Module 3 Flashcards
1
Q
Hypocalcemia
A
is defined as a calcium level of less than 8.5 mg/dL
2
Q
In response to hypocalcemia, secretion of parathyroid hormone (PTH)
A
increases, which leads to mobilization of calcium stores from the bone and an increase in the absorption of calcium in the intestines
3
Q
Carpopedal spasm (Trousseau’s sign)
A
is a violent, painful contraction of the hands or feet. It is one of the neuromuscular signs indicating hypocalcemia and is a significant sign of tetany. It is often preceded by muscle cramps in the legs and feet. Carpal spasm consists of a flexed elbow and wrist, adducted thumb over the palm, flexed metacarpophalangeal joints, adduction of hyperextended fingers, and extended interphalangeal joints. The response is elicited by inflation of a blood pressure cuff to 20 mm Hg above the level of the systolic blood pressure. Inflation is maintained for 3 minutes to elicit the response, which is secondary to ulnar and median nerve ischemia.
4
Q
Chvostek’s sign
A
It is an abnormal unilateral spasm of the facial muscle when the facial nerve is tapped below the zygomatic arch anterior to the earlobe. In severe hypocalcemia, spontaneous spasms may also occur in the lower extremities and feet.
5
Q
Chronic hypocalcemia may cause the skin to be
A
coarse, dry, and scaly
6
Q
Normal serum calcium values in adults range
A
from 9 to 11 mg/dL.
7
Q
Immediate medical treatment is indicated in patients with marked hypocalcemia
A
(less than 6.5 mg/dL)
8
Q
Gynecomastia
A
is the enlargement of glandular breast tissue in men, resulting in increased breast size. True gynecomastia involves enlargement of the stromal and ductal tissues; it may present unilaterally and progress to bilateral symmetrical or asymmetrical enlargement.
9
Q
Gynecomastia results from an imbalance of
A
androgen and estrogen or an increase in prolactin
10
Q
Gynecomastia associated with puberty has an age at onset
A
of 12 to 14 years. The duration is approximately 6 months, followed by spontaneous regression.
11
Q
A referral to an endocrinologist is required for all cases in which gynecomastia when
A
it occurs before puberty,
if gynecomastia does not resolve within 2 years after puberty,
if it occurs in the presence of abnormal serum levels of free testosterone and luteinizing hormone (LH),
or when gynecomastia is accompanied by the abnormal presence or the absence of secondary sex characteristics, undermasculinization, or small asymmetrical testes
12
Q
How to determine true gynecomastia vs pseudo
A
The patient is examined in a supine position while the examiner grasps breast tissue between the thumb and forefinger and gently moves the two digits toward the nipple. A firm or rubbery, mobile, disclike mound of tissue at least 2 to 4 cm in diameter arising concentrically from beneath the nipple and areolar region confirms gynecomastia. The glandular enlargement of gynecomastia is usually resistive and ropy in texture.
13
Q
The most common causes of gynecomastia
A
are puberty (25%), idiopathic (25%), drug related (15%), cirrhosis or malnutrition (10%), and testicular failure (10%). Other causes include renal failure, thyroid disease, neoplasms (including testicular cancer), hyperprolactinemia, Klinefelter’s syndrome, and gonadotropin deficiency.
14
Q
Hirsutism
A
is an increase in terminal hair growth on the face, chest, back, lower abdomen, pubic area, axilla, and inner thighs.
15
Q
Hirsutism is caused by
A
increased secretion of androgens by the ovary or adrenal glands or an increased sensitivity to androgens. It is often accompanied by menstrual irregularities.
16
Q
Vellus hair
A
is found over most of the body and is fine, soft, and unpigmented.
17
Q
Terminal hairs
A
are characteristically dark, coarse, pigmented, and thicker compared with vellus hair. Terminal hairs are found on the scalp, eyebrows, and the axillary and pubic areas after puberty.
18
Q
Most hirsuitism cases caused by
A
PCOS or idiopathic
19
Q
Labs to check- hirsutism
A
Evaluation of free testosterone levels, androstenedione, total testosterone, 17-hydroxyprogesterone, urine 17-hydroxycorticosteroids, thyroid-stimulating hormone, prolactin levels, LH, follicle-stimulating hormone (FSH), and dehydroepiandrosterone sulfate (DHEA-S)
20
Q
hormonal therapy for hirsutism
A
will stop further hair growth but won’t reverse present hair
may take 6-24 months
21
Q
Eflornithine 13.9% (Vaniqa) cream
A
is Food and Drug Administration–approved to reduce unwanted facial hair in women and has shown evidence of reducing hair growth on the upper lip, especially when combined with laser therapy
22
Q
The most common cause of increased neck size is
A
an enlarged thyroid gland.
23
Q
Signs of neoplasm in thyroid nodules
A
enlargement of node over several months, multiple nodal involvements, hard immobile mass
24
Q
Polydipsia is
A
excessive thirst
25
Polyphagia
refers to excessive eating before satiety. This symptom can present as a persistent or intermittent condition, resulting from endocrine and psychological disorders.
26
Polyuria
is a condition associated with increased urine production; it is defined as excretion of more than 3,000 mL (3 L) of urine per day
27
3 classic symptoms of diabetes
polyphagia
polydipsia
polyuria
28
Diagnosis of DM
HbA1c equal to or greater than 6.5%,
a fasting (following 8 hours of no caloric intake) blood glucose level equal to or greater than 126 mg/dL,
a 2-hour postprandial plasma glucose level equal to or greater than 200 mg/dL following a 75-g oral glucose tolerance test,
a random blood glucose level greater than 200 mg/dL in persons with classic symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, weight loss), or hyperglycemic crisi
29
A bruise (ecchymosis
) is an integumentary manifestation of extravasated blood
30
Macrophages that contain the RBCs excrete
hemosiderin and hematoidin. Hemosiderin is brown, and hematoidin is yellow.
31
Coloring of bruise
redness transitions to blue/purple in 1-2 days, change to green within 1 week and then yellow/brown
32
Thrombocytopenia
(platelet counts below 50,000 cells/mL
33
Spontaneous bruising may be seen with
platelet counts below 30,000 cells/mL, particularly on the arms and legs. Spontaneous bruising may also be associated with the chronic use of corticosteroid or anticoagulant therapies
34
Patient reports of fatigue that increases over the course of a day and abates after rest suggests
an underlying medical condition that may account for the fatigue
35
Functional fatigue is more typically characterized by
fatigue on awakening that may improve after exercise. The close associations of depression and anxiety with fatigue make for a difficult task in distinguishing functional causes of fatigue from the fatigue itself.
36
acute fever
temp tends to be >101.3
upper respiratory infections that are either bacterial or viral in etiology, drug reactions, gastroenteritis, or urinary tract infections
37
chronic fever
low grade temp elevations typical, rise above 100.4
in cases of infectious hepatitis, infectious mononucleosis (especially in the third and fourth weeks after the onset of symptoms), cancer, sinusitis, dental abscess, prostatitis, and tuberculosis (TB).
38
Fever of unknown origin in ambulatory pt
FUO is defined as a fever of greater than 101.3°F (38.5°C) that occurs on at least three occasions over a 3-week period in an ambulatory patient.
39
FUO hospitalized
A hospitalized patient is diagnosed with FUO if the unexplained fever persists for 1 week.
40
lymphadenopathy
is used in clinical practice to designate any abnormality of lymph nodes and, in particular, enlarged lymph nodes.
41
Lymphadenitis
is a term that suggests that inflammation is the cause of the lymph node enlargement
42
Common symptoms of influenza
include high fever, chills, myalgias, and malaise
43
Risk factor associated with URI
smoking
44
Symptoms of acute bronchitis
include cough (both productive or nonproductive), sputum, dyspnea on exertion, and wheezing, rhonchi
fever, sore throat, nasal congestion, or runny nose.
45
Treatment of acute bronchitis i
s primarily supportive
46
most important aspect in diagnosing a cough.
Taking a history is the
47
the most common cause of infectious conjunctivitis
Adenovirus , which is more prevalent during summer and represents 20% to 62% of the cases. Risk factors include overcrowding or close quarters, an urban setting, and an exposure to infected persons
48
Acute rhinosinusitis lasts
less than 4 weeks.
49
Chronic rhinosinusitis lasts
longer than 12 weeks
50
Risk factors for sinusitis
include smoking, a deviated septum, and asthma, among others. It is usually preceded by a viral URI
51
Symptoms suggestive of group A streptococcal pharyngitis
include anterior cervical adenitis, persistent fever, and tonsillopharyngeal exudates.
52
Malignant otitis externa mainly affects
elderly patients and those who are immunocompromised or have diabetes
53
The most dangerous complication of acute mastoiditis is
an intracranial abscess. Signs and symptoms include headache, fever, otalgia, and otorrhea
54
A person with OA will typically
awaken with stiffness and a cracking sound in the joints; as the day progresses, the pain and stiffness will gradually lesson with movement. There may be mild swelling around the joint. Toward the end of the day, the pain may worsen
55
A sprain is
caused by a stretched or torn ligament
56
A strain is
a stretch or a tear in a muscle or tendon. Strains occur frequently in athletes and are more common in sports requiring repetitive motion, such as football, hockey, baseball, or tennis.
57
shoulder fracture symptoms
sharp shoulder pain and are reluctant to move the upper extremity. It is important to verify that no neck pain or upper extremity paresthesias are present. These fractures usually best heal spontaneously after proper immobilization; they rarely require surgery.
58
proximal femoral (hip) fracture
most common of all adult fractures
2 types- femoral neck, intertrochanteric
59
Risks for hip fractures include
increasing age, previous fracture, visual impairment, institutionalization, and osteoporosis.
60
hip fracture physical exam
typically reveals an externally rotated and shortened injured leg. Any motion to this extremity will produce severe pain center around the affected groin. The pelvic bony prominences should be examined for tenderness because pubis ramus fractures may also be present or may be confused with the hip injury. It is important to check for lower-extremity pulses and neurological function. The entire limb should be examined for fractures at sites such as the femur, tibia, or ankle
61
knee fracture
associated with large effusion
swelling, significant pain with movement
62
ankle fracture symptoms
pain, swelling, inability to bear weight, decreased ROM
63
stress fractures
ommon in patients who experience bone pain after initiating or increasing high-impact activity
common in legs, feet
point tenderness over bone, ecchymosis, soft tissue swelling
64
most common type of headache
tension, migraine
65
A tension-type headache produces
bilateral mild to moderate pressure without other symptoms
66
migraine symptoms
A migraine headache may present with or without an aura. An aura may include visual, sensory, or speech symptoms that last less than 60 minutes and are reversible. A migraine usually occurs on one side of the head and lasts from 4 to 72 hours. Additional symptoms may include nausea, vomiting, photophobia, and/or phonophobia.
67
cluster headache symptoms
last from 15 to 180 minutes with severe head pain usually with associated symptoms of one-sided conjunctival redness, nasal congestion or rhinorrhea, eyelid edema, and forehead or facial swelling. The patient is usually restless or agitated.
68
red flags for headache
“The worst headache of my life”
Headache triggered by coitus, a cough, or exertion
Change in mental status or LOC
Age greater than 50 years of age
69
panic disorder symptoms
abrupt episode of fear or discomfort that usually peaks within minutes. Other symptoms include palpitations, sweating, trembling, shortness of breath, feelings of choking, chest discomfort, nausea, dizziness, and fear of losing control or dying
70
Depression is characterized by
a persistent low mood with a lack of positive affect and anhedonia (loss of interest in pleasurable activities) that have been present for a period of at least 2 weeks. Depression is more common among persons with chronic health conditions and those with unhealthy lifestyles (smoking, drinking, lack of activity)
71
acute diarrhea defined
Acute diarrhea is the passage of six or more stools daily without improvement for 3 or more days. Acute diarrhea may be caused by infections, noninfectious conditions, and medications.
72
Diarrhea patients with a bacterial infection
may have additional symptoms such as a fever, tenesmus, and/or bloody stools.
73
pt with viral diarrhea infection
nausea and/or vomiting with the onset 24 to 48 hours after possible exposure
74
foodborne illness diarrhea
experiences symptom onset 2 to 7 hours after possible exposure
75
if diarrhea over 7 days
suspect parasitic infection
76
constipation defined
Constipation is characterized by difficult stool passage, infrequent stools (fewer than three per week), or both
77
One of the most effective treatments for constipation
is increased water intake.
78
Common triggers of GERD by affecting the LES
include smoking, alcohol, citrus foods, spicy foods, caffeine, chocolate, and mints.
79
hypertension urgent care treatment
clonidine, pt sit quietly x20-30 min
80
UTI Risk factor- pre menopause
sexually active
previous UTI
81
UTI risk factor- post menopause
urinary incontinence
history of uti prior to menopause
82
purpose of skin
acts as a barrier to entry into the body
regulates body temperature
aids in the elimination of waste
helps prevent dehydration
It also contains the cutaneous nerves, is a reservoir for nutritional stores and water, and is a source of vitamin D when exposed to sunlight
83
Wound healing process phases
Injury phase
Inflammatory phase
Epithelialization phase
remodeling phase
84
Injury phase
involves coagulation and platelet release
process enhances the inflammatory response in the wound
85
Inflammatory phase
haracterized by increased capillary permeability, which allows white blood cells (WBCs) to migrate into the wound. Neutrophils and monocytes act as scavengers and rid the wound of debris and bacteria. In addition to providing wound defenses, inflammation stimulates other monocytes to promote fibroblast replication and neovascularization
86
Epithelialization phase
begins within hours of tissue injury and involves the migration of cells at the wound edges from one side of the incision to the other. Within 24 to 48 hours, incisional wounds are epithelialized
Collagen synthesis in the healing wound peaks at day 7 posttrauma
87
tensile strength values
the wound will have only 15% to 20% of its normal tensile strength at 3 weeks and 60% by 4 months
88
Remodeling phase
In this final phase, the process involves wound contraction and tissue formation. This process begins on the third day after the injury and continues for up to 6 months. The appearance of the wound can change during this period; for this reason, plastic surgeons will usually wait 6 months before considering revising a scar.
89
partial thickness wound
if all layers of the skin have not been violated
90
full-thickness
If any subdermal tissue can be seen in the wound, it is considered a
91
Circulation should be assessed by determining if
the distal extremity has a strong pulse
92
Exposed tendon will appear as
a shiny white structure in the wound.
Pain during movement can indicate a partial tendon laceration
93
If the wound is near a joint and a violation of the joint capsule cannot be ruled out
, a saline-load test can be used to assess whether penetration of the capsule has occurred, although such tests may not have high sensitivity. In this test, sterile normal saline is injected directly into the joint space in a sufficient volume to assess for leakage, e.g., 150–200 mL for the knee joint.
94
he presence of a fracture near the wound defect must be treated as
an open fracture
95
All patients with wounds should be asked about
prior tetanus immunization. If more than 5 years have elapsed, a tetanus booster should be administered
96
most effective way to decrease the bacterial count in a wound is through
irrigation with a high-pressure stream of solution aimed directly into the wound.
97
Wounds that have an increased risk of infection
* Crush injuries
* Dirty wounds
* Jagged wounds
* Wounds with devitalized tissue
* Wounds that are more than 12 to 19 hours old
* Bite wounds, especially from humans (particularly if they are meat eaters), cats, and dogs
* Wounds with retained foreign bodies
* Wounds closed with subcutaneous stitches
98
Patients with wound who have diabetes mellitus or who have a history of vascular compromise should be
started on antibiotics prophylactically. Parenteral administration of ampicillin/sulbactam, cephalexin, or ceftriaxone is the initial treatment of choice. This should be followed by oral therapy with amoxicillin/clavulanate, cephalexin, or cefadroxil
99
follow up high risk wound
1-2 days
100
risk of infection with cat bite
50%
101
Wounds at low risk for infection include bites on
the face, ears, scalp, and mouth.
102
High-risk bite wounds include
those in the distal extremities (hand, wrist, or foot), the scalp of an infant, a wound over a joint, or a penetrating wound of the cheek. Puncture wounds and nondebridable crush injuries are of high risk
103
signs of infection in bite wound
Infection will be evidenced by increased pain, swelling, erythema, warmth, decreased range of motion at joints, or drainage from a puncture-wound site
104
pain management bite wound
Nsaids
Tylenol
toradol if needed
105
For patients with absent or incomplete tetanus primary immunization
, 250 units of tetanus immune globulin should be given in addition to the primary vaccination.
106
antibiotic prophylactic therapy bite wound
3-5 days abx if fresh, bitten by cat, hand bite, mod-severe damage, wound with tendon/bone/joint
amoxicillin/clavulanate 3-5 days
107
follow up bite wound
2 days
108
medications that cause photosensitivity
, such as oral contraceptives, tetracyclines, amoxicillin, sulfa drugs, and thiazide diuretics
109
The response of all organ systems to burn injury occurs in a biphasic pattern of
hypofunction followed by hyper-function
110
fibroblastic phase
, which occurs approximately 4 to 20 days after the injury, cells needed for tissue repair and reconstruction proliferate. Fibroblasts at the wound site migrate over the new capillary network, laying down a bed of granulation tissue (collagen) to fill the wound space
111
superficial (first-degree) burns.
involve the epidermal layer only.
The patient presents with pain, hyperemia, and erythema.
the surface is dry, with no vesicles or blisters, and blanches with pressure.
The wound heals in approximately 5 days, without scarring.
Ex: a mild sunburn.
112
Superficial partial-thickness (second-degree) burns
These burns involve the epidermis along with the upper layer of dermis.
Signs and symptoms include erythema, hyperemia, pain, moist skin, and hypersensitivity to touch.
Vesicles and blisters appear several hours after the injury.
The healing time is within 21 days, with minimal scarring
113
Deep partial-thickness (second-degree) burns.
These burns produce destruction of the epidermis, along with most of the dermis. Epidermal cells lining hair follicles and sweat glands remain intact. This level of burn may convert to a full-thickness injury.
The burn wound is typically pale, mottled, pearly white, mostly dry, often insensate, and difficult to differentiate from a full-thickness burn.
The burn will heal by wound contraction and re-epithelialization within 3 to 6 weeks. Often excision and grafting are done to provide a better functional cosmetic result and to decrease the healing time.
114
Full-thickness (third-degree) burns.
These burns result in destruction of all layers of the skin, down to or past the subcutaneous fat layer, sometimes involving fascia, muscle, and bone. The nerves are also typically destroyed. Hair will pull easily out of the follicles, but in a painless manner. The clinical picture typically includes a thick, dry, leathery eschar, with a wound that is white, cherry red, or brown/black in color. The tissue is insensate, with thrombosed blood vessels. These wounds typically require skin grafting.
115
Major burn labs
CBC
electrolyte panel
BUN/creat
glucose
ABG
COHb
116
major burn definition
Partial-thickness burn greater than 25% TBSA in a person 10 to 50 years of age or greater than 20% TBSA in a child younger than 10 years of age or an adult older than 50 years of age
* Full-thickness burn greater than 10% TBSA in any individual
* Serious burn involving the hand, face, foot, or perineum
* A burn complicated by smoke or chemical inhalation injury
* An electrical burn
* A burn in an infant, an immunocompromised patient, or an elderly patient
117
Signs and symptoms of smoke inhalation
include facial burns, presence of soot around the mouth and nose and in the sputum, singed nasal hairs, coughing up of carbonaceous black sputum, difficulty swallowing, signs of hypoxemia including tachycardia, dysrhythmias, anxiety, or lethargy, increased or decreased respiratory rate, use of accessory muscles for breathing, intercostal or sternal retractions, inspiratory stridor, hoarseness, and expiratory stridor.
118
superficial (1st degree) burn tx
cool with wet compress
aloe vera
nsaid
prednisone if sever
119
2nd degree burn tx
irrigate with cool water
peel necrotic skin
small blisters left intact
fluid filled blister over 1 inch drained
silver sulfadiazine (silvadene)
cover with dressing (other than face), change 2x/day, continue 7-10 days
abx only if infected
120
chemical burn tx
stop burning process, arrange for transport to ED
irrigate with water for 30-60 min
121
burn injury follow up
1 day
122
leading cause of head injury
falls
123
cerebral contusion
is a focal brain injury involving cortical bruising, and, at times, vessel lacerations.
124
coup contusion
injury directly beneath point of impact
125
contre coup contusion
injury directly opposite the point of impact
126
concussion
associated with loss of consciousness
diffuse brain injury
retrograde/post traumatic amnesia
127
post concussion syndrome
24h-6 months after injury
HA, dizziness, fatigue, irritability, insomnia, anxiety, impaired concentration, loss of memory
128
order head CT on head injury if
on anticoag
LOC
altered mental status
etoh/drug ingestion
repeated vomiting
GCS below 15
>60 yrs
Battles sign or raccoon eyes
129
Epidural hematomas are typically characterized by
the patient losing consciousness briefly, followed by a brief lucid moment when the patient may be awake and talking, and then a return to a period of altered consciousness as the size of the epidural hematoma increases, becoming increasingly symptomatic and possibly progressing to coma.
130
When a patient complains of “the worst headache of my life,” the clinician should suspect
a subarachnoid hemorrhage
131
GCS areas
eye opening
motor response
verbal response
132
The early signs of increased ICP include
headache, nausea and vomiting, amnesia, altered level of consciousness, changes in speech, drowsiness, agitation, restlessness, and/or loss of judgment
133
Late signs of increased ICP are
dilated, nonreactive pupils (from pressure on the oculomotor nerve), unresponsiveness to verbal or painful stimuli, abnormal posturing patterns (e.g., flexion, extension, or flaccidity), increased systolic blood pressure resulting in a widening pulse pressure, decreased pulse rate, and changes in respiratory rate and pattern.
134
Cushing response
changes in RR
decrease HR
increased systolic BP (widened pulse pressure)
135
Hemotympanum
—blood behind the tympanic membrane
136
Battle’s sign
—ecchymosis over the mastoid process
137
PRICE Therapy
Tx of musculoskeletal strain/sprain
Protection
Rest
Ice
Compression
Elevation
138
follow up fracture
3-4 days by ortho surgeon after cast applied
139
Spontaneous pneumothorax, which accounts for two-thirds of all pneumothoraxes, occurs most commonly
and is more prevalent in tall, slender young men. It is usually the result of a rupture of a superficial bleb, which is an outpouching defect on the lung surfac
140
The most frequent presenting symptoms in patients with pneumothorax and hemothorax are
dyspnea and chest pain.
