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health assessment and primary care > health screening, cardiovascular, URI > Flashcards

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^^

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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

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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

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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

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5
Q

with history of CIN2 or higher, continue screening for… how many years?

A

20 years after spontaneous regression or appropriate management

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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

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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

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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

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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

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10
Q

CVD risk factors for women

A

-smoking
-HTN
-HDL-C < 40
-DM

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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

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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

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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

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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

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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

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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

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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

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18
Q

how long prior to breastfeeding should nicotine replacement therapy be avoided?

A

at least an hour

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19
Q

Burpropion hydrochloride sustained-release tables (Zyban) reduces…

A

cravings that smokers experience

SE: insomnia, dry mouth, nausea, skin rash

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20
Q

Varenicline tablets (Chantix) reduces…

A

withdrawal symptoms; blocks effect of nicotine if individual resumes smoking

SE: nausea, changes in dreaming, constipation

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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

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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
  1. Hepatitis B
    -three dose series: 0, 1, 6 months
    -high risk: multiple sex partners, men who have sex with men, IVDU, inmates
  2. Influenza
    -recommended yearly; inactivated influenza vaccine given in pregnancy and considered safe
  3. Pneumococcus (PCV13 and PPSV23)
    -recommended one time for all immunocompetent individuals age 65 and older
    -if immunocompetent: given injections at least one year apart
  4. Rubella
    -recommended for all nonpregnant women of childbearing age who lack documented lab evidence of immunity
    -CI in pregnancy (live vaccine), HIV
  5. Tdap
    -recommended three dose vaccine series
    -Tdap recommended at 32 weeks in every pregnancy
    -booster Td every 10 years for adults
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
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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!

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24
Q

immunizations during pregnancy and lactation

A
  1. live attenuated vaccines should NOT be given in pregnancy (Varicella, Rubella, live-attenuated flu, MMR)
  2. Varicella, Rubella, MMR can be given during lactation
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25
Q

who needs annual visual acuity tests regardless of age?

A

diabetic patients

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26
Q

cardiovascular disorders
1. Hypertension
-traditional definition vs updated defintions

A

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

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27
Q

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:

A

-smoking
-obesity > 30
-physical inactivity
-dyslipidemia
-diabetes
-microalbuminuria or eGFR < 60
-> 55 years in men, > 65 in women
-family history of premature cardiovascular disease

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28
Q

T/F men and women have similar prevalence of HTN from 45-64 years

A

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

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29
Q

prevalence of HTN overall in women is highest in…

A

non hispanic blacks

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30
Q

findings of hypertensive patient
-primary vs secondary causes

A

primary: elevated BP
secondary causes:
-retinopathy, S4 gallop, renal artery bruit, delayed or absent femoral pulses

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31
Q

differential diagnoses with HTN

A
  1. sleep apnea
  2. CKD
  3. primary aldosteronism
  4. Cushing’s syndrome
  5. drug-related/drug-induced (cocaine, COCs)
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32
Q

initial labs for hypertensive patient include…

A

a. urinalysis
b. CBC
c. blood glucose, serum K+, creatinine or estimated GFR, calcium, lipid profile
d. EKG

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33
Q

nonpharm interventions for HTN

A

-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

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34
Q

Pharm
-stage 1 (SBP 130-139, DBP 80-89)

A

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

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35
Q

pharm
-stage 2 HTN (SBP >140, DBP >90)

A

start with two antihypertensives from two different classes
f/u in 1 month/monthly until controlled then every 3-6 months

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36
Q

special considerations for reproductive-age women and HTN

A

-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

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37
Q

HTN PHARM
1. thiazide diuretics
2. beta blockers
3. CCB
4. ACE inhibitors
5. ARBS

A
  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
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38
Q

heart murmur definition

A

prolonged heart sounds produced by turbulent flow of blood; commonly asx with regurgitation or stenosis

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39
Q

innocent or functional murmurs vs pathologic murmurs
-symptoms

A
  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
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40
Q

diagnostic tests/findings for heart murmurs

A
  1. echo
  2. chest radiograph
  3. CBC- r/o anemia
  4. thyroid function test
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41
Q

bacterial endocarditis prophylaxis for susceptible patients recommended with murmur in patients who…

A

have valvular heart disease, prosthetic heart valves, or other structural cardiac abnormalities
oral amoxicillin 2 g 1 hour before procedure

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42
Q

Virchow’s triad
^^the origin of most venous thrombi

A
  1. endothelial damage
  2. stasis secondary to immobility
  3. hypercoagulability secondary to protein deficiency
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43
Q

risk factors for DVT
-acquired and inherited

A

-recent surgeries
-immobilization
-trauma or fractures
-pregnancy and early PP
-COCs
-obesity
-antiphospholipid syndrome
-smoking

inherited: factor V leiden, protein C or S deficiency

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44
Q

homan’s sign

A

pain elicited with dorsiflexion of foot

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45
Q

diagnostic tests/findings for DVT

A
  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)
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46
Q

superficial phlebitis management

A

-elevation of leg and compression with ace wrap

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47
Q

dyslipidemia definition
-cholesterol, triglycerides
-LDL
-HDL

A

-elevated LDL-C: greater than 130
-hypertriglyceridemia: greater than 200
-low HLD-C: less than 40

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48
Q

metabolic syndrome should be considered with any three of these risk factors:

A
  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
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49
Q

physical findings of dyslipidemia

A

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
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50
Q

optimal
-cholesterol
-LDL
-HDL
-triglycerides

A

-cholesterol: less than 200
-LDL: less than 100
-HDL: more than 60 is protective!!!
-triglycerides: less than 150 is normal

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51
Q

-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

A
  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
  3. 0-1 risk factors without CHD or CHD equivalents: LDL-C less than 160
52
Q

tx for hyslipidemia is based on risk of CHD events
-risk factors (other than high LDL)

A

-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
Q

dietary modification to lower LDL cholesterold

A
  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
Q

first line treatment for reducing LDL levels in adults?

A

statins

-inhibits HMG-CoA reductase, the enzyme that control cholesterol biosynthesis in cells

CI: severe liver disease, myopathy potential side effect

55
Q

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
A
  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
Q

Coronary Heart Disease (CHD) is defined as

A

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
Q

CHD
1. angina pectoris
2. acute coronary syndromes

A
  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
Q

T/F CHD is leading killer of women

A

true! known as the “silent killer”

59
Q

CHD risk factors

A

-smoking
-HTN
-dyslipidemia
-DM
-genetic predisposition
-obesity
-sleep apnea

60
Q

presentation/symptoms:
1. chronic STABLE angina pectoris

  1. Acute coronary syndromes/UNSTABLE angina
A
  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
Q

ECG
-stable angina

A

-stable: ST-segment depression, symmetric T wave inversion in affected leads; reverts to NORMAL DURING PAIN-FREE intervals

62
Q

what is a definitive test for coronary artery disease?

A

coronary angiography

63
Q

myocardial markers/lab test

A

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
Q

management/treatment of CHD
a. non pharm

b. pharm

A

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

  1. beta-adrenergic blockers: metoprolol, propranolol; preferred initial therapy in absence of CIs
  2. CCBs
  3. long-acting nitrates
65
Q

T/F any patient with new onset angina or patients with unstable angina should be referred

A

TRUE

66
Q

allergic rhinitis
-triggers what antibodies?

A

-IgE antibodies, causing histamine release and subsequent edema, itching, and sneezing

-SEASONAL, typically

67
Q

physical findings of allergic rhinitis

A

-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
Q

management of allergic rhinits?
#1 non pharm

A

TRIGGER AVOIDANCE

-vacuum, dust, remove carpeting

69
Q

what is considered first line??
think about the antibodies it triggers…

A
  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
Q

antihistamine examples

A

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
Q

other pharm management of allergic rhinitis
2. decongestants
3. topical (nasal) corticosteroids
4. mast cell stabilizers

A
  1. decongestants- Pseudoephedrine (Sudafed)
  2. topical (nasal) corticosteroids
    -therapeutic effect is not immediate
  3. mast cell stabilizers (Cromolyn)
72
Q

rebound rhinitis is from…

A

overuse of corticosteroid nasal spray (AKA rhinitis medicamentosa)

73
Q

conjunctivitis

-viral
-bacterial
-allergic

-etiology?
-symptoms of each: bilateral vs unilateral, nature of the discharge

A

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
Q

management/treatment of each

-VIRAL

-BACTERIAL

-ALLERGIC

A

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
Q

T/F patients with pain, photophobia, blurred vision should be refered

A

TRUE

-so should those with no improvement in 48 hours, or conjunctivitis caused by herpes simplex

76
Q

asthma
-short acting inhaled beta agonists

A

ALBUTEROL- MDI, nebulizer

-relaxes smooth muscle

SE: tachycardia, nervousness

duration: 2-6 hours

77
Q

asthma
-inhaled corticosteroids

A

FLUTICASONE (inhaled corticosteroids)
-inhibits inflammatory response

SE: thrush/oropharyngeal candidiasis

78
Q

asthma
-oral corticosteroids

A

Prednisone

inhibits inflammatory response

-masks infection,

79
Q

asthma
-long acting inhaled beta 2 agonist

A

Salmeterol DPI

relaxes bronchial smooth muscle by selective action on B2 receptors; duration 12 hours

NEVER EVER USE FOR SYMPTOM RELIEF/ACUTE EXACERBATIONS

80
Q

asthma
-leukotriene modifiers
-mast cell stabilizers
-methylxanthines

A

-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
Q

Acute Otitis Media definition and symptoms

A

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
Q

physical findings with AOM

A

-full or bulging tympanic membrane with absent or obscured landmarks
-distorted light reflex
-decreased/absent mobility of TM**

83
Q

management/tx of AOM

A

-most resolve spontaneously without antibiotics

-analgesics: NSAIDs, acetaminophen

ABX:
1. amoxicillin is first line choice

84
Q

Sinusitis
a. acute sinusitis
b. chronic sinusitis

A

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
Q

acute vs chronic sinusitis symptoms

A

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
Q

pharm and nonpharm management of sinusitis

A

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
Q

topical/nasal decongestants should not be used more than…

A

3-5 days to prevent rebound rhinitis

88
Q

URI/common cold is spread through…

A

airborne droplets and contact with infectious secretions on hands and environmental surfaces
incubation period of 48-72 hours

89
Q

pharyngitis
-viral
-bacterial

which is more common?

A

VIRAL MOST COMMON (cause is usually rhinovirus or adenovirus)

89
Q

URI/common cold management includes…

A

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
Q

symptoms of viral pharyngitis

A

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
Q

rapid streptococcal antigen test is recommended for adults with pharyngitis that meets two or more of the following criteria:

A
  1. fever
  2. lack of cough
  3. tonsillar exudates
  4. tender anterior cervical adenopathy
92
Q

treatment for pharyngitis
1. GABHS
2. Gonococcal pharyngitis

A
  1. Penicillin V PO/Benzathine penicillin IM
  2. Ceftriaxone IM
93
Q

infectious mononucleosis (IM)
-most common causal agent

A

Epstein-Barr virussy

94
Q

mono symptoms

A

-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
Q

diagnostic tests/findings for mono

A
  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
Q

patient education regarding mono

A

-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
Q

lower respiratory disorders
-community-acquired pneumonia (usually streptococcus/bacterial) risk factors

A

-smoking
-preceding viral URI
-older than 65
-chronic lung disease
-corticosteroid use
-immunosuppression (HIV/AIDS)

98
Q

symptoms of CAP

A

-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
Q

definitive diagnosis of CAP

A

chest radiograph
-helps differentiate CAP from bronchitis

100
Q

CBC in pneumonia will show.. with a shift to the…

A

elevation of WBC (>10,000)
shift to the left (bandemia neutrohilia, especially if bacterial etiology)

101
Q

empiric antimicrobial therapy for CAP as well as nonpharm interventions (in otherwise healthy indiviudals)

A

azithromycin or clarithromycin

-oral hydration and humidification; improve oxygenation!
-NSAIDs, acetaminophen

102
Q

in patients with comorbidities, risk factors for druge-resistant steptococcal pneumonia, etc.

A

fluoroquinolone (levofloxacin)

103
Q

patient education regarding prevention of pneumonia

A

-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
Q

T/F refer pneumonia patients if fever >102, pallor/cyanosis, no improvement in 24-36 hours

A

TRUE

105
Q

CURB criteria for hospitalization includes two or more of the following (5)

A
  1. Confusion
  2. Uremia (BUN >19(
  3. Respiratory rate > 30 bpm
  4. Blood pressure < 90 or 60
  5. 65 years old
106
Q

asthma is a…

A

CHRONIC, REVERSIBLE inflammation disorder of the airways

**can occur at ANY age

107
Q

ASTHMA
-intermittent: stage 1
-mild persistent: stage 2
-moderate persistent: stage 3
-severe persistent: stage 4

-daily symptoms, nocturnal symptoms, use of SABA

A
  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
Q

symptoms of asthma

A

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
Q

diagnostic test used for asthma is called…

A
  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
Q

a drop in peak flow below ___ indicates….

A

below 80% indicates an acute exacerbation and need to contact clinician for medication adjustment

111
Q

T/F a drop in peak flow below 50% indicates need for emergency treatment

A

TRUE

112
Q

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

A
  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
Q

severe exacerbations (<60% of peak flow) can occur with any category of asthma and should be treated with..

A

short course of oral corticosteroids 40-60 mg/day for 5-10 days

114
Q

T/F it is safer for pregnant women to be treated for asthma than to have asthma symptoms and exacerbations

A

TRUE
-albuterol is preferred

115
Q

TB can be active or latent

A

active: current signs and symptoms

latent: positive TB skin or blood test with no signs or symptoms

spread via small airborne particles

116
Q

who is at risk for TB

A

HIV-infected, individuals who are incarcerated, IVDU, foreign-born, works at long term care/hospitals

117
Q

active TB symptoms

A

night sweats, fever
malaise, weakness
weight loss
PRODUCTIVE cough, hemoptysis possible, chest pain, dyspnea
-pelvic pain, flank pain possible

118
Q

Lung findings in TB

A

increased TACTILE fremitus (“99”) and DULLNESS to percussion over consolidated areas; apical rates

119
Q

Purified protein derivative (PPD) skin test (antigen response) in TB

-interpretation of results:

  1. 5 mm
  2. 10 mm
  3. 15 mm
A

***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
Q

a false negative TB skin read can be from…

A

recent live virus vaccination
elderly
immunosuppressed

121
Q

a patient with a previously negative PPD, but is no positive is considered to be

A

a positive converter

122
Q

false positive PPD can results from

A

previous Bacillus Calmette-Guerin (BCG) vaccination

123
Q

Interferon-gamma release assay (IRGA) blood test to detect TB

A

measures immune reaction to bacteria causing TB
-requires only one visit; test results within 24 hours
-not affected by prior BCG vaccination
$$$$$

124
Q

latent TB treatment for individuals at high risk of it becoming active includes..

A

9 months of Isoniazid

CI: with severe hepatic disease, risk for peripheral neuropathy (take Vitamin B6/pyridoxine)

125
Q

T/F you must report active TB cases to local health departments

A

true

health assessment and primary care (5 decks)

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