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Acute & Chronic II > Test 4 > Flashcards

Test 4 Flashcards

1
Q

anaphylaxis pathophysiology

A

bronchoconstriction, coronary vasoconstriction, peripheral vasodilation

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2
Q

First diagnostics for anaphylactic reaction

A

pulse ox and EKG

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3
Q

epinephrine works on

A

alpha and beta adrenergic agonist receptors

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4
Q

epinephrine dosing for adults

A

0.2-0.5 mg IM, repeat every 5-15 min with max dose of 1 mg

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5
Q

epinephrine dosing for children

A

0.01 mg/kg IM repeat every 20 min- 4 hours with max dose of 0.5 mg

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6
Q

preferred injection site for epinephrine

A

vastus lateralis

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7
Q

other medications that can be used for anaphylaxis

A

diphenhydramine, beta2 agonists

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8
Q

delayed reaction to insect bites can occur

A

10-14 days after bite with fever, malaise, rash, lymphadenopathy

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9
Q

Local wound care for insect bites

A

removal of stinger, ice packs, anithistamines, topical steroids, NSAIDs, atbx if needed

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10
Q

There people should be given a medical warning tag, epi pen, and referral for venom immunotherapy

A

anaphylactic reaction to bees or wasps

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11
Q

common types of spider bites

A

brown recluse or black widow

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12
Q

Commonly found in the central Midwest south to the Gulf of Mexico. They travel in boxes and packages. They are also found in warm, dry areas such as abandoned buildings, woodpiles, and cellars

A

brown recluse spider

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13
Q

bite is usually painless with a mild erythematous lesion that may either heal spontaneously or become necrotic

A

brown recluse

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14
Q

healing time for brown recluse bites

A

6 weeks to 4 months

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15
Q

systemic symptoms that may occur within 24-48 hours of brown recluse spider bite

A

fever, chills, N/V, myalgias

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16
Q

treatment for brown recluse spider bite

A

no medication or antivenom;
tetanus prophylaxis
analgesics

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17
Q

Most venomous spider bite

A

female black widow

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18
Q

It is most common in the South and West. They tend to live in basements, gardens, woodpiles, and garages.

A

black widow spider

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19
Q

The bite is mildly to moderately painful with erythema, swelling, and muscle cramps beginning within 30 minutes to 12 hours.

A

black widow spider

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20
Q

bite from black widow can mimic

A

acute abdomen/peritonitis

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21
Q

complication of black widow bite

A

hypertension

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22
Q

black widow bite is fatal in

A

children and elderly

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23
Q

treatment for black widow bite

A

wound care,
tetanus prophylaxis,
analgesics,
antivenom is only indicated for severe bite b/c of risk of anaphylaxis

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24
Q

antivenom is only available for this kind of spider bite

A

black widow

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25
Q

venomous snakes includ

A

pit vipers and coral snakes

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26
Q

most snake bites occur between

A

april and october

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27
Q

venomous rattlesnakes and coral snakes have

A

fangs

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28
Q

the presentation of no envenomation from snake is

A

minimal pain and swelling

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29
Q

Minimum envenomation from snake presents with

A

local swelling less than 6 in with no systemic symptoms

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30
Q

Moderate envenomation from snake presents with

A

local swelling of 6-12 in with systemic s/s

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31
Q

Coral snake bites resemble

A

scratch marks and are painful

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32
Q

presenting s/s of coral snake bites

A

neurologic: tremor, dysarthia, dysphagia, diplopia

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33
Q

physical exam for all spider bites

A 
ABCs,
vitas,
examination of bite and extent to envenomation,
tissue damage,
neuro exam
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34
Q

diagnostics for snake bite

A

CBC, CMP, coags, UA, ECG

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35
Q

Management for snake bites

A

Go to ER for antivenom,
immobilize and elevate extremity ,
observe respiratory status

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36
Q

management for scorpion bites

A

supportive care

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37
Q

teaching to avoid snake bites

A

walk with stick tapping ahead;
wear loose, long pants with thick boots,
shine a flashlight

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38
Q

atbx is recommended for these kinds of bites

A

hand and cat bites. Treat with Augementin

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39
Q

treatment for human or dog bites

A

Augmentin or clindamycin can be given prophylactically, must be given within 12 hours of bite

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40
Q

common carriers of rabies virus

A

raccoons, bats, skunks, foxes

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41
Q

most common bacteria from human bites

A

staph aureus

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42
Q

a bite history includes

A

time of bite, rabies vaccination of animal, current immunization status, hx of splenectomy or liver disease

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43
Q

assess for this with any bite

A

compartment syndrome: paresthesias, pain, pallor, paralysis

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44
Q

Management for any kind of bite

A

irrigate with at least 150 mL of normal saline,

debride tissue, clots, foreign bodies

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45
Q

Wounds involving the hand or foot should be

A

elevated for 1-3 days

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46
Q

treatment for infected bites

A

Augmentin 500 mg tid x 5-7 days;
clindamycin + doxycycline;
TMP/SMZ;
ciprofloxacin

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47
Q

can assist in the diagnosis of corneal abrasion

A

fluorescein dye; abrasion appears as a bright green area

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48
Q

treatment for corneal abrasion

A

erythromycin or Polysporin ointment, oral analgesics

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49
Q

when to refer for corneal abrasion

A

if foreign body cannot be easily removed by a cotton tip applicator

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50
Q

most common symptom of corneal abrasion

A

sever eye pain

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51
Q

risk factors for epistaxis

A

nasal trauma, rhinitis, drying of mucosa from low humidity, deviation of septum, alcohol, anticoagulant meds

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52
Q

Most nosebleeds occur from the

A

anterior plexus (Kiesselbach’s plexus)

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53
Q

initial management of epistaxis

A

sit straight up, tilt head forward, apply firm pressure to anterior aspect of nose for 15 min

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54
Q

medication for epistaxis

A

phenylephrine 0.125% 1-2 sprays that acts as a vasoconstrictor, silver nitrate

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55
Q

When to refer for epistaxis

A

bleeding does not resolve in 15 min

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56
Q

teaching for epistaxis

A

avoid ASA, vigorous exercise, hot/spicy foods for a week

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57
Q

GCS variables

A

eye opening, motor response, verbal response

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58
Q

immediate ER referral for head trauma with

A 
AMS;
paralysis or paresthesia;
Raccoon's sign;
Battle's sign;
blood in external auditory canal
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59
Q

in elderly, the first sign of head trauma is

A

confusion, change in behavior

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60
Q

The neuro exam for head injury should include

A

pupillary response, EOM, Romberg test, gait, finger-to-nose test, memory, and concentration.

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61
Q

diagnostic for head injury

A

cervical x-ray, head CT,

CBC, CMP, UA, ABG, coags

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62
Q

immediate treatment for head injury

A

ABCs,
cervical spine stabilization,
assess GCS

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63
Q

high risk patients for heat-related mortalities

A

those less than 10 and older than 50, those with underlying heart/lung disease or diabetes

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64
Q

quick method to determine TBSA

A

back of the hand is 1% TBSA

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65
Q

Only involves the epidermis

A

first-degree

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66
Q

involves the epidermis and portions of the dermis

A

second-degree (partial thickness)

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67
Q

may look like first degree burns initially, but may show blistering 12-24 hours later. May present as dull or glossy with pink, red, or white pigmentation. Heal spontaneously in less than 3 weeks.

A

superficial partial-thickness burn

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68
Q

extend into the lower layers of the dermis and can cause scar formation. They usually heal in 3-9 weeks. However, they can cause hypertropic scarring and impaired joint function. These burns are best treated by excision and grafting.

A

Deep partial thickness

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69
Q

Involve all layers of the dermis and often underlying adipose tissue

A

third-degree (full-thickness)

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70
Q

Area appears matte with eschar

A

third-degree

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71
Q

Treatment for mild burns

A

irrigate with cool tap water, apply thin layer or antimicrobial (sulfadiazine), cover with nonadherant

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72
Q

Management of intact blisters in burns

A

Do not rupture as they maintain protection

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73
Q

treatment for moderate burns

A

irrigate with NS, chlorhexidine, debrided, cover with antimircobial, cover with nonadherant.

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74
Q

these kinds of dressings are preferred because they promote re-epithelialization

A

moist

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75
Q

burns that should be referred

A

partial-thickness burns greater than 10% TBSA;
Burns on face, hands, feet, genitalia, or major joints;
electrical/chemical burns

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76
Q

immediate referral to a plastic surgeon for

A

hand and face wounds

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77
Q

wounds involve the epidermis and dermis and may extend through the subcutaneous tissue into muscle and bone

A

full thickness wounds

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78
Q

diagnostics for lacerations

A

x-ray to identify bone/tendon involvement;
MRI to r/o osteomyelitis;
CBC

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79
Q

assess this with all lacerations

A

vascular, neurologic, and musculoskeletal function

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80
Q

wounds with smooth edges that is not grossly contaminated can be

A

approximated with steri-strips

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81
Q

These kinds of wounds should NOT be closed

A

crush injuries, bites to hand and feet, cat/human bites, puncture wounds, wounds more than 12 hours old (24 for face)

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82
Q

Should be administered if Tdap status is unknown or if patients has not completed 3 injections

A

Td and tetanus immune globulin

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83
Q

Td can be given if Tdap has been given within

A

5 years

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84
Q

these wounds do not need tetanus shot

A

less than 6 hours old

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85
Q

suggested suture size for scalp, trunk, arms, and legs is size

A

4-5

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86
Q

suggested suture removal for scalp

A

7-14 days

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87
Q

suggested suture removal for trunk and upper extremities

A

7 days

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88
Q

wounds that require atbx therapy

A

wounds more than 8 hours old;
crushing injuries;
wounds in patients with diabetes

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89
Q

infected wounds can be treated with

A

TMP/SMZ DS 160/800 bid or clindamycin 300-450 mg tid

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90
Q

acromegaly results from excessive secretion of

A

growth hormone and insulin-like growth factor (IGF-1)

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91
Q

most common cause of acromegaly is

A

adenoma of the anterior pituitary

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92
Q

feedback of GH hormone

A

GHRH and somatostatin secreted from hypothalamus –> GHRH stimulates GH secretion; somatostatin inhibits GH secretion

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93
Q

factors that affect GH secretion

A

sleep, stress, meals, aging

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94
Q

Manifested as excessive bone and soft tissue growth

A

acromegaly

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95
Q

common s/s of acromegaly

A

facial puffiness, enlarged jaw, swelling of hands and feet, hirsuitism

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96
Q

onset of acromegaly is

A

slow, about 12 years

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97
Q

diagnostics of acromegaly

A

IGF-1 is a direct indicator of GH levels, oral glucose tolerance test, MRI of pituitary gland

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98
Q

oral glucose tolerance test in those with acromegaly

A

oral glucose does not suppress GH secretion as it normally should.

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99
Q

complications of acromegaly

A

diabetes, HTN, sleep apnea, colon cancer

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100
Q

This disease has a high risk of colon cancer

A

acromegaly

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101
Q

feedback of adrenal glands

A

hypothalamus secretes CRH–> pituitary gland secretes ACTH –> adrenal glands secrete cortisol, aldosterone, and androgens

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102
Q

most common manifestation of adrenal crisis is

A

hypotension

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103
Q

primary adrenal insufficiency most commonly presents with

A

shock, abd tenderness, fever

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104
Q

in primary adrenal insufficiency this is NOT common

A

hypoglycemia

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105
Q

when adrenal glands produce too little cortisol (adrenal cortical hypofunction)

A

Addison’s disease

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106
Q

s/s of addison’s disease

A

chronic malaise, weight loss, abd pain, muscle cramps, hyperpigmentation, salt craving

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107
Q

Addison’s disease is characterized as

A

low glucocorticoids, mineralcorticoids, and androgens

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108
Q

Complication of Addison’s disease

A

adrenal crisis d/t low mineralcorticoids

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109
Q

Diagnostics of Addison’s disease

A

low levels of cortisol; high ACTH

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110
Q

when adrenal glands produce too much cortisol (adrenal cortical hyperfunction)

A

Cushing’s disease

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111
Q

common cause of Cushing’s

A

long-term use of steroids suppress ACTH suppression from anterior pituitary

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112
Q

when steroids can caused HPA suppression and Cushing’s

A

more than 15 mg/day for more than 3 weeks

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113
Q

s/s of cushing’s

A

weight gain, loss of menses, HTN, glucose intolerance, insomnia, “moon face”, “buffalo hump”, muscle wasting, hirsuitism, striae

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114
Q

diagnostic for Cushing’s

A

elevated cortisol in 24-hour urine collection

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115
Q

treatment for Cushing’s

A

daily ketoconazole; it competes with steroids

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116
Q

A catecholamine-secreting tumor of chromaffin cells, mostly found in the adrenal medulla.

A

pheochromocytoma

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117
Q

pheochromocytoma causes an abnormal production of

A

epinephrine and norepinephrine

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118
Q

symptoms of pheochromocytoma are

A

headache, sweating, tachycardia, HTN

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119
Q

episodes of pheochromocytoma

A

episodic, last 15-30 minutes, precipitated by position change, Valsalvia, exercise, anxiety

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120
Q

risk factor for pheochromocytoma

A

family hx

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121
Q

diagnosis of pheochromocytoma

A

high levels of metanephrines and catecholamines in 24-hour urine collection

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122
Q

most tumors in pheochromocytoma are found in

A

abdomen or pelvis

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123
Q

most common symptom of primary hyperparathyroidism is

A

hypercalcemia

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124
Q

the kidney’s role in calcium and phosphorus balance

A

PTH hormone causes kidneys to reabsorb calcium and excrete phosphorous

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125
Q

primary hyperparathyroidism is the inappropriate secretion of PTH in the setting of

A

hypercalcemia

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126
Q

primary hyperparathyroidism is mostly caused by

A

parathyroid adenoma

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127
Q

Excess PTH effect on the bone

A

increases release of calcium and phosphorus from the bone, causing weak bones

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128
Q

Excess PTH effect on the kidney

A

increase calcium resorption and phosphorus excretion; eventually causing nephrolithiasis

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129
Q

s/s of primary hyperparathyroidism

A

weakness, fatigue, anxiety, HTN, CAD, short QT interval, kidney stones, hyporeflexia

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130
Q

band keratopathy, a white cloudiness at the nasal and temporal borders of the cornea is seen in

A

primary hyperparathyroidism

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131
Q

diagnostics for primary hyperparathyroidism

A

PTH, serum calcium, albumin, and vitamin D, fasting phosphorus;
Bone mineral density of distal radius;
renal US;
24-hour urine collection for calcium and creatinine

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132
Q

complications of primary hyperparathyroidism

A

osteoporosis, nephrolithiasis, CVD

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133
Q

criteria for parathyroidectomy

A

age less than 50;
serum calcium greater than normal;
GFR less than 60;
Tscore less than -2.5

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134
Q

management of primary hyperparathyroidism

A

monitor calcium and creatinine annually; bone density every 1-2 years; keep vitamin D > 20 ng/mL;
weight bearing activities;
adequate fluid intake

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135
Q

hypercalcemia is serum calcium greater than

A

5.3 mg/dL

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136
Q

PTH dependent hypercalcemia is d/t

A

primary hyperparathyroidism, the parathyroid is nonsuppressed.

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137
Q

hypocalcemia is serum calcium less than

A

4.4 mg/dL

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138
Q

hypocalcemia can result from

A

increased calcium loss in circulation, decreased entry of calcium, or inadequate PTH produciton

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139
Q

s/s of hypocalcemia

A

muscle weakness, seizures, AMS, hyperreflexia, coarse/dry hair and nails

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140
Q

carpal spasm occurring after occlusion of the brachial artery with a BP cuff for 3 minutes

A

Trousseau’s sign with hypocalcemia

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141
Q

contraction of the facial muscle in response to tapping of the facial nerve against the bone anterior to the ear

A

Chvostek’s sign in hypocalcemia

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142
Q

Diagnostics in hypocalcemia

A

high phosphate, low calcium, low vitamin D

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143
Q

treatment for hypocalcemia

A

vitamin D

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144
Q

hypernatremia is sodium greater than

A

145 mEq/L

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145
Q

secretion of ADH

A

water loss, high osmolality –> stimulate thirst receptors, ADH secreted from posterior pituitary –> stimulates renal absorption of sodium and water

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146
Q

s/s of hypernatremia

A

neuro signs are intially seen: agitation, irritability, confusion;
muscle tremor, hyperreflexia, dehydration

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147
Q

treatment for hypernatremia

A

hypotonic saline (0.45% NaCl or D5W)

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148
Q

those at high risk for hypernatremia

A

elderly, those on diuretics/laxatives

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149
Q

hyponatremia is serum sodium less than

A

135 mEq/L

150
Q

response of ADH to hyponatremia

A

usually ADH is suppressed to allow diuresis

151
Q

chronic hyponatremia causes

A

fluid to seep into the cells leading to swelling.

152
Q

meds that can caused hyponatremia

A

ACEI, thiazide diuretics, NSAIDs, SSRIs

153
Q

excess production of ADH leading to hyponatremia and increased urine osmolality

A

SIADH

154
Q

s/s of hyponatremia

A

headache, blurred vision, lethargy, weakness

155
Q

Refer to ER is serum sodium is less than

A

125 mEq/L

156
Q

If asymptomatic with serum sodium greater than 125 mEq/L, management consists of

A

fluid restriction (1000-1500 mL/day), dietary sodium restriction, and loop diuretics.

157
Q

hyponatremia is common in

A

elderly, endurance runners

158
Q

feedback of thyroid hormones

A

hypothalamus secretes TRH –> anterior pituitary secretes TSH —> thyroid secretes T3 and T4.

159
Q

The synthesis of T3 and T4 requires

A

iodine intake

160
Q

Most T3 and T4 is

A

bound to proteins; but free T4 is always maintained at a constant level.

161
Q

Hyperthyroidism is characterized by TSH less than

A

0.3

162
Q

Graves disease is most common in

A

women 20-40

163
Q

When thyroid stimulating antibodies or immunoglobulins compete with TSH for TSH receptors on the thyroid and increase the production of thyroid hormones.

A

Grave’s disease

164
Q

Subacute thyroiditis is caused by

A

postviral illness

165
Q

majority of causes of subclinical hyperthyroidism is caused by

A

nodules or multinodular goiters

166
Q

Diagnostics for hyperthyroidism

A

thyroid peroxidase (TPO), thyroid US, radioactive iodine reuptake scan

167
Q

Normal or high radioactive uptake during the scan indicates

A

Grave’s disease or toxic multinodular goiter

168
Q

Decreased or zero radioactive uptake during the scan indicates

A

thyroiditis

169
Q

symptomatic treatment of hyperthyroidism is treated with

A

beta blockers

170
Q

major side effect of antithyroid drugs

A

agranulocytosis, liver failure

171
Q

instructions about radioactive iodine

A

no kissing or sharing food for 5 days;
wash dishes in dishwasher;
no close contacts with kids less than 8 for five days;
flush toilets twice

172
Q

complications of hyperthyroidism

A

afib, angina, osteoporosis

173
Q

s/s of thyroid storm

A

fever, profuse sweating, tachycardia, confusion

174
Q

causes of goiter

A

Grave’s, iodine deficiency/excess, thyroiditis

175
Q

Nontoxic goiter is mostly caused by

A

autoimmune thyroiditis

176
Q

meant when thyroid nodules are “hot”

A

concentrate iodine

177
Q

meant when thyroid nodules are “cold”

A

don’t concentrate iodine

178
Q

in goiter, lab studies may show

A

high or normal TSH

179
Q

when the thyroid gland enlarges in response to increased TRH and TSH production

A

nontoxic goiter

180
Q

treatment is only necessary when goiter

A

is symptomatic

181
Q

treatment for goiter

A

levothyroxine (T4) can suppress TSH, although controversial

182
Q

hypothyroidism is characterized as TSH of

A

greater than 4

183
Q

most common cause of hypothyroidism

A

chronic autoimmune thyroiditis where autoantibodies destroy thyroid tissue

184
Q

drugs that can cause hypothyroidism

A

amiodarone, lithium, IV contrast

185
Q

tender thyroid gland is suggestive of _____; whereas a nontender thyroid gland is suggestive of _______

A

subacute thyroiditis; chronic autoimmune thyroiditis

186
Q

treatment for hypothyroidism

A

synthetic T4 (levothyroxine)

187
Q

average T4 replacement for hypothyroidism

A

1.6 mcg/kg/body weight per day (about 50 mcg/day)

188
Q

those who should be started on a lower dose of levothyroxine

A

heart disease or afib

189
Q

dosing instructions for levothyroxine

A

taken on an empty stomach

190
Q

steady state of TSH when taking levothyroxine is not seen for

A

at least 6 weeks

191
Q

Dessicated thyroid (Armour) is

A

combination of T3 and T4

192
Q

dessicated thyroid (Armour) has a black box warning not recommending it for

A

weight reduction

193
Q

subclinical hypothyroidism is

A

elevated TSH with normal T4.

194
Q

treated for subclinical hypothyroidism is indicated when

A

TSH greater than 10

195
Q

complication of congenital hypothyroidism (Cretinism)

A

mental retardation

196
Q

risk factors for thyroid cancer

A

hx of head or neck radiation, family hx, age younger than 20 or older than 60, male

197
Q

____ has been associated with an increased risk of malignant transformation of a thyroid nodule

A

elevated TSH

198
Q

characteristics of a malignant thyroid nodule on ultrasound

A

increased vascular flow to nodule, hypoechoic, irregular margins

199
Q

gynecomastia is caused by an increase in the ratio of

A

estrogen to androgen

200
Q

gynecomastia is diagnosed as a palpable mass of tissue at least _____ in diameter

A

0.5 cm

201
Q

Gynecomastia differs from female breast development in that there is no

A

progesterone

202
Q

drugs that can cause gynecomastia

A

spironolactone, cimetidine, ketoconazole, 5-alpha-reductase inhibitors

203
Q

characteristics of gynecomastia

A

bilateral, centrally located to nipple area, symmetrical, tender

204
Q

breast development

A

thelarche

205
Q

Tanner stages

A

thelarche, pubarche, menarche

206
Q

first sign of puberty in males

A

testicular enlargement at 11 years average

207
Q

Precocious puberty is defined as the onset of secondary sexual development before the age of ___ in girls and ___ in boys.

A

8; 9

208
Q

Gonadotropin-dependent precocious puberty (central precocious puberty) is

A

caused by early maturation of the HPA axis

209
Q

Gonadotropin-independent precocious puberty is

A

caused by excess secretion of sex hormones by tumor

210
Q

In Gonadotropin-dependent precocious puberty, the LH levels are

A

elevated

211
Q

In Gonadotropin-independent precocious puberty, the LH levels are

A

normal or low

212
Q

If secondary sexual findings is noted, then next step is

A

radiographic assessment of bone age; abnormal if bone age is more than 20% older than age

213
Q

Delayed puberty is the absence of sex characteristics by the upper 95th percentile age for boys which is ___ and girls which is ____

A

14; 12

214
Q

delayed puberty is usually caused by

A

defective gonadotropin secretion from anterior pituitary

215
Q

feedback of GnRH secretion

A

hypothalamus secretes GnRH –> anterior pituitary secretes LH and FSH –> stimulate testosterone, estrogen, and progesterone release

216
Q

primary hypogonadism shows FSH and LH levels that are

A

high

217
Q

secondary hypogonadism shows FSH and LH levels that are

A

low or normal

218
Q

causes of secondary hypogonadism

A

constitutional delay, congenital GnRH deficiency, hypothyroidism, hyperprolactinemia.

219
Q

the physical exam for delayed pubtery

A

height, weight, arm span, secondary sex characteristic staging

220
Q

Patients with constitutional delay of puberty typically have bone ages of

A

12 to 13.5 years but rarely progress beyond this age.

221
Q

therapy for delayed puberty should be restricted to

A

boys older than 14 and girls older than 12

222
Q

those with hirsuitism needs this to be ruled out

A

ovarian or adrenal tumors

223
Q

An indicator of severe hirsuitism (hyperandrogenism)

A

virilization: deepening voice, balding, increased muscle mass, clitoromegaly

224
Q

diagnostics for hirsuitism

A

serum total testosterone

225
Q

oral contraceptive role in hirsuitism

A

inhibit LH secretion, this reducing testosterone

226
Q

Vitamin D of less than 20 ng/mL can be a cause of

A

secondary hyperparathyroidism

227
Q

vitamin D insufficiency is levels less than ___; vitamin D deficiency is levels less than ____

A

30 ng/mL; 20 ng/mL

228
Q

dosages of vitamin D

A

50,000 IU of vitamin D3 three times a week for 4 weeks

229
Q

Obstructive symptoms of BPH

A

urinary hesitancy, dribbling, decreased force of stream

230
Q

irritative symptoms of BPH

A

frequency, urgency, nocturia

231
Q

drugs that can cause symptoms of BPH

A

anticholinergics and sympathomimetics

232
Q

physical exam with BPH

A

enlarged, nontender, smooth prostate

233
Q

diagnostics for BPH

A

bladder ultrasound to determine post-void residual

234
Q

BPH is not a risk factors for

A

prostate cancer

235
Q

Progression of BPH and risk of prostate cancer can be decreased by

A

finasteride

236
Q

Work by lowering bladder neck and ureteral resistance in BPH

A

alpha adrenergic antagonist therapy

237
Q

direct alpha adrenergic antagonist

A

tamsulosin;

only act on smooth muscle of the prostate

238
Q

indirect alpha adrenergic antagonist

A

doxazosin;

act on all smooth muscle causing vasodilation

239
Q

shrink prostate gland by decreasing DHT levels

A

5alpha-reductase inhibitors: finasteride

240
Q

these two meds showed a higher risk reduction in BPH symptoms than when used alone

A

doxazosin and finasteride

241
Q

causes of acute and chronic prostatitis

A

gram negative: E. coli, Proteus, Klebsiella

242
Q

s/s of acute prostatitis

A

fever, chills, malaise, arthralgias, urinary sympoms

243
Q

s/s of chronic prostatitis

A

may be asymptomatic; may have recurrent UTI or urogenital symptoms

244
Q

physical exam with acute prostatitis

A

prostate is enlarged and tender. Avoid massaging to minimize risk of bacteremia.

245
Q

physical exam with chronic prostatitis

A

may have normal prostate; may feel tender.

246
Q

this should not be checked as it may appear elevated with prostatitis

A

PSA level

247
Q

diagnostic for prostatitis

A

acute: UA will show pyuria; Urine culture
chronic: prostatic specimen through urologist

248
Q

treatment for acute prostatitis

A

TMP/SMZ or fluoroquinolone for 2-6 weeks

249
Q

treatment for chronic prostatitis

A

TMP/SMZ or fluoroquinolone for at least 6 weeks

250
Q

teaching for prostatitis

A

sitz baths; avoid coffee, tea, alcohol; stool softeners; use condoms during therapy

251
Q

risk factors for prostate cx

A

men older than 65, Black, family history

252
Q

most common type of prostate cancer

A

adenocarcinoma

253
Q

difference between symptoms of BPH and prostate cancer

A

symptoms increase in intensity in 1-2 month intervals with prostate cancer whereas in BPH it is slow progression

254
Q

physical exam with prostate cancer

A

firm, indurated, asymmetric nodule on prostate

255
Q

screening for prostate cancer

A

recommended in all men starting at 50; 45 for black men; 40 for men with family hx

256
Q

PSA levels with prostate cancer

A

If less than 2.5 normal;
greater than 4 is abnormal- refer for biopsy;
greater than 10 indicative of cancer

257
Q

risk factors for renal cell carcinoma

A 
tobacco use; 
black; 
leather tanning and shoe-making; 
exposure to asbestos, gas, petroleum; 
family hx
258
Q

risk factors for bladder cancer

A

white male;
smoking;
ingestion of red meat

259
Q

symptoms of renal tumor

A

flank pain, hematuria, renal mass; however most are not diagnosed until it has metastasized

260
Q

occurs in those ages 3-4 and is usually unilateral

A

Wilms tumor

261
Q

s/s of bladder cancer

A

painless hematuria that continues throughout urination

262
Q

trx for bladder cancer

A

transurethral resection of bladder tumor

263
Q

diagnostic for bladder/renal cancer

A

UA, urine cytology, CBC, diagnostic ultrasound, cystoscopy, spiral CT

264
Q

loss of urine associated with activities that increased intra-abdominal pressure such as coughing, sneezing.

A

stress incontinence

265
Q

involuntary loss of urine usually preceded by a strong, unexpected urge to void.

A

urge incontinence

266
Q

an involuntary loss of urine associated with incomplete emptying

A

overflow incontinence

267
Q

DIAPPERS for incontinence

A 
Delirium;
Infection;
Atropic vaginitis;
Pharmaceuticals;
Psychological;
Excess urinary output;
Restricted mobility;
Stool impaction
268
Q

Diagnostics for urinary incontinence

A

UA, C&S, BUN/creatinine, postvoid residual, cystoscopy

269
Q

a PVR greater than ____ is considered abnormal

A

100 mL

270
Q

treatment for incontinence

A

time void every 2 hours, smoking cessation, pelvic muscle exercises, pessary placement;

271
Q

meds for stress incontinence

A

alpha adrenergic agonist (Sudafed), estrogen, tricyclic antidepressant

272
Q

meds for urge incontinencne

A

anitcholinergic/antimuscarinic agents: Detrol & Oxybutynin

273
Q

Meds for overflow incontinence

A

alpha adrenergic blockers (doxazosin or tamsulosin); alpha5 reductase inhibitors (finasteride)

274
Q

BPH can cause this type of incontinence

A

overflow

275
Q

risk factors for stone formation

A 
family history;
insulin-resistance;
HTN;
gout;
primary hyperparathyroidism (high calcium);
obesity;
dehydration
276
Q

Foods that can cause uric acid stones

A

seafood, meats

277
Q

foods that can cause oxalate stones

A

cola, chocolate

278
Q

Meds that can cause stone formation

A

HCTZ, antacids

279
Q

Most common type of urinary calculi in women

A

calcium oxalate stone

280
Q

Most common type of urinary calculi in men

A

uric acid stones

281
Q

s/s of nephrolithiasis

A

N/V, hematuria, dysuria, renal colic

282
Q

s/s of urolithiasis

A

dysuria, frequency, urgency, hematuria

283
Q

diagnostics for urolithiasis

A

UA, urine C&S, serum calcium, intact PTH

284
Q

urine pH less than 6.5 indicates what type of stone

A

calcium oxalate

285
Q

with urolithiasis, urine pH greater than 6.5 indicates

A

infection and f/u culture is necessary

286
Q

diagnostic for nephrolithiasis

A

renal ultrasound, KUB, noncontrast CT

287
Q

differential diagnosis for urolithiasis

A

gastroenteritis, appendicitis, abd aneurysm, ectopic pregnancy, peptic ulder

288
Q

Urinary stones less than ___ pass spontaneously, whereas urinary stones greater than ____ need surgical intervention

A

4 mm; 6-8 mm

289
Q

treatment for calcium oxalate stones

A

thiazide diuretic;

low calcium, protein, and sodium diet

290
Q

treatment for uric acid stones

A

allopurinol;
decrease purine intake;
increasing fluids

291
Q

In post-streptococcal glomerular nephritis, it is usually preceded by a hx of

A

GABHS skin or throat infection 1-3 weeks prior

292
Q

post-streptococcal glomerular nephritis is most common in

A

children 5-12 years old; those older than 60

293
Q

symptoms of post-streptococcal glomerular nephritis

A

edema, gross hematuria & proteinuria, HTN

294
Q

diagnostic for post-streptococcal glomerular nephritis

A

UA;

streptozyme test that measure 5 different streptococcal antibodies

295
Q

treatment for post-streptococcal glomerular nephritis

A

control HTN;
sodium and water restriction;
Loop diuretics

296
Q

Proteinuria is defined as urinary protein excretion of more than

A

150 mg/day

297
Q

Drugs that can cause proteinuria

A

lithium, cyclosporine, NSAIDs

298
Q

Diagnostic for proteinuria

A

1+ protein on urine dipstick x 2;
CBC, CMP, lipid panel;
24-hour protein and creatinine urine collection

299
Q

those with proteinuria should be tested for

A

Bence Jones proteins to r/o multiple myeloma

300
Q

Those with proteinuria need to be started on

A

ACEI or ARB, low sodium diet

301
Q

these people have high rates of hematuria

A

long distance runners

302
Q

Oliguria is defined as urine output of less than

A

400 mL in 24 hours

303
Q

Anuria is defined as urine output of less than

A

200 mL in 24 hours

304
Q

Prerenal ARF is caused by

A

dehydration and hypotension

305
Q

Intrarenal ARF is caused by

A

nephrotoxins (IV contrast, aminoglycosides

306
Q

postrenal ARF is caused by

A

BPH, bladder dysfunction or strictures, nephrolithiasis

307
Q

All patients with acute renal failure should be

A

hospitalized

308
Q

ESRD is a GFR of less than

A

15%

309
Q

Most common indicator of CKD is

A

proteinuria

310
Q

Best measure of kidney function

A

GFR

311
Q

Stage II kidney disease is GFR

A

60-89 mL/min

312
Q

Stage III kidney disease is GFR

A

30-59 mL/min

313
Q

Diet education for those with CKD

A

protein and phosphorus restriction; avoid salt substitutes as they contain high amount of potassium;
glycemic control;
increase calcium

314
Q

Vitamin D deficiency with CKD

A

give 50,000 IU of vitamin D2 monthly for 6 months

315
Q

testicular torsion is most commonly seen in

A

the left testicle

316
Q

s/s of testicular torsion

A

extremely painful, N/V, abdominal pain

317
Q

physical exam with testicular torsion

A

swollen and red scrotum, tender spermatic cord, absent cremasteric reflex

318
Q

Diagnostic for testicular torsion

A

Doppler US shows diminished blood flow

319
Q

Treatment for testicular torsion

A

must be sent to ER and treated within 6 hours

320
Q

testicular cancer is common in men ages

A

20-39 years old

321
Q

risk factors for testicular cancer

A

Caucasian;
cryptorchidism;
family hx;
scrotal trauma

322
Q

S/S of testicular cancer

A

testicular mass; swelling; sensation of fullness

323
Q

common causes of epididymitis in young men

A

Chalmydia and gonorrhea

324
Q

common causes of epididymitis in men older than 35

A

gram negative organisms;

TURP

325
Q

S/S of epididymitis

A

fever, chills, penile discharge, lower abd pain

326
Q

Physical exam with epididymitis

A

scrotum is red, enlarged, and tender.

327
Q

When pain is relieved with scrotal elevation (Prehn’s sign)

A

epididymitis

328
Q

Doppler US with epididymitis shows

A

normal blood flow

329
Q

medication for orhcitis and epididymitis

A

ceftriaxone, doxycycline, or levofloxacin

330
Q

education for epididymitis

A

scrotal elevation

331
Q

complication of epididymitis and orchitis

A

infertility

332
Q

Systemic, blood-borne infection that results in an acute inflammation of one or both testicles.

A

orchitis

333
Q

orchitis has similar signs and symptoms as

A

epididymitis

334
Q

causes of orchitis

A

may coexist with prostatitis or epididymitis; STDs

335
Q

The major classes of drugs that can affect erectile function are

A

antihypertensives, antidepressants, alcohol

336
Q

medications used to facilitate erection

A

PDE5 inhibitors:
sildenafil (Viagra),
vardenafil (Levitra),
tadalafil (Cialis)

337
Q

PDE5 inhibitors are contraindicated in those taking

A

nitrates

338
Q

Education for sildenafil (Viagra) and vardenafil (Levitra)

A

have a short duration of action; take on empty stomach; avoid taking with high fat meal

339
Q

Education for tadalafil (Cialis)

A

longer half-life for 24-36 hours. No dietary restrictions

340
Q

Patients taking SSRIs who have side effects of sexual dysfunction

A

take with buproprion

341
Q

most common organisms in UTI

A

gram negative : E. coli, Klebsiella, Enterobacter

342
Q

Any UTI in a male less than 50 years old is

A

considered complicated`

343
Q

common causes of urethritis

A

chlamydia and gonorrhea

344
Q

s/s of urethritis in males

A

dysuria, burning on urination

345
Q

Discharge with gonococcal urethritis is most often ___, whereas that with NGU tends to be ____.

A

purulent; clear or mucoid

346
Q

complicated UTIs occur in those

A

with urologic abnormalities, underlying disease (DM, renal failure), pregnancy, catheter, advanced age

347
Q

Four variables predict the presence of UTI

A

cloudy urine, malodorous urine, dysuria, nocturia

348
Q

UA in UTIs show

A

pyuria, high nitrates, hematuria

349
Q

avoid this medication pyelonephritis is suspected

A

nitrofurantoin

350
Q

Medication for UTI

A

nitrofurantoin x 5 days, TMP/SMZ DS x 3 days, fluoroquinolones x 3 days

351
Q

Recommended treatment duration for those with UTI who have DM.

A

10-14 days

352
Q

medication for UTI in children

A

third generation cephalosporins (cefexime, cefdinir); aminoglycosides

353
Q

Not recommended for trx of UTI in children d/t high resistance

A

amoxicillin and ampicillin

354
Q

s/s of pyelonephritis

A

UTI symptoms with fever, chills, flank pain, CVA tenderness, N/V

355
Q

Diagnostic for pyelonephritis

A

UA and Urine culture

356
Q

treatment for pyelonephritis

A

fluoroquinolones or TMP/SMZ for 7 days

357
Q

asymptomatic bacteruria refers to a colony count of at least ___ in the absence of symptoms

A

100,000/mL

358
Q

diagnosis of asymptomatic bacteruria in women

A

two clean catch urine specimens with more than 100,000 of bacteria

359
Q

risk factors for asymptomatic bacteruria

A 
advanced age;
nursing home;
incontinence;
women with diabetes;
pregnancy
360
Q

screening and treatment is indicated in these people with asymptomatic bacteruria

A

pregnant women and those undergoing urologic surgery

361
Q

avoid these eye drops with corneal abrasions

A

steroids

362
Q

where to avoid giving lidocaine and epi

A

fingers, toes, penis, nose

363
Q

treatment for most typical spider bites

A

supportive

364
Q

important to differentiate spider bites from

A

MRSA

365
Q

home remedy for bee/wasp stings

A

meat tenderizer paste

366
Q

s/s of UTI in elderly

A

confusion, AMS

367
Q

foods to avoid with incontinence

A

alcohol, caffeine, carbonated, spicy foods

368
Q

avoid these drugs with renal failure

A

NSAIDs, amnioglycosides, IV contrast

369
Q

blood under the finger or toe

A

subungual hematoma

370
Q

suggested suture removal for lower extremities

A

8-10 days

371
Q

suggested suture removal for face

A

5 days

Acute & Chronic II (4 decks)

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