Test 1 Flashcards
1
Q
Primary prevention
A
the prevention of disease
2
Q
Secondary prevention
A
early screening and detection of disease.
3
Q
Tertiary prevention
A
the restoration of health after illness or disease has occurred.
4
Q
health promotion
A
activities and preventive measures that contribute to an individual’s state of optimal health.
Should begin with the clinician.
5
Q
Non-modifiable Risk Factors
A
Nonmodifiable means the risk factors cannot be changed in any way.
Nonmodifiable risk factors include sex, age, and genetic/family history.
Because these factors are nonmodifiable, early and aggressive identification of all risk factors should be done so that these patients can make any possible changes in the modifiable risk factors in order to have a more favorable outcome.
6
Q
Modifiable risk factors
A
Modifiable risk factors include weight, diet, social habits, lifestyle choices, and stress.
7
Q
health literacy
A
as the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health
Many instruments are available to assess a person’s level of health literacy:
o Newest Vital Scale (N V S) instrument;
o Test of Functional Health literacy in Adults (T O F H L A); and
o Rapid Estimate of Adult Literacy in Medicine-Short Form (R E A L M-S F).
8
Q
Three major government initiatives that have had great impact on health promotion in the United States are
A
o National Prevention Strategy
o Healthy People 2020
o The U.S. Preventive Services Task Force.
9
Q
The National Prevention Strategy
A
a comprehensive plan that describes evidence-based and achievable means for improving health and well-being for all Americans at every stage of life.
The goal of the NPS is to transform us from a system of sick care to one based on wellness and prevention.
10
Q
NPS goals
A
Committed to 4 strategic directions of the NPS:
o Health and Safe Community Environments
o Clinical and Community Preventive Services
o Empowered People
o Elimination of Health Disparities
Seven Priorities are identified to reduce the burden of the leading causes of preventable death and major illness: o Tobacco-Free Living o Preventing Drug Abuse and Excessive Alcohol Use o Healthy Eating o Active Living o Injury and Violence-Free Living o Reproductive and Sexual Health o Mental and Emotional Well-being
11
Q
Healthy People 2020
A
Over the course of the decade, the four foundation health measures will be used to monitor progress toward promoting health, preventing disease and disability, eliminating disparities, and improving quality of life.
12
Q
Health protection
A
Health protection is defined as those interventions that are related to the environment made by regulatory bodies to protect a large population group.
13
Q
The United States Preventive Services Task Force (U S P S T F)
A
composed of private sector experts who make recommendations to the health-care community regarding clinical prevention strategies.
The U S P S T F meets and reviews scientific evidence for each of the current health-care screening guidelines as well as preventive medications, immunizations, and counseling and makes recommendations.
14
Q
what is the best example of primary health promotion
A
Immunizations
15
Q
Health Promotion Model
and
Health Belief Model
A
Health Promotion Model
Developed by Nola Pender. Pender’s model focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect, and behavioral outcomes. The theory notes that each person has unique personal characteristics and experiences that affect subsequent actions. The set of variables for behavior specific knowledge and affect have important motivational significance. The variables can be modified through nursing actions.
Health Belief Model
Key elements of the Health Belief Model focus on individual beliefs about health conditions, which predict individual health-related behaviors. The model defines the key factors that influence health behaviors as an individual’s perceived threat to sickness or disease (perceived susceptibility), belief of consequence (perceived severity), potential positive benefits of action (perceived benefits), perceived barriers to action, exposure to factors that prompt action (cues to action), and confidence in ability to succeed (self-efficacy).
16
Q
Factors of the health belief model that impact decision to take action
A
- Cognitive-perceptual factors = include items such as importance of health, perceived control of health, and perceived barriers to health-promoting behaviors.
- Modifying factors = include biological characteristics, situational factors, and demographic characteristics.
17
Q
Prevalence rate
A
The prevalence rate refers to the number of cases of a particular disease at a particular point in time divided by the percentage of the population at a point in time.
The prevalence rate does not distinguish between new and old cases.
18
Q
Incidence rate
A
The incidence rate is the number of new cases of a disease diagnosed at a point in time (example, 1 year).
19
Q
Epidemic
A
Epidemic is defined as the presence of an event (illness or disease) at a much higher than expected rate projected on the basis of past history
20
Q
Endemic
A
Endemic is the term used when the presence of an event is constant at or about the same frequency as expected based on past history
21
Q
Pandemic
A
A pandemic is defined as the presence of an event in epidemic proportions affecting many communities and countries in a short period of time.
22
Q
Evidence Based Practice
A
refers to using findings from the systematic review and appraisal of the most reliable studies to provide the best evidence for making decisions about healthcare in combination with the practitioner’s clinical expertise and practice-based knowledge, as well as the patient’s preferences
23
Q
AHRQ
A
Agency for Healthcare Research and Quality
the mission is to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans
AHRQ clinical practice guidelines are used not only as references for healthcare providers but also the framework for insurance utilization review, quality assurance and reimbursement
24
Q
Level One Evidence
A
Systematic Review or Meta-analysis of RCT
- highest level of evidence to base a change in practice
- searches all RCTs that address similar clinical questions
25
Level Two Evidence
Single well-designed RCT
- establishes cause of a disease
- efficacy of a treatment or intervention
- maintains a high degree of control and randomization allows for high degree of confidence
26
Level Three Evidence
Well-designed controlled trials without randomization
-attempts to improve internal validity with control of extraneous variables and standardization of treatment
27
Level Four Evidence
Well-designed case control or cohort studies
- risk of introducing bias without case-control in study
- useful for answering clinical questions related to prognosis or causation
28
Level Five Evidence
Systematic review of descriptive or qualitative studies
29
Level Six Evidence
Single descriptive or qualitative study
30
Level Seven Evidence
Opinion of authorities and/or expert committees
31
USPTF - AAA Screening
The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
Grade B
32
USPTF- Breast Cancer Screening
The USPSTF recommends biennial (every other year) screening mammography for women aged 50 to 74 years.
Grade B
33
USPTF- Cervical Cancer Screening
The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years.
For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).
Grade B
34
USPTF- Child Maltreatment
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment.
Children with signs or symptoms suggestive of maltreatment should be assessed or reported according to the applicable state laws.
GRADE I****
35
USPSTF - Colorectal Screening age 45-49
The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years.
Grade B
36
USPSTF - Colorectal Screening age 50-75
The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years
Grade A
37
USPSTF - Depression screening in Adults
The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Grade B
38
USPSTF - Depression screening in Children & Adolescents
The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.
Grade B
39
USPSTF - oral health children younger than 5yrs
The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.
Grade B
The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride.
Grade B
40
USPSTF - osteoporosis screening
The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.
Grade B x2
41
USPSTF - prostate cancer screening age 55-69
For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.
Grade C
42
USPSTF - prostate cancer screening age >70
The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older.
Grade D
43
USPSTF - smoking in adults and pregnant people
The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and US Food and Drug Administration (FDA)--approved pharmacotherapy for cessation to nonpregnant adults who use tobacco.
Grade A
44
USPSTF - smoking in children and adolescents
The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents.
Grade B
45
USPSTF- unhealthy alcohol use screening in adults 18 years or older, including pregnant women
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.
Grade B
46
Tests for strabismus
Corneal light reflex test
47
pseudostrabismus
It is the false appearance of eye crossing that most commonly occurs in infants and children with a wide nasal bridge and/or large epicanthal folds during the first few years of life. It is not a true strabismus but rather an optical illusion in which the wide nasal bridge or epicanthal folds cover the nasal sclera, making the eye appear esotropic, particularly when the child looks in lateral gaze
48
papilledema
papilledema of the optic disk? Refer to ER immediately
Papilledema occurs when raised intracranial pressure is transmitted to the optic nerve sheath
49
lens cloudiness
lens cloudiness is suggestive of cataract and not unusual in those 50 years and older, rare in children.
50
cornea cloudiness
cloudiness of the cornea suggests increased intraocular pressure. Such as primary angle-closure glaucoma.
51
symmetrical red reflex
normal finding
52
asymmetrical red reflex
abnormal- leukocoria.
In a child is HIGHLY suggestive of retinoblastoma
53
cataracts
cloudiness and opacification of the lens (normally crystalline). A cataract is an opacity of the lens of the eye that may cause blurred or distorted vision, glare problems, or, in very advanced cases, blindness.
no treatment. Refer to an ophthalmologist when vision is compromised (uncorrectable)
Most common cause of
treatable blindness; cataract removal is one of
the most frequent surgical procedure in patients
>65 yr
- In early life: Congenital and hereditary causes predominant; consider drug related, diabetes, and trauma
- In older age group: Nuclear sclerotic, cortical, and posterior subcapsular cataracts (after 40 yr)
Wait until vision is compromised before doing surgery.
• Plan cataract removal with intraocular lens (Fig. E3) implantation when vision is compromised and limiting activities of daily living, such as driving at night or reading. Removal of the cataract should be expected to improve the ability of the patient to perform these activities. Another indication to remove cataracts might be to improve the examination view for treatment and assessment of retinal diseases.
• Decision for timing of surgery depends upon patient complaints, best corrected visual acuity (e.g., 20/50), and glare measurements (brightness acuity test decreases vision significantly).
54
macular degeneration
Macular degeneration, usually referred to as age-related macular degeneration (AMD), is an acquired degeneration of the macula resulting in loss of central vision.
Decreased central vision, distortion of vision (metamorphopsia), poor night vision, yellowish deposits in the retina.
RISK FACTORS:
• Advancing age, especially over 70
• Family history: An individual with a sibling or a parent with AMD is 12 to 27 times more
susceptible
• Hyperlipidemia
• History of smoking within past 20 yr
• Dietary factors (low intake of antioxidants,
zinc, and omega-3 fatty acids; high fat diet)
• Obesity
• White race
refer to ophthalmologist
55
Open Angle Glaucoma
Glaucoma is a group of eye diseases traditionally characterized by elevated intraocular pressure (IOP). However, glaucoma is more accurately defined as an optic neuropathy than a disease of high pressure. In open-angle glaucoma, optic nerve damage results in a progressive loss of retinal ganglion cell axons, which is manifested initially as visual field loss and, ultimately, irreversible blindness if left untreated
Risk factors:
- advanced age
- Black race
- family history
- diabetes
- hypertension
- use of systemic or topical corticosteroids
- and elevated intraocular pressure (IOP)
Individuals with open-angle glaucoma rarely experience symptoms. Thus, open-angle glaucoma is generally detected incidentally during comprehensive ophthalmic examination. Central visual field loss is a late manifestation of open-angle glaucoma, usually preceded by ganglion cell loss and optic nerve damage.
56
Closed-Angle Glaucoma
Primary angle-closure glaucoma occurs when elevated intraocular pressure is associated with closure of the filtration angle or obstruction in the circulating pathway of the aqueous humor. When this drainage pathway is narrowed or closed, inadequate drainage of the aqueous humor leads to increased IOP and damage to the optic nerve
INCIDENCE (IN U.S.):
• 2% to 8% of all patients with glaucoma.
• Higher incidence among those with small eyes, frequent eye infections or trauma, cataracts, females, > 50 yr, far sighted.
Presentation!
- Inflammed, painful eye with corneal edema
- Side vision loss (early sign)
- Pupil may be dilated
- RED eyes
REFER TO ER!
TREAT with meds that lower IOP - beta blockers, mannitol, surgery
Do not use antihistamines or vasodilators with narrow-angle glaucoma.
57
How to distinguish conjunctivitis from corneal abrasion
"scratchy" or "gritty" sensation that develops suddenly and worsens with eye movement and blinking
58
most common symptom of corneal abrasion/FB
unilateral eye pain
other symptoms
- photophobia
- history of exposure to airborne objects
- contact lense
59
emergency treatment of corneal injury
- smoke, gas exposure
- chemical exposure
- welding
- thermal hazards and fire
- bloodborne pathogens (hepatitis, HIV)
- foreign bodies embedded in the corneal
flush with copious amounts of saline
60
Physical exam of corneal injury
- NEVER push on the eye, possibly embedded further
- Visual acuity assessment
- Peripheral vision and EOM
- examine pupils for size, shape, reactitivty
- inspect cornea with bright hand held light- abrasions will cast a shadow on the iris
- fluoroscein staining
61
FLUOROSCEIN STAINING
1) Numb cornea with topical anesthesia
2) Moisten fluorescein strip with sterile NS and touch strip to lower eyelid
3) Blink eye
4) Cobalt blue light - if you see bright green areas = corneal abrasions
5) Irrigate fluorescein out of eyes
62
Tetanus Booster?
Consider with penetrating globe injuries to eye
- administer if no shot in last 10 years
- if dirty, consider admin length of 5 years
- give TDAP
63
Treatment of corneal abrasion/FB
1) Instill antibiotic ointment (10% sulfacetamide or 0.3% ofloxacin QID)
2) Topical NSAID (diclofenac or ketorolac QID)
no longer recommend eye patch as deprives oxygen and creates a warm wet environment
follow up in 24hrs, check patient every 3 days
refer to opthamologist without improvement
64
when to use ocular anesthesia?
NEVER
ocular pain indicates there is a problem and masking the pain can lead to irreversible problems
65
hearing- inner ear
Inner ear is responsible for sensorineural hearing.
Sensorineural hearing loss is defined as a lesion in the organ of Corti or in the central neural pathways of the ear including the cranial nerve VII and auditory cortex.
Causes of Sensorineural Hearing Loss:
Presbycusis(age related hearing loss)
Meniere’s disease
Tumors (acoustic neuroma)
Medications (aminoglycosides, aspirin, quinine)
Trauma
Diseases (syphilis, viral infections such as mumps)
66
hearing- middle ear
Middle ear responsible for mechanical and conduction of hearing. Middle ear issues are often reversible
Conductive hearing loss results when the passage of sound waves through the TM and inner ear is impaired.
```
Causes of Conductive Hearing Loss:
Cerumen impaction
Perforation of TM
Chronic ear infections
Congenital Abnormalities
Otosclerosis or tympanosclerosis
Temporal bone fractures or other injuries
```
67
tinnitus
- Hearing loss
- Meniere’s disease
- Acoustic neuroma
- Ototoxic medications
- MS
- Head injury
- Thyroid disorders
- HLD
- Vit B12 deficiency
68
Mouth Sores
- Food or drug allergies
- Chemical irritation
- Dry mouth
- Mechanical or thermal injury
- Infections (bacterial, viral, fungal)
- Host immunosuppresion
- Nutritional deficiency
69
Hoarseness
voice with harsh quality and low pitch
cardinal sign of laryngeal cancer
70
Tests for hearing loss
1) Weber test
Weber tuning fork placed on the midline of the patients skull. (NORMAL RESULT: the sound is heard equally in both ears by the patient.)
- In sensorineural hearing loss the sound in the unaffected ear is louder.
- In conductive loss, the sound is louder in the affected ear.
2) Rinne
3) Schwabach
4) Audiometry (diagnostic) - This includes pure tone and speech as well as impedance (middle ear pressure) testing.
71
Important question to ask for complaints of hearing loss?
COMPLETE HX of prescription and over the counter drugs
also, is it unilateral or bilateral?
ANY PATIENT WHO PRESENTS WITH SUDDEN SENSORINEURAL HEARING LOSS SHOULD BE REFERRED TO ENT FOR FURTHER EVALUATION.
Hearing loss should be monitored closely this is a telltale sign of underlying acoustic neuroma.
72
Tinnitus risk factors
Risk factors include:
- hearing loss,
- labyrinthitis (inflammation of the inner ear),
- Meniere’s,
- otitis media, otitis external
- blood pressure abnormalities
- head trauma
- exposure to chronic noise
73
Meniere’s Disease
Meniere’s is a peripheral sensory disorder of both the labyrinth and cochlea of the inner ear
Endolymphatic volume and in turn ear pressure is increased d/t unknown etiology resulting in both vestibular (balance, proprioceptive) and auditory dysfunction characterized by recurrent acts of tinnitus, vertigo, and progressive hearing loss
Diagnostic criteria:
1. Two distinct episodes of rotational vertigo at least 20 min long
2. Sensorineural hearing loss AND either tinnitus or a perception of aurical fullness. (Weber and Rinne test typically elicit findings of sensorineural hearing defect.
Treatment: Palliative
- dietary changes (decrease caffeine, sodium, alcohol)
- stop smoking
- vestibular rehab and possibly surgery
74
Otitis Externa
inflammation of the membranous lining of the auditory canal and/or contiguous structures of the outer ear
75
Subjective findings of otitis externa
○ Acute severe otalgia (ear pain)
○ Pain may be worse at night
○ Exacerbated by pulla the pinna or apply pressure to tragus
○ In severe case, chewing can cause pain
○ Ear may feel full and temporary hearing loss is common in early stage
○ May be pruritic (itchy)
○ May have purulent discharge if bacterial
76
Objective findings of otitis externa
○ Classic sign: tenderness to traction of pinna and pain when pressure on tragus
○ Edematous erythematous auditory canal preventing visualization of external canal and tympanic membrane
○ May be purulent drainage
○ Diffuse: near complete involvement of auditory canal
○ Localized: focal lesions (pustules and furuncles)
○ Cerumen variable
○ Fluid may be apparent
77
Treatment otitis externa
Because the predominant symptom of otitis externa is pain, alteration in comfort is a primary focus of care. Medical management of the disease should focus on alleviating pain promptly, which includes the following measures:
* Local application of heat to the outer ear can offer some relief of pain.
* Some patients get relief with application of an ice pack to the outer ear.
* Nonprescription pain relievers such as aspirin or acetaminophen (325 to 650 mg by mouth [PO] every 4 hours as needed; maximum daily dose 4,000 mg/day) or an NSAIDs such as ibuprofen (400 to 600 mg PO every 4 to 6 hours as needed to a maximum dose of 1.2 g/day) are first-line agents.
* In cases of extreme pain, acetaminophen/codeine (Tylenol #3) 325 mg/5 mg one to two tablets PO every 6 hours or acetaminophen/hydrocodone (Vicodin) 325 mg/5 mg PO every 8 hours may be prescribed for the first 24 to 48 hours, but these medications carry an abuse potential.
Patients should be instructed to keep the ear dry and to avoid swimming or submersion of the ear under water for 4 to 6 weeks.
Diffuse bacterial otitis externa may be treated empirically with topical antibiotics and anti-inflammatory otic drops that may also serve to restore the protective acidic pH level of the ear canal.
Common topical otic preparations approved by the U.S. Food and Drug Administration include acetic acid/aluminum acetate, acetic acid/hydrocortisone, ciprofloxacin/hydrocortisone, ciprofloxacin/dexamethasone, neomycin/polymyxin B/hydrocortisone, and ofloxacin. Liquid ophthalmic preparations of gentamicin and tobramycin may be used otically to cover both P. aeruginosa and S. aureus.
78
protective factors against otitis media
Protective Factors against OM:
● Avoiding tobacco exposure
● Breastfed for first 6 months of life or more
● Annual flu vaccine for all children 6mo and older
● Prevnar-13 all children 6 weeks and older and all adults
● Pneumovax-23 high risk children 2 and older and high risk adults all ages and 50 and older for all adults
79
subjective findings of acute otitis media
```
● Marked deep ear pain
● Fever
● Unilateral hearing loss
● Otic discharge
● Recent hx of URI
● Dizziness
● Vertigo
● Tinnitus
● N/V
● Pain subsides when TM ruptures
```
80
objective findings of acute otitis media
● TM may be amber, yellow-orange- Pinkish gray to fiery red
● Typically full or bugling with absent or obscured bony landmarks and dull or absent cone light reflex
● Auditory canal usually is normal, but sometimes a discharge is visible if perforated TM
● Otorrhea may be purulent or mucoid, polymorphonuclear neutrophils are prominent in early stage
● Chronic- may see granulation tissue
● Chronic foul-smelling otorrhea is typical of anaerobic infection
● Lymphadenopathy of preauricular and posterior cervical lymph nodes
● Sometimes tenderness over mastoid process if acute mastoiditis
81
Otitis media management
Although there is an increasing trend to observe uncomplicated AOM in children for the first 48 to 72 hours, rather than prescribe early antibacterial treatment in the hopes of self-limited resolution, antimicrobial therapy in adults is largely the norm.
1) Tylenol and ibuprofen
2) Amoxicillin
In children older than 24 months, many cases of AOM may resolve and do not require antibiotics, as long as the symptoms are manageable with systemic analgesics, the child has access to reevaluation at 48 hours, and symptoms do not persist. If signs and symptoms of AOM persist for 48 to 72 hours in spite of using systemic analgesics, the child should be reassessed, and antibiotic treatment should be considered.
82
Coryza (rhinitis)
inflammation of the nasal mucosa, characterized by nasal congestion, rhinorrhea, sneezing, pruritus, and/or postnasal discharge. Allergic or Non-allergic. Allergic is either seasonal or perennial.
83
risk of Epistaxis
Prolonged use of nasal decongestants spray is also a risk factor as it leads to reflex inflammation of the nasal mucosa
Excessive dryness of the nasal mucosa in poorly humidified environments or at high altitudes weakens nasal vessels, which predisposes them to rupturing.
Septal deviation may thus contribute to epistaxis through the disproportionate exposure of one side of the nose to dry environmental air.
Malignant growths in the nasal or paranasal sinuses may erode into blood vessels and present with epistaxis as their sole manifestation.
Coagulopathies with resultant bleeding may be associated with chronic disorders such as cirrhosis, renal disease, cancer (Hodgkin’s), and hemophilia. Familial blood dyscrasias such as hemophilia A, hemophilia B, von Willebrand disease, and hereditary hemorrhagic telangiectasia.
84
primary goal with patient with acute infectious sore throat
identify and treat patients with GABHS pharyngitis (bacterial) in order to prevent complications of rheumatic fever, glomerulonephritis, and suppurative sequelae
85
secondary goal of patients with acute infectious sore throat
diagnose less common infections like peritonsillar abscess and bacterial pathogens that need to be treated and diagnosing nonbacterial pathogens like HIV, influenza, and mono
86
pivotal points in evaluating sore throat
1) presence of unilateral symptoms (abscess)
2) presence of exudate (GABHS)
3) risk factors for STD's or HIV
4) signs and symptoms of influenza and mono
87
subjective TMJ
Patient may present with facial pain, ear discomfort or dysfunction, headache, and TMJ discomfort or dysfunction.
Facial pain is usually unilateral with or without radiation to the ear, temporal region, angle of the jaw, or posterior neck. Facial pain is dull and can be constant or intermittent.
Ear pain, fullness, and tinnitus are common and typically lead to a referral.
Typical headache is unilateral and described as a deep pain that is worse in the morning.
TMJ dysfunction manifests as clicking, popping, jaw deviation, jaw locking and symptoms worse in the morning.
88
treatment of TMJ
Nonpharmacologic self-care (jaw rest, local heat) , biobehavioral pain management (biofeedback, relaxation/imagery techniques, cognitive therapy), bite guards, nutrition, and physical therapy.
Limit jaw function by eating softer foods, taking small bites, and not opening the mouth wide when eating. Avoid hard foods.
Ice packs can be used for acute pain and muscle spasms; for chronic pain, moist heat should be used following the same guidelines.
-----
Pharmacologic can be beneficial for controlling pain and inflammation. A course of 10-14 days of NSAIDs is initial drug of choice.
If there is pain on palpation of the muscles of mastication, short-term use of a short-acting muscle relaxant combined withed with NSAID may benefit some patients.
Tricyclic antidepressants are an option for long-term use. For patients with RA, treatment and control of the underlying disease is recommended but neither corticosteroids nor hyaluronic acid id recommended for long-term use. Opioids and benzos are discouraged.
For refractory cases, referral to a dentist or oral surgeon may be beneficial.
89
dysphonia cardinal sign
Dysphonia is a cardinal sign of laryngeal cancer (men aged 50-70)
90
dysphonia treatment
Review current medications that may be causing symptoms
Avoid vocal excess and irritants, such as inhaled smoke.
Completely rest the voice. Avoid whispering because this strains larynx.
Avoid antihistamines because they serve to dry the mucous membranes.
There is no benefit in using antibiotics to treat acute laryngitis.
Use of humidified air especially at night and during dry seasons may be helpful.
Encourage increased oral fluid.
Treatment with antireflux medication should not be undertaken in the absence of signs of symptoms of significant GERD
Voice therapy, typically one or two session per week for 4-8 weeks.
Oral steroids are not routinely recommended. Afrin should be avoided.
