CLIN MED LAB MIDTERM Flashcards
- Sinusitis - Headache - CVA - Mono
acute rhinosinusitis lasts for
< 4 weeks
subacute rhinosinusitis lasts for
4-12 weeks
chronic rhinosinusitis lasts for
> 12 weeks
recurrent acute rhinosinusitis
> /= 4 episodes per year with symptoms resolution in between
factors that would make you suspect a bacterial etiology of sinusitis
- Sx >10 days
- unilateral maxillary sinus pain
- maxillary tooth pain
- unilateral purulent nasal drainage
- second sickening
- fever
T/F: Most patients with viral URIs are febrile
FALSE - Most are afebrile
If fever is present in viral URI, it tends to occur ___
on the first 2 days of illness
As fever/constitutional Sx resolve, respiratory symptoms become more prominent, peaking in severity at ____ days
3 to 6 days of illness
resp Sx may continue to be present on day ___ of illness, but are less severe than earlier in the course
10 days
acute bacterial sinusitis pathogens
- Strep pneumo*
- H. flu*
- M. cattarhalis
- Staph aureus
1st line therapy for bacterial sinusitis
Augmentin
adults and kids
How would you Tx bact sinusitis for pt with PCN allergy
Doxycycline
Days of Abx fof bacterial sinusitis
- 5-7 days for adults
- 10-14 for kids
symptomatic therapy for sinusitis
- NSAIDS, Tylenol
- nasal spray/irrigation
- Flonase
- decongestants
complications of bacterial sinusitis
- preseptal cellulitis
- orbital cellulitis
- orbital subperiosteal abscess
- septic cavernous sinus thromnosis
- meningitis
- brain abscess
- osteomyelitis of the frontal bone
T/F: Migraines are usually bilateral
False - usually unilateral
T/F: Response to a triptan can be diagnostic if pt’s symptoms improve
True
what are some theories to pathophysiology of migraine
- dilation of vessels
- serotonin
- inflammatory process
- trigeminocervical complex
- calcitonin gene-related peptide
migraine prodrome occurs
few hours to days prior
migraine aura occurs
5-60 minutes prior
migraine attack occurs
4-72 hours
migraine postdrome occurs
23-48 hours after
1st line abortive migraine medication
- Excedrin
- NSAIDs
- Acetaminophen
2nd line abortive migraine meds
- triptans
- ergotamine nasal spray
3rd line abortive migraine meds
- toradol IM
- ergotamine IV
- dexamethasone
chronic migraine
15 headaches/month
lasting >4 hrs/day
you can Tx for migraines prophylactically when pt has
> 2-3 HA per month
migraine prophylaxis Tx
- beta-blockers (propanolol)
- Ca channel blockers
- anti-depressants (amitriptyline, nortriptyline)
- anti-sx (depakote, topamax)
- anti-CGRP
- botox
- magnesium
education on rebound headaches - simple analgesics
limit to 15 days or less per month
ASA, APAP, NSAIDs
education on rebound headaches - combo analgesics
limit 10 days or less per month
Excedrin, triptans
Tx for rebound HA
- stop all medications
- may try prednisone taper
patient education for migraines
- avoid triggers
- be aware of Sx and catch them early
- caution rebound Ha
- get evaluated for atypical migraines
- worse HA of your life = ER
- headache journal
- menstruation
highest incidence of symptomatic infection of EBV is what age group
15-24 y/o
incubation period for EBV
30-50 days
EBV is spread via
- saliva (most common)
- genital secretions
- blood transfusion
- bone marrow transplant
a pt who has mono can remain infectious for how long
6 months or longer
at which cells does EBV replicate and shed?
oral epithelial cells
______ that are specific to EBV control the acute infection
cytotoxic T cells
what is the triad for mono
- fever
- pharyngitis
- lymphadenopathy
clinical presentation for mono
- fever, fatigue
- posterior cervical LAD
- pharyngitis (kissing tonsils, exudates, palatal petechiae)
Pt with mono may develop a rash if given
amoxicillin (or ampicillin)
what would you expect to see on labs for mono pt
- lymphocytic leukocytosis
- monospot - heterophile Ab
- IgM & IgG
- transient abnormal LFTs
what type of cell would you expect to see with atypical lymphocytosis
Downey cell
slightly larger than normal lymphocyte with irregular nucleus – larger from antigen stim
Mono Tx
- usually self-limiting
- Tylenol/NSAIDs
- avoid contact sports for 2-3 weeks if HSM
complications of mono
- splenic rupture/hemorrhage
- airway compromise
- malignancy
- encephalitis
- myocarditis
- hepatitis
mono: when does fever and sore throat resolve?
by 10 days
mono: when does HSM and LAD resolve?
by 4 weeks
mono: when does fatigue resolve?
2-3 months
CHADS2 score
score > 2 = high risk of stroke - needs anticoags
CHF HTN Age >75 DM Stroke/Tia = 2 points
what visual deficit is associated with PCA stroke
homonymnous hemianopsia
what aphasia is associated with PCA stroke
anomic aphasia (difficulty naming objects)
Alexia without agraphia is associated with what stroke
PCA
what type of infarction can result in pure motor or pure sensory deficits
lacunar
which stroke can lead to dysarthria-clumsy hand syndrome
lacunar stroke
when evaluating for CVA, ____ is more sensitive to detect early ischemia
MRI
when evaluating for CVA, ____ is used to evaluate arteries for stenosis, occlusion, or aneurysm
MRA
when evaluating for CVA, ____ is used to check for carotid stenosis
Carotid doppler
when evaluating for CVA, ____ is used to evaluate for possible embolic source
Echo
when evaluating for CVA, ____ is used to evaluate for hemorrhage
non-con CT
tPA criteria
- age >18 years
- clinical Dx of ISCHEMIC CVA
- time onset <4.5 hours
before thrombolysis, patient’s BP should be less than ____
<185/110
after thrombolysis, BP should be maintained at ___
<180/105 for at least 24 hours
if no thrombolytic therapy, pt’s BP should be treated unless ___
> 220/120
what are options of antithrombotic therapy
- ASA, Plavix, Aggrenox
- Warfarin or NOACs (for those with a-fib)
what other meds/add’l mgmt should be considered for stroke pts
- VTE prophylaxis
- atorvastatin, lipitor
- anti-HTN
- smoking cessation
- exercise/weight reduction
