Moslem Doctor
Forum Senior
Topics: 39
Posts: 157
|
kaplan:Anorexia nervosa cognitive behavior therapy then hospitalization: UW : hospitalization immediate
osgood-schlatter Uw : cast and limit excercise
kaplan: no need to limit or cast , let him excersise and if pain after exercise so put ice and rest
in kaplan , u can start screening for lipid at 20 age according to another protocol and also mention the task force recommendation for screen at 35 men, 45 women
in kaplan u screen for ovarian cancer in post menepause women and high risk women by Transvaginal ultrasound and c 129
kaplan
(( ovarian cancer screening ))
: -Should be done in postmenopausal women And those with hight risk (dermatomyositis, brca 1,Family history,hnpcc )
-include CA-125 followed by transvaginal US if CA-125 >35
UW: no screen for ovarian cancer
in kaplan : pneumo vaccine not waranted to COPD ptns unless FEV less than 40
UW: didnt put cut off value
kaplan pneumococal vaccine for DM , heart , and Other chronic lung disease EXcept (asthma ) so still there is confilict becuz UW didnt put this exception and said any chronic lung disease
in kaplan : there is screening for DM after 45 age for obese and in obese with risk factors before 45 . UW: no
in kaplan : low tidal volume is best for ARDS and better than peep , while UW  eep is of choice
in UW , dout for meninigitis give treatment now before LP
in kaplan it depends : patient dont need CT scan (no focal , no paplledema , no altered concious level ) so do LP then give TT , IF need CT so give ttt first
u also share and discuss
___________________
Say ye: "We believe in Allah, and the revelation given to us, and to Abraham, Isma'il, Isaac, Jacob, and the Tribes, and that given to Moses and Jesus, and that given to (all) prophets from their Lord: We make no difference between one and another of them: And we bow to Allah (in Islam)." Holy Quran
|
| usmletopper2
Forum Senior
Topics: 25
Posts: 117
|
seniors need help here
___________________
99/99/no us exp/need visa/not yet certified,yet to take cs in oct/3 Ivs ,5 Rjs
|
| peter90036
Forum Elite
Topics: 28
Posts: 315
|
anorexia: ....
osgood shlatter .....
lipid screen: GUIDELINES
routine screen: men >35 years ,women >45years for lipid disorders
men 20-35 years and women 20-45 years with these factors:
* Diabetes.
* A family history of cardiovascular disease before age 50 years in male relatives or age 60 years in female relatives.
* A family history suggestive of familial hyper-lipidemia.
* Multiple coronary heart disease risk factors (e.g., tobacco use, hypertension).
Lipid risk factors: age, gender, diabetes, elevated blood pressure, family history (in younger adults), smoking.
Screen for lipids every 5 years. # The optimal interval for screening is uncertain- reasonable options include every 5 years, shorter for people with lipids at the limit, and longer intervals for low-risk people who’ve had low or repeatedly normal lipid levels. # An age to stop screening is not established. Screening may be appropriate in older people who have never been screened, but repeated
screening is less important in older people because lipid levels are unlikely to increase after age 65 years.
ovarian cancer screen: GUIDELINES: recommends against routine screening for ovarian cancer (low prevalence of ov C, ca125 or T-V u/s, smalleffect on mortality)
pneumo vaccine: asthma does not count as chronic lung (its in the FDA vaccine GUIDELINES, we talked about it here too in past threads)(its actually not parenchimal if i think about it, i think)
screen for diabetes: CONTROVERSY = CRAP 
i just looked this up on UpToDate... also similar to Wash U PDF:
However, it has not been firmly established that early detection of type 2 diabetes and intervention improve long-term outcome.
The ADA recommends testing for diabetes or prediabetes in all adults with BMI ≥25 kg/m2 and one or more additional risk factors for diabetes. In individuals without risk factors, testing should begin at age 45 years [14,20] . Either fasting plasma glucose or 2-h OGTT is appropriate for testing.
Diabetes risk factors include the following:
* Age ≥45 years
* Overweight (body mass index ≥25 kg/m2)
* Family history diabetes mellitus in a first-degree relative
* Habitual physical inactivity
* Belonging to a high-risk ethnic or racial group (eg, African-American, Hispanic, Native American, Asian-American, and Pacific Islanders)
* History of delivering a baby weighing >4.1 kg (9 lb) or of gestational diabetes mellitus
* Hypertension (blood pressure ≥140/90 mmHg)
* Dyslipidemia defined as a serum high-density lipoprotein cholesterol concentration ≤35 mg/dL (0.9 mmol/L) and/or a serum triglyceride concentration ≥250 mg/dL (2.8 mmol/L)
* Previously identified impaired glucose tolerance or impaired fasting glucose
* Polycystic ovary syndrome
* History of vascular disease
then the UpToDate author concludes: A suggested approach — Consistent with ADA guidelines, we recommend measurement of fasting blood glucose in individuals who are considered high risk (BMI ≥25 kg/m2 with one or more additional risk factors for diabetes) and everyone aged 45 years or older receiving health care (or maintenance).
...
the [url=http://www.cdc.gov/diabetes/news/docs/screening.htm]CDC : authors concluded that population-based and selective screening programs in community settings, such as outreach programs, health fairs, and shopping malls, have uniformly demonstrated low yield and poor follow-up. Such screening usually does not represent a good use of resources. Periodic screening of high-risk individuals as part of ongoing medical care may be warranted, understanding that evidence in support of this is incomplete.
ARDS:....
Meningitis & LP: if no sign of high ICP --> LP, if signs of ICP --> CT, if CT delayed >20min = give IV AB
Edited by peter90036 on 06/07/08 - 09:39 AM
|
| Vietnamese
Forum Elite
Topics: 12
Posts: 285
|
Screening: is testing done on seemingly heathy people to idenify those at increased risk of disease...........Most important, the screening test must be valid; i.e., the test must have been shown in a randomized, double-blinded trial to decrease overall mortality in the screened population.
___________________
Nothing is impossible.
|
| Moslem Doctor
Forum Senior
Topics: 39
Posts: 157
|
thats great Dr peter
lets continue
kaplan : endo carditits prophylaxis changed at 2007 so now only hight risk eg( previous IE) patients who need prophylaxis
UW: make it big dilema and follow old guidelines
what u see?
___________________
Say ye: "We believe in Allah, and the revelation given to us, and to Abraham, Isma'il, Isaac, Jacob, and the Tribes, and that given to Moses and Jesus, and that given to (all) prophets from their Lord: We make no difference between one and another of them: And we bow to Allah (in Islam)." Holy Quran
|
| usmletopper2
Forum Senior
Topics: 25
Posts: 117
|
http://www.cdc.gov/flu/professionals/acip/persons...
Annual vaccination against influenza is recommended for:
all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others; all children aged 6–59 months (i.e., 6 months–4 years); all persons aged 50 years and older; children and adolescents (aged 6 months–18 years) receiving long-term aspirin therapy who therefore might be at risk for experiencing Reye syndrome after influenza virus infection; women who will be pregnant during the influenza season; adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus); adults and children who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus; adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration; residents of nursing homes and other chronic-care facilities; health-care personnel; healthy household contacts (including children) and caregivers of children aged <5 years and adults aged 50 years and older, with particular emphasis on vaccinating contacts of children aged <6 months; and healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza.
Page last updated October 23, 2007 Content Source: Coordinating Center for Infectious Diseases (CCID) National Center for Immunization and Respiratory Diseases (NCIRD)
Edited by usmletopper2 on 06/10/08 - 01:02 AM
___________________
99/99/no us exp/need visa/not yet certified,yet to take cs in oct/3 Ivs ,5 Rjs
|
| usmletopper2
Forum Senior
Topics: 25
Posts: 117
|
6. Pneumococcal polysaccharide vaccination
Medical indications:
[font face="Helvetica,Italic" color="#231f20"]
[/font]
[font size="4"]chronic pulmonary disease (excluding asthma);[/font]
Other indications: chronic cardiovascular diseases; diabetes mellitus; chronic liver[font size="2"]
diseases, including liver disease as a result of alcohol abuse (e.g.,
cirrhosis); chronic alcoholism, chronic renal failure, or nephrotic
syndrome; functional or anatomic asplenia (e.g., sickle cell disease or
splenectomy [if elective splenectomy is planned, vaccinate at least 2
weeks before surgery]); immunosuppressive conditions; and cochlear
implants and cerebrospinal fluid leaks. Vaccinate as close to HIV
diagnosis as possible.
[/font]
populations and residents of nursing homes or other long-term–care
facilities.
Alaska Natives and certain American Indian
7. Revaccination with pneumococcal polysaccharide vaccine
One-time revaccination after 5 years for persons with chronic renal
failure or nephrotic syndrome; functional or anatomic asplenia (e.g.,
sickle cell disease or splenectomy); or immunosuppressive conditions.
For persons aged >65 years, one-time revaccination if they were
vaccinated >5 years previously and were aged <65 years at the time
___________________
99/99/no us exp/need visa/not yet certified,yet to take cs in oct/3 Ivs ,5 Rjs
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Moslem Doctor wrote:
kaplan:Anorexia nervosa cognitive behavior therapy then hospitalization: UW : hospitalization immediate
Thanks for posting these...
With Anorexia Nervosa, you have to hospitalize because they get electrolyte imbalances which lead to arrhythmias and DEATH, so this is an important point! That's why they make such a big deal about differentiating bulemia from anorexia, because anorexia NEEDS to be hospitalized... Remember, if she is underweight and has amenorrhea, you can dx. AN, even if she has binge/purge behavior. If she is normal weight and has normal menses, it's most likely bulemia.
So HOSPITALIZATION is the FIRST STEP in AN. You can do any other necessary psych interventions later when the patient is admitted.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Moslem Doctor wrote:
osgood-schlatter Uw : cast and limit excercise
kaplan: no need to limit or cast , let him excersise and if pain after exercise so put ice and rest
This is another Good one.
Kap: Immobilization of the KNEE in an extension or cylinder cast for 4-6 weeks.
UW: Rest and Stretching of the QUADRICEPS.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
peter90036 wrote:
lipid screen: GUIDELINES
routine screen: men >35 years ,women >45years for lipid disorders
men 20-35 years and women 20-45 years with these factors:
* Diabetes.
* A family history of cardiovascular disease before age 50 years in male relatives or age 60 years in female relatives.
* A family history suggestive of familial hyper-lipidemia.
* Multiple coronary heart disease risk factors (e.g., tobacco use, hypertension).
Lipid risk factors: age, gender, diabetes, elevated blood pressure, family history (in younger adults), smoking.
Screen for lipids every 5 years. # The optimal interval for screening is uncertain- reasonable options include every 5 years, shorter for people with lipids at the limit, and longer intervals for low-risk people who’ve had low or repeatedly normal lipid levels. # An age to stop screening is not established. Screening may be appropriate in older people who have never been screened, but repeated
screening is less important in older people because lipid levels are unlikely to increase after age 65 years.
ovarian cancer screen: GUIDELINES: recommends against routine screening for ovarian cancer (low prevalence of ov C, ca125 or T-V u/s, smalleffect on mortality)
I agree 100% with your lipid screening guidelines -I have the same in my notes.
As for Ovarian cancer screening, yes its true that we don't screen the general population for OVarian cancer,
BUT if there is a higher than average risk for Ovarian Cancer in a woman (eg. Family Hx), then we screen with CA-125 and Vaginal U/S. (Both yearly)... This has a 80% Sensitivity in post-menopausal women.
IF there is a VERY HIGH RISK, (many family members), we can do a BRCA-1, and BRCA-1, AND twice yearly CA-125 and Vaginal U/S.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
Moslem Doctor wrote: in kaplan : pneumo vaccine not waranted to COPD ptns unless FEV less than 40 UW: didnt put cut off value kaplan pneumococal vaccine for DM , heart , and Other chronic lung disease EXcept (asthma ) so still there is confilict becuz UW didnt put this exception and said any chronic lung disease
Pneumococcal vaccine for ALL adults over 65 (?), Hx. of Sickle cell, Splenectomy, CV disease, Alcholism, cirrhosis... And "consider" for CF patients.
Not sure about the COPD thing, but if you get a patient with COPD, I think it would be better to give the vaccine if they don't tell you the FEV (especially if its an older smoker with any of the above conditions).
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| DrVirgo
Forum Hero
Topics: 1096
Posts: 3,515
|
peter90036 wrote: screen for diabetes: CONTROVERSY = CRAP i just looked this up on UpToDate... also similar to Wash U PDF:
 no age recommendation really... just look if the patient is at high risk of developing DM. like obese, impaired fasting glucose, fam. hx. etc.
Thats good info in the PDF... Thanks for posting!
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
|
| |
| | | | | | | | | | | | |
