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Primary Care III > Module 5 > Flashcards

Module 5 Flashcards

1
Q

bruise

A

bruise (ecchymosis) is an integumentary manifestation of extravasated blood. Discoloration of the skin is attributed to a local interstitial pool of erythrocytes, which causes a light to dark blue skin color associated with red pigment

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2
Q

bruise coloring changes

A

red, blue/purple, green, brown

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3
Q

Spontaneous bruising may be seen with platelet counts below

A

30,000 cells/mL

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4
Q

Spontaneous bruising may also be associated with the chronic use of

A

corticosteroid or anticoagulant therapies

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5
Q

fatigue

A

Fatigue presents as a complaint of tiredness that cannot be explained on the basis of exercise or other activity

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6
Q

acute fatigue

A

Acute fatigue is most often associated with viral or bacterial infections

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7
Q

functional fatigue

A

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.

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8
Q

acute fever

A

tends to be greater than 101.3

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9
Q

The ability of the body to elevate the temperature in the event of infection diminishes with

A

advancing age, due to a weakening of the immune system as one gets older.

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10
Q

chronic fever

A

tend to be low grade (100.4)

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11
Q

fever of unknown origin

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

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12
Q

fevers in excess of 104°F (40°C) tend to be associated with

A

pancreatitis, pyelonephritis, and intracranial pathology (e.g., bacterial meningitis)

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13
Q

Fevers between 101.3°F (38.5°C) and 104°F (40°C) are associated with

A

urinary tract infections and some acute viral syndromes

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14
Q

Fevers less than 101.3°F (38.5°C) are characteristic of

A

infectious hepatitis, some acute viral infections, and TB.

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15
Q

lymphadenopathy is used in clinical practice to designate

A

any abnormality of lymph nodes and, in particular, enlarged lymph nodes.

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16
Q

Typical sites for allergen exposure are

A

the skin and respiratory tree, where local reactions may occur.

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17
Q

atopy

A

Atopy is a term used to characterize an immunoglobulin (Ig)E-mediated immune response that is exaggerated or out of character for exposure to what appear to be innocuous environmental allergens

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18
Q

allergic reaction distribution

A

equal b/tw sexes, races
incidence higher in children

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19
Q

key cells types involved in allergic response

A

mast cells
basophils
eosinophils

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20
Q

group 1-3 allergic reaction

A

dependent on circulating antibodies

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21
Q

group 4 allergic reaction dependent on

A

cellular immune components

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22
Q

Type 1 allergic reaction

A

Immunoglobulin E mediated immediate hypersensitivity response

allergic rhinitis, asthma, anaphylaxis

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23
Q

7 step treatment for anaphylaxis

A
  1. give epi in upper lateral thigh with head below heart level
  2. repeat epi q 5-15 min
  3. support bronchodilation by giving albuterol
  4. if pulm arrest, intubate and provided resp support
  5. Start IV fluids to maintain BP above 90
  6. Give benadryl to relieve cutaneous symptoms
  7. Transfer to emergency center, give steroids
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24
Q

type 2 allergic reaction

A

antibody mediated cellular cytotoxicity response

neonatal Rh incompatibility

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25
Q

Type 3 allergic reaction

A

allergen immune complex response

systemic, delayed drug reactions

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26
Q

type 4 allergic reaction

A

delayed type cellular hypersensitivity response

contact dermatitis

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27
Q

2 elements common to subjective complaints associated with allergies

A
  1. exposure to allergen precedes onset of symptoms
  2. pts typically attempt to control symptoms with self care
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28
Q

urticaria associated with

A

type 1 response

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29
Q

type 1 response diagnostics

A

skin tests- if positive, wheal within 15-20 min

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30
Q

The most common form of asthma is

A

an allergen-driven atopic disease characterized by type 1 immune responses to environmental allergens, although it is distinct from systemic anaphylaxis

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31
Q

type 2 response diagnostics

A

rh testing of blood during pregnancy

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32
Q

type 3 response diagnostics

A

ELISA or biopsied skin reaction

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33
Q

type 4 diagnostic

A

skin testing
antigen specific igE levels

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34
Q

initial management allergic reaction

A

avoid further allergenic exposure

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35
Q

sympathomimetic (alpha receptor agonist)

A

sudafed, afrin
vasoconstrict engorged mucosa, may increase HR, irritability, anxiety, addiction
high abuse potential

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36
Q

immunotherapy

A

allergens given SQ in 0.5ml allotments with progressive increase in concentration until symptoms controlled for 3-5 years

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37
Q

rheumatoid arthritis

A

Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disease that primarily affects the synovial joints, although it may affect many organ systems. Joints are destroyed over a long course of disease remissions and exacerbations. Structural deformities, which create emotional as well as physical trauma for the patient, are common as the disease progresses.

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38
Q

RA epidemiology

A

women
prevalence increases with age, peak between 40-60
family pattern

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39
Q

RA subjective

A

awaken with joint pain, stiffness, improves as day progresses

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40
Q

RA objective

A

peripheral symmetric arthritis, morning stiffness >1 hour
PIP and MCP joints most affected, tender, swollen, immobile

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41
Q

RA diagnostics

A

initial- periph circulating RF
anti- CCP antibodies, ESR, CRP, CBC
xray (may not show anything early)

subsequent checks: monitor ESR or CRP

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42
Q

a positive RF titer of greater than 1:150 indicates

A

a poorer prognosis and is often accompanied by findings of severe disease, such as rheumatoid nodules

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43
Q

RA initial management

A

PT, heat/cold, exercise, rest (2h/day), assistive device, splints, meditation, chiropractor, weight loss

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44
Q

meds to treat RA

A

analgesics (acetaminophen, capsaicin cream)
NSAIDs
Steroids (daily therapy for max 6 months)
Plaquenil, arava, neoral, humira, rituxan

45
Q

RA follow up

A

Labs every 90 days- CBC, CMP, CRP (less than 0.8mg)

46
Q

CFS/fibromyalgia epidemiology

A

women
occurs in those affected by systemic inflammation disorders
hx: sexual/physical abuse

47
Q

CFS/fibromyalgia subjective

A

post exercise malaise, fatigue, polyarthralgia, HA, impaired memory, depression, sore throat

48
Q

CFS/FMS objective

A

sudden onset, shotty cervical lymph nodes
widespread muscular pain that is present for 3 months or more in 11/18 or more tedner points

49
Q

CFS/FMS treatment

A

cognitive behavioral therapy
graded exercise
very little evidence for med treatment

50
Q

sjogrens syndrome

A

chronic inflammatory autoimmune caused by exocrine dysfunction
dryness in all areas of body

51
Q

sjogren’s epidemiology

A

women
possible genetic predisposition
40-60 yrs

52
Q

sjogrens subjective

A

eye dryness, dry mouth, loss of taste/smell, dental caries, dysphagia

53
Q

sjogren’s objective

A

foul breath
beefy red tongue

54
Q

six defining criteria Sjogren’s

A
  1. inadequate tear production
  2. cornel epithelial damage
  3. decreased saliva
  4. lymphocytic infilitration of labil salivary gland tissue
  5. impaired salivary gland function
  6. autoantibiodes
55
Q

sjogren’s diagnostics

A

CBC, RF, ANA, Y-globulin profile

56
Q

sjogren’s treatment

A

symptom supportive care- quarterly dental eval, artificial tears
rituxan

57
Q

SLE epidem

A

women
3rd or 4th decade of life
African decent- 4x increase

58
Q

SLE diagnosis

A

4/11

arthritis
photosensitivity
oral/nasal ulcers
malar rash (butterfly)
discoid rash (raised red patch)
serositis of pleura
renal disease
hem disorders
positive ANA
neuro disorders
immune abnormalities

59
Q

SLE subjective

A

malaise, fever, anorexia, unplanned weight loss, blurred vision, sleeplessness, depression

60
Q

SLE objective

A

butterfly rash
alopecia
splinter hemorrhages
lymphadenopathy
raynaud’s
swollen joints
impaired cognition
abdominal tenderness

61
Q

SLE diagnostics

A

CBC, BMP, albumin, ANA, UA, antiphospholipid antibodies

62
Q

SLE treatment

A

symptom control
NSAIDs, Plaquenil, prednisone, Benlysta, Cellcept

63
Q

SLE increases risk for

A

lymphoma, breast cancer, abnormal pap, squamous cell skin cancer

64
Q

Infectious mononucleosis

A

viral syndrome characterized by prolonged malaise and fatigue, fever, sore throat, and tender cervical lymphadenopathy.

majority caused by EBV

65
Q

symptomatic cases of mono most common in

A

teens, young adults

66
Q

mono epidem

A

incidence of clinical infection up to 30x higher in whites than blacks

67
Q

EBV most commonly spread via

A

saliva

68
Q

Mono subjective

A

fever, sore throat, adenopathy, fatigue, N/v, anorexia

69
Q

Mono objective

A

high fever (102.5), tender cervical lymphadenopathy
enlarged tonsils, exudate
enlarged liver, spleen
fine maculopapular rash (viral exanthem)

70
Q

mono diagnostics

A

CBC, CMP, monospot
throat culture to r/o strep

71
Q

monospot

A

less sensitive in younger pts

72
Q

mono treatment

A

supportive care
limit contact sports for at least 4 weeks

73
Q

Lyme disease

A

caused by borrelia burgdorferi (tick carrying this)

74
Q

early signs lyme

A

fever, chills, HA, fatigue, myalgia, arthralgia, lymphadenopathy

75
Q

later manifestations of lyme

A

meningitis, arthritis, facial palsy, arrhythmias, nerve pain, memory loss

76
Q

erythema migrans

A

bulls eye rash, lyme disease

77
Q

most lyme infections occur

A

in late spring, summer, early fall

78
Q

likelihood of b. burgdorferi infection depends on

A

duration of tick exposure
must feed for at least 24-48 hours

79
Q

Lyme subjective

A

flu like illness (fever, chills, myalgia), rash, fatigue, HA, neck pain/stiffness

80
Q

Lyme objective

A

erythema migrans (pruritic, burning)
arthritis, arthralgias, neuro

81
Q

bannwarth syndrome

A

more common in european causes of lyme

lymphocytic meningitis
cranial nerve palsies
radiculoneuritis

82
Q

Lyme diagnostics

A

enzyme immunoassay, then western blot

83
Q

Lyme treatment if attached tick

A

single dose doxycycline 200mg

84
Q

early localized lyme disease tx

A

doxycycline 100mg bid 10-14 days

85
Q

cardiac, neuro, arthritis manifestations lyme tx

A

30 days doxycycline 100mg bid

86
Q

Jarisch-Herxheimer reaction

A

worsening of symptoms with rigors, fever, hypotension in 1st 24 hours of antibiotics

87
Q

Often, pts with HIV are

A

asymptomatic for many years before diagnosis made

88
Q

HIV epidemiology

A

2/3 new infections occur in Africa
men who have sex with men, African Americans, latinos

89
Q

HIV 1

A

predominant strain in USA and wordwide

90
Q

HIV 2

A

West Africa, results in slower disease progression and less transmissible

91
Q

Transmission of HIV

A

sexual contact
needle sharing
(previous) blood transfusions
mother to newborn

92
Q

Following initial HIV infection, pts become more vulnerable to

A

outbreaks of common infections

93
Q

if pt presents with thrush

A

consider testing for HIV

94
Q

HIV objective

A

persistent generalized lymphadenopathy
candida infection
STI
weight loss

95
Q

HIV testing should be

A

part of routine care for those age 15-65

96
Q

people with these risk factors should be tested annually

A

men who have sex with men
sex with HIV positive partner
more than 1 sex partner since last testing
uses injected drugs
exchanged sex for drugs/money
dx with hepatitis, TB

97
Q

PrEP

A

given to those with substantial risk of getting HIV

Test for HIV, hep B/c, CMP for renal function

truvada daily

98
Q

PEP

A

HIV uninfected has exposure that carries substantial risk of HIV infection

infrequent exposures

Start within 72 hours of exposure

Labs prior: HIV, HBV, HCV, creat, liver enzymes

28 day course of 3 drug ARV reigmen

99
Q

Post exposure HIV testing

A

4-6 weeks after initial exposure, test HIV, creat, liver enzymes

100
Q

Acute HIV/early HIV treatment

A

ART, regardless of CD4 count

101
Q

initial disclosure of hiv test results

A

done face to face
provide immediate interventions
encourage pt to disclose HIV status to partners
Discuss transmission

102
Q

Initial lab testing for newly diagnosed pt with HIV

A

CD4
HIV viral load
genotype resistance testing
tropism testing
Hep a, b,c
CBC with diff
CMP
FLP
HgA1C
Tb test
UA
STI
Hcg

103
Q

baseline viral load HIv

A

2 separate viral load tests 2-3 weeks apart

104
Q

repeat viral load testing

A

4-6 weeks after starting ARV

105
Q

AIDS

A

person with HIV with CD4 count less than 200

106
Q

if HIV pt complains of visual problems (loss of visual acuity, eye pain, photophobia, floaters)

A

suspect CMV retinitis or fungal endophthalmitis

107
Q

candidiasis tx AIDS

A

fluconazole 100mg x1-2 weeks

108
Q

HSV tx AIDS

A

acyclovir 200-400mg po tid x7-10 days

Primary Care III (7 decks)

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