Difference between acute, persistent, chronic and subacute cough
Acute- less than 3 weeks
Persistent- 3 to 8 weeks
Chronic- >8weeks
Subacute- post infectious cough for 3 to 8 weeks
when cough lasts more than 3-6 wks what imaging should be done
chest radiography
cough lasting more than 3 weeks what is considered
pertussis
If ACE inhibitor, respiratory infection, and radiography abnormals are absent what should be expected
post nasal drip, GERD, Asthma
Dyspnea with persistant cough check for
HF, anemia, chronic lung disease
Patient with acute cough abnormal vital signs, chest dullness (on percussion) with egophony what are next two studies to perform
C-reactive protein (Positive if >30mg/dL) and chest xray
Persistant cough, no ACE-I or postinfection, what would you check? how would you check? what if that test is negative?
Suspect pertussis
check with polymerase chain reaction
negative PCR suspect asthma, GERD, post nasal drip
Step 1 therapy for asthma
beta 2 agonist
step 1 therapy for GERD
PPI
STEP 1 therapy for post nasal drip
therapy for allergy and chornic sinusitis
Early treatment of pertussis
macrolide antibiotics
Pertussis for more than 7-10 days treatment
Tdap, macrolide antibiotics for those at risk (wont help cough)
what is the difference in reflex cough and persistant cough symdromes
Reflex cough is when someone sees something they jsut cough
persistant cough syndromes deals with vagus/laryngeal nerve dysfunction
When to refer patient with cough
1) failure of tx to control persistent or chronic cough
2) recurrent symptoms (oto, pulm, gas)
3) adults needing Tdap FOR cocooning of at risk kids
How to diagnose pneumonia
CXR, blood levels of procalcitonin and C-reactive protein
Hemoptysis essential inquires
1) fever cough lower respiratory tract infecoin
2) smoking history
3) nasopharyngeal or gastric bleed
4) cxr, cbc, INR
Diagnostics tests for hemoptysis
CXR, cbc, renal function test, urinalysis, coagulation studies
young obese patient with hyperlipidemia, and smoking with chest pain, EKG depressed ST, expect
Acute coronary syndrome
Patient with chest pain, you do a TIMI and Goldman score and Troponin T, then you discharge patient why
TIMI 1 or less
Goldman score 1 or less
Troponin T in normal
Patient with chest pain, you do a TIMI and HEART score and Troponin I, then you discharge patient why
TIMI 1 or less
Heart was 3 or less
Troponin was normal
75y Patient comes in with palpitations, syncope, has abnormal ECG, hematocrit less than 30%, SOB, RR24, Hx of HF, should they be admitted
yes
Treatment of lower extremity edema do to venous insufficiency without comorbid HF includes
leg elevation
compression therapy
ambulatory
NO DIURETICS ( may damage kidneys)
normal celcius body temp range
36.7 (36to 37.4)
neuroleptic malignant syndrome and serotonin syndrom cause what to occur body temp
hyperthermic
treatment of neuroleptic malignant syndrome
dantrolene in combo with bromocriptine or levodopa
treatment of serotonin syndrome
cyproheptadine or cholrpromazine , with benzodiazepine
patient comes in with dilated pupils, sweating, diarrhea for days, shivering, headache, and confusion. reports starting new medication for mood. What would be expected, how would you treat
expect serotonin syndrome
treat with cyproheptadine (or chlorpromazine) and benzodiazepine
Three common findings of weight loss of 5% over 6-12month period
1) cancer (30%)
2) GI disorders (15%)
3) dementia/depression
First tests to run when significant weight loss is seen
cbc, tsh, urinalysis, fecal occult blood, serological test (hiv), cxr, upper gi
when weight loss is seen, a second phase of tests to run
gastrointestinal (for malabsorption) and cancer screening (colonoscopy may not be adequate for symptom of weight loss only)
When weight loss is seen along with anorexia nervosa, depression, or dementia what should be considered
psychological consult
how many percentage of weight loss cases can go without specific cause
15-25%
When initiating nutrition back to some one who had significant weight loss intake goal should be
30 to 40 kcal/kg/d
3 common types of categories of treatment for weight loss include
1) appetite stimulants
2) growth hormone
3) anticatabolic agents
appetite stimulant medications include
corticosteroids, dronabinol, progestational agents, and serotonin antagonists
anticatabolic agents for treatment of weight loss include
hydrazine sulfate, omega 3 fatty acid, pentoxifylline, and thalidamide
Patients with significant weight lose should be referred when
1) caused by malabsorption
2) anorexia nervosa or bulimia
3) persistent nutrition deficit despite adequate supplementation
Patients with significant weight loss should be admitted when
1) cachexia 2nd to psych disorder
2) severe protein deficient (kwarshiorkor or marasmus)
3) severe vitamin deficient
4) electrolyte fluid replacement
After physical assessment labs to be used for chronic fatigue diagnosis are
cbc chemistry erythrocyte sedimentation rate antinuclear antibodies urinalysis TB Lyme serology serum cortisol rheumatoid factor immunoglobin levels Hiv antibodies
An acute headache seen in someone who is >50 or HIV positive, especially with mental or neuro abnormals on exam requires what type of imaging
neuroimaging
Patients that have acute onset of headache and are
40 or older, have neck pain or stiffness, limited neck flexion, witnessed loss of consciousness, onset during exercise, thunderclap headache should be evaluated for
subarachnoid hemorrhage
If suspicion of subarachnoid hemorrhage what diagnosis tests should be done
CT noncontrast then CT with contrast then lumbar puncture then angiography
urinalysis is most helpful in presentation of
atypical cystitis
patient with complaints of dysuria and severe flank pain what is likely considered? requires what type of imaging
kidney infection, hydronephrosis,
>use renal ultrasound or ct scanning
or nephrothiasis
> CT helical scanner
Academy of pediatrics committe on drugs states what antibiotics are safe during breast feeding
ciprofloxicin ofloxicin trimethoprim-sulfamethoxazole(unless G6PD deficient) amoxicillin nitrofurantoin
