Term
|
Definition
primary=no disease present: educate
secondary=screening at risk population
tertiary=disease already exists now using rehab, p.t etc. |
|
|
Term
|
Definition
Rhinitis, URI, Coryza
Seasonal variation:symptoms most common during the 1st 2 wks of school then mid winter/spring
children 1-5-avg 6 episodes annually
adults-avg 3 episodes annually
spread via droplets inhaled/hands |
|
|
Term
|
Definition
| caused by 1 or more viral strains;5-10% caused by >1 strain |
|
|
Term
| 2010 leading health indicators |
|
Definition
mneumonic: avid stoma:activity,violence,immunization,
drugs,sexual behavior, tobacco,obesity,mental health,access |
|
|
Term
| Pender's Health Belief model |
|
Definition
| focus is on CAPABILITY, rather than pathology |
|
|
Term
| what are the common pathogens of viral URI? |
|
Definition
rhinovirus, coronavirus,respiraory synactial virus, influenzae virus, adenovirus.....etc.
*virus invades host cell and exploits metabolic systems to replicate itself. Host cell fragments trigger immune response resulting in cold symptoms.
*influenza virus causes more host cell damage and more severe symptoms |
|
|
Term
|
Definition
| nasal irritation, congestion, clear discharge. Stimulates sneeze reflex and watery eyes |
|
|
Term
| two types of screening tests |
|
Definition
1. wellness screening
2.surveillance screening i.e. diabetic patients look for retinopathy,kidney infection, uti etc. |
|
|
Term
|
Definition
| dry sore throat which stimulates the cough reflex. Can be caused by environmental irritants. Fever and lymphadenopathy may be more indicative of a bacterial source. |
|
|
Term
| Prostate cancer, what is gold standard for finding it? |
|
Definition
| Trans-urethral ultrasound with biopsy |
|
|
Term
|
Definition
| may indicate spread to lower region of upper respiratory tract. |
|
|
Term
| test panels; what do you do with the results? |
|
Definition
order tests selectively
avoid general panels,you own abnormal results, repeat the abnormal test |
|
|
Term
|
Definition
fever-low grade to none unless influenza
headache-result of edema in the nasal passages
ears popping-eustachian tube dysfunction from rhinitis
prodrome of malaise, myalgias, decreased appetite
symptoms vague and diffuse |
|
|
Term
| TQ* after age 65; Pap smear guidelines |
|
Definition
| if there have been three consecutive negatives then no more paps are needed. |
|
|
Term
|
Definition
middle ear obstruction secondary to inflammation
precipitation of asthma atack or bronchospasm in susceptible individuals
bacterial infections: sinusitis, otitis media, pneumonia, bronchitis, bacterial pharyngitis |
|
|
Term
| USPTF: new for 2008 men who have smoked |
|
Definition
| AAA screening if men age 65-75 |
|
|
Term
99% Bronchitis is viral
How does the patient look? |
|
Definition
|
|
Term
| usptf clinical guidelines; based on current best evidence |
|
Definition
Gtade A-good evidence
Grade B fair evidence
Grade C -no recommendation
Grade D-recommend against in asymptomatic patients
Gtade I- insufficient evidence |
|
|
Term
|
Definition
clear nasal drainage errythematous, neck supple
plan: decongestant, saline spray, tylenol, fluids, rest, humidification, no bloodwork |
|
|
Term
| colorectal cancer screening |
|
Definition
colonoscopy for 50 y.o and older 5-10 years x2: if negative
stool cards x 3 at 40 annually |
|
|
Term
Breast cancer screening 40-49
Breast cancer screening after 50 |
|
Definition
every one to two years
annually |
|
|
Term
|
Definition
|
|
Term
| EKG baseline at what age? |
|
Definition
|
|
Term
| Goal of Pharmacotherapy for URI |
|
Definition
provide palliative relief of symptoms & prevent complications.
*prevent misuse of antibiotic therapy for patients with viral symptoms
*educate demanding patients about proper use of antibiotics |
|
|
Term
|
Definition
nasal decongestants(sympathomimetic amines)-alleviates nasal drainage and vascular damage that occurs from frequent nose blowing
available as topical/oral
psudoephedrine(sudafet)sig:30mg tab (60mg q 4-6hrs.prn)
nasal sprays (Afrin, neosynephrine) |
|
|
Term
| decongestant side effects |
|
Definition
stinging drying of nasal mucosa
nervousness, restlessness, anxiety,sedation
palpitations, hypertension, arryhmias
altered glucose tolerance (Increase BS) |
|
|
Term
| decongestants side effects |
|
Definition
rebound nasal congestion (rhinitis medicamentosa)in patients who use topical products>72hrs.
ischemic changes-nasal tissue necrosis with overuse.
mask serious medical problem with overuse.
inhalation less effect than oral agents |
|
|
Term
| oral decongestant caution |
|
Definition
| cardiovascular disease, diabeted, hyperthyroidism, BPH (urinary symptoms increase) |
|
|
Term
| contraindications of decongestants |
|
Definition
| HTN, narrow angle glaucoma, severe CAD |
|
|
Term
| Do not use psuedafed for more than 72 hours |
|
Definition
|
|
Term
| antihistamines okay with Inc. BS and HTN |
|
Definition
| claritin, allegra, clarinex, zyrtec, loratidine |
|
|
Term
|
Definition
anitussives
MAO-inhibits cough reflex -suppresses cough
pharmacotherapeutics-for pts with dry non productive coughs, secondary to cold or allergy
narcotic vs. non-narcotic antitussives |
|
|
Term
|
Definition
most potent cough suppressant prescription only
respiratory suppression may be a problem with compensated respiratory function |
|
|
Term
| common adverse rxn to opiate antitussives |
|
Definition
| CNS and respiratory suppression, lightheadedness, constipation, nausea, drying of respiratory mucosa, drug interactions:CNS depressants, alcohol |
|
|
Term
|
Definition
Robitussin AC (10mg codeine/15ml)1-2 tsp. q 4 hr.-lower
abuse potential
hydrocodone-hycotuss, hycodan syrup, tussionex syrup |
|
|
Term
| non opioid antitussives **********TQ**************** |
|
Definition
dextromethorphan-1/2 as potent on a mg basis than codeine as a cough suppressant. Lacks narcotic properties.
Side effects rare (Tussiorganidin DM)
Tessalon(safe in pregnancy) 100mg Perles or 200mg caps sig 100-200 mg p.o. tid
other non opioid benedryl. |
|
|
Term
| immunizations TDdap (adacel) (how often) |
|
Definition
| all adults every 1 years (Tdap first, then TD every ten years thereafter) |
|
|
Term
| Flu shot (adult USPTF recommendation) |
|
Definition
| aduuts age 50 year and older annually |
|
|
Term
| non opioid antitussives*********TQ |
|
Definition
dexromethorphan-1/2 effective as milligram codeine as cough suppressant.
Benzonate (tessalon)100mg Perles or 200mg Caps sig:100-200mg po.tid(safe in pregnancy)
kephenhydramine(benadryl)cough suppressant properties |
|
|
Term
| Pneumoccal vaccine (pneumovax) (how often) |
|
Definition
| every 5 years for over 65 unless (or any age if smoker or asthma |
|
|
Term
|
Definition
|
|
Term
| Hepatitis A (how often for who?) |
|
Definition
| 2 doses. susceptible adults, hep C |
|
|
Term
| Meningococcal (Menatra) vaccine |
|
Definition
| susceptible adults x1 dose |
|
|
Term
| expectorants and mucolytics |
|
Definition
mucinex 600mg q 12hr.
guaifenesin (glyceryl guaicolate)-productive cough
enhances respiratory removal of mucous secretions by reding mucous adherence
liquid or sustained release-caution with chronic cough or dry persistant cough.
can be dehydrating |
|
|
Term
| Pregnancy guidelines for vaccine: what can they get? |
|
Definition
NO MMR, varicella, zoster or IPV in pregnancy
inactivated influenza o.k during flu season( Dec.-March) PPD o.k. in pregnancy |
|
|
Term
| expectorants and mucolytics******** |
|
Definition
robitussin DM Syrup 2 tsp Q 4 hrs
Mucinex 600 mg tablets q 12 hrs
tusiiorganidin DM strup 2 tsp po q4hrs
durratuss DM syrup |
|
|
Term
| Vaccinations (may have reaction if allergic to what?) |
|
Definition
|
|
Term
|
Definition
fluids, rest
steam humidification hand washing
educate why no antibiotics
normal duration of illness, potential
complications,
follow up if S/s persist or increase
F/U if s/s get worse |
|
|
Term
| Pharyngitis: viral vs. bacterial |
|
Definition
viral-pharygitis-
URI symptoms
low grade fever
doesn't appear sick
no abdominal symptoms |
|
|
Term
|
Definition
group A Beta hemolytic Strep (GABHS)
incidence high in children
no uri symptoms
sudden onset of high fever
tonsillar exudate
enlarged lymph nodes
fetid breath
n/v;abd.pain
appears ill |
|
|
Term
| treatment plan bacterial pharyngitis |
|
Definition
dx:rapid strep;24 hr blood agar culture
(Gold Standard)
Rx:Pen-Vee K, Amoxicillin, Ampicillin
tabs/caps:250 mg, 500mg oral suspension 250mg/5cc and IM preparations
adult dosing: 250mg po tid or 500mg po bid for 10 days on an empty somach |
|
|
Term
Screening: blood work for adults
U/A for who? |
|
Definition
CBC,thyroid in women >35.diabetic patient: annual dilated eye exam.
those at risk for UTU: pregnant women, DM, older men with BPH, obstruction |
|
|
Term
| Hearing screen what age? (adults) |
|
Definition
|
|
Term
| Dilated eye exam?what ages?) |
|
Definition
| every 3-5 years before 40, every 2-4 years from 40-64 |
|
|
Term
| cecephalosporins 2nd line or if no improvement within 72 hrs |
|
Definition
1st generation: Cephalexin (Keflex)-good for skin infections)
available as 250-500mg caps and susps.
adult dosing 250-500 qid
cefadroxil(Duracef)-good for skin infections.
Available as 500 caps, 1 gm tab and suspension
adult dosing 1-2 gm daily in divided doses-depending on source of infection |
|
|
Term
|
Definition
Nitmachi
neopleasm,infection,trauma,
mechanical,autoimmune,collagen,
hematologic,
idiopathic |
|
|
Term
| cephalosporins -2nd generation |
|
Definition
| 2nd generation:cefaclor (ceclor), cefuroxime (ceftin)-good for sinus infection otitis media cause by Hflu |
|
|
Term
| Cephalosporin:3rd generation |
|
Definition
Cefixime (suprax)good for otitis media.
gonorrhea=400mg tab x 1 |
|
|
Term
| Cephalosporins:4th generation |
|
Definition
|
|
Term
| varicella vaccine (how many?) |
|
Definition
| adults who recieved only one dose should get a 2nd dose (new recommendation) |
|
|
Term
| Penicillin Allergic Macrolides |
|
Definition
Type I Erythromycin (E-mycin, Ery-Tab, EES, Eryc, ERped)
difficult on the GI system;cheap
inhibits cytochrome P450 which prolong the 1/2 life of certain drugs |
|
|
Term
| Type 2: Clarithromycin (Biaxin) |
|
Definition
250-500mg and suspension
inhibits cytochrome 450
metalic taste |
|
|
Term
Macrolides continued
Type 3: Azithromycin (Zithromax) |
|
Definition
misused, does not inhibit cytochrome 450 system
low side effect
zithromax come in 250, 500, 600, and suspension 100/5, 200/5cc; 1gm packet and 2 gm suspension
z pack as directed
tri pack (3x500mg) |
|
|
Term
| Complication of Pharyngitis |
|
Definition
peritonsillar abscess:
muffle voice
severe sore throat
odynophagia(pain on swallowing)
trismus-difficulting chewing
culture drainage
ent referral |
|
|
Term
LRTI's :bronchitis (acute and chronic)
bronchiolitis,pneumonia |
|
Definition
90 % of bronchitis is viral
T.Q: cough is always present with a LRTI |
|
|
Term
|
Definition
strep like symptoms
hepatosplenomegaly
lab work:hereophile agglutination Test (mono spot)
Anti EBV elevated LFT's
atypical lymph on cbc
sed rate |
|
|
Term
|
Definition
if pt with viral pharyngitis isn't better after 1 week get TC and pursue other avenues
if after 2 negative TC and normal BW consider GERD
give trial of prevacid 30mg or prilosec 20 mg qd
considere referal o ent/gi |
|
|
Term
| Treatment of acute bronchitis |
|
Definition
| no antibiotics unless symptoms present for > 2 weeks. If wheezing: oral seroids for 5 days, and an inhaled beta agonist(ventolin, albuterol, maxair, proventil) |
|
|
Term
|
Definition
change in the voice
Rx:rest voice, warm salt water gargle,
may try steroid MDI for 7 days if no infection
follow up 7-10 days
no improvement after 4 weeks refer to ENT |
|
|
Term
Chronic bronchitis (usually a smoker not an asthmatic)
symptoms: ( a board question) |
|
Definition
increase mucous cells, airway edema,
symptoms for at least 3 consecutive months for a minimum of 2 consecutive years |
|
|
Term
|
Definition
inflammation and infection of the auditory canal and external structure of the ear
s/s:painful auricle & tragus, errythema and swelling of he auditory canal. Possible ear drainage whitish greenish
Acute Bacterial:pseudomonas, staphyloccocus aureus, srptococcus, and psudomonas, e coli has been implicated.
chronic bacerial P. Aeruginosa
Fungal: swimmers ear |
|
|
Term
| Treatments of chronic bronchitis |
|
Definition
| smoking cessation!Also inhaled steroid and long acting bronchodilators such as: advair 100/50,250/50,500/50 bid.or combivent:(albuterol=short acting, and atrovent |
|
|
Term
| Treatment options otitis externa |
|
Definition
TOPICAL STEROIDS AND ANTI INFECTIVE:
cortosporin otic suspension is a combination product IV gtts affected ear qid x 5 days; use ear wick or cotton ball with gtts 1st 24-48 hrs to increase distribution
2nd line products: floxin and cipro otic drops quinilone;acetic acid (vosol or Otic domebro): often used for prophylactic treatment of swimmers ear.
complications: perforated tympanic membrane
education return for follow up |
|
|
Term
| otitis media with effusion (serous) |
|
Definition
common in adults
s/s:fullness in ear(perceived hearing loss)popping/cracking with yawning and nose blowing, may follow URI;tm retracted with yellowish or dusky fluid behind; decrease mobility of tm on pneumatic otoscopy. |
|
|
Term
Pneumonia:definition
what bacteria causes 40-60% of pneumonia? |
|
Definition
| acute inflammation of terminal airways, alveoli, and secondary to bacterial invasion. Caused by Strep pneumoniae, then h.influenza, m.pneumoniae,and c. pneumoniae |
|
|
Term
| Treatment of OME or Serous OM |
|
Definition
tmpanogram to assess movement of tympanic membrane
mild symptoms typically 2-3 wks
treat with topical decongestants (saline nasal sprays to avoid hypercongestion of nasal mucosa)
decongestants or anti histamines to relieve ET dysfunction
referral to allergist or ENT if persists. |
|
|
Term
|
Definition
more common in children
s/s: ear pain and decreased hearing,
bulging hyperemic tm, purulent fluid behind tm;bullae on tm (bullous |
|
|
Term
| Differential diagnosis of pneumonia *TQ |
|
Definition
| purulent, productive rust colored sputum with cough. Acute onset of fever, tachycardia, tachypnea, pleuritic chest pain, signs of lung consolidation |
|
|
Term
| Acute Bronchitis presents how? (s/s) |
|
Definition
| URI preceeds it. Acute cough, low grade fever, fatigue, course rhonchi |
|
|
Term
| Pneumonia: an immunosuppressed person commonly has what seen on a chest xray? |
|
Definition
| involvement of multi lobular penumonia |
|
|
Term
| Hospital acquired pneumonia (occurs in 10% of hospitalized patients) What organisms are commonly seen with nosocomial pneumonia? |
|
Definition
| Gram negative bacilli that are antibiotic resistant and carry 40% mortality rate (Klebsiella, enterobacter, pseudomonas) |
|
|
Term
| Diagnostic work up of pneumonia? |
|
Definition
| cxr is gold standard (infiltrates are seen) Also, gram stain/culture of sputum, blood cultures, O2 Sat and ABG's, CBC, PPD, antibody titers. IN primary care, they often just go ahead and treat. |
|
|
Term
| 80% of patients with community acquired pneumonia (CAP) are treated outpatient. What meds? |
|
Definition
| erythromycin, biaxin, zithromax (1st line for s. pneumoniae)Quinolones, doxycycline (good for atypical, watch for photosensitivity). Alternative 1st line tx: Augmentin or Ceftin(2nd or 3rd generation cephalosporins |
|
|
Term
| TQ* What are the indicators to admit for inpatient care of pneumonia? |
|
Definition
tachypnea >30
hypotension <90/60
fever >101, hypoxemia <90% saturation on ra, resp. failure, evidence of sepsis or organ failure for example creatinine> 2.5 |
|
|
Term
| What are social and demographic factors that may require pneumonia patient to be hospitalized? *TQ |
|
Definition
| >65 year old, home care not available, questionable compliance, menta impairment or disability |
|
|
Term
| What are host (the patient's) factors that may make hospitalization necessary for pneumonia? |
|
Definition
co-existing illness i.e. diabetes, CAD.
aspiration pneumonia
ETOH abuse, malnutrition, immunosuppression |
|
|
Term
| Pneumoccocal vaccine: the goal of Healthy people 2010 is to get what level of immunization? (age and percent) |
|
Definition
goal is for 90% over the age of 65 y.o.
Re-vaccinate every 5 years. Also recommended for splenectomy, bone marrow suppression, cirrhosis, smokers |
|
|
Term
| Influenza: transmission and incubation? |
|
Definition
| droplet transmission, incubation 1-2 days |
|
|
Term
| Prophylactic treatment for flu |
|
Definition
amantadine, rimantadine (type A)
Zanamivir (type A& B)
Tamiflu (Oseltamivir) is now resistant to type A
Shortens illness by one day if started within 48 hours |
|
|
Term
| Recommendation for prophylaxis with antiviral agents |
|
Definition
persons at high risk who have not been vaccinated
unvaccinated members of persons in household of high risk person, unvaccinated persons who provide care to high risk persons, immunocompromised persons |
|
|
Term
| Influenza vaccines: types? |
|
Definition
A/Brisbane and B Brisbane like antigens.
Flumist (live intranasal): ages 5-49 healthy and non-pregnant. |
|
|
Term
| Influenza vaccine recommendations for high risk groups..who are they? |
|
Definition
| >65, nursing home and LTC residents, adults and children >6 mos. with asthma, persons age 2-64 with comorbid conditions, children age 6 mos. -2 years, pregnant women in 2nd, 3rd trimester. Out of home caregivers, adults and children >6 mos. who need regular medical care, children age 6 mos-18 years who must have ASA therapy (can develop Reyes syndrome after the flu) |
|
|
Term
| Contraindication to flu vaccine |
|
Definition
severe reaction to eggs
severe reaction to previous flu shot
previously developed Guillan Barre within 6 weeks of flu shot |
|
|
Term
| H1N1 treatment guidlelines target: |
|
Definition
pregnant women
persons caring for infants<6 mos (parents, siblings, daycare providers)
Health care workers,
persons age 6 mos-24 years
persons age 25-64 with medical conditions that put hem at high risk |
|
|
Term
| The most common cause of CAP (community acquired pneumonia?) |
|
Definition
Strep pneumoniae is most common.
Next is H. influenza |
|
|
Term
|
Definition
fever or hypothermia, chills, sweats
New cough with or without sputum production or change in color of sputum
chest discomfort or dyspnea
fatigue, myalgia, abdominal pain, H/A, anorexia |
|
|
Term
|
Definition
| resp rate>20, tachycardia, crackles heard on auscultation, signs of consolidation |
|
|
Term
| Signs of consolidation with pneumonia? |
|
Definition
| locaized, diminished breath sounds, egophany (ee sounds like aa) Bronchophony (voice sounds clearer than it should) Whipered petroliloquy (whispers are louder and clearer)tactile fremitus (increased vibration) percussion: chest dullness. Assess for s/s/ of dehydration esp. in elderly, assess mental status |
|
|
Term
clinical pneumonia presentation r/t
type of organism: S: pneumoniae |
|
Definition
| s.pneumoniae (most common) may occur in healthy adults after URI, usually elderly. Often presents with abrupt onset high fever, shaking chills, prouctive cough, purulent rusty sputum |
|
|
Term
| clinical presenation pneumonia with H. influenza |
|
Definition
| tends to be elderly or cigarette smokers or pt. with COPD. Often occurs after influenza. Symptoms same as S. pneumoniae. |
|
|
Term
| staph pneumonia affects who? |
|
Definition
| nursing home residents, alcohol abuse, chronic diseases |
|
|
Term
| Moraxella catarrhalis pneumoniae:who? what are s/s? |
|
Definition
| usually pt. with COPD. symptoms are mild and usually do not have myalgia, chills, pleuritic pain |
|
|
Term
| Pneumonia caused from Gram neg. Bacilli? Who is at risk and why? |
|
Definition
| High mortality rate. Risk factors are old age, nursing home resident, ETOH abuse, malnutrition |
|
|
Term
| Any patient who says they have had a cough for more than one month should get what test? |
|
Definition
|
|
Term
| Pneumonia patients >40 and all smokers should have repeat chest xray. why?when? |
|
Definition
| 4-8 weeks post treatment t rule out bronchogenic carcinoma which has a similiar presentation as pneumonia |
|
|
Term
| Physical findings which should be considered for hospitalization |
|
Definition
| resp >30. B.P <90, pulse >125, temp greater than 40 C, PH <7.35, BUN >30 PO2 <60, glucose >250 |
|
|
Term
Treatment recommendation for pneumonia
(outpatient) |
|
Definition
| advanced generation macrolide (Azithromycin or clarithromycin) OR doxycycline (should only be used if patient is allergic to or intolerant of macrolides) |
|
|
Term
| outpatient pneumonia with assoc. cardiopulmonary disease or underlying factors should be treated with what antibiotics? |
|
Definition
| Beta Lactam (cefpodoxime, cefuroxime, augmentin or parenteral ceftriaxone f/b cefpodoxime PLUS macrolide or doxycycline OR floroquinolone alone |
|
|
Term
| Patient education for pneumonia: what should they do? what should they not do? |
|
Definition
Increase oral fluids.
Do not take cough suppresants or smoke |
|
|
Term
| if someone aspirates and developes pneumonia what would you expect the cxr location of infiltrate? |
|
Definition
| RIGHT upper lobe infiltrate or right lower lobe |
|
|
Term
|
Definition
| ear pain and decrease hearing, bulging, hyperemic TM, purulent fluid behind TM, bullae on TM (bullous myringitis=mycoplasma reat with macrolide), most common bacteria H Glu (treat with Amoxicillin, Bactrim) |
|
|
Term
| impacted cerumen treatment |
|
Definition
cerumenex otic solution 10% fill ear canal and insert cotton plug; leave for 30 minutes and then irrigate with warm h2o
Debrox otic soln. 6.5%;5-10 gtts in ear canal bid x 4 days then irrigate
contraindicated in pts with OM or perforated typmanic membrane. |
|
|
Term
| nasoRhinitis-differential dx |
|
Definition
|
|
Term
| Heartburn is the most common manifestation of GERD. How does the patient usually describe it? |
|
Definition
| a burning feeling rising from the stomach up towards the neck |
|
|
Term
|
Definition
| haemophilus influenzae, strep pneumonie, moraxella catarrhalis |
|
|
Term
| Atypical symptoms of GERD? |
|
Definition
| chest pain, hoarseness,sore throat. globus,wheezing. |
|
|
Term
|
Definition
facial pain when bending over-key
toothe pain, eye pain, nausea,
pain increases in the ethmoid, frontal and shpeniod in supine
pain increases maxillary sinus in upright position |
|
|
Term
acute sinusitis<3 weeks
chronic sinusitis>3 months |
|
Definition
|
|
Term
|
Definition
| stuffy on same side of nostril |
|
|
Term
|
Definition
| stuffiness from one side to the other |
|
|
Term
|
Definition
| @ least 14 days >3 weeks duration |
|
|
Term
| what percent of people with reflux symptoms have erosive esophagitis |
|
Definition
|
|
Term
|
Definition
| turbinates edemetous, boggy, erythematous, patchy pharynx, TM's retracted |
|
|
Term
| What are dietary factors that aggravate GERD? |
|
Definition
| caffeine, fatty foods, spicy foods,citrus fruits and juices, tomato based products, alcohol, peppermint |
|
|
Term
|
Definition
7-10 days
Augmentin 875ng bid
amoxicillian 500mg or 850mg bid
bactrim ds bid
cephlosporins:Ceftin Cefzil,
no macrolides secondary to restance
3rd line agent:Cipro |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| barrett's esophagus, stricture, ulceration, bleeding, asthma, reflux laryngitis |
|
|
Term
|
Definition
conjunctivae cobblestone appearance,
allergic shiners, allergic salute, pruritis of nose , tearing sneezing cough;nasal exam whie bluish gray, boggy |
|
|
Term
|
Definition
| a change in the esophageal epithelium, precancerous lesions. Patient's with Barrett's have 30-60 times more likely to develop this cancer (adenocarcinoma)the incidence of Barretts esophagus is rising |
|
|
Term
| What is the primary diagnostic tool for GERD |
|
Definition
| the history,GERD can be diagnosed on histor of alone |
|
|
Term
| treatment/evaluation rhinitis |
|
Definition
topical steroid nasal spray x 4 wks
add oral antihistamines or combination products
F/U 4 weeks
environmental controls |
|
|
Term
steroid nasal sprays
*caution >60 glaucoma, cataract linkage |
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Definition
| flonase, veramyst, nasocort AQ, rhinocort, nasonex, beconase AQ |
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Term
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Definition
| allegra, claritin, clarinex, zyrtec |
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Term
| history is not enough if alarm systems are present such as? |
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Definition
| dysphagia,bleeding,weight loss, choking, chronic cough, chest pain |
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Term
| endoscopy: why is it useful for patient's with GERD? |
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Definition
| the only reliable method to detect Barrett's esophagus. |
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Term
GERD: trial of acid suppression therapy
what drugs would you use? |
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Definition
| PPI's are the agents of choice |
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Term
| management options in GERD |
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Definition
| lifestyle measures, pharmacologic,antireflux surgery |
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Term
| abdominal pain-diagnosing |
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Definition
| location of pain;think geographically;look @ clues from history |
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Term
| Identify the lifestyle measures? |
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Definition
raise HOB,or lie on left side.
Decrease fat intake
Avoid certain foods
Avoid lying down for 3 hours after eating.stop smoking, lose weight |
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Term
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Definition
classic involuntary guarding or rebound tenderness
mcburney-appendicitis
psoas peritoneal irritation
murphys's gallbladder |
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Term
| acute choleycystitis-risk factors |
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Definition
risk 5 F's fat, female, forty, flatulent, fertile
biliary colic |
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Term
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Definition
cassic-pain RUQ or episgastrium radiating to the scapular region accompanied by N/V, anorexia, and fever without jaundice.
Murphy inspiratory arrest in respone to RUQ palpation
labs-elevated WBC's Alkphos, and bilirubin |
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Term
| acute mesenteric infarction:risk factors |
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Definition
elderly, atherosclerotic risk factors,or other embolic risk (arterial insufficiency)
soft abdominal exam
dissection or rupture of an abdominal aortic aneurysm produces severe acute abdominal pain that radiates to the back and genital area
chronic arterial insufficiency may proceed infarction
cramping or dull mid-abdominal pain 15 minutes after a meal secondary to lack of blood supply to the bowel
abdominal angina |
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Term
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Definition
risk factors:generally younger patients
diffuse or periumbilical pain progresses over hours to RLQ pain
focal peritonitis of the retroperitonium may be tested by having the patient lie on the left side and extend the right hip-psoas sign
finger point tenderness @ McBurney's point
pain is accentuated by pressure changes
steadily worsening fever, leukocytosis |
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Term
| Acute Abdominal pain-causes |
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Definition
gall stone disease, etoh, recent binge, high triglycerides, certain medications
postprandial, mid abd. or diffuse pain radiating to the back
N/V |
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Term
|
Definition
blunt abd. trauma
llq pain
shock |
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Term
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Definition
risk factors: prior abd surgery, adhesions, hernia
key feature:unable to pass stool or flatus, feculent emesis, disended tympanic abdomen
partial obstruction;diarrhea
large bowel obstruction less painful
distention greater, often accompanied by occult blood
xray of abd supine and upright shows distension of loops in the small bowel with high air fluid levels and absence of gas in the large bowel=sbo |
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Term
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Definition
| chronic constipation with bowel obstruction;elderly,narcotics, and Ca++ blockers, constipation, hard stool on abdominal and rectal exam. |
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Term
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Definition
risk factors: elderly and h/o prior diverticulosis
LLQ pain develops usually over days
painless rectal bleeding
fever |
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Term
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Definition
risk factors:chron's disease, prior renal stone, gout, paroxysms of pain,writhing
pain radiates to genital, flank, groin
hematuria
spiral CT scan
(hyperparathyroidism) |
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Term
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Definition
valtrex 1 gm tid x 7 days
pain along dermatome with vesicular eruption
complications:post herpetic neuralgia |
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Term
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Definition
sexually active prior pid iud
sudden severe lower quadrant pain (one side)
pallor due to anemia
positive preg test
confirm with HCG will not rise with ectopic
pelvic ultrasound |
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Term
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Definition
risk:sexually active, prior std, iud,douching
severe lower abd. pain with fever shortly after menses
cervical motion tenderness
purulent discharge
abn. vag. bleeding
high ESR high WBC |
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Term
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Definition
| gerd,pud, biliary colic,ibs, ibd, obstipation,chronic mesenteric ischemia,atypical angina |
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Term
| Red flags in evaluation patients with abdominal pain |
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Definition
abnormal vital signs and peritoneal signs
dyspnea, pallor, cyanosis, hypotension, tachycardia, rigid abd=worrisome signs that need immediate evaluation
fever, sweats, weight loss, melena, cachexia worrisome symptoms-imaginging by CT scan. |
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Term
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Definition
narcotics not recommended
therapeutic trials with antacids and H2 blocker if suspected GERD or PUD
anticholinergis and high fiber diets if suspected IBS
antidepressant therapy for pt with abd.pain and depression |
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Term
| Causes for hospitalization of abd pain |
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Definition
severe pain of unclear cause
peritoneal signs, unstable vital signs,
suspected cholangitis, cholecystitis, bowel obstruction or perforation
appendicitis, aneurysmal leak, splenic rupture, ectopic pregnancy, tubo-ovarian abscess
pyleonephritis or PID wih vomiting that need IV fluids/antibiotics |
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Term
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Definition
narrow differential by acuity and location of pain.
order a pregnancy test/pelvic exam in young women if unclear cause
painful soft abd in elderly is ischemic bowel disease until proven otherwise
myocardial infarction and pulmonary embolus can masquerade as abdominal pain |
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Term
| Peptic Ulcer Disease-meds |
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Definition
metronidazole(flagyl) 250mg po qid x 14 days
PREVPAC:lansoprazole(prevacid)30mg po bid#28
amoxicillin 100mg po bid#28
clarithromycin(biaxin)500mg bid #28
Bismuth compounds (peptobismol)2 tabs po qid x14 days used in combination with antibiotics.
tetracycline 500mg po qud x 14 days
amoxicillin 100mg po bid x 14 days
clarithromycin (Biaxin)500 mg bid x 14 days |
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Term
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Definition
H2 receptor antagonists:
mechanism of action:binds to the receptor site, displacing histamine from the receptor binding sites and preventing simulation of gastric acid secretion and pepsin
therapeutic uses:used to heal gastric and duodenal ulcers in 4-6weeks (70-95% healing rate). |
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Term
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Definition
Cimetidine(Tagament)-300mg qid, 400mg bid, 800mg qhs
ranitidine(zantac)150mg bid, 300mg qhs,
famotidine(pepcid)20mg bid, 40mg qhs,
nizatidine(axid)150mg bid, 300mg qhs |
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Term
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Definition
inhibit acid secretory pump in gastric parietal cell by altering the activity of H+K+-ATPase(gastric proton pump)
inhibition of both basal and stimulate gastric acid secretion
superiro to H2 recepor Antagonists in healing duodenal lcers. better symptom relief. treat 8-16 weeks
adverse:h/a, diarhea, abd.pain, inc. lft's and alk phos.
*Inhibits CP450enzyme system and may interfere with metabolism of other drugs affected by this system |
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Term
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Definition
omerprazole(prilosec)20mg bid,40mg qhs
lansoprazole(prevacid)30mg bid-tid
pantoprazole(protonix)40mg qd
esomeprazole(nexium)40mg qd
rabeprazole(aciphex)20mg bid |
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Term
| antacids-alkaline compounds |
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Definition
magnesium hydroxide(MOM)
aluminum hydroxide(gavison,Amphogel)
Calcium carbonate(tums,rolaids)
sodium bicarbonate (alka seltzer)
combo products(Maalox, Mylanta) |
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Term
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Definition
Prostaglandin:Misoprostol(cytotec)
gastric ulcers induced by nsaids and asa
used prophylactically for patient on nsaids to prevent ulcer or with h/o ulcer
sheilds stomachs lining from the damage of acid by increasing mucous and bicarbonate production and by enhancing blood flow to the stomach
adverse:diarrhea, abd. pain, nausea, flatulence, h/a, dyspepsia, vomiting, constipation,vaginal spotting
200mcg qid |
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Term
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Definition
| diet:increase fiber, increase fluid,exercise, regular toilet regimen,laxatives |
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Term
| laxatives*bulk forming laxatives |
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Definition
absorbs water in the gut
increases stool bulk and moisture
stimulates peristalsis
1st line agent for symptomatic treatment of constipation
adverse:flatulence,diarrhea, stomach upset, fullness
caution:in patients with anatomical defects, & DM secondary to increased CHO
psyllium(metamucil,fiberall)
methycellulose (citrucel)
ca+ Polycabophil(fibercon) |
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Term
| surfactant laxatives,emollients, stool softners |
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Definition
decreases surface tension of liquids promoting incorporation of fat and liquid into stool, softening it
colace,surfak,mineral oil |
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Term
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Definition
exerts direct irritant action on colon promoting peristalsis
dulcolax,cascara,senna,castor oil |
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Term
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Definition
increases osmotic action drawing H2O into intestinal lumen of the small intestine and the colon, distending the bowel from fluid accumulation thus stimulating peristalsis and bowel evacuation
MOM,Epsom Salts,MGcitrate,fleets enema
s/s:dehydration, electroyte imbalances |
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Term
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Definition
produces osmoic effect in the colon distending the bowel from fluid accumulation, promoting peristalsis and bowel movements
golytely, lactulose, glycerin suppository,sorbitol |
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Term
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Definition
| an increase in the frequency of loose watery stools usually over a period of 24-48;a symptom of one of the following: bacterial infection,parasites,laxative abuse,impaction |
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Term
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Definition
opioids:act on smooth muscle of the intestinal tract to slow GImotility and propulsion;may be habit forming
diphenoxylate HCL 2.5/atropine SO4 0.025(Lomotil),Immodium, Paregoric
Absorbants act by binding bacteria and toxins in the GI tract
Kaopectate used for mild to moderate diarrhea;peptobismol used for mild to moderate diarrhea, indigestion, adjunct to H pylori
dark stool,discolored tongue, increased risk of toxicity with concurrent ASA, warfarin,hypoglycemics |
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Term
| Nausea and vomiting as predominant or initial symptom |
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Definition
acute:digitalis toxicity,ketoacidosis,opiate use,chemotherapy, early pregnancy,MI,drug withdrawal, binge drinking, hepatitis
Chronic:psychogenic vomiting,metabolic disurbances,gastric retention,bile reflux post gasric surgery, pregnancy |
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Term
| N/V in association with abdominal pain |
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Definition
| viral gastroenteritis, acute gastritis, food poisoning,PUD,acute pancreatitis,SBO,acute appendicitis,acute pyelonephritis,acute choleycytitis,MI |
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Term
| N/V associated with Neurologic Symptoms |
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Definition
| increased intracranial pressure, midline cerebellar hemorrhage,migraine headaches,autonomic dysfunction |
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Term
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Definition
antimuscarinic agents:5HT3 receptor agonists:used befor chemo or in OR-zofran/kytril
dopamine antagonists(phenohiazines):compazine, phenergan
butyrophenones and benzodiazapines:ativan,valium,haldol |
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Term
|
Definition
antihistamines and anticholinergics:
scopalamine,benadryl, anivert, atarax,dramamine,
other antiemetics:reglan, glucocorticoids, cannabinoids(marinol) |
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Term
| differential dx acute diarrhea |
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Definition
viruses
bacterial toxins:staph & clostridium
Bacteria:salmonella & shigella
protozoa:giardia lmablia, entamoeba histolytica. |
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Term
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Definition
drugs:
laxatives,antibiotics,caffeine, alcohol |
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Term
| chronic/recurrent diarrhea |
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Definition
protozoa Inflammation:ulcerative colitis,crohns,ischemic colitis
functional:IBS,diverticulosis
tumors malabsorption:celiac sprue,lactase deficiency,pancreatic insufficiency;post surgical,cirrhosis,DM
addisons,thyroid |
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Term
| Diagnostic tests-diarrhea |
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Definition
stool culture and sensitivity
ova & parasites x 3
fecal fat:qualitative
U/S abdomen,CT scan Abd,CBC |
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Term
|
Definition
antidiarrheal agents:opioids-act on smooth muscle of the intestinal tract to slow gi motility and propulsion;may be habit forming
opioid preparations:lomotil, immodium, paregoric
absorbents:act by binding baceria and toxins in the GI tract:Kaopectate used for mild to mod. diarrhea
peptobismol-used for mild to mod diarrhea,indigestion,adjunct to H pylori-dark stool, discolored tongue, increased risk of toxicity with concurrent ASA, warfarin, hypoglycemics |
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Term
| Treatment for Travelers Diarrhea |
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Definition
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