Mental health
Many treatments similar – SSRI’s, CBT
Cage assessment – alcohol abuse, 4 questions for it
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Have you felt the need to Cut down on your drinking?
Do you feel Annoyed by people complaining about your drinking?
Do you ever feel Guilty about your drinking?
Do you ever drink an Eye-opener in the morning to relive the shakes?
SIGECAPS – depression
Major depression 4 or more
2-3 sigecaps for dysthymia
sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide
side effects of SSRI’s – sexual dysfunction, weight gain, sedation, qtc prolongation, drug to drug
interactions, N/V/D
only FDA approved treatment of bulimia is fluoxetine
Hematology
What is Virchow’s triad? 3 contributing factors in the formation of thrombosis
Venous thromboembolism
3 components of triad
Venous stasis – stasis of blood flow
Hyper coagulopathy
Endothelial injury
Folic acid – neural tube defects – recommended to start at least 3 months before conception
First step in approaching anemia?
Check CBC and identify low H&H
Step two evaluate MCV – microcytic vs macrocytic vs normocytic
H&H ratio 1:3
Msk
A lot of treatments similar – RICe – conservative therapy
Phalen test – carpal tunnel
Positive if parasthesias
Finkelstein maneuver – de quiervain’s tenosynovitis – radial
red flag symptoms for cauda equina syndrome
non pharm options for management of osteoarthritis
weight loss
PT
Low impact exercise or strengthening
Assistive devices – braces, splints, walking aids
x-ray findings of osteoarthritis
Transgender, eating disorders
Diagnostic criteria for bulimia nervosa
Two weight compensatory methods for weigh control – laxatives and purging
Tend to be average weight
---------Anorexia – below weight
Hormone for masculinizaing medical therapy and effects
Cisgender – individual whose gender identity correlates with gender assigned at birth
Terminology is very important
Ask how to address – ask pronouns
Geriatrics
Medicare parts A, B, D cover what?
A hospitalization – acute care
B medical coverage – getting “better” – outpatient medical
C – option for private insurance
D drugs
-----3 steps for the mini cog test
Step 1 – three word registration
Step 2 – Clock drawing – time of 11:10
Step 3 – Three word recall
--------Three causes of delirium –
Hospitalization stays, infection, medications –
First line treatment – non pharmacology – uninterrupted sleep
Second line treatment – anti psychotic – Seroquel
Age ranges for the old
Old – over 75
Old-old – over 85
Centarian – over 100
Avoid nsaids – kidney
Tylenol good – 3 gm max, 2gm if liver involvement
Rotator cuff abduction – supraspinatus
Symptoms not consistent of fibromyalgia –
5 year history of chronic knee history – joint space narrowing – osteoarthritis
DSM V criteria – not anorexia diagnostics
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Muscle wasting
Plantar fasciitis – arch support
Transwoman – gender affirming surgery – recommended screening – digital rectal exam – apparently
Probably should be breast screening – hormones increase chance of breast cancer
Tendinitis – over use, reduced ROM, acute pain pressure on tendon
Not resuilt of macroscopic tear
Pain at thumb base –
Trigger finger – injections