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Deep venous thrombosis: update on treatment

Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014
Urinary Tract Infections
Faculty: William Gluckman, DO, MBA, FACEP

1. The most common organism causing urinary tract infections is:
a. Staph Saprophyticus b. Enterococcus c. Proteus mirabilis d. Escherichia coli 2. Which of the following is NOT considered a complicated UTI?
a. Infection in the face of HIV b. Infection in the face of a kidney stone c. Infection in a patient >80 years old d. Infection in the face of a ureteral stent 3. Which of the following statements is TRUE?
a. Asymptomatic bacteriuria is associated with IUGR and LBW (intrauterine growth retardation and low birth weight) b. All pregnant women should be screened for bacteriuria c. Ampicillin should no longer be used because of high resistance rates d. Pyelonephritis in pregnant females can lead to maternal sepsis, preterm labor 4. Uncomplicated cystitis with no previous infection should be treated with how
many days of antibiotic therapy?
5. Acceptable antibiotics for the treatment of UTI’s include all of the following
a. Trimethoprim/Sulfamethoxazole b. Levofloxacin c. Ampicillin d. Nitrofurantoin 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Urinary Tract Infections Continued
Faculty: William Gluckman, DO, MBA, FACEP

6. All of the following regimens may be used to treat urethritis EXCEPT:
a. Ceftriaxone plus Azithromycin b. Ceftriaxone plus Doxycycline c. Ciprofloxacin 500mg single dose d. Cefixime 400mg single dose e. Azithromycin 2g single dose 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Vomiting, Diarrhea, and Constipation
Faculty: William Gluckman, DO, MBA, FACEP

7. One of the most important tests when evaluating a female with vomiting is:
8. Vomiting may occur as a result of:
a. Bowel obstruction b. Infection c. Head injury d. Myocardial Infarction e. All of the above 9. Which of the following organisms is most closely associated with hemolytic
Uremic Syndrome (HUS)?
a. EHEC 0157:H7 b. Salmonella c. Yersinia d. Shigella e. Campylobacter 10. Diarrhea may be caused by:
a. Chronic pancreatitis b. Cystic fibrosis c. Antibiotic use d. All of the above e. None of the above 11. Common medications associated with constipation include all of the
following EXCEPT:
a. Antidepressants b. Verapamil c. Ferrous Sulfate d. Opiates 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Vomiting, Diarrhea, and Constipation Continued
Faculty: William Gluckman, DO, MBA, FACEP

12. A 75 female presents to the urgent care center with a complaint of
constipation for 1 week. You should do all of the following EXCEPT:
a. Perform a rectal exam b. Give a bottle of magnesium citrate and a fleets and show her the bathroom c. Obtain a good medication history d. Ask about her typical stool frequency 13. A serious cause of constipation is:
a. Cauda Equina Syndrome b. Opiate use c. Hemorrhoids d. Appendicitis 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014
Abdominal Pain
Faculty: William Gluckman, DO, MBA, FACEP

14. Which of the following is FALSE?
a. Appendicitis pain is typically is periumbilical and radiates to the RLQ b. Pts with appendicitis often have a normal WBC count on a CBC c. Pts with appendicitis always have a fever d. Appendicitis rarely occurs in children less than 12 15. A patient that is writhing around with abdominal and flank pain, can’t get
comfortable and is vomiting most likely has:
a. Appendicitis b. PID c. Pyelonephritis d. Renal Colic 16. The best imaging modality for evaluating potential ovarian pathology is:
a. CT Scan of the pelvis b. Ultrasound c. MRI d. KUB 17. The imaging modality that offers the most information when evaluating a pt
with suspected renal colic is:
a. CT Scan of the Abdomen and pelvis without contrast b. CT scan of the Abdomen and Pelvis with contrast c. Renal Ultrasound d. Renal nuclear scan 18. A 13 year old male presents with sudden onset of left groin pain 2 hours ago
and you suspect a testicular torsion. You should immediately:
a. Call your urologist and get a stat office appointment b. Order a nuclear testicular scan to look for flow c. Send immediately to the emergency department d. Attempt manual detorsion by twisting the left testicle counter clockwise e. C&D 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Abdominal Pain Continued
Faculty: William Gluckman, DO, MBA, FACEP

19. All of the following are indications to transfer to an emergency department
a. Free air noted on KUB b. Uncontrolled vomiting c. Abdominal pain with hypotension d. Reducible abdominal wall hernia 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Ano-Rectal Disorders
Faculty: Natasha Cruz, MD

20. The following are true regarding thrombosed external hemorrhoids EXCEPT:
a. Patients presenting within 72 hours of thrombosis are best managed by an b. Patients presenting after 72 hours of onset of thrombosis are best managed c. Patients presenting within 72 hours of thrombosis are best managed by d. Hot sitz baths, topical nitroglycerin and topical calcium channel blockers help 21. The following are true regarding internal hemorrhoids EXCEPT:
a. Most thrombosed and strangulated internal hemorrhoids require emergent b. There are no RCT’s to support the widespread use of topical steroids for c. Use of 30 grams of fiber per day treats symptomatic and bleeding grades I–II d. Patients with portal hypertension do not have increased risk of developing
22. The following are true of anorectal abscesses and fistulas EXCEPT:
a. The most common cause is Crohn’s disease b. Patients under 40 years old and non-diabetics are at greatest risk of fistula development after the first episode of anal abscess c. 35-50% develop anal fistula after the first episode of anorectal abscess d. Spontaneous drainage is accompanied by improvement in symptoms but patients still require a formal incision and drainage
23. The following are true regarding pilonidal abscess EXCEPT:
a. Identification of the midline pit, 4-5 cm cephalad to the anus, helps differentiate pilonidal abscess from anorectal abscess b. Pilonidal disease begins as an embryological skin defect (pit) with a secondary opening off the midline; blockage of this pit with hairs, poor hygiene and repeated trauma may precipitate infection c. The secondary opening off the midline may occur caudad from the primary opening in 7% of cases and needs to be differentiated from an anal fistula d. Deep incision and drainage of pilonidal abscess is curative 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Ano-Rectal Disorders Continued
Faculty: Natasha Cruz, MD

24. The following are true regarding perianal/perineal hidradenitis suppurativa
a. More common in men b. Associated with anemia, fistula, squamous cell carcinoma and death c. Associated with obesity, smoking and poor hygiene d. Acute subcutaneous hidradenitis abscess may mimic an ischiorectal abscess 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Kidney Stones
Faculty: Stephanie Whitko, MD

25. Which patient has the highest likelihood of developing a kidney stone?
a. 20 year old Asian American female from California with history of frequent b. 75 year old African American male from New York with history of gout c. 42 year old Caucasian male from Florida with family history of kidney stones d. 18 year old African American female from Oregon with history of sarcoidosis
26. What is the definitive treatment of choice for cystine stones?

a. Shock Wave Lithotripsy b. Alkalinization of urine c. Dietary intervention d. Ureteroscopy
27. Which of the following statements is true?

a. 90% of stones measuring 4-6 mm will pass spontaneously b. After the first episode of kidney stones, the 5 year recurrence rate is 80% c. IVP is the diagnostic study of choice when evaluating a patient for kidney d. Kidney stones presenting in the distal ureter are more likely to pass spontaneously than stones positioned in the proximal ureter 28. Which of the following patients can be discharged from the urgent care with
outpatient follow up?
a. 38 year old, previously healthy male who has new onset of right flank pain radiating to the groin. Patient is afebrile and tolerating oral fluids. His pain is well controlled after a dose of IM Toradol® and oral narcotics. CT scan is unavailable to make a definitive diagnosis of presumed kidney stones. b. 75 year old female with history of chronic stable angina, diabetes and kidney stones who presents with vomiting and abdominal pain. Kidney stones were visualized on a plain abdominal X-Ray. c. 45 year old male with a history of obesity, hypertension and gout who presents with fever and severe flank pain. Helical CT reveals a 5mm obstructing kidney stone. d. 18 year old male with a history of newly diagnosed sarcoidosis who presents 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Kidney Stones Continued
Faculty: Stephanie Whitko, MD

29. Which of the following dietary recommendations are made to patients with
new onset kidney stones?
a. Increased fluid intake b. Decreased oxalate intake c. Increased citrate intake d. All of the above 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Testicular Disorders
Faculty: Jason Chao, MD, MS
30. Which one of the following should not be part of the initial evaluation of a
painful, swollen scrotum?
a. Needle aspiration of scrotal contents b. Noting whether there is pain relief with testicular elevation c. Transillumination of scrotal contents d. Noting a discrepancy in the size of the testicles e. Palpating for tenderness of the epididymis
31. Which one of the following is atypical in the presentation of testicular
torsion?
a. Acute onset of scrotal pain with swelling b. Unilateral scrotal pain c. Cremasteric reflex (stroking of the medial thigh causing elevation of the ipsilateral scrotum) is absent on the affected side d. History of prior mild scrotal pain that spontaneously resolved e. Pre-pubertal boy (age 8-10)
32. A man with acute epididymitis is least likely to have which infecting
organism?
a. Chlamydia trachomatis b. Escherichia coli c. Herpes simplex d. Mycoplasma genitalium e. Neisseria gonorrhoeae 33. Acute scrotal pain is least likely to be caused by which of the following?
a. Epididymo-orchitis b. Testicular torsion c. Testicular tumor with infarction d. Inflammatory bowel disease e. Incarcerated or strangulated inguinal hernia 34. Which one of the following is NOT a cause of chronic scrotal swelling?
a. Hydrocele b. Mumps orchitis c. Spermatocele d. Inguinal hernia e. Varicocele 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Testicular Disorders Continued
Faculty: Jason Chao, MD, MS

35. Which one of the following is NOT true of acute prostatitis?
a. Septic shock may occur as a complication b. Prostate gland is tender on rectal exam c. Initial antibiotic treatment should cover gram-negative organisms d. Prostatic abscess may occur as a complication e. Pain during or after ejaculation is a common complaint 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014
Pelvic Disorders
Faculty: Tomas Gigena, MD
36. All of the following are indicated for control of abnormal uterine bleeding in
the non-pregnant female EXCEPT:
a. Oral contraceptive pill twice daily for 5-7 days b. Provera® 10mg per day for 10 days c. Naproxen 500mg twice a day d. Aspirin 650mg QID 37. Which of the following is the most common cause of vaginitis?
a. Trichamonas b. Irritants c. Bacterial Vaginosis d. Candidiasis 38. Which of the following is true with regards to Bacterial Vaginosis (BV)?
a. Yogurt is beneficial for treatment b. BV recurs in 20-40% of patients after one month c. Symptomatic pregnant women should not be treated d. Unrelated to sexual intercourse or menses 39. All of the following are criteria for inpatient treatment of PID EXCEPT:
a. Cervical motion tenderness and low grade fever b. Inability to tolerate oral antibiotics c. Pregnancy d. Clinical failure of outpatient treatment after 3 days 40. Which of the following tests is most sensitive for detection of Chlamydia?
a. Culture b. PCR c. Enzyme immunoassay d. Nucleic Acid Hybridization (NA probe) 2009 Institute of Urgent Care Medicine Core Content In Urgent Care Medicine
GI/GU Module
Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date:
November 30, 2014

Pelvic Disorders Continued
Faculty: Tomas Gigena, MD

41. When treating empirically for cervicitis or urethritis, all of the following are
acceptable EXCEPT:
a. Ceftriaxone IM plus Azithromycin PO b. Cefixime (Suprax®) plus Azithromycin PO c. Ciprofloxacin plus Doxycycline PO d. Ceftriaxone plus Doxycycline PO 42. All of the following are risk factors for ectopic pregnancy EXCEPT:
a. Multiple pregnancies b. PID c. Previous ectopic d Previous tubal surgery 43. Which of the following is true about suspected ectopic pregnancies?
a. They all need surgery b. If no IUP, patient hemodynamically stable, and serum HCG < 1500, re-check c. Medical therapy with Methotrexate is indicated when ectopic mass is > 3.5 cm d. If patient is unstable with suspected ectopic, pelvic US and serum HCG 2009 Institute of Urgent Care Medicine
  • To receive a statement of credit for up to 8.75 AMA PRA Category 1 Credit™ you must:
  • 1. Register your name in association with the DVD at www.UrgentCareCME.com to assure your eligibility to receive CME credit for these modules. You will use your full name without spaces as your username, and the serial number found on the spine of the DVD case for your password. Remember, the fee for only one (1) person to obtain CME credit for this module is included in the cost for the entire DVD package.
  • 2. Print out the handouts (on the DVD) and posttest files (obtained only after registering on www.UrgentCareCME.com; these files are available on the Posttest tab) prior to reviewing the presentations.
  • 3. Review the full content of the module and all presentations associated with the module. It is best to fill out the posttest on the print out as you complete each presentation.
  • 4. Review any supplementary materials referenced under the Handout Material section of the DVD.
  • 6. Successfully complete the online posttest for the entire module at www.UrgentCareCME.com. A 70% passing grade is required to move on to the evaluation and credit claim form. As before, sign-in using your full name without spaces as your username, and the serial number found on the spine of the DVD case as your password. Go to the appropriate posttest on the “Take the Posttest” section of the “Posttest” tab.
  • 7. Once you have successfully completed the online posttest(s), you will be directed to the Continuing Medical Education website at Case Western Reserve University to complete the evaluation for the course. Once you submit your evaluation, you will be taken directly to the online credit claim form. You should only claim credit commensurate with your participation in the activity. Once you submit your credit, a certificate will come up that you can print for your records.
  • 8. You will be asked to enter your email address and to create a password if you do not already have one for the CME website. Please keep your email address and the password that you create in a safe place. This is how you will sign in each time you do an evaluation and claim credit for a module. You can also get your cumulative transcript from the CME website using this information.
  • Your credits will be recorded by the Case Western School of Medicine CME Program and made a part of your cumulative transcript.
  • Estimated Time to Complete this Educational ActivityIncluding review of the supplementary material and completion of the posttest, this activity is expected to take at total of 8.75 hours to complete.
  • PostTest_CME_Instructions_Video_Version_Text.pdf
  • Core Content In Urgent Care Medicine
  • Release Date: December 1, 2009 Review Date: January 31, 2011 Expiration Date: November 30, 2014
  • To receive a statement of credit for CME you must:
  • 1. Print out the handouts and posttest files prior to reviewing the presentations. You can find the handouts by clicking on each module; choose "Module Overview and Handouts", then select "Handout Material". To print the Post Test files choose "Click Here for Post Test and CME", choose the appropriate module, and download the PDF file found at the top of the page.
  • 2. Review the full content of the module and all presentations associated with the module. It is best to fill out the posttest on the print out as you complete each presentation.
  • 3. Review any supplementary materials referenced under the Handout Material section.
  • 5. Successfully complete the online posttest for the entire module. A 70% passing grade is required to move on to the evaluation and credit claim form. Go to the appropriate post test by choosing the Post Test and CME link.
  • Choose the Post Test you wish to take by selecting the link, re-read the posttest instructions, then click "Begin" found at the bottom of the page.
  • 6. Once you have successfully completed the online posttest(s), you will be given a CME code for the completed module. Please print this page and note the CME code for the completed module. Once you submit, you will not be able to use the Back button to return to this page.
  • 7. After clicking “Submit Test Results”, you will be directed to the Continuing Medical Education website at Case Western Reserve University to complete the evaluation for the course. This website is managed separately from the NextCare Core Content in Urgent Care Medicine site, so follow the instructions carefully: You will be asked to enter your email address and to create a password if you do not already have one for the CME website. Please keep your email address and the password that you create in a safe place. This is how you will sign in each time you do an evaluation and claim credit for a module. You can also get your cumulative transcript from the CME website using this information.
  • After signing in, you will be asked to compete and evaluation for this course.
  • Once you submit your evaluation, you will be taken directly to the online credit
  • claim form. You should only claim credit commensurate with your
  • participation in the activity. Once you submit your credit, a certificate will
  • come up that you can print for your records.
  • Your credits will be recorded by the Case Western School of Medicine CME
  • Program and made a part of your cumulative transcript.
  • 2009 Institute of Urgent Care Medicine
  • Source: http://www.urgentcarecmeonline.com/pdf/GI_GU_posttests.pdf

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