E.T. is a 66-year-old obese female patient is to undergo a TKR at a local teaching hospital. The medical team plans to start E.T. on warfarin therapy for venous thromboembolism prophylaxis with an INR target range of 1.8 to 2.3 for a duration of 3 weeks. The first dose will be administered in the evening on the day of surgery. Her medical history includes epilepsy for the past 10 years, controlled with phenytoin; hypercholesterolemia for the past 15 years, for which she takes pravastatin; and HTN for the past 20 years, for which she takes lisinopril. She takes acetaminophen for …

Discuss management of pain in the elderly – what are the particular concerns?  What meds are available (including their risks and benefits)?  What different modes of administration might be considered? According to the World Health Organization (WHO) chronic geriatric pain is a common problem faced by healthcare providers therefore a guideline for pain management was established. Who recommends to Giving drugs ‘‘by the clock’’- schedule dosing By mouth (oral route) Following ‘‘analgesic ladder’’ Mild pain – acetaminophen. Mild to moderate pain or pain uncontrolled with acetaminophen – NSAIDs. Pain refractory to NSAIDs – weaker opioid agonist. For pain refractory to …

Assignment: Tx for esophagitis and hiatal hernia and gastropathy   Esophagitis Treatment: Esophagitis- Pill induces Instruct patients to take pills with 4 oz water and to remain upright for 30 minutes after ingestion Known offending agents should not be given to patients with esophageal dysmotility, dysphagia, or strictures Candidal esophagitis Systemic therapy required for suspected (empiric treatment) or proven esophageal candidiasis: fluconazole, 400 mg on day 1, then 200–400 mg/day orally for 14–21 days CMV esophagitis For initial therapy Ganciclovir, 5 mg/kg every 12 hours intravenously for 3–6 weeks After symptoms resolve, convert to valganciclovir, 900 mg once daily orally …

Work up for esophageal mass – which tests first and are there different approaches based on what the expected Dx is?   Laboratory Tests Anemia related to chronic disease or occult blood loss Elevated aminotransferase or alkaline phosphatase suggest hepatic or bony metastases Hypoalbuminemia Imaging: Chest x-ray may show adenopathy, a widened mediastinum, pulmonary or bony metastases, or signs of tracheo-esophageal fistula such as pneumonia.   While researching the topic most common way the work up was described, “maybe, most of the time, sometimes” barium swallow is the first study obtained to evaluate dysphagia Barium coats the surface of the …

Informant: Self CC: “My voice sounds different” x a few weeks (Hoarseness) Diagnosis: Papillary Thyroid Cancer HPI: 38 years old reliable female with no significant PMHx came to the clinic complaining of hoarseness for the past few weeks. The pt states that the hoarseness began 6 weeks and it is progressively becoming worse. Pt describes the voice as raspy and rough as it sounds strange to her ears. The pt states, she has tried to alleviate the voice changes by drinking tea and warm water with no relief. Along with the hoarseness, pt complains of pain with swallowing solid foods. …

These are the five antibiotics that I would choose to be part of the hospital practice. I tried to choose antibiotic based on their coverage spectrum in order to serve broad range of patients. Ceftriaxone– provides great support against gram negative bacteria so I can use this antibiotic on patient who needs gram negative coverage and differ the use of Zosyn. Also, ceftriaxone has high potency, wide spectrum of activity, and low risk of toxicity which makes the antibiotic favorable. It can be used to treat bacterial infections including pneumonia, bone infections, abdominal infections, Skin and soft tissue infections, and …

Assignment: Research endometrial and colon cancer (Lynch Syndrome)   Lynch Syndrome Endometrial cancer is the most common of the gynecologic cancers. Fortunately, most women will survive their initial diagnosis, making this the largest group of survivors who had a gynecologic malignancy. However, most patient will develop a second type of cancer and the majority of recurrence occur within three years after the treatment. Most common second type cancers are Colon and breast cancers There is a specific population, who are in increases risk of both endometrial and colon cancer. These population have an autosomal dominant condition known as Lynch syndrome. …

Patient Presentation ID: Mr. Dawson is a 67 y/o male residing in the VA LTC since 4/2016. He was admitted due to cognitive decline and being unsafe at home alone. Informant: self and medical records. Pt. has a h/o dementia so is a somewhat unreliable historian CC: “My throat hurts when I eat” x a few days HPI 67 y/o obese male with a PMH of schizophrenia, HTN, PTSD, COPD Dementia, secondary polycythemia, BPH, OA, seizure disorder, HLD and CAD complains today of occasional burning pain in his chest. Pt. states worsening, intermittent burning sensation in his chest has been …

OB/GYN article Summary of Article: A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy   The reasoning for conducting the study UTI is very common among pregnant patient and even asymptomatic bacteria need to be treated to avoid further complications. This treatment process of UTI leads a lot of antibiotic prescription which leads to increase antibiotic resistance. The author of this article is trying to identify other non-pharmacological intervention that can be utilized to prevent frequent UTI.   Aim of the study: The aim of this study was to systematically review the literature to …