Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
399 Cards in this Set
- Front
- Back
|
What age group are gastric ulcers most common in?
|
55-65
|
|
|
What are causes of peptic ulcer disease?
|
H. pylori
medicaions ushc as NSAIDS, ASA and glococorticoids smoking (more common in people who smoke > 1/2 PPD) stree is possibly a risk factor |
|
|
Are alcohol and diet factors in PUD?
|
they are not believed to be.
|
|
|
What are signs and symptoms of duodenal ulcers?
|
Gnawing epigastric pain characterized by rhymicity and periodicity
pain well localized t the epigastrium relied of pain with eating |
|
|
What are signs and symptoms of gastric ulcers?
|
gnawing epigastric pain characterized by rhythmicity and periodicty
pain well localized to epigastrium pain worsens with eating |
|
|
If someone has a gastric ulcer does pain usually improve, or worsen with eating?
|
worsen
|
|
|
If someone has a duodenal ulcer is pain usually relieved or worsened with eating?
|
relieved
|
|
|
If someone is suspected to have an ulcer and the pain improves with eating, what type of ulcer is it likely to be?
|
duodenal
|
|
|
If someone has an ulcer and it worsens with eating, which type of ulcer is it likely to be?
|
gastric
|
|
|
What are signs of GI bleeding?
|
melena, hematemesis, coffee grounds emesis
|
|
|
What are signs, symptoms PE findings of someone with a peptic ulcer perforation?
|
severe epigastric pain, board like abdom, rigidity
|
|
|
What will cause a bowel perph in adults?
|
ulcer
diverticulum appendix |
|
|
What lab tests are used in diagnosing PUD?
|
CBC to reflect bleeding
serology or urea breath test for H. pylori |
|
|
What will an X-ray show in someone who has a bowel perf?
|
air under the diaphragm
|
|
|
How should a patient be evaluated after treatment for PUD?
|
endoscopy after 8-12 weeks of treatment
|
|
|
What is the first line treatment for someone with PUD?
|
H2 receptor antagonists
|
|
|
Name some H2 receptor antagonists.
|
Cimetidine (tagamet)
Ranitidine (Zantac) Famotidine (pepcid) nizatidine (axid) |
|
|
What type of drug are:
Cimetidine (tagamet) Ranitidine (Zantac) Famotidine (pepcid) nizatidine (axid) |
H2 receptor antagonists
|
|
|
What is second line treatment for PUD?
|
Proton pump inhibitors
|
|
|
Name some proton pump inhibitors.
|
Lansoprazole (prevacid)
Rabeprazole (Aciphex) Pantoprazole Ompeprazole (prilosec) |
|
|
What type of drug are?
Lansoprazole (prevacid) Rabeprazole (Aciphex) Pantoprazole Ompeprazole (prilosec) |
Proton pump inhibitors
|
|
|
What drugs can be used for PUD in addition to Acid-abtusecretory agents?
|
Mucosal protective agents:
sulcarafate bismuth subsalicylate misoprostal antacids |
|
|
How should mucosal protective agents be taken?
|
2 hours apart from other medications
|
|
|
How does bismuth subsalicylate (pepto bismal) help in PUD?
|
it has a direct antibacterial action against H. pylori
it promotes prostaglandin production/ stimulates gastric bicarbonate |
|
|
How does misoprostal (cytotec) help in PUD?
|
It is used as prophylaxis against NSAID induced ulcers. It stimulates mucous and bicarbonate production
|
|
|
What drug is used as prophylaxis against NSAID induced ulcers?
|
Misoprostal (cytotec)
|
|
|
What type of patient should not be given misoprostal (cytotec)?
|
pregnant ones
|
|
|
What drug should not be give to pregnant women with PUD?
|
misoprostal
|
|
|
How is a patient with H pylori treated?
|
2 antibiotics plus either a proton pump inhibitor or bismuth for about 7 days. They should then take antiulcer therapy for 4-7 weeks to ensure symptoms relief and promote ulcer healing
|
|
|
What are some drugs used to treat H.Pylori?
|
metronidazole, omeprazole and clarithromycin
metronidazole, omeprazole and amoxicillin bismuth subsalicylate, metronisazole and tetracycline |
|
|
What is the management for someone with a perforated peptic ulcer?
|
hospital
obtain IV access baseline lab studies- CBC, PT, PTT, BMP O2 endoscopy urinary catheterization nasogastric tube for lavage withhold foods and antacids IV H2 blockers GI/surgical evaluation |
|
|
What is the patho behind GERD?
|
there is backflow of acidic gastric contents into the esophagus.
Caused by incompetent lower esophageal sphincter incompetence and delayed gastric emptying |
|
|
What are the signs and symptoms of GERD?
|
retrosternal burning
bitter taste in mouth belching excessive salivation frequent occur at night or in recumbent position may be relieved by sitting up, antacids, water or food |
|
|
What are some diagnostic tests that can be done in someone suspected of having GERD?
|
Upper GI series or esophagogastroduodenoscopy (EGD) to rule out cancer, Barretts esophagus or peptic ulcer disease
|
|
|
What are nonpharmacologic options for managing GERD?
|
elevate head of bed
avoid alcohol, caffeine, spices, peppermint, etc stop smoking weight reduction if obese |
|
|
What are pharmacologic options for managing GERD?
|
Antacids PRN
H2 blockers proton pump inhibitors if H2 blockers are ineffective or erosive esophagitis is present Should follow up in 2 weeks and if symptoms are improved continue therapy for 8 weeks |
|
|
What is gastroenteritis?
|
a nonspecific term usually applied to a syndrome of acute nausea, vomiting, diarrhea and cramping resulting from an acute inflammation/irriation of the gastric mucosa
|
|
|
What are some causes of gastroenteritis?
|
viruses (more common during the winter)
bacterial parasitic emotional stress |
|
|
What are signs, symptoms and PE findings of gastroenteritis?
|
nausea/vomiting
watery diarrhea anorexia abdominal cramping general sick feeling hyperactive bowel sounds abdominal distention fever tachycardia hypotension |
|
|
When are lab tests indicated and what lab tests are indicated for an adult with gastroenteritis?
|
Lab tests are only indicated if symptoms persist >72 hours or if blood is noted in the stool.
Stool culture for WBC and O&P Stool guiac |
|
|
What is the non pharmacologic management for gastroenteritis?
|
supportive care
fluids for rehydration (clear liquids, progressing) |
|
|
What are antibiotics indicated in gastroenteritis
|
Antibiotics are indicated when an organism is isolated, leukocytes or dysentery are present, shigella is present, the patient is having >8-10 stools per day or the patient is immunocompromised
|
|
|
When are antimotility medications contraindicated in someone with gastroenteritis?
|
When there is blood in the stool or fever
|
|
|
What drugs can be used for travelers diarrhea prophylaxis?
|
bismuth subsalicylate
lactobacillus ciprofloxacin, norflxacin rifaximin |
|
|
What is hepatitis in general terms? What is it caused by?
|
inflamation of the liver with resultant liver dysfunction
Caused by viral (types A, B, C, D, E, and G) autoimmune alcoholic |
|
|
How is hepatitis A transmitted?
|
Mainly via the oral fecal route. Common source of outbreaks result from comtaminated water and food, poor sewage. Can also occur from sexual contact with body secreations.
|
|
|
What is the mortality rate associated with Hepatitis A?
|
Very low
|
|
|
How is Hepatitis B spread?
|
serum, saliva, semen and vaginal secreations, via blood and blood products, sexual activty and mother-fetus transmission
|
|
|
How is Hepatitis C spread?
|
traditionally with blood transfusion. Now mainly through IV drug use
Often the source of infection is unknown |
|
|
What are the signs and symptoms of viral hepatitis?
|
Pre-icteric: fatigue, malaise, anorexia, n/v, headache, aversion ro smoking and alcohol
Icteric: weight loss, jaundice, pruritis, RUQ pain, clay colored stool, dark urine, low grade fever may be present, hepatosplenomegally may be present |
|
|
What sill the laboratory tests reflect in someone with viral hepatitis?
|
WBC low to normal
UA- proteinuria, lulirubinuria Elevated AST and ALT (500-2000 IU/L) LDH, bilirubin, alkaline phosphatase and PT normal or slightly elevated |
|
|
What serology testing is done to diagnose someone with Hepatitis A?
|
Anti HAV IgM implies recent infection. It peaks during the first week of clinical illness and disappears in 3-6 months. This is diagnostic of acute Hep A.
Anti- HAV IgG implies previous exposure and confers immunity. The presence of IgG aline is not diagnostic of acute HAV indection. It indicates previous exposure, noninfectivity and immunity to recurring HAV infection. |
|
|
What test is most important for diagnosing ACUTE hepatitis A infection?
|
Anti HAV IgM implies recent infection. It peaks during the first week of clinical illness and disappears in 3-6 months. This is diagnostic of acute Hep A.
|
|
|
How can you test someone to see if they are immune to Hep A?
|
Anti-HAV IgG
|
|
|
What lab test indicates active virus? What lab test indicated recovered virus?
|
Active- IgM- (M for immediatly)
Recovered- IgG (G for GONE) |
|
|
What serology tests are helpful in diagnosing Hepatitis B?
|
Active Hep B- HBsAg, HBeAg, Anti-HBc, IgM
Chronic Hep B- HBsAg, Anti-HBc, Anti-HBe, IgM and IgG Recovered Hep B- Anti-HBc, Anti-HBsAg |
|
|
What does Hepatitis B surface antigen (HBsAg)tell you?
|
It is the first efidence of HBV infection. It remains positive in asymptomatic carriers and chronic hapatitis B patients.
|
|
|
What does Anti-Hbc indicate?
|
Antibody to hepatitis B core antigen is a marker of acute, chronic, or resolved HBV infection. It is not a marker of vaccine-induced immunity. It may be used in prevaccination testing to determine previous exposure to HBV infection.
|
|
|
What does HBeAg indicate?
|
It is a protein derived from HBV core. It indicates circulating HBV and hihghly infectious sera. Its presence indicates viral replication and infectivity.
|
|
|
What does Anti-HBe indicated?
|
If appears after HBeAg disappears. It signifies diminished viral replication and decreased infectivity.
|
|
|
What serology would indicate active Hep B infection?
|
HGsAg, HBeAg, Anti-HBc, Igm
|
|
|
What would you conclude about someone from the following serology?
HGsAg, HBeAg, Anti-HBc, Igm |
Active Hep B infection
|
|
|
What serology would indicate Chronic Hep B infection?
|
HBsAg, Anti-HBc, Anti-HBe, IgM and IgG
|
|
|
What would you conclude from the following serology? HBsAg, Anti-HBc, Anti-HBe, IgM and IgG
|
They have chronic Hep B infection
|
|
|
What sould the serology indicate for someone with recovered hepatitis B infection/
|
Anti-HBc, anti-HBsAg
|
|
|
What could you conclude about a patient with the following serology?
Anti-HBc and Anti-HBsAg |
Recovered Hep B
|
|
|
What tests are used for the diagnosis of hepatitis C?
|
Enzyme immunoassay to detect the presence of antibodies to Hep C
RIBA assay detects antibodies to HCV PCR (polymerase chain reaction) is used to differentiate prior exposire from current viremia |
|
|
What serology would you find in someone with Hep C?
|
Anti-HCV, HCV RNA
|
|
|
What disgnosis would you make in someone with Anti-HCV and HCV RNA?
|
Acute Hep C or chronic hep C
|
|
|
What is the management for viral hepatitis?
|
Generally suportive- rest during active phase of infection
increase fluids to 3000-4000 cc/day aviod alcohol/drugs/substances detoxified by the liver NO Protein diet Vitamin K for a prolonged PT >15 seconds Lacutlose orally or rectally for elevated ammonia level If sedation is needed use oxazepam (serax) |
|
|
What is diverticulitis?
|
An inflammation or localized perforation of one or more diverticula with abscess formation
|
|
|
What are risk factors for diverticulitis?
|
More common in women than in men
Higher incidence in those with diet low in dietary fiber |
|
|
What are the signs, symptoms and PE findings of diverticulitis?
|
Mild to moderate aching abdominal pain in the LLQ
Constipation or loose stools may be present Nausea and vomiting low grade fever LLQ tenderness to palpation patients with perforation perforation present with a more dramatic picture and peritoneal signs |
|
|
What do laboratory/diagnostic tests suggest in someone with diverticulitis?
|
mild to moderate leukocytosis
elevated ESR stool heme + in 25% of cases sigmodoscopy shows inflamed mucose may condider CT scan to evaluate abscess plain abdominal films are obtained on all patients to look for ecidence of free air (perph) |
|
|
What is the management of diverticulitis?
|
a lot depends on the condition of the patient.
NPO IV fluids to maintain hydration IV antibiotics (Metronidazole, ciprofloxacin, ceftazidine, clindamycin, ampicillin) If GI pleeding is present treat like PUD Surgical consultation |
|
|
What is irritable bowel syndrome?
|
A clinical condition of uncertain cuase characterized by lower abdominal pain and alternationg diarrhea and/or constipation
|
|
|
Who is at risk for irritable bowel symdrome?
|
people with high stress
greater incidence in women |
|
|
How common is irritable bowel syndrome?
|
affects approximatly 10-12% of the population
|
|
|
When is the typical onset of irritable bowel syndrome?
|
late teens to early 20s
|
|
|
What are the signs and symptoms of irritable bowel syndrome?
|
abdominal cramping
abdominal pain relieved by defication patient may be preoccupied with bowel symptoms changes in stool sonsistency and/or pattern dyspepsia fatigue c/o anxiety and depression are common |
|
|
What are physical exam findings in someone with irritable bowel syndrome?
|
essentially none
may appear anxious or depressed |
|
|
What studies can be considered in someone with symptoms of irritable bowel syndrome?
|
sigmoidoscopy
barium studies rectal exam electrolytes |
|
|
What is the management for someone with irritable bowel syndrome?
|
emotional support- refer for couseling/therapy as needed
recommend a high fiber diet for severe cases may employ anticholinergic, antidiarrheal and/or antidepressant agents as warrented |
|
|
What is cholecystitis?
|
inflammation of the gallbladder. It is associated with gallstones in >90% of cases.
|
|
|
What are the symptoms of cholecystitis?
|
often percipitated by a large or fatty meal
Sudden appearance of steady, severe pain in epigastrium or right side. Vommiting often brings relief |
|
|
What are physical exam findings in patients with cholecystitis?
|
Murphys sign
RUQ tenderness to palpatation, palpable gallbladder in 15% of cases muscle guarding and rebound pain fever |
|
|
What is Murphy's sign? In what condition is it found?
|
examiner places fingers under the ribcage. deep pain is felt on inspiration.
It is associated with cholecystiis |
|
|
What do laboratory/diagnostic tests reflect in someone with cholecystitis?
|
WBC's 12-15,000
serum bilirubin may be elevated serum ALT, AST, LDH and Alk phosphate levels are increased amylase may be elevated plain folms may show radiopaque gallstones ultrasound or hida scan may show disease/inflamation/gallstones |
|
|
What is the management for someone with cholecystitis?
|
pain management
NGT for gastric decompression Maintain NPO crystalloid solutions IV broad spectrum antibiotics surgical consultation for laparoscopic cholecystectomy |
|
|
What is a bowl obstruction?
|
A complete blockage of the lumen of the intestine that impedes the passage of gas and contents through the bowl
|
|
|
What are the causes of a bowl obstruction?
|
adhesions
hernia volvulus tumors fecal impaction ileus (functional obstruction) |
|
|
What are symptoms of a bowel obstruction?
|
cramping periumbilical pain initially, later becomes constant and diffuse
vomiting within minutes of pain (if proximal blockage) to 2 hours of pain (if a distal blockage) No fever |
|
|
What are the physical exam findings for someone with a bowel obstruction?
|
abdominal distension
mild tenderness but no peritoneal findings, high pitched, tinkling bowl shounds, unable to pass stool/gas |
|
|
How can youo determine if a bowel obstruction is proximal or distal?
|
In a proximal bowel obstruction there is vomiting within minutes of pain and minimal abdominal distention.
If the obstruction is distal there is vomitting within two hours of pain and pronounces abdominal distention. |
|
|
How is a bowel obstruction diagnosed?
|
plain X ray films show dilated loops of bowel and air-fluid levels.
Horizontal pattern in SBO. Frame pattern in LBO. |
|
|
What is the management of a patient with a bowel obstruction?
|
Fluid resuscitation
NGT suction broad spectrum antibiotics surgical intervention in all cases of complete obstruction In partial obstruction, may treat medically |
|
|
What is ulcerative colitis?
|
An idiopathic inflammatory condition characterized by diffuse mucosal inflamation of the colon. It always involves the rectum and may extend upward involving the whole colin. The disease is characterized by stmptomatic episodes and remissions.
|
|
|
What is the hallmark symptom of ulcerative colitis?
|
bloody diarrhea
|
|
|
How is the diagnosis of ulcerative made?
|
sigmiodoscopy establishes the diagnosis
|
|
|
How is ulcerative colitis managed?
|
mesalamine (canasa) suppositories or enemas
hydrocortisone suppositories and enema |
|
|
Who is at increased risk for colon cancer?
|
patients with a family history or colon cancer or other adenocarcinomas, high fat/refined carbohydrate diet, polyps, or inflammatory bowel disease
|
|
|
What are ths symptoms of colon cancer?
|
often asymptomatic until complications occur (bowel obstruction) or found during routine screening.
changes in bowel habits thin, "pencil like" stools, anorexia, weight loss |
|
|
What are physical findings in colon cancer?
|
abdominal or rectal mass is possible
occult fecal blood may be present |
|
|
What diagnostic tests can aid the diagnosis of colon cancer?
|
stool may be guiac positive
colonoscopy will show cancer Carcinoembryonic antigen will be elevated. The normal is <2.5 for nonsmokers, <5 for smokers |
|
|
What is the management of colon cancer?
|
surgical consult followed by oncology consult
pain management supportive care patient/family education |
|
|
What causes appendicitis?
|
inflammation of the appendix, precipitated by obstruction of the appendiceal lumen. It can be from fecalith, foreign body, inflammation or neoplasm.
|
|
|
What can happen if appendicitis is not treated?
|
gangrene and perforation may develop within 36 hours
|
|
|
How common is appendicitis?
|
it effects 10% of the population
|
|
|
What age group/sex is more effected by appendicitis?
|
men
18-30 years of age |
|
|
What are the signs and symptoms of appendicitis?
|
begins with vague, colicky umbilical pain
after several hours pain shifts fo RLQ Nausea with 1-2 episodes of vomiting (more suggests another diagnosis) Pain worsens and localizes with coughing |
|
|
What are physicl findings in appendicitis?
|
fever- low grade (high grade suggests perf or another diagnosis)
RLQ guarding with rebound tenderness Psoas sign obturator sign positive rosvig's sign local abdominal tenderness |
|
|
What is the Psoas sign? What diagnosis does it indicate?
|
Pain with right thigh extension. Indicates appendicitis.
|
|
|
What is the obturator sign? What does it indicate?
|
Pain with internal rotation of flexed right thigh. Indicates appendicitis.
|
|
|
What is the a positive Rosvigs sign? What dose it idicate?
|
RLQ pain when pressure is applied to the LLW. It is suggestive of appendicitis.
|
|
|
How is appendicitis diagnosed?
|
WBC 10,100-20,000
CT or ultrasound is diagnostic |
|
|
What is the management for appendicitis?
|
Surgical treatment
IV abx iV fluids pain management |
|
|
What are causes of acute bronchitis?
|
viral (rhinovirus, coronavirus, adenovirus)
Bacterial (mycoplasma pneumoniae, streptococcus pneumoniae, H. Flu, moraxella catarrhalis) |
|
|
In whom is acute bronchitis more common?
|
smokers
people under 55 |
|
|
What are signs and symptoms of acute bronchitis?
|
productive cough
headache chest pain wheeze fever (higher in bacterial bronchitis) |
|
|
What are the physical findings in acute bronchitis?
|
NO EVIDENCE OF LUNG CONSOLIDATION
clear to auscultation resonant to percussion upper airway rhonchi clears with cough afebrile or low grade temperature (viral) more pronounced temperature (bacterial) |
|
|
How can acute bronchitis be differentiated from pneumonia?
|
In bronchitis there is no evidence of consolidation
|
|
|
What laboratory/diagnostic test can be used in evaluating someone with suspected acute bronchitis?
|
Usually none are indicated
If diagnosis is unclear, sputum culture and sensitivity and chest radiograph can be done |
|
|
What is the management of acute bronchitis?
|
supportive treatment
humidifiers increased fluid intake cough suppressants used judiciously- when cough interferes with significantly with daily function analgesics for chest pain and feverB2 adrenergic agonist for wheeze (albuterol) Antibiotics only indicated for bacterial infections (macrolides, doxycycline, trimethoprim-sulfamethoxazole) |
|
|
What is asthma?
|
A condition characterized by an increased responsiveness of the trachea and bronchi to various stimula and manifested by widespread narrowing of the airways, hypertrophy of smooth muscles, mucosal edema and hyperemia, thickening of epithelial basement membrane, hypertrophy of mucus glands, acute inflammation and plugging of airways by thick viscid mucous
|
|
|
What are exacerbates asthma?
|
Dust mites
pets cockroaches indoor molds exercise cigarette smoke |
|
|
What are signs and symptoms of asthma in an adult?
|
respiratory distress at rest
difficulty speaking diaphoresis use of accessory muscles respiratory rate >28 pulse >110 pulsus paradoxus >12mmHg (this is unique to asthma) hyperressonance on percussion Cough chest tightness |
|
|
What are ominous signs in an asthmatic adult?
|
fatigue, absent breath sounds, inability to maintain recumbency, cyanosis
|
|
|
What type of respirtory dysfunction is asthma?
|
obstructive
|
|
|
When is hospitalization recommended (based on FEV1) for an adult with asthma?
|
If FEV1 is <30% predicted or does not increase to at least 40% predicted after 1 hour of vigerous therapy.
|
|
|
When is hospitalization recommended (based on peak flow) for an adult with asthma?
|
If peak flow is <60 liters/minute initially or does not improve to >50% after 1 hour of treatment
|
|
|
What improvement do you expect to see in FVC/FEV1 after inhailed bronchodilator?
|
15%
|
|
|
What will the ABG reflect in someone with uncontrolled asthma?
|
respiratory alkalosis with mild hypoxemia
|
|
|
What is the management of asthma?
|
Step 1
Short acting B2 adrenergic agonist (albuterol) for symptomatic relief or before exercise Step 2 Daily maintenance with inhaled corticosteriods (pulmicort, azmacort) Short acting B2 adrenergic agonist for breakthrough symptoms. Step 3 If symptoms persist despite increase in corticosteriod, add a long acting B2 adrenergic agonist (serevent) Other options include inhailed anticholinergics (atrovent)- good if patient has a lot of secreations. Antileukotrienes are useful in the maintenance of chronic asthma (singulair, accolate) |
|
|
What conditions are included in the term COPD?
|
Chronic bronchitis and emphysema. Patients usually have symptoms of both.
|
|
|
What characterizes chronic bronchitis?
|
excessive secretion of bronchial mucus, manifested by productive cough for 2 months or more in at least 2 consecutive years in the absence of any other disease that could account for the symptom.
|
|
|
What characterizes emphysema?
|
Abnormal, permanent enlargement of air spaces distal to the terminal bronchiole
|
|
|
What are signs and symptoms of chronic bonchitis?
|
Itermittent to moderate dyspnea
onset of symptoms after age 35 copious purulent sputum production Stocky, obese body Chest AP diameter normal Percussion norma hematocrit increased hypercapnea, and hypozemia on ABG |
|
|
Do the following symptoms describe emphysema or chronic bronchitis?
Itermittent to moderate dyspnea onset of symptoms after age 35 copious purulent sputum production Stocky, obese body Chest AP diameter normal Percussion norma hematocrit increased hypercapnea, and hypozemia on ABG |
Chronic bronchitis
|
|
|
What are the signs and symptoms of emphysema?
|
Progressive, constant dyspnea
onset of symptoms after age 50 mild clear sputum body is this and wasted Chest A-P diameter is increased percussion is hyperresonant bulla and blebs on CXR hyperinflation on CXR hematocrit is normal total lung capacity is increased |
|
|
What lab/diagnostic findings help in the diagnosis of COPD?
|
Low, flattened diaphragm by CXR
FEV1 and all other measurements of expiratory airflow reduced TLC, FRC and RV may be increased Increased paCO2 increased HCO3 |
|
|
How is COPD managed as an outpatient?
|
discontinuation of smoking
avoidance of irritants or allergens postural drainage may clear excess secretions inhaled ipratropium bromide or sympathomimetics are the mainstay of therapy |
|
|
What is the patho behind pneumonia?
|
Inflammation of the lower respiratory tract as microorganisms gain access by aspiration, inhalation or hematogenous dissemination.
|
|
|
What is the most commonetilogical agent of community aquired pneumonia?
|
Strep pneumonia
|
|
|
What are the signs and symptoms of pneumonia?
|
Fever/shaking chills
purulent sputus lung consolidation on physical exam malaise increased tactile fremitus |
|
|
What is involved in the diagnosis of pneumonis?
|
Elevated WBC
infiltrates seen on CXR GS and culture if indicated ABG if respiratory failure is suspected blood cultures |
|
|
Is a patient diagnosed with community aquired pneumonia is generally healthy, less than 60 yrs old, has no comorbidities and has taken no recent antibiotic therapy, what would you treat him with?
|
A macrolide such as azithromycin, clarithromycin or erythromycin or doxycline
|
|
|
If a patient with community aquired pneumonia has health problems like COPD, diabetes, heaty failure or cancer or is >60 years old and has not taken any recent antibiotic therapy, what would you treat him with?
|
Fluoroquinlone such as levofloxacin, gatifloxacin, gemifloxacin or moxifloxicin
|
|
|
How should nosocomial pneumonia be treated?
|
cefepime
meropenem pipercillin |
|
|
How should a patient with pseudomonal nosocomial pneumonia be treated?
|
double drug coverate is appropriate such as antipseudomonal penicillin and levoflozacin, meropenem, aminoglycoside or aztreonam
|
|
|
What systems can be effected by TB?
|
pulmonary, lymphatics, genitourinary, bone, meninges, peritoneum, heart
|
|
|
What people are at risk for TB?
|
people with HIV
institutionalized people those in crowded living conditions those with diabetes, chronic renal insufficiency, malignancy, malnutrition and other forms of immunosuppression |
|
|
What are signs and symptoms of TB?
|
majority of patients are symptomatic
fatigue and anorexia dry cough progressing to productive, sometimes blood tinged weight loss, low grade fever night sweats pleuritic chest pain |
|
|
What is the laboratory diagnosis of someone with TB?
|
Definitive diagnosis is by culture of M. Tuberculosis x3
AFB smears are presumptive edivence of active TB small homogeneous infiltrate in upper lobes by CXR PPD shows exposure but is not diagnostic |
|
|
What is the management for TB?
|
Isonizid, rifampin, pyrazinamide and ethambutol or streptomycin. If the TB isolate proves to be fully susceptable to ING and RIF, then the fourth drug may be dropped. The 3 drugs should be continued daily for 8 weeks, then rifampin and INH should continue for 16 weeks.
|
|
|
How long should TB therapy be continued for someone with HIV?
|
9 mo
|
|
|
How should a patient be monitored while on pulmonary TB therapy?
|
Sputum smears and cultures weekly for the first 6 weeks after initiation of therapy, then monthly until negative cultures are documented.
|
|
|
When would you be suspicious that a case of TB is drug resistant?
|
If symptoms continue or cultures are positive after 3 months of treatment
|
|
|
What is involved in the baseline evaluation for a patient diagnosed with TB before starting treatment?
|
LFTs, CBC, serum cretinine. Patients with normal baseline labs do not require monthly labs, but should be questioned about symptoms of drug toxicity.
|
|
|
What testing should patients taking ethambutol have?
|
visual acuity and red-green color perception
|
|
|
If a patient has a positive skin test for TB, but a negative CXR, what should you do?
|
Treat them with INH for 6 mo
|
|
|
What size PPD is considered positive for someone with HIV, contacts of a known case, or persons with a chest film typical for TB?
|
5mm
|
|
|
When is a PPD reading of 5mm considered to be positive?
|
in someone with HIV, a contact of someone with known TB, or a person with a chest film typical for TB.
|
|
|
When is a PPD reading 10mm considered to be positive?
|
for immigrants from high prevalence areas, or those in high risk groups, health care workers
|
|
|
When is a PPD of 15 mm considered to be positive?
|
For everyone
|
|
|
What size PPD is considered to be positive for immigrants from high prevalence areas, those in high risk groups and healthcare workers?
|
10mm
|
|
|
What size PPD is considered to be positive for the general population?
|
15mm
|
|
|
What is the leading cause of cancer deaths in the US?
|
lung cancer
|
|
|
What are causes of lung cancer?
|
smoking
asbestos exposure |
|
|
In what age group is lung cancer most common?
|
50-70
|
|
|
What are the signs and symptoms of lung cancer?
|
smokers cough
dyspnea chest pain fatigue weight loss/anorexia hemopytisis |
|
|
What are physical exam findings in someone with lung cancer?
|
may not be significant
localized wheeze area of dullness to percussion |
|
|
What lab/diagnostic tests are used in making the diagnosis of lung cancer?
|
chest radiograph
sputum for cytology bronchoscopy with biopsy CT scan of chest |
|
|
How is lung cancer managed?
|
Physician referral
supportive care pain management |
|
|
What pulmonary function tests measure airflow rates?
|
FVC
FEV1 FEV25-75 PEFR |
|
|
What pulmonary function test measure volume?
|
TLC
FRC RV |
|
|
What characterizes obstructive lung diseases?
|
reduced airflow rates with lung volumes in the normal range or larger
|
|
|
What characterizes restrictive lung diseases?
|
reduced volumes and expiratory flow rates
|
|
|
What type of lung disease are characterized by reduced volumes?
|
Restrictive
|
|
|
What type of lung diseases are characterized by reduced airflow rates with lung volumes normal or larger?
|
Obstructive diseases
|
|
|
What lung disease are obstructive?
|
Asthma
COPD |
|
|
What lung disease are restrictive?
|
Pneumonia
ARDS Sarcodosis |
|
|
Asthma and COPD are _____ lung diseases.
|
obstructive
|
|
|
Pneumonia, ARDS, Sarcodosis are ____ lung diseases?
|
restrictive
|
|
|
What is FVC?
|
the volume of gas forcefully expelled from the lungs after maximal inspiration
|
|
|
What PFT measures the volume of gas forcefully expessed from the lungs after maximal inspiration?
|
FVC
|
|
|
What is FEV1?
|
The volume of gas expelled in the first second of the FVC maneuver
|
|
|
What PFT measures the volume of gas expelled in the first second of the FVC maneuver.
|
FEV1
|
|
|
What is FEV25-75?
|
The maximal mid-expiratory airflow rate
|
|
|
What PFT measures the maximal mid-expiratory airflow rate?
|
FEV25-75
|
|
|
What is the PEFR?
|
the maximal airflow rate achieved in FVC maneuver
|
|
|
What is the PFT for the maximal airflow rate achieved in the FVC maneuver?
|
PEFR
|
|
|
What is the TLC?
|
the volume of gas in the lungs after maximal inspiration
|
|
|
What PFT measures the volume of gas in the lungs after maximal inspiration?
|
TLC
|
|
|
What is the FRC?
|
functional residual capacity
|
|
|
What is the RV?
|
the volume of gas remaining in the lungs after maximal expiration
|
|
|
What is the PFT that measures the volume of gas remaining in the lungs after maximal expiration?
|
RV
|
|
|
Name and define 4 types of pleural effusions.
|
Transudate: clear fluid
Exudate: increased protein content in the pleural fluid, creamy/tan fluid Empyema: pus hemorrhagic: blood |
|
|
What causes the s1 heart sound?
|
the closure of the av valves
|
|
|
Name the AV valves.
|
tricuspid (right)
Mitral (left) |
|
|
What causes the s2 heart sound?
|
the closure of the semilunar valves
|
|
|
Name the semilunar valves.
|
aortic
pulmonic |
|
|
When is systole (by auscultation)?
|
the period between S1 and S2
|
|
|
When is diastole (by auscultation)?
|
The period between s2 and s1
|
|
|
What is the S3 heart sound associated with?
|
increased fluid states, such as pregnancy and CHF
|
|
|
What heart sound might you hear in an increased fluid state, such as pregnancy and CHF?
|
s3
|
|
|
What is the s4 heart sound associated with?
|
a stiff ventricular wall- previous MI, chronic hypertension, L ventricular hypertrophy
|
|
|
What does mitral stenosis sound like?
|
loud S1 murmur, low pitched, mid-diastolic, apical crescendo rumble
|
|
|
What does mitral regurgitation sound like?
|
s3 with systolic murmur at 5th intercostal MCL. May radiate to base of left axilla, musical, blowing, or high pitched
|
|
|
What does aortic stenosis sound like?
|
systolic, blowing, rough harsh murmur at 2nd right ICS, usually radiating to the neck
|
|
|
What does aortic regurgitation sound like?
|
A distal, "blowing murmur at the 2nd left ICS.
|
|
|
Where are aortic murmurs heard?
|
High up in chest- 2nd or 3rd intercostal
|
|
|
Where are mitral murmurs heard?
|
midchest, 5th intercostal, nipple line
|
|
|
What does the memory trick Ms. Ard and Mr. Ass stand for?
|
Mitral
Stenosis Aortic Regurgitation Diastolic Mitral Regurgitation Aortic Stenosis Sytolic |
|
|
What is heart failure?
|
a syndrome that results when the cardiac output is insufficient to meet the metabolic needs of the body
|
|
|
What is acute heart failure?
|
it has an abrupt onset that usually follows an acute MI or valve rupture
|
|
|
What is chronic heart failure?
|
It develops as the result of inadequate compensatory mechanisms that have been employed over time to improve cardiac output
|
|
|
What is acute heart failure also called?
|
Left sided heart failure
|
|
|
What is chronic heart failure also called?
|
Right sided heart failure
|
|
|
What is another name for left sided heart failure?
|
acute heart failure
|
|
|
What is another name for right sided heart failure?
|
chronic heart failure
|
|
|
What is systolic heart failure?
|
The inability to contract results in decreased cardiac output
|
|
|
The inability to contract, resulting in decreased cardiac output is what type of heart failure?
|
systolic heart failure
|
|
|
The inability to relax and fill resulting in decreased cardiac output is what type of heart failure?
|
diastolic heart failure
|
|
|
What is diastolic heart failure?
|
the inability to relax and fill resulting in decreased cardiac output
|
|
|
What type of drug is needed in someone with systolic heart failure?
|
digoxin
|
|
|
What type of drug is needed in someone with diastolic heard failure?
|
a vasodilator
|
|
|
What are ths signs and symptoms of left sided (acute) heart failure?
|
Think blood backs up into lungs:
Dyspnea at rest coarse rales over all lung fields wheezing, frothy cough S3 gallop appears generally healthy except for the acute event murmur of mitral regurg |
|
|
What are the signs and symptoms of right sided (chronic) heart failure?
|
Think blood backing up into body:
fatigue on excertion dependent edema abdominal fullness paroxysmal nocturnal dyspnea appears chronically ill hepatomegaly, splenomegaly JVD Diffuse chest wall heave displaced PMI S3 and/or S4 |
|
|
What might an ABG show in someone with heart failure?
|
hypocapnia
|
|
|
What might the BMP show in someone with ABG?
|
it is usually normal unless chronic failure
|
|
|
What might the chest X-ray show in someone with heart failure?
|
pulmonary edema
Kerleys B lines effusions |
|
|
What are Kerleys B lines?
|
markings on an xray that indicate interstitial edema. They are seen in heart failure
|
|
|
What is the non-pharmacologic management of chronic heart failure?
|
sodium restriction
rest/activity balance weight reduction |
|
|
What is the pharmacologic management of heart failure?
|
diuretics
Ace inhibitors Angiotensin II receptor antagonists diitalis in systolic failure consider calcium chanel blockers or other vasodilators in diastolic failure vasodilators beta blockers |
|
|
What is the definition of hypertension?
|
a sustained elevation of systolic blood pressure >140 or diastolic >90 at least three times on two different occations
|
|
|
What are the two types of hypertension?
|
Primary/essential- 95% of all cases. Onset usually <55yrs
secondary- 5% of all cases, secondary to other known causes such as estrogen use, renal disease, pregnancy, endocrine disorders, etc. |
|
|
What factors exacerbate hypertension?
|
smoking, obesity, excessive alcohol intake, use of NSAIDS
|
|
|
What are some signs and symptoms of hypertension?
|
often none
elevated BP suboccipital pulsating headache occuring early in the morning (in back of head) and resolving throughout the day epistaxis dizziness/lightheadeadness S4 related to left ventricular hypertrophy |
|
|
What lab tests can be done in someone with hypertension?
|
uranalysis for proteinuria and hematuria
Other tests to rule out particular causes: -rapid sequence IVP for renovascular disease -Chest Xray if coarctation of the aorta or cardiomegaly are suspected -plasma aldosterone level to rule out aldosteronism AM/PM cortisol levels to rule out Cushing's syndrome - |
|
|
What is normal BP?
|
<120/80
|
|
|
What is considered prehypertension?
|
120-139/80-89
|
|
|
What is considered stage 1 hypertension?
|
140-159/90-99
|
|
|
What is considered stage 2 hypertension?
|
>/= 160/100
|
|
|
What baseline studies should be done before starting someone on hypertension management?
|
UA, BMP, CBC, Ca+, Phos, uric acid, cholesterol, triglycerides
ECG for dysrythmias, bundle branch block and left ventricular hypertrophy PA and lateral chest Xray |
|
|
What is the nonpharmacologic management for hypertension?
|
weight reduction
low sodium diet cessation of smoking avioiodance/reduction of alcohol intake stress management relaxation/exercise |
|
|
What is the management for stage 1 hypertension?
|
Monotherapy with a thiazide type diuretic for most. May consider ACEI, ARB, BB, CCB or combination
|
|
|
What is the management for stage 2 hypertension?
|
Two drug combination for most, usually a thiazide type diuretic and ACEI, ARB, BB or CCB
|
|
|
Name the categories of drugs for managing hypertension.
|
Beta blockers
calcium channel blockers loop diuretics ACE inhibitors Adrenergic inhibitors |
|
|
Name some beta blockers?
|
Propanolol hydrochloride (inderal), Atenolol (Tenormin), Naldolol (Corgard), Acebutolol (sectral)
|
|
|
Propanolol hydrochloride (inderal), Atenolol (Tenormin), Naldolol (Corgard), Acebutolol (sectral)
Are what type of drug? |
Beta blockers
|
|
|
What class of antihypertensive are good for African Americans, patients with migraines and patients with angina?
|
Beta blockers
|
|
|
In what types of patients are beta blockers particularly effective?
|
African Americans, patients with migraines and patients with angina
|
|
|
In what types of patients are calcium channel blockers particularly effective?
|
patients with afib/tach, migraines or diabetes mellitus
|
|
|
What antihypertensive is good for patients with afib/tach, migrains or diabetes?
|
Calcium channel blockers
|
|
|
Name some calcium channel blockers.
|
Diltiazem (Cardizem), verapamil (calan/Isoptin SR), amlodipine (norvasc), nicardipine (Cardene SR), felodipine (Plendil)
|
|
|
What class of drugs are:
Diltiazem (Cardizem), verapamil (calan/Isoptin SR), amlodipine (norvasc), nicardipine (Cardene SR), felodipine (Plendil) |
Calcium channel blockers
|
|
|
Name a loop diuretic.
|
Furosemide
|
|
|
What class of drugs does furosemide belong to?
|
loop diuretics
|
|
|
In what types of patients are loop diuretics particularly effective?
|
African Americans, elderly patients with isolated systolic hypertension, patients with CHF
|
|
|
What class of antihypertensive is most appropriate for African Americans, elderly patients with isolated systolic hypertension, patients with CHF?
|
Loop diuretics
|
|
|
Name some ACE inhibitors.
|
Captopril (capoten), Enalopril (vasotec), Benzapril (lotensin), Ramipril (altace)
|
|
|
What class of drugs do the following belong to?Captopril (capoten), Enalopril (vasotec), Benzapril (lotensin), Ramipril (altace)
|
Ace inhibitors
|
|
|
In what patients are ACE inhibitors particularly effective?
|
Caucasians <65, patients with diabetes.
|
|
|
What type if antihypertensive is particularly good for caucaisans <65 and patients with diabetes?
|
ACE inhibitors
|
|
|
What is a side effect of ACE inhbitors?
|
cough, bronchospasm
|
|
|
Name some adrenergic inhibitors.
|
Clonidine (catapress), methyldopa (Aldomet), Guanethidine (ismelin), Guanadrel (Hylorel), Prazosin (Minipress), doxazosin (Cardura), Labetalol (Normodyne/Trandate), Carvedilol (coreg)
|
|
|
What class do the following drugs belong to?
Clonidine (catapress), methyldopa (Aldomet), Guanethidine (ismelin), Guanadrel (Hylorel), Prazosin (Minipress), doxazosin (Cardura), Labetalol (Normodyne/Trandate), Carvedilol (coreg) |
Adrenergic inhibitors
|
|
|
What is considered a hypertensive urgency?
|
situations which require BP reduction over hours. BP> 220/125 or if patient has accompanying symptoms (headaches, heart failure, angina, disk edema, progressive target organ complications) >200/120
|
|
|
What is the management for hypertensive urgencies?
|
oral therapy with Clonitine (Catapress), Captopril (capoten), Nifedipine (Procardia), loop diuretics, etc.
|
|
|
What is considered a hypertensive emergency?
|
rare situations that require immediate (within 1 hour) blood pressure reduction to prevent or limit target organ damage. Ganerally classified when the diastolic blood pressure is >130.
|
|
|
What is the initial goal of treatment in a hypertensive emergency?
|
to reduce the MAP by no more than 25% within 2 hours.
|
|
|
What are examples of hypertensive emergencies.
|
Malignant hypertension (fundoscopic changes include flame shaped retinal hemorrhages, soft exudates and papilledema)
hyperactive encephalopathy intracranial hemorrhage unstable angina acute MI acute LV failure with pulmonary edema Dissecting aortic aneurysm eclapsia |
|
|
What is the management in hypertensive emergencies?
|
IV agents
critical care bed invasive arterial pressure monitoring Sodium nitroprusside, a potent vasodilator, is the drug of choice, given by continuous IV indusion. |
|
|
Why do you want to avoid rapid, severe drops in BP in a hypertensive emergency?
|
Because cerebral infarction can occur.
|
|
|
What causes angina?
|
decreased blood flow through the vessel-> tissue ichemia -> angina
|
|
|
What are the 4 types of angina?
|
Stable (classic or chronic)- this occurs with exertion and is the most common
Printzmetal's (Variant)- this occura at various times, including rest, and is due to coronary vasospasm Unstable (preinfarction, rest or crescendo, coronary syndrome) microvascular- occurs in people with metabolic sydrome |
|
|
What are the signs and symptoms of angina?
|
chest discomfort that lasts for several minutes
exertional usually precipitated by physical activity- subsides with rest nitroglycerine shortens or prevents attacks |
|
|
What are the physical exam findings in someone with angina?
|
Often normal
may see signs of peripheral arterial disease elevated BP Levine's sign ransient S4 systolic murmur is not uncommon |
|
|
What is Levine's sign?
|
clentched fist sign, clenched fist ofter chest, indicates that the person is having chest pain
|
|
|
What may you find on the EKG of someone experiancing angina?
|
down sloping of ST segment of T wave weak, or inversion during an attack
|
|
|
What lab tests do you want to order in someone experiancing angina?
|
ECG
exercise ECG serum lipis levels coronary angiography- is definitive diagnostic procedure but is not indicated soley for diagnosis |
|
|
What is the management of a patient with angina?
|
reduce risk factis
lower LDL cholesterol is v. important Low dose enteric coated aspirin nitrates beta blockers calcium channel blockers |
|
|
What are the symptoms of an MI?
|
Anginal pain or atypical anginal pain
most infarctions occur at rest with pain similar to angina but more severe Nitroglycerine has little effect cold sweats, weakness impending doom apprehension lightheadedness syncope dyspnea cough nausea and vomiting |
|
|
What are PE findings in someone having and MI?
|
dysrhythmia common
presence of S4 very cmmon wheezing pulmonary rales secondary to edema low grade fever during the first 48 hours tachycardia |
|
|
What EKG change might you see in someone with angina?
|
Peaked T waves, ST elevation, Q wave development. Not all patients will have changes so it is important to check cardiac enzymes too.
|
|
|
What cardiac enzymes do you draw in someone suspected of having an MI? What do they tell you?
|
Troponin T, Troponin I and CK-MB
Troponin I and CK-MB are both specific to cardiac tissue and are only elevated in an MI. Cardiac enzyme elevation is above normal within 4-6 hours and remain high for 3 days to 3 weeks |
|
|
What is the management of an MI?
|
ASA 325 mg tablet to chew
NTG SL q 5 minutes x 3 begin O2 therapy IV @ KVO- 3 total 12 lead EKG and cardiac monitor morphine/dilaudid 2-4mg IVP Furosemide if pulmonary edema is present metoprolol ACE inhibitor if patient has failure or a large infarction Possibly heparin or low molecular weight heparin Glycoprotein IIb/IIIa inhibitors may be a useful adjunct to PTCA or stenting monitor therapuetic coagulation values |
|
|
What is the normal INR? And the therapuetic value
|
.8-1.2
2.5-3.5 x the normal |
|
|
What is the normal PT? What is the therapuetic value?
|
11-16 seconds
1.5-2.5 normal |
|
|
What is the normal partial thronboplastin time (PTT)?
|
60-90 seconds
1.5-2.5 x normal |
|
|
What are the indications for pharmacologic revascularization in someone who has had an MI?
|
Unrelieved CP with ST segment elevation >0.1mV in 2 or more leads
|
|
|
What are the contraindications to pharmacologic revascularization post MI? Absolute, stong and relative
|
Absolute: active bleeding, including abnormal coagulation values, major trauma/surgery
Strong: histry of hemorrhagis stroke, severe HTN, tumors Relative: History of recent GI bleed HTN> 165/95 prolonged/traumatic CPR Cardiogenic shock history of ischemic stroke or cerebrovascular disease |
|
|
What is a venous thrombosis?
|
A partial or complete occlusion of a vein by a thrombus with secondary inflammation to the wall of the vessel. May be superficial or deep.
|
|
|
What increases the risk of venous thrombosis?
|
Immobility
female post-operative period prolonged bed rest use of oral contraceptives hypercoaguability |
|
|
What are the symptoms of venous thrombosis?
|
Sudden onset of pain (superficial)
Pain or tenderness especially while walking (deep) Pain may be present as dull ache or tiche feeling (deep) |
|
|
What are the PE findings in someone with venous thrombosis?
|
localized heat and erythema (superficial)
edema distal to occlusion (deep) low grade temperature palpable cord in calf skin may be cyanotic if obstruction is severe skin cool to touch |
|
|
What laboratory/diagnostic tests can be used to diagnose a venous thrombosis?
|
Doppler ultrasound blood flow and impedance plethysmography
ascending contrast venography |
|
|
What is the management of a superficial venous thrombis?
|
elevation of extremity
warm compresses non-steriodal agents D/C oral contraceptives |
|
|
What is the management of a deep venous thrombis?
|
Bed rest with leg elevated until local tenderness subsides 7-14 days.
Walking gradually reintroduced lovenox 1mg/kg q 12 or heparin infusion for 7-10 days coumadin therapy for 12 weeks physician consult when anticoagulant therapy is instituted |
|
|
What is peripheral vascular disease?
|
arteriosclerotic narrowing of the lumen of arteries resulting in decreased blood supply to the extremities.
|
|
|
What are the risk factors for peripheral vascular disease?
|
atherosclerosis
similar risk factors for CAD peak incidence between 40-70 hyperlipidemia smoking diabetes mellitus |
|
|
What are the symptoms of peripheral vascular disease?
|
calf pain- usually the first symptom
cold/numbness to extremities progress to pain at rest |
|
|
What are the physical exam findings for someone with peripheral vascular disease?
|
shiny/hairless skin
pallor cyanosis ulcerations rependent rubor reduced pulses |
|
|
What are the diagnostic tests used to evaluate someone with suspected peripheral vascular disease?
|
doppler U/S to evaluate flow
X-rays may show calcification arteriography is the most definitive test |
|
|
What is the management of peripheral vascular disease?
|
Stop smoking and all tobacco use
exercise- walk one hour/day, stopping during pain and resuming when pain subsides- to develop collateral circulation Trental (pentoxifylline) or plental (cilostanzol) weight reduction as needed manage diabetes and hyperlipidemia if present angioplasty bypass surgery with a vein graft amputation may be needed if gangrene is present. |
|
|
What is chronic venous insufficiency?
|
impaired venous return due to either destruction of valves, changes due to deep thrombophlebitis, leg trauma, or sustained elevation of venous pressure
|
|
|
Who is at increased risk for chronic venous insufficiency?
|
more common in women than men
may be a genetic predisposition history of leg trauma |
|
|
What are the symptoms of chronic venous insufficiency?
|
aching of the lower extremities relieved by elevation
edema after prolonged stanging night cramps of the lower extremities |
|
|
What are they physical exam findings in someone with chronic venous insufficiency?
|
trophic changes with brownish discoloration
stasis leg ulcers edema of lower extremities dermatitis cool to touch |
|
|
How is chronic venous insufficiency diagnosed?
|
It is a diagnosis of exclusion. Need to rule out edema due to CHF, chronic renal diseases, autoimmune diseases and thrombosis
|
|
|
What is the management of chronic venous insufficiency?
|
bed rest with legs elevated to diminish chronic edema
use of heave duty elastic support stockings weight reduction in the obese treat dermatitis or ulcers as indicated |
|
|
How do you manage acute weeping ulcers associated with chronic venous insufficiency?
|
wet compresses
0.5% hydrocortisone cream after compresses systemic antibiotics only indicated if active indection is present |
|
|
What are normal lipid labs?
|
total cholesterol <200
triglicerides <150 HDL >40 LDL < 160 in the general population LDL < 130 if any risk factors LDL <100 if 2 or more risk factors LDL < 70 is diabetic or previous MI |
|
|
What is the LDL goal for someone with diabetes or a previous MI?
|
<70
|
|
|
What is the LDL goal for someone with 2 or more cardiac risk factors (but no diabetes or previous MI)?
|
<100
|
|
|
What is the LDL goal for someone with 1 cardiac risk factors (but no diabetes or previous MI)?
|
<130
|
|
|
What are the 4 distinct roles of the nurse practitioner?
|
expert clinician
consultant/collaboratoyy educator researcher |
|
|
What are the steps in the research process?
|
Formulating the research problem
reviewing related literature formulating the hypothesis selecting the research disign identifying the population to be studied specifying methods of data collection designing the study conducting the study analyzing the data interpreting the results communicating the findings |
|
|
What are 3 broad types of research designs?
|
nonexperimental
experimental qualitative |
|
|
What is a nonexperimental study deisgn?
|
includes 2 categories
descriptive research- aims to describe situations, experiances and phenomena as they exist Ex post facto/correlational- examines relationships among variables |
|
|
What are the experimental and quasiexperimental study designs?
|
includes experimental manipulation of variables utilizing randomization and a control group to test the effects of an intervention or experiment
Quasi experimental research involves manipulation of variables but lacks a comparison group or randomization |
|
|
What is a qualitative study design?
|
includes case studies, open-ended questions, field studies, participant observation and ethnographic studies, where observations and interview techniques are used to explore phenomena through detailed descriptions of people, events, situations or observed behavior.
In this type of study there is the risk of researcher bias and lack of generalizability of findings, but it also produces rich data. |
|
|
What is a confidence interval?
|
an interval, with limits at either end, with a specified probability of includin the parameter being estimated.
|
|
|
What is the standard deviation?
|
a measure of the spread or dispersion of a set of data. 95% of a sample falls within one SD of the mean.
98% of the sample falls within 2 standard deviations. |
|
|
What is the level of significance?
|
The probability of a false rejection of the null hypothesis in a statistical test, p < 0.5
|
|
|
What is a perfect correlation?
|
a measure of the interdependence of two random variables that range in value from -1 to +1 indicating perfect negative correlation at -1, absence of correlation at 0 and perfect positive correlation at +1
|
|
|
What is a P value?
|
it measures statistical significance- it represents the probability of error that is involved in accepting our observed result as valid, that is, as "representative of the population"
|
|
|
What is a T test?
|
The calculated mean and standard deviation may by chance deviate from the real mean and standard deviation
|
|
|
What is test-retest reliability?
|
the index of variable consistency. Tests the same over time = reliability. Optimal test-retest reliability >/= .70
|
|
|
What is validity?
|
The degree to which a variable measures that it is intended to measure
|
|
|
What dictates the NPs scope of practice?
|
The individual state's practice act
|
|
|
How does the ANA define "collaboration"?
|
As a "true partnership" in which all players have and desire power, share common goals, and recognize/accept separate areas of responsibility and activity
|
|
|
Define negligence.
|
The failure of an individual to do what a reasonable person would do, resulting in injury to the patient
|
|
|
Define malpractice.
|
failure of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else. It may involve:
professional misconduct unreasonable lack of skill illegal/immoral conduct other allegations resulting in harm to a patient |
|
|
Define assault.
|
Placing someone in imminent fear of illegal, willful, angry, violent, or negligent attack to himself, his clothes, or anything wish which he is in contact.
This can be as sible as making the motion to inject someone against his will |
|
|
define Battery.
|
an illegal, willful, angry, violent, or negligent striking of a person, his clothes, or anything with which he is in contact. One can commit battery on an unconscious person, but not assauly
|
|
|
define defamation
|
a communication that causes someone to suffer a damaged reputation. can be
Libel- defaming, distrubuted written material or slander- spoken defamation- spoken to someone other than the defamed party |
|
|
What is involuntary commitment?
|
in most states there is a duty to commit someone who is in danger if huring himself or others
|
|
|
What is covered by medicare part a?
|
Covers impatient hospital and post hospital skilled nursing care, home health and hospice care. Most people get part A automatically, talthough certain criteria must apply
|
|
|
What is covered by medicare part b?
|
a supplemental medical insurance requiring recipients to pay premium. Services covered include physician visits, outpatient care, home care, lab, xray, and other related medical services and supplies.
|
|
|
What is covered by medicare part C?
|
also called Medicare Advantage
Patients entitled to medicare part A and enrolled in part B are eligible to recieve all of their health care servvices through one of the provider organizations under part C |
|
|
What is covered by medicare part D?
|
prescription drug coverage plan for everyone with medicare. Plans offered by insurance and other private companies approviced by medicare.
|
|
|
What are the 2 overarching goals of healthy people 2010?
|
-increase the quality and years of healthy life
-eliminate health disparities among Americans |
|
|
Define nonmaleficence.
|
The duty to do no harm
|
|
|
Define utilitarianism
|
the right act is the one that produces the greatest good for the greatest number of people
|
|
|
define beneficence
|
the duty to prevent harm and promote good
|
|
|
define justice
|
the duty to be fair
|
|
|
define fidelity
|
the duty to be faithful
|
|
|
define veracity
|
the duty to be truthful
|
|
|
define autonomy
|
the duty to respect an individuals thoughts and actions
|
|
|
What is an advanced directive?
|
a written statement of a patients intent regarding medical treatment. The patient self determination act requires that all patients entering a hospital should be advised of their rights to execute an advanced directive
|
|
|
What is patient advocacy
|
Facilitatin the right to self-determination related to health and promoting decision=making that is congruent with a person's values
|
|
|
Define competence- as related to patient ethics
|
decisional capability. a state in which a patient is able to make personal decisoins abut his/her care. It implies the ability to understand, reason, diffeerentiate good and bad, and communicate.
|
|
|
Define informed consent.
|
A state indicating that a patient has recieved adequate instruction or information regarding aspects of care to make a prudent personal choice reguarding such treatment. Generally concent is assumed if the patients condition is life threatening.
|
|
|
What is Right to refuse care?
|
patients must be advised at the time of their admission to a feerally funded instutution such as a hospital, nursing home, hospice, HMO, etc, that they have a right to refuse care
|
|
|
How often is a tetnus/diptheria booster needed?
|
every 10 years
|
|
|
What are the recomendations for mamography?
|
begin at age 35-40 years. Every 1-2 years for women ages 40-49 then yearly at age 50
|
|
|
When should cholesterol first be checked in someone with no risk factors? How often?
|
At age 20
then every 5 years after if everything is norma |
|
|
What should prostate cancer screening begin? How often should it occur?
|
A digital exam and a PSA begining at age 40 for men with a family history of prostate Ca or if African American.
For other men, both these should start at 50, |
|
|
When should a healthy adult have an EKG?
|
at age 40 for baseline
|
|
|
When should colon cancer screening begin? How often should it occur?
|
Age 50 for people with no family history.
An annual fecal occult blood test. A flexible sig q 5 years a colonoscopy q 10 years or a double contrast barium enema q 5-10 years |
|
|
When should glaucoma screening begin? How often should it occur?
|
age 40
anually |
|
|
When should a patient recieve the zostavax vaccine?
|
age 60
|
|
|
Define sensitivity and specificity
|
sensitivity- true positive- the degree to which those individuals with the disease screen/test positive
specificity- true negative- the degree to which those individuals without disease screen/test negative |
|
|
What are the major causes of death in adolescents?
|
motor vehical accidents
suicide accidents homicide malignancy cardiovascular or congenital diseases |
|
|
What are the major causes of death for young adults (20-39)?
|
motor vehicle crashes
homicide suicide injuries heart disease AIDS |
|
|
What are the major causes of death for middle aged adults (40-59)?
|
Heart disease
accidents lung cancer CVA breast and colorectal cancer COPD |
|
|
What are the major causes of death for elderly adults (>60)?
|
Heart disease
CVA COPD Pneumonia and/or influenza lung and colorectal cancer |
|
|
What are the 5 stages in Maslow's Hierarchy of Needs?
|
1. Survivall needs - food, water, sleep
2. safety and secruity- protection from physical dangers 3. Love and belonging- affection and companionship 4. self-esteem 5. self-actualization- achieving one's highest personal goals 4. |
|
|
What is the Health Belief model?
|
Backer posed that health is influenced by numerous entities such as age, sex, race and income. Key components of this theory include: Threats to health
Outcome expectations |
|
|
Describe the general systems theory?
|
Von Bertalanffy viewed the world in terms of interdependent parts, making the point that nothing exists in isolation (independent from other parts).
|
|
|
What are Eriksons stages of psychosocial development?
|
Trust vs. mistrust
Autonomy vs. shame and doubt initiative vs. guilt industry vs inferiority identity vs role confusion intimacy vs isolation generavity vs stagnation ego identity vs despair |
|
|
Define primary prevention. Give some examples.
|
includes measure to promote health prior to the onset of any recognizable problems
examples: healthy diet, exercise, safety, avioding tobacco, wearing seat belts |
|
|
Define secondary prevention, give some examples.
|
focuses on early identification and treatment of existing problems.
Ex. Pap smears screening, prostate cancer screening,, cholesterol screening |
|
|
Define tertiary prevention, give some examples.
|
includes rehabilityaion and restoration of health. Examples: cardiac rehab following an MI, physical therapy following an MVC, etc
|
|
|
How do you calculate ideal body weight for a woman?
|
medium build: 100lbs for the first 5 feet, then 5 lbs for ever additional inch.
small build: subtract 10% large build: add 10% |
|
|
How do you calculate the ideal body weight for a man?
|
medium: 106 lbs for the first 5 feet then 6 lbs for each additional inch.
small build: subtract 10% large build: add 10% |
|
|
How do you calculate daily caloric needs?
|
sum of basal caloric needs and activity caloric needs.
Basal caloric needs: Ideal Body Weight (IBW) x 10 Activity caloric needs: Ideal body weight x normal daily activity level Normal daily activity levels: 10 if patient has a strenuous daily activity level 5 if the patient has a moderate daily activity level 3 if the patient has a sedentary daily activity level |
|
|
What should patient over 35 who have never had a program of exercise have before instituting an exercise program?
|
complete history
physical exam exercise stress test |
|
|
What are normal age related changes to the skin of the elderly?
|
loss of turgor
loss of fat in face and limbs hair changes decreased elasticity |
|
|
What are normal age related changes to the pulmonary system of the elderly?
|
increased AP diameter
hyperresonance to percussion Decreased ability for effective cough |
|
|
What are normal age related changes to the cardiovascular system in the elderly?
|
Decreased sensitivity of baroreceptors
decreased in heart rate and stroke volume, cardiac output <30% sclerosis and thickening of valves- systolic ejection murmur common loss of elasticity in vessels-HTN Decreased cardiac conduction, increased dysrhythmias |
|
|
What are normal age related changes to the gastrointestinal system of elderly?
|
poor relaxation of the espohageal sphincter
reduced motility and peristalsis of the esphagus missed deffication signal |
|
|
What are normal age related changes in the musculoskeletal system of the elderly?
|
decreased muscle mass
degenerative joint disease |
|
|
What are normal neurological changes in the elderly?
|
delayed deep tendon reflexes
decreased sense of touch increased pain tolerance |
|
|
What are antigens?
|
substances capable of inducing a specific immune response
|
|
|
What are antibodies?
|
molecules synthesized in reaction to an antigen
|
|
|
What is active immunity?
|
immunity congerred by antibody formation stimulated with a specific antigen such as typhoid fever immunization and toxoids.
|
|
|
What is passive immunity?
|
immunity conferred by the introduction of antibody proteins such as gamma globulin injections or maternal immunity transferred to the fetus
|
|
|
What are people at risk for 2-3 days after a myocardial infarction?
|
pericarditis
|
|
|
What are signs and symptoms of pericarditis?
|
substernal chest pain that worsens with deep breathing and movement and is relieved with sitting up and leaning forward
|
|
|
What is the likely diagnosis in someone who had a MI 2 days ago and now has substernal chest pain that worsens with deep breathing and movement and is relieved with sitting up and leaning forward?
|
pericarditis
|
|
|
What drugs are associated with adrenal insufficiency?
|
mitotane and phenytion
|
|
|
How does medicare reimburse NPs as compared to physicians?
|
At 85% of the physician change
|
|
|
What is a common early symptom of bells palsy?
|
pain in or behing the ear
|
|
|
How is early glaucoma best detected?
|
Fundoscopic exam to look at the cup to disk ration. Tonometry readings are less helpful in early disease because they are often falsely low early on
|
|
|
When should a statin be discontinued in someone who has increased liver enzymes?
|
When there is elevation of 3x the upper limit of normal on 2 seperate occasions with at least one week between measurements requires discontinuation of the drug
|
|
|
What are expected lab findings in someone wiht addisons diease?
|
hyperkalemia, hyponatremia and hypogylcemia
|
|
|
Who develops the standards of care for nurse practitioners?
|
professional organizations
|
