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*Summative Cases > Cases 1/29- Constipation, UTI, Presbycusis, Asthma, Flu > Flashcards

Cases 1/29- Constipation, UTI, Presbycusis, Asthma, Flu Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of airways characterized by bronchial hyperresponsiveness, underlying inflammation, recurring sx

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2
Q

Sx of asthma

A 
Wheeze on exhalation
Cough (worse at night)
SOB
Chest tightness
Sputum production
Dyspnea
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3
Q

Sx of asthma if severe airflow obstruction

A

tachypnea, tachycardia, prolonged expiratory phase of respiration, tripod position, accessory muscle use, belly breathing, nasal flaring, tracheal tugging

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4
Q

How do you diagnose asthma?

A

Chest X-ray, blood tests, allergy tests, PFT, bronchodilator response

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5
Q

If doing a spirometry what do you expect to see with asthma?

A

reduced FEV1/FVC ratio

<7.0 = obstructive pattern

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6
Q

In adults, what are other DDx for asthma symptoms?

A

COPD, CHF

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7
Q

You should get a _________ for a wheezing patient to detect __________, _________, ___________, ________

A

CXray

pneumonia, FB, CHF, nonasthmatic causes of wheezing

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8
Q

What does an Xray show in an asthma patient?

A

Normal or hyperinflation due to air trapping

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9
Q

What are the most common SABA?

A

Albuterol

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10
Q

ADRs of Albuterol

A

flushing
tremors
tachycardia

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11
Q

What are cromolyn sodium and nedocromil?

A

Mast cell stabilizer

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12
Q

What drug is useful in the management of nocturnal symptoms and exercise-induced asthma?

A

Salmeterol

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13
Q

What is pathology of asthma?

A

airway edema
increased mucus production
bronchospasm

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14
Q

Classify the asthma: Symptoms less than or equal 2 times per week; less than or equal 2 times per month of nighttime symptoms, FEV1 or PEF greater or equal to 80%

A

Intermittent

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15
Q

Classify the asthma: Daily symptoms, daily use of beta-2 agonist, affects activity; Nighttime symptoms >1 time a week, but not nightly; FEV1 or PEF 60-80%

A

Persistent-moderate

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16
Q

Classify the asthma: Symptoms >2 times per week, but 3-4 times per month; FEV1 or PEF >80%

A

Persistent- mild

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17
Q

Classify the asthma: continual symptoms with use of beta2 agonist multiple times in 1 day, limited physical activity; Nighttime symptoms frequently at times almost each night; FEV1 or PEF

A

Persistent-severe

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18
Q

Step 1 Asthma Treatment

A

SABA PRN - Albuterol

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19
Q

Step 5 of Asthma Treatment

A

SABA PRN + high dose ICS + long acting beta agonist (consider omalizumab for patients with allergies)

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20
Q

Step 3 of Asthma Treatment

A

SABA PRN + low-dose ICS + LABA OR medium dose ICS

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21
Q

Step 2 Asthma Treatment

A

SABA PRN + low-dose ICS

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22
Q

Step 6 Asthma Treatment

A

SABA PRN + high-dose ICS + LABA + oral corticosteroids AND consider omalizumab for pts who have allergies

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23
Q

What are the Sx of constipation?

A

Must of have 2 of the following:
Straining, hard lumpy stool, sensation of incomplete evacuation, use of digital maneuvers, sensation of anorectal obstruction or blockage in 25% of BM, less than 3 stools/week

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24
Q

Metabolic causes of constipation

A 
hypothyroid
hypercalcemia
hypokalemia
scleroderma
amyloidosis
pregnancy
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25
GI causes of constipation
tumors IBS diverticulitis
26
Neurogenic causes of constipation
``` trauma to brain/spinal cord CNS tumor Parkinsons paraplegia prior pelvic surgery DM Colonic mass Hirschsprung disease ```
27
Perianal causes of constipation
``` Fissue hemorrhoids Rectocele Rectal prolapse Diverticular disease ```
28
Medication causes of constipation
``` Opiates CCB Anticholinergics TCA Diuretics Antacids Conidine Levodopa Laxative abuse ```
29
What are diagnostic techniques of constipation?
Rectal X-ray; abdominal x-ray | If new onset in older adults: CBC, serum electrolytes, TSH, Ca level, anoscopy
30
What are examples of bulk-forming agents? (3)
psyllium (bloating, impaction above strictures), methycellulose (fluid overload, impaction with insufficient fluid), polycarbophil (fluid overload, impaction)
31
What are examples of osmotic laxatives? (3)
lactulose (bloating), magnesium salts (MOM; Mg toxicity), sorbitol (bloating) MOM c/i in renal failure
32
What are examples of stimulants? (3)
bisacodyl (gastic or renal irritation), senna (degeneration of myoneural plexuses), casathranol (degeneration of myoneural plexuses)
33
What are examples of stool softeners?
docusate sodium (skin rashes, hepatotoxicity)
34
What are indications for further lab testing with constipation?
refractory constipation, new onset constipation in older adults, heme-positive stools, unclear etiology
35
What is presbycusis?
age related hearing that is a bilateral sensorineural impairment of higher frequencies that may compromise speech comprehension
36
What are symptoms of presbycusis?
Progressive, symmetric hearing loss of high frequency, tinnitus, vertigo, falls, low self-esteem, isolation, depression
37
What are diagnostics for presbycusis?
Otoscopy (for cerumen impaction, infx, TM perf, tumors) Whispered ear Tuning forks (weber vs rinne) Audiogram
38
What is treatment for presbycussis?
Hearing aid Cochlear implantation Assistive listening devices Auditory rehab
39
What is the difference between conductive vs sensorineural?
``` Conductive = inability to mechanically transmit sound vibrations Sensorineural = inability to effectively transduce sound info ```
40
What is Meniere disease?
acquired condition (not age-related) that affects the inner ear and can affect balance and hearing
41
What are sx of Meniere disease?
episodes of tinnitus, progressive hearing loss (low-pitched loss usually U/L), Hyperacusis and nystagmus may be present
42
What ages for Meniere disease?
30-60
43
What is treatment for Meniere disease?
diuretics (acetazolamide or hydrochlorothiazide) | Salt restriction
44
What is otosclerosis?
hereditary disorder in which ossification of labyrinth of inner ear occurs, resulting in tinnitus and CONDUCTIVE hearing loss; not age related
45
What is the treatment for otosclerosis?
surgical to otolaryngologist
46
What is an acoustic neuroma?
Schwannoma of CN VIII that grows to compress the nerve and brainstem
47
What is labyrinthitis?
Inflammation of labyrinth and usually follow URI; causes vomiting and severe vertigo
48
How long does it take to recover from labyrinthitis?
1-6 weeks
49
Treatment of labyrinthitis?
Meclizine, dimenhydrinate, antiemetics, benzodiazepines
50
Sx of UTI
dysuria, frequency, urgency, suprapubic pain, hematuria delirium in elderly Others- fever, chills, flank pain, CVA tenderness, N/V
51
Diagnostics of UTI?
UA Urine culture CVA tenderness
52
What are sx of UTI in infants and children?
irritability, fever, N/V, bed wetting, diarrhea
53
What are sx elderly patients may have of UTI?
change in mental status, malaise, incontinence, poor appetite
54
When should chlamydial or gonococcal infection be suspected?
gradual onset of illness, no hematuria, no suprapubic pain, more than 7 days of symptoms
55
What do older men usually have a UTI or irritative symptoms secondary to?
BPH
56
What do WBC casts indicate?
upper tract involvement
57
What are diagnostic criteria of acute uncomplicated cystitis?
UA for pyuria and hematuria
58
Treatment of uncomplicated cystitis?
``` Fosfomycin Nitrofurantoin TMP/SMX Trimethoprim Ciprofloxacin Oxfloxacin Norfloxacin ```
59
What are diagnostic criteria for complicated UTI?
urine culture with a bacterial count of more than 10,000 CFU/mL of urine
60
What is treatment for complicated UTI?
If Gram -, oral fluoroquinolone If Enterococcus species, ampicillin or amoxicillin w/ or w/o gentamicine Treat for 10-14 days
61
What are the causes of the flu?
Influenza A or B
62
What are symptoms of flu?
Abrupt onset of HA, fever, malaise, and myalgia Possibly non-productive cough, sore throat, nasal discharge
63
Diagnostics of flu
Rapid influenza antigen test Viral culture RT-PCR is preferred test
64
Treatment of flu
antiviral therapy (Zanamivir or oseltamivir)

*Summative Cases (2 decks)

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