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Primary Care I > Modue 6 > Flashcards

Modue 6 Flashcards

1
Q

Dysuria

A

is the subjective experience of pain or a burning sensation on urination and can also be accompanied by urinary frequency, hesitancy, urgency, and strangury (slow, painful urination).

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2
Q

However, dysuria is most commonly associated with

A

lower urinary tract infection

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3
Q

Meds that cause dysuria

A

SSRIs
opiates
scopalamine

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4
Q

the easiest, least invasive, and most economical way to identify urinary tract infections and other renal problems

A

Urinalysis is

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5
Q

Hematuria

A

is defined as blood in the urine and can be visible (gross) or occult (microscopic

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6
Q

Asymptomatic microhematuria has many benign causes such as

A

infection, menstruation, vigorous exercise, viral illness, and trauma

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7
Q

On microscopic examination, hematuria is characterized by more than

A

three red blood cells (RBCs) per high-power microscopic field (hpf)

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8
Q

Transient hematuria

A

occurs on a single occasion whereas persistent hematuria occurs on two or more consecutive occasions. Both transient and persistent hematuria can be a sign of serious underlying disease

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9
Q

RBC casts usually indicate

A

injury to the nephron and are diagnostic of hematuria of renal origin.

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10
Q

intact uniform RBCs with no casts suggests

A

hematuria originating in the lower urinary tract

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11
Q

The presence of both proteinuria and hematuria is suggestive of

A

glomerular or interstitial nephritis.

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12
Q

bladder irritants- dietary substances such as

A

caffeine, spices, tomatoes, chocolate, aged cheeses, citrus fruits, and soy sauce may act as bladder irritants. Alcohol and cigarettes are also bladder irritants

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13
Q

questions to ask with hematuria

A

menstrual hx
exercise
recent strep infection?
family hx
recent travel

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14
Q

Hematuria accompanied by colicky flank pain suggests a

A

ureteral stone

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15
Q

When bleeding occurs only at the beginning or end of urination,

A

a prostatic or urethral source is likely

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16
Q

Hematuria accompanied by hypertension, edema, and a sore throat or a skin infection may be indicative of

A

poststreptococcal glomerulonephritis

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17
Q

The most important diagnostic tool in cases of hematuria is .

A

urinalysis

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18
Q

What to order with all hematuria pt

A

UA with cx & sens
ABX
Re-eval UA 2 weeks later

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19
Q

Proteinuria is

A

usually indicative of renal pathology, most often of glomerular origin. Proteinuria can be functional as a result of acute illness, emotional stress, or excessive exercise, in which case it is a benign process or simply a resultant sign of a transient condition.

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20
Q

Bence Jones proteinuria (characterized by free monoclonal light chain components of immunoglobulin proteins) may also be associated with

A

lymphosarcoma, Hodgkin’s disease, and leukemia.

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21
Q

the standard dipstick proteinuria test does not detect

A

Bence Jones proteins or other light chain immunoglobulins, as it is most sensitive to larger proteins such as albumin.

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22
Q

the most accurate way to quantify the amount of protein in the urine is with

A

a 24-hour urine collection;

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23
Q

A 24-hour urine collection with more than

A

150 mg of protein is considered abnormal, and a specimen with more than 3.5 g is indicative of a nephrotic process.

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24
Q

If renal function is normal in a patient with elevated urinary protein, the patient should be

A

evaluated for orthostatic proteinuria.

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25
Q

Sexually transmitted infections (STIs)

A

in men and women are caused by viruses, bacteria, and parasites and can occur in the throat, eyes, anal and perianal areas, external genitalia, vestibular glands, vagina, cervix, uterus, or adnexa

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26
Q

Common STIs include

A

herpes simplex virus (HSV),
human immunodeficiency virus (HIV),
human papillomavirus (HPV),
Chlamydia trachomatis,
Neisseria gonorrhoeae,
Trichomonas vaginalis, and
Treponema pallidum (the causative agent of syphilis)

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27
Q

Transmitted infections via sexual contact but not considered STIs

A

hepatitis B virus (HBV), hepatitis C virus (HCV), molluscum contagiosum, pediculosis pubis, scabies, and methicillin-resistant Staphylococcus aureus

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28
Q

most prevalent communicable diseases in the United States after upper respiratory infections,

A

STIs

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29
Q

The most common STI is

A

genital HPV,

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30
Q

most commonly reported STI

A

chlamydia

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31
Q

STIs disproportionally affect

A

adolescents and young adults between the ages of 15 and 24 years, primarily because of increased sexual encounters and risk-taking behaviors

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32
Q

STI High-risk groups also include

A

men who have sex with men and racial minorities

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33
Q

Estimation of infection of STI (not including HIV_

A

1 in 5

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34
Q

STIs that can be treated with abx

A

chlamydia,
gonorrhea,
syphilis,
and trichomonas

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35
Q

Condition that if left untreated can lead to PID

A

mucopurulent cervicitis

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36
Q

PID

A

causes inflammation and formation of scar tissue in the genitourinary tract, which can result in a higher risk of miscarriage, ectopic pregnancy, and infertility

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37
Q

In men, untreated chlamydia, gonorrhea, and trichomoniasis can cause

A

asymptomatic urethritis, epididymitis, and prostatitis and lead to disseminated gonococcal infection.

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38
Q

In both men and women, untreated syphilis may lead to

A

a tertiary form of infection that can cause serious injury to the central nervous system (CNS), aortitis, and nodular granulomatous lesions on the skin, bone, and solid organs known as gummas

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39
Q

most common virus caused STI

A

HPV

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40
Q

most serious viral STI

A

HIV- progresses to AIDS

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41
Q

The female reproductive tract is naturally protected from infection by several mechanisms, i

A

ncluding a low acidic pH resulting from vaginal secretions and the presence of commensal nonpathogenic microbial flora, namely hydrogen peroxide

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42
Q

alterations of the vaginal pH can occur from

A

hormonal influences, aging, douching, antibiotic use, exposure to semen, existing infections, and underlying diseases such as diabetes.

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43
Q

Susceptibility to sti is also influenced by

A

aging and the presence of an existing infection

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44
Q

The incidence of chlamydia and HPV infections is higher in young women because

A

the squamocolumnar junction, a vulnerable area for infection, is prominent on the ectocervix

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45
Q

presence of one sti

A

increases risk of another

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46
Q

Women with __________________________________ can transmit these diseases to a fetus during pregnancy and to infants via breastfeeding

A

HIV, HSV, and syphilis

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47
Q

symptom of most STIs

A

asymptomatic

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48
Q

painless lesions that usually resolve on their own but are, nevertheless, still infectious

A

chancre with initial stage of syphilis
HPV infection

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49
Q

symptoms of chlamydia and gonorrhea may not present until

A

PID develops,

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50
Q

may indicate presence of STI

A

erythema, inflammation, or a lesion

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51
Q

HPV lesion may appear

A

warty

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52
Q

HSV lesions may be

A

vesicular

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53
Q

Normal vaginal discharge is

A

clear or white

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54
Q

Odorous, purulent, and colored discharge is found in

A

BV, chlamydia, gonorrhea, and trichomonas

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55
Q

A finding of pain when the cervix is moved with a gloved finger , may indicate PID.

A

(cervical motion tenderness)

56
Q

The U.S. Preventive Services Task Force (USPSTF) recommendations for STI screening

A

annual screening for chlamydia, gonorrhea, HIV, and syphilis in all nonpregnant women with high-risk sexual behaviors,

as well as screening for chlamydia and gonorrhea in all sexually active women younger than 25 years.

57
Q

All pregnant women should be screened for

A

HBV, HIV, and syphilis. In addition, pregnant women younger than 25 years or those engaged in high-risk behaviors should also be screened for chlamydia and gonorrhea

58
Q

Screening for cervical cancer

A

should begin at age 21 years, and specific screening for high-risk HPV serotypes begins at age 30 years.

59
Q

Men engaging in high-risk behaviors should be screened for

A

HIV and syphilis,

60
Q

The USPSTF recommends HIV screening for everyone

A

aged 15 to 65 years of age.

61
Q

Management of STI

A

provide correct diagnosis
prescribe appropriate tx
provide education to prevent reinfection

62
Q

Prevention of reinfection largely depends on

A

the concurrent treatment of intimate partners and the use of barrier protection during sexual contact.

63
Q

Patients with chlamydia and gonorrhea must be queried about the sexual partners they have had in the preceding ______ , and all efforts should be made to ensure treatment of these partner(s)

A

60 days

64
Q

expedited partner therapy (EPT) is

A

considered a useful option to prevent reinfection. EPT is legal in most states and allows the practitioner to treat partners of patients with chlamydia and gonorrhea by giving the partner’s prescription to the patient, if the practitioner cannot be reasonably sure the partner(s) will seek treatment

only available to hetero individuals

65
Q

Because of high reinfection rates with trichomoniasis, testing for reinfection is recommended

A

at 3 months

66
Q

Although state guidelines differ, the following currently require reporting in all states:

A

HIV, AIDS, syphilis, gonorrhea, chancroid, and chlamydia

67
Q

Chancroid

A

Painful, irregularly shaped, deep red ulcer with red halo and undermined edges

68
Q

chancroid tx

A

Azithromycin 1 g orally single dose

OR

Ceftriaxone 250-mg intramuscular injection single dose

OR

Ciprofloxacin 500 mg orally twice a day for 3 days

OR

Erythromycin base 500 mg orally four times a day for 7 days

69
Q

LGV Chlamydia trachomatis

A

Primary lesion: small painless erosion that heals quickly

Inguinal stage: inguinal lymphadenopathy; may have headache, fever, and polymyalgia

Late stage: anorectal swelling, perirectal abscesses, fistulae, swelling and ulcerations on labia

70
Q

LGV Chlaymydia trachomatis tx

A

Doxycycline 100 mg orally twice a day for 21 days

OR

Erythromycin base 500 mg orally four times a day for 21 days.

71
Q

Genital HSV

A

Multiple painful vesicular or ulcerated lesions that may last 12 days in the initial outbreak or 4–5 days in recurrent outbreaks.

Flu-like symptoms (common with first outbreak), adenopathy, and tingling at the site before outbreak.

72
Q

Genital HSV tx

A

First episode:

Acyclovir 400 mg orally three times a day for 7–10 days

OR

Acyclovir 200 mg orally five times per day for 7–10 days

OR

Valacyclovir 1 g orally twice a day for 7–10 days

OR

Famciclovir 250 mg orally three times a day for 7–10 days

Recurrent episodes:

Acyclovir regimens

400 mg orally three time a day for 5 days

800 mg orally twice a day for 5 days

800 mg orally three times a day for 2 days

OR

Valacyclovir regimens

500 mg orally twice a day for 3 days

1 g orally once a day for 5 days

73
Q

Syphilis

Treponema pallidum

A

Primary: painless ulcer at initial site of contact (chancre), adenopathy Secondary: maculopapular rash on the palms and soles, flu-like symptoms, mucocutaneous lesions, lymphadenopathy Tertiary/late: cardiac, neurologic, ophthalmic, auditory, and gummatous lesions

74
Q

Syphlis tx

A

Treatment is driven by staging. Primary and secondary or early latent (<1 year since infection): Benzathine PCN G 2.4 million units intramuscularly one time If PCN allergy: Doxycycline 100 mg orally twice a day for 14 days

OR

Tetracycline 500 mg orally four times a day for 14 days

OR

Ceftriaxone 1 g intramuscularly or intravenously daily for 8–10 days

Late latent, latent of unknown duration, or tertiary with normal cerebrovascular fluid examination: Benzathine penicillin B 2.4 units intramuscularly once a week for 3 doses

If PCN allergy:

Tetracycline 400 mg orally four times a day for 4 weeks OR

Doxycycline 100 mg orally twice a day for 4 weeks

Neurosyphilis and ocular syphilis: Aqueous crystalline penicillin G 3–4 million units intravenously every 4 hours for 10–14 days (or continuous infusion).

Alternate therapy if compliance is assured:

Procaine penicillin 2.4 million units intramuscularly daily

PLUS

Probenecid 500 mg orally four times a day for 10-14 days

If PCN allergy:

Desensitize and treat with penicillin as above

OR

Ceftriaxone 2 g intramuscularly/intravenously once a day for 10–14 days

75
Q

Trichomoniasis Trichomonas vaginalis

A

Most infected persons have minimal or no symptoms.

Some infected women may have diffuse, frothy, malodorous, or yellow-green discharge and vulvar irritation.

Infected men may have symptoms of urethritis, epididymitis, or prostatitis.

76
Q

trichomoniasis tx

A

Metronidazole 2 g orally for one dose

OR

Tinidazole 2 g orally for one dose

OR

Metronidazole 500 mg orally twice a day for 7 days

Avoid alcohol consumption during treatment with metronidazole.

77
Q

Urethritis

Neisseria gonorrhoeae

A

May be asymptomatic Dysuria, urethral pruritus, mucoid or purulent discharge

78
Q

Gonorrhea Neisseria gonorrhoeae

A

Usually asymptomatic. Partner may have an infection, requiring treatment.

Women may report purulent, yellow, or green vaginal discharge; bleeding or pain with intercourse; and pelvic pain; may have inflammation of Skene’s and Bartholin’s glands.

Men may report inflammation of the urethra, discharge, and dysuria.

79
Q

gonorrhea tx

A

Primary therapy:

Ceftriaxone 250 mg intramuscularly for one dose

PLUS

Azithromycin 1 g orally for one dose Alternative therapy (less effective):

Cefixime 400 mg orally for one dose PLUS

Azithromycin 1 g orally for one dose If azithromycin allergy:

Doxycycline 100 mg orally twice a day for 7 days AND test of cure in 1 week.

80
Q

patients who complain of abdominal pain do not receive an accurate diagnosis

A

50%

81
Q

The source of the abdominal pain may be from one of a triad of vascular emergencies: .

A

mesenteric ischemia, abdominal aortic aneurysm, or myocardial infarction

82
Q

All patients with abdominal pain should undergo these exams

A

rectal, genital, and pelvic evaluations

83
Q

visceral pain

A

is caused by distention or spasm of a hollow viscus and is usually generalized and dull. Distention of an organ capsule, such as Glisson’s capsule around the liver; vascular compromise; and mucosal irritations cause pain that is visceral in nature.

84
Q

parietal pain,

A

described as sharp and well localized, is caused by irritation of the peritoneum. Appendicitis often causes this type of pain as the peritoneum becomes involved

85
Q

colicky abdominal pain

A

gallstones or renal stones

86
Q

Burning pain

A

, caused by irritation of the gastric mucosa by gastric contents, is associated with peptic ulcers and esophagitis

87
Q

if pain is very severe, abdomen rigid

A

refer to physician

88
Q

Labs for abdominal pain

A

complete blood count, serum chemistries, liver function tests, urinalysis, pregnancy test, and abdominal films

89
Q

most common gastrointestinal (GI) disorder in the United States

A

constipation

90
Q

The most common cause of constipation in the United States is

A

a lack of dietary fiber; the recommended amount is 30 grams daily for optimal bowel health

91
Q

Other common causes of constipation are .

A

habitual use of laxatives, irritable bowel syndrome (IBS), decreased physical activity, a change in environment or travel, use of medications with constipating potential, suppression of the urge to defecate, and painful defecation caused by anorectal problems

92
Q

3 categories of constipation

A

functional, disordered motility, secondary

93
Q

Functional constipation

A

generally results from a diet that is low in fiber. A sedentary lifestyle contributes as well. In addition, some people have difficulty defecating in an environment other than their own home and suppress the urge to defecate, thereby promoting functional constipation.

94
Q

Disordered motility

A

is most often seen in older adults and is caused by slowed transit time. Megacolon and megarectum are also common disorders of motility, but they most frequently occur in children with conditions such as Hirschsprung disease. Other conditions that cause disordered motility and constipation include IBS and diverticular disease.

95
Q

Secondary constipation often is a result of

A

medications such as opioids, analgesics, calcium channel blockers, antidepressants, antiparkinsonian drugs, cough medicine, and aluminum antacids. Box 38.1 presents a list of constipating drugs. Other common causes of secondary constipation are chronic laxative use, prolonged immobilization, and organic diseases of the lower GI system, such as colorectal cancer.

96
Q

Patients who develop constipation that cannot be explained, have abdominal pain, report blood or mucus in their stool, or require a substantial increase in their laxative use

A

require more investigation

97
Q

ribbon-like stools often indicate

A

a motility disorder but can also be caused by an organic narrowing of the distal or sigmoid colon

98
Q

f the patient complains of a progressive decrease in the diameter of the stools,

A

this suggests an organic lesion

99
Q

If steatorrhea and greenish-yellow stools are associated with the constipation,

A

the practitioner should look for a small bowel or pancreatic lesion

100
Q

Constipation alternating with diarrhea is often a result of

A

IBS

101
Q

management for simple constipation

A

education about bowel habit, increase physicial activity, dietary intervention
slowly increse dietary fiber to 25-35g/day, at least 12-15 at breakfast

102
Q

The only constipation agents that are appropriate for long-term use are

A

bulking agents

103
Q

osmotic diarrhea

A

when the osmotic gap between the stool and the serum is over 50 mOsm/kg.
Carbohydrate malabsorption is the most common cause and includes lactose, fructose and sorbitol
usually responds to fasting

104
Q

Celiac disease is

A

a malabsorption syndrome related to an immune reaction to gluten in the diet. It is most common in women, and the peak incidence is in women aged 40 to 50 years. Gluten is found in food products that contain wheat, barley, and rye. The effects on the intestinal mucosa cause the villi to become flat, the crypts to hypertrophy, and an increased number of intraepithelial lymphocytes and plasma cells to appear. Complications such as collagenous sprue and intestinal ulcers, nutritional complications, and malignancy are possible. The patient will have a history of chronic diarrhea, foul-smelling stools, abdominal bloating, weakness, and fatigue. A presumptive diagnosis is based on a combination of clinical presentation and positive serology. Distal duodenal biopsy is needed to confirm the diagnosis. Treatment includes a lifelong gluten-free diet and treatment of nutritional deficiencies such as iron, folate, and vitamin B12

105
Q

secretory diarrhea

A

produces voluminous, watery stools but is unresponsive to fasting. Most cases of acute and chronic diarrhea are secretory in nature

106
Q

Diarrhea is associated with morphological changes within the mucosa of the intestinal wall that occur with inflammatory conditions of the intestines

A

, and these changes can result in acute or chronic diarrhea. Both Crohn’s disease and ulcerative colitis cause inflammation of the mucosa of the intestinal lumen, resulting in diarrhea.

107
Q

Acute diarrhea

A

usually has an abrupt onset and lasts for less than 1 week. Nausea, vomiting, or fever may be associated with acute types of diarrhea

108
Q

Chronic diarrhea

A

lasts for more than 2 weeks or recurs over months or years. When diarrhea occurs suddenly in an otherwise healthy patient without signs or symptoms of other organ involvement, the most likely cause is an infectious agent, most often viral.

109
Q

Other common causes of diarrhea the practitioner should consider are

A

IBS, IBD, ingestion of magnesium-containing antacids, lactose intolerance, antibiotic therapy, laxative abuse, and AID

110
Q

Heartburn is occasionally described as

A

extreme pain, and this makes it difficult to distinguish heartburn pain from that of angina pectoris or myocardial infarction. Patients with heartburn sometimes describe the pain as radiating to the back, arms, or jaw, which further complicates the diagnosis

111
Q

Symptoms of dyspepsia include

A

epigastric discomfort, postprandial fullness, early satiety, anorexia, belching, nausea, heartburn, vomiting, bloating, borborygmi, dysphagia, and abdominal burning. These symptoms most often have functional or organic causes. The possibility of an organic cause for dyspepsia increases as a person ages.

112
Q

If the symptoms of dyspepsia are continuous and associated with anorexia and weight loss,

A

gastric cancer may be the cause.

113
Q

The most common cause of heartburn is

A

gastroesophageal reflux disease

114
Q

Jaundice (icterus) is a

A

yellow coloration of the skin, mucous membranes, and sclera resulting from an accumulation of bilirubin in the blood

115
Q

Hyperbilirubinemia and jaundice in most patients result from

A

cholestasis, either because of impaired bile formation and/or bile flow, which can be the result of extrahepatic biliary tract obstruction or hepatic parenchymal disease.

116
Q

Icterus is not usually evident until the serum bilirubin level exceeds

A

2.5 to 3.0 mg/dL. The normal serum bilirubin level is 0.3 to 1.0 mg/dL.

117
Q

Cholestasis is also characteristically accompanied by

A

an increase in the serum gamma-glutamyl transpeptidase (GGT) and 5(-nucleotidase. Extreme elevations in alkaline phosphatase (greater than three times normal) in conjunction with elevation of the GGT indicate a mechanical obstruction of the biliary system by a tumor, stricture, or stone

118
Q

A patient who presents with jaundice often has complaints of

A

pruritis, anorexia, nausea, vomiting, fever, light-colored stools, weight loss, and fatigue

119
Q

jaundice exam

A

Examination may reveal right upper quadrant pain and tenderness, dark urine, and abdominal distention. Pruritus, dark urine, and light-colored stools in conjunction with the jaundice are indicative of cholestasis

120
Q

The most common cause of melena is

A

upper gastrointestinal (GI) bleeding, but bleeding in the small bowel or the right colon can also produce melena. It is the action of gastric acid and intestinal secretions that reduces bright red blood to black, tarry stools. To produce melena, about 100 to 200 mL of blood must be present.

121
Q

common causes of melena

A

iron supplements, bismuth subsalicylate (Pepto-Bismol), and a variety of foods

122
Q

is the most common cause of nausea and vomiting in adults and children.

A

Gastroenteritis

123
Q

If the vomiting occurs 1 to 2 hours after eating,

A

diseases of the biliary tract or pancreas should be suspected.

124
Q

Vomiting following a meal can occur with

A

gastritis and in digitalis toxicity.

125
Q

Projectile vomiting without nausea is classically a sign of

A

a neurological source, such as increased intracranial pressure

126
Q

repeated vomiting without bile staining is indicative of

A

pyloric obstruction, which can be caused by scars from an ulcer or a tumor

127
Q

vomiting of undigested food could indicate an

A

esophageal obstruction.

128
Q

3 swallowing phases

A

oral phase
pharyngeal phase
esophageal phase

129
Q

the oral phase of swallowing involves

A

movement of the tongue and jaw allowing for mastication and preparation of food into a bolus and making it ready for swallowing

130
Q

the pharyngeal phase includes

A

the reflexive passage of the bolus from the oral cavity through the pharynx and into the upper esophagus

131
Q

the esophageal phase is

A

the reflexive passage of the bolus through the esophagus and into the stomach.

132
Q

Eighty percent of oral phase and pharyngeal phase abnormalities have a

A

neurologic origin

133
Q

if there is a problem in the oral phase,

A

dribbling, spillage, pocketing of food in the mouth, or aspiration may be present.

134
Q

problems that occur with pharyngeal phase

A

The pharyngeal phase is the first reflexive, or involuntary, phase; problems during this phase are characterized by nasal regurgitation, aspiration, and/or altered voice. This is the phase where aspiration most commonly occurs during swallowing.

135
Q

Esophageal phase problems are characterized by

A

neck pain, heartburn, and the sensation of food becoming “stuck” below the sternum

Primary Care I (7 decks)

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