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30 Cards in this Set
- Front
- Back
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89. Use of nasal steroids for acute purulent sinusitis (2)?
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1. Fluticasone
2. Beclomethasone b. May be worth a trial if sinusitis is secondary to allergic rhinitis or if there is concurrent allergic rhinitis. |
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90. Tx of Chronic sinusitis?
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a. Tx w/a broad-spectrum penicillinase-resistant abx.
b. Refer to an otolaryngologist-endoscopy drainage may be necessary. |
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91. Laryngitis causes?
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a. Usually viral in origin
b. May also be caused by Moraxella catarrhalis or H. flu. c. Common cause of hoarseness; cough be present along w/other URI sx. d. Typically self-limiting e. Pts should rest voice until laryngitis resolves to avoid formation of vocal nodules |
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92. If a pt has a cold beyond 8-10 days, or if the cold sx improve and then worsen after a few days “double-sickening”, consider?
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a. Acute bacterial sinusitis: May be a secondary bacterial infection after a primary viral illness).
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93. AE of antihistamines for infections?
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a. Have a drying effect (making secretions thicker) and can sometimes worsen congestion.
b. If this occurs, avoid decongestants w/antihistamines |
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94. Most common causes of sore throat?
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a. Viruses are by far the most common cause:
1. Adenovirus 2. Parainfluenza 3. Rhinovirus 4. EBV 5. HSV |
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95. Other organisms responsible for sore throat>
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a. Chlamydia, mycoplasma
b. Gonococci (oral sex) c. Corynbacterium diphtheria d. Candida (if immunosuppressed, on abx, or severely ill). |
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96. What makes a viral vs. bacterial etiology of sore throat more likely?
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a. If pt has cough and runny nose, virus is more likely.
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97. Diagnosis of sore throat?
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a. Throat culture: Takes 24 hours, but is more accurate than rapid strep test.
b. Rapid strep test- Results w/in 1 hour, but will not indicate whether sore throat is caused by a bacterium other than strep. c. Monospot if mono is suspected |
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98. What 4 things should you think of if the pt has a sore throat?
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a. Viral infection
b. Tonsillitis (usually bacterial) c. Strep throat d. Mono |
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99. What % of pts have pharyngeal exudates w/strep throat?
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a. Only 50%.
b. Also, only 50% of pts w/pharyngeal exudates have strep throat. |
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100. Tx of Strep throat?
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a. Pcn for 10 days (erythromycin if pt has pcn allergy).
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101. Tx of sore throat secondary to mono?
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a. Advise rest and acetaminophen/ibuprofen for sx.
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102. Symptomatic tx of sore throat?
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Acetaminophen or ibuprofen
b. Gargling w/warm salt water c. Use of a humidifier d. Sucking on throat lozenges, hard candy, flavoured frozen desserts (such as popsickles. |
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103. Dyspepsia?
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a. Refers to a spectrum of epigastric sx, including heartburn, “indigestion”, bloating, and epigastric pain/discomfort.
b. Dyspepsia is extremely common, and sometimes is confused w/angina. |
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104. Etiologies of dyspepsia?
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a. GI causes: peptic ulcer disease (PUD), GERD, no-nulcer dyspepsia (functional dyspepsia), Gastritis.
b. Hepatobiliary causes: Hepatobiliary disease (cholecystitis, biliary colic) c. Malignancy (gastric, oesophageal) d. Pancreatic disease (pancreatitis, pseuodcyst, cancer) e. Oesophageal spasm |
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105. Other causes of Dyspepsia?
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a. Lactose intolerance
b. Malabsorption c. DM (gastroparesis) d. IBS. |
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106. Diagnosis of Dyspepsia?
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a. Base the decision to perform tests on clinical presentation and response to empiric therapy.
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107. Test of choice for evaluation of dyspepsia?
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a. Endoscopy!
b. It can ID oesphageal stricture or ulcer, cancer, and reflux esophagitis |
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108. General indications for endoscopy for dyspepsia?
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a. Pts w/alarming sx: wt. loss, anaemia, dysphagia, or obstructive sx.
b. Pts >45 w/new-onset dyspepsia. c. Pts w/recurrent vomiting or any evidence of upper GI bleed. d. Pts who do not respond to empiric therapy e. Pts w/sign of complications of PUD f. Pts w/recurrent sx g. Pts w/evidence of systemic illness. |
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109. How to proceed after noninvasive testing for H. pylori?
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a. If +, tx for H. pylori
b. If negative, PUD is unlikely and the pt likely has either GERD or nonulcer dyspepsia (treat empirically). |
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110. Tx of dyspepsia?
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a. Treat cause if known
b. Advise pt to: i. Avoid alcohol, caffeine, and other foods that irritate the stomach ii. Stop smoking iii. Raise the head of bed when sleeping iv. Avoid eating before sleeping c. Use antacids; Use H2 blcoker, sucralfate, or a PPI if antacids fail. d. Endoscopy is indicated if al these fail to relieve sx. e. Eradication of H. pylori. |
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111. What are up to 90% of cases of dyspepsia/heart burn due to?
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a. PUD
b. GERD c. Gastritis d. Nonulcer dyspepsia. |
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112. Nonulcer dyspepsia?
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a. A diagnosis of exclusion after appropriate tests (including endoscopy) do not reveal a cause.
b. Dyspepsia sx must be present for at least 4 weeks to make the diagnosis of nonulcer dyspepsia. |
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113. General characteristics of GERD?
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a. GERD is a multifactorial problem. Inappropriate relaxation of the LES (decreased LES tone is the primary mechanism, leading to retrograde flow of stomach contents into the esophagus.
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114. Other factors that may contribute to GERD?
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a. Decreased oesophageal motility to clear refluxed fluid.
b. Gastric outlet obstruction c. Hiatal hernia (common finding in pts w/GERD) |
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115. What dietary factors may decrease LES pressure and exacerbate GERD?
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a. Alcohol
b. Tobacco c. Chocolate d. High-fat foods e. Coffee |
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116. What does the prevalence of GERD increase with?
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a. Age.
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117. Clinical features of GERD?
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a. Heartburn, dyspepsia:
i. Retrosternal pain/burning shortly after eating (esp, after large meals). ii. Exacerbated by lying down after meals. iii. May mimic cardiac chest pain (which may lead to unnecessary workup for ischaemic heart disease). b. Regurgitation c. Waterbrash-reflex salivary hypersecretion. d. Cough- Due to either aspiration of refluxed material or a reflex triggered by acid reflux into the lower oesophagus. e. Hoarseness, sore throat, feeling a lump in the throat. f. Early satiety, postprandial N/V. |
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118. Diagnosis of GERD?
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a. Endoscopy w/biopsy- test of choice.
b. Upper GI series (barium contrast study) c. 24 hour pH monitoring in the lower oesophagus. d. Oesophageal manometry- Use if motility disorder is suspected. |
