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Clin Med 1 Lab > Final > Flashcards

Final Flashcards

1
Q

what virus causes Epstein Barr Virus?

A

HHV 4 (human herpes virus 4)

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2
Q

highest incidence of mono is in what age group

A

15-24 yo

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3
Q

incubation period of mono

A

30-50 days

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4
Q

highest morbidity in mono

A

college and military

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5
Q

EBV enters body thru

A

oral epithelial cell

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6
Q

mono infects what type of cell

A

B cells

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7
Q

mono causes the release of

A

cytokines

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8
Q

diagnostic test for mono

A

heterophile abs

sheep and horse cells

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9
Q

humoral immunity involves

A

extracellular microbes → bacteria

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10
Q

cellular immunity involves

A

cellular immunity → intracellular viruses

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11
Q

mono triad

A

fever

pharyngitis

posterior cervical LAD

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12
Q

mono often starts w.

A

malaise, HA, low grade fever

kissing tonsils

tonsillar exudates

palatal petechiae

splenomegaly

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13
Q

what type of drug causes rashes in mono pt

A

penicillins

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14
Q

penicillin induced rash in mono is characterized by

A

maculopapular

generalized

pruritic

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15
Q

less common findings in mono

A

+/- jaundice, periorbital edema, CNS findings, myocarditis

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16
Q

mono lab findings

A

lymphocytic leukocytosis:

absolute count > 4500

differential: >50% → inverted differential

atypical lymphocytes

increase of CD8+ T lymphocytes

Downey cell

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17
Q

what is an inverted differential

A

lymphocytes > neutrophils

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18
Q

what is a downey cell

A

reactive, atypical lymphocyte specific to viral infxn

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19
Q

the monospot test uses

A

heterophile abs

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20
Q

the monospot test is not always ___ or ___

A

specific; sensitive

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21
Q

how might mono affect LFTs

A

transient abnormal

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22
Q

ddx for mono

A

strep pharyngitis

CMV

toxoplasmosis

malignancy

peritonsillar abscess

malignancy

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23
Q

in strep pharyngitis, you will not see

A

splenomegaly

extreme fatigue

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24
Q

CMV is not is not _

and doe not involve _

A

exudative

splenomegaly

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25
Q

toxoplasmosis does not involve hepatic or _ symptoms

A

pharyngeal

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26
Q

malignancy is more likely to be __ than mono

and _ is uncommon

A

asymmetric

pharyngitis

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27
Q

peritonsillar abscess triad

A

hot potato voice

trismus

deviation of uvula

pain unilaterally

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28
Q

mono is usually _

and tx is mostly _

A

self limited

supportive

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29
Q

pharm for mono

A

tyelonol

NSAIDS

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30
Q

indications for steroids in mono tx

A

impending airway obstruction

severe thrombocytopenia w. hemorrhage

meningitis

AI hemolytic anemia

sz

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31
Q

are antivirals recommended in mono

A

no!

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32
Q

contact sports should be avoided for how long in mono

A

2-3 weeks

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33
Q

complications of mono are rare, but include

A

splenic rupture

airway compromise

malignancy → lymphoma; nasopharyngeal carcinoma

AI hemolytic anemia

encephalitis

myocarditis

hepatitis

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34
Q

fatigue from mono could last

A

2-3 months

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35
Q

definition of acute sinusitis

A

<4 weeks

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36
Q

definition of subacute sinusitis

A

4-12 weeks

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37
Q

definition of chronic sinusitis

A

>12 weeks

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38
Q

definition of recurrent acute sinusitis

A

at least 4 episodes/year w. interim sx resolution

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39
Q

signs of bacterial sinusitis

A

symptoms >10 days

unilateral maxillary sinus/facial pain

maxillary tooth pain

unilateral purulent nasal d/c

second sickening

fever

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40
Q

characteristics of viral URI fever

A

only first 2 days w. HA, myalgia

as fever resolves → respiratory s/sx may persist on day 10, but are less severe

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41
Q

acute bacterial sinusitis pathogens

A
  1. strep pneumo → 75%
  2. H.flu
  3. M. catarrhalis
  4. S. aureus
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42
Q

what pathogen accounts for 75% of bacterial sinusitis

A

strep pneumo

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43
Q

tx for bacterial sinusitis

A
  1. Augmentin (Amox Clauv) → adults AND kids
  2. Penicillin allergy → Doxycyline
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44
Q

bacterial sinusitis abx duration - kids

A

10-14 days

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45
Q

bacterial sinusitis abx duration - adults

A

5-7 days

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46
Q

sinusitis complications (8)

A
  1. preseptal swelling
  2. orbital cellulitis
  3. orbital superiosteal abscess
  4. septic cavernous sinus thrombosis
  5. meningitis
  6. osteomyelitis
  7. subdural abscess
  8. brain abscess
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47
Q

preseptal cellulitis

A

swelling, erythema of periorbital area and eyelids

NO proptosis or limitation of eye movement

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48
Q

orbital cellulitis

A

periorbital swelling

eyelid erythema.

pain w. eye movements

chemosis and proptosis

ophthalmoplegia → paralysis/weakness of eye muscles

diplopia, vision loss

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49
Q

orbital superiosteal abscess

A

same s/sx as orbital cellulitis plus marked globe displacement

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50
Q

eye complications of bacterial sinusitis from least to most concerning

A

least → most concerning:

  1. preseptal cellulitis
  2. orbital cellulitis
  3. orbital superiosteal abscess
  4. osteomyelitis of frontal bone
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51
Q

septic cavernous sinus thrombosis

A

bilateral ptosis

proptosis

ophthalmoplegia

periorbital edema

AMS

septic appearing

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52
Q

osteomyelitis of frontal bone

A

Pott Puff tumor

forehead/scalp swelling/tenderness

HA, photophobia

fever, vomiting, lethargy

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53
Q

subdural abscess

A

fever, severe HA

meningeal irritation

progressive neuro deficits, sz

papilledema

vomitting

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54
Q

brain abscess

A

HA, stiff neck

AMS, neuro deficits

vomiting

CN III, VI deficits

papilledema

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55
Q

chronic sinusitis may actually be

A

migraines

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56
Q

migraine pain is usually

A

unilateral

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57
Q

migraines are concerning if they last for > than

A

18-24 hr

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58
Q

migraine pain is often described as

A

throbbing

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59
Q

response to what med can be diagnostic of mirgaines

A

triptans

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60
Q

4 Phases of a Migraine

A
  1. prodrome
  2. aura
  3. HA
  4. postdrome
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61
Q

migraine prodrome can last

A

a few hours to days

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62
Q

migraine aura can last

A

5-60 min

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63
Q

migraine HA can last

A

4-72 hr

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64
Q

migraine postdrome can last

A

24-48 hr

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65
Q

the longest phase of a migraine is

A

prodrome

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66
Q

5 symptoms of migraine prodrome

A

irritability

DPN

yawning

polyruria

nausea

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67
Q

migraine aura - 3 symptoms

A
  1. visual disturbances
  2. temporary loss of sight
  3. numbness/tingling
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68
Q

migraine HA - 5 symptoms

A
  1. throbbing
  2. drilling
  3. icepick in head
  4. burning
  5. vomiting
  6. giddiness
  7. nasal congestion
  8. neck pain
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69
Q

migraine - postdrome 5 symptoms

A
  1. inability to concentrate
  2. fatigue
  3. DPN
  4. euphoria
  5. lack of comprehension
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70
Q

fewer %age of people experience which phase of migraines

A

aura

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71
Q

3 abortive migraine meds

A

order of most to least recommended:

  1. OTC analgesics → Excedrin is most effective
  2. Triptans; Ergotamine spray
  3. ketorolac injxn; ergotamine IV; dexamethsone
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72
Q

chronic migraine is defined as

A

at least 15 HA/mo lasting 4 hr/day or longer

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73
Q

migraine prophylactic meds

A
  1. beta blockers → Propranolol is best
  2. CCB
  3. antidepressants → tines and triptylines
  4. anticonvulsants → Valproic acid, Topamax
  5. anti-calcitonin gene-related peptide therapy → expensive
  6. botox
  7. magnesium
  8. CBT; acupuncture
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74
Q

best propylactic migraine med for pt w. HTN

A

beta blocker

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75
Q

best migraine med for pt w. insomnia

A

amitriptyline

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76
Q

best migraine med for pt who needs to lose wt

A

Topamax

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77
Q

s.e of Topamax

A

brain fog

tastes awful

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78
Q

OTC analgesics should be limited to

A

15 days or less/mo

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79
Q

Excedrin should be limited to

A

no more than 10 days/mo

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80
Q

which migraine med can cause rebound HA

A

Triptans

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81
Q

concern for rebound HA when

A

pt has to take med every day to control HA

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82
Q

CVA that lasts < 24 hr

A

TIA

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83
Q

occlusion forms locally at ischemic site

A

thrombotic

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84
Q

clot breaks off from another location and travels to brain

A

embolic

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85
Q

reversibly damaged brain tissue around ischemic core

A

penumbra

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86
Q

3 causes of hemorrhagic stroke

A
  1. aneurysm
  2. head trauma
  3. cocaine
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87
Q

small vessel/lacunar stroke is occlusion of the __ arteries

and is usually caused by __

A

small

longstanding HTN

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88
Q

Afib can cause __ stroke

A

embolic CVA → clot forms in heart → travels to brain

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89
Q

scoring system that determines risk for ischemic stroke

A

CHADS 2

CHADSVASC

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90
Q

CHADS scores of 2 or more indicate

A

need for anticoagulation

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91
Q

components of CHADS2

A

CHF (1)

HTN (1)

age > 75 (1)

DM (1)

stroke/TIA (2)

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92
Q

components of CHADSVAS

A

CHF

HTN

Age >75 yo (2)

DM

stroke/TIA

vascular dz

age > 65-74 (2)

female

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93
Q

symptoms of ACA stroke

A

contralateral paralysis and sensory loss mostly affecting leg

abulia → apathy

urinary incontinence

gait apraxia

grasp reflex or sucking reflex

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94
Q

symptoms of MCA stroke

A

hemiparesis primarily affecting face and arm

hemisensory deficit primarily affecting face and arm

gaze preference toward affected hemisphere

aphasia

hemianopsia

+/- apraxia

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95
Q

PCA stroke symptoms

A

homonymous hemianopsia affecting contralateral vision field

anomic aphasia → difficulty naming objects

alexia w.o graphia → can’t read/write

visual agnosia → can’t see or interpret visual info

contralateral hemisensory loss and hemiparesis

unilateral HA

CN III palsy

balance

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96
Q

which type of stroke is most common

A

MCA

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97
Q

lacunar stroke symptoms

A

absence of cortical signs (aphasia, agnosia, hemianopsia, apraxia, etc)

PLUS ONE of the following:

pure motor hemiparesis → face, arm, leg on one side of body; no sensory deficit

pure sensory stroke → numbness of face, arm, leg on one side of body; no motor deficit

ataxic hemiparesis → weakness and ataxia out of proportion to motor deficit

sensorimotor stroke on one side of body

dysarthria-clumsy hand syndrome → facial weakness, dysarthria, dysphagia. slight weakness, clumsiness of one hand

98
Q

evaluation of CVA

A
  1. neuro exam
  2. CT non contrast to eval for hemorrhage
  3. MRI → detects early ischemia
  4. EKG
  5. carotid doppler/US → carotid stenosis
99
Q

what should always be the first imaging for CVA

A

CT w.o contrast

100
Q

best imaging to eval for stenosis

A

carotid doppler/US

101
Q

best imaging to eval for possible embolic source of CVA

A

Echo

102
Q

best imaging to identify early ischemia

A

MRI

103
Q

tPA inclusion criterai

A
  1. at least 18 yo
  2. clinical dx of ischemic CVA w. measurable deficit
  3. time of onset <4.5 hr → time of onset unknown → usually don’t qualify for tPA
104
Q

hard no’s for tPA

A
  1. minor or isolated neurologic signs
  2. rapidly improving
  3. major surgery or serious trauma in past 2 weeks
  4. GI or urinary tract bleeding in past 3 weeks
  5. MI in last 3 weeks
  6. sz at onset of stroke w. neurological impairments
  7. pregnancy
105
Q

gray areas for tPA

A
  1. age >80
  2. oral anticoagulant use regardless of INR
  3. severe stroke → NIHSS score >25
  4. combo of previous ischemic stroke and DM
106
Q

tPA exclusion criteria

A
  1. e.o intracranial hemorrhage on CT
  2. previous intracranial hemorrhage
  3. severe uncontrolled HTN → SBP > 185; DBP >110
  4. known AVM, neoplasm, aneurysm
  5. thrombocytopenia <100k
  6. current use of anticoags
  7. Heparin w.in last 48 hr
  8. hypoglycemia → BG <50
  9. basically anything w. high risk for bleeding
107
Q

significantly lowering BP in stroke patient can lead to

A

worse outcomes

108
Q

bp goal pre thrombolysis

A

SBP: <185 to >110

109
Q

maintenance bp post thrombolysis

A

>180/105 for at least 24 hr

110
Q

bp goal for no thrombolytic therapy

A

SBP > 220 or DBP >120

111
Q

for chronic management post CVA what is preferred over Heparin

A
  1. ASA
  2. Warfarin
112
Q

does Bell’s Palsy have race, geographic, or gender predilection

A

NO

113
Q

RF for Bell’s Palsy

A

3x greater during pregnancy → 3rd trimester or 1 week postpartum

DM

114
Q

most likely pathogen in Bell’s Palsy

A

herpes simplex

115
Q

second leading cause of Bell’s Palsy

A

herpes zoster

116
Q

non infectious Bell’s Palsy etiologoes

A

trauma

ischemia

compression of CN VII

genetic predisoposition

117
Q

Bell’s Palsy clinical features

A

unilateral facial paralysis

ear pain

inability to move forehead

inability to close eye

flattening of nasolabial fold

drooping of mouth

decreased tearing

hyperacusis

loss of taste → anterior ⅔ of tongue

118
Q

reflex eval in Bell’s Palsy

A

orbicularis reflex → asymmetry in blinking

bell phenomenon → upward movement of eye w. eye closing

119
Q

Bell’s Palsy is a __ diagnosis

A

clinical

120
Q

criteria for clinical dx of Bell’s Palsy

A
  1. diffuse facial nerve involvement w. paralysis of facial muscles
  2. acute onset over 1-2 days
121
Q

Bell’s Palsy usually reaches maximal weakness w.in

A

3 weeks

122
Q

partial or complete recovery in Bell’s Palsy is usually w.in

A

6 months

123
Q

imaging for Bell’s Palsy is intended to

A

r.o other causes → CT/MRI

124
Q

what is the House-Brackmann scale used to evaluate

A

Bell’s Palsy

125
Q

first line tx for Bell’s Palsy

A

Prednisone 60-80 mg daily x 1 week → best w.in 3 days of onset

126
Q

if given alone, __ do not work well for Bell’s Palsy

A

antivirals

127
Q

combo therapy of Prednisone + antiviral is recommended for Bell’s Palsy w. __ or higher on the HB scale

A

IV →

minimal movement, asymmetric resting tone

no forehead movement

incomplete eye closure

slight mouth movement

128
Q

signs of improvement in Bell’s Palsy are usually seen w.in __ weeks

A

3

129
Q

further work up for BP if improvement not seen w.in _

A

3-4 months

130
Q

worse prognosis in BP if (3 things)

A

hyperacusis

advanced age

severe pain at onset

131
Q

H&P clues that point to PAD

A
  1. pt can walk 4 blocks (discrete distance) prior to pain
  2. sitting helps → pain resumes w. activity
  3. pain in legs w. reclining in chair → dangling them relieves pain
  4. advil does not help
132
Q

PAD PE exam findings

A
  1. diminished pulses
  2. smooth, hairless legs
  3. legs that are cooler to the touch
  4. thickened toenails
  5. color changes
  6. +Buerger test
133
Q

what is the Buerger test

A

pt supine → elevate both legs to 45 degrees for 1-2 min:

pallor in feet/lower extremities → indicates ischemia

pt sits up and hangs legs over bed → color should return → blue or red

134
Q

PAD is most commonly caused by

A

atherosclerosis

135
Q

advanced PAD dz indicates

A

ischemia in multiple vessels

136
Q

PAD can be

A

asymptomatic

137
Q

common symptoms of PAD

A
  1. intermittent claudication
  2. atypical pain
  3. nonhealing wounds → usually on feet
  4. ulcers
  5. gangrene
  6. thin, hairless, shiny skin
  7. cool skin
  8. blue toe syndrome
  9. DM worsens all of these
138
Q

in PAD, location of pain can correlate with

A

site of the lesion

139
Q

PAD pain: buttocks and hips indicates

A

aortoiliac dz

140
Q

Leriche syndrome triad

A

PAD:

claudication

absent or diminished femoral pulses

ED

141
Q

PAD: thigh pain indicates what claudication site

A

common femoral artery

142
Q

PAD: claudication in upper ⅔ of calf indicates ischemia

A

in the superficial femoral artery

143
Q

PAD: claudication in the lower ⅔ of calf indicates ischemia

A

in the popliteal artery

144
Q

PAD: claudication in the food indicates ischemia in the

A

tibial/peroneal arteries

145
Q

most common claudication complaint in PAD

A

calf

146
Q

complication of PAD: acute limb ischemia - 6Ps

A

pain

pale

pulseless

paresthesias

pallor

perishingly cold

147
Q

tx for acute limb ischemia

A

immediate Heparin

immediate revascularization

emergent surgical consult

148
Q

ABI test is done using a

A

Doppler probe

149
Q

ABI is assessing the

A

ratio of the ankle systolic bp / brachial systolic pressure

150
Q

nl ABI

A

1.0-1.4

151
Q

ABI <0.9

A

diagnostic for PAD

152
Q

ABI > __

indicates __

A

1.3

calcified vessels

153
Q

exercise testing may be considered in PAD pt with (2 things)

A

atypical pain

normal ABI

154
Q

ABI less than __ after exercise is diagnostic of arterial obstruction

A

20%

155
Q

first test for PAD is always

A

ABI

156
Q

after, ABI next test for PAD is

A

CTA

157
Q

gold standard for vascular imaging

A

conventional arteriography (angiogram)

158
Q

the pro of conventional arteriogaphy in acute ischemia is that

A

it can be simultaneously diagnostic and intervention

159
Q

cons of conventional arteriography

A

invasive → have to puncture artery

higher risk

160
Q

the go to imaging for acute linb ischemia

A

conventional arteriography (same same angiogram, angiography)

161
Q

order of testing for PAD

A
  1. ABI
  2. CTA
  3. conventional arteriography → best for acute ischemia
162
Q

tx for PAD

A
  1. lifestyle modifications
  2. long term antithrombotic theray → ASA OR Plavix
  3. at least a moderate intensity statin regardless of LDL
163
Q

all PAD patients should be on what 2 meds

A

Aspirin OR Plavix

Statin (at least moderate intensity regardless of LDL)

164
Q

tx for claudication (3 things)

A
  1. supervised exercise
  2. Cliostazol (Pletal) → phosphodiesterase inhibitor
  3. revascularization
165
Q

Cliostazol (Pletal) is absolutely contraindicated in what pt population

A

CHF

166
Q

s.e of Cliostazol (Pletal)

A

ha, diarrhea, infxn, rhinitis

167
Q

revascularization for claudication is recommended in patients w.

A

life threatening ischemia

pt w. significant disabling symptoms unresponsive to lifestyle mods or meds

168
Q

arterial ulcers are

A

severely painful

169
Q

venous ulcers are

A

less painful than arterial

erythematous, brown-blue

170
Q

neuropathic ulcers are

A

painless

171
Q

Wells Criteria for DVT

A
  1. cancer tx past 5 mo
  2. paralysis or paresis or cast of lower extremity
  3. bedridden for at least 3 days in past 4 weeks or major surgery past 12 weeks
  4. tenderness localized along deep venous system
  5. swelling of entire leg
  6. unilateral calf swelling >3 cm compared to other side
  7. unilateral pitting edema
  8. superficial collateral veins
  9. prior DVT
  10. alternate dx as or more likely than DVT
172
Q

Wells DVT: 0 - <0

A

3% probability for DVT

order D-dimer

normal → no further testing

positive → US

173
Q

Wells DVT: 1-2 points

A

moderate probability - 7%

order high sensitivity D-dimer:

normal → no further testing

positive → US

174
Q

Wells DVT 3-8 points

A

high probability - 50-75%

NO Ddimer!!

order US

175
Q

Wells is used for

A

DVT and PE

176
Q

Pretest Probability for PE: <2

A

low →

apply PERC:

all criteria fulfilled → done

one or more not fulfilled → CTPA

177
Q

Wells PE: 2-6

A

intermediate →

D-dimer →

negative → done

positive → CTPA

178
Q

Wells PE: >6

A

high -→ CTPA

179
Q

PERC is only used for pt w. __ Wells probability for PE

A

low → <2

180
Q

Wells Pretest Probability for PE

A

DVT symptoms

PE is as likely or more likely than an alternate dx

bedrest 3 or more days or surgery in last 4 weeks

previous DVT/PE

hemoptysis

ca tx in last 6 mo or current palliation

heart rate >100

181
Q

There are separate Wells Pretest Probability criteria for both __

and __

A

DVT

PE

182
Q

PERC criteria

A

Pulmonary Embolism Rule Out Criteria

183
Q

DVT on an US will look like

A

noncompressibility of the veins

184
Q

CTPA

A

computed tomography pulmonary angiogram

185
Q

CTPA is same same

A

CTA

186
Q

CTPA/CTA is both __

and __ for diagnosing

__

A

sensitive

specific

PE

187
Q

proximal DVT locations (3)

A

popliteal veins

femoral veins

iliac veins

188
Q

distal DVT locations (3)

A

anterior tibial veins

posterior tibial veins

peroneal veins

189
Q

hemodynamically unstable (massive) PE definition

A

SBP <90 for >15 min

hypotn requiring vasopressors

clear e.o shock

190
Q

tx for massive PE

A

IV fluids and vasopressor support (epinephrine, norepinephrine, vasopressin)

reperfusion therapy:

thrombolytic therapy OR

embolectomy

191
Q

submassive PE definition

A

RV dysfxn and borderline BP

192
Q

saddle pulmonary embolism

A
193
Q

thrombolytic therapy is called

A

tPA

194
Q

in pulmonary embolism, tPA is used for which dx

A

hemodynamically unstable (massive) PE

195
Q

in pulmonary embolism, embolectomy is used for

A

those who fail tPA OR

those who have contraindication for tPA

196
Q

unprovoked DVT/PE is

A

idopathic → start work up

197
Q

provoked DVT is

A

caused by a known event

198
Q

known events for provoked DVT include

A

surgery

hospital admit

C-section

pregnancy

estrogen therapy

reduced mobility

199
Q

persistent risk factors for provoked DVT (inherited vs acquired)

A

malignancy

inheritable thrombophilias (Leiden Factor V, prothrombin gene mutation)

anatomic risk factors

chronic dz → ex IBD

200
Q

common meds that cause provoked DVT

A

estrogen

OCPs

testosterone

tamoxifen

steroids

201
Q

anticoagulation for DVT/PE

A

heparin (Lovenox) → bridging to Coumadin (5mg) OR

Eliquis, Pradaxa, Xarelto, Savaysa

202
Q

INR goal for anticoagulant tx

A

2-3

203
Q

do you need to Heparin bridge w. NOACs

A

No!

204
Q

minimum amt of time to anticoagulate for DVT/PE

A

3 months

205
Q

risk of VTE recurrence is highest in the

A

1-2 years after the event

206
Q

pt w. active malignancy have a __ risk of DVT/PE recurrence

A

15-20%

207
Q

DVT/PE pt’s that are usually indefinitely anticoagulated (3)

A
  1. recurrent proximal DVT and/or symptomatic PE w.o identifiable risk factors
  2. any VTE associated w. active cancer not precipitated by major provoking event
  3. 1st episode of proximal DVT and/or symptomatic PE w.o identifiable risk factor
208
Q

indefinite anticoagulation not recommended for DVT/PE pt w.

A

first episode VTE w. transient major risk factor

209
Q

goal of IVC filters

A

prevent embolization of a lower extremity clot to the lung

210
Q

IVC filters are recommended for pt’s w. acute proximal DVT and PE who have

A

absolute contraindication to anticoagulant therapy →

active bleeding, hemorrhagic CVA, recent surgery etc

211
Q

emphysema definition

A

abnormal enlargement of terminal airspace

obvious fibrosis

212
Q

mMRC scale

A

dyspnea

213
Q

CAT (COPD Assessment Scale)

A
214
Q

COPD FEV1/FVC diagnostic score

A

<0.7

215
Q

GOLD COPD Staging

A
216
Q

COPD tx steps

A
  1. assess symptoms w. mMRC or CAT
  2. assess risk of future exacerbations using GOLD
  3. Place pt in Group A-D
217
Q

tx for COPD

A
  1. SMOKING CESSATION!
  2. flu and PNA vaccines
  3. exercise
  4. pt ed
218
Q

SABAs

A

Albuterol (ProAir, Proventil, Ventolin)

Levalbuterol (Xopenex)

219
Q

SAMAs

A

Ipratropium (Atrovent)

220
Q

Combo: Ipratropium + Albuterol

A

Combivent

Duoneb

221
Q

LABAs

A

Salmeterol

Formoterol

Aformoterol

Indacaterol

Olodaterol

222
Q

Paulson’s choice for COPD

A

Spiriva (LAMA) + Albuterol

223
Q

LAMAs

A

Tiotropium (Spiriva)

Aclidinium

Umeclidinium

Glycopyrronium

224
Q

ICS + LABA

A

Advair

Symbicort

Dulera

Breo Ellipta

225
Q

Theophyline

A

Bronchodilator

  • not used as much*
  • lots of drug interactions*
226
Q

Oxygen therapy for COPD must be used at least __ hr per day

A

16

227
Q

PaO2 and O2 sat for O2 therapy in COPD

A

PaO2: 55 or less

O2 sat: 88% or less

228
Q

qualifications for hospice (3)

A

2 physicians certify that pt is terminally ill → < 6 mo left to live

pt or family must sign to choose hospice over curative

eligibility depends on dz process

229
Q

pulmonary dz hospice eligibility

A
  1. disabling dyspnea at rest; poor response to meds
  2. increasing ER visits/hospitalizations
  3. PaO2 55 or less; O2 sat less than 88% at rest
  4. cor pulmonale 2/2 to pulmonary dz
  5. unintentional wt loss >10% x 6 mo
  6. resting tachycardia >100/min
230
Q

what are PAs allowed to do in hospice

A
  1. provide, manage, Medicare reimbursement
  2. establish and review plan of care
231
Q

PA AND NP hospice limitations

A
  1. only physician or medical director may certify terminal illness
  2. only medical director may admit pt to hospice
  3. PAs can’t take position of physician in interdisciplinary team
232
Q

PA but not NP hospice limitation

A

face-to-face encounter prior to recertification for hospice to determine continued eligibility → PAs can not do this, NPs can

233
Q

dying process - comfort meds (2)

A
  1. morphine (oral elixir is Roxanol)
  2. lorazepam
234
Q

what comfort med also helps w. anxiety

A

Lorazepam (Ativan)

235
Q

what helps w. the death rattle

A

discontinue IVF

place pt on side

scopolamine patch

atropine

glycopyrrolate injxn

236
Q

comfort meds - nausea

A
  1. Haloperidol (Haldol)
  2. rectal prochlorperazine (Compazine)
  3. Odansetron (Zofran)
237
Q

comfort meds: pain, nausea, anorexia, and asthenia

A

glucocorticoids

238
Q

ICDs in hospice

A

deactivating ICD will not cause immediate death!

w. biventricular pacing you can just turn off ICD

239
Q

pronouncement of deat

A

check ID bracelet/pulse

check pupils

check response to verbal/tactile stimuli

check for spontaneous respiration

check for heart sound/pulses

note time of death

speak to family

240
Q

what to document when pronouncing death

A
  1. date and time
  2. brief statement of cause of death
  3. note absence of pulse, respiration, pupil response, rxn to verbal/tactile stimuli
  4. not if family informed or response
  5. notification of pastoral care, social work, hospice agency, attending
241
Q

comfort meds that are good for pt w. impaired swallowing

A

morphine

ativan (lorazepam)

available in liquid form

Clin Med 1 Lab (1 decks)

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