
– 10 to 19 suggest moderate dementia
Depression tx in elderly?
– r/o medical cause
– tx improves mortality
– SSRI ok (AE = SIADH, GI bleed)
– stimulants if apathetic
– mirtazapine if not eating
– ECT if refractory
The most common cause of hearing loss
presbycusis, or age–related hearing loss. – results in high–frequency hearing loss, which typically impairs sound localization and hearing the spoken voice (particularly in noisy environments).
whispered voice test?
(examiner stands 2 feet behind a seated patient and assesses the ability of the patient to repeat a whispered combination of numbers and letters)– as good as audiometry
The most common causes of visual impairment in older persons
refractive errors, cataracts, and age–related macular degeneration (AMD)
The American Academy of Ophthalmology recommends comprehensive eye examinations
every 1 to 2 years for persons 65 years or older who have no risk factors
Urinary incontinence is categorized as
(1) urge incontinence (loss of urine accompanied by sense of urgency; caused by detrusor overreactivity); (2) stress incontinence (loss of urine with effort, coughing, or sneezing; caused by sphincter incompetence);
(3) mixed urge and stress incontinence; and (4) overflow incontinence (caused by outlet obstruction).
Functional incontinence
not getting to the toilet quickly enough
the two most effective behavioral therapies for incontinence
– Pelvic floor muscle training (PFMT, or Kegel exercises) – bladder training/urge suppression techniques
considered first–line therapy for patients with stress incontinence and is of likely benefit in patients with mixed urge and stress incontinence.
pelvic floor muscle traiing
effective in elderly nursing home residents with functional incontinence.
Prompted voiding (periodically asking the patient about incontinence, reminding and assisting the patient to go to the toilet, and providing positive reinforcement for continence)
In patients with stress incontinence for whom PFMT has not been successful, what is another option
duloxetine a serotonin and norepinephrine reuptake inhibitor
first line therapy for urge incontinence
anticholinergic antimuscarinic medications are first–line therapy. Options include oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin, and trospium.
Medications that have been found to be ineffective for incontinence
pseudoephedrine (an α–agonist), oral estrogens (may worsen incontinence), and transdermal and vaginal estrogens
Stage I ulcers treatment
can generally be treated with transparent films and do not require debriding
Stage II ulcers treatment
occlusive dressing to keep the area moist. Wet–to–dry dressings should be avoided because debridement is usually unnecessary at this stage.
Stage III and IV ulcers treatment
generally require surgical or nonsurgical debridement, treatment of wound infection, and appropriate dressings based on the wound environment
For nonhealing wounds that are stage III or higher
imaging to rule out underlying osteomyelitis is indicated

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