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Family Blueprints 1 > Allergies, Back Pain, Chest pain > Flashcards

Allergies, Back Pain, Chest pain Flashcards

1
Q

Allergies are mediated by what imunnoglobulin?

A

IgE

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2
Q

What are common skin manifestations of allergies?

A

urticaria, eczema

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3
Q

What are common food allergens in children?

A

Milk, eggs, peanuts, soy, wheat, tree nuts, shellfish, fish

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4
Q

Stings from which insects can cause anaphylaxis?

A

Hymenoptera (bees, wasps, ants)

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5
Q

What is the most likely cause of perennial (year-round) allergies?

A

Dust, feathers, animal dander, molds (household allergens)

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6
Q

Food allergies manifest as:

A

GI and skin sx

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7
Q

Sx of anaphylaxis include:

A

agitation, palpitations, paresthesias, puritis, difficulty swallowing, cough, and wheezing

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8
Q

How will the nasal mucosa appear with allergies?

A

swollen and pale

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9
Q

What other nasal symptom is common with allergies?

A

Polyps

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10
Q

What are allergic shiners?

A

darkening of the infraorbital skin in people with chronic allergies

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11
Q

What is atopic dermatitis?

A

Exudative eruption with oozing and crusting primarily occurring in the head and neck areas, diaper area, forearms and wrists.
Flexor surfaces
Lichenification

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12
Q

What blood test is available to identify specific allergies?

A

RAST

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13
Q

What skin test is available to identify specific allergies?

A

Skin-prick

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14
Q

What should be performed if no specific allergies are identified on RAST or skin-prick?

A

flexible nasolaryngoscopy to rule out anatomic or pathologic abnormalities

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15
Q

What is first-line therapy for rhinitis?

A

Antihistamine

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16
Q

What is the MOA and main SE of antihistamines?

A

Block H1 selectors, prevent release of histamine; SE is sedation

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17
Q

What drugs are used to treat allergies?

A 
Antihistamines
decongestants 
corticosteroids
Antileukotrienes
Intranasal cromolyn
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18
Q

What are contraindications in the use of oral decongestants?

A

HTN, thyroid disease, DM, problems with urination

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19
Q

What is the tx of choice for moderate-to-severe persistent allergic rhinitis?

A

Intranasal steroids:
Mometasone (Nasonex)
Budesonide nasal spray (Rhinocort Aqua)
Fluticasone propionate (Flonase)

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20
Q

What is the first-line tx of allergies for children and pregnant women?

A

Cromolyn (Mast cell stabalizer, OTC)

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21
Q

What are some Leukotriene modifiers that can be used for both asthma and allergies?

A

Monteleukast (singulair)

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22
Q

What are intranasal anticholinergics that can help allergies?

A

Ipratropium (Atrovent)

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23
Q

What are treatments for skin sx of allergies?

A

Oral antihistamines, topical steroids, cool colloid baths

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24
Q

What is the treatment of choice for anaphylaxis?

A

Epinephrine

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25
Q

What can be done for refractory cases of allergies?

A

Immunotherapy injecting pt with increasing doses of allergens to promote tolerane

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26
Q

What is the most common cause of nerve root impingement?

A

Disc herniation

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27
Q

What is the most common site of disk herniation?

A

L5-S1 followed by L4-5

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28
Q

What deficits are consistent with L4 impingement?

A

Patellar jerk (reflex)
Dorsiflexion of foot
sensation of medial aspects of tibia
Sciatica uncommon

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29
Q

What deficits are consistent with L5 impingement?

A

Extensor of great toe
Dorsum of foot/base of first toe sensation
Sciatica common

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30
Q

What deficits are consistent with S1 impingement?

A

Ankle jerk reflex
Plantar flexion
Buttock, post thigh, calf, lateral ankle, foot sensation

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31
Q

What are red flags of back pain?

A

Fever, night pain, weight loss, bone pain

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32
Q

What are the sx of cada equina syndrome?

A

Difficulty urinating
Fecal incontinence
Progressive weakness
Saddle anesthesia

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33
Q

What are the sx of spinal stenosis?

A

After age 50
Back pain, pseudoclaudication of lower ext that worsens with back extension or standing and is relieved by bending forward

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34
Q

What can cause nighttime awakening due to back pain that does not improve with bed rest?

A

Tumor, infection, inflammatory disease

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35
Q

What are manifestations of muscular back pain?

A
  • Acute onset
  • Triggered by heavy lifting
  • Lateralized back pain, pain in buttock and posterior upper thigh
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36
Q

What are manifestations of disk herniation?

A
  • Recurrent pain
  • Triggered by trivial stress
  • Nerve root L5, S1 impingements, frequent sciatica
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37
Q

What are manifestations of spinal stenosis?

A
  • Old age or congenital
  • Triggered by OA or congenital
  • Pseudoclaudication relieved by bending forward
38
Q

What are manifestations of spondylolisthesis?

A
  • Chronic pain
  • Triggered by OA or spondylolysis
  • Nerve root L5, S1 impingement with hyperextension activities
39
Q

What are the manifestations of compression fractures?

A
  • Acute onset
  • Osteoporosis, steroid use, myeloma is high risk
  • Pain in middle to lower spine
40
Q

What are the manifestations of spinal neoplasms?

A
  • Insidious onset

- Night pain not relieved by supine position

41
Q

What are the manifestations of cauda equina syndrome?

A
  • Old age
  • Massive disk herniation
  • Overflow incontinence, saddle anesthesia, decreased sphincter tone
42
Q

What are the manifestation of osteomyelitis?

A
  • Acute onset
  • Hx of back procedure
  • Fever, spinal tenderness
43
Q

What are the manifestations of inflammatory diskitis?

A
  • Young age
  • S. Aureus
  • Refusal to walk, fever, signs of sepsis, disk space narrowing, sclerosis per radiograph
44
Q

What are the manifestations of Ankylosing spondylitis?

A
  • Young age
  • HLA-B27
  • Morning spinal stiffness, hx of IBD, Sacroiliitis, chest expansion on radiograph
45
Q

What are manifestations of spondylolysis?

A
  • > 10 yrs
  • Triggered by hyperextension
  • Back, buttock pain with lordosis and activity, tight hamstrings
46
Q

What are the manifestations of Scheuermann disease?

A
  • Young age
  • Triggered by fatigue
  • Round back, vertebral wedging, end plate irregularity per radiograph
47
Q

What does focal tenderness of the spine indicate?

A

Tumor, infection, fracture, disc herniation

48
Q

What test will be positive with sciatica?

A

Straight leg raise

49
Q

What systemic diseases can present as back pain?

A

Metastatic cancer
Multiple myeloma
Osteoporosis

50
Q

What are indications for imaging for back pain (10)?

A
  • Pain persisting beyond 6 weeks
  • Age >50
  • Hx of trauma
  • Neuro deficit
  • Systemic sx
  • Chronic steroid use
  • Hereditary condition
  • Hx drug alcohol use
  • Hx osteoporosis
  • Immunodeficient
51
Q

What blood tests can be run for back pain that might have a systemic cause?

A
  • CBC (infection or anemia associated with malignancy)
  • UA
  • Calcium/phosphorus
  • ESR (malig, infection, connective tissue dz)
52
Q

80-90% of patients with mechanical low back pain will improve within what time period?

A

6 weeks

53
Q

What restrictions should be placed on a pt with mechanical back pain?

A
  • No bed rest unless pain limits activities, then no more than 2-3 days
  • Continue normal activity
  • Lift no more than 25 lbs
  • Avoid heavy lifting, twisting, prolonged sitting, driving for prolonged periods, heavy vibration
54
Q

What is first line tx in mechanical back pain?

A

NSAID/Acetaminophen

55
Q

What are contraindications for NSAIDS?

A

Gastritis, ulcers, HTN, chronic renal failure, CHF

56
Q

What is a second-line mechanical back pain treatment and what is the advantage of this med? ADR?

A

COX-2 inhibitors; fewer GI side-effects

ADR: increased risk of heart attack and stroke

57
Q

What medications can be used in the acute setting of mechanical back pain?

A

Narcotic

Muscle relaxants

58
Q

What medications can be used for radicular back pain?

A

Antiepileptics like gabapentin

59
Q

What medication may be useful in pts with chronic low back pain?

A

TCAs

60
Q

What is the treatment for cauda equina syndrome?

A

Emergency surgery

61
Q

When is a diskectomy indicated?

A

Herniated disk not responding to conservative therapy for 4-6 weeks

62
Q

What are sx of myocardial pain?

A

Substernal chest tightness or pressure that radiates to the left arm, shoulders, or jaw with diaphoresis, SOB, nausea, vomiting

63
Q

What are sx of anginal chest pain?

A

Brought on by exercise and lasts 5-15 min and disappears with rest or nitroglycerine

64
Q

What are sx of pericardial pain?

A

Persistent, sharp, severe, relieved by sitting up or leaning forward.
Aggrevated by breathing, lying back, coughing

65
Q

What are the sx of aortic dissection pain?

A

Anterior, severe, ripping or tearing with radiation to back or abdomen

66
Q

What are the sx of pneumothorax pain?

A

Sudden onset, sharp, unilateral, pleuritic, associated with SOB

67
Q

What is Beck’s triad and what does it indicate?

A

JVD, muffled heart sounds, decreased blood pressure- cardiac tamponade

68
Q

What does a friction rub and pulsus paradoxus indicate?

A

Pericarditis

69
Q

What does chest pain with hypotension, absence of peripheral pulses, and murmur of aortic insufficiency indicate?

A

Aortic dissection

70
Q

What does chest pain with normal auscultatory findings, tachycardia, tachypnea, and lower extremity edema indicate?

A

Pulmonary embolism

71
Q

What does ST elevation or depression indicate?

A

Cardiac ischemia

72
Q

What does diffuse ST segment elevation indicate?

A

Pericarditis

73
Q

What do Q waves indicate?

A

Old or recent MI

74
Q

What blood levels can be drawn for damaged cardiac myocytes?

A

CPK, Troponin, Myoglobulin

75
Q

What are the first markers to rise with myocyte damage and how long will it stay elevated?

A

Troponin; remain elevated for 5-14 days.

Most sensitive and specific for MI

76
Q

When does CPK-MB begin to rise and when does it peak after an MI?

A

Begins to rise within 4 hrs and peaks at 24 hours.

77
Q

What is indicated in stable patients with suspected cardiac disease and what should be obtained beforehand?

A

Exercise stress test with a baseline ECG before

78
Q

What should be done if an exercise stress test is positive?

A

Radionucleotide testing, stress echo, coronary angiography

79
Q

What stress test can be performed in patients that cannot exercise?

A

Chemical stress test with dobutamine or adenosine to achieve the correct HR

80
Q

What test can detect wall motion abnormalities?

A

Echocardiogram

81
Q

What imaging should be performed if PE is suspected?

A

Ventilation/perfusion scan

Spiral CT

82
Q

What is the initial management for acute MI?

A

Morphine
Oxygen
Nitroglycerine
ASA

83
Q

What can be given to pts if they are allergic to ASA?

A

Clopidogrel

84
Q

What is the target systolic BP and HR for pts with acute MI?

A

100-120 mmHg

60 BPM

85
Q

Who is eligible for thrombolytics in pts with acute MI?

A

ST elevation
Sx of acute MI
< 75 yrs old
Within 6 hrs of onset of chest pain

86
Q

What other drugs are used to treat an acute MI?

A 
Beta blockers
Heparin
Nitrates
ACE inhibitors
Thrombolytics
87
Q

What are contraindications for thrombolytics in acute MI?

A 
Active internal bleeding
Hx of cerebrovascular dz
recent surgery
intracranial neoplasm
AV malformation
aneurysm
Severe HTN
88
Q

What is a good alternative to thrombolytics?

A

Percutaneous transluminal coronary angioplasty (PTCA)

89
Q

How is stable angina treated?

A

ASA
Nitro for acute episodes
Beta blockers (reduce frequency, increase anginal threshold, reduce risk of MI)

Add CCB if this is not enough

90
Q

How is a PE treated?

A

Concomitant warfarin and heparin until INR is in target range, then d/c heparin

91
Q

How is a pneumothorax managed?

A

If small, conservative

If large, chest tube insertion

Family Blueprints 1 (2 decks)

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