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Primary Care II > Module 4 > Flashcards

Module 4 Flashcards

1
Q

most common mode of transmission for acute infectious gastroenteritis is

A

the fecal–oral route from contaminated food or water.

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2
Q

Numerous fecal leukocytes in patients with acute diarrhea is indicative of

A

diffuse colonic inflammation and is highly suggestive of an invasive pathogen such as Shigella, Salmonella, or Campylobacter.

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3
Q

A stool culture should be done on any patient who

A

has severe diarrhea, a fever of 101.3°F (38.5°C) or higher, the presence of bloody stools, or stools that test positive for leukocytes, lactoferrin, or occult blood

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4
Q

if persistent diarrhea

A

examine stool for ova or parasites

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5
Q

Viral gastroenteritis should be suspected in patients who present with

A

vomiting as the major symptom and in cases where food- or waterborne contamination is suspected and the incubation period is greater than 12 hours

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6
Q

gastroenteritis fluid replacement

A

sodium content 45-75 mEq

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7
Q

gastroenteritis diet

A

calories come from boiled starches, cereal to facilitate enterocyte renewal

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8
Q

ABX gastroenteritis

A

only if positive leukocytes

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9
Q

hepatitis types

A

ABCDE chronic

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10
Q

HAV cause

A

contaminated water or food
fecal oral
no chronic cases

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11
Q

HBV cause

A

direct contact with infected blood, blood products, sexual contact

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12
Q

HCV

A

genotype 1 most common
percutaneous exposure to blood
chronic cases common

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13
Q

HDV

A

requires hbv for replication

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14
Q

HEV

A

transmitted fecal oral route
not as easily transmitted as HAV

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15
Q

chronic hepatitis

A

elevated AST, ALT for more than 6 months
85% of people with HCV

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16
Q

prodromal phase hepatitis

A

abrupt or insidious onset with anorexia, n/v, URI, flu symptoms
fever
abdominal pain mild and RUQ

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17
Q

icteric phase

A

jaundice, dark urine 5-10 days after initial symptoms

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18
Q

convalescent phase

A

increased sense of well being

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19
Q

hallmark of all forms of acute hepatitis

A

elevated aminotransferase levels

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20
Q

hep tx

A

supportive
restrict activity

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21
Q

appendicitis

A

RLQ pain (begins as vague pain, then periumbilical then RUQ)
fever

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22
Q

if pt with RLQ pain presents with shaking chills

A

suspect perforation of appendix

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23
Q

appendicitis abx

A

third gen cephalosporins (gentamicin, clindamycin)

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24
Q

In most patients, the normal resting or baseline LES pressure is

A

10 to 30 mm Hg

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25
Q

In patients who have severe disease, the LES is incompetent, with a resting pressure of

A

less than 10 mm Hg

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26
Q

Barrett’s epithelium

A

he body replaces the normal squamous epithelium with metaplastic columnar epithelium (Barrett’s epithelium) containing goblet and columnar cells. This new epithelium is more resistant to acid and, therefore, supports esophageal healing. Barrett’s epithelium is a premalignant tissue, however, and confers a 40-fold increased risk for the development of esophageal adenocarcinoma

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27
Q

gerd lifestyle mods

A

weight loss (moderate level of evidence); elevating the head of the bed 6 to 8 inches and avoidance of meals 2 to 3 hours before bedtime (low level of evidence); and avoidance of certain foods known to trigger reflux (chocolate, alcohol, caffeine, acidic or spicy foods)

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28
Q

PPIs

A

trial for 8 weeks
taken 30-60 min before meals

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29
Q

peptic ulcer dx

A

penetrates the muscularis mucosa and is usually larger than 5 mm in diameter.

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30
Q

damage from PUD is caused by

A

h pylori or
Nsaids

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31
Q

PUD ulcer location

A

mostly duodenum, within 3 cm of pylorus

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32
Q

hallmark of PUD

A

burning or gnawing senesation relieved by food or antacids

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33
Q

PUD tx

A

PPI, H2RA,

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34
Q

h pylori tx

A

The standard triple-drug therapy is the combination of two antibiotics (clarithromycin and either amoxicillin or metronidazole) with a PPI all twice a day for 14 days

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35
Q

Internal hemorrhoids most often present with

A

rectal bleeding described as bright red streaks on the toilet paper.

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36
Q

hemorrhoid tx- lifestyle

A

directed at decreasing straining with defecation and modification of toilet habits. Patients are encouraged to avoid sitting on the toilet for long periods of time, to use some form of bulk-forming laxative, and to increase their daily fiber intake slowly to 25 to 35 g to establish regular, formed stools

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37
Q

hemorrhoid tx meds

A

topical hydrocortisone cream

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38
Q

most common type of hernia

A

groin ( indirect inguinal)

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39
Q

shutter mechanism

A

, whereby the internal oblique muscle and the transversus abdominis muscles contract to overlap, strengthening the posterior wall of the inguinal canal

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40
Q

closure or sphincter-type mechanism causes contraction

A

of the musculature, displacing the transversalis fascia, which in effect decreases the diameter of the deep inguinal ring.

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41
Q

indirect inguinal hernia

A

tissue herniates through the internal inguinal ring, which in men extends the length of the spermatic cord. With continued pressure, the sac can reach the scrotum, where it is then palpable just proximal to Hesselbach’s triangle

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42
Q

IBS definition

A

two of the following features must be present: abdominal pain or discomfort that is relieved by defecation; change in frequency in stool; and a change in the appearance of the stool.

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43
Q

IBS presentation

A

LLQ pain, sharp/burning or ache, precipitated by eating, relieved with BM

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44
Q

IBS lifestyle mods

A

high fiber regardless of initial presentation
hydration
probiotics

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45
Q

ibs med tx

A

antidiarrheal short term only
dicyclomine (antispasmodic) for abdominal pain
TCAs

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46
Q

Celiac dx

A

may be asymptomatic
diarrhea, weight loss, dyspepsia, flatulence

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47
Q

celiac dx lab

A

anti-tTG igA antibodies

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48
Q

bowel obstruction

A

sudden onset of colicky abdominal pain accompanied by n/v- intermittent and corresponds with perstaltic waves
brown feculent type emesis
diarrhea
observe for areas of previous abdominal sx

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49
Q

dx of bowel obstruction

A

XR

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50
Q

diverticular dx cause

A

? low fiber diet implicated

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51
Q

diverticular dx presentation

A

LLQ abdominal pain
pain worse after eating
diarrhea, constipation alternating

52
Q

diverticulitis presentation

A

fever, chills, tachycardia, llq abdominal pain

53
Q

diverticulitis dx

A

CT with oral contrast

54
Q

mild diverticulitis tx

A

rest, clear liquid diet

55
Q

abx for diverticulitis

A

amoxicillin and clavulanate potassium bid x7-10 days

56
Q

IBD types

A

ulcerative colitis, crohn’s dx

57
Q

UC stool characteristics

A

blood, purulent mucus diarrhea

58
Q

UC presentation

A

abdominal cramps relieved with defecation, blood and mucus in stool

59
Q

CD presentation

A

abdominal cramping, tenderness, fever, anorexia, weight loss, spasm

60
Q

acute UC dx

A

sigmoidoscopy, colonoscopy only when improvement or tx begun

61
Q

UC tx

A

nutrition counseling- avoid caffeine, raw fruits, veggies, other foods high in fiber
steroid enema/foam nightly x2 weeks
advanced: systemic glucocorticoid with other therapy

62
Q

crohns tx

A

oral prednisone daily
sulfasalazine
immunosuppressive tx

63
Q

colorectal ca

A

2nd leading cancer killer in USA

64
Q

risk factor colorectal ca

A

age is most important

65
Q

The physiology of micturition involves three major components of urine storage and release:

A

the central nervous system (CNS), the bladder, and the bladder outlet (urethral sphincters).

66
Q

during physical exam for UI, monitor for

A

CHF- 50% of pts with CHF have UI

67
Q

UI Dx tests

A

UA with cx
postvoid residual

68
Q

Stress incontinence

A

is the involuntary loss of urine resulting from increased intra-abdominal pressure, such as that caused by coughing, sneezing, and laughing

69
Q

stress incontinence tx

A

pelvic floor ed
electrical stim
weight loss
eliminate diuretics

70
Q

urge incontinence

A

involuntary leakage of urine resulting from an inability to delay voiding. The patient has the sensation of a full bladder but is not able to store the urine long enough to reach the toilet

71
Q

urge incontinence tx

A

pelvic floor tx
scheduled or prompted voiding

72
Q

overflow incontinence

A

involuntary leakage of small amounts of urine

73
Q

Credé’s maneuver

A

involves applying pressure over the symphysis pubis and slowly pressing down. This is particularly helpful in patients who have a spinal cord injury or other neurologic problems.
use in overflow incontinence

74
Q

most common cause of uti

A

e coli

75
Q

uncomplicated uti tx

A

3 day course of TMP-SMX or 10 days ampicillin
alternatively, 7 days macrobid

76
Q

pyelonephritis presentation

A

triad: fever, CVA pain, N/v

77
Q

pyelonephritis f/u

A

48 hours after initial tx to assess response

78
Q

nephrolithiasis types

A

calcium salt (most common)
struvite
uric acid
cystine

79
Q

kidney stone risk factor

A

sedentary lifestyle
occupation with high environmental temps

80
Q

kidney stone presentation

A

renal colic (pain that isn’t relieved with position changes)
nausea, urinary frequency, vomiting, diaphoresis

81
Q

kidney stone tx

A

hydration
pain management- NSAIDs, narcotics

82
Q

acute kidney injury definition

A

AKI is defined when one of the following criteria is met: serum creatinine rises to 26 mol/L or more within 48 hours or 1.5-fold or greater from the reference value, which is known or presumed to have occurred within 1 week, or urine output is less than 0.5 mL/kg/h for more than 6 consecutive hours

83
Q

major risk factor for AKI

A

surgery

84
Q

Prerenal azotemia is

A

any condition that leads to an overall decrease in renal perfusion; etiologies in this group include hypovolemia, renovascular disease, decreased cardiac output, systemic vasodilation, renal vasoconstriction, and impairment of renal autoregulation of blood flow, which is often associated with drugs such as ACE inhibitors or NSAIDs

85
Q

Intrarenal azotemia

A

refers to disorders that affect the renal parenchyma itself, such as glomerulonephritis, acute tubular necrosis (ATN) (often caused by ischemic insult or nephrotoxic drugs such as aminoglycosides), interstitial nephritis (often an allergic reaction to various drugs or transfusion reactions), and tubular obstruction

86
Q

Postrenal azotemia

A

refers to any etiology that might lead to an obstruction of urine flow from the kidneys, including ureteral obstruction, bladder neck obstruction, or urethral obstruction. Major causes include benign prostatic hyperplasia/hypertrophy (BPH), prostate or bladder cancer, and metastatic disease affecting the urinary tract.

87
Q

no-reflow phenomenon.

A

Renal blood flow can be reduced by 50% after an ischemic episode; this is termed the

88
Q

reperfusion injury.

A

The formation of free radical reactive oxygen species further exacerbates cellular damage and apoptosis (programmed cell death) during reperfusion after a prolonged renal ischemic event, an event termed

89
Q

Clinical indications of ANT

A

oliguria (less than 500 ML urine daily)
decreased urea excretion, elevated BUN, elevated creat

90
Q

reasons why kidney suspectible to toxic damage

A

Blood continuously circulates through the kidney, repeatedly exposing the tissues to all substances carried by the blood. Also, the kidney is the major excretory organ for toxic substances, and, as these substances await transport within renal cells, they disrupt cellular function

91
Q

symptoms of AKI

A

Not present until GFR is 10-15% of normal
fatigue, malaise, n/v, pruritus, mental status change

92
Q

initiating stage

A

begins when the kidney is injured; this stage is variable in length, from minutes to several days (e.g., renal damage caused by contrast dye may occur within 2 minutes). Decreased urine volume and other signs and symptoms of renal impairment may then become evident. These may include anorexia, lethargy, nausea, headache, muscle cramps, and fatigue

93
Q

oliguric stage

A

usually lasts from 5 to 15 days but can persist for weeks, depending on the nature of renal damage. Renal repair begins as tubular cells regenerate. The destroyed basement membrane is replaced with fibrous scar tissue, and nephrons become obstructed with a build-up of inflammatory products

94
Q

diuretic stage

A

, defined as beginning when urine output increases to greater than 400 mL per day and BUN begins to fall. This stage is considered to last until the BUN level stabilizes or is in the normal range and may take from 1 to 2 weeks

95
Q

recovery phase

A

, extends from the time BUN stabilizes and urine output returns to normal to the day the patient returns to normal activity. This recovery process may take up to 10 months or more, and some patients never recover but instead progress to CRF

96
Q

The major underlying conditions leading to ESRD are

A

diabetes mellitus and primary hypertension seen in approximately 70% of cases,

97
Q

Malignant nephrosclerosis is associated

A

with marked hypertension, headache, congestive heart failure, and blurred vision. Unlike the progression of benign nephrosclerosis, renal failure develops rapidly in malignant nephrosclerosis.

98
Q

Stage 1 CKD

A

Stage 1 disease is characterized by persistent albuminuria with a normal GFR greater than 90 mL/min per 1.73 m2 of BSA.

99
Q

Stage 2 CKD

A

Stage 2 disease is characterized by albuminuria with a GFR between 60 and 89 mL/min per 1.73 m2 of BSA

100
Q

Stage 3 CKD

A

Stage 3 disease is defined as a GFR between 30 and 59 mL/min per 1.73 m2 of BSA.

101
Q

Stage 4 CKD

A

Stage 4 disease is defined as a GFR between 15 and 29 mL/min/1.73 m2 of BSA

102
Q

Stage 5 CKD

A

Stage 5 disease is ESRD, defined as a GFR less than 15 mL/min/1.73 m2 of BSA

103
Q

baseline DI for CKD

A

US kidneys

104
Q

Given the importance of maintaining renal perfusion in CKD

A

systolic BPs lower than 110 mm Hg should be avoided

105
Q

CKD diet

A

2L water/day, 2g sodium/day, restricted protein

106
Q

renal tumor symptoms

A

dull, achy flank pain, abdominal mass
weight loss, fatigue

107
Q

bladder tumor symptoms

A

frequently asymptomatic, hematuria

108
Q

hallmarks of major depression, however, are

A

sadness and anhedonia (loss of pleasure)

109
Q

peripartum depression

A

1-3 weeks after birth

110
Q

PPD

A

During pregnancy, or up to 4 weeks after delivery
Risk: hx of depression, unplanned pregnancy, preterm birth

111
Q

criteria for major depressive episode

A

require 5 or more symptoms having been present during same 2 week period

112
Q

Definition of depression remission of symptoms

A

50% decrease in PHQ9 score

113
Q

initial therapy for moderate-severe depression (meds)

A

sertraline, escitalopram

114
Q

Bipolar Disorder I

A

Bipolar Disorder I: Patients with BD I have had at least one episode of mania. A major depressive episode is not required for diagnosis.

115
Q

Bipolar Disorder II

A

BD II is characterized by a history of both depression and hypomania.

116
Q

Cyclothymic Disorder

A

: Cyclothymia involves 2 years of symptoms of hypomania and depression that do not meet the full criteria for either mood episode.

117
Q

Treatment options for patients with BD I with hypomania, mania, or mixed episodes should begin with

A

lithium, valproic acid (Depakote), or atypical antipsychotic agents

118
Q

Lamotrigine is effective for patients who predominantly have had

A

depressed episodes

119
Q

gold standard for treatment of BD and has been shown to be uniquely effective in decreasing suicidal behavior

A

lithium

120
Q

tenth leading cause of death in USA

A

suicide

121
Q

Parasuicidal behavior describes patients who

A

injure themselves in nonlethal, ocassionally attention-seeking gestures, such as superficial cuts on wrists, but who do not wish to die. The behavior is a risk factor for suicide.

122
Q

The best predictor of suicide risk is a

A

history of a previous suicide attempt

123
Q

Generalized anxiety disorder (GAD) is characterized by

A

excessive worry (over 6 months) about multiple concerns that are difficult to control.

124
Q

Autonomic hyperactivity is

A

commonly manifested by excessive sweating, various gastrointestinal symptoms (increased acidity, nausea, and epigastric pain), palpitations, concentration problems, tachycardia, headaches, and shortness of breath

125
Q

panic disorder age peaks

A

Panic disorders typically appear in late adolescence or young adulthood, with a peak at 25 years of age. There is a second peak between 35 and 44 year

126
Q

PTSD symptom categorization

A

re-experiences traumatic event, avoidance symptoms, negative thoughts/feeling, hyperarousal symptoms for at least 1 month

127
Q

PTSD meds

A

paroxetine, sertraline

Primary Care II (4 decks)

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