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Clin Med I > CLIN MED LAB MIDTERM > Flashcards

CLIN MED LAB MIDTERM Flashcards

- Sinusitis - Headache - CVA - Mono

1
Q

acute rhinosinusitis lasts for

A

< 4 weeks

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2
Q

subacute rhinosinusitis lasts for

A

4-12 weeks

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3
Q

chronic rhinosinusitis lasts for

A

> 12 weeks

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4
Q

recurrent acute rhinosinusitis

A

> /= 4 episodes per year with symptoms resolution in between

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5
Q

factors that would make you suspect a bacterial etiology of sinusitis

A
  • Sx >10 days
  • unilateral maxillary sinus pain
  • maxillary tooth pain
  • unilateral purulent nasal drainage
  • second sickening
  • fever
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6
Q

T/F: Most patients with viral URIs are febrile

A

FALSE - Most are afebrile

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7
Q

If fever is present in viral URI, it tends to occur ___

A

on the first 2 days of illness

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8
Q

As fever/constitutional Sx resolve, respiratory symptoms become more prominent, peaking in severity at ____ days

A

3 to 6 days of illness

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9
Q

resp Sx may continue to be present on day ___ of illness, but are less severe than earlier in the course

A

10 days

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10
Q

acute bacterial sinusitis pathogens

A
  • Strep pneumo*
  • H. flu*
  • M. cattarhalis
  • Staph aureus
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11
Q

1st line therapy for bacterial sinusitis

A

Augmentin

adults and kids

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12
Q

How would you Tx bact sinusitis for pt with PCN allergy

A

Doxycycline

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13
Q

Days of Abx fof bacterial sinusitis

A
  • 5-7 days for adults

- 10-14 for kids

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14
Q

symptomatic therapy for sinusitis

A
  • NSAIDS, Tylenol
  • nasal spray/irrigation
  • Flonase
  • decongestants
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15
Q

complications of bacterial sinusitis

A
  • preseptal cellulitis
  • orbital cellulitis
  • orbital subperiosteal abscess
  • septic cavernous sinus thromnosis
  • meningitis
  • brain abscess
  • osteomyelitis of the frontal bone
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16
Q

T/F: Migraines are usually bilateral

A

False - usually unilateral

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17
Q

T/F: Response to a triptan can be diagnostic if pt’s symptoms improve

A

True

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18
Q

what are some theories to pathophysiology of migraine

A
  • dilation of vessels
  • serotonin
  • inflammatory process
  • trigeminocervical complex
  • calcitonin gene-related peptide
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19
Q

migraine prodrome occurs

A

few hours to days prior

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20
Q

migraine aura occurs

A

5-60 minutes prior

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21
Q

migraine attack occurs

A

4-72 hours

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22
Q

migraine postdrome occurs

A

23-48 hours after

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23
Q

1st line abortive migraine medication

A
  • Excedrin
  • NSAIDs
  • Acetaminophen
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24
Q

2nd line abortive migraine meds

A
  • triptans

- ergotamine nasal spray

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25
Q

3rd line abortive migraine meds

A
  • toradol IM
  • ergotamine IV
  • dexamethasone
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26
Q

chronic migraine

A

15 headaches/month

lasting >4 hrs/day

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27
Q

you can Tx for migraines prophylactically when pt has

A

> 2-3 HA per month

28
Q

migraine prophylaxis Tx

A
  • beta-blockers (propanolol)
  • Ca channel blockers
  • anti-depressants (amitriptyline, nortriptyline)
  • anti-sx (depakote, topamax)
  • anti-CGRP
  • botox
  • magnesium
29
Q

education on rebound headaches - simple analgesics

A

limit to 15 days or less per month

ASA, APAP, NSAIDs

30
Q

education on rebound headaches - combo analgesics

A

limit 10 days or less per month

Excedrin, triptans

31
Q

Tx for rebound HA

A
  • stop all medications

- may try prednisone taper

32
Q

patient education for migraines

A
  • 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
33
Q

highest incidence of symptomatic infection of EBV is what age group

A

15-24 y/o

34
Q

incubation period for EBV

A

30-50 days

35
Q

EBV is spread via

A
  • saliva (most common)
  • genital secretions
  • blood transfusion
  • bone marrow transplant
36
Q

a pt who has mono can remain infectious for how long

A

6 months or longer

37
Q

at which cells does EBV replicate and shed?

A

oral epithelial cells

38
Q

______ that are specific to EBV control the acute infection

A

cytotoxic T cells

39
Q

what is the triad for mono

A
  • fever
  • pharyngitis
  • lymphadenopathy
40
Q

clinical presentation for mono

A
  • fever, fatigue
  • posterior cervical LAD
  • pharyngitis (kissing tonsils, exudates, palatal petechiae)
41
Q

Pt with mono may develop a rash if given

A

amoxicillin (or ampicillin)

42
Q

what would you expect to see on labs for mono pt

A
  • lymphocytic leukocytosis
  • monospot - heterophile Ab
  • IgM & IgG
  • transient abnormal LFTs
43
Q

what type of cell would you expect to see with atypical lymphocytosis

A

Downey cell

slightly larger than normal lymphocyte with irregular nucleus – larger from antigen stim

44
Q

Mono Tx

A
  • usually self-limiting
  • Tylenol/NSAIDs
  • avoid contact sports for 2-3 weeks if HSM
45
Q

complications of mono

A
  • splenic rupture/hemorrhage
  • airway compromise
  • malignancy
  • encephalitis
  • myocarditis
  • hepatitis
46
Q

mono: when does fever and sore throat resolve?

A

by 10 days

47
Q

mono: when does HSM and LAD resolve?

A

by 4 weeks

48
Q

mono: when does fatigue resolve?

A

2-3 months

49
Q

CHADS2 score

A

score > 2 = high risk of stroke - needs anticoags

CHF
HTN
Age >75
DM
Stroke/Tia = 2 points
50
Q

what visual deficit is associated with PCA stroke

A

homonymnous hemianopsia

51
Q

what aphasia is associated with PCA stroke

A

anomic aphasia (difficulty naming objects)

52
Q

Alexia without agraphia is associated with what stroke

A

PCA

53
Q

what type of infarction can result in pure motor or pure sensory deficits

A

lacunar

54
Q

which stroke can lead to dysarthria-clumsy hand syndrome

A

lacunar stroke

55
Q

when evaluating for CVA, ____ is more sensitive to detect early ischemia

A

MRI

56
Q

when evaluating for CVA, ____ is used to evaluate arteries for stenosis, occlusion, or aneurysm

A

MRA

57
Q

when evaluating for CVA, ____ is used to check for carotid stenosis

A

Carotid doppler

58
Q

when evaluating for CVA, ____ is used to evaluate for possible embolic source

A

Echo

59
Q

when evaluating for CVA, ____ is used to evaluate for hemorrhage

A

non-con CT

60
Q

tPA criteria

A
  • age >18 years
  • clinical Dx of ISCHEMIC CVA
  • time onset <4.5 hours
61
Q

before thrombolysis, patient’s BP should be less than ____

A

<185/110

62
Q

after thrombolysis, BP should be maintained at ___

A

<180/105 for at least 24 hours

63
Q

if no thrombolytic therapy, pt’s BP should be treated unless ___

A

> 220/120

64
Q

what are options of antithrombotic therapy

A
  • ASA, Plavix, Aggrenox

- Warfarin or NOACs (for those with a-fib)

65
Q

what other meds/add’l mgmt should be considered for stroke pts

A
  • VTE prophylaxis
  • atorvastatin, lipitor
  • anti-HTN
  • smoking cessation
  • exercise/weight reduction

Clin Med I (21 decks)

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