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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
Q

About 80% of hemoptysis cases are related to

A

inflammatory causes, such as bronchitis, bronchiectasis, pneumonia, and TB

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26
Q

About 95% of pulmonary blood circulation is supplied by the

A

pulmonary artery and its branches, which is a low-pressure system.

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27
Q

hemoptysis bleeding arises typically from

A

bronchial circulation (high pressure system)

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28
Q

If hemoptysis occurs in patients aged 45 years or younger, it is likely caused by

A

mitral stenosis, TB, bronchiectasis, or lung abscess.

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29
Q

For patients older than age 45 years, common causes of hemoptysis include

A

bronchogenic carcinoma, bronchitis, TB, and pulmonary embolus with infarction

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30
Q

Nicotine addiction fulfills all the criteria of a drug addiction:

A

compulsive use, psychoactive effects, withdrawal symptoms, and drug-reinforcing behavior.

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31
Q

the leading preventable cause of disease, disability, and death in the United States, particularly from cardiovascular disease, cancer, and lung disease.

A

Tobacco use is

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32
Q

% of smokers that start before age 18

A

90%

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33
Q

primary predictors of smoking status in the United States and Canada.

A

low socioeconomic status and low educational attainment are now the

34
Q

nicotine

A

At low doses, it acts as a stimulant; at high doses, it depresses the central nervous system (CNS)

35
Q

amount of nicotine that delivers to lungs

A

1-2 mg/cigarette

36
Q

nicotine affects the transmission of nervous system signals by mimicking

A

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
Q

CO affect on oxygen carrying capacity

A

binding affinity for hemoglobin molecule that is 250x greater than O2

38
Q

The irritating effect of the smoke causes what on respiratory system .

A

hyperplasia of cells, including goblet cells, which results in increased mucus production

39
Q

Chronic effects of nicotine use include the development of

A

tolerance and chemical dependence

40
Q

Nicotine withdrawal symptoms includ

A

e a dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, poor concentration, restlessness, decreased heart rate, and increased appetite

41
Q

smokers vitals

A

Their weight and blood pressures are slightly lower and their heart rates are slightly faster than those of nonsmokers.

42
Q

Women who smoke are at increased risk for

A

decreased fertility, early menopause, decreased bone density, and osteoporosis.

43
Q

Smokers are at increased risk for

A

bone fractures, premature skin wrinkling, gingival recession, dental caries, periodontal disease, cataracts, and glaucoma.

44
Q

should alert the clinician to respiratory problems related to smoking.

A

A productive cough, dyspnea, wheezing, and fatigue

45
Q

a major metabolite of nicotine and is a useful marker

A

Cotinine is

46
Q

5 A’s of smoking cessation

A

Ask, Advise, Assess, Assist, and Arrange

47
Q

five stages of behavioral change in their attempts at cessation

A

(1) precontemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance

48
Q

precontemplation stage

A

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
Q

contemplation stage

A

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
Q

Preparation stage

A

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
Q

action stage

A

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
Q

maintenance stage

A

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
Q

hypnosis and smoking cessation

A

The effects of hypnosis are often short lived. Controlled trials of hypnosis have generally not documented long-term efficacy for smoking cessation.

54
Q

Buproprion

A

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
Q

chantix (varenicline)

A

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
Q

nictoine replacement therapies

A

gum, patches, lozenges, nasal spray, inhalers
gum- must be chewed until peppery, then placed in buccal mucosa

57
Q

nicotine patch

A

if >10 cigs/day, highest dose
AE: skin reaction, insomnia, vivid dreams, myalgias

58
Q

nicotine nasal spray

A

delivers nicotine at more rapid pace than other modalities
AE: nasal/throat irritation, rhinitis, sneezing, coughing, watering eyes

59
Q

off label meds for smoking cessation

A

nortriptyline
clonidine

60
Q

smoking cessation f/u

A

1 week post quit date phone call
f/u 1-3 months

61
Q

decrease in deaths over past 40 years in CV events are from

A

advances in medication, surgical treatment- not behavior modification

62
Q

lifestyle changes can have a significant impact in reducing mortality risk,

A

including smoking cessation (12%) and an increase in physical activity (5%)

63
Q

Critical components of the history include appraisal of the major symptoms of heart disease,

A

including chest pain, dyspnea, syncope, and heart failure.

64
Q

if chest pain ask all age groups about

A

exercise tolerance

65
Q

anxiety and bereavement can cause

A

diffuse chest pain that lasts for hours

66
Q

the pain of costochondritis (a type of chest wall syndrome [CWS]) is often described as

A

localized, and it may be replicated with arm movement or pressing on the area of tenderness (point tenderness).

67
Q

the discomfort of angina pectoris is classically described as

A

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
Q

The terms “unstable angina,” “preinfarct angina,” and “crescendo angina” are synonyms used to describe

A

the new onset of cardiac ischemic chest pain at rest but without evidence of acute myocardial infarction (MI).

69
Q

chest pain with ____ is particularly worrisome

A

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
Q

the patient who is experiencing an acute MI often complains of

A

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
Q

In particular, women, older adults, and people with diabetes mellitus are likely to have

A

minimal or atypical symptoms with an acute MI

72
Q

If the patient reports a sensation of a strong but regular rhythmic beating of the heart after stress or exertion, this likely indicates

A

a normal physiological response to increased catecholamine production.

73
Q

If there is a report of skipped or missed beats, particularly with the sensation that the heart “stopped” momentarily, this may indicate

A

the presence of an atrial or ventricular ectopic beat.

74
Q

Atrial ectopic beats

A

are most often benign, occurring with excessive caffeine, alcohol, or tobacco use

75
Q

Ventricular ectopic beats

A

are somewhat more likely to indicate cardiac pathology than atrial ectopy.

76
Q

Syncope

A

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
Q

Cardiac-related syncope

A

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
Q

Presyncope

A

, a state of light-headedness, feeling faint, and muscular weakness, is most often cardiovascular in origin.

79
Q

vertigo

A

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
Q

Orthopnea

A

is shortness of breath that begins when the patient has been in a supine position, such as when lying face up in bed.

81
Q

three-pillow orthopnea

A

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
Q

Paroxysmal nocturnal dyspnea (PND)

A

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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