Clin Med I > CLIN MED LAB MIDTERM > Flashcards

CLIN MED LAB MIDTERM Flashcards

- Sinusitis - Headache - CVA - Mono (65 cards)

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1
Q

acute rhinosinusitis lasts for

A

< 4 weeks

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2
Q

subacute rhinosinusitis lasts for

A

4-12 weeks

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3
Q

chronic rhinosinusitis lasts for

A

> 12 weeks

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4
Q

recurrent acute rhinosinusitis

A

> /= 4 episodes per year with symptoms resolution in between

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5
Q

factors that would make you suspect a bacterial etiology of sinusitis

A
  • Sx >10 days
  • unilateral maxillary sinus pain
  • maxillary tooth pain
  • unilateral purulent nasal drainage
  • second sickening
  • fever
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6
Q

T/F: Most patients with viral URIs are febrile

A

FALSE - Most are afebrile

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7
Q

If fever is present in viral URI, it tends to occur ___

A

on the first 2 days of illness

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8
Q

As fever/constitutional Sx resolve, respiratory symptoms become more prominent, peaking in severity at ____ days

A

3 to 6 days of illness

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9
Q

resp Sx may continue to be present on day ___ of illness, but are less severe than earlier in the course

A

10 days

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10
Q

acute bacterial sinusitis pathogens

A
  • Strep pneumo*
  • H. flu*
  • M. cattarhalis
  • Staph aureus
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11
Q

1st line therapy for bacterial sinusitis

A

Augmentin

adults and kids

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12
Q

How would you Tx bact sinusitis for pt with PCN allergy

A

Doxycycline

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13
Q

Days of Abx fof bacterial sinusitis

A
  • 5-7 days for adults

- 10-14 for kids

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14
Q

symptomatic therapy for sinusitis

A
  • NSAIDS, Tylenol
  • nasal spray/irrigation
  • Flonase
  • decongestants
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15
Q

complications of bacterial sinusitis

A
  • preseptal cellulitis
  • orbital cellulitis
  • orbital subperiosteal abscess
  • septic cavernous sinus thromnosis
  • meningitis
  • brain abscess
  • osteomyelitis of the frontal bone
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16
Q

T/F: Migraines are usually bilateral

A

False - usually unilateral

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17
Q

T/F: Response to a triptan can be diagnostic if pt’s symptoms improve

A

True

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18
Q

what are some theories to pathophysiology of migraine

A
  • dilation of vessels
  • serotonin
  • inflammatory process
  • trigeminocervical complex
  • calcitonin gene-related peptide
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19
Q

migraine prodrome occurs

A

few hours to days prior

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20
Q

migraine aura occurs

A

5-60 minutes prior

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21
Q

migraine attack occurs

A

4-72 hours

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22
Q

migraine postdrome occurs

A

23-48 hours after

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23
Q

1st line abortive migraine medication

A
  • Excedrin
  • NSAIDs
  • Acetaminophen
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24
Q

2nd line abortive migraine meds

A
  • triptans

- ergotamine nasal spray

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25
3rd line abortive migraine meds
- toradol IM - ergotamine IV - dexamethasone
26
chronic migraine
15 headaches/month | lasting >4 hrs/day
27
you can Tx for migraines prophylactically when pt has
>2-3 HA per month
28
migraine prophylaxis Tx
- beta-blockers (propanolol) - Ca channel blockers - anti-depressants (amitriptyline, nortriptyline) - anti-sx (depakote, topamax) - anti-CGRP - botox - magnesium
29
education on rebound headaches - simple analgesics
limit to 15 days or less per month | ASA, APAP, NSAIDs
30
education on rebound headaches - combo analgesics
limit 10 days or less per month | Excedrin, triptans
31
Tx for rebound HA
- stop all medications | - may try prednisone taper
32
patient education for migraines
- avoid triggers - be aware of Sx and catch them early - caution rebound Ha - get evaluated for atypical migraines - worse HA of your life = ER - headache journal - menstruation
33
highest incidence of symptomatic infection of EBV is what age group
15-24 y/o
34
incubation period for EBV
30-50 days
35
EBV is spread via
- saliva (most common) - genital secretions - blood transfusion - bone marrow transplant
36
a pt who has mono can remain infectious for how long
6 months or longer
37
at which cells does EBV replicate and shed?
oral epithelial cells
38
______ that are specific to EBV control the acute infection
cytotoxic T cells
39
what is the triad for mono
- fever - pharyngitis - lymphadenopathy
40
clinical presentation for mono
- fever, fatigue - posterior cervical LAD - pharyngitis (kissing tonsils, exudates, palatal petechiae)
41
Pt with mono may develop a rash if given
amoxicillin (or ampicillin)
42
what would you expect to see on labs for mono pt
- lymphocytic leukocytosis - monospot - heterophile Ab - IgM & IgG - transient abnormal LFTs
43
what type of cell would you expect to see with atypical lymphocytosis
Downey cell | slightly larger than normal lymphocyte with irregular nucleus -- larger from antigen stim
44
Mono Tx
- usually self-limiting - Tylenol/NSAIDs - avoid contact sports for 2-3 weeks if HSM
45
complications of mono
- splenic rupture/hemorrhage - airway compromise - malignancy - encephalitis - myocarditis - hepatitis
46
mono: when does fever and sore throat resolve?
by 10 days
47
mono: when does HSM and LAD resolve?
by 4 weeks
48
mono: when does fatigue resolve?
2-3 months
49
CHADS2 score
score > 2 = high risk of stroke - needs anticoags ``` CHF HTN Age >75 DM Stroke/Tia = 2 points ```
50
what visual deficit is associated with PCA stroke
homonymnous hemianopsia
51
what aphasia is associated with PCA stroke
anomic aphasia (difficulty naming objects)
52
Alexia without agraphia is associated with what stroke
PCA
53
what type of infarction can result in pure motor or pure sensory deficits
lacunar
54
which stroke can lead to dysarthria-clumsy hand syndrome
lacunar stroke
55
when evaluating for CVA, ____ is more sensitive to detect early ischemia
MRI
56
when evaluating for CVA, ____ is used to evaluate arteries for stenosis, occlusion, or aneurysm
MRA
57
when evaluating for CVA, ____ is used to check for carotid stenosis
Carotid doppler
58
when evaluating for CVA, ____ is used to evaluate for possible embolic source
Echo
59
when evaluating for CVA, ____ is used to evaluate for hemorrhage
non-con CT
60
tPA criteria
- age >18 years - clinical Dx of ISCHEMIC CVA - time onset <4.5 hours
61
before thrombolysis, patient's BP should be less than ____
<185/110
62
after thrombolysis, BP should be maintained at ___
<180/105 for at least 24 hours
63
if no thrombolytic therapy, pt's BP should be treated unless ___
> 220/120
64
what are options of antithrombotic therapy
- ASA, Plavix, Aggrenox | - Warfarin or NOACs (for those with a-fib)
65
what other meds/add'l mgmt should be considered for stroke pts
- VTE prophylaxis - atorvastatin, lipitor - anti-HTN - smoking cessation - exercise/weight reduction
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