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Primary Care I > Module 3 > Flashcards

Module 3 Flashcards

1
Q

Hypocalcemia

A

is defined as a calcium level of less than 8.5 mg/dL

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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

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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.

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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.

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5
Q

Chronic hypocalcemia may cause the skin to be

A

coarse, dry, and scaly

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6
Q

Normal serum calcium values in adults range

A

from 9 to 11 mg/dL.

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7
Q

Immediate medical treatment is indicated in patients with marked hypocalcemia

A

(less than 6.5 mg/dL)

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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.

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9
Q

Gynecomastia results from an imbalance of

A

androgen and estrogen or an increase in prolactin

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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.

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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

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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.

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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.

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14
Q

Hirsutism

A

is an increase in terminal hair growth on the face, chest, back, lower abdomen, pubic area, axilla, and inner thighs.

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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.

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16
Q

Vellus hair

A

is found over most of the body and is fine, soft, and unpigmented.

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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.

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18
Q

Most hirsuitism cases caused by

A

PCOS or idiopathic

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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)

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20
Q

hormonal therapy for hirsutism

A

will stop further hair growth but won’t reverse present hair
may take 6-24 months

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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

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22
Q

The most common cause of increased neck size is

A

an enlarged thyroid gland.

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23
Q

Signs of neoplasm in thyroid nodules

A

enlargement of node over several months, multiple nodal involvements, hard immobile mass

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24
Q

Polydipsia is

A

excessive thirst

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25
Q

Polyphagia

A

refers to excessive eating before satiety. This symptom can present as a persistent or intermittent condition, resulting from endocrine and psychological disorders.

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26
Q

Polyuria

A

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

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27
Q

3 classic symptoms of diabetes

A

polyphagia
polydipsia
polyuria

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28
Q

Diagnosis of DM

A

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

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29
Q

A bruise (ecchymosis

A

) is an integumentary manifestation of extravasated blood

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30
Q

Macrophages that contain the RBCs excrete

A

hemosiderin and hematoidin. Hemosiderin is brown, and hematoidin is yellow.

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31
Q

Coloring of bruise

A

redness transitions to blue/purple in 1-2 days, change to green within 1 week and then yellow/brown

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32
Q

Thrombocytopenia

A

(platelet counts below 50,000 cells/mL

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33
Q

Spontaneous bruising may be seen with

A

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

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34
Q

Patient reports of fatigue that increases over the course of a day and abates after rest suggests

A

an underlying medical condition that may account for the fatigue

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35
Q

Functional fatigue is more typically characterized by

A

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.

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36
Q

acute fever

A

temp tends to be >101.3
upper respiratory infections that are either bacterial or viral in etiology, drug reactions, gastroenteritis, or urinary tract infections

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37
Q

chronic fever

A

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).

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38
Q

Fever of unknown origin in ambulatory pt

A

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.

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39
Q

FUO hospitalized

A

A hospitalized patient is diagnosed with FUO if the unexplained fever persists for 1 week.

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40
Q

lymphadenopathy

A

is used in clinical practice to designate any abnormality of lymph nodes and, in particular, enlarged lymph nodes.

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41
Q

Lymphadenitis

A

is a term that suggests that inflammation is the cause of the lymph node enlargement

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42
Q

Common symptoms of influenza

A

include high fever, chills, myalgias, and malaise

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43
Q

Risk factor associated with URI

A

smoking

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44
Q

Symptoms of acute bronchitis

A

include cough (both productive or nonproductive), sputum, dyspnea on exertion, and wheezing, rhonchi
fever, sore throat, nasal congestion, or runny nose.

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45
Q

Treatment of acute bronchitis i

A

s primarily supportive

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46
Q

most important aspect in diagnosing a cough.

A

Taking a history is the

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47
Q

the most common cause of infectious conjunctivitis

A

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

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48
Q

Acute rhinosinusitis lasts

A

less than 4 weeks.

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49
Q

Chronic rhinosinusitis lasts

A

longer than 12 weeks

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50
Q

Risk factors for sinusitis

A

include smoking, a deviated septum, and asthma, among others. It is usually preceded by a viral URI

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51
Q

Symptoms suggestive of group A streptococcal pharyngitis

A

include anterior cervical adenitis, persistent fever, and tonsillopharyngeal exudates.

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52
Q

Malignant otitis externa mainly affects

A

elderly patients and those who are immunocompromised or have diabetes

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53
Q

The most dangerous complication of acute mastoiditis is

A

an intracranial abscess. Signs and symptoms include headache, fever, otalgia, and otorrhea

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54
Q

A person with OA will typically

A

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

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55
Q

A sprain is

A

caused by a stretched or torn ligament

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56
Q

A strain is

A

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.

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57
Q

shoulder fracture symptoms

A

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
Q

proximal femoral (hip) fracture

A

most common of all adult fractures
2 types- femoral neck, intertrochanteric

59
Q

Risks for hip fractures include

A

increasing age, previous fracture, visual impairment, institutionalization, and osteoporosis.

60
Q

hip fracture physical exam

A

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
Q

knee fracture

A

associated with large effusion
swelling, significant pain with movement

62
Q

ankle fracture symptoms

A

pain, swelling, inability to bear weight, decreased ROM

63
Q

stress fractures

A

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
Q

most common type of headache

A

tension, migraine

65
Q

A tension-type headache produces

A

bilateral mild to moderate pressure without other symptoms

66
Q

migraine symptoms

A

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
Q

cluster headache symptoms

A

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
Q

red flags for headache

A

“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
Q

panic disorder symptoms

A

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
Q

Depression is characterized by

A

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
Q

acute diarrhea defined

A

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
Q

Diarrhea patients with a bacterial infection

A

may have additional symptoms such as a fever, tenesmus, and/or bloody stools.

73
Q

pt with viral diarrhea infection

A

nausea and/or vomiting with the onset 24 to 48 hours after possible exposure

74
Q

foodborne illness diarrhea

A

experiences symptom onset 2 to 7 hours after possible exposure

75
Q

if diarrhea over 7 days

A

suspect parasitic infection

76
Q

constipation defined

A

Constipation is characterized by difficult stool passage, infrequent stools (fewer than three per week), or both

77
Q

One of the most effective treatments for constipation

A

is increased water intake.

78
Q

Common triggers of GERD by affecting the LES

A

include smoking, alcohol, citrus foods, spicy foods, caffeine, chocolate, and mints.

79
Q

hypertension urgent care treatment

A

clonidine, pt sit quietly x20-30 min

80
Q

UTI Risk factor- pre menopause

A

sexually active
previous UTI

81
Q

UTI risk factor- post menopause

A

urinary incontinence
history of uti prior to menopause

82
Q

purpose of skin

A

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
Q

Wound healing process phases

A

Injury phase
Inflammatory phase
Epithelialization phase
remodeling phase

84
Q

Injury phase

A

involves coagulation and platelet release
process enhances the inflammatory response in the wound

85
Q

Inflammatory phase

A

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
Q

Epithelialization phase

A

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
Q

tensile strength values

A

the wound will have only 15% to 20% of its normal tensile strength at 3 weeks and 60% by 4 months

88
Q

Remodeling phase

A

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
Q

partial thickness wound

A

if all layers of the skin have not been violated

90
Q

full-thickness

A

If any subdermal tissue can be seen in the wound, it is considered a

91
Q

Circulation should be assessed by determining if

A

the distal extremity has a strong pulse

92
Q

Exposed tendon will appear as

A

a shiny white structure in the wound.
Pain during movement can indicate a partial tendon laceration

93
Q

If the wound is near a joint and a violation of the joint capsule cannot be ruled out

A

, 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
Q

he presence of a fracture near the wound defect must be treated as

A

an open fracture

95
Q

All patients with wounds should be asked about

A

prior tetanus immunization. If more than 5 years have elapsed, a tetanus booster should be administered

96
Q

most effective way to decrease the bacterial count in a wound is through

A

irrigation with a high-pressure stream of solution aimed directly into the wound.

97
Q

Wounds that have an increased risk of infection

A
  • 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
Q

Patients with wound who have diabetes mellitus or who have a history of vascular compromise should be

A

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
Q

follow up high risk wound

A

1-2 days

100
Q

risk of infection with cat bite

A

50%

101
Q

Wounds at low risk for infection include bites on

A

the face, ears, scalp, and mouth.

102
Q

High-risk bite wounds include

A

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
Q

signs of infection in bite wound

A

Infection will be evidenced by increased pain, swelling, erythema, warmth, decreased range of motion at joints, or drainage from a puncture-wound site

104
Q

pain management bite wound

A

Nsaids
Tylenol
toradol if needed

105
Q

For patients with absent or incomplete tetanus primary immunization

A

, 250 units of tetanus immune globulin should be given in addition to the primary vaccination.

106
Q

antibiotic prophylactic therapy bite wound

A

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
Q

follow up bite wound

A

2 days

108
Q

medications that cause photosensitivity

A

, such as oral contraceptives, tetracyclines, amoxicillin, sulfa drugs, and thiazide diuretics

109
Q

The response of all organ systems to burn injury occurs in a biphasic pattern of

A

hypofunction followed by hyper-function

110
Q

fibroblastic phase

A

, 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
Q

superficial (first-degree) burns.

A

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
Q

Superficial partial-thickness (second-degree) burns

A

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
Q

Deep partial-thickness (second-degree) burns.

A

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
Q

Full-thickness (third-degree) burns.

A

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
Q

Major burn labs

A

CBC
electrolyte panel
BUN/creat
glucose
ABG
COHb

116
Q

major burn definition

A

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
Q

Signs and symptoms of smoke inhalation

A

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
Q

superficial (1st degree) burn tx

A

cool with wet compress
aloe vera
nsaid
prednisone if sever

119
Q

2nd degree burn tx

A

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
Q

chemical burn tx

A

stop burning process, arrange for transport to ED
irrigate with water for 30-60 min

121
Q

burn injury follow up

A

1 day

122
Q

leading cause of head injury

A

falls

123
Q

cerebral contusion

A

is a focal brain injury involving cortical bruising, and, at times, vessel lacerations.

124
Q

coup contusion

A

injury directly beneath point of impact

125
Q

contre coup contusion

A

injury directly opposite the point of impact

126
Q

concussion

A

associated with loss of consciousness
diffuse brain injury
retrograde/post traumatic amnesia

127
Q

post concussion syndrome

A

24h-6 months after injury
HA, dizziness, fatigue, irritability, insomnia, anxiety, impaired concentration, loss of memory

128
Q

order head CT on head injury if

A

on anticoag
LOC
altered mental status
etoh/drug ingestion
repeated vomiting
GCS below 15
>60 yrs
Battles sign or raccoon eyes

129
Q

Epidural hematomas are typically characterized by

A

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
Q

When a patient complains of “the worst headache of my life,” the clinician should suspect

A

a subarachnoid hemorrhage

131
Q

GCS areas

A

eye opening
motor response
verbal response

132
Q

The early signs of increased ICP include

A

headache, nausea and vomiting, amnesia, altered level of consciousness, changes in speech, drowsiness, agitation, restlessness, and/or loss of judgment

133
Q

Late signs of increased ICP are

A

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
Q

Cushing response

A

changes in RR
decrease HR
increased systolic BP (widened pulse pressure)

135
Q

Hemotympanum

A

—blood behind the tympanic membrane

136
Q

Battle’s sign

A

—ecchymosis over the mastoid process

137
Q

PRICE Therapy

A

Tx of musculoskeletal strain/sprain
Protection
Rest
Ice
Compression
Elevation

138
Q

follow up fracture

A

3-4 days by ortho surgeon after cast applied

139
Q

Spontaneous pneumothorax, which accounts for two-thirds of all pneumothoraxes, occurs most commonly

A

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
Q

The most frequent presenting symptoms in patients with pneumothorax and hemothorax are

A

dyspnea and chest pain.

Primary Care I (7 decks)

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