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Adult Health > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Rhino sinusitis most often caused by…

A

VIRUS

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2
Q

Think bacterial rhino sinusitis when..

A
  1. Symptoms >10 days w/o improvement
  2. Severe symptoms (fever >102, facial pain lasting longer than 3 days, purulent nasal drainage)
  3. Symptoms got better and then worse again
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3
Q

Rhinosinusitis treatment VIRAL

A

OTC analgesics, intranasal steroids (budesonide, flucticasone (flonase, nasacort, nasonex), decongestants sometimes (no longer than 3 days)

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4
Q

Rhinosinusitis treatment Bacterial

A
  1. amoxicillin or amoxicillin-clavulante (Augmentin is better, generally for pts with risk factors for resistance, give if pt looks sick – region with resistance, antibiotic use in past month, hospitalization in last 5 days, immunocompromise, comorbidities, severe infection-temp >102)
    1. (Penicillin allergic) Doxycycline (not in pregnancy) OR 3rd generation cephalosporin (cefixime, cefpodoxime) with or without clindamycin. OR respiratory fluoroquinolone (last line d/t side effects-prolonged QT, not in pregnancy) (levofloxacin, moxifloxacin)
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5
Q

Pharyngitis/tonsillitis most often caused by….

A

VIRAL

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6
Q

pharyngitis/tonsillitis when caused by bacteria think…

A

group A streptococcus

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7
Q

pharyngitis/tonsillitis can also be caused by….

A

Group C&G Strep, STI, diptheriae, EBV, Cytomegalovirus, Herpes simplex

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8
Q

Center scoring for rapid strep test…

A 
Criteria 
Absence of cough: +1
Swollen, tender anterior lymph nodes: +1
Temp> 100.4 +1
Age 3-14 +1
15-44 0
45 or older -1

Score
1-2 no further testing or antibiotics
3-4 rapid strep test and treat
5 consider empiric treatment

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9
Q

Other diagnostics to order for pharyngitis/tonsillitis

A

throat culture (for high risk, DO NOT empirically treat before results are obtained), Monospot (false negative if tested within 7 days of symptom onset)-could do CMP (liver enzyme elevation with mono), CBC (lymphocytosis and atypical lymphocytes), cytomegalovirus will not show up on monospot, EBV & CMV serology testing may be used if repeat monospot is negative

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10
Q

Treatment for tonsillitis from group A Strep

A
  1. Penicillin V or Amoxicillin
  2. (penicillin allergy) Cephalosporins or Macrolide. Mild non-IgE reactions: 2nd or 3rd generation cefuroxime, cefdinir, cefpodoxime. Any possible IgE reaction/severe penicillin reaction: Macrolide- azithromycin, if macrolide resistant strep-clindamycin
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11
Q

Mono treatment

A

supportive care, no steroids in routine cases, avoid contact sports for a few months d/t spleenic rupture risk

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12
Q

Peritonsillar Abscess S/S

A

unilateral severe throat, muffled voice, fever, pooling saliva, drooling, neck swelling and pain, soft palate appears to be caving in

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13
Q

Peritonsillar Abscess diagnostics

A

CT

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14
Q

Peritonsillar Abscess treatment

A

ENT consult, steroids, Augmentin OR Clindamycin

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15
Q

Epiglottitis

A

EMERGENCY

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16
Q

Acute Otitis Media most common cause

A

upper respiratory infections, strep pneumoniae. May also be caused by H. influenza, moraxella cararrhalis, staph aureus

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17
Q

AOM S/S

A

earache, decreased hearing, dizziness, fever, donut looking bulging TM and yello purulent color (red TM does NOT indicate infection), decreased TM motility, otorrhea

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18
Q

AOM with effusion S/S

A

Fluid in middle ear without S/S of infection, TM dull non-bulging, decreased motility, ear-fluid lines

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19
Q

AOM Treatment

A
  1. Amoxicillin or Augmentin
  2. (penicillin allergy) Non IgE Cephalosporin (cefdinir, cefpodoxime, cefuroxime, ceftriaxone). Severe IgE allergy: doxycycline (NOT in pregnancy) OR macrolide (azithromycin, clarithromycin)
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20
Q

Upper respiratory infections cause

A

VIRAL

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21
Q

Otitis Externa cause

A

bacterial, P. aeruginose is most common, could also be staph epidermidis, staph aureus, fungal

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22
Q

Otitis Externa S/S

A

itching, plugging of ear, ear pain, ear discharge, pain on manipulation of pinnae, eczema of pinnae, ear canal red, containing discharge and debris

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23
Q

Otitis Externa Treatment

A

Clean ear canal and outer ear (peroxide with water). Antibiotics: Topical floroquinolones ofloxacin and ciprofloxacin or cipro combined with dextamethasone, Polymyxin B and neomycin (aminoglycoside), Tobramycin and gentamicin (NOT if TM is ruptured-ototoxic)

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24
Q

Labyrinthitis definition

A

ACUTE inflammation or viral infection of inner ear (labrynth)

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25
Q

Labrynthitis S/S

A

vertigo and hearing loss in one ear, n/v, ear fullness, tinnitus, nystagmus, upper respiratory symptoms

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26
Q

Labrynthitis Treatment

A

Antiemetics-zofran, antihistamines-meclizine, benzodiazepines, steroids

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27
Q

Meniere’s Disease definition

A

CHRONIC condition with recurrent inner ear attacks

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28
Q

Meniere’s S/S

A

recurrent attacks of hearing loss, tinnitus, vertigo, ear fullness, pallor, sweating, n/v

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29
Q

Dental Infections

A

most often gram + bacterial

treat with Pencillin G, amoxicillin, Augmentin, Clindamycin

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30
Q

Sialothiasis s/s

A

unilateral pain and swelling around involved gland, aggravated by eating, compression of salivary gland without saliva output, stones are rock hard and small

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31
Q

Sialthoiasis treatment

A

Increased fluid intake, tart hard candy, stop anticholinergic medications, NSAIDs

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32
Q

Parotitis cause

A

most commonly poly microbial, Staph aureus, strep pneumonia, strep viridians, h. influenzae

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33
Q

Parotitis S/S

A

pt looks sick, fever, unilateral swelling (if bilateral swelling think mumps), warmth, redness, over cheek, purulent drainage from stensons ducts

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34
Q

Parotitis treatment

A

Send to ED for IV antibiotics-recommended, Oral antibiotics- Clindamycin with ciprofloxacin OR amoxicillin-clavulanate with or without linezolid

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35
Q

Mumps s/s

A

parotid swelling usually bilateral lasting >2 days with no other causes, may have fever, neck ache, and malaise

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36
Q

TB S/S

A

stuffy nose, runny nose, post nasal drip, sneezing, productive cough, purulent yellow sputum, hemoptysis: coughing up blood or blood tinged mucous

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37
Q

PPD induration results

A

Induration >5mm + in: HIV infected pts, persons w/fibrotic changes on CXR consistent with prior TB, organ transplants, immunosuppressed (taking the equivalent of >15mg/day of prednisone for 1 month or longer, taking TNF-alpha antagonists). Induration > 10mm + in: recent immigrants <5yrs, IVDU, residents and employees of high risk settings, mycobacteriology lab personnel, persons with clinical conditions that put them at risk, children <4. Induration >15mm or more + in anyone

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38
Q

TB management

A

Preferred regimen for treating adults consists of 2 intensive phases of 3 months of isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) followed by a continuation phase of 4 months of INH and RIF. Avoid once weekly regimen of INH 900/RPT 600

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39
Q

Lung cancer, most common

A

NSCLCs are about 85% of malignancies, primary types (in order of prevalence) are adenocarcinoma, squamous-cell carcinoma, large cell carcinomas.
SCLCs are 13% of malignancies. Smoking is most related to SCLCs and squamous cell carcinoma.

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40
Q

Lung cancer S/S

A

cough, weight loss, dyspnea, wheezing, chest pain, pleural effusions, absent or diminished breath sounds, diminished resonance on percussion, decreased tactile fremitus, clubbing, anemia

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41
Q

Lung cancer diagnostics

A

CBC: anemia, leukocytosis, thrombocytosis, Hct: <40 males, < 35 females, Calcium: elevated, Baseline PFT’s, CXR, CT with contrast, Flexible fiberoptic bronchoscopy, Transthoracic percutaneous fine needle aspiration biopsy

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42
Q

Acute bronchitis cause

A

Most often caused by VIRUS, rarely bacteria, usually fall and winter.
Influenza A & B, parainfluenza, and RSV most common, less common coronavirus, adenovirus, rhinovirus, and metapneumovirus
H. influenza and strep pneumoniae

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43
Q

Chronic bronchitis should be considered when…

A

Chronic bronchitis should be considered only for pts who have had cough and sputum production on most days of the month for at least 3 months of the year during 2 consecutive years.

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44
Q

Acute bronchitis treatment

A

Smoking cessation. Humidification, rest, fluids
Bronchodilators x 7 days, Beta-adrenergic bronchodilators could be used in patients with acute bronchitis and wheezing associated with cough
Cough suppressants (dextromethorphan cough preparation every 4 hours, benzonatate, codeine, or hydrocodone if cough is severe)
Oral steroids x 5 days

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45
Q

Acute bronchitis treatment for influenza

A

Influenza is most common pathogen in acute bronchitis therefore if influenza is suspected or confirmed, antivirals medications such as oseltamivir, zanamivir may be effective within 48 hours of illness onset

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46
Q

Acute bronchitis treatment if pertussis is suspected

A

Antibiotic therapy if pertussis is suspected, pertussis is gram-negative bacterium. Suspicion of pertussis should be limited to individuals with a high probability of exposure, such as in community outbreaks. Pts w/ confirmed or probable pertussis should receive antibiotic therapy and be isolated for 5 days from the start of treatment. Macrolides are first line-azithromycin, erythromycin, clarithromycin. Second line therapy is trimethoprim sulfamethoxazole (Bactrim). Erythromycin has been the drug of choice. Azithromycin can cause QT prolongation and shouldn’t be used in those with CVD.

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47
Q

Asthma S/S

A

symptoms are variable and intermittent, wheezing, dyspnea, coughing, prolonged expiration due to air trapping (they won’t sound like they are exhaling, you won’t hear anything, you’ll hear a big breath in, a short breath out and nothing else), may be worse at night and cause pt to awaken

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48
Q

Asthma Diagnosis

A

FEV1/FVC <80% AND reversal of obstruction after bronchodilator administration

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49
Q

FVC

A

Forced Vital Capacity (FVC) shows the amount of air a person can forcefully and quickly exhale after taking a deep breath

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50
Q

FEV1

A

Forced expiratory volume is measured during the forced vital capacity test, the forced expiratory volume (FEV1) in one second measurement shows the amount of air a person can fully exhale in one second of the FVC test.

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51
Q

Intermittent asthma classification..

A

Symptoms: <2 days/wk
Nighttime awakenings: <2/month
SABA use for symptoms: <2 days/wk
Interference with normal activity: none
Lung function: Normal FEV1, FEV1 >80%, FEV1/FVC normal
Exacerbations requiring oral systemic steroids: 0-1/yr
Recommended step for initiating treatment: Step 1

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52
Q

Mild Persistent asthma classification

A

Symptoms: >2 days/wk but not daily
Nighttime awakenings: 3-4/month
SABA use for symptoms: >2 days/wk but not daily, and not more than 1/day
Interference with normal activity: minor limitation
Lung function: FEV1 >80%, FEV1/FVC normal
Exacerbations requiring oral systemic steroids:>2/yr
Recommended step for initiating treatment: Step 2

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53
Q

Moderate Persistent Asthma classification…

A

Symptoms: daily
Nighttime awakenings: >1/wk but not nightly
SABA use for symptoms: daily
Interference with normal activity: some limitation
Lung function: FEV1 >60%, FEV1/FVC reduced 5%
Exacerbations requiring oral systemic steroids: >2/yr
Recommended step for initiating treatment: Step 3 & consider course of oral steroids

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54
Q

Severe Persistent Asthma classification

A

Symptoms: throughout the day
Nighttime awakenings: often nightly
SABA use for symptoms: several time a day
Interference with normal activity: extremely limited
Lung function: FEV1 <60%, FEV1/FVC reduced > 5%
Exacerbations requiring oral systemic steroids: >2/yr
Recommended step for initiating treatment: Step 4 or 5 & consider course of oral steroids

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55
Q

Asthma treatment step 1

A

SABA PRN (albuterol, levalbuterol, peributerol)

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56
Q

Asthma treatment step 2

A

Preferred: Low-dose ICS (beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone)
Alternative: Cromolyn,
Leukotriene receptor agonist- LTRA (montelukast, zafirlukast), Theophylline (class: methylxanthines)

SABA PRN

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57
Q

Asthma treatment step 3

A

Preferred: Low-dose ICS + LABA (salmeterol, formoterol) or Medium-dose ICS

Alternative: Low-dose ICS + LTRA, theophylline, or zileuton

SABA PRN

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58
Q

Asthma treatment step 4

A

Preferred: Medium-dose ICS + LABA

Alternative: Medium-dose ICS + LTRA, theophylline, or zileuton

SABA PRN

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59
Q

Asthma treatment step 5

A

Preferred: High-dose ICS + LABA AND consider omalizumab for allergy pts

SABA PRN

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60
Q

Asthma treatment step 6

A

Preferred: High-dose ICS + LABA + oral steroid (prednisone) AND consider omalizumab for allergy pts

SABA PRN

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61
Q

Short Acting Beta Agonists (SABA)

A

albuterol, levalbuterol

Quick relief, rescue med
bronchodilators , relax smooth muscle

Side effects: tachycardia, HTN, HA, dizziness, tremors, hyperactivity, tremors, insomnia, nausea, muscle cramps
When they don’t promptly resolve symptoms of bronchoconstriction, systemic corticoids are indicated

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62
Q

Systemic corticosteroids

A

prednisone

Used short term for asthma exacerbations not controlled by SABA’s, do NOT taper dose

63
Q

Inhaled corticosteroids (ICS)

A

beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone

Most effective long term asthma control medication
Recommended for every pt with persistent asthma
Side effects: hoarseness, oral thrush, prevented with good oral hygiene and spacers

64
Q

Long Acting beta agonsits (LABA)

A

salmeterol, formoterol

Never to be used for quick relief, used in conjunction with ICS for long term control and prevention in moderate or severe persistent asthma, of all therapies, LABAs are preferred to combine with ICS

Side effects: watch using them in pts with heart issues (rare sudden cardiac death)
Combination ICSs and LABAs: fluticasone/salmeterol (Advair), fluticasone/vilanterol (BreoEllipta), budesonide/formoterol (Symbicort)

65
Q

Cromolyn

A

Good for pts w/allergies
Used in prophylaxis of mild to moderate asthma, useful when exposure to identifiable trigger triggers symptoms and may be useful when a known trigger cannot be avoided, safe

66
Q

Leukotriene receptor agonists (LTRA)

A

montelukast (singulair), pranlukast, zafirlukast, zileuton

Increase persistent dilation to reduce symptoms, reduce medication use, and decrease the need for quick relief therapy

Side effects: increase prothrombin times, elevate liver enzymes and will increase levels of theophylline

67
Q

Methylxanthines

A

theophylline, aminophylline

Bronchodilators that also have inotropic effect on the diaphragm
narrow therapeutic index, many drugs affect the metabolism and careful monitoring of serum levels in needed

Toxicity may cause HA, N/V/D, arrhythmias, seizures

68
Q

Immunomodulators

A

omalizumab

Monoclonal antibody that prevents the binding of IgE to mast cells, it is used as adjunctive therapy in those 12 and older who have moderate to severe persistent asthma caused by hypersensitivity reactions

High costs

Pts must be monitored for anaphylaxis after administration

69
Q

COPD S/S

A

tachypnea, resp. Distress, cyanosis, (increased AP diameter) barrel chest, distant heart sounds, JVD, dyspnea upon exertion, gough, sputum, purulent sputum, pursed lip breathing, resonance on chest percussion

Lung disease causes hypertrophy of R ventricle resulting in cor pulmonale, which may reveal neck vein distention, peripheral edema, hepatomegaly from elevated R arterial pressure, pulmonary hypertension and R ventricle distention

70
Q

S/S indicating deterioration of COPD

A

Increased dyspnea, increased sputum, increased purulence

71
Q

COPD diagnostics

A

Perform spirometry if any s/s present > 40yo
Gold standard of diagnosis
FEV1/FVC less than 0.70 is considered diagnostic of airflow limitation (COPD)

72
Q

GOLD 1: Mild COPD

A

FEVI/FVC <70%, FEV1 >80% predicted

73
Q

GOLD 2: Mild COPD

A

FEVI/FVC <70%, FEV1 50%- <80% predicted

74
Q

GOLD 3: Mild COPD

A

FEVI/FVC <70%, FEV1 30%- <50% predicted

75
Q

GOLD 4: Mild COPD

A

FEVI/FVC <70%, FEV1 < 30% predicted

76
Q

Mild COPD treatment

A

SABA (albuterol, levalbuterol) PRN first choice for pts w/intermittent symptoms.

Anticholinergics (Ipratropium bromide-Atrovent, Tiotropium-Spiriva, Aclidinium-Pressair) are first line for pts w/daily symptoms
Spiriva dosed 6x daily (short acting), others are once a day (long acting)

Group A (UptoDate) Recommendation SABA or SABA + anticholinergic. Alternative LABA

77
Q

Moderate COPD treatment

A

SABA PRN, anticholinergic, or LABA

LABA (salmeterol, formoterol) may be helpful in pts w/nocturnal symptoms

Combination meds of anticholinergic and SABA have been shown to be superior than any drug alone,
Ipratropium + albuterol or anticholinergic umeclidinium + LABA vilanterol is combination med Anoro Ellipta

Methylxanthine (theophylline) therapy is 3rd line
Watch for toxicity with other meds (H2 blockers and fluoroquinolones)

Group B (more symptomatic, less risk of exacerbations) First choice: Long acting anticholinergic, or LABA, SABA PRN. For persistent symptoms: Long acting anticholinergic + LABA combination

Group C (less symptomatic, more risk of exacerbations) First choice: Long acting anticholinergic, SABA PRN. For exacerbations: Long acting anticholinergic + LABA (less preferred) OR LABA + ICS

78
Q

Severe COPD treatment

A

Same as Moderate+ ICS
ICS (budesonide, ciclesonide, celomethaone)

Phosphodiesterase inhibitors (roflumilast) can be used for pts with severe COPD to reduce exacerbations
Reduces inflammation
Not for monotherapy and contraindicated w/liver dysfunction

Group D (more symptomatic, high risk) First choice: LABA + long acting anticholinergic combination. LABA plus ICS may be preferred if symptoms of asthma/COPD overlap. SABA PRN. Long acting anticholinergic alone if LABA contraindicated. For further exacerbations: Long acting anticholinergic + LABA +ICS. If exacerbations continue may add roflumilast (if FEV1 <50%), OR theophylline, stop ICS

79
Q

Acute Exacerbation of COPD cause

A

Bacteria: H. influenzae (most common), S. pneumoniae, M. Catarrhalis

Advanced patients: pseudomonas

80
Q

Degree of COPD exacerbation criteria and grading

A

Major criteria (Increased sputum volume, Increased sputum purulence, Worsening baseline dyspnea)

Additional criteria: (Upper resp infection in the last 5 days, Fever of unknown cause, Increase in wheezing and cough, Increase in RR and HR 20% above baseline
Nonspecific S&S (fatigue, depression, insomnia))

Mild-1 major criterion + 1 or more additional criteria
Moderate-2 major criteria
Severe-all 3 major criteria

81
Q

S/S of COPD acute exacerbation

A

Hypoxia, tachypnea, shallow, pursed-lip breathing, diminished breath sounds, prolonged expiratory phase, rhonchi, wheezes, barrel-shaped chest, cyanosis, clubbing

82
Q

Diagnostics of COPD acute exacerbation

A

CXR, Procalcitonin will show whether it is pneumonia, COPD exacerbation, bacterial infection, Sputum culture to know what you are treating, CT, Spirometry/PFT’s

83
Q

Treatment of COPD acute exacerbation

A

Supportive: oxygen, hydration, nutrition
Corticosteroids
SABA or Anticholinergics.

Choice of antibiotic depends on symptom severity

First line: Doxycycline (not in pregnancy), macrolides (azithromycin, clarithromycin, prolong QTc), Trimethoprim-sulfamethoxazole (Bactrim, know kidney function)
Second line & outpts: Azithromycin, cefpodoxime, cefprozil, cefuroxime, fluoroquinolones (levofloxacin, moxifloxacin, not good for elderly, tendon rupture risk)

84
Q

Community aquired pneumonia causes

A

Strep pneumoniae, H. influenza, moraxella catarrhalis, mycoplasma & chlamydophila (atypical), viruses

85
Q

Community aquired pneumonia S/S

A

fever, chills, cough, purulent sputum (possibly), pleuritic chest pain. Elderly may present with confusion.

86
Q

CAP diagnostics

A

CXR: PA and lateral

Labs: CBC w/diff, d-dimer, culture, ABG’s, PCT, Oximetry

87
Q

CAP treatment previously healthy pts

A

Previously healthy with no recent ATB (within 3 months) and no comorbidities, should be afebrile 48-72h & no other instability

Azithromycin, Clarithromycin, Doxycycline

88
Q

CAP treatment, co-morbidity

A

Pts w/ co-morbidities (COPD, DM, RF, CHF, use of ATB in 3 mnths) (smokers are more common to have atypical bacteria)

Respiratory quinolones: moxifloxacin (Avelox), gemifloxacin, levofloxacin (Levaquin), or a beta lactam (amoxicillin, amoxicillin-clavulanate (Augmentin), cefpodoxime, cefuroxime, ceftriaxone) PLUS either a macrolide (azithromycin, clarithromycin, erythromycin) OR doxycycline

89
Q

CAP treatment for influenza

A

Oseltamivir or zanamivir is recommended

90
Q

CURB 65 Index for CAP

A

1 point for each positive symptom

1-2 points total: can treat outpt
3 or more points total: consider hospitalization
4-5 consider ICU

Confusion: 1
Urea >7mmol/l:1
Resp rate > 30:1
SBP <90:1
DPB<60:1
Age >65: 1
91
Q

Prostatitis S/S

A

fever, chills, malaise, myalgia, hesitancy, frequency, urgency, notcuria, dysuria, incomplete bladder emptying, UTI, scrotal pain

92
Q

Prostatitis causes

A

nonbacterial- most common (irritation, nerve disorders, viruses, bicycle riding, , bacterial- gram negative organisms (E. coli, proteus, klebsiella, Enterobacter and Serratia are most common) gram + (staph Aureus, strep, enterococci, gonorrhea, chlamydia)

93
Q

Prostatitis Diagnostics

A

DRE- prostate enlarged, tender, indurated. Urinalysis, culture, CBC (left shift, increased leukocytes), STI screen

94
Q

Prostatitis Treatment

A

sitz baths, analgesics, antipyretics, stool softeners, outpt meds: trimethoprim-sulfamethoxazole (Bactrim) and fluoroquinolones (levofloxacin, ciprofloxacin) 6 weeks
hospitalization-IV fluoroquinolones

95
Q

Prostate Cancer S/S

A

hesitancy, urgency, nocturia, frequency, and hematuria, although usually asymptomatic in early stages. Symptoms will increase in intensity during a 1-2 month period (whereas BPH has a slow, gradual progression

96
Q

Prostate Cancer diagnostics

A

DRE- prostate firm, nodule, induration, stony, asymmetric

97
Q

PSA screening

A

not recommended <40, for men 55-69 screening every 2 yrs is based on individual preference, none if >70,

98
Q

PSA results

A

<4 normal, 4-10 early cancer or other benign conditions, >10 cancer

high PSA can be triggered by prostatitis, prostate exam, or intercourse, get baseline PSA if going on meds that shrink the prostate

99
Q

Prostate Cancer Treatment

A

Low risk – active surveillance, radiation therapy or radical prostatectomy
Med risk– active surveillance if low life expectancy, radiation therapy or radical prostatectomy
High risk- radiation therapy, radical prostatectomy with extended lymph node dissection

100
Q

BPH cause

A

obstruction -static tissue build up blocks flow

Dynamic constriction-increase in muscle tone through adrenergic stimulation blocks flow

Tricyclic antidepressants, antihistamines can lead to urinary retention

101
Q

BPH S/S

A

Episodic and be be present over many years with gradual increase in intensity

Symptoms are usually either obstructive or irritative, obstructive: urinary hesitancy, decreased caliber and force of the stream, post void dribbling. Irritative symptoms: frequency, urgency, nocturia which occur as a result of decreased bladder capacity and instability or infection. On occasion, hematuria may accompany BPH

102
Q

BPH diagnosis

A

DRE- uniform focal prostate enlargement, non-tender, rubbery, smooth, UA to exclude UTI

103
Q

BPH treatment Alpha-1 agonists

A

Silodosin, Terazosin, Doxazosin, Tamsulosin (flomax), Alfuzosin

main treatment, work by relaxing smooth muscle in the bladder neck, prostate capsule, and urethra

Initiate at bedtime to avoid postural hypotension

104
Q

BPH treatment 5-alpha reductase inhibitors

A

Finasteride, dutasteride

work by shrinking the prostatic glandular hyperplasia but may take up to 6-12 months to notice improved symptoms

can be used for men with mild to moderate BPH symptoms who also have ED

105
Q

Epididymitis cause

A

Most often infectious STI, or UTI, may be caused by trauma or autoimmune disease

106
Q

Epididymitis S/S

A

Gradual onset of scrotal pain, sometimes radiating to the groin over 1-2 days. May have urethral discharge symptoms of UTI. Entire scrotum becomes red and swollen, the testes become indistinguishable from the epididymis; scrotal wall becomes thick and indurated. Epididymis is tender to palpation, elevation of the testes/epididymis reduces discomfort (Prehn sign), cremasteric reflex is present (if absent think testicular torsion). May have low grade fever, chills, and heavy sensation

107
Q

Epididymitis diagnostics

A

+ phrens sign (elevation of testicles reduces pain), + cremasteric reflex, UA/ culture, NAAT for STI’s

108
Q

Epididymitis supportive treatment

A

bed rest, activity restiriction, scrotal elevation, stool softeners, ice pack

109
Q

Epididymitis treatment sexually active men <35

A

First line doxycycline for 10 days (chlamydia coverage), plus ceftriaxone IM (gonorrhea coverage)

110
Q

Epididymitis treatment men >35, no suspected STI

A

(fluoroquinolones) levofloxacin, ofloxacin, ciprofloxacin

111
Q

Testicular Torsion S/S

A

acute onset of pain, often during period of inactivity, nausea and vomiting are common. Pain is sudden and extremely painful, may wake patient from sleep, may have fever and abdominal pain. A testicle that rides high in the scrotum, testicle is swollen and very tender, scrotum is enlarged, red, edematous, and painful, cremasteric reflex is absent, pain is not relieved with scrotum elevation (neg prehns sign).

112
Q

Testicular torsion diagnostics

A

doppler US by demonstrating lack of blood flow, - phrens signs (elevation of testicles does not relieve pain), - cremasteric reflex

113
Q

testicular torsion treatment

A

SURGICAL CONSULTATION!

114
Q

Hydrocele causes

A

Trauma, tumor, epididymitis, radiation, infection, VPS, or peritoneal dialysis

115
Q

Hydrocele S/S

A

Swelling in scrotum or inguinal canal, painless, heaviness in the scrotum, may have pain radiating to lower back

116
Q

Hydrocele diagnostics

A

Transillumination
Fluid appears pink, yellow, or red
Scrotal swelling that may fluctuate in size with position changes
Inguinoscrotal ultrasound

117
Q

Varicocele definition

A

Abnormal venous dilation above the testes, engorgement of internal spermatic vein, may cause testicular atrophy and decreased sperm count/infertility

118
Q

Varicocele S/S and grading

A

Pain and engorgement of testes, sensation like a bag of worms
Upright position: engorged veins may extend up into the external inguinal ring, valsalva maneuver while laying will cause increased venous dilation
Grade 1: palpable only during valsalva
Grade 2: palpable when standing
Grade 3: visual inspection and light palpation

119
Q

Varicocele diagnostics and treatment

A

scrotal ultrasound

supportive care, scrotal support, surgeon referall

120
Q

Gonorrhea S/S & Treatment

A

purulent urethral discharge, dyspuria, pruritus, anorectal burning, skin lesions, females frequently asymptomatic, abnormal uterine bleeding, cervical motion tenderness, vaginal discharge

Also treat chlamydia
Ceftriaxone IM single dose (gonorrhea) PLUS Azithromycin or doxycycline (chlamydia)

121
Q

Chlamydia S/S & Treatment

A

often asymptomatic, male: dysuria, penile discharge, itching. Female: abnormal discharge yellow or green, bleeding, dysuria, cervical friability or edema

Azithromycin or doxycycline

122
Q

Trichomonas S/S & treatment

A

men: asymptomatic, clear or mucopurulent discharge, dysuria, itching after intercourse. Women: asymptomatic, purulent, malodorous, thin discharge, burning, putuitis, dysuria, frequency, lower abdominal pain, post coital bleeding, erythema of vulva and vaginal mucosa, green-yellow frothy malodorous discharge

metronidazole

123
Q

Bacterial vaginosis S/S & treatment

A

vaginal discharge, off white, thin, and odor “fishy smell”

metronidazole

124
Q

Syphilis S/S & treatment

A

early infection: chancre painless heal over 3-6 wks, secondary infection: fever, HA, malaise, sore throat, weight loss, myalgias, adenopathy of cervical, axillary, inguinal, femoral, and epitrochlear nodes

Penicillin G or doxycycline (if penicillin allergic)

125
Q

Herpes S/S & treatment

A

painful genital ulcers, dysuria, fever, lymphadenopathy, headache

Acyclovir, famciclovir, valacyclovir

126
Q

Renal Calculi causes

A

dehydration, Diets high in salt, animal proteins, purines (Seafood, organ meats), oxalates (chocolate, colas), calcium, and phosphates, osteoporosis treatment

127
Q

Renal Calculi S/S

A

depend on size and location, renal colic (pain), nausea, vomiting, hematuria, fever, chills, dysuria, severe flank pain, abdominal or groin pain, restlessness. Exam findings usually reveal fever, tachycardia, diaphoresis, pale, cool/clammy skin, CVA tenderness

128
Q

Renal Calculi diagnostics

A 
Non-contrast helical CT is best
Renal and bladder US
Dipstick/UA, hematuria 
Urine culture
CBC w/diff
CMP (looking for gout, hyperparathyroidism)
Intravenous pyelogram (IVP)
129
Q

Renal Calculi Treatment

A

hydration, pain meds, let it pass

Medication expulsion therapy: calcium channel blockers and alpha blockers relax smooth muscle (nifedipine and Tamsulosin)

procedures for large stonees

130
Q

Uncomplicated UTI

A

UTI does not cross bladder, uncircumcised men and men that engage in anal sex

131
Q

Complicated UTI

A

(pyelonephritis) UTI extends past bladder, fever >99.9, chills, rigors, malaise, flank pain, CVA tenderness, pelvic or perineal pain in men

132
Q

4 clinical indicators of UTI

A

cloudy, malodorous urine, dysuria, nocturia

elderly women will not experience classic symptoms but will have delirium and weakness

133
Q

UTI diagnostics

A

may need pelvic/reactal exam, UA/dipstick (leukocytes, nitrites, hematuria, bacteria), microscopic exam, culture

134
Q

Uncomplicated UTI 1st line Treatment

A
  1. Nitrofurantoin-Macrobid (first line in young healthy females, don’t use if GFR <60 so don’t use for older women, bacteriostatic, slows bacteria but doesn’t kill it)
  2. Trimethoprim-sulfamethoxazole-Bactrim (treat UTI’s that can damage kidneys
  3. Fosfomycin
135
Q

Uncomplicated UTI 2nd line Treatment

A 
Beta lactams (amoxicillin-clavulanate, cefpodoxime, cefdinir, cefadroxil)
If beta lactams cannot be used, fluoroquinolones (ciprofloxacin, levofloxacin)
136
Q

Uncomplicated, in the past 3 months if the pt has had a MDR gram - urinary infection, inpt hospital stay or ECF, use of antibiotic (fluoroquinolone, bactrim, or broad spectrum antibiotic), or travel to India, Israel, Spain, Mexico

A

Nitrofurantoin (Macrobid) or Fosfomycin

137
Q

Complicated (pyelonephritis) with contraindications to fluoroquinolones (drug interactions)

A

Ceftriaxone (preferred), ertapenem, Gentamicin, tobramycin

Followed by non-floroquinolones, Trimethoprim-sulfamethoxazole -Bactrim, amoxicillin-clavulanate (Augmentin), cefpodoxime, cefdinir, cefadroxil

138
Q

Complicated (pyelonephritis) with community prevalence of E coli resistance <10%

A

fluoroquinolones (ciprofloxacin, levofloxacin)

139
Q

Complicated (pyelonephritis with community prevalence of E coli resistance >10%

A

Ceftriaxone, ertapenem, gentamicin, tobramycin

Followed by a fluoroquinolone (ciprofloxacin, levofloxacin)

140
Q

Complicated (pyelonephritis) with risk factors for an MDR gram - infection (history of the following in past 3 months: MDR gram - urinary infection, inpt hospital/ecf stay, use of antibiotic (fluoroquinolone, bactrim, or broad spectrum antibiotic), travel to india, israel, spain, mexico)

A

Ertapenem IM

Followed by a fluoroquinolone (ciprofloxacin, levofloxacin)

141
Q

Complicated (pyelonephritis) with risk factors for an MDR gram - infection (history of the following in past 3 months: MDR gram - urinary infection, inpt hospital/ecf stay, use of antibiotic (fluoroquinolone, bactrim, or broad spectrum antibiotic), travel to india, israel, spain, mexico) AND contraindication to fluoroquinolone or high risk for fluoroquinolone resistance (use of fluoroquinolone in past 3 months)

A

Ertapenem IM

And tailor other antimicrobial based on culture

142
Q

UTI treatment in pregnant women

A

amoxicillin, amoxicillin-clavulanate (Augmentin), 3rd generation cephalosporins (cefuroxime, cephalexin), nitrofurantoin (Macrobid-only in 2nd trimester)

143
Q

Fluoroquinolones

A

“floxacin” ciprofloxacin, levofloxacin, moxifloxacin, Gemifloxacin

Breaks bacteria DNA strands and inhibits DNA repair

cipro-kills below the belt

levofloxacin- idiots antibiotic will kill anything

Respiratory fluoroquinolones: moxifloxacin, Gemifloxacin

QT prolongation, tendon rupture risk, hypoglycemia, photosensitivity, hepatotoxicity, NOT safe in pregnancy

144
Q

Tetracyclines

A

“cycline” doxycycline, minocycline, tetracycline

Inhibit bacterial protein synthesis

used for gram negative infections, can treat atypicals, gonorrhea, can be used for MRSA in pts who can’t take sulfonamides

Photosensitivity, N/V, Do NOT use in pregnancy or children (tooth discoloration, bone development)

145
Q

Macrolides

A

“mycin” erythromycin, azithromycin, clarithromycin, fosfomycin

Inhibit RNA protein synthesis

Good activity against atypicals

Chemically big, have potential for interaction with other drugs

azithromycin (z-pack)

D/N/V, QT prolongation, safe in pregnancy

146
Q

Sulfonamides

A

Sulfamethoxazole-trimethoprim (Bactrim), Sulfamethoxazole-trimethoprim (Septra)

inhibit folate synthesis

broad gram + and - coverage

stevens-johnsons syndrome, sulfa allergy, can cause renal impairment, can increase warfarin levels, contraindicated in late pregnancy and infants

147
Q

Beta-Lactams

A

All penicillin’s and all cephalosporins

148
Q

Antibiotics that work against beta-lactamase producing bacteria

A

Amoxicillin-clavulanate (Augmentin), amoxicillin-sulbactam (unasyn), pipercillin/tazobactam (Zosyn), 3rd generation cephalosporins (cefdinir, cefixime, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftizoxime, ceftriaxone

149
Q

Penicillin’s

A

“cillin” amoxicillin, ampicillin,

Inhibit cell wall synthesis, kills gram +, can work on some gram -

rash, N/V/D, anaphylaxis, sz,

150
Q

Cephalosporins

A

“cef”

inhibit cell wall synthesis

start at more gram + coverage and goes to more gram - coverage

D, HA, rash

151
Q

1st generation cephalosporins

A

cefadroxil (duracef), cefazolin, cephalexin (Keflex)

most effective against gram +, good for skin infections, staph

higher risk of penicillin reaction

152
Q

2nd generation cephalosporins

A

cefaclor, cefotetan (caftan), cefoxtin, cefuroxime

less gram + activity, but more gram - activity

153
Q

3rd generation cephalosporins

A

cefixime, cefdinir (omnicef), cefpodoxime, ceftriaxone (Rocephin) , cefotaxime, ceftazidime

good coverage against beta-lactamase producing bugs and gram -, not as good gram + (except for ceftriaxone and cefdinir)

154
Q

Anticholinergics

A

“tropium” ipratropium, tiotropium

used for COPD, prevent bronchoconstriction

flushing, cognitive changes, increase IOP (watch for glaucoma), urinary retention, hot, dry, constipation

Adult Health (1 decks)

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