health screening, cardiovascular, URI Flashcards
1
Q
Breast cancer screening recommendations
-clinical breast exam (ACS, ACOG, USPSTF)
-mammogram
-Breast self awareness (BSA)
A
CBE
-ACS: does not recommend among average-risk women
-ACOG: may be offered every 1-3 years women aged 35-39 years and annually for women 40 and older
-USPSTF: insufficient evidence to assess balance of benefits and harms
MAMMOGRAM
-ACS: yearly starting at 45 for avg risk; women 555 and older can transition to biennial screening; should have opportunity to begin MMG starting between 40-44; no definite age to d/c
-ACOG: starting at 40; initiate between 40-49 but recommend no later than 50; annually or biennial; no definite age to d/c
USPSTF: biennial screening from 50-74 years old
BSA
-ACS: educate women age 20 and older about BSA and when to see further eval
ACOG is same as ACS^^
2
Q
cervical cancer screening recommendations
<21
21-29
30-65
>65
A
< 21: screening not recommended
21-29: cytology alone every 3 years
30-65: cytology and HPV co-testing every 5 years OR cytology alone every 3 years
> 65” stop if screening has adequate prior negative screening results- defined as 3 consecutive negative cytology results or 2 consecutive co-testing results wihtin 10 years and most recent within past 5 years
3
Q
Colorectal cancer screening recommendations
A
-45 and older should undergo regular screening with colonoscopy or cologaurd
-more frequent/earlier testing in high risk patients: IBS, personal or family history of colonic polyps or colon cancer, Lynch syndrome)
-continue screening until 75 years old
-colonoscopy every 10 years
-cologaurd (stool DNA test) every 3 years
4
Q
T/F once cervical cancer screening has stopped, it should not be resumed in women > 65, even if they report having a new partner
A
TRUE
5
Q
with history of CIN2 or higher, continue screening for… how many years?
A
20 years after spontaneous regression or appropriate management
6
Q
cervical cancer screening recommendations for any age with total hysterectomy (cervix removed)
A
no further screening necessary unless hx of CIN2, CIN3, adenocarcinoma in situ, or cervical cancer in past 20 years
7
Q
lung cancer screening
-screen individuals ages __ to ___ with…
A
-individuals ages 55-74 in fairly good health who have risk factors for lung cancer
RISK FACTORS: 30+ pack-year smoking history and still smoking or quit within the last 15 years
low dose CT scan done every year
8
Q
prostate cancer screening
A
for men aged 55-69 years
client-clinician discussion of benefits and harms based on family history, race/ethnicity
9
Q
diabetes screening recommendations
-every ___ years starting at age ____
A
-every 3 years starting at age 45
-more frequent testing with BMI > 25, and one or more risk factors: obesity, HTN, dyslipidemia, cardiovascular disease, physical inactivity, PCOS, diabetes, AA, Asian, Hispanic, Native American, hx of GDM
10
Q
CVD risk factors for women
A
-smoking
-HTN
-HDL-C < 40
-DM
11
Q
hyperlipidemia/dyslipidemia screening recommendations startings at
A
age 40-75 including measurement of total cholesterol, LDL-C, and HDL-C levels
every 5 years is reasonable
12
Q
osteoporosis screening recommendations
-all women > ___ should be screened
A
women 65 years and older should be screeed with BMD test for osteoporosis/osteopenia
13
Q
who is at risk for osteoporosis?
A
low BMI, history of low-trauma fracture, smoking, alcohol intake > 3 drinks/day, family hx of hip fracture or osteoporosis
14
Q
all individuals born between 1945 and 1965 should be screened once for ___
A
hepatitis C if no other risk factors
other risk factors: IVDU, HIV infection
15
Q
calcium and vitamin D requirements for women
A
14-18: 1300 mg/day of calcium, 18-50 1000 mg of calcium. 51+: 1200 mg of calcium/day
14-70: 600 IU vitamin D, 70+: 800 IU vitamin D
16
Q
physical activity guidelines
A
150-300 minutes of moderate-intensity aerobic activity OR 75-150 minutes of vigorous exercise each week
max HR = 220 minus your age
engage in strength training of all muscle groups 2-3x/week
17
Q
the 5 A’s of smoking cessation
A
Ask about tobacco use
Advise to quit
Assess willingness to attempt quit
Assist in quit attempt
Arrange follow up
18
Q
how long prior to breastfeeding should nicotine replacement therapy be avoided?
A
at least an hour
19
Q
Burpropion hydrochloride sustained-release tables (Zyban) reduces…
A
cravings that smokers experience
SE: insomnia, dry mouth, nausea, skin rash
20
Q
Varenicline tablets (Chantix) reduces…
A
withdrawal symptoms; blocks effect of nicotine if individual resumes smoking
SE: nausea, changes in dreaming, constipation
21
Q
alcohol use disorder is defined as…
A
-three or more drinks per day or more than 7 drinks per week for all women and for men aged 65 years and older
binge drinking: 4 or more drinks in one sitting/within a couple hours
22
Q
Immunizations
1. Hepatitis B
2. Influenza
3. Pneumococcus
4. Rubella
5. Tdap
6. Varicella
7. Zoster (shingles)
8. Hepatitis A
9. HPV
10. Meningococcal
A
- Hepatitis B
-three dose series: 0, 1, 6 months
-high risk: multiple sex partners, men who have sex with men, IVDU, inmates - Influenza
-recommended yearly; inactivated influenza vaccine given in pregnancy and considered safe - Pneumococcus (PCV13 and PPSV23)
-recommended one time for all immunocompetent individuals age 65 and older
-if immunocompetent: given injections at least one year apart - Rubella
-recommended for all nonpregnant women of childbearing age who lack documented lab evidence of immunity
-CI in pregnancy (live vaccine), HIV - Tdap
-recommended three dose vaccine series
-Tdap recommended at 32 weeks in every pregnancy
-booster Td every 10 years for adults - Varicella
-recommended for all nonpregnant adolescents and adults without immunity
-given in two doses 4-8 weeks apart
-do NOT give in pregnancy; but can give in pp period - Zoster (shingles)
-recommended two dose series 2 to 6 months apart for individuals 50 years and older regardless of hx of herpes zoster
-CI: pregnancy, HIV - Hepatitis A
-rec for individuals who are traveling to countries with high levels of hep A infection, MSM, illicit drug users
-two doses at least 6 months apart - HPV
-target HPV types 16 and 18, 6 and 11, and 5 more
-routine vaccination starting at 11-12 years; can be given as early as 9
-< 15: two doses, with second dose 6-12 months after first dose
-> 15 years old: three doses: 0, 2, 6 month intervals - Meningococcal
-recommended initial age 11-12 as one time dose
-recommended booster at 16 (booster not needed if initial vaccine done at 16 or older)
**Recommended for all first-year college students living in dorms if not previously vaccinated
23
Q
T/F individuals already infected with one or more HPV types will still get protection from types not yet acquire with HPV vaccine
A
true!
24
Q
immunizations during pregnancy and lactation
A
- live attenuated vaccines should NOT be given in pregnancy (Varicella, Rubella, live-attenuated flu, MMR)
- Varicella, Rubella, MMR can be given during lactation
25
who needs annual visual acuity tests regardless of age?
diabetic patients
26
cardiovascular disorders
1. Hypertension
-traditional definition vs updated defintions
Traditional: SBP >140 mm or DBP > 90 based on avg of two or more bp readings on each of two or more offic visits
UPDATED:
a. normal: SBP < 120, DBP < 80
b. elevated: SBP: 120-129 and DBP less than 80
c. stage 1 HTN: SBP: 130-139, DBP 80-89
stage II HTN: SBP: >140, DBP > 90
27
documented HTN has three objectives:
1. to identify secondary causes
2. to assess for organ damage (eyes, brain, blood vessels, heart, kidney)
3. to identify cardiovascular risk factors that guide therapy including:
-smoking
-obesity > 30
-physical inactivity
-dyslipidemia
-diabetes
-microalbuminuria or eGFR < 60
-> 55 years in men, > 65 in women
-family history of premature cardiovascular disease
28
T/F men and women have similar prevalence of HTN from 45-64 years
TRUE
yet women are more likely to develop HTN in the fifth decade of life and have higher rates than men in later life
menopause is associated with a two-fold increase in risk of HTN
29
prevalence of HTN overall in women is highest in...
non hispanic blacks
30
findings of hypertensive patient
-primary vs secondary causes
primary: elevated BP
secondary causes:
-retinopathy, S4 gallop, renal artery bruit, delayed or absent femoral pulses
31
differential diagnoses with HTN
1. sleep apnea
2. CKD
3. primary aldosteronism
4. Cushing's syndrome
5. drug-related/drug-induced (cocaine, COCs)
32
initial labs for hypertensive patient include...
a. urinalysis
b. CBC
c. blood glucose, serum K+, creatinine or estimated GFR, calcium, lipid profile
d. EKG
33
nonpharm interventions for HTN
-recommended for ALL patients with HTN; first line!!
-weight reduction, diet rich in fruits and veggies, low-fat dairy, Mediterranean diet and plant-based eating pattern s
-dietary sodium restriction: < 1500 mg/day
-physical activity: at least 40 minutes most days of the week
-moderate consumption of alcohol (no more than one drink/day for women)
-smoking cessation
34
Pharm
-stage 1 (SBP 130-139, DBP 80-89)
start with one antihypertensive med: thiazide diuretic, CCB, ACE inhibitor, ARB
follow up in 1 month , if BP goal of < 130/80 not achieved consider titrating up or switching to other agent
follow up monthly until controlled then every 6 months
35
pharm
-stage 2 HTN (SBP >140, DBP >90)
start with two antihypertensives from two different classes
f/u in 1 month/monthly until controlled then every 3-6 months
36
special considerations for reproductive-age women and HTN
-uncontrolled cHTN increases risk of maternal, fetal and neonatal morbidity and mortality
-ACE and ARBs are CI in pregnancy
-estrogen containing contraceptive methods are CI if woman has uncontrolled HTN or vascular disease; not recommended even if adequately controlled
-LARC and POPS are good options
37
HTN PHARM
1. thiazide diuretics
2. beta blockers
3. CCB
4. ACE inhibitors
5. ARBS
1. thiazide diuretics (hydrochlorothiazide)
-inhibits sodium reabsorption
-SE: hypokalemia, orthostatic hypotension
-NSAIDS may reduce effect
-CI: sulfonamid allergy,
-NOTE: second line as tx choice in pregnancy
2. beta blockers (propranolol, labetalol)
-inhibits sympathetic stimulation of the heart, reduces outflow to peripheral vasculature
-SE: bronchospasm, hypotension, mask s/sx of hypoglycemia
-CI: asthma**, caution with diabetes
-NOTE: labetalol considered for initial tx in pregnancy with cHTN
3. CCB (nifedipine/Procardia XL, Diltiazem)
-blocks influx of calcium through calcium channels that trigger smooth muscle contraction- results in prolonged vascular relaxation
-SE: dizziness, hypotension, GI symptoms
-avoid in individuals with GERD
-NOTE: Nifedipine may also be considered for initial tx of pregnant women with cHTN
4. ACE inhibitors (captopril)
-inhibits angiotensin-converting enzyme
-SE: cough, hypotension, angioedema
-CI in pregnancy, hyperkalemia
5. ARBS (Losartan)
-CI in pregnancy
38
heart murmur definition
prolonged heart sounds produced by turbulent flow of blood; commonly asx with regurgitation or stenosis
39
innocent or functional murmurs vs pathologic murmurs
-symptoms
1. innocent: transient, heard during systole, no structural or functional cardiac abnormality, OFTEN noted in pregnancy because of increased CO
SX: not symptomatic, soft (grade 1 or 2), medium pitch, systolic murmur, disappears with standing or straining
2. pathologic: indicative of heart or valvular disease
SX: murmur above grade 3, intensifies with exercise or Valsalva, mid or late systolic click (asx with MVP), cyanosis, JVD, pedal edema, hepatomegaly, diminished femoral pulses
40
diagnostic tests/findings for heart murmurs
1. echo
2. chest radiograph
3. CBC- r/o anemia
4. thyroid function test
41
bacterial endocarditis prophylaxis for susceptible patients recommended with murmur in patients who...
have valvular heart disease, prosthetic heart valves, or other structural cardiac abnormalities
oral amoxicillin 2 g 1 hour before procedure
42
Virchow's triad
^^the origin of most venous thrombi
1. endothelial damage
2. stasis secondary to immobility
3. hypercoagulability secondary to protein deficiency
43
risk factors for DVT
-acquired and inherited
-recent surgeries
-immobilization
-trauma or fractures
-pregnancy and early PP
-COCs
-obesity
-antiphospholipid syndrome
-smoking
inherited: factor V leiden, protein C or S deficiency
44
homan's sign
pain elicited with dorsiflexion of foot
45
diagnostic tests/findings for DVT
1. duplex u/s
2. plasma d-dimer enzyme linked immunosorbent assay (ELISA)
-elevated in 95 to 98% of DVT; useful in ruling out DVT if negative but positive results are not diagnostic (can be elevated with afib, impaired renal function, pregnancy)
46
superficial phlebitis management
-elevation of leg and compression with ace wrap
47
dyslipidemia definition
-cholesterol, triglycerides
-LDL
-HDL
-elevated LDL-C: greater than 130
-hypertriglyceridemia: greater than 200
-low HLD-C: less than 40
48
metabolic syndrome should be considered with any three of these risk factors:
1. abdominal obesity/waist circumference
a. men > 40 inches
b. women > 35 inches
2. triglycerides: 150 mg or greater
3. HDL-
a. men < 40
b. women < 50
4. BP: 130/85
5. fasting glucose: 110 or greater
49
physical findings of dyslipidemia
usually asymptomatic**
1. Xanthomas- slightly raise, yellowish laques along nasal portion of eyelids
2. corneal arcus: thin grayish white arc near edge of cornea
3. central obesity
50
optimal
-cholesterol
-LDL
-HDL
-triglycerides
-cholesterol: less than 200
-LDL: less than 100
-HDL: more than 60 is protective!!!
-triglycerides: less than 150 is normal
51
-2 or more risk factors: determine 10 year risk with Framingham tool
GOALS FOR:
1. CHD or CHD risk equivalents
2. 2+ risk factors without CHD or CHD equivalents
2. 0-1 risk factors without CHD or CHD equivalents
1. CHD or CHD risk equivalents:
-LDL-C les than 100
2. 2+ risk factors without CHD or CHD equivalents: LDL-C less than 130
2. 0-1 risk factors without CHD or CHD equivalents: LDL-C less than 160
52
tx for hyslipidemia is based on risk of CHD events
-risk factors (other than high LDL)
-smoking
-HTN (>140/90)
-low HDL cholesterol (less than 40)
-family hx of premature CHD (<65 in male relative, <65 in female first degree relative)
53
dietary modification to lower LDL cholesterold
1. reduce trans fat to les than 1% of calories
2. reduct saturated fat to no more than 5-6% of total calories
3. emphasize fruits, veggies, whole grains
4. limit red meat and sugary food and beverages
5. moderate-intensity exercise for 30 minutes/day
6. stop smoking
7. weight loss for overweight and obese patients
54
first line treatment for reducing LDL levels in adults?
statins
-inhibits HMG-CoA reductase, the enzyme that control cholesterol biosynthesis in cells
CI: severe liver disease, myopathy potential side effect
55
choice of statin based on LDL-C level
1. LDL-c >190, regardless of CHD or diabetes, 21-75 years old
2. LDL-C < 190, no CHD or diabetes, estimated CHD > 7.5%, 40-70 years old
3. individuals with diabetes and 40-75 years old
1. high intensity statin (atorvastatin, 40-80 rosuvastatin 20-40mg- lowers LDL on average > 50%)
2. medium to high intensity statin (moderate intensity: atorvastatin 10-20 mg, Rosuvastatin 5-10 mg; lowers LDL by 30-50%)
3. moderate or high intensity statin
56
Coronary Heart Disease (CHD) is defined as
atherosclerotic changes to coronary vasculature; decreased blood flow through coronary arteries due to partial obstruction or vasospasm
ETIOLOGY:
atherosclerosis develops with formation of fatty streaks, fibrous plaques, and complicated lesion that narrow the lumen of the coronary arteries
57
CHD
1. angina pectoris
2. acute coronary syndromes
1. myocardial ischemia secondary to inability of coronary arteries to supply oxygenated blood to meet myocardial oxygen demands
2. a plaque may rupture with thrombus formation that impedes or completely occludes the coronary lumen
a. unstable angina
b. acute myocardial infarction
58
T/F CHD is leading killer of women
true! known as the "silent killer"
59
CHD risk factors
-smoking
-HTN
-dyslipidemia
-DM
-genetic predisposition
-obesity
-sleep apnea
60
presentation/symptoms:
1. chronic STABLE angina pectoris
2. Acute coronary syndromes/UNSTABLE angina
1. chronic STABLE angina pectoris: discomfort in chest, jaw, shoulder, back precipitated by exertion and relived by rest or nitroglycerin; PREDICTABLE frequency, severity, duration, and provocation; pattern remains the same
2. Acute coronary syndromes/UNSTABLE angina
-chest pain: pressure, heaviness, squeezing, crushing
-pain generally involve sternum and or epigastrium
-pain may radiate to shoulder, arm, jaw, neck
-asx: nausea, vomiting, diaphoresis, dyspnea
61
ECG
-stable angina
-stable: ST-segment depression, symmetric T wave inversion in affected leads; reverts to NORMAL DURING PAIN-FREE intervals
62
what is a definitive test for coronary artery disease?
coronary angiography
63
myocardial markers/lab test
a. Troponin I and T: high sensitivity and specificity; become elevated within 3-4 hours of event and continue to be released for as long as 7-14 days after cardiac event
b. myoglobin- released within 1-3 hours of myocardial cell injury; not as cardiac specific as troponin; normalizes in 24 hours
64
management/treatment of CHD
a. non pharm
b. pharm
NON PHARM
-primary prevention: smoking cessation, dietary management of HTN, dyslipidemia, diabetes
-secondary prevention: surgical revascularization
PHARM
1. sublingual nitroglycerine 0.4 mg as needed for symptomatic relief of anginal episodes
2. beta-adrenergic blockers: metoprolol, propranolol; preferred initial therapy in absence of CIs
3. CCBs
4. long-acting nitrates
65
T/F any patient with new onset angina or patients with unstable angina should be referred
TRUE
66
allergic rhinitis
-triggers what antibodies?
-IgE antibodies, causing histamine release and subsequent edema, itching, and sneezing
-SEASONAL, typically
67
physical findings of allergic rhinitis
-pale, boggy nasal mucosa
-clear, thin drainage
-"nasal crease"- horizontal crease across lower bridge of nose caused by repeated upper rubbing of tip of nose with palm of hand (lauren seehafer)
-"allergic shiners" or dark discoloration beneath both eyes
68
management of allergic rhinits?
#1 non pharm
TRIGGER AVOIDANCE
-vacuum, dust, remove carpeting
69
what is considered first line??
think about the antibodies it triggers...
1. antihistamines are considered first line therapy
highly effective in reducing itching, sneezing, runny nose
BUT limited effect on nasal congestion
more effective if given before onset of symptoms
70
antihistamine examples
Diphenhydramine (benadryl, short acting first generation)
-SE: drowsiness
-avoid use in elderly, OK in pregnancy- actually the DOC in pregnancy! but not recommended in lactation
Cetirizine (Zyrtec), Loratidine (Claritin)- both second generation long acting/24 hours
-fewer sedating effects
71
other pharm management of allergic rhinitis
2. decongestants
3. topical (nasal) corticosteroids
4. mast cell stabilizers
2. decongestants- Pseudoephedrine (Sudafed)
3. topical (nasal) corticosteroids
-therapeutic effect is not immediate
4. mast cell stabilizers (Cromolyn)
72
rebound rhinitis is from...
overuse of corticosteroid nasal spray (AKA rhinitis medicamentosa)
73
conjunctivitis
-viral
-bacterial
-allergic
-etiology?
-symptoms of each: bilateral vs unilateral, nature of the discharge
VIRAL
-adenovirus most common; herpes simplex and herpes zoster
-SX: acute onset, uni or bilateral with watery discharge, pre auricular adenitis, may be asx with URI
BACTERIAL
-staphlococci, chlamydia, streptococci
-SX: symptoms begin in one eye and spread to the other, mucopurulent d/c, patient reports eyelids matted together on awakening
ALLERGIC
-type 1, IgE mediated hypersensitivity reaction from allergens
-sx: major cause of chronic conjunctivitis, complaints of bilateral itching, tearing, redness, and mild lid swelling, d/c is clear and watery, STRINGY
eye exam should still reveal PERRLA (pupils equal, round, reactive to light; visual acuity with no acute change
74
management/treatment of each
-VIRAL
-BACTERIAL
-ALLERGIC
VIRAL: self-limited, cold compresses and lubricants for comfort
BACTERIAL:
a. broad spectrum topical antibiotics- erythromycin; sodium sulfacetamide
b. systemic antibiotics for gonococcal and chlamydia: ceftriaxone, azithromycin, doxycycline
ALLERGIC:
-removal of offending allergen if possible
a. short term treatments for acute episodes: dual tx with topical antihisamines and vasoconstrictions
b. extended therapy: combination of topical antihistamines and mast cell stabilizer
c. topical NSAIDs- Ketorolac (acular)
75
T/F patients with pain, photophobia, blurred vision should be refered
TRUE
-so should those with no improvement in 48 hours, or conjunctivitis caused by herpes simplex
76
asthma
-short acting inhaled beta agonists
ALBUTEROL- MDI, nebulizer
-relaxes smooth muscle
SE: tachycardia, nervousness
duration: 2-6 hours
77
asthma
-inhaled corticosteroids
FLUTICASONE (inhaled corticosteroids)
-inhibits inflammatory response
SE: thrush/oropharyngeal candidiasis
78
asthma
-oral corticosteroids
Prednisone
inhibits inflammatory response
-masks infection,
79
asthma
-long acting inhaled beta 2 agonist
Salmeterol DPI
relaxes bronchial smooth muscle by selective action on B2 receptors; duration 12 hours
NEVER EVER USE FOR SYMPTOM RELIEF/ACUTE EXACERBATIONS
80
asthma
-leukotriene modifiers
-mast cell stabilizers
-methylxanthines
-leukotriene modifiers: Montelukast suppresses leukotriene biosynthesis; not for acute attacks
-mast cell stabilizers: Cromolyn prevents mass cells' release of histamine, leukotrienes; not for acute attacks
-methylxanthines: Theophylline relaxes bronchial smooth muscles
81
Acute Otitis Media definition and symptoms
infection of middle ear the is often PRECEDED by URI or allergies (often viral)
not often seen in adults
SX: rapid onset, short duration, ear pain, decreased hearing, fever (fever not commonly seen in adults), aural pressure, vertigo, N/V
82
physical findings with AOM
-full or bulging tympanic membrane with absent or obscured landmarks
-distorted light reflex
-decreased/absent mobility of TM****
83
management/tx of AOM
-most resolve spontaneously without antibiotics
-analgesics: NSAIDs, acetaminophen
ABX:
1. amoxicillin is first line choice
84
Sinusitis
a. acute sinusitis
b. chronic sinusitis
a. acute sinusitis: caused by viral or bacterial infections and allergies; bacterial causes include streptococcus; infection usually involves maxillary and ethmoid sinuses
b. chronic sinusitis: occurs with episodes of prolonged infection that resist treatment
85
acute vs chronic sinusitis symptoms
ACUTE
nasal congestion facial pain, toothache, headache, fever, yellow/green nasal drainage
increased pain with bending over or sudden head movements
"double sickening"- URI that improves followed by increasing nasal symptoms
CHRONIC
-nasal congestion, discharge, or cough that lasts longer than 30 days
-dull ache/pressure across forehead and or midface
-constant postnasal drip and chronic cough
86
pharm and nonpharm management of sinusitis
Pharm: antibiotics are indicated when:
-symptoms present more than 10 days without improvement, sx worsen after 5-6 days when patient was initially improving, high fever (>102) and facial pain/purulent nasal d/x for 3 days
FIRST LINE: amoxicillin-clavulanat (Augmentin) for 5-7 days
if no improvement within 72 hours, reevaluate, consider changing antibiotic
antihistamines NOT recommended
nonpharm: saline nasal spray, steam inhalation, warm compress, hydration
87
topical/nasal decongestants should not be used more than...
3-5 days to prevent rebound rhinitis
88
URI/common cold is spread through...
airborne droplets and contact with infectious secretions on hands and environmental surfaces
incubation period of 48-72 hours
89
pharyngitis
-viral
-bacterial
which is more common?
VIRAL MOST COMMON (cause is usually rhinovirus or adenovirus)
89
URI/common cold management includes...
nonpharm: inhalation of warm vapors, saline nasal drops, saline gargles, increased fluids
pharm: acetaminophen or NSAIDs, oral decongestatns, cough suppressants- dextromethorphan (Robitussin), expectorants (Guaifenesin (Mucinex))
90
symptoms of viral pharyngitis
VIRAL: sore throat, fever, rhinitis, cough, conjunctivitis may also be present; physical exam: mild erythema with little or no exudates
Bacterial (GABHS)
sudden onset of sore throat, fever, chills, HA
(rhinitis, cough, conjunctivitis NOT typically present); physical exam: marked erythema of throat, exudates, tender anterior cervical lymphadenopathy; erythematous "sandpaper" rash in groin and axillae with scarlet fever
91
rapid streptococcal antigen test is recommended for adults with pharyngitis that meets two or more of the following criteria:
1. fever
2. lack of cough
3. tonsillar exudates
4. tender anterior cervical adenopathy
92
treatment for pharyngitis
1. GABHS
2. Gonococcal pharyngitis
1. Penicillin V PO/Benzathine penicillin IM
2. Ceftriaxone IM
93
infectious mononucleosis (IM)
-most common causal agent
Epstein-Barr virussy
94
mono symptoms
-prodrome: headaches, malaise, fatigue, anorexia
-fever, sore throat, swollen lymph node (classic traid)
-tonsillar enlargement with exudate
-palatal petechiae (25%)
-lymphadenopathy particularly posterior cervical chain
-fever
-hepatomegaly (25%)
-splenomegaly (50%)
95
diagnostic tests/findings for mono
1. monospot/heterophile antibody test
a. initially negative, usually positive 1-2 weeks after onset symptoms
2. CBC- lymphocytic leukocytosis
3. LFTs: may be elevated
4. throat culture
5. CT scan- may reveal splenomegaly or hepatomegaly
96
patient education regarding mono
-rest during acute phase of illness; activity as tolerate
-contact sports, heavy lifting, strenuous activity should be avoided for at least 1 month if having splenomegaly
-avoid alcohol for at least 1 month
-seek immediate care with sudden onset of severe abdominal pain
97
lower respiratory disorders
-community-acquired pneumonia (usually streptococcus/bacterial) risk factors
-smoking
-preceding viral URI
-older than 65
-chronic lung disease
-corticosteroid use
-immunosuppression (HIV/AIDS)
98
symptoms of CAP
-fever, chills, sweat
-cough with or w/o sputum production
-dyspnea, pleuritic chest pain
-lethargic, headache
PHYSICAL:
-tachycardia, tachypnea, dyspnea
-percussion is often normal early, dull over areas of consolidation
-coarse RHONCHI may clear ot shift with cough
99
definitive diagnosis of CAP
chest radiograph
-helps differentiate CAP from bronchitis
100
CBC in pneumonia will show.. with a shift to the...
elevation of WBC (>10,000)
shift to the left (bandemia neutrohilia, especially if bacterial etiology)
101
empiric antimicrobial therapy for CAP as well as nonpharm interventions (in otherwise healthy indiviudals)
azithromycin or clarithromycin
-oral hydration and humidification; improve oxygenation!
-NSAIDs, acetaminophen
102
in patients with comorbidities, risk factors for druge-resistant steptococcal pneumonia, etc.
fluoroquinolone (levofloxacin)
103
patient education regarding prevention of pneumonia
-pneumonia vaccination in adults 65 years old and older or at high risk for pneumonia
-avoid cough suppressants; we WANT you to clear thick secretions
104
T/F refer pneumonia patients if fever >102, pallor/cyanosis, no improvement in 24-36 hours
TRUE
105
CURB criteria for hospitalization includes two or more of the following (5)
1. Confusion
2. Uremia (BUN >19(
3. Respiratory rate > 30 bpm
4. Blood pressure < 90 or 60
5. 65 years old
106
asthma is a...
CHRONIC, REVERSIBLE inflammation disorder of the airways
**can occur at ANY age
107
ASTHMA
-intermittent: stage 1
-mild persistent: stage 2
-moderate persistent: stage 3
-severe persistent: stage 4
-daily symptoms, nocturnal symptoms, use of SABA
1. intermittent: stage 1
-daytime symptoms 2 times/week
-nocturnal: 2 times/month
-use of SABA 2 days/week
-no or one exacerbation requiring oral corticosteroids in last year
2. mild persistent: stage 2
-daytime symptoms > 2 times/week but not daily
-nocturnal symptoms 3-4/month
-two or more exacerbations requiring oral corticosteroids
-mild interference with normal activity
3. moderate persistent: stage 3
-daily symptoms; nocturnal symptoms more than once per week but not nightly
-daily use of SABA to manage symptoms
-two or more exacerbations requiring oral corticosteroids
-some limitation in performing normal activities
4. severe persistent: stage 4
-continual daily symptoms, frequent nocturnal symptoms
-use of SABA throughout day
-two ore more exacerbations/year
-major limitations in performing normal activities
-FEV1 less than 60% predicted
108
symptoms of asthma
episodic wheeze, chest tightness, SOB
symptoms worsen at night
hyperresonance with percussion, hyperexpansion of thorax
diminished breath sounds
atopic dermatitis/eczema or other skin manifestations
109
diagnostic test used for asthma is called...
1. the pulmonary function test/spirometry- useful to differentiate between restrictive and obstructive lung disease
a. FVC- normal is > 80% of predicted value
b. FEV1 used to determine severity of airway obstruction normal is >80% of predicted norma for age
2. peak expiratory flow (PEF): with peak flow meter, obstruction suggested by < 80% of personal best; measured at home
110
a drop in peak flow below ___ indicates....
below 80% indicates an acute exacerbation and need to contact clinician for medication adjustment
111
T/F a drop in peak flow below 50% indicates need for emergency treatment
TRUE
112
Staged approach to treatment in asthma patient
1. intermittent: stage 1
2. mild persistent: stage 2
3. moderate persistent: stage 3
4. severe persistent: stage 4
1. intermittent: stage 1
-no daily medications
SABA as need for symptoms
2. mild persistent: stage 2
-low-dose inhaled corticosteroids
-SABA as needed for symptoms
3. moderate persistent: stage 3
-low to medium-dose inhaled corticosteroids and LABA
-SABA as needed for symptoms
4. severe persistent: stage 4
-high dose inhaled corticosteroids and LABA
-SABA as needed
113
severe exacerbations (<60% of peak flow) can occur with any category of asthma and should be treated with..
short course of oral corticosteroids 40-60 mg/day for 5-10 days
114
T/F it is safer for pregnant women to be treated for asthma than to have asthma symptoms and exacerbations
TRUE
-albuterol is preferred
115
TB can be active or latent
active: current signs and symptoms
latent: positive TB skin or blood test with no signs or symptoms
spread via small airborne particles
116
who is at risk for TB
HIV-infected, individuals who are incarcerated, IVDU, foreign-born, works at long term care/hospitals
117
active TB symptoms
night sweats, fever
malaise, weakness
weight loss
PRODUCTIVE cough, hemoptysis possible, chest pain, dyspnea
-pelvic pain, flank pain possible
118
Lung findings in TB
increased TACTILE fremitus ("99") and DULLNESS to percussion over consolidated areas; apical rates
119
Purified protein derivative (PPD) skin test (antigen response) in TB
-interpretation of results:
1. 5 mm
2. 10 mm
3. 15 mm
***must come back in 48-72 hours for test to be interpreted
5 mm: considered positive in patients who: have an HIV infection, abnormal chest radiographs consistent with TB lesions, recent close contact with infected person
10 mm is considered positive in patients who: are recent arrivals (<5 years) from high-prevalence ares, low SES/homeless, aged, nursing home residents, incarcerated individuals, individuals with chronic disease (DM)
15 mm or more is positive among individuals without risk factors
120
a false negative TB skin read can be from...
recent live virus vaccination
elderly
immunosuppressed
121
a patient with a previously negative PPD, but is no positive is considered to be
a positive converter
122
false positive PPD can results from
previous Bacillus Calmette-Guerin (BCG) vaccination
123
Interferon-gamma release assay (IRGA) blood test to detect TB
measures immune reaction to bacteria causing TB
-requires only one visit; test results within 24 hours
-not affected by prior BCG vaccination
$$$$$
124
latent TB treatment for individuals at high risk of it becoming active includes..
9 months of Isoniazid
CI: with severe hepatic disease, risk for peripheral neuropathy (take Vitamin B6/pyridoxine)
125
T/F you must report active TB cases to local health departments
true
