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Primary Care III > Module 5 > Flashcards

Module 5 Flashcards

1
Q

bruise

A

bruise (ecchymosis) is an integumentary manifestation of extravasated blood. Discoloration of the skin is attributed to a local interstitial pool of erythrocytes, which causes a light to dark blue skin color associated with red pigment

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2
Q

bruise coloring changes

A

red, blue/purple, green, brown

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3
Q

Spontaneous bruising may be seen with platelet counts below

A

30,000 cells/mL

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4
Q

Spontaneous bruising may also be associated with the chronic use of

A

corticosteroid or anticoagulant therapies

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5
Q

fatigue

A

Fatigue presents as a complaint of tiredness that cannot be explained on the basis of exercise or other activity

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6
Q

acute fatigue

A

Acute fatigue is most often associated with viral or bacterial infections

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7
Q

functional fatigue

A

Functional fatigue is more typically characterized by fatigue on awakening that may improve after exercise. The close associations of depression and anxiety with fatigue make for a difficult task in distinguishing functional causes of fatigue from the fatigue itself.

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8
Q

acute fever

A

tends to be greater than 101.3

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9
Q

The ability of the body to elevate the temperature in the event of infection diminishes with

A

advancing age, due to a weakening of the immune system as one gets older.

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10
Q

chronic fever

A

tend to be low grade (100.4)

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11
Q

fever of unknown origin

A

FUO is defined as a fever of greater than 101.3°F (38.5°C) that occurs on at least three occasions over a 3-week period in an ambulatory patient. A hospitalized patient is diagnosed with FUO if the unexplained fever persists for 1 week.

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12
Q

fevers in excess of 104°F (40°C) tend to be associated with

A

pancreatitis, pyelonephritis, and intracranial pathology (e.g., bacterial meningitis)

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13
Q

Fevers between 101.3°F (38.5°C) and 104°F (40°C) are associated with

A

urinary tract infections and some acute viral syndromes

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14
Q

Fevers less than 101.3°F (38.5°C) are characteristic of

A

infectious hepatitis, some acute viral infections, and TB.

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15
Q

lymphadenopathy is used in clinical practice to designate

A

any abnormality of lymph nodes and, in particular, enlarged lymph nodes.

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16
Q

Typical sites for allergen exposure are

A

the skin and respiratory tree, where local reactions may occur.

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17
Q

atopy

A

Atopy is a term used to characterize an immunoglobulin (Ig)E-mediated immune response that is exaggerated or out of character for exposure to what appear to be innocuous environmental allergens

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18
Q

allergic reaction distribution

A

equal b/tw sexes, races
incidence higher in children

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19
Q

key cells types involved in allergic response

A

mast cells
basophils
eosinophils

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20
Q

group 1-3 allergic reaction

A

dependent on circulating antibodies

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21
Q

group 4 allergic reaction dependent on

A

cellular immune components

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22
Q

Type 1 allergic reaction

A

Immunoglobulin E mediated immediate hypersensitivity response

allergic rhinitis, asthma, anaphylaxis

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23
Q

7 step treatment for anaphylaxis

A
  1. give epi in upper lateral thigh with head below heart level
  2. repeat epi q 5-15 min
  3. support bronchodilation by giving albuterol
  4. if pulm arrest, intubate and provided resp support
  5. Start IV fluids to maintain BP above 90
  6. Give benadryl to relieve cutaneous symptoms
  7. Transfer to emergency center, give steroids
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24
Q

type 2 allergic reaction

A

antibody mediated cellular cytotoxicity response

neonatal Rh incompatibility

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25
Type 3 allergic reaction
allergen immune complex response systemic, delayed drug reactions
26
type 4 allergic reaction
delayed type cellular hypersensitivity response contact dermatitis
27
2 elements common to subjective complaints associated with allergies
1. exposure to allergen precedes onset of symptoms 2. pts typically attempt to control symptoms with self care
28
urticaria associated with
type 1 response
29
type 1 response diagnostics
skin tests- if positive, wheal within 15-20 min
30
The most common form of asthma is
an allergen-driven atopic disease characterized by type 1 immune responses to environmental allergens, although it is distinct from systemic anaphylaxis
31
type 2 response diagnostics
rh testing of blood during pregnancy
32
type 3 response diagnostics
ELISA or biopsied skin reaction
33
type 4 diagnostic
skin testing antigen specific igE levels
34
initial management allergic reaction
avoid further allergenic exposure
35
sympathomimetic (alpha receptor agonist)
sudafed, afrin vasoconstrict engorged mucosa, may increase HR, irritability, anxiety, addiction high abuse potential
36
immunotherapy
allergens given SQ in 0.5ml allotments with progressive increase in concentration until symptoms controlled for 3-5 years
37
rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disease that primarily affects the synovial joints, although it may affect many organ systems. Joints are destroyed over a long course of disease remissions and exacerbations. Structural deformities, which create emotional as well as physical trauma for the patient, are common as the disease progresses.
38
RA epidemiology
women prevalence increases with age, peak between 40-60 family pattern
39
RA subjective
awaken with joint pain, stiffness, improves as day progresses
40
RA objective
peripheral symmetric arthritis, morning stiffness >1 hour PIP and MCP joints most affected, tender, swollen, immobile
41
RA diagnostics
initial- periph circulating RF anti- CCP antibodies, ESR, CRP, CBC xray (may not show anything early) subsequent checks: monitor ESR or CRP
42
a positive RF titer of greater than 1:150 indicates
a poorer prognosis and is often accompanied by findings of severe disease, such as rheumatoid nodules
43
RA initial management
PT, heat/cold, exercise, rest (2h/day), assistive device, splints, meditation, chiropractor, weight loss
44
meds to treat RA
analgesics (acetaminophen, capsaicin cream) NSAIDs Steroids (daily therapy for max 6 months) Plaquenil, arava, neoral, humira, rituxan
45
RA follow up
Labs every 90 days- CBC, CMP, CRP (less than 0.8mg)
46
CFS/fibromyalgia epidemiology
women occurs in those affected by systemic inflammation disorders hx: sexual/physical abuse
47
CFS/fibromyalgia subjective
post exercise malaise, fatigue, polyarthralgia, HA, impaired memory, depression, sore throat
48
CFS/FMS objective
sudden onset, shotty cervical lymph nodes widespread muscular pain that is present for 3 months or more in 11/18 or more tedner points
49
CFS/FMS treatment
cognitive behavioral therapy graded exercise very little evidence for med treatment
50
sjogrens syndrome
chronic inflammatory autoimmune caused by exocrine dysfunction dryness in all areas of body
51
sjogren's epidemiology
women possible genetic predisposition 40-60 yrs
52
sjogrens subjective
eye dryness, dry mouth, loss of taste/smell, dental caries, dysphagia
53
sjogren's objective
foul breath beefy red tongue
54
six defining criteria Sjogren's
1. inadequate tear production 2. cornel epithelial damage 3. decreased saliva 4. lymphocytic infilitration of labil salivary gland tissue 5. impaired salivary gland function 6. autoantibiodes
55
sjogren's diagnostics
CBC, RF, ANA, Y-globulin profile
56
sjogren's treatment
symptom supportive care- quarterly dental eval, artificial tears rituxan
57
SLE epidem
women 3rd or 4th decade of life African decent- 4x increase
58
SLE diagnosis
4/11 arthritis photosensitivity oral/nasal ulcers malar rash (butterfly) discoid rash (raised red patch) serositis of pleura renal disease hem disorders positive ANA neuro disorders immune abnormalities
59
SLE subjective
malaise, fever, anorexia, unplanned weight loss, blurred vision, sleeplessness, depression
60
SLE objective
butterfly rash alopecia splinter hemorrhages lymphadenopathy raynaud's swollen joints impaired cognition abdominal tenderness
61
SLE diagnostics
CBC, BMP, albumin, ANA, UA, antiphospholipid antibodies
62
SLE treatment
symptom control NSAIDs, Plaquenil, prednisone, Benlysta, Cellcept
63
SLE increases risk for
lymphoma, breast cancer, abnormal pap, squamous cell skin cancer
64
Infectious mononucleosis
viral syndrome characterized by prolonged malaise and fatigue, fever, sore throat, and tender cervical lymphadenopathy. majority caused by EBV
65
symptomatic cases of mono most common in
teens, young adults
66
mono epidem
incidence of clinical infection up to 30x higher in whites than blacks
67
EBV most commonly spread via
saliva
68
Mono subjective
fever, sore throat, adenopathy, fatigue, N/v, anorexia
69
Mono objective
high fever (102.5), tender cervical lymphadenopathy enlarged tonsils, exudate enlarged liver, spleen fine maculopapular rash (viral exanthem)
70
mono diagnostics
CBC, CMP, monospot throat culture to r/o strep
71
monospot
less sensitive in younger pts
72
mono treatment
supportive care limit contact sports for at least 4 weeks
73
Lyme disease
caused by borrelia burgdorferi (tick carrying this)
74
early signs lyme
fever, chills, HA, fatigue, myalgia, arthralgia, lymphadenopathy
75
later manifestations of lyme
meningitis, arthritis, facial palsy, arrhythmias, nerve pain, memory loss
76
erythema migrans
bulls eye rash, lyme disease
77
most lyme infections occur
in late spring, summer, early fall
78
likelihood of b. burgdorferi infection depends on
duration of tick exposure must feed for at least 24-48 hours
79
Lyme subjective
flu like illness (fever, chills, myalgia), rash, fatigue, HA, neck pain/stiffness
80
Lyme objective
erythema migrans (pruritic, burning) arthritis, arthralgias, neuro
81
bannwarth syndrome
more common in european causes of lyme lymphocytic meningitis cranial nerve palsies radiculoneuritis
82
Lyme diagnostics
enzyme immunoassay, then western blot
83
Lyme treatment if attached tick
single dose doxycycline 200mg
84
early localized lyme disease tx
doxycycline 100mg bid 10-14 days
85
cardiac, neuro, arthritis manifestations lyme tx
30 days doxycycline 100mg bid
86
Jarisch-Herxheimer reaction
worsening of symptoms with rigors, fever, hypotension in 1st 24 hours of antibiotics
87
Often, pts with HIV are
asymptomatic for many years before diagnosis made
88
HIV epidemiology
2/3 new infections occur in Africa men who have sex with men, African Americans, latinos
89
HIV 1
predominant strain in USA and wordwide
90
HIV 2
West Africa, results in slower disease progression and less transmissible
91
Transmission of HIV
sexual contact needle sharing (previous) blood transfusions mother to newborn
92
Following initial HIV infection, pts become more vulnerable to
outbreaks of common infections
93
if pt presents with thrush
consider testing for HIV
94
HIV objective
persistent generalized lymphadenopathy candida infection STI weight loss
95
HIV testing should be
part of routine care for those age 15-65
96
people with these risk factors should be tested annually
men who have sex with men sex with HIV positive partner more than 1 sex partner since last testing uses injected drugs exchanged sex for drugs/money dx with hepatitis, TB
97
PrEP
given to those with substantial risk of getting HIV Test for HIV, hep B/c, CMP for renal function truvada daily
98
PEP
HIV uninfected has exposure that carries substantial risk of HIV infection infrequent exposures Start within 72 hours of exposure Labs prior: HIV, HBV, HCV, creat, liver enzymes 28 day course of 3 drug ARV reigmen
99
Post exposure HIV testing
4-6 weeks after initial exposure, test HIV, creat, liver enzymes
100
Acute HIV/early HIV treatment
ART, regardless of CD4 count
101
initial disclosure of hiv test results
done face to face provide immediate interventions encourage pt to disclose HIV status to partners Discuss transmission
102
Initial lab testing for newly diagnosed pt with HIV
CD4 HIV viral load genotype resistance testing tropism testing Hep a, b,c CBC with diff CMP FLP HgA1C Tb test UA STI Hcg
103
baseline viral load HIv
2 separate viral load tests 2-3 weeks apart
104
repeat viral load testing
4-6 weeks after starting ARV
105
AIDS
person with HIV with CD4 count less than 200
106
if HIV pt complains of visual problems (loss of visual acuity, eye pain, photophobia, floaters)
suspect CMV retinitis or fungal endophthalmitis
107
candidiasis tx AIDS
fluconazole 100mg x1-2 weeks
108
HSV tx AIDS
acyclovir 200-400mg po tid x7-10 days

Primary Care III (7 decks)

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