PCM REVIEW Flashcards
what percentage of US adults smoke?
21%
how many people start smoking by age 18?
80%
how many deaths annually can be attributed to smoking?
1 in 5
what is the leading preventable cause of death in the US?
smoking
if you tell someone to quit at each visit you can raise the quit rate by______________
30%
what are the 5 A’s?
- ask about tobacco use
- advise to quit
- assess willingness to try
- assist in quit attempt
- arrange followup
what are the 5 stages of change?
precontemplative contemplative preparation action maintenance
what percent of people who try to quit on their own are smoking within 30 days?
80%
what percentage of smokers quit successfully annually?
3%
how is cognitive therapy involved in smoking cesation?
helps smokers combat addiction, craving triggers, stress/environmental cues and withdrawal sings
what happens to quit rates when counseling is combined with pharmacotherapy?
quit rates double
how does varenicline work?
partial agonist at the alpha4beta2 nicotinich ACh receptor
which antismoking drug is the most effective alone?
varenicline
what are notable adverse effects of varenicline and buproprion?
psychiatric adverse effects
how does buproprion work?
NE and dopamine re-uptake inhibitor (decreases cravings and withdrawal symptoms while interactin with pathways underlying addiction)
rank the smoking cessation drugs from best to worst>
Varenicline>buproprion>nicotine replacement
what is a notable side effect of clonidine?
rebound htn
how does mecamylamine work?
nicotine antagonist (ganglionic blocker) data shows that mecamylamine + nicotine is better than nicotine alone
how does clonidine work?
blocks cravings, anxiety, restlessness, tension and hunger
how does naltrexone work?
opiate antagonist (DOESNT WORK)
what pts shouldnt get mecamylamine?
coronary or renal insufficiency, glaucoma, uremia
who is supposed to get the flu shot?
pts 6 months and older
what are the 2 kinds of flu shot?
- shot is inactivated killed virus
2. nasal spray is live attenuated virus (only for healthy people 5-49 yrs)
how many strains does each vaccine have?
3
adults get which pneumococcal vaccine?
23 valent inactivated vaccine
kids get which pneumococcal vaccine?
7 valent conjugate vaccine
bronchial breath sounds + egophony triples the likelihood of what?
pneumonia in pt with fever and cough
the algorithms for cough are indicated for what patients?
15 yrs and older
upper airway cough syndrome (UACS) is also known as what?
post-nasal drip
pts with pneumonia and risk factors for lung cancer should have a follow up CXR around when?
6-12 wks
- assure resolution
- avoid missing a lung cancer hidden by infiltrates
what kind of things cause a subacute cough?
usually subacute
-pertussis
post-tussive vomiting and paroxysmla cough in a subacute setting are sugestive of what?
pertussis
how do you treat pertussis?
erythromycin
if you have a chronic cough and you’ve done a good hx and physical what else do you need to order?
CXR
if you have a pt where the history, physical, and CXR are normal, what are 4 possible causes?
smoking
ACE-inhibitor
GERD
Asthma
do you have to evaluate a change in chronic cough if the pt is a smoker?
YES
True or False: all that wheezes is asthma
FALSE
how do you diagnose asthma?
clinical based on multiple findings in hx (no specific test )
asthma is easily recognized when it presents with what?
intermittent wheezing
what should be high on your ddx if your pt has: wheezing, dyspnea, cough, chest tightness
asthma
what are some findings in asthma with high likelihood ratios?
nocturnal dyspnea
wheezing and exertional dyspnea
what are the key points to diagnosing asthma?
episodic symptoms of airflow obstruction
reversibility of airflow obstruction
exclusion of other likely diseases
how do you know if you should hospitalize an asthmatic patient?
pts w/ an exacerbation and 1 of the following:
- hx of sudden severe exacerbations
- prior admission to ICU
- recent ER visit
- use of 2 or more canisters of beta2agonist in last month
what can the physical exam tell you about a pt with asthma?
not much, generally a poor marker of the severity of disease
what 2 pieces of info are the most important for making admission decisions?
- spirometry
2. hx of the pt’s prior exacerbations
a succinct and complete __________________ should always be included in oral presentations and written histories and physicals in the respective assessment sections
illness script
what is the purpose of an illness script?
- facilitate diagnostic thinking
- better communicate your conclusions to others
- give others insight into your diagnostic reasoning
define a likelihood ratio
(probability of a finding in pt w/ disease) / (probability of same finding in pt w/o disease)
