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Early Patient Encounter > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

Acute illnesses

A

Sudden and last a short time few days or weeks.

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2
Q

Example of an acute illness

A

Acute pharyngitis

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3
Q

Chronic conditions

A

Develop slowly and may worsen over an extended period of time- months to years.

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4
Q

Chronic conditions

A

Hypertension

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5
Q

Upper respiratory infection involves

A
  1. Nose
  2. Sinuses
  3. Pharynx
  4. Larynx
  5. Large airways
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6
Q

One of the viral causes of URTI?

A

COVID-19

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7
Q

COVID-19

A

Infectious viral diseases caused by an enveloped single stranded RNA novel coronavirus.

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8
Q

Length of common cold

A

1 1/2 weeks

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9
Q

Length of acute otitis media

A

4 days

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10
Q

Length of acute sore throat

A

1 week

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11
Q

Length of acute pharyngitis

A

1 week

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12
Q

Length of acute tonsillitis

A

1 week

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13
Q

Length of Acute rhinosinusitis

A

2 1/2 weeks

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14
Q

Length of Acute cough

A

3 weeks

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15
Q

Length of Acute bronchitis

A

3 weeks

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16
Q

Rhino-sinusitis

A
  1. Nasal congestion
  2. Purulent rhinorrhea
  3. Postnasal drip
  4. Headache
  5. Facial pain
  6. Anosmia
  7. Cough
  8. Fever
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17
Q

Rhino-Rhinitis

A
  1. Nasal congestion
  2. Rhinorrhea clear
  3. Runny nose
  4. Itching red eyes
  5. Nasal crease
  6. Seasonal symptoms
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18
Q

Sinusitis

A

Purulent discharge with congested nasal mucosa.

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19
Q

Rhinitis

A

Clear discharge with congested nasal mucosa.

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20
Q

Management for sinusitis

A
  1. Analgesia (paracetamol +- ibuprofen)
  2. Fluids
  3. Steam inhalation
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21
Q

Treatment options for sinusitis

A
  1. Decongestants
  2. Steroid nasal sprays
  3. Antibiotics (amoxicillin 500 mg 3 times per day) only if severe symptoms
22
Q

Severe symptoms

A

More than 2.5 weeks or high risk of serious complications.

23
Q

Emergency if

A

Suspected orbital cellulitis

24
Q

Acute pharyngitis

A

Caused by respiratory viruses and are self limited. Symptoms of viral pharyngitis broadly overlap with pharyngitis caused by important causes such as group A streptococcus (GAS).

25
Q

Investigation pharyngitis

A

Usually clinical. Evidence of infection can be gained by measuring change in antibody response (ASO titre) which is negative in 78% of infections.

26
Q

Management of pharyngitis

A

Centor and FeverPAIN criteria for sore throat:
If >= 3 GAS pharyngitis should be suspected and antibiotic should be prescribed for 10 days.

27
Q

Centor Criteria

A

1 point for each feature
1. Tonsillar exudate.
2. Tender anterior cervical LNs.
3. History of fever >38
4. Absence of cough

28
Q

Fever Pain score

A

1 point for each feature:
1. Fever in previous 24 hours.
2. Pus in tonsils.
3. Attends rapidly ( less than 3 days onset)
4. Severely inflamed tonsils.
5. No cough/coryza.

29
Q

Pharyngitis urgent referral

A

Unexplained sore throat for more than month.

30
Q

Referral for tonsillectomy

A
  1. Recurrent acute tonsillitis that leads to missing a lot of school/work: more than 7 attach per year in 2 years.
  2. Airway obstruction: very large tonsils causing sleep apnea.
  3. Chronic tonsillitis more than 3 months and halitosis.
  4. Recurrent quinsy.
  5. Unilateral tonsillar enlargement to exclude malignancy.
31
Q

Hypertension

A

Silent killer
Persistent elevation of blood pressure.

32
Q

Hypertension blood pressure

A

140/90 or higher
1e0/80 or higher

33
Q

Normal blood pressure

A

Systolic: less than 120
Diastolic: less than 80

34
Q

Elevated blood pressure

A

Systolic: 120-129
Diastolic: less than 80

35
Q

Hypertension stage 1

A

Systolic: 130-139
Diastolic: 80-89

36
Q

Hypertension stage 2

A

Systolic: more than 140
Diastolic: more than 90

37
Q

Resistant hypertension

A

Blood pressure above goal despite adherence to a combination of at least 3 optimally dosed antihypertensive medications with different mechanism of actions.

38
Q

Hypertensive urgency

A

Acute rise in blood pressure (diastolic higher than 120) without evidence of acute end-organ dysfunction.

39
Q

Hypertensive emergency

A

Acute rise in blood pressure (diastolic higher than 120) accompanied by objective findings of acute end-organ dysfunction (usually heart, kidneys, or brain).

40
Q

White coat hypertension

A

Blood pressure that is significantly higher when measured in the medical office then when measured at home or via ambulatory blood pressure monitor in patient’s usual environment.

41
Q

Diagnosis of hypertension

A
  1. Asymptomatic
  2. Symptoms of end organ damage:
    a. Dyspnea
    b. Chest pain
    c. Severe headache
    d. Blurry vision
    e. Nausea
    f. Vomiting
    g. Confusion
    h. Seizure
    i. Focal neurological
  3. Mild headache, dizziness, or epistaxis with elevated blood pressure but do not suggest end organ dysfunction.
42
Q

Symptoms of secondary cause

A
  1. Fatigue
  2. Polyuria
  3. Oliguria
  4. Edema
  5. Dysuria
  6. Flank pain
  7. Dyspnea by pulmonary edema
  8. Headache
  9. Flushing
  10. Palpitations
  11. Syncope or near syncope
  12. Visual disturbances
  13. Excessive perspiration
  14. Change in body habits such as weight gain with truncal obesity, buffalo lump, moon facies, or purple striae
  15. Cold extremities and lower extremity claudication
43
Q

Aim of patient evaluation

A
  1. To assess lifestyle and identify cardiovascular risk.
  2. To reveal identifiable causes of high blood pressure.
  3. To assess target organ damage and cardiovascular disease.
44
Q

Clinical examination of hypertension

A

A. General
1. Blood pressure measurements
2. Weigh and height
3. Waist circumference
4. Peripheral and femoral pulses
B. Cardiac
1. Left ventricular hypertrophy
2. Ejection murmur over aortic area
C. Abdominal
1. Renal mass
2. Aortic aneurysm
D. Neurological

45
Q

Investigation: Basic testing

A
  1. Fasting blood glucose
  2. Complete blood count
  3. Lipid profile
  4. Serum creatinine with eGFR
  5. Serum sodium, potassium, calcium
  6. Thyroid-stimulating hormone
  7. Urinalysis
  8. Electrocardiogram
46
Q

Investigation: optional testing

A
  1. Echocardiogram
  2. Uric acid
  3. Urinary albumin to creatinine ratio
47
Q

Management of hypertension

A

Less than 130/80

48
Q

Lifestyle measures (dose and pharmacological intervention skipped)

A
  1. Weight loss
  2. Healthy diet (dash dietary pattern)
  3. Reduced intake of dietary sodium
  4. Enhanced intake of dietary potassium
  5. Physical activity (aerobic)
  6. Moderation in alcohol intake
49
Q

Initiation of antihypertensive in stage 1

A

Single antihypertensive
BP goal 130/80

50
Q

Initiation of antihypertensive in stage 2

A

2 first line agents of different classes either as separate or fixed dose combination
BP goal 20/10 above target

51
Q

Follow up

A

Systemic strategies to improve blood pressure
1. HBPM
2. Team-based care
3. Telehealth strategies

52
Q

Referral criteria

A
  1. Emergencies
  2. Secondary referral in case of resistant hypertension, cardiovascular, renal, and neurological complication

Early Patient Encounter (3 decks)

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