hesi primary 3 Flashcards
The Cullen sign
The Cullen sign is ecchymosis noted in the periumbilical area and is indicative of intraperitoneal hemorrhage.
The Blumberg sign
The Blumberg sign is acute pain elicited with the abrupt release of abdominal pressure, and is indicative of peritoneal inflammation. The Blumberg sign, also known as rebound tenderness, is positive when the pain is worsened with the abrupt release of abdominal pressure. When assessing for the Blumberg sign, palpate the painful area last, using care. In addition to the patient verbalizing pain, watch for winces, guarding, or sharp inhalations.
Although the Blumberg sign is common in appendicitis, it can be positive in any condition that causes localized or generalized peritoneal inflammation.
The Murphy sign
The Murphy sign is localized tenderness over the gallbladder, commonly noted in acute cholecystitis. It is elicited by palpating the gallbladder area as the patient deeply inhales. Abrupt cessation of the inspiration is a positive finding.
The Markle sign
The Markle sign is the acute right lower quadrant abdominal pain associated with the jarring heel-drop test, and is suggestive of acute appendicitis.
glomerulonephritis
inflammation of the glomerulus is termed glomerulonephritis.
Clinical manifestations of glomerular disease may include foamy or cola-colored urine, nausea, vomiting, edema, and hypertension. Glomerular disease can manifest as proteinuria on the urinalysis (≥500 mg/day) and other testing may indicate declining renal function. Hematuria may also be present in glomerulonephritis.
glomerulus
The glomerulus is a complex network of vasculature and nerve endings surrounding the end of the renal tubule. It serves an important role in the function of the kidneys
thrombosed hemorrhoid.
A blood clot may form inside a hemorrhoidal vein which can obstruct the blood flow and cause painful swelling. This condition is known as a thrombosed hemorrhoid. This thrombosis can occur after coughing, heavy lifting, or straining at the stool. This condition has an acute onset and can cause severe pain and discomfort. On examination, the thrombosed hemorrhoid will appear as a firm, bluish, nodule covered with skin. They can be several centimeters in size.
treatment of thrombosed hemorrhoid.
Small and less painful thrombosed hemorrhoids may be conservatively treated with warm sitz baths, analgesics, and ointments, however, when the patient is seen within the first 24-48 hours of onset and is experiencing severe symptoms, the most effective management for fast symptom relief is the administration of 1% lidocaine and excision and removal of the clot. A dry gauze dressing is placed for 12-24 hours after excision, and then daily sitz baths are started.
The first-line medications for major depressive disorder are ?
The first-line medications for major depressive disorder are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). The choice between these medications depends on individual patient factors such as cost and side effects.
SNRI examples
SNRI examples are venlafaxine (Effexor) and duloxetine (Cymbalta). Providers should be aware that both SNRIs and SSRIs have a suicide risk.
SSRI examples
Escitalopram (Lexapro) is an effective and commonly prescribed SSRI. Providers should be aware that both SNRIs and SSRIs have a suicide risk.
starting depression meds
A patient with severe depression may have enough energy to attempt suicide after starting the medication. Additionally, patients should be made aware that it may take several weeks before they experience symptom relief. Both SNRIs and SSRIs require a taper after depression remission and should not be discontinued abruptly.
alternative for depression treatment
Tricyclic antidepressants (TCA) are an alternative for treatment but require caution due to their potential for cardiotoxicity and side effects (hypertension, syncope, seizures, and myocardial infarction).
Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) can be effective medications for major depression, but they have more side effects and interactions (drug and food).
genital gonorrhea symptoms
Up to 70% of women with genital gonorrhea are asymptomatic; if symptoms develop they usually occur by day 10 following exposure
A positive urine culture should be treated how?
Urinary tract infections and asymptomatic bacteriuria commonly occur during pregnancy. A positive urine culture should be treated with antibiotics, even if the patient is asymptomatic. Untreated UTIs can cause adverse pregnancy outcomes including preterm birth and low birth weight . Clinicians should be mindful of patient allergies, history of resistance, and safety during pregnancy when selecting an antibiotic for treatment. Fosfomycin (Monurol) is a safe and effective single-dose treatment when there is no concern for pyelonephritis. Additional options for treatment include Amoxicillin-clavulanate (Augmentin), Nitrofurantoin (Macrobid), Trimethoprim-sulfamethoxazole (Bactrim), and Cephalexin (Keflex). Both Macrobid and Bactrim should be avoided during the first trimester because of fetal risks. A test of cure should be performed during pregnancy to make sure the infection has been adequately treated.
screening for CRC
Patients with ulcerative colitis and Crohn’s disease (that affects at least 30% of the colon) are at an increased risk for CRC. The risk of cancer development is dependent on disease extent, age of onset, and severity. Early detection of CRC in patients with IBD is very important to reduce morbidity and mortality.
The recommendation is an initial screening colonoscopy eight years after diagnosis. Patients with ileal Crohn’s disease are not at an increased risk for the development of colorectal cancer because of the lack of colonic inflammation. There are no specific screening guidelines for patients with Crohn’s not affecting the colon.
Almost all patients with Barrett’s esophagus are treated with
a proton-pump inhibitor (PPI). Research shows that reducing chronic acid exposure to the lining of the esophagus may prevent adenocarcinoma. Adherence to PPI therapy is very important for the reduction of exposure to acid and preventing chronic inflammation. PPIs are often prescribed once per day and should be taken before meals. Patient’s with Barrett’s esophagus are treated with a PPI and monitored closely via endoscopy for dysplasia. High-grade dysplasia and development of carcinoma may require other interventions such as ablative therapy or resection.
Progestin-only contraceptives
come in different forms that include implants, intrauterine devices, injections, and pills. They work to thicken cervical mucus, which leads to sperm not being able to migrate as easily to the egg if ovulation has occurred. This type of contraception also slows the migration of the egg from an ovary through the fallopian tubes and thins the lining of the endometrium, which can make it difficult for an egg to implant if fertilized.
Side effects of progestin-only contraceptives
Side effects of progestin-only contraceptives include unscheduled bleeding, menstrual changes, ovarian cysts, and acne.
the benefit to progestin-only contraceptives
A benefit of this type of contraceptive is that it does not increase the risk of hypertension, elevated liver enzymes, or deep venous thrombosis. Another benefit is that it can help decrease a patient’s risk of developing endometrial cancer.
Contraindications to progestin-only contraceptives
Contraindications to this birth control method include known pregnancy, breast cancer, undiagnosed abnormal uterine bleeding, history of bariatric surgery, or liver disease.
Iron deficiency anemia
Iron deficiency anemia is a microcytic anemia with labs that include a low MCV value (less than 80 fL) and a high total iron binding capacity level.
Patients with an iron deficiency may present with what symptoms?
Patients with an iron deficiency may present with symptoms of anemia (restless leg syndrome and ice cravings are common) prior to an actual drop in Hgb level. The gold standard for the diagnosis of iron deficiency is the absence of storage iron on bone marrow stains.
Although ferritin levels are often used successfully to reflect iron stores, patients with inflammatory diseases, infections, liver disease, heart failure, or cancer may have normal or elevated ferritin levels despite iron deficiency because ferritin is an acute phase reactant.
If patient is having symptoms ex. fatigue, drowsiness, etc. but the CBC is normal.
Order Ferratin level. Stage 1 – Storage Depletion – Lower than expected blood ferritin levels. Ferritin is the storage form of iron, and low ferritin levels are the first sign that the body’s iron stores are compromised. Stage 2 – Mild Deficiency- During the second stage of iron deficiency, transport iron ( known as transferrin) decreases. This is often accompanied by a reduction in size of red blood cells even though hemoglobin levels remain normal. Stage 3 – Iron Deficiency Anemia – Hemoglobin begin to drop in the final stage which, depending on other blood work, may formally be defined as IDA. At this stage your red blood cells are fewer in number, smaller and contain less hemoglobin.
formation of kidney stones.
A high uric acid concentration and an acidic pH causes a reaction which converts soluble urate salt into insoluble uric acid which promotes the formation of stones.The two major factors for uric acid stone formation are a persistently low pH (acidic urine) and a high uric acid concentration. The combination of these two factors causes a reaction that converts soluble urate salt into insoluble uric acid. There is a correlation between certain conditions and high uric acid production. These include myeloproliferative disorders, malignancies, psoriasis, obesity, down syndrome, and hemolytic disorders.
The formation of uric acid stones in relation to gout
The formation of uric acid stones is significantly increased in patients with gout. The primary factor in this condition is persistently acidic urine. This acidic pH creates an ideal environment for uric acid overproduction and the formation of stones.
Distinguishing the type of stone is important in guiding treatment. The composition of the kidney stone can be determined by chemical analysis and helical CT scan. Management of the patient with uric acid stones includes measures to cause the urine to be more alkaline, increased fluid intake, and reduction of uric acid production by reducing purine intake and the use of xanthine oxidase inhibitors.
constipation in elderly
In the older adult population, chronic constipation is a relatively prevalent condition, but there are serious diseases that can cause constipation, most notably colon cancer. Once a serious disease is ruled out, fiber supplements are recommended for first-line treatment.
pneumonia
Patients often present with the classical symptoms of fever, productive cough, purulent sputum, dyspnea, and pleuritic chest pain. Clinical presentation is often subacute. Findings on the clinical exam may include tachypnea, audible rales over the involved lobe or segment, increased or decreased tactile fremitus, bronchial breath sounds, egophony, and dullness on chest percussion. A chest X-ray is used to confirm the diagnosis of pneumonia.
frostbite
Pallor and lack of sensation occur with first-degree frostbite. The skin may also appear red with swelling after rewarming in first-degree injuries. Erythema, edema, sloughing, and blistering are seen with second-degree frostbite. Because granulation tissue develops under the blisters, tissue loss is usually avoided.
Blisters occur in third-degree frostbite but the thermal injury progresses further into the skin. Eschar often develops and tissue loss occurs. Fourth-degree frostbite is severe and may result in mummification and gangrene. The cold-induced injury extends beyond the subcutaneous tissue and into the musculature and bone.
Cranial nerves both sensory and motor functions
Cranial nerves V, VII, IX, and X have both sensory and motor functions. Assessment of cranial nerve function is used to diagnose neurological disorders.
