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Comps - Mod 2 > ENT and pumonary - PC 617 - Sheet1 > Flashcards

ENT and pumonary - PC 617 - Sheet1 Flashcards

1
Q

C

A

Near vision card, penlight with blue filter, topical anestetic, fluorescein strips, topical mydriatic

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2
Q

Cranial nerves 2-7 control

A

Pupils, visual fields, EOMs, facial droop

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3
Q

Inspection/palpation of eye and surrounding structures

A

Assess for asymmetry, proptosis, enophthalmos, orbital rim

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4
Q

Slit lamp exam assess…

A

Anterior segment of the eye

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5
Q

Fundoscopy assesses….

A

Posterior segment of the eye.

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6
Q

Contraindication to dilation of eye

A

Significant head trauma, suspected rupture, history of glaucoma

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7
Q

Assessment of intraocular pressure

A

Goldman applanation tonometry, Tonopen

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8
Q

Exam of anterior segment of the eye

A

Perform at slit lamp - or ophthalmascope. Inspect conjunctiva, cornea, anterior chamber, iris, lens

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9
Q

Estimating anterior chamber depth of the eye

A

Shine a light from the temporal side of the head across the front of the eye parallel to the plane of the iris. Look at the nasal aspect of the iris. If two thirds or more of the nasal iris is in shadow, the chamber is probably shallow and the angle narrow.

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10
Q

Tonometry

A

Measures the intraocular pressure by calculating the force required to depress the cornea a given amount with a tonometer

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11
Q

Normal intraoccular pressure

A

10 - 20 is normal

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12
Q

IOP and chronic open angle glaucoma

A

Can be 20-30

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13
Q

IOP and acute angle closure glaucoma

A

Can be greater than 40

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14
Q

The swinging flashlight test

A

Measures both the direct and consesual response of pupil to light

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15
Q

Steps of the swinging flashlight test

A
  1. Shine light in right eye. This will cause BOTH pupils to constrict via CN III through Edinger-Westphal nucleus. 2. Then swing pen light to left and ensure the left eye CONSTRICTS. If it constricts, this means that the LEFT CN II is intact and is causing a direct pupillary reflex. If it dilates, then this is a sign that the LEFT retina or optic nerve is damaged and is called an Afferent pupillary defect (APD).
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16
Q

Assessment of posterior segment of the eye

A

Vitreous, optic disc, retinal vessels, macula

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17
Q

Key worrisome clinical findings - ophtho referral needed

A

Pain - pain in eye often indicates more serious intraocular pathology (iritis, glaucoma); Visual acuity - if decreased, usually more serious cause; Pupil - if sluggish, worry about acute glaucoma; Pattern of redness - ciliary flush (redness worse near cornea, usually serious intraocular cause: iritis or glaucoma)

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18
Q

Ciliary flush

A

Injection of deep conjunctival vesels and episcleral vessels surrounding the cornea. Seen in iritis or acute glaucoma. NOT seen in simple conjunctivitis

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19
Q

Iritis

A

Inflammation in the anterior chamber

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20
Q

Red eye - Key historical questions

A

Do you have any pain? Do you wear contacts? Do you have any associated symptoms

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21
Q

Pain in eye

A

Biggest distinguishing factor between emergent and non-emergent

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22
Q

Wearing contacts and eye history

A

Increased risk of keratitis-corneal infection

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23
Q

History of associated eye symptoms

A

Decreased vision, photophobia/diplopia, flashes/floaters, halos/N/V/abd pain. Any requires a referral

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24
Q

Main differential of red eye

A

Conjunctivitis (infectious/noninfectious), trauma - foreign body, subconjunctival hemorrhage, acute closure glaucoma, iritis/uveitis, keritits, scleritis - episcleritis

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25
Q

Ocular emergencies

A

Closed-angle glaucoma; retinal detachment; foreign body; orbital fractures; corneal abrasions; lacerations, ulcers; chemical burns; ruptured globe; CRAO; retrobulbar hematoma

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26
Q

Acute angle closure glaucoma (AACG) diagnosis

A

History - acute onset, higher risk in far-sighted; symptoms - pain, halos (around lights), visual loss (usually peripheral), nausea/vomiting; Signs - conjunctival injection, corneal edema, mid-dilated, fixed pupil, increased IOP

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27
Q

Pathophysiology of glaucoma

A

Aqueous humor produced by ciliary body, enters anterior chamber, drains via trabecular meshwork at angle to enter canal of Schlemm. In AACG, iris obstructs trabecular meshwork by closing off angle. Optic nerve damage secondary to increased IOP.

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28
Q

Treatment of acute angle closure glaucoma

A

Reduce production of aqueous humor - topical b-blocker (trimolol 0.5% - 1-2 gtt), carbonic anhydrase inhibitor (acetazolamide 500 mg IV or PO), systemic osmotic agent (mannitol 1-2 g/Kg IV over 45 min) OR increase outflow - topical a-agonist (phenylephrine 1gtt), miotics (pilocarpine 1-2%) ALSO topical steroid (prednisolone acetate 1%) 1gtt Q 15-30 min x 4 then q1h

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29
Q

Definitive treatment of acute angle closure glaucoma

A

Optho referral - laser peripheral iridectomy

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30
Q

Pathophysiology of retinal detachment

A

Separation of neurosensory layer of retina from underlying choroid and retinal pigment epithelium. Schaffer’s sign

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31
Q

Schaffer’s sign

A

Presence of vitreous pigment. Useful in that it has a NPV of 99% for detachment

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32
Q

Risk factors for retinal detachment

A

Increasing age, history of posterior vitreous detachment, myopia (nearsightedness), trauma, diabetic retinopathy, family history, cataract surgery

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33
Q

Signs and symptoms of retinal detachment

A

“black curtain coming down over visual field”, bright flashes of light (photopsia), increasing floaters, decreased visual acquity, distortion of objects (metamorphopsia), +APD on exam

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34
Q

Diagnosis of retinal detachment

A

If direct ophthalmoscopy is inconclusive, refer to ophtho for dilated fundux exam with indirect ophthalmoscope. Direct ophthalmoscopy is not very effective at visualizing periphery where most RD’s occur

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35
Q

Treatment of retinal detachment

A

Surgery to replace retina onto nourishing underlying layers. Surgical options include laser photocoagulation therapy, and scleral buckle with intraocular gas bubble to keep retinal in place while it heals

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36
Q

Key management point of retinal detachment

A

Know “classic” presentation so you can refer to an ophthalmologist quickly

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37
Q

Foreign body

A

Often metallic following work injury.

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38
Q

Signs and symptoms of foreign body

A

Foreign body sensation, tearing, red, or painful eye. Pain often relieved with the instillation of anesthetic drops.

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39
Q

Assessment of foreign body

A

Stain with fluorescein stain and illuminate under blue fluorescent light (Wood’s lamp) is effective to see corneal epithelial defects

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40
Q

Treatment of corneal foreign body

A

Apply topical anesthetic. Remove foreign body with sterile irrigating solution or moistened sterile cotton swab. Never use a needle. Apply antibiotic ointment. 24-hr follow-up is mandatory. Refer if foreign body cannot be removed.

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41
Q

Signs and symtpoms of orbital blowout fracture

A

Enophthalmos; diplopia; impairment of eye movement secondary to EOM entrapment; orbital hemorrhage or nerve damage; orbital emphysema; infraorbital n. anesthesia

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42
Q

Diagnosis of orbital blowout fracture

A

CT should include axial and coronal cuts

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43
Q

Disposition of orbital blowout fracture

A

If no diplopia, minimal displacement, and no muscle entrapment, discharge with ophthalmology follow up within a week

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44
Q

Treatment of orbital blowout fracture

A

Surgery - for enophthalmos, muscle entrapment, or visual loss

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45
Q

Management of orbital blowout fracture

A

Ice packs beginning in clinic/ED and for 48 hrs will help decrease swelling associated with injury. Elevate head of bed (decrease swelling). If sinuses have been injured, give prophylactic antibiotics and instruct patient not to blod nose. Treat nausea/vomiting with antiemetics.

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46
Q

Coroneal injuries

A

Abrasions, lacerations, ulcers

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47
Q

Symptoms of corneal injuries

A

Extreme eye pain, relieved with lidocaine drops. Visual acuity usually decreased, depending on location of injury in relation to visual axis. Inflammation leading to corneal edema can decrease visual acquity

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48
Q

Diagnosis of corneal injuries

A

Fluorescein staining to see epithelial defect. Seidel’s test for aqueous leakage to diagnose laceration.

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49
Q

Seidel’s test

A

Concentrated fluorescein is dark orange but turns bright green under blud light after dilation. This indicates aqueous leakage which is diluting the green dye.

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50
Q

Management of corneal injury

A

Topical antibiotics and follow up with ophthalmologist. For lacerations, 1cm, refer to ophthalmologist to rule out globe rupture and for possible suture placement. Avoid contact lenses. Avoid patching.

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51
Q

Chemical burns

A

Constitutes an emergency. Every minute counts. Do not waste time on history or physical exam. Alkali burns more common and worse than acid

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52
Q

Alkali chemical burns to eye

A

Saponification - denatures collage, thromboses vessels - household cleaners, fertilizers, and drain cleaners

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53
Q

Acid chemical burns to eye

A

Coagulation, H+ perecipitates protein - barrier. Industrial cleaners, batteries, vegetable preservatives

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54
Q

Initial treatment of chemical burns to eye

A

Immediate copious irrigation - topcial anesthesia (tetracaine), can use NS, LR, irrigate at least 30 min; angiocath or irrigating lens can be used; lids should be retracted and fornices swabbed for particulate matter; check pH with litmus paper after initial irrigation - (7.0-7.3). Once pH stabilized - cyclopegic agent (0.25% scopolamine), broad-spectrum antibiotic (cipro, ofloxacin, gentamicin, or robramycin should be applied). Refer to ophtho immediately w/o stopping irrigation.

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55
Q

Ruptured globe

A

Penetrating trauma leads to corneal or scleral disruption and extravasation of intraocular contents. Can lead to: irreversible visual loss and endophthalmitis

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56
Q

Endophthalmitis

A

Inflammation of the intraocular cavities

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57
Q

Signs and symptoms of ruptured globe

A

Pain, decreased vision; hyphema; loss of anterior chamber depth; “tear-drop” pupil which points toward laceration; severe subconjunctival hemorrhage completely encircling the cornea.

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58
Q

Diagnosis of ruptured globe

A

Seidel’s test, clinical exam

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59
Q

Management of ruptured globe

A

Stop exam. Cover with metal eye shield or cup. DO NOT PATCH. Consult ophthamology immediately. Do not perform tonometry. CT head and orbit to evaluate for concomitant facial/orbital injury. NPO. Tetanus. Antibiotics - cefazolin + Cipro provides gooc coverage. Antiemetics and analgesics decreases risk of Valsalva or movement which could increase IOP.

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60
Q

Etiology of central retinal artery occlusion

A

Emboli-cardiac,atherosclerotic, fat; vasculitis, coagulopathy, sickle cell

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61
Q

Signs and symptoms of central retinal artery occlusion

A

Sudden onset severe monocular vision loss over seconds; usually preceded by amaurosis fugax; 90% will have visual acquity of counting fingers or less; after visual activity, do IOP, pupillary response (APD common); dilate pupils immediately and perform fundoscopic exam

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62
Q

Cranial retinal artery occlusion (CRAO)

A

Narrow arterioles, optic disc and retinal pallor, cherry red spot at fovea (due to maintained perfusion of cilio-retinal artery), emboli seen 20%

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63
Q

Treatment of cranial retinal artery occlusion (CRAO)

A

Must have VERY high index of suspicion, especially in patients with appropriate risk factors. Immediate referral. Retina can become irreversibly damaged in 100 min. Mannitol 0.25-2 g/Kg IV or acetazolamide 500 mg PO once to reduce IOP. Carbogen inhalation (95% O2 and 5% CO2). Oral nitrates. Lay pt flat on back. Massage orbit. This is thought to help dislodge clot from a larger to smaller retinal artery branch, minimizing area of visual loss. Ophthalmologist may perform paracentesis of aqueous humor to reduce IOP.

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64
Q

Retrobulbar hematoma

A

Acute orbital compartment syndrome secondary to blunt or penetrating trauma. Hemorrhage into closed space of orbit. Increased IOP leading to vision loss from optic nerve damage/retinal ischemia

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65
Q

Clinical diagnosis of retrobulbar hematoma

A

Ocular pain, APD, proprosis, ophthalmophegia, diminished vision, increased IOP. Immediate lateral canthotomy and cantholysis indicated if IOP > 40 mmHg or vision loss

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66
Q

What to do if fish hook in the eye

A

Stabilize hook. Brief exam to document visual acuity, pupillary responses, visual fields. Protect eye from further damage. NPO. Tetanus. IV antibiotics. Pain control. Antiemetics. Refer.

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67
Q

Blepharitis

A

Inflammation of the eyelids. 2 categories anterior and posterior. As a result of oil secretions or solidification of meibum, a chalazion or hordeolum may develop.

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68
Q

Anterior blepharitis

A

Involves the anterior lid margin surrounding the lid margin and is usually associated with Staph infection or seborrhea.

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69
Q

Anterior staphylococcal blepharitis

A

A cell mediated response resulting in lid margin inflammation

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70
Q

Anterior seborrheic blepharitis

A

Often associated with generalized seborrhea

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71
Q

Posterior blepharitis

A

Caused by meibomian gland dysfunction and an alteration in meibomian gland secretions

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72
Q

History and clinical presentation of blepharitis

A

Burning, tearing, or foreign body sensation. Itching, redness, discharge. Absent lashes. Lashes crusted with meibum. Seborrheic blepharitis may have greasy scales along the lid margins with foamy tears, diffuse seborrhea or the scalp and ears. Rosacea is related to meibomian gland dysfunction. Patients may have erythema or telangiectasia over the cheeks and nose or pustular skin eruptions.

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73
Q

Management of blepharitis

A

Lid hygiene - warm, moist compresses for 5-10 minutes; lid scrubs with Q-tip and baby shampoo. Antibiotic ointment - E-mycin or bacitracin. Artificial tears. Referral to ophthalmologist for corticosteroids

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74
Q

Hordeolum

A

An acute infection of a gland in the eyelid. Inflammed area or eyelid where eyelashes meet eyelid. Bacteria (usually staph) gets into the oil gland that lubricates the eye. Similiar process to a pimple.

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75
Q

History and clinical presentation of hordeolum

A

Swollen single gradually emerging red bump on the eyelid, gritty scratchy sensation, sensitivity to light, tearing, tenderness on the eyelid.

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76
Q

Management of hordeolum

A

Usually self-limited. Spontaneous improvement in 1-2 weeks with conservative treatment. Frequent warm, moist compresses. Teaching light and gentle massage, lid hygiene with lid scrubs. Refer if I&D needed

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77
Q

Chalazia

A

Chronic, sterile lipogranulomatous inflammatory lesion of the meibomian gland.

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78
Q

Lipogranuloma

A

Caused by a blockage in the Meibomian gland or oil gland that lubricates the eye. A gradually localized enlarging nodule where glands are located near the eyelashes.

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79
Q

History and clinical presentation of chalazia

A

Hard, non-tender module found on the mid-portion of the eyelid away from the lid border. May develop on lid margin with lid tenderness, pain, and swelling. Eyelid tenderness, increased tearing. Gradually enlarging nodule on the eyelid, sensitivity to light, pain, or pressure if pressing against the cornea.

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80
Q

Management of chalazion

A

Usually self-limiting in 25-50% of cases. Spontaneous improvement in 1-3 months with conservative treatment. Frequent warm, moist compresses to liquify glandular secretions. Teaching: gentle massage to express impacted secretions. Referral for corticosteroid injections or I&D if necessary.

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81
Q

Viral conjunctivitis

A

Inflammation of the conjunctiva or the transparent mucosal tissue than lines the eye and inner surface of the eyelids. Generally caused by adenovirus. Highly contagious

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82
Q

History and clinical presentation of viral conjunctivitis

A

Red eye (from corners inward). Excessive watering. Itching. Watery discharge. Photophobia. Foreign body sensation. Begins in one eye and spread to the other. Abrupt onset. 50% may have tender preauricular lymph nodes.

83
Q

Management of viral conjunctivitis

A

Self-limiting usually 5-14 days. Treatment is supportive. Artificial tears. Cool compresses. Teaching: good hand hygiene, don’t share towels, avoid contact lens use until resolved and discard used lenses.

84
Q

Allergic conjunctivitis

A

Airborne allergen comes in contact with the ocular surface. Inflammatory response occurs. IgE mast cell-mediated response and hypersensitivity

85
Q

History and clinical presentation of allergic conjunctivitis

A

Allergic rhinitis, headache, fatigue, often have a positive family history of hay fever or atopy, generally begins simultaneously in both eyes, itching, periocular skin discoloration, thickening erythema

86
Q

Management of allergic conjunctivitis

A

Cool compresses. Teaching: remove irritants. Oral/systemic antihistamines. Ophthalmic antihistamines - Naphcon A Vasocon (otc)

87
Q

Bacterial conjunctivitis

A

Bacterial infection of the conjunctiva-membrane lining the eyelid by a wide range of gram-positive and gram-negative organisms. Staph aureus is most common. Tears contain enzymes and antibiotics that kill bacteria.

88
Q

History and clinical presentation of bacterial conjunctivitis

A

Red eye (corners inward). Blurred vision, crust or matted discharge forming on eyelid overnight. Early morning glued eyes. Thich mucoid discharge. Absence of itching.

89
Q

Management of bacterial conjucntivitis

A

Antibiotic drops or ointment - tobramycin, fluoroquinolone trimephoprim-polymixin B. Warm compresses frequently. Teaching should include changing pillowcases daily, dispose of eye cosmetics. Do not share towels or hankerchiefs. Good hand hygiene. Contact lens clearning and/or disposal.

90
Q

Pathophysiology and clinical presentaiton of corneal abrasion

A

A cut, scratch or abrading of the thin, clear, protective coat of the anterior portion of the ocular epithelium often the result of trauma. Pain (sand or grit), tearing, photophobia, history of event, contact lenses? Photophobia. Known or suspected foreign body.

91
Q

Management of corneal abrasion

A

Visualize eye structures. Observe for foreign body, perform a visual acuity. EOM. Fluorescein staining-visualize with cobalt blue light. Do not patch. Symptoms should resolve in 24-72 hrs. Teaching - do not rub. Refer if pain worses or persists.

92
Q

Glaucoma-angle closure

A

Increased pressure occurs when the exit of aqueous humor fluid is suddenly blocked and results in quick, severe pain

93
Q

History and clinical presentation of glaucoma-angle closure

A

Sudden and severe pain. Cloudy vision. N/V. Red eye. Rainbow-like halos around lights. Oval pupil from bowed iris. Cloudy cornea. May have history of recent eye dilation.

94
Q

Management of glaucoma-angle closure

A

This is a medical emergency. Immediate referral.

95
Q

Uveitis

A

Inflammation of the uvea or the middle portion of the eye. Involves the middle, pigmented vascular structures. Includes the ciliary body, chorioid. Noninfectious, autoimmune or infectious causes. May be isolated to the eye or be associated with systemic diseases.

96
Q

History and clinical presentation of uveitis

A

Redness of eye (from center outward), blurred vision, photophobia, eye pain, floaters, headaches

97
Q

Management of uveitis

A

Treatment of underlying condition. Immediate and emergent referral. Dark glasses. Steroid eye drops managed by ophtho

98
Q

Allergic rhinitis

A

Allergic inflammation of the nasal membranes generally caused by breathing in pollen, dust, dander, or insect venom. Allergic triggers the production of IgE. When caused by pollens of plants it is called pollinitis. When caused by grass it is caused hay fever.

99
Q

Hisotry and clinical presentaiton of allergic rhinitis

A

Rhinorrhea - generally clear. Pale, boggy nasal mucosa. Itching watery eyes. Nasal congestion. Swollen nasal turbinates. Eyelid swelling. Lower eyelid venous stasis (allergic shiners). Sneezing. No fever.

100
Q

Management of allergic rhinitis

A

1 - Avoid irritants- pt teaching. Saline nasal spray ( can use with pregnancy). Intranasal corticosteroids - benclomethazone (may be used with pregnancy). Antihistamines - 1st generation - sedating; second generation - 1st line chlorpheniramine (may use with pregnancy). Decongestants (not for use in pregnancy), limit to 3 days or less.

101
Q

Epistaxis

A

Bleeding that occurs from broken capillaries in the nose. Most occur in the front of the nasal septum. May result from some kind of trauma. May have history of allergies, snoring, HTN, headaches, foreign object. Lesion on nasal mucosa.

102
Q

Clinical presentation of epistaxis

A

Bloody nasal discharge. Damage to nasal mucosa from foreign object or lesion. HTN

103
Q

Management of epistaxis

A

Pinch lower part of nose to apply direct pressure. Lean forward to facilitate clot formation and avoid post-nasal drainage. Cautery or packing may be required. C&S is lesion is present. Treat underlying cause. Teaching - no foreign object in nose, including fingers

104
Q

Acute sinusitis

A

Obstruction of the sinus ostia which is a small opening in which the maxillary, frontal, ethmoid and sphenoid sinuses drain into the nasal cavity. Mucous stasis may allow pathogens to grow. Can be viral or bacterial

105
Q

History and clinical presentation of acute or chronic sinusitis

A

Facial pain. Headache teeth pain. Ear pain/pressure. Cough. Increased pressure above, below or behind eyes on leaning forward. Social history smoking or second hand smoke. Environmental exposures. Tenderness over sinus cavity. Acute symptoms: fever and purulent nasal discharge, presistant >10 days

106
Q

Management of acute or chornic sinusitis

A

Most cases resolve without treatment. Saline, decongestant, or corticosteroid nasal spray. Analgesic and antipyretic - tylenol and NSAID. For symptoms greater than 10 days - amoxil, doxy, trimethoprim/sulfamethoxazole

107
Q

Auricle disorders

A

The skin over cartilage. Most are dependent on problem such as: rheumatoid nodules, tophi, hematoma, carcinoma, infection

108
Q

History and clinical presentation of auricle disorders

A

Deformity of auricle. Discharge - drainage. Lesion

109
Q

Management of auricle disorders

A

Specific to the problem. Biospy lesions - basal cell (pearly borders with ulcerated center) and squamous cell (rough, scaly surface). Pressure dressings for trauma cauliflower ear. Piercings - alcohol for clearning, oral/systemic antibiotics such as cephalexin or dicloxacillin or cefriaxone or cephalexin IM/IV

110
Q

Otitis externa

A

Inflammation of the ear canal. Usually bacterial or fungal. Most often caused by - S. aureus (MRSA), pseudomonas, candida, aspergillus. Cerumen impaction

111
Q

History and clinical presentation of otitis externa

A

Pain and tenderness on palpation of traugus. Social history - swimming. History of clearning ear with a Q-tip. Allergies. Hearing aids.

112
Q

Management of otitis externa

A

Cerumen removal if impacted. Teaching - no Q-tip in ears. Antibiotic/steroid ear drops - ciprodex, cortisporin otic. Keep ear canals dry for 7-10 days. Alcohol or vinegar drops. Limit use of ear plugs/phones and hearing aids until resolved. Antifungals for fungal infections - fluconozole

113
Q

Pathophysiology of otitis media

A

Infection of the middle ear causing inflammation and pain which may be fungal, bacterial, or viral. Bacteria most often associated are S. pneumoniae, H. influenzae introduced in the eustacian tube through the nasopharynx following an upper respiratory infection or allergies

114
Q

History and clinical presentation of acute otitis media

A

Earache, lymphadenopathy, headache, fever, upper respiratory symptoms, N/V, dizziness, sore throat, cough

115
Q

Management of otitis media

A

Analgesica - topical (antipyrine/benzocaine) and oral (tylenol or ibuprofen). Antibiotics - amoxil, amoxicillin clavulanate, azithromycin. Antihistamines - second generation

116
Q

Aphthous stomatitis

A

Chronic inflammation of the oral mucosal tissue with ulcers. Painful, shallow, recurrent ulcers of the oral mucosa. May be caused by direct trauma, vitamin deficiency, anemia, allergies

117
Q

History and clinical presentation of aphthous stomatitis

A

Circular shallow ulcers covered by a gray membrane and raised border that is inflammed. Minor occurrence - 1-5 ulcers. Major recurrent 2 or more large ulcers. Herpetiform-recurrent with 5-100 ulcers.

118
Q

Management of aphthous stomatitis

A

Self-limiting, correct vitamin deficiency. Teaching - eliminate causes. Magic mouthwash - benadryl, maalox or mylanta; may include nystatin if fungal etiology is suspected; swish and swallow

119
Q

Glossitis

A

Inflammation and depapillation of the doral side of the tongue

120
Q

History and clinical presentation of glossitis

A

Finger-like bumps on the surface of the tongue may be missing. Swollen, tender tongue, smooth surface, pale or fire red. Dry mouth. Recent infection. Injury. Low iron, skin condition, yeast, sore tongue. Difficulty chewing, swallowing, or speaking. Swollen tongue.

121
Q

Management of glossitis

A

Good oral hygiene. Magic mouthwash. Teaching - avoid irritants - food, beverage. Correct dietary/vitamin deficiencies. Antibiotics/antifungals

122
Q

Thrush

A

Skin and mucous membrane infections caused by Candida albicans. Yeast infection of the mucus membrane lining the mouth and tongue.

123
Q

History and clinical presentation of thrush

A

White, velvety sores over red tissue that may bleed easily

124
Q

Management of thrush

A

Nystatin 4-6 ml (100,000 u/ml) swish and swallow. Diflucan 100-200 mg daily for moderate to severe disease in immunocompromised persons

125
Q

Strep pharyngitis

A

Inflammation of the pharynx and surrounding lymph tissue. Caused by Group A Steptococcus bacteria

126
Q

History and clinical presentation of strep pharyngitis

A

Sore throat, fever, headache, N/V, swollen lymph nodes

127
Q

Centor score - strep pharyngitis

A

Patients are judged on 4 criteria. Each is worth 1 point: fever, tonisillar exudate, tender anterior cervical adenopathy, absence of cough. Add pts age to criteria: age 15 subtract 1 point. 0-1 point - no antibiotic or culture. 2-3 points - throad culture and antibiotic if positive. 4-5 points - treat empirically with antibiotic

128
Q

Management of strep pharyngitis

A

Based on RST, culture, empirical treatment based on Centor Score. Penicillin-amoxil: zithromax if PCN allergic. Teaching - dispose of toothbruth in 3 days. Tylenol or NSAIDS for pain or fever

129
Q

Infectious mononeucleosis

A

Viral infection caused by Epstein Barr or cytomegalovirus

130
Q

History and clinical presentation of infectious mononeucleosis

A

Fever, sore throat, swollen lymph nodes, severe fatigue, splenomegaly

131
Q

Management of infectious mononeucleosis

A

Fluids, rest, analgesics or NSAIDs for pain and fever, salt water gargles, corticosteroids for extreme swelling of throat/tonsils. Teaching - no contact sports for 4-6 weeks. Extremely infectious.

132
Q

The best prevention for swimmer’s ear (external otitis) is to use

A

Ear drops made from alcohol and vinegar in each ear after swimming

133
Q

Mononucleosis differs from strept throat in that:

A

Symptoms such as fatigue and anorexia occur prior to sore throat onset

134
Q

Maury, age 52, has throbbing pain in this left eye, pupiliary constriction, marked photophobia, and redness around the iris. What is your initial diagnosis?

A

Iritis

135
Q

Acute otitis media is diagnosed when there is

A

An arythematous, opaque tempanic membrane

136
Q

The first-line antibiotic therapy for an adult with no know drug allergies and suspected group A beta hemolytic streptococcal pharyngitis:

A

Penicillin

137
Q

Considerations of an adult compaining of a respiratory infection

A

Where is the infection? Is there an underlying condition that creates an additional risk? Is this consistent with a viral or bacterial picture? What is the presentation of a lower respiratory infection?

138
Q

Lower respiratory tract infections involve…

A

Trachea, bronchial tubes, bronchioles, and alveoli

139
Q

Bronchitis

A

Limited to trachea and mainstem bronchi

140
Q

Pneumonia

A

Involves lobes of lungs

141
Q

Elderly patient with chronic cardiac or lung disease and presentation of respiratory infection

A

They may de-compensate from the same organism that the immume system of a healthy young person would manage without problems. May wish to consult with a physician.

142
Q

Underlying conditions and respiratory infections

A

Alcoholism, smoking, and impaired immunity such as HIV increases changes you are dealing with a more pathogenic or resistent organism that requires an broad spectrum antibiotic

143
Q

Antibiotic response of viral bronchitis or pneumonia

A

Except for CMV, it will not respond to an antibiotic

144
Q

Manifestations of pathogenic bacterial which colonize the oropharynx

A

Takes over and causes a frank infection in the denuded epithelium remaining after a viral infection.

145
Q

If a history that sounds viral becomes worse instead of better…

A

It is most likely a bacterial process

146
Q

Presentation of lower respiratory infection

A

Fever, malaise, cough, sputum production, and chest wall pain related to coughing

147
Q

Presentation of bronchitis

A

Clear lungs of diffuse wheezes and rhonchi due to large airway secretions and bronchospasms. May have low-grade fever.

148
Q

Medications and bronchitis

A

Usually viral and does not require antibiotics. Inhalers are used for wheezing and will help decrease bronchospams, thereby decreasing cough

149
Q

Presentation of lobar pneumonia

A

Caused by pneumococcus. Typically has crackles, wheezes, bronchial breath sounds, and dullness to percussion over involved areas of lungs. Areas of lung with infiltrate will also have increased fremitus and egophony.

150
Q

Presentations of atypical pneumonia caused by nycoplasma or chlamydia pneumoniae

A

Less dramatic symptoms but will usually have wheezing and or crackles. Headache and myalgia are common with low-grade fever, scanty sputum production, minimal respiratory distress and minimal physical findings. Dramatic patchy infiltrates that are out of proportion with physical exam.

151
Q

Current research, antibiotics, and uncomplicated bronchitis in low risk individuals

A

Should not be prescribed. Prepare to meet disbelief andn resistance from patients.

152
Q

Preferred outpatient treatment for atypical pneumonia proven by clinical exam and x-ray

A

Azithromycin

153
Q

Sympathomimetic agent is drug of choice for asthma

A

Beta 2 agonists

154
Q

Patient works with a person recently diagnosed with active TB, what is first step in care of patient?

A

Mantoux testing

155
Q

Patient with persistent asthma in Step 2 should have this medication added to their short acting beta agonist

A

Low-dose inhaled corticosteroid

156
Q

Patient suspected of having pneumonia. A chest x-ray is negetive. This finding…

A

Does not exclude the diagnosis of pneumonia

157
Q

Tuberculosis

A

Infectious disease caused by mycobacterium tuberculosis and affects the apex of the lung primarily

158
Q

Secondary tuberculosis

A

Usually pulmonary

159
Q

Clinical manifestations of pulmonary tuberculosis

A

Fatigue, anorexia, weight loss, night sweats, low-grade diurnal fever, cough, chest pain related to cough, hemoptysis, irregular menses

160
Q

Exam of pulmonary tuberculosis

A

Maybe rales in upper posterior area, maybe evidence of pleural effusion, lymphadenopathy

161
Q

TB diagnostic testing

A

Mantoux test (read in 48-72 hrs, two-step, anergy), QFT-G blood test (resulted in 24 hrs), chest x-ray

162
Q

TB diagnostic chest x-ray

A

If positive to exclude pulmonary disease; if negative then prophylaxis with isoniazid

163
Q

Candida antigen

A

Used to determine if the individual’s immune system is functioning well; a normal immune system demonstrates a positive reaction

164
Q

Criteria for TB prophylaxis with INH

A

Positive TB skin test, other tests negative, no liver contraindications, regardless of history of BCG vaccination

165
Q

Side effects of TB prophylaxis with INH

A

Hepatitis - need baseline and monthly LFTs; drugs that increase risk; peripheral neuropathy

166
Q

Treatment of peripheral neuropathy with TB prophylaxis

A

Use B6 (pyridoxine) to decrease risk if patient has diabetes, uremia, alcoholism, malnutrition, during pregnancy, or if patient has a seizure disorder requiring Dilantin

167
Q

If x-ray shows active TB

A

Refer

168
Q

Reporting of TB

A

Mandatory in all 50 states and must be reported to local health department

169
Q

Influenza

A

Active infection of respiratory tract - virus Type A or B, highly contagious, self-limiting, spread by droplet, virus shed 24 hrs before symptoms occur

170
Q

Signs and symptoms of influenza

A

Fever, chills, headache, malaise, loss of appetite, dry cough, nasal congestion with clear drainage, sore throat, cough is most prominent

171
Q

Diagnostic test of influenza

A

Rapid test or cell culture for virus - takes 2-7 days

172
Q

Treatment of influenza

A

Rest, fluids, antipyretic/analgesic. Antiviral meds - zanamivir (relenza) and osteltamivir (tamiflu) should be started within first 48 hrs; reduces severity and durations of symptoms and may be used prophylactically for high-risk persons.

173
Q

Prevention of infuenza

A

Vaccine

174
Q

Asthma

A

Chronic inflammatory disorder of the airways. 6th most common reason for visit - most common respiratory disorder of all age groups. Can be acute severe asthma or chronic stable asthma

175
Q

Triggers of asthma

A

Many factors, including allergens, infections, exercise, changes in weather, irritants, allergy to aspirin

176
Q

Signs and symptoms of asthma

A

Episodic wheezing associated with dyspnea, cough, breathlessness, anxiety, sputum production. Most common - cough. Between attacks - none. Exercise induced - begins 5-10 minutes after exercise

177
Q

Allergens of asthma

A

Cat dancer, dust mites, cochroach allergen, tree and grass pollen

178
Q

Other causes of asthma

A

Viral illness, occupational exposure, socioeconomic deprivation, anxiety, depression, stress

179
Q

Initial assessment of asthma

A

Diagnosis by signs, symptoms, and spirometry

180
Q

Physical exam of asthma

A

Forced expiration, both inspiratory and expiratory as it worsens, use of accessory muscles increases, hyperinflation

181
Q

Severe asthma attacks

A

Labored breathing = ED

182
Q

Diagnostic tests of asthma

A

Spirometry - most useful = peak expriatory flow rate (PERF), FEVI, MMEFR, and FVC; diagnostic hallmark - decreased obstruction after bronchodilator

183
Q

Diagnosis of mild asthma

A

Decreased PEFR, FEVI, MMEFT

184
Q

Diagnosis of bronchospasm

A

Decreased FEVI, MMEFT, and FEVI/FVC ratio

185
Q

Control of asthma

A

Environmental controls, anti-inflammatory medications, patient education

186
Q

Classification of severity of asthma

A

Steps 1-4 or 5

187
Q

Acute bronchitis

A

Transcient inflammation of the trachea and major bronchi. Begins with URI, cough that causes burning pain in chest, nose, and throat symptoms that subside but cough persists, along with wheezes, rhonchi, course rales

188
Q

Clinical diagnosis of acute bronchitis

A

Signs, symptoms. No diagnostic testing

189
Q

Other causes of acute bronchitis

A

Viral illness, occupational exposure, socioeconomic deprivation, anxiety, depression, stress

190
Q

Treatment of acute bronchitis

A

Refer is not responding to treatment or if symptoms linger for longer than 2 weeks. Education - side effects of medication; cough may persist 10-14 days

191
Q

Pneumonia

A

Bacteial and atypical or “walking pneumonia”. Bacterial - most common organism for CAP - streptococcus pneumoniae

192
Q

Mortality of pneumonia

A

Leading cause of death from infectious disease and 7th most common cause of death in US from all causes

193
Q

Organisms of gram positive pnemonia

A

Streptococcus pneumoniae

194
Q

Organism of gram negative bacteria

A

Haemophilus influenza

195
Q

Organism of atypical pneumonia

A

Mycoplasm pneumoniae

196
Q

History and physical exam of pneumonia

A

Will determine pneumonia but will not reveal the causative organism.

197
Q

Outpatient management of Group I pneumonia

A

Macrolides are first line or doxycycline. Dynamed outpatient CAP - macrolides (level I evidence). If comorbidities or high risk for resistance - moxifloxacin, genifloxacin, or lefofloxacin or macrolide + augmentin

198
Q

Patient education and pneumonia

A

Rest, increased fluids, antipyretic/analgesic, avoid cough suppressant, directions for antibiotic use and side effects, follow-up

199
Q

Smoking

A

Most preventable cause of premature death in US; 1 in 5 death is related to smoking. 35 million try to stop smoking each year and about 7% succeed. A few minutes of counseling is an effective way to help people stop smoking

200
Q

Six phases of change

A

Precontemplation, contemplation, determination, action, maintenance, and relapse

201
Q

Four “A’s” for health care providers

A

Ask, advise, assist, arrange

202
Q

General concerns about quitting smoking

A

Women - weight gain; men - professional athlete image; adolescents - point out effect on appearance; adults - more concern about health

203
Q

Pharmacologic interventions for smoking cessation

A

Nicotine replacement, buproprion (wellbutrin, zyban), varenicline (chantix), nic vax - facilitates nicotine antibody development that prevents nicotine getting to the brain

Comps - Mod 2 (9 decks)

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