CS6 Flashcards
What are the differential diagnosis for syncope?
Vasovagal syncope, situational syncope, orthostatic syncope, HCM, ventricular arrhythmias, sick sinus syndrome, Bradyarrhythmias, atrioventricular block, Congenital long QT syndrome
How does aura, head movements, pulse, sleeping/sitting position differentiate seizures from syncope?
Aura is possible in seizures also can occur and sleeping/sitting position also have a head movements and rapid strong pulse is as a post to weak slow pulses.
What is the only instance in which sleeping/sitting position can occur in syncope?
Cardiac arrhythmias
What is the instance in which clonic jerks can occur in syncope?
Prolonged cerebral hypo perfusion
According to the patient’s audience, what are the signs that are present in a patient who has vasovagal syncope?
Pallor, diaphoresis
Explain to postictal state? And how it differs from syncope?
Delayed return to baseline usually sleepy and confused afterwards. Syncope has immediate spontaneous return
Syncope can be invoked by what?
Upright position, emotions, heat, crowded places
Describe the consciousness level in dizziness/vertigo?
There’s no loss of consciousness
How does anxiety/panic present?
Probably adrenergic symptoms like sweating or palpitations. Followed by seven fear
What could be mistaken for a seizure?
Brief myoclonic activity during syncope
What is the relationship between transient ischemic attack and Seizure?
Ischemic tissue from prior stroke can serve as a nidus for seizure. A true TIA rarely present as a loss of consciousness
What are the cardiac arrythmias that can cause low heart rate?
Sick sinus syndrome, Bradyarrhythmias, atrioventricular block
What can be the common misconception of patients who believe that they’re having vaginal bleeding?
Hemateria or rectal bleeding
What is the definition of abnormal uterine bleeding (AUB)?
Bleeding that is heavy, last greater than seven days, occurs more frequently than 21 days, occurs less than every 35 days
What can light spotting and a heavy bleeding tell the provider about the source of bleeding in women?
Heavy bleeding comes from the endometrium most likely. Light spotting can be from either the endometrium or other genitourinary sites like the cervix or vagina.
Describe AUB as it pertains to uterine leiomyomas?
Heavy bleeding during a normal cycle
Describe AUB as a pertains to endometrial hyperplasia?
Bleeding in between Menses
Describe AUB as a pertains to polycystic ovarian syndrome?
Irregular bleeding
Where is the source of Postcoital bleeding?
Usually from the source of the cervix or vaginal mucosa
What patients are endometrial hyperplasia or malignancy a concern in?
In patients older than 45 especially post menopausal patients
What is the possible consequence for prolonged oligomenorrhea?
Abnormal endometrial proliferation
What are the causes of AUB in non-pregnant women?
PALM
Polyps, adenomyosis, leiomyoma, malignancy and hyperplasia
COEIN
Coagulopathy, Ovulatory dysfunction, endometrial infection or inflammation, Iatrogenic (anticoagulants)
What should ruled out first for patients with AUB?
Pregnancy and pregnancy related complications such as placenta abruption and ectopic pregnancies
What kind of birth control are associated with increased bleeding?
Copper intrauterine devices
In patients with AUB what test should always be done?
Pelvic examination
What should you ask for permission when dealing with AUB patient?
Pelvic examination, transvaginal ultrasound, pregnancy test
What test should be ran for patients with AUB?
Urine pregnancy test, complete blood count, coagulation studies, TSH, prolactin, FSH; Transvaginal ultrasound to evaluate structural reasons. Screen for a cervical cancer (Pap test should be done if indicated)
What are the follow-up components for palliative care assessment for patients with terminal cancer?
Medication titration schedule, advance derivatives and decision making, care coordination
Sources of distress in patients with Terminal Cancer?
Pain, other somatic symptoms like nausea and dyspnea, psychological and spiritual distress, functional and cognitive decline, caregiver burden
Explain the palliative care assessment?
Source of the stress, support and resources, setting goals, follow up
Explain the support and resources portion of palliative care?
Family, close love ones. Living situation, financial and material resources, outside support (PT/OT)
What is a dilemma associated with pain management for terminal cancer patients?
For setting goals, having different priorities. Complete pain relief at the cost of diminished alertness or side effects. Nominal pain relief with minimum cognitive impairment
What should you be able to discuss during closing encounter involving treatment?
Counsel the patient on the purpose and possible side effect of medications/treatment
What should be clarified first when evaluating a patient with vomiting?
That the patient is not experiencing reflux or regurgitation
Chronic or severe vomiting can impair what?
Adequate intake of food and fluid and lead to complications
What should be done for most acute vomiting patients?
Most of these patients are self limited and may require minimal or no diagnostic testing
What is the objective of the evaluation for chronic or severe vomiting?
Associated symptoms or complications
What are the possible complications for chronic or severe vomiting?
Dehydration, acidosis
What is the definition of vomiting, reflux, regurgitation?
Vomiting is involuntary forceful expulsion of gastric contents.
Reflux is nonforceful retrograde passage of gastric contents
Regurgitation is pharyngeal return of esophageal contents
What question can you ask to discern between vomiting reflux and regurgitation?
Whether it was forceful, food stuck in the esophagus?
Asthma should be specified as what, How is it risk stratified?
Intermittent or persistent (mild moderate severe)
What are the different types of persistent asthma?
Mild: symptoms 2 to 6 days a week with minimal limitation activity.
Moderate: Daily symptoms with noticeable limitation in activity.
Severe: constant or near constant symptoms with significant limitation in activity
What are the possible interventions for asthma Follow up?
Medications, vaccines, education in order to mitigate the risk of exacerbation
What is the objective evaluation for disease status in asthma?
Peak expiratory flow rate
What asthma patients can be managed with the short acting beta agonist PRN?
Mild intermittent symptoms
What patients should Receive low-dose inhaled glucocorticoid?
Persistent symptoms
What are the instances in which a patient’s asthma condition could be worsening despite appropriate treatment? What should be done?
Original diagnosis is incorrect or incomplete, diagnosis is correct but the treatment is in inappropriate or in adequate, if there’s an acute problem that causes decompensation of the patient condition. Should alter medication regimen
In what cases may asthma symptoms be exacerbated?
Non-compliant (with therapy or using inhalers incorrectly), Acute infection or environmental triggers (such as smoking or seasonal pollen)
What is the first question you ask a patient with asthma? What is the question that you must ask involving compliance?
How are you doing with your asthma? Can you show me how you would use your inhaler?
What are two special past medical history questions that you asked for patients who are getting a follow up for asthma visit?
Did you receive an influenza vaccination this season? Have you received a vaccine for pneumococcal pneumonia?
When should spirometry be given?
If patient has not responded to therapy as expected
What test should be ran for asthma follow up patients?
Peak Expiratory flow rate. Flow oximetry or arterial blood gas analysis. Complete blood count. Chest X-ray
Gastrointestinal causes for vomiting?
Cholecystitis, appendicitis, pancreatitis, peptic ulcer, liver disease, gastric outlet or intestinal obstruction
Where are the cardiovascular issues that can cause vomiting?
Acute Myocardial ischemia, Mesenteric ischemia
Genitourinary causes of vomiting?
Pyelonephritis us, Kidney failure, pregnancy
What are the family history questions should be asked for a patient who is experiencing abnormal vaginal bleeding?
Do you have any family history of bleeding disorders? Has anyone in your family had recurrent miscarriage is?
When should endometrial biopsy be considered in patients with abnormal vaginal bleeding?
Age equal to or greater than 45.
Risk factors for unopposed estrogen (like obesity, PCOS)
What illicit drug may cause vaginal bleeding?
Cocaine
What are the differential diagnosis for terminal cancer patients?
Decompensation of comorbid conditions (like worsening heart failure or Pericarditis secondary to cancer treatment). New cognitive or psychological disorders especially depression
What is the asthma action plan?
Discuss his current management and review plans for possible exacerbation
