Nonsense Flashcards
substance screening for young ppl
CRAFFT= car, relax, alone, forge, family/friends, trouble
Most useful EtOH biomarkers
EtG- urine, hair, nail
who is brief intervention useful for and what is the goal
non-dependent problem drinkers. Cut use (not abstinence)
Steps in brief intervention
Advise (personal advice change), Assess (willingness to change), Assist (help make change), Arrange (reinforcement)
four principles of MI
express empathy, develop discrepancy, roll with resistance, support self-efficacy
MI techniques:
OARS: open-ended questions, Affirmations, Reflective listening, Summaries
stages of change
precontemplation, contemplation, preparation, action, maintenance
Limbic system in IBD
Anterior cingulate cortex determines how pain is emotionally experience. Increased activity in IBS
changes in pain pathway in IBD
visceral hypersensitivity (increased awareness, central sensitization), hyperalgesia (peripheral sensitization, decreased PAG activity)
HPA axis in IBD
affected by stress levels, impacts intestinal motility
Serotonin in IBD
IBS-D=overproduction of serotonin, IBS-C=underproduction of serotonin
most common psychiatric condition in IBD
Anxiety disorder
Visceral anxiety in IBD
GI-specific anxiety. Hypervigilance of GI symptoms.
Catastrophizing in IBD
Rumination about symptoms and their consequences. Feelings of helplessness
what age group has 70% of diarrhea deaths? How has incidence and mortality of under5 diarrhea changed
under 2. Mortality down, incidence stayed the same.
Global Enteric Multicenter Study (GEMS): what did it find
Rotavirus, cryptosporidium, ST-ETEC, shigella account for most diarrhea. Higher odds of death, decrease in linear growth
Osmolarity of hydration salts? Of Normal Saline? What solutes does it contain? What other nutrients do you give them?
245 mmol/L, 154 mmol/L. Na, K, glucose to facilitate Na absorption, citrate. Zinc supplementation, antibiotics
What can be done to prevent diarrhea
Exclusive breastfeeding for at least 6 months!!, vaccinate against rotavirus
Cycle of Ascariasis, hookworm, trichuriasis (whipworm), W. bancrofti
ingested>portal>lungs>intestine.
Larvae penetrate skin>bloodstream>lungs>intestine>feed on blood
ingested>live in ascending colon>lay eggs in colon
Mosquito>lymphatics (causes lymphatic filariasis)>mosquito
what is the definition of diarrhea
> 3 stools/day, >200 g/day
most common cause of chronic (>4 wks) diarrhea seen in US
IBD
Key difference b/w soap note and H&P
SOAP focuses on active problems and is used for daily progress updates
what goes in subjective?
what patient tells you as well as key updates since the last time patient was seen (test results, concerns, etc)
for pts with multiple problems, how do you write up the Assessment/plan
you group by problem (problem 1, plan 1, problem 2, plan 2)
