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*Summative Cases > Cases 1/29- Constipation, UTI, Presbycusis, Asthma, Flu > Flashcards

Cases 1/29- Constipation, UTI, Presbycusis, Asthma, Flu Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of airways characterized by bronchial hyperresponsiveness, underlying inflammation, recurring sx

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2
Q

Sx of asthma

A 
Wheeze on exhalation
Cough (worse at night)
SOB
Chest tightness
Sputum production
Dyspnea
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3
Q

Sx of asthma if severe airflow obstruction

A

tachypnea, tachycardia, prolonged expiratory phase of respiration, tripod position, accessory muscle use, belly breathing, nasal flaring, tracheal tugging

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4
Q

How do you diagnose asthma?

A

Chest X-ray, blood tests, allergy tests, PFT, bronchodilator response

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5
Q

If doing a spirometry what do you expect to see with asthma?

A

reduced FEV1/FVC ratio

<7.0 = obstructive pattern

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6
Q

In adults, what are other DDx for asthma symptoms?

A

COPD, CHF

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7
Q

You should get a _________ for a wheezing patient to detect __________, _________, ___________, ________

A

CXray

pneumonia, FB, CHF, nonasthmatic causes of wheezing

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8
Q

What does an Xray show in an asthma patient?

A

Normal or hyperinflation due to air trapping

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9
Q

What are the most common SABA?

A

Albuterol

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10
Q

ADRs of Albuterol

A

flushing
tremors
tachycardia

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11
Q

What are cromolyn sodium and nedocromil?

A

Mast cell stabilizer

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12
Q

What drug is useful in the management of nocturnal symptoms and exercise-induced asthma?

A

Salmeterol

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13
Q

What is pathology of asthma?

A

airway edema
increased mucus production
bronchospasm

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14
Q

Classify the asthma: Symptoms less than or equal 2 times per week; less than or equal 2 times per month of nighttime symptoms, FEV1 or PEF greater or equal to 80%

A

Intermittent

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15
Q

Classify the asthma: Daily symptoms, daily use of beta-2 agonist, affects activity; Nighttime symptoms >1 time a week, but not nightly; FEV1 or PEF 60-80%

A

Persistent-moderate

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16
Q

Classify the asthma: Symptoms >2 times per week, but 3-4 times per month; FEV1 or PEF >80%

A

Persistent- mild

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17
Q

Classify the asthma: continual symptoms with use of beta2 agonist multiple times in 1 day, limited physical activity; Nighttime symptoms frequently at times almost each night; FEV1 or PEF

A

Persistent-severe

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18
Q

Step 1 Asthma Treatment

A

SABA PRN - Albuterol

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19
Q

Step 5 of Asthma Treatment

A

SABA PRN + high dose ICS + long acting beta agonist (consider omalizumab for patients with allergies)

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20
Q

Step 3 of Asthma Treatment

A

SABA PRN + low-dose ICS + LABA OR medium dose ICS

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21
Q

Step 2 Asthma Treatment

A

SABA PRN + low-dose ICS

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22
Q

Step 6 Asthma Treatment

A

SABA PRN + high-dose ICS + LABA + oral corticosteroids AND consider omalizumab for pts who have allergies

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23
Q

What are the Sx of constipation?

A

Must of have 2 of the following:
Straining, hard lumpy stool, sensation of incomplete evacuation, use of digital maneuvers, sensation of anorectal obstruction or blockage in 25% of BM, less than 3 stools/week

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24
Q

Metabolic causes of constipation

A 
hypothyroid
hypercalcemia
hypokalemia
scleroderma
amyloidosis
pregnancy
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25
Q

GI causes of constipation

A

tumors
IBS
diverticulitis

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26
Q

Neurogenic causes of constipation

A 
trauma to brain/spinal cord
CNS tumor
Parkinsons
paraplegia
prior pelvic surgery
DM
Colonic mass
Hirschsprung disease
27
Q

Perianal causes of constipation

A 
Fissue
hemorrhoids
Rectocele
Rectal prolapse
Diverticular disease
28
Q

Medication causes of constipation

A 
Opiates
CCB
Anticholinergics
TCA
Diuretics
Antacids
Conidine
Levodopa
Laxative abuse
29
Q

What are diagnostic techniques of constipation?

A

Rectal X-ray; abdominal x-ray

If new onset in older adults: CBC, serum electrolytes, TSH, Ca level, anoscopy

30
Q

What are examples of bulk-forming agents? (3)

A

psyllium (bloating, impaction above strictures), methycellulose (fluid overload, impaction with insufficient fluid), polycarbophil (fluid overload, impaction)

31
Q

What are examples of osmotic laxatives? (3)

A

lactulose (bloating), magnesium salts (MOM; Mg toxicity), sorbitol (bloating)

MOM c/i in renal failure

32
Q

What are examples of stimulants? (3)

A

bisacodyl (gastic or renal irritation), senna (degeneration of myoneural plexuses), casathranol (degeneration of myoneural plexuses)

33
Q

What are examples of stool softeners?

A

docusate sodium (skin rashes, hepatotoxicity)

34
Q

What are indications for further lab testing with constipation?

A

refractory constipation, new onset constipation in older adults, heme-positive stools, unclear etiology

35
Q

What is presbycusis?

A

age related hearing that is a bilateral sensorineural impairment of higher frequencies that may compromise speech comprehension

36
Q

What are symptoms of presbycusis?

A

Progressive, symmetric hearing loss of high frequency, tinnitus, vertigo, falls, low self-esteem, isolation, depression

37
Q

What are diagnostics for presbycusis?

A

Otoscopy (for cerumen impaction, infx, TM perf, tumors)
Whispered ear
Tuning forks (weber vs rinne)
Audiogram

38
Q

What is treatment for presbycussis?

A

Hearing aid
Cochlear implantation
Assistive listening devices
Auditory rehab

39
Q

What is the difference between conductive vs sensorineural?

A 
Conductive = inability to mechanically transmit sound vibrations
Sensorineural = inability to effectively transduce sound info
40
Q

What is Meniere disease?

A

acquired condition (not age-related) that affects the inner ear and can affect balance and hearing

41
Q

What are sx of Meniere disease?

A

episodes of tinnitus, progressive hearing loss (low-pitched loss usually U/L), Hyperacusis and nystagmus may be present

42
Q

What ages for Meniere disease?

A

30-60

43
Q

What is treatment for Meniere disease?

A

diuretics (acetazolamide or hydrochlorothiazide)

Salt restriction

44
Q

What is otosclerosis?

A

hereditary disorder in which ossification of labyrinth of inner ear occurs, resulting in tinnitus and CONDUCTIVE hearing loss; not age related

45
Q

What is the treatment for otosclerosis?

A

surgical to otolaryngologist

46
Q

What is an acoustic neuroma?

A

Schwannoma of CN VIII that grows to compress the nerve and brainstem

47
Q

What is labyrinthitis?

A

Inflammation of labyrinth and usually follow URI; causes vomiting and severe vertigo

48
Q

How long does it take to recover from labyrinthitis?

A

1-6 weeks

49
Q

Treatment of labyrinthitis?

A

Meclizine, dimenhydrinate, antiemetics, benzodiazepines

50
Q

Sx of UTI

A

dysuria, frequency, urgency, suprapubic pain, hematuria
delirium in elderly
Others- fever, chills, flank pain, CVA tenderness, N/V

51
Q

Diagnostics of UTI?

A

UA
Urine culture
CVA tenderness

52
Q

What are sx of UTI in infants and children?

A

irritability, fever, N/V, bed wetting, diarrhea

53
Q

What are sx elderly patients may have of UTI?

A

change in mental status, malaise, incontinence, poor appetite

54
Q

When should chlamydial or gonococcal infection be suspected?

A

gradual onset of illness, no hematuria, no suprapubic pain, more than 7 days of symptoms

55
Q

What do older men usually have a UTI or irritative symptoms secondary to?

A

BPH

56
Q

What do WBC casts indicate?

A

upper tract involvement

57
Q

What are diagnostic criteria of acute uncomplicated cystitis?

A

UA for pyuria and hematuria

58
Q

Treatment of uncomplicated cystitis?

A 
Fosfomycin
Nitrofurantoin
TMP/SMX
Trimethoprim
Ciprofloxacin
Oxfloxacin
Norfloxacin
59
Q

What are diagnostic criteria for complicated UTI?

A

urine culture with a bacterial count of more than 10,000 CFU/mL of urine

60
Q

What is treatment for complicated UTI?

A

If Gram -, oral fluoroquinolone
If Enterococcus species, ampicillin or amoxicillin w/ or w/o gentamicine
Treat for 10-14 days

61
Q

What are the causes of the flu?

A

Influenza A or B

62
Q

What are symptoms of flu?

A

Abrupt onset of HA, fever, malaise, and myalgia

Possibly non-productive cough, sore throat, nasal discharge

63
Q

Diagnostics of flu

A

Rapid influenza antigen test
Viral culture
RT-PCR is preferred test

64
Q

Treatment of flu

A

antiviral therapy (Zanamivir or oseltamivir)

*Summative Cases (2 decks)

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