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158 Cards in this Set
- Front
- Back
- 3rd side (hint)
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In what types of patients and in what areas of the body should you avoid using a local anesthetic with epinephrine?
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Fingers, ears, nose, toes and hose (penis)
Not for periorbital block in people with closed angle glaucoma Caution is people with: HTX, DM, PVD, thyrotoxicosis, or Cerebral vascular disease |
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In a patient who is allergic to Novocaine, can you use Xylocaine? Should you use the multidose vial or the single dose vial?
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-Yes, because Novocaine is a Ester (more allergies) and Xylocaine is an Amide (less allergies) and the two groups do not cross-react
- Multidose vials of amides may have preservatives similar to esters. It is best to use a single dose |
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Does epinephrine extend or shorten the duration of a local anesthetic
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Epinephrine will increase the duration of anesthetics because it constricts the vessels and keeps the drug from dissipating.
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Which causes less pain: SubQ or intradermal injection?
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Sub Q is less painful but takes longer to work.
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What can you do to reduce the pain of an injection?
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- Distract patient
- Use small needle - Inject slowly - Inject SubQ - Add sodium bicarbonate to buffer anesthetic - Warm solution Pinch and shake skin during injection - Us topical anesthetic prior to injection |
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How long does it take EMLA to work and can you use it on broken & unbroken skin
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EMLA is a mixture of prilocaine and lidocaine
Onset is 1-2 hrs. and last for 1-2 hours Used only for intact skin May cause methamoglobinemia in G6PD and pts on sulfa drugs. |
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How long does it take for a digital nerve block to work?
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5-10 minutes
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Describe the direction of pressure used to loosen and lift an ingrown nail. Then describe the way that the nail is split and removed.
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Upward
Roll it out of the nail bed then cut toward the cuticle |
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What is Phenol used for and what complication can occur with it?
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- Chemical cauterization of the germinal tissues of the nail bed.
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How do you differentiate a subungual hematoma from a subungual melanoma, splinter hemorrhages, and green nail syndrome?
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Melanomas are linear (longitudinal) and pigment may extend to the soft tissue (hutchinson's sign)
Subungual hematomas are horizontal and never pigment the soft tissue of the cuticle |
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Describe the difference between the procedure for removing a 1-barb versus a 2-barb fish hook.
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Single Barb: 1)Anesthesia over the tip of the hook 2) Advance it 3) Clip the tip off with wire clippers 4) then back the hook out.
Double Barb Hook: 1) Push point through the skins 2) Cut off the back part of the hook 3) advance the rest of hook all the way through the skin |
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How do you pull out a tick and what should you avoid doing?
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1) paint around the area with betadine
2) Grasp the tick as close to the skin surface as possible and pull outward away from the skin - Do NOT twist, jerk, squees or crush tick. |
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Know how to perform a punch biopsy and how you know if you are through to the subQ tissue
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1) Clean area
2) Ring of anesthesia around lesion 3) Use punch that is 2 mm larger than lesion 4) Punch larger than 4mm usually requires a suture. 5) A decrease in resistance will indicate that you have passed through to the dermis. Plug should pop up above the skin surface. |
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How many mm beyond the margin of the lesion must you freeze for a benign lesion?
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For small or flat lesions, start with a freeze for 5-10 secs, until a 1-3mm ice ring forms around the lesion.
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What are the disadvantages and contraindications to cryotherapy?
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Disadvantages:
- Destroys melanocytes - Destroys hair follicles - Area is more susceptible to sunburn - Superficial nerve damage Contraindications: - Melanoma - Recurrent basal or squamous cell cancers - Patient requests |
Relative Risks:
- Cold intolerance/ Raynaud's - Cold uticaria - Cryglobulinemia - Heavily pigmented skin - lesions in pretibial, eyelids, nasolabial folds, hair bearing areas |
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What type of suture is best for skin and what size is used on the body?
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4-0 or 5-0 Nylon (Ethilon) that is monofilament and unbraided
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What is the preferred technique for biopsy for pigmented lesions?
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Excisional Biopsy
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Why is a cervical polyp removed?
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If they are large or symptomatic
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When do you need to give tetanus immune globulin?
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When patients have an unclear history of receiving the vaccine. Igs when there is less than 3 tetanus shots or an unclear history
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What is Hutchinson’s sign?
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- Streak of pigmentation under the nail that encompasses the cuticle which is a sign of melanoma.
- Shingles that encompasses the Tip of the nose. - Notched teeth in a patient with congenital syphilis |
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Define diagnostic criteria for DMII
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Must be confirmed on two occassions:
1) Fasting glucose >126 2) Abnormal OGTT > 200 at 2hrs 3) Random BG > 200 4) HgA1c > 6.5 |
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How does HgA1c correlate to EAG (est. avg. glucose)
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6 ~ 135 mg/dl
7 ~ 170 8 ~ 205 9 ~ 240 10 ~ 275 11 ~ 310 12 ~ 345 13 ~ 380 |
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How effective are lifestyle changes in the management of DMII?
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Best treatment
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Define Macro and Microvascular diseases in DMII
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Macro: due to hyperinsulinemia
- Cerebral Vascular accidents - Heart disease - Renal Artery stenosis Micro: due to glucose levels - Retinopathy - Retinal Hemorrhages - Cataracts - Neuropathy |
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What is the initial treatment of DMII based on HgA1c > 7 vs. HgA1c > 9 with symptoms?
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HgA1c > 7 use a dual therapy of medcations
HgA1c > 9 with symptoms: use triple therapy with insulin |
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What is the role of lipid lowering and blood pressure control in DMII, what medications are used?
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Lipids: Reduces cardiovascular complications.
BP: reduces microvascular complications Reduces heart disease and stroke Reduces kidney problems |
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Define clinical findings of hyper and hypothyroidism.
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Hyperthyroidism:Nervousness, irritability, tremors, heat intolerance, sweating, exophthalmos
Hypothyroidism: Fatigue, Cold intolerant, brittle hair, weight gain |
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What is the most common cause of hyper and hypothyroidism?
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Hyperthyrodism: Graves disease
Hypothyrodism: Hashimoto's disease |
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What are the lab tests that correspond to hyper and hypothyroidism?
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Hyper: Low TSH and high free T4 and T3
Hypo: High TSH and low T4 and T3 and Anti-TPO |
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What medications are used to treat hyper and hypothyroidism?
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Hyper: Methimazole or Propylthiouracil for Pregnant pts
Hypo: Levothyroxine (T4) |
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What is the difference between Cushings Disease and Cushings Syndrome?
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Syndrome: High levels of glucocorticoids and the effects
Disease: a specific cause for high corticoids which is Pituitary adenoma |
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What are the clinical findings in Cushings Syndrome, what are the lab tests used to diagnose?
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ACTH is High with adenoma
ACTH is low with drug therapy or adrenal adenoma Dx: 1) Demonstrate Elevated Cortisol 2) Identify cause (ACTH high or low) I |
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What is the most common cause of Cushing’s Syndrome?
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Exogenous glucocorticoid therapy
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Compare and contrast Addison’s Disease with Hyperaldosteronism, what are some of the metabolic differences?
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Addison's disease: Primary adrenal insufficiency, Pigmenation of skin
-Inadequate production of glucocorticoids, mineralcorticoids, and androgens. Autoimmune (most common) Hyperaldosteronism: Idiopathic (most common cause) increased aldosterone and suppressed RAA system. Most common Secondary Hypertension |
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What is a pheochromocytoma, list common symptoms (5 P’s) and the labs associated with the diagnosis.
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Palpitations
Perspiration Pain - Headaches, tremors Pallor Pressure - Hypertension resistant to therapy |
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A defect in 21-hydroxylase enzyme will cause what substrate to increase?
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17-hydroxyprogesterone which spills over to increase Androgens (virilization)
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How is Pheochromocytoma diagnosed?
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24 hour urine collection of Free Metanephrines and Catecholamines
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When is hCG first detectable in a pregnant women?
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8-10 days post fertilization
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What is the fundal height for a 12wk and 20 wk pregnant lady?
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12 = Barely above the pubic symphysis
20 = Umbilicus |
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What are the major drugs that should be discontinued during pregnancy?
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Lithium - Malformed tricuspid, thyroid, neuromuscular system
Phenytoin - IUGR, cardiac defects, hypoplastic nails ACEI - Renal tubular dysplasia, IUGR Vitamin A - CNS defects, cleft lip, thymic agenesis |
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What are the cardinal signs of placenta abrupto?
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Painful bleeding
Fetal distress |
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What are fetal reasons for induction of labor?
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- IUGR
- Abnormal fetal testing - Infection - Rh incompatibility - Oligohydramnios |
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What are the signs of separation of the uterus?
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- Uterus becomes globular
- Gush of blood - Uterus rises in abdomen - Cord elongation |
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What are the methods of determining how strong the contractions are?
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Palpation
External transducer Internal Pressure Catheter |
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What are the four types of maternal pelvis?
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1) Gynecoid - good
2) Anthropoid - good 3) Android - Poor 4) Platyepelloid - Poor |
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What are the cardinal movements of labor?
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1) engagement
2) descent 3) Flexion 4) Internal Rotation 5) Extension 6) External Rotation 7) Restitution |
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What is Asynclitism?
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Where the baby's head is tilted so that it is not in line with the birth canal.
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What is the difference between a Frank Breech and a Complete Breech?
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The Babies knees are flexed in complete and extended in Frank
Frank is more likely to deliver vaginally. |
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What are the major neonatal complications due to premature delivery?
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Pulmonary hypoplasia
Respiratory Distress Syndrome Intraventricular Hemorrhage Necrotizing Enterocolitis Systemic Infection/Sepsis |
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What are the 5 processes by which breast milk is carried out?
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- Exocytosis
- Reverse Pinocytosis - Transcytosis - Apical Transport - Paracellular movement |
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What is often the most common sign of Vulvar/vaginal hematoma?
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Hemodynamic instability secondary to blood loss into the abdomen or pelvis
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What are some causes of Postpartum fever?
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Womb = endometritis
Water = pyelo, UTI Walk = DVT, PE Wind = atelectasis, pneumonia Wound = infection from wound Weaning = breast engorgement, mastitis, abscess Wonder = Drug fever |
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What are the two most emergent conditions that must be considered in a woman of childbearing age who presents with abdominal / pelvic pain?
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Hemorrhagic Shock (Ectopic preg)
Septic Shock (from PID) |
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What is the relationship of previous episodes of Pelvic Inflammatory Disease to future fertility?
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The more episodes of PID the more infertile the patient becomes.
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Complete this sentence: The diagnosis of ectopic pregnancy should be considered ....
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In any women of childbearing age presenting with lower abdominal pain or pelvic pain.
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What are the important areas of focus in the history of a woman of childbearing age presenting with abdominal / pelvic pain?
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- Current Pregnancy status
- Menstration - Prior pregnancies - Dizziness and/or vomiting - Fever - Pain |
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What is the temporal relationship of nausea and vomiting in ectopic pregnancy as opposed to bowel obstruction and appendicitis?
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Ectopic pregnancy: Occurs concurrently with pelvic pain
Obstruction/Append: Vomiting occurs before the onset of pain. |
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Discuss the history of radiation of pain in female with pelvic pain as it relates to several differential diagnoses.
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Unilateral - Torsion, adnexal disease, cyst rupture, tubal inflammation
Radiation to back - retroperitoneal abscess, bladder infection, dysmenorrhea Radiation to extremities - Fibroids, ectopic pregnancy, and dysmenorrhea |
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Discuss the timing and rate of onset of pain as it relates to several differential diagnoses for ectopic pregnancy.
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Ectopic pain - Severe, continuous, unilateral pelvic pain that rapidl becomes diffuse.
PID - More insidious bilateral pain that progresses over days |
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What are the risk factors for ectopic pregnancy and for pelvic inflammatory disease?
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Females between 20-30 y/o
Black enthicity Previous PID secondary to GC Current IUD use Multiple sexual partners Recurrent UTIs Previous tubal pregnancy Tubal surgery is associated with a 10 fold increase |
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Discuss the method of pregnancy testing used today that is most reliable and sensitive.
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Quantitative hCG
- Sensitive to pregnancy detection after 7 days of conception. UAs are less reliable |
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Discuss the use of a complete blood count in the work-up of a female with abdominal / pelvic pain
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The blood count may be normal even if the pt is bleeding since patients bleed whole blood.
A WBC shift may indicate infection or may be elevate from stress of the pain alone |
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Discuss the use of urinalysis in the work-up of the female with abdominal / pelvic pain.
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Differentiate between UTI and Ureteral Cacluli from PID or ectpic pregnancy
Be aware that two diseases may co-exist (i.e. PID and Calculi) |
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What is the earliest that ectopic pregnancy be found on ultrasound?
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- Transvaginal ultrasound is the most effective way for detecting an ectopic pregancy as early as 4-5 weeks.
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Discuss pain history, precipitating events, associated symptoms, laboratory findings, and management of ectopic pregnancy
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A) Severe, constant, unilateral pelvic pain, that rapidly becomes diffuse across entire lower abdomen and pelvis, Pain may radiate to shoulder
Occurs 5-8 weeks after LNMP |
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Discuss pain history, precipitating events, associated symptoms, laboratory findings, and management for pelvic inflammatory disease.
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- Fever, Leukocytosis, purulent endocervical discharge. Associated with pelvic pain and tenderness
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Discuss pain history, precipitating events, associated symptoms, laboratory findings, and management of endometriosis.
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Constant pain beginning 2-7 days before menses which increases until menses flows. May radiate to back, thighs, rectum, bladder, vagina, oradnexa. Usually history of repeated attacks, associated with menses
Associated with infertility or sterility; painful defecations. |
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Discuss pain history, precipitating events, associated symptoms, laboratory findings, and management ruptured corpus luteum cyst / torsion of ovarian cyst
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Sudden onset; initially severe, intermittent, and localized to one adenexa. becomes continuous with local pain then general peritonitis
No precipitating factors Cyst rupture 6-8 wks from Last Normal Menstrual Period Utlrasound may reveal pathology but laproscopy may be needed fro diagnosis Cystic pain resolves after 2-4 hours |
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Discuss pain history, precipitating events, associated symptoms, laboratory findings, and management of degeneration of uterine fibroids / myomas
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Sudden sever localized pain
Older females, especially blacks Menorrhagia, intermenstrual bleeding, occasionaly dysmenorrhea or urinary frequency Palpation of mobile non-tender, firm, smooth masses |
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Discuss pain history, precipitating events, associated symptoms, laboratory findings, and management of mittelschmerz
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Sudden sharp, continous pain that is localized to one adnexa. May radiate to ipsilateral shoulder
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The most common alternative to ectopic pregnancy with patient with positive hCG , abnormal pain and vaginal bleeding?
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Threatened abortion
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Make a diagnosis based on the results of the ELISA, Western Blot, HIV RNA or p24 antigen
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ELISA - Not positive until 3-7 weeks
Western Blot - Confirmatory; may show none or one band during the acute phase HIV p24 antigen - can detect before seroconversion HIV viral load (PCR) - extremely high during acute HIV is positive 3-5 days earlier than p24 antigen. |
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When is a person usually symptomatic in acute HIV and how long does it last?
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2-4 wks after infection and lasts 2-4 weeks
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What does the rash of acute HIV usually look like and what is the distribution?
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Maculopapular & symmetrical, primarily face and trunk. Usually does not itch
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Is the risk of sexual transmission higher in acute or chronic HIV?
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Acute - due to the high viral load
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What causes a higher susceptibility to transmission?
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Bacterial vaginosis
GC Chlamydia Candida Trichomonas |
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Describe some of the most common signs and symptoms of a person presenting with acute HIV
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Fever (most common)
General Malaise, fatigue, pharyngitis, weight loss, myalgias, headache, nausea, night sweats, diarrhea, vomiting, mucocutaneous ulcers and rash |
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When should a person be tested for HIV antibodies after a needle stick?
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ASAP with ELISA to get a basline for a HIV negative serum
Follow-up with 6wks, 3 months and 6 months |
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In a high risk exposure setting(ie Needle stick), when should postexposure prophylaxis of HIV be initiated?
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Within 36 hrs of exposure
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Is it more common for a person with an acute HIV infection to be symptomatic or asymptomatic?
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Symptomatic - 80-90% are symptomatic
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What is the most common way to transmit HIV worldwide? in the US?
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Worldwide - Heterosexual intercourse
US - Homosexual intercourse |
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How long after exposure is the HIV virus transported to the regional lymph nodes?
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within 48-72 hours
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What is it called when the HIV RNA levels and the immune system reach a steady state?
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The viral set point
- occurs within 6 months of infection |
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What is the common clinical feature of a patient with Acute HIV?
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Fever then fatigue
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What is the definition of a:
Macule Patch Papule Plaque Nodule Tumor Vesicle Pustule Bullae Pustule |
Macule - <.5 cm change in skin color; not raised
Patch - > .5 cm change in skine color, not raised Papule - raised but smaller than .5 cm Plaque - Raised but larger than .5 cm Nodule - firm lesion thicker and deeper than plaque or papule Tumor - large nodule Vesicle = Raise CLEAR fluid < .5 cm Bullae - Raised CLEAR fludi > .5 cm Pustules - Raised with pus |
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What is the difference between an erosion and an ulcers?
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Erosion - burn, aphthous ulcer, herpes that only removes epidermis
Ulcers - Removes epidermis and dermis |
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Lichenification
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Thickening of the skin
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Desquamation
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Peeling of the skin after acute injury - Steven-Jonhson's syndrome
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What type of lesions would have a blanching color?
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Uticaria and inflammatory lesions blanch
Hemorrhagic lesion (petichiae and purpure from vasculitis) do NOT blanch |
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What is the presentation, toxin and treatment that is involved with Loxosceles reclusa
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Asymptomatic bite that becomes a large necrotic ulcer; summer
Toxin: Sphyngomyelinase D Tx: Elevation and cold compress which slows down the toxin |
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What is the presentation, toxin and treatment for Latrodectus Mactans bite?
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Sharp pinprick pain that becomes painless. CC: Muscle rigidity, abd cramps, pain and nausea. Anxiety
Toxin: a-Latrotoxin - neuotoxin which releases neurotransmitter Tx: Cold compresses, Narcotics, possibly muscle relaxants |
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What is the presentation of a patient with fleas?
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Lesions below the knees
Erythematous macules - pruritic Lesions in groups of 3's Fleas can lie dormant for a year Tx: Steroidal creams and Antihistamines |
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What is the typical presentation of chiggers?
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Stylostomes in the dermis where the larva attach
Intesnely red itchy papules develop after a delay of many hours Usually a history of grass exposure Tx: Vigorous cleansing to remove the larva, Topical steroids and antihistamines |
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What are the symptoms of Lyme disease?
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Rash - erythema migrans (Targetoid)
Stage I - Influenza like symptoms (fatigue, myalgias, headache, fever Stage II - Cardiac problems (arrhythmias and haert block, Bell's palsy) Stage III - Arthritis and continued chronic neurological problems |
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What are the classic signs and symptoms and treatment of Scabies?
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Debilitating itching that is worse at night
Excoriasion in the finger webs Tx: Permethrin cream (Elimite) from neck down |
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What is the clinical presentation of Impetigo and the treatment?
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Nonbullous or Bullous forms
Yellow crusts Either by Staph or GABHS Tx: Mupiroxcin TID for non-bullous or Dicloxacillin PO in bullous cases |
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What are the causes and treatment for Folliculitis?
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Causes: Staph and Pseudomonas
Tx: Bactroban (mupirocin) or Dicloxacillin or cephalexin |
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What is the significance of the hutchinson's sign in Shingles?
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Hutchinson's sign is the involvement of the tip of the nose and puts the patient at risk for serious ocular complications
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What is the treatment for Shingles?
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Acyclovir within 72 hours of onset of symptoms.
Zostavax vaccine for anyone 60 years and older |
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What complication occurs when a child < 5 years old gets HSV-1 around the oral area?
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Gingivostomatitis
- fever, sorethroat, ulcerative lesions in and around the mouth and throat |
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What is Herpetic Whitlow?
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Herpes infection of the distal fingers more frequently seen with health care workers
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What is Herpes Gladiatorum?
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Disseminated skin lesion often seen in wrestlers caused by HSV
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What isoforms of Coxsackie cause Herpangina?
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A2, A6-8, A10
A16 causes Hand-foot and mouth disease |
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What is Entropion? Ectropion?
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Entropion - Inward turning of the eyelids (Chlamydia)
Ectropion - outward turning of the eyelids |
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What is the tx for Pinguecula and Pterygium?
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Artificial tears
Topical vasoconstrictors Surgery |
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What is the treatment for corneal abrasion due to Herpes Simplex?
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Viroptic 5x daily
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What are some common causes of bacterial Conjunctivitis?
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Staphylococcus
Streptococcus Haemophilus |
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What is the treatment for Bacterial Conjunctivitis?
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Topical Antibiotics QID x 4 days
Warm Compresses |
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When should viral conjunctivitis be referred to a ophthalmologist?
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If there's pain, photophobia or decreased vision
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What are the different S/sx of someone with Pre-septal cellulitis vs. Orbital Cellulitis?
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Pre-septal - vision, pupils and motility are normal
Orbital - Pain, fever, blurred vision, diplopia, limited motility, ABNORMAL pupil |
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What are the symptoms of tear deficiency?
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Burining
Foreign-body sensation Reflex tearing |
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What conditions are associated with Tear Deficiency?
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Aging
Rheumatoid Arthritis Steven-Johnson Syndrome Systemic medications |
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Temporal Arteritis may cause what effects on the eye?
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Ischemic Optic Neuropathy
Cranial Nerve Palsies Retinal vascular occlusions |
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What symptoms indicate the need for an X-ray>
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Gross deformity
Point tenderness Swelling and ecchymosis Decreased ROM of joint Laceration or punture wound NEAR joint |
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At what age do the different parts of the elbow ossify?
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Capitulum - 2 years
Radial Head - 4 years Medial epicondyle - 6 years Trochlea - 8 years Olecranon - 10 years Lateral epicondyle - 12 years |
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What are the complex bone fractures that are needed to refer to an orthopedist?
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Spiral fx
Comminuted fx Compression fx Salter III/IV/V or displaced Salter I/II |
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Meralgia Paresthetica involves what nerve?
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Lateral Femoral Cutaneous Nerve
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What nerve is damaged in Tarsal tunnel syndrome?
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Distal tibial nerve
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What are some of the causes of Carpal tunnel syndrome?
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Idiopathic - Most
RA DM Hypothyroidism Repeated injury Pregnancy |
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What are the medications used for Neuropathy?
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Amitriptyline
Gabapenitin Tylenol with codeine Topical Capscasin |
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What is Mononeuritis multiplex?
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Painful sensory and motor neuropathy involving at least 2 separate nerve areas
Associated with systemic diseases: DM, Vasculitis, amyloidosis |
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What is Diabetic Thoracic Radiculopathy?
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Neuropathy that has a burning, stabbing, belt-like pain
Unilateral May occur in 1 or more spinal roots |
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What are the cardinal signs of Parkinson's?
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Resting tremor
Rigidity Bradykinesia Postural Instability (asymmetric Onset) |
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What is the most common cause of a tremor?
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Essential tremor
- unkown cause - Symmetric and intentional (vs parkinson's) or isolated head tremor - Family history is predictive |
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What are the non-motor symptoms of Parkinson's disease?
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Psychosis or hallucinations (usually visual)
Mood disorders - depression Sleep disturbances Pain Fatigue Olfactory dysfunction Dementia (20-40%) |
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What is the gene that is associated with MS?
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HLA DRB1 - 1501
Allows lymphocytes into CNS Adhesion moelcule is VLA4 |
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What is the test done that can help dx MS?
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Elevated IgG levels in CNS demonstrated by oligoclonal banding on electrophoresis
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What are the common manifestations of MS?
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Optic Neuritis - orbital pain and variable visual loss (may be exacerbated by heat)
Cerebellar Ataxia Cortical hemiparesis Facial nerve palsies inlcuding tic douloureux Nystagmus and internuclear ophthalmoplegia |
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What other disease may mimic MS?
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HIV
SLE Vasculitis Lyme disease |
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What is the treatment for MS?
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Support - depression/suicide
Glucocorticoids for acute flares Interferons - IFNB-1b, INFB-1a (inhibit INF-gamma activity) |
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What neurons are affects by ALS?
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UMN - Precentral gyrus
- Spascticity, abnormal reflexes LMNs - Anterior Horn of spinal cord - muscle flaccidity, atrophy Prefrontal neurons: cognition - loss of executive functions |
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What are the risk factors for ALS?
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Smoking
Eating food products made from Cycad |
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What four regions of ALS?
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Bulbar - Muscles of face, mouth and throat
Cervical - Muscle of neck, shoulders, upper extremities Thoracic - Muscles of chest and abdomen Lumbosacral - Lower back, groin, lower extremities |
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What are the clinical manifestations of ALS?
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Progressive weakness to a certain region :
Bulbar - dysphagia, dysarthria, respiratory Hyperreflexia: babinski, hoffman's sign Fasciculations |
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What are 3 life-extending procedures done for someone with ALS?
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Non-invasive ventilation
Percutaneous endoscopic gastrostomy - aspiration Riluzole - Gluatmate pathway antagonis |
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Define diarrhea, inflammatory diarrhea, noninflammatory diarrhea, and acute and chronic diarrhea.
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Diarrhea - Loose or watery stools >3/day or increased volume
Inflammatory diarrhea - Colic tissue damage Noninflammatory - watery, nonbloody |
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Discuss the areas of focus in the history of a patient presenting with diarrhea.
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Onset, duration
Stress related Nocturnal diarrhea - Diabetic neuropathy Frequency - fluid rehydration |
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Discuss the areas of focus in the physical of a patient presenting with diarrhea.
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General Appearance - hydration, mental status
Vital signs Abd exam - peritoneal pain? Rectal - fistulas, fecal impaction |
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List the top 3 causes of inflammatory diarrhea due to bacterial tissue invasion.
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1-3 days onset (similar to ETEC)
Salmonella - Food borne eggs, poultry, beef, veggies, fruit Shigella - human to human Campylobacter - Chicken (guillain barre syndrome) |
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List 2 causes of cytotoxin-induced inflammatory diarrhea.
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EHEC - Shiga-like toxin attacks intestinal endothelial cells (beef, unpasteurized juice)
C diff - within 2 mos of Antibiotics Vibrio Parahemolyticus - shell fish |
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List the causes of noninflammatory diarrhea due to food poisoning from a preformed enterotoxin.
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S. Aureus - (1-6 hr incubation) prominent vomiting, lasts 24-48 hrs, Mayonnaise, creams/custards, meats
B Cereus - Emetic onset 1-6 hrs, Diarrhea onset 8-14, Last for 12-24 hrs. Rice and starches C. perfringens - Diarrhea after 6-12 hrs (no vomiting?); Lasts 24-48 hrs; reheated meats and gravies |
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What is the most important therapeutic measure in patients with diarrhea and how is it best accomplished?
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Rehydration - oral is preferred method but only if tolerated
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What organism is hemolytic uremic syndrome associated with?
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EHEC infections:
may be triggered by use of Loperamide or antibiotics with EHEC infection Associated with undercooked hamburger meat, raw milk, lake water and Apple cider |
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Discuss the concern with anti-peristaltic agents and when they should not be used in patients with diarrhea.
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They should not be given when a patient has Fever, bloody diarrhea or children
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Define diarrhea, inflammatory diarrhea, noninflammatory diarrhea, and acute and chronic diarrhea.
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Diarrhea - Loose or watery stools >3/day or increased volume
Inflammatory diarrhea - Colic tissue damage Noninflammatory - watery, nonbloody |
|
|
|
Discuss the areas of focus in the history of a patient presenting with diarrhea.
|
Onset, duration
Stress related Nocturnal diarrhea - Diabetic neuropathy Frequency - fluid rehydration |
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Discuss the areas of focus in the physical of a patient presenting with diarrhea.
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General Appearance - hydration, mental status
Vital signs Abd exam - peritoneal pain? Rectal - fistulas, fecal impaction |
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List the top 3 causes of inflammatory diarrhea due to bacterial tissue invasion.
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1-3 days onset (similar to ETEC)
Salmonella - Food borne eggs, poultry, beef, veggies, fruit Shigella - human to human Campylobacter - Chicken (guillain barre syndrome) |
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List 2 causes of cytotoxin-induced inflammatory diarrhea.
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EHEC - Shiga-like toxin attacks intestinal endothelial cells (beef, unpasteurized juice)
C diff - within 2 mos of Antibiotics Vibrio Parahemolyticus - shell fish |
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List the causes of noninflammatory diarrhea due to food poisoning from a preformed enterotoxin.
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S. Aureus - (1-6 hr incubation) prominent vomiting, lasts 24-48 hrs, Mayonnaise, creams/custards, meats
B Cereus - Emetic onset 1-6 hrs, Diarrhea onset 8-14, Last for 12-24 hrs. Rice and starches C. perfringens - Diarrhea after 6-12 hrs (no vomiting?); Lasts 24-48 hrs; reheated meats and gravies |
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What is the most important therapeutic measure in patients with diarrhea and how is it best accomplished?
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Rehydration - oral is preferred method but only if tolerated
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What organism is hemolytic uremic syndrome associated with?
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EHEC infections:
may be triggered by use of Loperamide or antibiotics with EHEC infection Associated with undercooked hamburger meat, raw milk, lake water and Apple cider |
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Discuss the concern with anti-peristaltic agents and when they should not be used in patients with diarrhea.
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They should not be given when a patient has Fever, bloody diarrhea or children
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Differentiate between heat cramps, heat exhaustion, and heat stroke.
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Heat cramps - Cramping of muscles due to dilutional hyponatremia.
Heat Exhaustion - dizziness, N/V, with profuse sweating. No mental status changes. Heat Stroke - hyperpyrexia, CNS dysfunction, anhidrosis. |
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What type of test is used to assess IV with nominal information and DV that has nominal information
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Chi squared
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Assessing data that has the IV with measurement data and DV with measurement data?
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Pearson correlation
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IV nominal data and DV measurement data?
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ANOVA - for more than 2 variables
T-test - for 2 variables |
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IV measurement data and DV measurement data
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Spearman Correlation
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