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Clin Med Lab midterm exam > Cases 1-4 > Flashcards

Cases 1-4 Flashcards

1
Q

Define Acute, subacute , chronic and recurrent sinusitis

A
  • Acute rhinosinusitis: symptoms < 4 weeks
  • Subacute rhinosinusitis: symptoms for 4-12 weeks
  • Chronic rhinosinusitis: symptoms > 12 weeks
  • Recurrent acute rhinosinusitis: ≥4 episodes per year, with interim symptom resolution
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2
Q

What would make you suspect bacterial sinusitis

A 
Symptoms > 10 days (without improvement) 
•Unilateral maxillary sinus/facial pain 
•Maxillary tooth pain 
•Unilateral purulent nasal discharge 
•Second sickening 
•Fever
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3
Q

What pathogens cause acute bacterial sinusitis

A

-Strep pneumo
•H influenza
•M cattarhalis
•Staph aureus

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4
Q

What medications would you use to treat bacterial sinusitis and how long for both adults and children

A 
1st line therapy: Amoxicillin/clavulanate (Augmentin) 
•Adults or kids 
•Penicillin allergic: Doxycycline 
•Adults: 5-7 days 
•Kids: 10-14 days
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5
Q

How would you treat viral Rhinosinusitis

A 
Analgesics/antipyretics 
•NSAIDs &amp; Tylenol 
•Saline irrigation/nasal spray 
•Intranasal glucocorticoids 
•Flonase 
•Oral or nasal decongestants 
•Sudafed, Afrin 
•Vicks
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6
Q

What are some complications of sinusitis?

A
  1. Preseptal cellulitis- swelling and erythema but no proptosis or limitation of eye movement
  2. Orbital cellulitis- Proptosis, limitation of eye movements, diplopia, vision loss
  3. Septic cavernous sinus thrombosis- bilat ptosis, proptosis, HA, mental status change
  4. Meningitis- HA, Fever, Nuchal rigidity
  5. Osteomyelitis of frontal bone
  6. Epidural, brain, and subdural abscess
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7
Q

Who is more likely to get a migraine men or woman

A

Woman

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8
Q

What are some migraine triggers?

A
  1. Change in weather
  2. Sleep: to much or to little
  3. Skipping meals
  4. Medications
  5. Menses
  6. Aged cheese, cured meats, red wine, dried fruits
  7. Nuts
  8. SEX
  9. Altitude
  10. Sun/heat
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9
Q

What is the pathophysiology of migraine

A

People who experience migraines are thought to have an increase in Calcitonin gene related signaling. CGRP is a neuropeptide that signals pain in the trigeminal nerve. The release or overproduction of CGRP, which is usually a genetic inheritance, causes the pain associated with a migraine

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10
Q

What are the 4 stages of a migraine

A
  1. Prodrome
  2. Aura
  3. Headache
  4. Postdrome
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11
Q

Define Prodrome

A

beginning phase of a migraine, can last hours to days.

S/Sx: 
irritability 
depression
sensitivity to light
Nausea 
difficulty sleeping
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12
Q

Define Aura

A

Can last 5-60mins

S/Sx:
visual disturbances, temporary loss of sight, numbness and tingling on part of the body.

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13
Q

The migraine/HA itself

A

Can last 4-72hrs

S/Sx:

Throbbing unilaterally
Drilling 
Ice Pick 
Burning 
Nausea
Vomiting 
Insomnia
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14
Q

Define Postdrome

A

Last stage of Migraine, can last 24-48 hours

S/Sx: 
Inabillity to concentrate 
Fatigue 
Depressed Mood 
Weird but Euphoric Mood
Lack of comprehension
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15
Q

What is the abortive therapy for an acute migraine

A

1st line

  • APAP/ASA/Caffeine(Excedrin)
  • NSAIDs
  • Acetaminophen

2nd line

  • Triptans
  • Ergotamine nasal spray

3rd line

  • Ketorolac injection
  • Ergotamine IV
  • Dexamethasone
  • Opioids- DO NOT USE!!!!!!
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16
Q

What are some prophylaxis Txs for migraines

A
  • Beta Blockers
  • Calcium channel blockers
  • Anti-depressants
    1. SSRIs/SSNRIs: fluoxetine, venlafaxine
    2. Tricyclic antidepressants (amitriptyline, nortriptyline)

-Anti-Convulsants: Valproic acid, topiramate

  • Calcitonin Gene-Related Peptide Therapy
  • Botox
  • Magnesium
  • Biofeedback/acupuncture/cognitive behavior therapy
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17
Q

What are the differences btw migraine and tension HA

A

Tension: is generalized or bilateral, affects neck, traps and back of head. Is a steady pain, usually occur in the afternoon, N/V not common

Migraine: Unilateral, Temporal, Throbbing Pain, can happen anytime, N/V more common

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18
Q

Pt education for migraine

A
  1. Avoidance of triggers
  2. Be aware of symptoms and catch them early
  3. Beware of rebound headaches/medication overuse
  4. If there is a headache that is different than your typical ones, come in
  5. Worst headache of your life, go to the ER
  6. Migraine symptoms can include….
  7. Side effects of new treatments
  8. Headache diary
  9. Menstruation
  10. Genetic
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19
Q

What are the main things to watch out for when prescribing a abortive therapy

A

-People with a history of MI, or Stroke or Hemorrhage should not take because these are vasoconstrictors

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20
Q

What are the three Types of CVA

A
  1. Ischemic
  2. Hemorrhagic
  3. Small Vessel (lacunar)
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21
Q

If an ischemic stroke last less than 24hrs what is it called?

A

This is known as a TIA and are caused by focal brain, spinal cord, or retinal issues and resolve on their own

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22
Q

What are the two types of ischemic stroke

A
  1. Thrombotic: Occlusion forms locally at the site

2. Embolic: Occlusion breaks off from another place moves and gets clogged in a different place

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23
Q

Difference BTW Hemorrhagic Vs Lacunar

A

Lacunar strokes are either pure motor or pure sensory deficits they do not have both

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24
Q

Risk Factors for a CVA

A
  1. Increased age
  2. Afib
  3. Hypercoagulable states
  4. HTN
  5. Smoking
  6. DM
  7. Drug use
  8. TIAs
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25
Q

S/Sx of ACA stroke

A
  1. Contralateral paralysis and sensory loss that mostly (or only) affects the leg
  2. Abulia (apathy)
  3. Urinary incontinence
  4. Gait apraxia
  5. Grasp reflex or sucking reflex
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26
Q

S/Sx of MCA stroke

A

Hemiparesis primarily affecting face & arm

Hemisensory deficit primarily affecting the face & arm

Gaze preference toward the affected hemisphere

Aphasia (if dominant hemisphere is affected)

Hemianopsia

May have apraxia and sensory neglect

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27
Q

S/Sxs of PCA stroke

A

Homonymous hemianopsia affecting the contralateral visual field
May be denser superiorly

Anomic aphasia (difficulty naming objects)

Alexia without agraphia (inability to read, but able to write)

Visual agnosia

Contralateral hemisensory loss and hemiparesis

Unilateral headache

Memory impairment

Oculomotor (III) nerve palsy

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28
Q

What are some S/Sxs of Lacunar strokes

A
  1. Pure Motor Hemiparesis
  2. Pure sensory Stroke
  3. Ataxic hemiparesis
  4. Sensorimotor Storke
  5. Dysarthria- Clumsy hand syndrome
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29
Q

S/Sxs of pure motor lacunar stroke

A

Weakness involving the face, arm, and leg on one side of the body. No sensory deficit

30
Q

Pure Sensory lacunar Storke S/Sxs

A

Numbness of the face, arm, and leg on one side of the body. No motor deficit

31
Q

Ataxic Hemiparesis lacunar stroke S/Sx

A

Weakness and numbness of the face, arm, and leg on one side of the body

32
Q

Dysarthria-clumsy hand syndrome

s/sxs

A

Facial weakness, dysarthria, dysphagia, and slight weakness and clumsiness of one hand

33
Q

Evaluation of CVA

A
  1. Neuro exam
  2. CT w/o contrast to eval for hemorrhage
  3. MRI: More sensitive to detect early ischemia
  4. MRA: Eval arteries for stenosis, occlusion, or aneurysm
  5. EKG: Eval for arrhythmia
  6. Carotid Doppler: Check for carotid stenosis
  7. Echo: Eval for possible embolic source
34
Q

What is the TPA inclusion Criteria

A
  1. Age ≥ 18 years
  2. Clinical diagnosis of ischemic CVA with a measurable neurologic deficit
  3. Time of onset <4.5 hours
35
Q

What are some exclusion criteria for TPA

A
  1. Evidence of intracranial hemorrhage on CT
  2. Previous intracranial hemorrhage
  3. Severe uncontrolled HTN (SBP>185 or DBP >110)
  4. Known AVM, neoplasm, or aneurysm
  5. Thrombocytopenia <100k
  6. Current use of an anticoagulant with INR >1.7 or PT >15 seconds
  7. Heparin use within 48 hours and abnormally elevated aPTT
  8. Current use of a direct thrombin inhibitor or direct factor Xa inhibitor with lab evidence of anticoagulant effect
  9. Arterial puncture at a noncompressible site in previous 7 days
  10. Active internal bleeding
  11. Significant stroke or head trauma in the previous 3 months
  12. Recent intracranial or intraspinal surgery
  13. Serum glucose < 50
36
Q

What are some relative Exclusion criteria for TPA

A
  1. Minor or isolated neurologic signs
  2. Rapidly improving stroke symptoms
  3. Major surgery or serious trauma in the previous 2 weeks
  4. GI or urinary tract bleeding in the previous 3 weeks
  5. MI in previous 3 months
  6. Seizure at the onset of stroke with postictal neurologiuc impairments
  7. Pregnancy
37
Q

Relative exclusion criteria if onset was from 3-4.5 hrs

A
  1. Age >80
  2. Oral anticoagulant use regardless of INR
  3. Severe stroke (NIHSS score >25)
  4. Combination of both previous ischemic stroke and diabetes
38
Q

BP management for ischemic CVA

A
  • need a blood pressure to maintain perfusion to the brain
  • drastic lowering of BP usually makes Pts worse
  • Before thrombolysis: lower SBP to <185 and DBP to <110
    Afterward, BP needs to be maintained <180/105 for at least 24 hours
39
Q

If a Pt is not going to get TPA do they suggest you treat the BP? If they do at what BP level would you intervene

A

If not pushing TPA than no BP intervention needed unless SBP> 220 or DBP>120 or if they have any of the following
-active ischemic CAD

  • heart failure
  • aortic dissection

-hypertensive
encephalopathy

  • ARF
  • preeclampsia/eclampsia
40
Q

Additional Management of CVA Pt

A

Antithrombotic therapy
Aspirin, clopidogral (Plavix), or aspirin-extended release dipyridamole (Aggrenox) all choices
Warfarin or NOAC for those with afib

VTE prophylaxis

Lipid lowering with statin

Blood pressure reduction after the acute phase of the ischemic stroke has passed

Smoking cessation

Exercise

Weight reduction

41
Q

What are some clues from H&P that will make you think claudication

A
  1. Pt can walk 4 blocks (discrete distance) prior to pain
  2. Sitting helps
  3. Pain resumes with activity again
  4. Pain in legs with reclining in chair
    • Dangling them down relieves the pain
  5. Advil does not help
  6. PMH clues you in
  7. Diminished pulses, smooth hairless legs that are cooler to touch, thickened toenails, color changes, +Buerger test
42
Q

What would be a positive Buerger test

A

Pallor in the feet/ lower extremities after lowering legs from holding them at an angle of 45 degrees for 1-2 minutes

43
Q

What is the Main Cause of PAD

A

PAD is most commonly secondary to atherosclerosis

44
Q

What are some clinical S/Sxs of PAD

A
  1. Asymptomatic
  2. Intermittent claudication
  3. Atypical pain
  4. Pain at rest
  5. Nonhealing wounds
    Usually on feet
  6. Ulcers
  7. Gangrene
  8. Dry or wet
  9. Thin, hairless/shiny skin
  10. Cool skin
  11. Blue toe syndrome
45
Q

Define claudication

A
  1. Exertional leg pain that classically occurs after a certain distance of walking
  2. Resolves with rest
  3. Symptoms resume again when patient resumes walking and goes the same distance
  4. Buttocks, hip, thigh, or leg pain
    Location can often correlate with the site of the lesion
46
Q

aortoilliac disease affects what parts of the body?

A

Buttocks & Hips

Aching, may have weakness of thigh or hip with walking. Diminished pulses in 1 or both groins
Leriche syndrome: triad of claudication, absent or diminished femoral pulses, & ED

47
Q

Where would find a clot in someone experiencing pain in the thigh

A

Common Femoral Artery

48
Q

Clot in the upper 2/3 of superficial femoral artery would affect what body part?

A

This would cause pain in the calf

49
Q

Clot in the lower 2/3 of femoral artery would affect what body part?

A

Popliteal area

50
Q

If a Pt was experiencing pain in the foot where would you expect the clot to be?

A

Tibial or peroneal

51
Q

What is the Tx for acute limb ischemia

A

Start heparin immediately & immediate revascularization

52
Q

Define an Arterial Ulcer

A

Arterial ulcers are very painful whereas venous are dull and achy

Arterial Ulcers are also deeper than venous ulcers, have well defined boarders, and are more dry than venous ulcers

53
Q

What are the 6 Ps for acute limb ischemia

A

Pain, pallor, pulselessness, paresthesia, paralysis, and perishingly cold

54
Q

Define Venous Ulcer

A

These ulcers are usually found on the lower part of the legs, are shallow, have irregular boarders, and have a moderate to heavy amount of exudate and are considered “wet”.

55
Q

Define Diabetic Ulcer

A

They are usually seen on the bony prominences of the body where continues pressure occurs. The main difference with these types of ulcers is that there will not be any pain associated with the ulcer. The pt is unable to feel it or even notice it.

Absent Reflexes, foot deformities

56
Q

What do you use for ABIs

A

this is performed using a doppler probe

57
Q

What is an ABI?

A

This is a ratio of the ankle systolic BP divided by the Brachial systolic BP

58
Q

Whats a normal range for an ABI

A

0.9 to 1.3

59
Q

What ABI is diagnosiable for PAD

A

A value less than or equal to 0.90

60
Q

What does an ABI > 1.3 indicate?

A

This is indicative of calcified vessels

61
Q

An ABI that is down 20% after exercise is diagnostic of what?

A

Arterial obstruction

62
Q

Who might you consider having perform Exercise testing?

A

Might be considered in patients with atypical pain & a normal ABI

63
Q

What does an Exercise test show?

A

Exercise treadmill tests give the most objective evidence of how much someone is functionally limited
Can also show response to treatment

64
Q

What is the initial imaging study for PAD

A

-CT angiography: initial study

-Conventional arteriography remains the gold standard for vascular imaging
In cases of acute ischemia, is preferred because simultaneous intervention possible

65
Q

Whats the reason for ordering vascular imaging?

A

Main goal: Provide clinicians with the information needed for an intervention
Level & extent of disease

66
Q

Tx for PAD

A

Risk factor modification
Smoking cessation, control DM and HTN, lose weight
Antithrombotic therapy long-term
ASA or Clopidogrel (Plavix)
Lipid-lowering therapy with at least a moderate intensity statin
Irrespective of LDL cholesterol level

67
Q

Tx for claudication

A
  1. Initial: supervised exercise program
  2. Cilostazol (Pletal)
    Contraindicated in ANY patients with CHF (↓survival). Patients with CAD have ↑ risk of angina & MI
    s/e: headache, diarrhea, infection, rhinitis
  3. Revascularization
    - For life threatening ischemia –or-
  • Patients with significant/disabling symptoms unresponsive to lifestyle modifications & medication
  • Need to first undergo vascular imaging to determine the anatomy & extent of disease
  • Stenting or bypass
68
Q

Prognosis/Complications of PAD

A
  1. PAD is a strong predictor of adverse CV outcomes
    Regarded as a CHD risk equivalent
  2. Predictors of progression to critical ischemia: Diabetes, ↑pack year smoking hx, lower ABI
  3. Risk of major amputation in patients with intermittent claudication
    7% over 5 years
    12% over 10 years
69
Q

What affects Med dosing?

A 
Age
Weight
Renal Function
Hepatic Function
Other current medications
70
Q

What are the available forms of Amoxicillin

A

Capsules: 250 mg, 500 mg
Tablets: 500 mg, 875 mg
Chewable: 125 mg, 250 mg
Suspension: 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml

71
Q

Describe the Schedule I-V drug classes

A

Schedule I
No currently accepted medical use in the US, lack of accepted safety, and high potential for abuse
Ie: heroin, marijuana (psh lies), cocaine

Schedule II
High potential for abuse, physical, and psychological dependence
Oxycodone, morphine, dilaudid, fentanyl, Ritalin, amphetamine

Schedule III
Lower potential for abuse
Ketamine, depo-testosterone, Tylenol with codeine

Schedule IV
Low potential for abuse (relative to other categories)
Xanax, , valium, Ativan, restoril, klonopin

Schedule V
Low potential for abuse, usually a preparation with limited quantities of narcotics
Robitussin with codeine

Clin Med Lab midterm exam (3 decks)

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