More articles from 1-Minute Consult
Intravenous or oral steroids: Which is better for acute exacerbations of asthma or COPD?For asthma, oral steroids appear to be as effective as intravenous. For COPD, we have less evidence.
Is there an age at which we should stop performing screening Pap smears and mammography?Mammography is reasonable if life expectancy is at least 5 years, but screening for cervical cancer is more complex.
- What is the best way to determine if thrombocytopenia in a patient on multiple medications is drug-induced?
The only way is to stop the suspected drug and see if the thrombocytopenia resolves. But how to avoid stopping needed drugs that are not a problem?
What is the best diagnostic approach when pheochromocytoma is suspected?First prove there is catecholamine overproduction, then obtain an MRI to locate the tumor.
What is the best way to diagnose streptococcal pharyngitis?Rapid tests are highly specific but less sensitive. Throat culture is still the gold standard.
When is perioperative ‘steroid coverage’ necessary?Although data are lacking, it seems prudent to boost glucocorticoid doses in the perioperative period for patients receiving long-term steroid therapy.
When should central venous catheters be changed in the intensive care unit? Should there be a rigid time-based protocol for doing so?The decision is made case by case rather than on a time-based protocol. Proactive strategies can reduce the risk of infection.
How often are atrial septal defects associated with thromboembolism? When should they be looked for?In the absence of other causative conditions, an atrial septal defect may be presumed to be the underlying cause of a stroke, especially in younger patients.
Who should receive hepatitis A vaccine?Vaccination is recommended for overseas travelers, children, older adults, transplant recipients, patients with chronic liver disease, and others at risk.
- At what level of hyperkalemia or creatinine elevation should ACE inhibitor therapy be stopped or not started?
These drugs are a double-edged sword: they slow the decline in renal function in many patients, yet reduce renal function in some.