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Grad: 511 > 511 Final > Flashcards

511 Final Flashcards

1
Q

A disease only of the colon

A

Ulcerative colitis

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2
Q

What is UC?

A

An inflammatory bowel disease where the mucosal surface of the colon is inflamed

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3
Q

Where does UC most often occur

A

in the rectosigmoid areas
May involve entire colon

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4
Q

UC is characterized by what

A

bloody and purulent diarrhea

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5
Q

UC results in what changes to the intestinal wall

A

Friability, erosion and bleeding of the mucosal wall.

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6
Q

What is the only “cure” for UC?

A

A total colectomy (not first treatment option)

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7
Q

Who is most at risk for diverticulitis

A

obese patients

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8
Q

How do some patient present with divertic

A

Bleeding not associated with pain or discomfort

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9
Q

What do you see when diverticula become inflamed?

A

Usual s/s of infection (fever, chills, tachy)

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10
Q

Typical presentation of divertic

A

Localized pain and tenderness of the LLQ
Anorexia, nausea, vomiting

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11
Q

Why would you do a CT scan in a divertic patient

A

to rule out GYN etiologies (like cysts or tumors) as well as bowel pathology (abdominal abcesses)

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12
Q

What is the best management for divertic

A

a high-fiber diet

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13
Q

What is C. diff

A

a bacterial infection of the large intestine

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14
Q

Where is c.diff found

A

in water, air, soil, processed foods, feces

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15
Q

Symptoms of c. diff.

A

-profuse, watery, mucoid diarrhea
- may be asymptomatic

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16
Q

Risk factors for c. diff

A

-Working in healthcare facility
-Long duration hospitalization
-Long-term use of antibiotics that affects normal -GI flora
-Long-term use of medications that reduce GI acidity
-Consumption of contaminated food or water
-Touching infected soil, objects and surfaces

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17
Q

Symptoms of mild/mod c. diff infection

A

-watery diarrhea 3+ per day for 2+ days
-mild abdominal cramping and tenderness

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18
Q

Symptoms of severe c. diff infection

A

-10-15 watery stools per day
-Strong foul odor
-acute abdomen secondary to toxic megacolon with perf.
-fever
-abdominal distention
-nausea/vomiting/dehydration requiring hospitalization
-blood or pus in stools (very severe)

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19
Q

Diagnostic tests for C. diff

A

-CBC: elevated WBC
-ELISA: detects toxins
-Cell cytotoxicity assay: identifies effects of bacterial toxins on human cells
-polymerase chain reaction: detects bacterial genes
-endoscopy: pseudomembranes that suggest c-diff infection

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20
Q

C. Diff treatment

A

-metronidazole
-probiotics
-colectomy in severe cases

-maintain fluids
-clear liquid diet
-starchy foods to prevent diarrhea
-avoid caffeine, spicy foods, milk, greasy foods

-GI consult

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21
Q

GERD symptoms

A

-Regurgitation HS
-heartburn
-dysphasia
-water brash (reflex salivation)
-sour taste in am
-odynophagia
-belching
-coughing
-hoarseness
-wheezing at HS

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22
Q

When to refer a GERD pt to endoscopy

A

if diet modifications and 6 weeks of omeprazole has not helped

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23
Q

What to test with GERD

A

biopsy for h pylori

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24
Q

What to avoid in GERD

A

-coffee
-alcohol
-chocolate
-peppermint
-spicy foods

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25
Q

what to change in GERD

A

-eat small meals
-stop smoking
-stay upright for 2 hours after meals
-elevate HOB on 6-8in blocks
-dont eat 3 hours before bed

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26
Q

What age is rotavirus most common

A

kids under 3

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27
Q

symptoms of rotavirus

A

-low grade fever
-loss of appetite
-copious watery diarrhea
-flatulence
-vomiting
-stomach cramps

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28
Q

treatment for rotavirus

A

-fluids
-supportive care
-antiemetics

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29
Q

Most common cause of appendicitis

A

fecalith: stone made of feces found in colon

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30
Q

symptoms of appendicitis

A

-periumbilical pain shifting to RLQ
-vomiting following pain
-small volume diarrhea
-fever/chills
-loss of appetite

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31
Q

Clinical signs of appendicitis

A

-Mild elevation of CBC with early L)shift
(becomes high with gangrene or perf)
-WBC/RBC in urine
-ketonuria (if prolonged vomiting)
-Obturator sign

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32
Q

Treatment for appendicitis

A

-surgery
-antimicrobial therapy

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33
Q

Gastroenteritis

A

irritation and inflammation of the stomach

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34
Q

causes of gastroenteritis

A

–most often from infectious agent
Bacteria accounts for 30-80%
–Dietary factors: coffee, tea, soda with caffeine, meds,
–Metabolic factors: DM, hyperthyroidism, adrenal insufficiency

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35
Q

Symptoms of gastroenteritis

A

-watery diarrhea
-nausea/vomiting
-abdominal pain/cramping
-low grade fever
-headache
-dehydration

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36
Q

gastroenteritis diagnostic tests

A

-Stool culture: for those with severe diarrhea, fever, bloody stools,
——Identifies: shigella, salmonella, Campylobacter, Aeromonas and Yersinia
-Blood Cultures: for those with s/s of typhoid or enteric fever, hospitalized, fever
-Stool exam: for those who traveled to russa, Nepal or Rocky Mnts, negative stool culture
-Bowel Bx: for those with negative stool culture
-Flexible sigmoidoscopy:
——Reserved for those with colitis that is unresponsive to abx
——-For persistent diarrhea undiagnosed with labwork

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37
Q

——–differential diagnosis for gastroenteritis

A

-IBS
-IBD
-Ischemic bowel
-Partial bowel obstruction
-Pelvic abscess

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38
Q

————-s/s of h. pylori

A
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39
Q

treatment of h. pylori

A

-amoxicillin, clarithromycin and omeprazole for 2 weeks

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40
Q

Salmonella symptoms start

A

with nausea/vomiting followed by colicky abdominal pain and bloody or mucoid diarrhea

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41
Q

Causes of diarrhea

A

-Osmotic:
—Occurs when osmotic gap between stool and serum is over 50 (they are usually equal implying ingestion or substance malabsorption
——–Carbohydrate malabsorption: lactose, fructose, and sorbitol
-Laxative abuse
-Celiac disease: immune reaction to gluten in wheat, barley and rye

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42
Q

differential diagnoses for diarrhea

A

 Acute viral gastroenteritis
 IBS
 IBD
 Ingestion of antacids containing magnesium
 Lactose intolerance
 Abx therapy
 Laxative abuse
 AIDS
 Acute: abrupt onset and last for less than 1 week and Associated with N/V, fever
* Often viral causes: Acute viral gastroenteritis: most common cause

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43
Q

giardia causes

A

-Drinking unfiltered water (common cause for traveler’s diarrhea)
-Oral-anal intercourse
-Diarrhea for kids in day-care

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44
Q

Giardia treatment

A

–Quinacrine hydrochloride (atabrine) 100mg TID after meals for 5-7 days
–Metronidazole 250mg orally TID for 7-10 days (5-7?)

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45
Q

PUD is associated with what infection

A

h. pylroi

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46
Q

What is the hallmark of PUD

A

c/o buring/gnawing (hunger) sensation or pain (dyspepsia) in the epigastrium which is often relieved by food or antacids

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47
Q
A
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48
Q

Splenic sequestration is associated with what condition

A

sickle cell anemia

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49
Q

Symptoms of splenic sequestration

A

-abdominal pain
-pallor
-tachycardia

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50
Q

who should be taught the s/s of splenic sequestration

A

parents: it can be lifesaving
-teach s/s of anemia and enlarging spleen

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51
Q

What are two causes of macrocytic normochronic anemias

A

-folic acid deficiency
-b12 deficiency

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52
Q

G6PD is what

A

an x-linked recessive disorder in blacks that causes episodic hemolytic anemia because of an inability of RBC to deal with oxidative stress

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53
Q

What is the goal standard for dx of sickle-cell

A

hemoglobin electrophoresis

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54
Q

Risk factors for iron deficiency anemia

A

-older than 60
-poverty
-recent illness (ulcer, divertic, colitis, hemorrhoids, GI tumors)

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55
Q

s/s of IDE

A

-pale conjunctivae and nail beds
-tachycardia
-heart murmur
-cheilosis (fissures at angles of reddened lips)
-glossitis
-stomatitis
-splenomegaly
-koilonchia (concave finger nails with raised edge)
-esophageal webs (plummer-vinson syndrome)
-melena
-menorrhagia

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56
Q

What tests should be done on all clients with suspected iron deficiency anemia

A

fecal occult blood
(need to see if it is just from poor iron intake, decreased absorption or chronic blood loss)

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57
Q

treatment of IDA

A

-increase dietary iron first
-iron supplementation

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58
Q

What are reticulocytes

A

-newly maturing RBC still covered in its endothelial reticulum.

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59
Q

Reticulocyte count is elevated when

A

when body is trying to replace lost blood, during treatment for anemias and in bone marrow disorders

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60
Q

What is MCV

A

“mean corpuscular volume”
-indicates average size of each blood cell

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61
Q

Normal MCV range

A

76-96

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62
Q

What does an increased MCV indicate

A

-macrocytic
-seen in megaloblastic anemias (vb12, folate), liver disease, some drugs

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63
Q

most common cause of megaloblastic anemia (pernicious anemia)

A

b12 deficiency
(macrocytic and normochromic)

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64
Q

Siderblastic anemia

A

group of disorders when the body has enough iron but is unable to use it to make hgb. As a result, iron accumulates in the mitochondria giving a ringed appearance to the neuclus

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65
Q

diagnostic test for sideroblastic anemia

A

prussian blue stain

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66
Q

microcytic hypocromic anemia causes and diagnosis———–

A
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67
Q

what should be checked in an iron deficient anemia kid

A

lead level

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68
Q

Folic acid deficiency

A

Macrocytic anemia
-found with normal b-12 but low folate levels
-almost always due to inadequate intake
-can be caused by impaired metabolism and storage (alcoholism, drugs)
-impaired absorption

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69
Q

how does anemia of chronic disease

A

-low serum iron
-low TIBC
-serum transferrin normal or increased
-transferrin saturation low

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70
Q

Principle of iron supplementation

A

-dietary increase first
-Iron supplementation: 325 TID for 3-6 mo after normal levels restored
-IV only in oral failure

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71
Q

What is the most common cancer in children

A

acute lymphoblastic leukemia

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72
Q

symptoms of acute lymphoblastic leukemia

A

-pallor
-fatigue
-bleeding
-fever
-bone pain
-adenopathy
-arthralgias
-hepatosplenomegaly

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73
Q

how to diagnose acute lymphoblastic leukemia

A

cbc with differential

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74
Q

what are children who recieve radiation for acute lymphoblastic leukemia at an increase risk for

A

brain tumor as a secondary malignancy
(12% develope a new cancer within 20 years of being treated for the primary cancer)

75
Q

Most common type of leukemia in the US

A

chronic lymphocytic leukemia

76
Q

Median age of onset for chronic lymphocytic leukemia

A

70 years

77
Q

causes of functional incontinence

A

-delirium
-fecal impaction
-lack of manual dexterity
-decreased mobility
-Meds: diuretics, hypotics, alcohol, narcotics, decongestents

78
Q

symptoms of stress incont.

A

urine leaking with cough or sneezing

79
Q

primary cause of stress incont.

A

hx of vaginal deliveries

80
Q

Labs in urinary incont. workup

A

-urinalysis and culture
-serum electrolytes
-BUN
-Creatinine
-calcium (for polyuria without diuretics)
-glucose
-post void cath

81
Q

what is overactive bladder

A

A syndrome of symptoms that include:
-urgency
-frequency
-nocturia

Due to the involuntary contractions of the detrusor muscle

urge incont. may or may not be a feature (1/3 do)

82
Q

what is urge incontinence

A

sudden, intense urge to urinate and an involuntary loss of urine

83
Q

how is the diagnosis of a uti made

A

Subjective complaint and a clean-catch sample showing bacteria (esp. more than 100k)
-Culture is gold standard but urinalyisis with microscopy is quick

84
Q

Symptom of uti in elderly

A

altered mental status

85
Q

Medication for symptom relief in UTI

A

pyridium: relieves burning, pain, urgency and frequency

86
Q

Priapism

A

prolonged erection usually without sexual arousal

87
Q

drug of choice for low-flow priapism

A

Phenyleprine (neo-synephrine) (pure alpha-agonist effects and minimal beta activity)

88
Q

phimosis

A

unusually long foreskin or a foreskin that cannot be retracted over the glans during exam
-normal in uncircumcised infants

89
Q

Who needs referral to urologist with phimosis

A

anyone older than infancy

90
Q

hypospadias

A

opening of the penis is on the underside

91
Q

hypospadias is common in

A

infants with a family history

92
Q

how to fix hypospadias

A

-surgical correction by 1st grade
-these kids should not be circ.d because surgeon may need to repair later in life

93
Q

Varicocele symptoms

A

-testicular pain
-“bag of worms” feeling
-soft, movable blood vessels underneath the scrotal skin on palpation

94
Q

varicocele

A

an abnormal totuosity and dialation of the veins of the pampiniform plexus within the spermatic cord

95
Q

treatment and timing for undescended testes

A

-orchiopexy before the age of 6

96
Q

why do undescended testes need orchiopexy

A

-to promote normal spermatogenesis and hormone production
-prevent tumor formation
-leave them where they can be palpated

97
Q

Expected drop in PSA after 6mo of finasteride (Proscar)

A

50% drop

98
Q

what if PSA doesnt drop after 6mo of finasteride

A

consider prostate cancer

99
Q

when can men resume sex after prostate sx

A

4-6 weeks.
(if sex before then, spasmodic contractions at time of ejacultation can trigger delayed bleeding)

100
Q

not a first line treatment for BPH

A

saw palmetto

101
Q

Feeling of prostate in BPH

A

diffusely smooth and enlarged

102
Q

does the size of the prostate correlate to urinary symptoms

A

no

103
Q

first line tx for BPH

A

5-alpha-reductace inhibitors

-finasteride (proscar)
-dutasteride (avodart)

104
Q

What meds have been shown to cause ED

A

-antiandrogens
-antihypertensives (BB)
-symphatholytics (reserpine)
-anticholinergics
-antidepressants
-antipsychotics
-CNS depressants
-alcohol, tobacco, heroin

105
Q

bacterial prostatitis

A

recurrent bacterial infection of the prostate and urinatry tract

106
Q

age range for bacterial prostatitis

A

50-80

107
Q

S/S of bacterial prostatitis

A

accompanied by bladder obstruction symptoms such as:
-weak stream
-hesitancy or dribbling
-hematuria
-hematospermia
-painful ejeculation

108
Q

Most common pathogen for bacterial prostatitis

A

e. coli

109
Q

most common cause of bacterial prostatitis in 20 year olds

A

gonorrhea

110
Q

Differential for bacterial prostatitis

A

prostatic abcess

111
Q

how should a rectal exam be done in bacterial prostatitis

A

-gently because vigorous manipulation can result in septicemia (prostatic massage is contraindicated)

112
Q

Acute bacterial prostatis is always associated with what

A

-UTI with abrupt onset
-fevers, chills, low back pain, tenesmus, urinary complaints typical of a uti

113
Q

Prostate cancer is associated with

A

human cytomegalovirus

114
Q

latent symptoms of prostate cancer

A

-bone pain
-wt loss
-anemia
-SOB
-lymphedema
-lymphadenopathy

115
Q

risk factors for prostate cancer

A

-1st degree relative (2x as likely)
-high fat diet (primarily animal fat)
-smoking

116
Q

Treatment for prostate cancer

A

-Goserelin acetate (zoladex) IM
-leuprolide acetate (lupron) IM

(both block release of FSH and LH)

117
Q

Carpal tunnel syndrome

A

inflammation of the median nerve

118
Q

characteristic of carpal tunnel

A

-wrist achiness that radiates to base of thumb and palm of hand
-may be awakened at hs with pain and numbness

119
Q

initial tx for carpal tunnel syndrome

A

-wrist splint
-NSAIDS

120
Q

Who is more likely to have rotator cuff tears or degenerative arthritis

A

-older patients (>55)

121
Q

Who is most likely to present with glenohumeral dislocation of the shoulder

A

patients less than 30

122
Q

Who is most likely to present with fractures and dislocations of the shoulder

A

older than 55 years patienss

123
Q

Who is likely to suffer from impingement syndrome

A

middle-aged patients

124
Q

shoulder pain management

A
125
Q

Shoulder dislocation has pain with what movement

A

shrugging shoulders due to excessive pressure put on the shoulders

126
Q

CAUSES/RISK FACTORS of herniated disk

A

-age related degenerative changes
-smoking
-narrowed lumbar canal
-obesity
-osteoporosis
-stress
-muscle tension
-trauma
-frequent lifting without proper mechanics
-Vibration (driving, riding for long time)

127
Q

Most common area for herniated disc

A

L4-L5 with weakness in great toe

128
Q

EVALUATION OF HERNATIED DISC

A

-Motor and sensory function and DTR eval
-Straight leg raise to both limbs
-MRI if unclear dx and for those with neurologic symptoms

129
Q

Herniated disc prevention

A

-stop smoking
-reduce weight
-good posture and body mechanics
-adherence to exercise regimen

130
Q

Patellofemoral dysfunction:

A

encompasses a continuum of disorders due to overuse

131
Q

management of patellofemoral dysfunction

A

conservative treatment with NSAIDs and quad strengthening exercises

132
Q

What does the McMurray test evaluate

A

tears in the meniscus

133
Q

Phalen’s test

A

Flexing the wrist for 60s leading to painor paraesthesia in the median nerve

134
Q

Anterior drawer test is used when

A

when suspected rupture of the cruciate ligaments

135
Q

Rovsign sign

A

pain felt in the RLQ on palpation of the left side
(indicated acute appendicitis)

136
Q

WORK UP OF LOW BACK PAIN

A

-CBC, urine, ESR, CRP to dx infectious or inflammatory
–xray to eval boney structures
-CT to identify disc rupture, stenosis, tumors
-MRI if soft tissue injury
-EMG to dx radiculopathy

137
Q

differential diagnoses for acute and chronic low back pain

A

-ovarian cyst
-ankylosing spondylitis
-infection

138
Q

S/S of lumbar spinal stenosis

A

-radicular complaints in legs (w/wo pain)
-Short term relief when leaning forwars (they also often lean on stuff)
-Proximal to distal progression
-Walking/prolonged standing causes pain and weakness in legs and buttocks

139
Q

Red flags that may alert to spinal fx

A

-fall hx
-prolonged steroid use
-osteopenia
-osteoporosis

140
Q

Cervical spondylosis

A

Degenerative arthritis
A blanket term for chronic degenerative process that affect the vertebrae and facet joints

141
Q

s/s of cervical spondylosis

A

pain
stiffness
disability

142
Q

Cervical myelopathy symptoms

A

-radicular of the upper extremities and weakness
-Leg weakness and gait issues, loss of bowel and bladder in severe cases

143
Q

radicular symptoms include

A

pain, weakness, numbness and tingling due to narrowing of the space where nerve roots exit the spine due to stenosis, bone spurs, herniated discs.

144
Q

Primary cause of veterbral fractures

A

osteoporosis

145
Q

L4 nerve root symptoms

A

-weakness in the anterior tibialis
-numbness in shin
-thigh pain
-asymmetric knee relfex

146
Q

Paresthesis over the anterior thigh just above the knee indicates what level of involvement

A

L4
(L3 in book)

147
Q

HOW TO ASSESS PERIPHERAL NEUROPATHY+++++++++++++++++++

A
148
Q

peripheral neuropathy is characterized

A

“stocking-glove”
distal sensorimotor paresthesia with diminished or variable DTR

149
Q

Myofacial pain

A

Painful contractions of muscles after exertion, such as heat cramps

150
Q

cause of myofacial pain

A

may be related to hyponatremia or other electrolyte imbalances.

151
Q

common sites of myofacial pain

A

Usually, the gastrocnemius and hamstring muscles are involved.

152
Q

Treatment of heat cramps includes

A

-passive muscle stretching,
-cessation of activities,
-transfer to a cooler environment,
-drinking cool liquids.
-Sports drinks that contain electrolytes, such as Gatorade, may be beneficial

153
Q

Treatment for myofscial pain includes:

A

-indentifying and eliminating aggravating factors
-trigger point injections
-dry needling
-massage therapy.
Additional treatments include:
-muscle relaxants
-NSAIDs
-COX-2 inhibitors
-tricyclic antidepressants in cases that do not respond to other treatments.
-Narcotics and oral corticosteroids are not indicated.

154
Q

first degree ankle sprain

A

ligaments are stretched but not torn

155
Q

second degree ankle sprain

A

most common
-painful tearing of the ligament

156
Q

third degree ankle sprain

A

most severe
-ligament is torn completely

157
Q

muscle strains can be causes by

A

not properly warming up prior to exercise
(always suggest stretching and warm up exercises prior to full routine)

158
Q

treatment for a muscle strain

A

-NSAID
-low back strengthening exercises (depending on pain level, dont over do it)

159
Q

cervical neck sprain s/s

A

-pain most common presenting symptom
-headache (occipital for months)

160
Q

ANKLE SPRAIN S?S+++++++++++++++++P

A
161
Q

Patients with wounds should be asked about what vaccination

A

Tetanus (give booster if more than 5 years since)

162
Q

Suture removal for face

A

4-6d

163
Q

Suture removal for scalp

A

6-10 days

164
Q

Suture removal for trunk

A

7-10 days

165
Q

Suture removal for arms

A

10-14 days (same as legs)

166
Q

Suture removal for legs

A

10-14 days (same as arms)

167
Q

Suture removal for joints

A

14 days

168
Q

when can dermabond be used

A

on clean superficial lacerations less than 6cm and in low tension areas

169
Q

Who needs prophylactic abx for wounds

A

-DM
-vascular compromise

170
Q

initial abx treatment of choice in laceration prophylactic

A

Parental administration of:
-ampicillin/sulbactam,
-cephalexin,
-ceftriaxone

171
Q

secondary abx treatment for laceratin

A

Oral:
-amoxicillin/clavulanate
-cephalexin
-cefdroxil.

If the patient has allergies to penicillin or cephalosporins, the clinician should consider prescribing doxycycline, with or without clindamycin, or ciprofloxacin.

172
Q

Patient teaching with wounds and bites

A

watch for:
-red streaks
-increased warmth at the wound site
-increasing pain
-foul odor
-increased drainage from the bite wound

—all of which should trigger the patient to seek urgent assessment in the clinic or ED.

173
Q

Pain management for animal bite is commonly provided with analgesic agents such as:

A

-NSAIDs
-acetaminophen (Tylenol).

If nonnarcotic oral agents are ineffective and the patient is in severe pain:
-ketorolac (Toradol) 30 to 60 mg may be effective.

174
Q

How to clean a lacerated wound

A

Saline irrigation or even soapy water is preferred over dilute povidone-iodine (Betadine) solution, because povidone-iodine can be irritating and cytotoxic to lacerated tissue. The clinician should avoid hydrogen peroxide (H2O2), because it can be irritating to the wound.

175
Q

What to assess in puncture wounds

A

assessed for:
-skin integrity
-vascular and neurological function
-range of motion

176
Q

Flexor tendon injuries usually require:

A

primary wound closure by an orthopedic specialist

There is a high morbidity associated with flexor tendon injuries.

177
Q

abscess care

A

-must drain or it wont heal
-pack or dont
-abx or not (bactrum, clinda or doxy for MSRA if so)
-change dressing daily or PRN for saturation
-apply warm compress

178
Q

L5 nerve root involvement symptoms

A

-weakness in great toe extension
-numbness on top of foot and first web space
-posterolateral thigh and calf pain

179
Q

S1 nerve root involvement symptoms

A

-weakness in great toe flexor, gastrocsoleus with inability to sustain tiptoe walking
-numbness in lateral foot
-posterior calf pain
-asmmetrical ankle reflex

180
Q

Red flags of low back pain trauma

A

-sports injury
-fall from height
-MVA ACCIDENT
-coughing
-sneezing
-heavy lifting

181
Q

Red flags low back pain tumor

A

-advanced age (over 50)
-fevers
-night sweats (Severe)
-pain when lying flat
-severe pain at hs
-Unintended wt loss (greater than 10% in 6mo)

182
Q

Red flags low back pain infection

A

-pain at hs
-hx of bacterial infection
-hx of spinal procedure
-IV substance abuse
-immunocompromised
-immigrant backgroung
-recent travel
-hx of malignant pathology

183
Q

differentials for shoulder pain

A

younger: traumatic injuries or instablility such as glenohumeral dislocations and AC joint separations
middle aged: impingement and rotator cuff tears
-Old: rotator cuff tears or degenerative arthritis, fractures, dislocations

Grad: 511 (2 decks)

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