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Primary Care I > Module 4 > Flashcards

Module 4 Flashcards

1
Q

Each year americans seek treatment for this more than any other complaint

A

cough

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2
Q

chronic cough

A

is defined as one that lasts longer than 8 weeks.

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3
Q

Research indicates that this is the most accurate way for a patient to rate dyspnea

A

vertical analog- scale 1-10

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4
Q

The most common cause of chronic cough

A

is cigarette smoking, which triggers the cough reflex by direct bronchial irritation

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5
Q

All patients taking nitrofurantoin (Macrobid) should be monitored for changes in

A

lung function.

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6
Q

Crackles are typically related to

A

fluid accumulation in the lungs, and generally do not clear with cough.

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7
Q

Rhonchi

A

, which are typically due to mucus accumulation, do clear after the patient is asked to cough and clear the airways.

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8
Q

The CT scan has replaced bronchography in diagnosing

A

bronchiectasis

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9
Q

In patients with chronic cough who are weak and debilitated, the goal is to

A

reduce complications from uncontrolled, forceful coughing, such as fractured ribs, pneumothorax, aspiration, exhaustion, sleep deprivation, and post-tussive syncope.

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10
Q

With severe, acute coughing that disrupts sleep and causes pain or extreme fatigue and weakness, it may be necessary to treat with

A

antitussives

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11
Q

Decongestants and antihistamines, alone or in combination, are indicated in cases of

A

allergic rhinitis and postnasal drip

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12
Q

Expectorants are intended to

A

decrease sputum viscosity and are used when the patient has a productive cough and needs help in clearing the airways.

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13
Q

most cost effective way to liquefy secretions

A

increse water intake to 3-4 liters/daily

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14
Q

if taking guaifenesin, patient must

A

drink plenty of fluids

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15
Q

two herbal remedies used for cough

A

horehound- cough suppressant
licorice-calm coughs, expectorant qualities (may increase BP)

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16
Q

cigarette smoke effect on airway

A

Cigarette smoke destroys the mucociliary structures of the airway lining and reduces the body’s natural ability to clear mucus and respiratory pathogens

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17
Q

is estimated to be the third most frequent reason for seeking medical attention

A

Dyspnea, or shortness of breath,

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18
Q

In older patients, this is the major atypical presentation for ischemic heart disease and myocardial infarction and is considered a frequent anginal equivalent.

A

dyspnea

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19
Q

common presentation of anxiety-related dyspnea

A

Onset of dyspnea at rest, accompanied by a sense of chest tightness, a feeling of suffocation, and an inability to “get air in,” is a .

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20
Q

Bronchial lung sounds heard at other than the normal locations (tubular sounds) are common with

A

acute bronchitis.

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21
Q

Borg scale for perceived exertion

A

with a score of 6 to 20 (6 = no exertion; 20 = very, very hard exertion

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22
Q

COHb levels found in heavy smokers

A

4-15%

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23
Q

Initial dyspnea treatment is directed at

A

helping the patient find relief from the shortness of breath by removing the underlying cause and contributing factors

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24
Q

Hemoptysis

A

is defined as the expectoration of blood

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25
About 80% of hemoptysis cases are related to
inflammatory causes, such as bronchitis, bronchiectasis, pneumonia, and TB
26
About 95% of pulmonary blood circulation is supplied by the
pulmonary artery and its branches, which is a low-pressure system.
27
hemoptysis bleeding arises typically from
bronchial circulation (high pressure system)
28
If hemoptysis occurs in patients aged 45 years or younger, it is likely caused by
mitral stenosis, TB, bronchiectasis, or lung abscess.
29
For patients older than age 45 years, common causes of hemoptysis include
bronchogenic carcinoma, bronchitis, TB, and pulmonary embolus with infarction
30
Nicotine addiction fulfills all the criteria of a drug addiction:
compulsive use, psychoactive effects, withdrawal symptoms, and drug-reinforcing behavior.
31
the leading preventable cause of disease, disability, and death in the United States, particularly from cardiovascular disease, cancer, and lung disease.
Tobacco use is
32
% of smokers that start before age 18
90%
33
primary predictors of smoking status in the United States and Canada.
low socioeconomic status and low educational attainment are now the
34
nicotine
At low doses, it acts as a stimulant; at high doses, it depresses the central nervous system (CNS)
35
amount of nicotine that delivers to lungs
1-2 mg/cigarette
36
nicotine affects the transmission of nervous system signals by mimicking
acetylcholine. It occupies receptor sites at the synapses and prevents the transmission of nerve impulses from neuron to neuron and from neuron to muscle cells
37
CO affect on oxygen carrying capacity
binding affinity for hemoglobin molecule that is 250x greater than O2
38
The irritating effect of the smoke causes what on respiratory system .
hyperplasia of cells, including goblet cells, which results in increased mucus production
39
Chronic effects of nicotine use include the development of
tolerance and chemical dependence
40
Nicotine withdrawal symptoms includ
e a dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, poor concentration, restlessness, decreased heart rate, and increased appetite
41
smokers vitals
Their weight and blood pressures are slightly lower and their heart rates are slightly faster than those of nonsmokers.
42
Women who smoke are at increased risk for
decreased fertility, early menopause, decreased bone density, and osteoporosis.
43
Smokers are at increased risk for
bone fractures, premature skin wrinkling, gingival recession, dental caries, periodontal disease, cataracts, and glaucoma.
44
should alert the clinician to respiratory problems related to smoking.
A productive cough, dyspnea, wheezing, and fatigue
45
a major metabolite of nicotine and is a useful marker
Cotinine is
46
5 A's of smoking cessation
Ask, Advise, Assess, Assist, and Arrange
47
five stages of behavioral change in their attempts at cessation
(1) precontemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance
48
precontemplation stage
Smokers in the precontemplation stage have no desire to quit in the next 6 to 12 months. These individuals usually benefit from motivational interventions that increase awareness of the adverse effects of smoking.
49
contemplation stage
Smokers who seriously thinking about and express interest in quitting but are not yet ready to do so are in the contemplation stage. These smokers also benefit from motivational counseling emphasizing the negative effects of smoking.
50
Preparation stage
Smokers who are serious about quitting and have taken the initial steps toward cessation are in the preparation stage. Individuals in this stage benefit from interventions that assist them in quitting. These interventions include providing information about nicotine replacement and developing behavior modification skills.
51
action stage
During the action stage, the smoker quits smoking. The action stage lasts from several weeks to 6 months after cessation, which is a common time of relapse. Because of the likelihood of relapse during this stage, interventions should address relapse prevention, including congratulating successes and rewarding positive behavioral changes with more frequent contacts by the clinician.
52
maintenance stage
When a smoker has abstained from cigarettes for 6 months, the maintenance stage begins. Most successful quitters relapse and recycle through these stages three or four times before attaining long-term abstinence; some may take several years to move through these stages until abstinence can be maintained.
53
hypnosis and smoking cessation
The effects of hypnosis are often short lived. Controlled trials of hypnosis have generally not documented long-term efficacy for smoking cessation.
54
Buproprion
smoking deterrent, antidepressant well tolerated- AE: HA, insomnia, dry mouth small risk of seizure Should be started 1-2 weeks prior to patient's quit date. 150mg daily x3 days, then bid daily Tx duration: 7-12 weeks
55
chantix (varenicline)
smoking cessation aid begin 1 week prior to target quit date 0.5mg x3 days, 0.5mg bid x4 days, 1mg bid x12 weeks caution with psych history
56
nictoine replacement therapies
gum, patches, lozenges, nasal spray, inhalers gum- must be chewed until peppery, then placed in buccal mucosa
57
nicotine patch
if >10 cigs/day, highest dose AE: skin reaction, insomnia, vivid dreams, myalgias
58
nicotine nasal spray
delivers nicotine at more rapid pace than other modalities AE: nasal/throat irritation, rhinitis, sneezing, coughing, watering eyes
59
off label meds for smoking cessation
nortriptyline clonidine
60
smoking cessation f/u
1 week post quit date phone call f/u 1-3 months
61
decrease in deaths over past 40 years in CV events are from
advances in medication, surgical treatment- not behavior modification
62
lifestyle changes can have a significant impact in reducing mortality risk,
including smoking cessation (12%) and an increase in physical activity (5%)
63
Critical components of the history include appraisal of the major symptoms of heart disease,
including chest pain, dyspnea, syncope, and heart failure.
64
if chest pain ask all age groups about
exercise tolerance
65
anxiety and bereavement can cause
diffuse chest pain that lasts for hours
66
the pain of costochondritis (a type of chest wall syndrome [CWS]) is often described as
localized, and it may be replicated with arm movement or pressing on the area of tenderness (point tenderness).
67
the discomfort of angina pectoris is classically described as
a diffuse, retrosternal sensation of pain, often with radiation, and a heavy, burning sensation, usually lasting more than 1 minute but less than 10 minutes. Exertional symptoms are usually more common in individuals with fixed atherosclerotic lesions
68
The terms “unstable angina,” “preinfarct angina,” and “crescendo angina” are synonyms used to describe
the new onset of cardiac ischemic chest pain at rest but without evidence of acute myocardial infarction (MI).
69
chest pain with ____ is particularly worrisome
The presence of diaphoresis with chest pain is particularly worrisome, often indicating a significant drop in cardiac output during the episode of pain and subsequent decreased perfusion of the skin
70
the patient who is experiencing an acute MI often complains of
anginal-like chest pain that lasts in excess of 20 minutes but occasionally waxes and wanes during that period. The pain is frequently accompanied by dyspnea, diaphoresis, nausea, and dizziness. The pain may radiate to the neck, jaw, shoulder, or arm (left side more than right)
71
In particular, women, older adults, and people with diabetes mellitus are likely to have
minimal or atypical symptoms with an acute MI
72
If the patient reports a sensation of a strong but regular rhythmic beating of the heart after stress or exertion, this likely indicates
a normal physiological response to increased catecholamine production.
73
If there is a report of skipped or missed beats, particularly with the sensation that the heart “stopped” momentarily, this may indicate
the presence of an atrial or ventricular ectopic beat.
74
Atrial ectopic beats
are most often benign, occurring with excessive caffeine, alcohol, or tobacco use
75
Ventricular ectopic beats
are somewhat more likely to indicate cardiac pathology than atrial ectopy.
76
Syncope
is a loss of consciousness that occurs abruptly as a discrete episode and usually lasts for a short period of only a few minutes
77
Cardiac-related syncope
is an ominous sign associated with high rates of mortality. A syncopal episode may be the only warning sign of impending sudden cardiac death. One of the most common cardiac causes of syncope is cardiac arrhythmias.
78
Presyncope
, a state of light-headedness, feeling faint, and muscular weakness, is most often cardiovascular in origin.
79
vertigo
is the sensation of spinning that can often be reproduced by a change in head position. Vertigo is not usually caused by decreased cerebral blood flow; an inner ear disturbance is the most common cause.
80
Orthopnea
is shortness of breath that begins when the patient has been in a supine position, such as when lying face up in bed.
81
three-pillow orthopnea
The patient usually compensates for this sensation by sleeping on an increased number of pillows to elevate the upper body, hence the use of the qualifying term
82
Paroxysmal nocturnal dyspnea (PND)
is shortness of breath that occurs 1 to 2 hours into sleep, concurrent with the redistribution of bodily fluids and a subsequent rise in left atrial pressure. The person awakens suddenly with significant difficulty breathing. He or she usually stands or sits up until symptoms are relieved in about 10 to 30 minutes. As with orthopnea, the diagnosis of CHF should be considered in patients with PND

Primary Care I (7 decks)

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