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).
2
Q
However, dysuria is most commonly associated with
A
lower urinary tract infection
3
Q
Meds that cause dysuria
A
SSRIs
opiates
scopalamine
4
Q
the easiest, least invasive, and most economical way to identify urinary tract infections and other renal problems
A
Urinalysis is
5
Q
Hematuria
A
is defined as blood in the urine and can be visible (gross) or occult (microscopic
6
Q
Asymptomatic microhematuria has many benign causes such as
A
infection, menstruation, vigorous exercise, viral illness, and trauma
7
Q
On microscopic examination, hematuria is characterized by more than
A
three red blood cells (RBCs) per high-power microscopic field (hpf)
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
9
Q
RBC casts usually indicate
A
injury to the nephron and are diagnostic of hematuria of renal origin.
10
Q
intact uniform RBCs with no casts suggests
A
hematuria originating in the lower urinary tract
11
Q
The presence of both proteinuria and hematuria is suggestive of
A
glomerular or interstitial nephritis.
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
13
Q
questions to ask with hematuria
A
menstrual hx
exercise
recent strep infection?
family hx
recent travel
14
Q
Hematuria accompanied by colicky flank pain suggests a
A
ureteral stone
15
Q
When bleeding occurs only at the beginning or end of urination,
A
a prostatic or urethral source is likely
16
Q
Hematuria accompanied by hypertension, edema, and a sore throat or a skin infection may be indicative of
A
poststreptococcal glomerulonephritis
17
Q
The most important diagnostic tool in cases of hematuria is .
A
urinalysis
18
Q
What to order with all hematuria pt
A
UA with cx & sens
ABX
Re-eval UA 2 weeks later
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.
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.
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.
22
Q
the most accurate way to quantify the amount of protein in the urine is with
A
a 24-hour urine collection;
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.
24
Q
If renal function is normal in a patient with elevated urinary protein, the patient should be
A
evaluated for orthostatic proteinuria.
25
Sexually transmitted infections (STIs)
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
26
Common STIs include
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)
27
Transmitted infections via sexual contact but not considered STIs
hepatitis B virus (HBV), hepatitis C virus (HCV), molluscum contagiosum, pediculosis pubis, scabies, and methicillin-resistant Staphylococcus aureus
28
most prevalent communicable diseases in the United States after upper respiratory infections,
STIs
29
The most common STI is
genital HPV,
30
most commonly reported STI
chlamydia
31
STIs disproportionally affect
adolescents and young adults between the ages of 15 and 24 years, primarily because of increased sexual encounters and risk-taking behaviors
32
STI High-risk groups also include
men who have sex with men and racial minorities
33
Estimation of infection of STI (not including HIV_
1 in 5
34
STIs that can be treated with abx
chlamydia,
gonorrhea,
syphilis,
and trichomonas
35
Condition that if left untreated can lead to PID
mucopurulent cervicitis
36
PID
causes inflammation and formation of scar tissue in the genitourinary tract, which can result in a higher risk of miscarriage, ectopic pregnancy, and infertility
37
In men, untreated chlamydia, gonorrhea, and trichomoniasis can cause
asymptomatic urethritis, epididymitis, and prostatitis and lead to disseminated gonococcal infection.
38
In both men and women, untreated syphilis may lead to
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
39
most common virus caused STI
HPV
40
most serious viral STI
HIV- progresses to AIDS
41
The female reproductive tract is naturally protected from infection by several mechanisms, i
ncluding a low acidic pH resulting from vaginal secretions and the presence of commensal nonpathogenic microbial flora, namely hydrogen peroxide
42
alterations of the vaginal pH can occur from
hormonal influences, aging, douching, antibiotic use, exposure to semen, existing infections, and underlying diseases such as diabetes.
43
Susceptibility to sti is also influenced by
aging and the presence of an existing infection
44
The incidence of chlamydia and HPV infections is higher in young women because
the squamocolumnar junction, a vulnerable area for infection, is prominent on the ectocervix
45
presence of one sti
increases risk of another
46
Women with __________________________________ can transmit these diseases to a fetus during pregnancy and to infants via breastfeeding
HIV, HSV, and syphilis
47
symptom of most STIs
asymptomatic
48
painless lesions that usually resolve on their own but are, nevertheless, still infectious
chancre with initial stage of syphilis
HPV infection
49
symptoms of chlamydia and gonorrhea may not present until
PID develops,
50
may indicate presence of STI
erythema, inflammation, or a lesion
51
HPV lesion may appear
warty
52
HSV lesions may be
vesicular
53
Normal vaginal discharge is
clear or white
54
Odorous, purulent, and colored discharge is found in
BV, chlamydia, gonorrhea, and trichomonas
55
A finding of pain when the cervix is moved with a gloved finger , may indicate PID.
(cervical motion tenderness)
56
The U.S. Preventive Services Task Force (USPSTF) recommendations for STI screening
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
All pregnant women should be screened for
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
Screening for cervical cancer
should begin at age 21 years, and specific screening for high-risk HPV serotypes begins at age 30 years.
59
Men engaging in high-risk behaviors should be screened for
HIV and syphilis,
60
The USPSTF recommends HIV screening for everyone
aged 15 to 65 years of age.
61
Management of STI
provide correct diagnosis
prescribe appropriate tx
provide education to prevent reinfection
62
Prevention of reinfection largely depends on
the concurrent treatment of intimate partners and the use of barrier protection during sexual contact.
63
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)
60 days
64
expedited partner therapy (EPT) is
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
Because of high reinfection rates with trichomoniasis, testing for reinfection is recommended
at 3 months
66
Although state guidelines differ, the following currently require reporting in all states:
HIV, AIDS, syphilis, gonorrhea, chancroid, and chlamydia
67
Chancroid
Painful, irregularly shaped, deep red ulcer with red halo and undermined edges
68
chancroid tx
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
LGV Chlamydia trachomatis
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
LGV Chlaymydia trachomatis tx
Doxycycline 100 mg orally twice a day for 21 days
OR
Erythromycin base 500 mg orally four times a day for 21 days.
71
Genital HSV
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
Genital HSV tx
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
Syphilis
Treponema pallidum
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
Syphlis tx
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
Trichomoniasis Trichomonas vaginalis
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
trichomoniasis tx
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
Urethritis
Neisseria gonorrhoeae
May be asymptomatic Dysuria, urethral pruritus, mucoid or purulent discharge
78
Gonorrhea Neisseria gonorrhoeae
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
gonorrhea tx
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
patients who complain of abdominal pain do not receive an accurate diagnosis
50%
81
The source of the abdominal pain may be from one of a triad of vascular emergencies: .
mesenteric ischemia, abdominal aortic aneurysm, or myocardial infarction
82
All patients with abdominal pain should undergo these exams
rectal, genital, and pelvic evaluations
83
visceral pain
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
parietal pain,
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
colicky abdominal pain
gallstones or renal stones
86
Burning pain
, caused by irritation of the gastric mucosa by gastric contents, is associated with peptic ulcers and esophagitis
87
if pain is very severe, abdomen rigid
refer to physician
88
Labs for abdominal pain
complete blood count, serum chemistries, liver function tests, urinalysis, pregnancy test, and abdominal films
89
most common gastrointestinal (GI) disorder in the United States
constipation
90
The most common cause of constipation in the United States is
a lack of dietary fiber; the recommended amount is 30 grams daily for optimal bowel health
91
Other common causes of constipation are .
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
3 categories of constipation
functional, disordered motility, secondary
93
Functional constipation
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
Disordered motility
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
Secondary constipation often is a result of
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
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
require more investigation
97
ribbon-like stools often indicate
a motility disorder but can also be caused by an organic narrowing of the distal or sigmoid colon
98
f the patient complains of a progressive decrease in the diameter of the stools,
this suggests an organic lesion
99
If steatorrhea and greenish-yellow stools are associated with the constipation,
the practitioner should look for a small bowel or pancreatic lesion
100
Constipation alternating with diarrhea is often a result of
IBS
101
management for simple constipation
education about bowel habit, increase physicial activity, dietary intervention
slowly increse dietary fiber to 25-35g/day, at least 12-15 at breakfast
102
The only constipation agents that are appropriate for long-term use are
bulking agents
103
osmotic diarrhea
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
Celiac disease is
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
secretory diarrhea
produces voluminous, watery stools but is unresponsive to fasting. Most cases of acute and chronic diarrhea are secretory in nature
106
Diarrhea is associated with morphological changes within the mucosa of the intestinal wall that occur with inflammatory conditions of the intestines
, 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
Acute diarrhea
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
Chronic diarrhea
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
Other common causes of diarrhea the practitioner should consider are
IBS, IBD, ingestion of magnesium-containing antacids, lactose intolerance, antibiotic therapy, laxative abuse, and AID
110
Heartburn is occasionally described as
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
Symptoms of dyspepsia include
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
If the symptoms of dyspepsia are continuous and associated with anorexia and weight loss,
gastric cancer may be the cause.
113
The most common cause of heartburn is
gastroesophageal reflux disease
114
Jaundice (icterus) is a
yellow coloration of the skin, mucous membranes, and sclera resulting from an accumulation of bilirubin in the blood
115
Hyperbilirubinemia and jaundice in most patients result from
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
Icterus is not usually evident until the serum bilirubin level exceeds
2.5 to 3.0 mg/dL. The normal serum bilirubin level is 0.3 to 1.0 mg/dL.
117
Cholestasis is also characteristically accompanied by
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
A patient who presents with jaundice often has complaints of
pruritis, anorexia, nausea, vomiting, fever, light-colored stools, weight loss, and fatigue
119
jaundice exam
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
The most common cause of melena is
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
common causes of melena
iron supplements, bismuth subsalicylate (Pepto-Bismol), and a variety of foods
122
is the most common cause of nausea and vomiting in adults and children.
Gastroenteritis
123
If the vomiting occurs 1 to 2 hours after eating,
diseases of the biliary tract or pancreas should be suspected.
124
Vomiting following a meal can occur with
gastritis and in digitalis toxicity.
125
Projectile vomiting without nausea is classically a sign of
a neurological source, such as increased intracranial pressure
126
repeated vomiting without bile staining is indicative of
pyloric obstruction, which can be caused by scars from an ulcer or a tumor
127
vomiting of undigested food could indicate an
esophageal obstruction.
128
3 swallowing phases
oral phase
pharyngeal phase
esophageal phase
129
the oral phase of swallowing involves
movement of the tongue and jaw allowing for mastication and preparation of food into a bolus and making it ready for swallowing
130
the pharyngeal phase includes
the reflexive passage of the bolus from the oral cavity through the pharynx and into the upper esophagus
131
the esophageal phase is
the reflexive passage of the bolus through the esophagus and into the stomach.
132
Eighty percent of oral phase and pharyngeal phase abnormalities have a
neurologic origin
133
if there is a problem in the oral phase,
dribbling, spillage, pocketing of food in the mouth, or aspiration may be present.
134
problems that occur with pharyngeal phase
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
Esophageal phase problems are characterized by
neck pain, heartburn, and the sensation of food becoming “stuck” below the sternum
