Module 2 Flashcards

1
Q

all meningitis has

A

increased WBC in CSF, symptoms of meningeal irritation

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2
Q

most cases of infectious meningitis caused by

A

virus

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3
Q

most common virus to cause meningitis

A

enterovirus

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4
Q

higher incidence of meningitis in

A

spring and fall

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5
Q

signs, symptoms of meningitis

A

fever, headache, and stiff neck, usually accompanied by vomiting, lethargy, confusion, seizures, or coma

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6
Q

Brudzinski’s sign

A

(hip and knee flexion when the neck is flexed), positive with meningitis

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7
Q

Kernig’s sign

A

(inability to fully extend the legs) positive with meningitis

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8
Q

A computed tomography (CT) examination of the head should be performed before LP in cases of

A

an abnormal neurologic examination (alteration of consciousness, focal findings, papilledema) to assess risk for herniation with LP.

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9
Q

early sign of hydrocephalus

A

drowsiness, headache, double vision (from cranial nerve six palsy), and confusion.

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10
Q

later sign of hydrocephalus

A

decreasing levels of consciousness; hemiparesis; pupillary changes; and Cushing’s triad of hypertension, bradycardia, and respiratory changes.

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11
Q

most common causes of encephalitis

A

virus

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12
Q

neurologic signs and symptoms of encephalitis are usually preceded by

A

other signs of viral infection, such as fever, malaise, muscle aches, rashes, gastrointestinal disturbances, or respiratory symptoms.

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13
Q

pt presentation encephalitis

A

confusion, altered LOC, meningitis symptoms

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14
Q

risk of shingles increases

A

with age

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15
Q

Varicella-zoster virus is most often found in the

A

sensory ganglia of the ophthalmic division of the trigeminal nerve and in the dorsal root ganglia of the mid to lower spinal cord

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16
Q

shingles symptoms

A

pain along dermatome 48-72 hours before eruption of classic rash (vesicular, starts as erythema, changes to popular lesions that rapidly form vesicles, develop for 3-5 days)

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17
Q

hutchinson sign

A

Ocular involvement is more common in patients who have concurrent lesions at the tip of the nose (shingles)

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18
Q

shingles tx

A

antiviral, steroids, calamine, tight wrap

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19
Q

post herpetic neuralgia

A

persistent pain resulting from shingles that lasts more than 3 months after the disease has run its course. PHN rarely occurs in individuals younger than age 40, is more severe in individuals older than age 50

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20
Q

trigeminal neuralgia

A

excruciating facial pain that usually lasts 3 seconds, disabling, on cranial nerve V. stimulated by triggers
more frequent in women, risk increase with age

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21
Q

trigeminal neuralgia tx

A

carbamazepine or gabapentin, TCA
TENS, ablation

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22
Q

bell’s palsy

A

an idiopathic cranial nerve seven palsy causing lower motor neuron facial paralysis, typically occurring on one side of the face
self limiting, complete recovery in weeks- months

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23
Q

Bell’s phenomenon

A

(the eyeball turns upward when the patient tries to close the eyelid)

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24
Q

bell’s palsy tx

A

steroids within first few days of symptom onset
protect eye, esp during sleep

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25
Q

Guillain barre syndrome

A

acute monophasic immune-mediated polyradiculoneuropathy. It is usually an ascending paralysis most often beginning in the legs and then progressing in an ascending fashion. Sensation can be involved, and patients usually report tingling in the extremities. Back pain and autonomic dysfunction are also common

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26
Q

Guillian Barre syndrome tx

A

IV gamma globulin or PLEX

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27
Q

Myasthenia Gravis

A

disorder of the neuromuscular junction.
targets receptor for acetylcholine
muscle fatigue, weakness associated with use

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28
Q

MG tx

A

anticholinesterase agents

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29
Q

Multiple sclerosis

A

chronic and potentially disabling demyelinating disease of the CNS that begins most commonly in young adulthood. Common symptoms include visual changes (unilateral vision loss, double vision), weakness and numbness, and loss of balance.

most common cause of disability of young adults

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30
Q

3 classifications of MS

A

relapsing remitting
primary progressive
secondary progressive

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31
Q

first symptoms of MS occur

A

between 20-50 years, median onset age 30

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32
Q

most common presenting MS symptoms

A

weakness of the legs, bladder and bowel dysfunction, ataxic gait, paresthesias in the extremities, and optic neuritis

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33
Q

Transverse myelitis

A

(spinal cord inflammation) causes bilateral weakness, numbness, spasticity, and bladder dysfunction.

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34
Q

For a diagnosis of MS to be made,

A

two or more areas of the CNS must be involved at two different periods of time.

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35
Q

CSF in MS

A

lymphocytes, oligoclonal IgG bands

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36
Q

McDonald criteria

A

are used for definitive diagnosis of MS (Polman et al., 2011). A clinically definitive diagnosis of MS requires either (1) evidence from history of two episodes at least 1 month apart, signs of one lesion on examination, and evidence from evoked responses or MRI of other lesions or (2) evidence from both history and neurologic examination of more than one lesion.

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37
Q

most URIs caused by

A

viruses

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38
Q

On average, children have approximately

A

three to eight URIs per year

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39
Q

The incubation period for most viral URIs is

A

1 to 4 days.

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40
Q

coryza transmission in adults

A

Hand-to-hand transmission, however, is probably the most common mode of transmission in adults, underscoring the importance of frequent hand washing in the prevention of new cases

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41
Q

influenza symptoms

A

usually abrupt, with fever, chills, malaise, myalgia, headache, nasal stuffiness, sore throat, and sometimes nausea. A nonproductive cough is usually present and occurs early in the course of illness. The fever may be as high as 103°F
lasts 1-7 days
most common complication: pneumonia

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42
Q

common cold symptoms

A

headache, myalgia, nasal congestion, watery rhinorrhea, sneezing, foul breath, and a “scratchy throat.

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43
Q

management of flu, common cold

A

symptomatic

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44
Q

type a influenza tx

A

antiviral (tamiflu, relenza) within 48 hours of symptoms

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45
Q

Treatment of laryngitis includes

A

complete voice rest, steam inhalations, codeine or nonnarcotic cough suppressants for cough and pain, and a liquid or soft diet.

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46
Q

For the management of croup

A

, racemic epinephrine and dexamethasone are indicated, and intubation may be needed in severe case

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47
Q

Pneumonia is typically an

A

acute inflammation of the lung parenchyma, usually infectious in origin. The lung tissue typically becomes consolidated as alveoli fill with exudate. Gas exchange may be impaired as blood is shunted around nonfunctional alveoli.

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48
Q

Community-acquired pneumonia (CAP) occurs

A

outside the hospital or is diagnosed within 2 days after hospitalization in a patient who has not resided in a long-term care facility for 2 weeks or more before the onset of the symptoms.

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49
Q

most common cause of community acquired pneumonia

A

streptococcus pneumoniae

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50
Q

most common cause of nosocomial pneumonia

A

gram negative bacteria

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51
Q

pneumonia presentation with percussion

A

dull

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52
Q

Lobar pneumonia involves

A

an entire lobe of the lung

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53
Q

interstitial pneumonia is a

A

patchy or diffuse inflammatory process throughout regions of the interstitium

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54
Q

pneumonia lung lobe most commonly affected

A

lower lobes, d/t gravity

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55
Q

Pneumococcal pneumonia typically includes four responsive stages of infection:

A

engorgement, red hepatization, gray hepatization, and resolution

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56
Q

engorgement phase pneumonia

A

alveolar capillaries become congested, bacteria and exudate pour into alveoli from alveolar capillaries, and the bacteria multiply without inhibition

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57
Q

red hepatization phase pneumonia

A

continued engorgement of the capillaries, with diapedesis of erythrocytes giving the lungs the gross appearance of liver

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58
Q

gray hepatization phase pneumonia

A

As the leukocyte count increases in the exudate, it compresses the capillaries and causes the lung tissue to assume a gray color

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59
Q

resolution phase pneumonia

A

The stage of resolution is reached when the pneumococci have been destroyed and macrophages are seen within the alveolar spaces, where they lyse and absorb exudate

60
Q

Legionnaires’ diseas

A

bacteria thrive in aquatic environment
more common in smokers, alcoholics, older adults

61
Q

mycoplasma pneumonia

A

“walking pneumonia”
long incubation 2-3 weeks

62
Q

typical pneumonia symptoms

A

a sudden onset of fever, cough, chest pain (pleuritic), rusty sputum, feeling cold, myalgia and fatigue, crackles, dullness
patient with productive cough- bacterial

63
Q

pneumonia dx testing

A

chest xr, cbc with diff, gram stain of sputum

64
Q

pneumonia tx

A

antimicrobial tx (doxycycline or a respiratory quinolone) , analgesics, antipyretics, increased fluid intake, bedrest

65
Q

CURB 65

A

Confusion
BUN <50
Respiratory Rate >30
Blood pressure <90 or <60
Age over 65

66
Q

f/u chest xr after pneumonia

A

if smokers or over 40, in 3-6 months

67
Q

pneumonia f/u

A

if uncomplicated, contact within 24-48 hours after starting therapy
schedule in office visit at 1 week and 4-6 weeks p tx

68
Q

leading cause of death worldwide from any single infectious agent

A

TB

69
Q

M. tuberculosis is most commonly transmitted from person to person by

A

droplet nuclei that are aerosolized by coughing, sneezing, or speaking

70
Q

TB symptoms

A

Onset commonly is insidious, with symptoms of anorexia, fatigue, digestive disturbances, slow weight loss, irregular menses, and lack of stamina.
productive cough, purulent yellow sputum, and repeated occurrences of coryza-like symptoms with rhinorrhea and nasal congestion

71
Q

most accurate and widely used method for TB skin testing

A

Mantoux Tb skin test

72
Q

The current minimal acceptable duration of treatment for all children and adults with culture-positive TB is

A

6 months

73
Q

3 triggers for exacerbations of asthma

A
  1. allergens/ environmental factors
  2. infections
  3. psych factors
74
Q

Asthma is a

A

chronic inflammatory disease characterized by reversible hyperreactivity of the bronchi and bronchioles to a variety of stimuli

75
Q

With each acute exacerbation of asthma,

A

inflammatory mediators incite a structural remodeling of the airways.

76
Q

asthma acute attack symptoms

A

breathlessness, unable to talk, profuse sweating, air hunger, recurrent cough, wheezing,
usually worse at night

77
Q

asthma diagnosis

A

made by demonstrating the reversibility of airway obstruction from the pre- and postbronchodilator PFTs. Reversibility is defined as a 10% or greater increase in the FEV1 after two puffs of a short-acting beta-agonist (SABA) have been inhaled.

78
Q

intermittent asthma

A
  • Intermittent symptoms less than 2 days per week
  • Nighttime asthma symptoms less than twice per month
  • Asymptomatic and normal peak expiratory flow (PEF) between exacerbations
  • PEF or forced expiratory volume in 1 second (FEV1) >80% predicted; PFT variability >20%
79
Q

mild persistent asthma

A
  • Symptoms more than 2 days per week but not daily; may be several times at night per month
  • PEF or FEV1 >80% predicted; PFT variability 20%–30%
80
Q

moderate persistent asthma

A
  • Symptoms daily, but not continual; nighttime symptoms more than once a week, but not nightly
  • Exacerbations affect activity and sleep
  • PEF or FEV1 60%–80% predicted; PFT variability >30%
81
Q

severe persistent asthma

A
  • Continuous daily symptoms; frequent nighttime symptoms
  • Frequent exacerbations
  • Physical activities limited by asthma
  • PEF or FEV1: <60% predicted; PFT variability >30%
82
Q

acute asthma attacks treated with

A

SABAs like albuterol

83
Q

treatment of choice as anti inflammatory controller therapy for asthma

A

inhaled corticosteroids

84
Q

African Americans have negative rx to this asthma therapy

A

LABA bronchodilators

85
Q

irreversible obstructive lung dx

A

emphysema, chronic bronchitis

86
Q

chronic bronchitis as a clinical disorder characterized by

A

excessive mucus secretion in the bronchial tree. It is manifested by chronic or recurrent cough (with or without sputum production), present on most days for a minimum of 3 months of the year, for at least 2 successive years. In addition, dyspnea with or without wheezing is present.

87
Q

Cigarette smoking is responsible for

A

80% to 90% of the cases of COPD, and it is also the risk factor most amenable to modification for preventing or delaying the development of COPD.

88
Q

In chronic bronchitis, long-term hypoxia leads to

A

pulmonary vasoconstriction, which can result in pulmonary hypertension.

89
Q

hallmark of acute exacerbation of bronchitis

A

Increased purulent sputum production and worsened shortness of breath are the hallmark of such episodes,

90
Q

strongest predictors of mortality in COPD

A

Age and FEV1

91
Q

Stage 1 COPD

A

mild
FEV1 ≥80% predicted

92
Q

Stage 2 COPD

A

moderate COPD
FEV1 <50% to <80% predicted

93
Q

Stage 3 COPD

A

severe COPD
FEV1 >30% to <50% predicted

94
Q

Stage 4 COPD

A

very severe COPD
FEV1 <30% predicted

95
Q

pink puffers

A

emphysema
severe dyspnea, normal ABGs
barrel chest

96
Q

first line of therapy for COPD

A

SABAs, “rescue”

97
Q

severe copd f/u

A

seen by pcp monthly

98
Q

stable copd f/u

A

annual

99
Q

HTN occurs in

A

1 in 3 Americans

100
Q

prevalence of HTN continues to increase with

A

age

101
Q

BP reading- If the cuff used is too small, an artificially

A

high BP reading may result

102
Q

Malignant HTN is diagnosed when a patient presents with severely elevated BP in the range of

A

180/110 mm Hg or higher and evidence of acute TOD

103
Q

stage 1 htn

A

130-139/80-89

104
Q

stage 2 htn

A

> 140/ >90

105
Q

metabolic syndrome

A

atherogenic and diabetogenic factors
increased BMI, BP, triglycerides, BS and low HDL

106
Q

if cardiovascular risk >10%

A

start anti htn med

107
Q

older adult htn parameters

A

> 160/80

108
Q

when htn initially found, tx

A

should be lifestyle modifications x1 month, then f/u

109
Q

first line htn drugs

A

thiazide type diuretics
help preserve bone density
chlorthalidone or HCTZ

110
Q

ACEI

A

used in diabetic pts, preserve renal function

111
Q

after starting med for antihtn

A

bp check in 2-3 weeks

112
Q

start statin therapy if

A

> 7.5% risk for stroke/MI

113
Q

normal total cholesterol

A

<200

114
Q

normal triglycerides

A

<150

115
Q

optimal HDL

A

> 60

116
Q

Most nutritionists advocate reducing total fat to

A

25% to 30% of daily calories and saturated fat to less than 7% of daily calories

117
Q

high intensity statin

A

atorvastatin 40-80mg
rosuvastatin 20-40mg
decrease LDL by 50%

118
Q

moderate intensity statin

A

atorvastatin 10-20mg
rosuvastatin 5-10mg
reduce LDL by 30-50%

119
Q

low intensity statin

A

pravastatin 10-20mg
simvastatin 10mg
decrease ldl up to 30%

120
Q

is the leading cause of death in the United States, responsible for more than one in seven deaths per year.

A

Coronary heart disease (CHD)

121
Q

symptoms of CHD are not reported until

A

75% of a coronary artery is narrowed due to atherosclerosis

122
Q

biomarker is commonly elevated in individuals with CHD

A

CRP

123
Q

if anginal symptoms, most clinicians recommend

A

low dose daily asa to decrease incidence of first mi

124
Q

Unstable angina due to myocardial ischemia is

A

newly diagnosed angina or previously diagnosed angina that has changed in pattern, frequency, or severity.

125
Q

MI,

A

which is necrosis or death of the myocardium as a result of prolonged ischemia due to an insufficient supply of oxygenated blood

126
Q

Variant angina

A

may occur in patients with normal coronary arteries who have cyclically recurring angina at rest that is unrelated to effort

127
Q

Stable angina

A

(chronic exertional angina) is a diagnosed condition of myocardial ischemia that is predictable in pattern and frequency and controlled with medication.
not considered a form of acs

128
Q

NSTEMI indicates

A

an infarction caused by a nonocclusive thrombus that partially interrupts perfusion of the myocardium and results in an infarction affecting only part of the myocardial wall, rather than its full thickness
majority of MIs

129
Q

STEMI is

A

caused by an occlusive thrombus that leads to a complete transmural MI—an infarction of the full thickness of the myocardial wall.

130
Q

Anaerobic metabolism yields a low energy output that can sustain the heart tissue for a maximum of only

A

20 minutes

131
Q

pain of ACS may frequently occur after meals because of

A

increased oxygen consumption during the meal and greater diversion of blood flow to the splanchnic circulation.

132
Q

may relieve symptoms of angina

A

rest and nitro

133
Q

MI symptoms

A

In acute MI, the patient often complains of anginalike chest pain lasting more than 20 minutes, while occasionally waxing and waning during that period. Often, dyspnea, diaphoresis, nausea, and dizziness are also reported. Radiation of the pain to the neck, jaw, shoulder, or arm (left more often than right) is usually described.

134
Q

most specific laboratory tests to rule out MI are

A

cardiac-specific troponin I (cTnI) and T (cTnT)
Troponin levels rise within the first 2 to 4 hours after an MI and remain elevated for 7 to 10 days

135
Q

CK-MB test

A

CK-MB levels rise within 4 to 8 hours after an MI and generally return to normal by 48 to 72 hours.
correlates better with infarct size than does troponin level.

136
Q

earliest serum cardiac marker to rise after MI

A

myoglobin

137
Q

decision to proceed with thrombolytic therapy in the setting of an acute MI is largely based on

A

the presence of ST-segment elevation in two or more ECG leads. The presence of ST-segment elevation greater than 1 mm in contiguous leads

138
Q

Myocardial ischemia is demonstrated by

A

enlargement and inversion of T waves due to altered late repolarization

139
Q

systolic dysfunction heart failure

A

can result from a dysfunctional ventricle that is unable to eject an adequate amount of blood
forward failure

140
Q

diastolic dysfunction heart failure

A

from the inability of the ventricle to fill with a sufficient amount of blood
backward failure

141
Q

left sided hf

A

most common type of hf
Most often the LV becomes dysfunctional due to long-standing HTN. Systemic HTN increases resistance against the LV, thereby increasing workload. This leads to LVH, and eventually the LV decompensates into failure. In addition, the LV is vulnerable to ischemic insults due to CAD and may endure an MI.
pulmonary signs and symptoms
exertional dyspnea, crackles

142
Q

right sided hf

A

commonly occurs as a result of left sided heart failure
cor pulmonale
manifestations of right- and left-sided HF often appear together
JVD, hepatomegaly, ascites

143
Q

hf vitals

A

tachycardia, pulsus alternans (a weak pulse alternating with a strong pulse), atrial fibrillation (which may contribute to HF), rapid and shallow respirations at rest or with minimal exertion, and possibly Cheyne-Stokes respirations if the patient is asleep (a crescendo-decrescendo pattern of respiratory swings terminating in apnea) caused by a prolonged circulation time from the heart to the brain.

144
Q

BNP greater than indicates CHF

A

500

145
Q

tx chf

A

ACEIs or ARBs
carvedilol
spironolactone if stage C