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Internal Medicine - Harrison 21th Edition > Cardinal Manifistations and Presentation of Diseases > Flashcards

Cardinal Manifistations and Presentation of Diseases Flashcards

1
Q

What is acute pain? A _____ signal indicating _____ or _____ tissue damage that triggers a _____ reaction.

A

Warning. actual. potential. protective.

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2
Q

What is acute pain injury associated with?

A

Trauma, surgery and acute illness.

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3
Q

How long does acute pain last?

A

< 1 month

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4
Q

How long does subacute pain last?

A

1–3 months

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5
Q

How long does chronic pain last?

A

> 3 months

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6
Q

_____ acute pain, chronic pain has _____ protective role in preventing further tissue damage

A

Unlike. no.

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7
Q

What can trigger nociceptive pain?

A

Chemical, mechanical, thermal (noxious) stimuli

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8
Q

Nociceptors are _____ nerve fibers that detect _____ or ______ _____ stimuli.

A

Specialized. actual. potential. noxious.

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9
Q

What are the 2 types of nociceptive pain?

A

somatic and visceral

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10
Q

Somatic pain is _____, _____ pain that _____ in duration and quality (which fibers?)

A

Localized. sharp. varies. (Aδ fibers).

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11
Q

Visceral pain is _____, _____, _____ pain (which fibers?)

A

dull, diffuse, deep (C fibers)

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12
Q

What can be a typical example of how (diffuse) visceral pain may shift to (localized) somatic pain?

A

Appendicitis

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13
Q

Neuropathic pain is caused by _____ neural activity that arises secondary to _____, _____, or _____ of the nervous system

A

Abnormal. disease. injury. dysfunction.

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14
Q

The clinical presentation of neuropathic pain _____, but patients often describe a _____ sensation.

A

Varies. burning.

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15
Q

What are the 3 types of nociceptive pain?

A

Central, peripheral and sympathetic mediated.

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16
Q

Which syndromes can be within central pain?

A

Poststroke Pain, Phantom Limb Pain.

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17
Q

Which complications can be within peripheral pain?

A

Diabetic Neuropathy, Postherpetic Neuralgia.

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18
Q

Which syndrome can be within sympathtic mediated pain?

A

Complex Regional Pain.

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19
Q

Nociceptors detect a chemical, mechanical, or thermal noxious stimulus → _____ of stimulus to an electrical signal (action potential) → C fibers and Aδ fibers carry afferent input to the _____ horn of the spinal cord → secondary nociceptive neurons in the _____ tract carry afferent input to the _____ in the CNS → pain perception and a response sent along _____ pathways, which results in pain modulation and/or a reaction

A

Conversion. dorsal. spinothalamic. thalamus. efferent.

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20
Q

When is action potential formed in the nociceptors?

A

When surpasses threshold of them.

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21
Q

Withdrawal reflex is _____ _____ reflex that causes a part of the body to move away from a painful stimulus, via _____ of flexor muscles and _____ of extensor muscles

A

Polysynaptic. spinal. contraction. relaxation.

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22
Q

What is Hyperalgesia?

A

Exaggerated response to painful stimuli
(increased sensitivity to painful stimuli)

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23
Q

What is Allodynia?

A

Pain from non-painful stimuli

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24
Q

_____ _____ pain disorders can be a significant driver to the sensitization of central nociceptive neurons, depends on _____, _____ and _____ predisposing factors of the CNS prior to and during the onset of injury.

A

Chronic. peripheral. psychological. biological. environmental.

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25
Q

_____ changes of neuronal properties in the CNS result in a _____ threshold for what causes _____ pain.

A

Maladaptive. lower. continious.

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26
Q

What is reffered pain?

A

different location from causative stimulus

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27
Q

Dermatome is an _____ of the _____ that receives _____ innervation from a specific _____ root.

A

Area. skin. sensory. spinal.

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28
Q

Myotome is a _____ of _____ that are innervated by a _____ spinal nerve root

A

Group. muscles. single.

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29
Q

Visceral fibers from internal organs and somatic fibers from the skin and muscles _____ in the posterior _____ of the spinal cord and share _____ pathway to the _____.

A

Coverge. horn. common. brain.

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30
Q

What can cause referred pain to the right shoulder?

A

Cholecystitis / perforated Peptic Ulcer Disease

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31
Q

What can cause referred pain to the left shoulder?

A

Hemoperitoneum (classically secondary to splenic rupture)

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32
Q

What can cause referred pain to the left-sided chest and arm?

A

Myocardial Infarction (MI)

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33
Q

What can cause referred pain to the periumbilical?

A

early stages of Appendicitis.

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34
Q

Reffered pain from important internal organs: (dermatome+projection):
A) diaphragm
B) heart
C) esophagus
D) stomach
E) liver, bladder
F) small bowel
G) colon
H) bladder
I) kidneys, tetsicles

A

A) C4, shoulder
B) T3-4, left chest
C) T4-5, retrosternal
D) T6-9, epigastrium
E) T-10-L-1, right upper quadrant
F) T-10-L-1, periumblical
G) T-11-L-1, lower abdomen
H) T-11-L-1, suprapubic
I) T-10-L-1, groin

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35
Q

Pain scales are used to _____ a patient’s pain and _____ to pain _____ over time

A

Assess. response. management.

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36
Q

What is the name of the 3-step algorithm for the management of acute and chronic pain?

A

WHO analgesic ladder

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37
Q

What to give in mild pain? (step 1)

A

nonopioid analgesics (Acetaminophen, NSAIDs…)

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38
Q

What to give in moderae pain? (step 2)

A

nonopioid analgesics, consider mild opioids (codeine, hydrocodone, tramadol…)

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39
Q

What to give in severe pain? (step 3)

A

nonopioid, mild opioids, consider strong (morphine, hydromorphone, fentanyl…)

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40
Q

Which modification has been done about treatment management of the WHO analgesic ladder?

A

Step 4 for persistent pain (ex. nerve block)

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41
Q

For both opioid and nonopioid analgesics, use the _____ effective dose for the _____ duration of time to minimize _____ effects.

A

Minimal. shortest. adverse.

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42
Q

For Acetaminophen - how to administer?

A

325–1000 mg PO every 4–6 hours as needed (max. dose 4000 mg/day)

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43
Q

NSAIDs - how to administer for:
A) Aspirin
B) Ibuprofen
C) Diclofenac
D) Naproxen
E) Indomethacin
F) Meloxicam

A

A) 325–975 mg PO every 4–6 hours as needed (max. dose 4000 mg/day)
B) 400–800 mg PO every 6–8 hours as needed
C) 50 mg PO every 6–8 hours or 75 mg every 12 hours as needed.
D) 250–500 mg PO every 12 hours as needed
E) 25–50 mg PO every 8–12 hours as needed
F) 7.5–15 mg PO once daily as needed

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44
Q

For Celecoxib - how to adminiser?

A

400 mg PO once on the first day, then 200 mg every 12 hours as needed.

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45
Q

Opioids - how to administer for:
A) Oxycodone (immediate-release)
B) Hydromorphone (immediate-release)
C) Tramadol

A

A) 5–30 mg PO every 4–6 hours as needed.
B) 2–4 mg PO every 4–6 hours as needed
C) 50–100 mg PO every 4–6 hours as needed

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46
Q

Combination analgesics -how to administer for:
A) Codeine/acetaminophen
B) Hydrocodone/acetaminophen
C) Hydrocodone/ibuprofen
D) Oxycodone/acetaminophen

A

A) Codeine 15–60 mg/acetaminophen 300 mg 1 to 2 tablets PO every 4 hours as needed for pain
B) Hydrocodone 5 mg/acetaminophen 325 mg 1–2 tablets PO every 4–6 hours as needed
C) Hydrocodone 2.5–7.5 mg/ibuprofen 200 mg PO every 4–6 hours as needed
D) Oxycodone 2.5–10 mg/acetaminophen 300–325 mg PO every 6 hours as needed

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47
Q

When Acetaminophen is contraindicated?

A

Liver failure / active hepatic disease

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48
Q

Which 2 analgesics drugs are the preferred first-line for mild to moderate pain? which drug is not preferred?

A

Preferred: Ibuprofen, Naproxen. Not: Indomethacin.

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49
Q

When NSAIDs are contraindicated?

A

Recent MI, perioperative period CABG (exception: low-dose aspirin in the management of acute MI)

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50
Q

When NSAIDs preferred not to be used?

A

Bleeding disorders, before invasive procedures.

51
Q

When NSAIDs preferred to be used with caution?

A

PUD and renal disease.

52
Q

Which drug is preferred to be second-line analgesic for mild to moderate pain?

A

Celecoxib (Selective COX-2 inhibitor, more expensive than NSAIDs)

53
Q

Which drug is preferred for patient with PUD?

A

Celecoxib

54
Q

When Celecoxib preferred to be used with caution?

A

Renal or cardiovascular disease

55
Q

When Opioids are contraindicated? (5)

A

Asthma
respiratory depression
Bowel obstruction
Biliary colic
Head injury

56
Q

Which drug is not recommended for patients with epilepsy, as it lowers the seizure threshold?

A

Tramadol

57
Q

Which drug is not recommended for perioperative or postoperative analgesia in opioid-naive patients?

A

Oxycodone

58
Q

Monitor for respiratory _____ in the first _____ hours after _____ or _____ the opioid dose.

A

Depression. 72. initiating. increasing.

59
Q

When to consider management of combination analgesics?

A

moderate to severe pain

60
Q

Headache red flags (SNOOP10):
S - ?
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache or recent onset
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

S- ystemic symptoms (nonspecific e.g., fever, malaise)

61
Q

Headache red flags (SNOOP10):
Systemic symptoms
N - ?
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache or recent onset
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

N - eoplasm in history

62
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
N - ?
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache or recent onset
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

N - eurological deficits/dysfunction

63
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
O - ?
Older age at onset
Pattern changes of headache or recent onset
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

O - nset of headache is sudden

64
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
O - ?
Pattern changes of headache or recent onset
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

O - lder age at onset (>50)

65
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
P - ?
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P - attern changes of headache

66
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
P - ?
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P- ositional headache

67
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
P - ?
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P - recipitated by sneezing, coughing, exercise

68
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
P - ?
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

Papilledema signs of increase ICP

69
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
P - ?
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P- rogressive headache and atypical features

70
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
P - ?
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P - regnancy or postpartum period

71
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
P - ?
Posttraumatic onset
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P - ain eye + autonomic + visual features

72
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
P - ?
Pathology of the immune system
Painkiller overuse or new drug at onset of headache

A

P - osttraumatic onset

73
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
P - ?
Painkiller overuse or new drug at onset of headache

A

P - athology of the immune system

74
Q

Headache red flags (SNOOP10):
Systemic symptoms
Neoplasm in history
Neurological deficits/dysfunction
Onset of headache is sudden or abrupt
Older age at onset
Pattern changes of headache
Positional headache
Precipitated by sneezing, coughing, or exercise
Papilledema and other signs of increased ICP
Progressive headache and atypical features
Pregnancy or postpartum period
Pain of the eye with autonomic features and visual deficits
Posttraumatic onset
Pathology of the immune system
P - ?

A

P - ainkiller overuse, new drug onset

75
Q

Headache is a pain related to _____ and/or _____ of _____ or _____ structures with _____ receptors

A

Irritation, inflammation, intracranial, extracranial, pain.

76
Q

What is a primary headache?

A

Not by another underlying condition

77
Q

What are included in the primary headache?

A

Migraine, tension, trigeminal autonomic cephalalgias (TACs)

78
Q

What is a secondary headache?

A

Caused by another underlying condition.

79
Q

What is the classical triad of Meningitis?

A

Fever, headache, and neck stiffness.

80
Q

What can be other signs of Meningitis?

A

Meningismus (meningeal irritation, ex. photophobia) +
Altered mental status, GI, seizures.

81
Q

What are the characteristics of the Meningitis pain?

A

Dull, diffuse (holocephalic) worsens over h/d.

82
Q

What is the other name of Intracerebral hemorrhage? (ICH)

A

Intraparenchymal hemorrhage

83
Q

What are the characteristics of the ICH pain?

A

Acute, severe, nonspecific headache.

84
Q

What are the symptoms of ICH?

A

GI, decreased consciousness, seizures.

85
Q

Can ICH can lead to an injury of specific anatomical region in NS?

A

Yes, focal neurological signs.

86
Q

In which condition, patients often describe their headaches as “the worst headache they have ever experienced”?

A

Subarachnoid hemorrhage.

87
Q

What are the characteristics of the SAH pain?

A

Acute onset of thunderclap headache.

88
Q

Can SAH can lead to an injury of specific anatomical region in NS?

A

Yes, focal neurological signs.

89
Q

What are the symptoms of SAH?

A

Meningismus, rapidly worsening neurological status.

90
Q

What can be the result of extensive hemorrhage and / parenchymal injury in SAH?

A

Seizures.

91
Q

What are the characteristics of Subdural hematoma? (SDH)

A

Diffuse headache, worse side hematoma.

92
Q

How long does lucid interval in SDH may last?

A

Days to weeks.

93
Q

What are the signs of SDH?

A

Impaired consciousness, confusion, focal deficits.

94
Q

Which symptoms can be in chronic subdural hemorrhage?

A

Psychomotor impairment, memory loss.

95
Q

What are the characteristics of Epidural hematoma? (EDH)

A

Headache localized side of hematoma.

96
Q

How long does lucid interval in EDH may last?

A

Minutes to hours.

97
Q

Which symptom can be in EDH?

A

Contralateral focal symptoms/hemiplegia.

98
Q

What other symptoms can be in EDH?

A

Mental, loss consciousness, seizures, GI.

99
Q

What are the characteristics of Cerebral venous sinus thrombosis?

A

Nonspecific headache (rarely sudden-onset)

100
Q

What are the risks factors for CVST?

A

Pregnancy, prothrombotic, vasculitis, smoking, oral contraceptives.

101
Q

Which syndrome can be caused by CVST?

A

Cavernous sinus syndrome.

102
Q

Which symptoms can be in CVST?

A

Seizures, impairment consciousness, increase ICP.

103
Q

What is the other names of Giant cell arteritis? (GCA, 2)

A

Horton disease, Temporal arteritis.

104
Q

What are the characteristic of GCA?

A

Unilateral headache, temporal/occipital area .

105
Q

Which artery is more prominent and tender in GCA?

A

Temporal artery

106
Q

Which symptoms can be in GCA?

A

Jaw claudication, scalp tenderness, B.

107
Q

What is the other names of Hypertensive crisis?

A

Acute severe hypertension

108
Q

What are the characteristic of Hypertensive crisis?

A

Diffuse, pulsating, exacerbated physical activity.

109
Q

What are the other symptoms of Hypertensive crisis?

A

> 180/120 mm Hg, signs of end-organ damage.

110
Q

What are characteristics of Ischemic stroke headache?

A

Tension-type headache

111
Q

What are the other symptoms of Ischemic stroke headache?

A

Focal neurological deficits, Altered mental.

112
Q

What are the characteristics of Intracranial space-occupying lesions?

A

Dull, usually bifrontal, worsen w/m.

113
Q

Which signs will be seen in intracranial space-occupying lesions?

A

Increased ICP

114
Q

What other symptoms will be intracranial space-occupying lesions?

A

Focal neurological, altered mental, seizures, GI.

115
Q

What are the characteristics of Medication overuse headache?

A

Variable characteristics

116
Q

Which symptoms will be in Medication overuse headache?

A

Autonomic, cognitive or behavioral.

117
Q

Which history is needed to be checked in Medication overuse headache?

A

Analgesic overuse

118
Q

What are the other names of Trigeminal neuralgia? (2)

A

Tic douloureux, Prosopalgia.

119
Q

What are the characteristics of Trigeminal neuralgia?

A

Paroxysmal (sec-2 min) and stabbing pain

120
Q

What can be the triggers of Trigeminal neuralgia?

A

Chewing, talking, cold, touching specific.

121
Q

_____ and _____ of Trigeminal neuralgia episodes usually _____ over time

A

Frequency, intensity, increase.

122
Q

What are the characteristics of Acute angle-closure glaucoma?

A

Sudden unilateral, severe ocular pain / headache

123
Q

What may be presented with palpitation of Acute angle-closure glaucoma?

A

Hard palpitation of the eye

Internal Medicine - Harrison 21th Edition (2 decks)

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