Flashcards in Test #3 Deck (148):
What possibly could a persistant, dry cough indicate?
Tumor, congestion, or hypesensitive airways
What possibly could a productive cough indicate?
If clear= viral infection
If colored= bacterial infection or secondary infection (something that began as a viral infection)
What is hemoptysis?
Blood in mucous
What could hemoptysis possibly indicate?
Infection, inflammation, tumor, or infarction
What does pleuritic mean?
Sharp chest pain that gets worse with coughing or sneezing
What are the signs and symptoms of pulmonary disease? (x4)
Cough (persistant.dry, productive), hemoptysis, dyspnea, and chest pain
What is asthma?
An increased responsiveness of the tracheobronchial tree to stimuli--they respond with too much vasoconstriction, hence why it gets difficult to breath)
What is the most common chronic disease in children and adults?
What percentage of all Americans have asthma? What percentage of children?
2-3% of Americans
4% of children
True or false:
The prevalence, morbidity, and mortality of asthma has not increased over recent years.
False...it is increasing
When does asthma classically appear?
Before the age of 5
True or false:
A child that has "grown out of asthma" could potentially have it occur later in life. Why or why not?
True...this could be the case with high school athletics (increased training and use of lungs) or with smoking
Is asthma more commonly diagnosed in children or adults?
What are two history questions that make a patient more likely to suffer from asthma?
-history of allergic rhinitis
-FHx of asthma
Describe the pathophysiology of asthma.
The smooth muscle cells in the bronchial tree are hyperactive and thus constrict in response to stimuli. Additionally, inflammation is another component. This causes edema and increased mucous production which also leads to a smaller airway
What are the signs and symptoms of asthma?
-recurrent episodes of coughing or wheezing
-signs of respiratory difficulty
What is the most common cause of chest pain in children?
What are the 4 categories of asthma? How often does symptoms occur in each category?
1) Mild intermittent (symptoms 2 times per week but
What is a typical asthma treatment regimen?
1- short-acting beta agonist
2- inhaled corticosteroid +/- long actin beta agonist
3- leukotriene antagonist
4- oral steroids (for severe asthma)
What is the goal for use of a rescue inhaler?
Use it less than 2 times per day
What should be used in an acute asthma attack?
Nebulizers, oral or iv corticosteroids, or O2
Why should asthmatic patients check their peak flow every morning?
The reading tends to drop before they have symptoms (can indicate a possible attack)
When using an inhaler, how much of the medicine is actually deposited into the lungs? What device could help improve this percentage?
10-30%...a spacer device can help this
What is the other name for exercise induced asthma (EIA)?
Exercise induced bronchospasm
What percentage of all athletes suffer from exercise induced asthma?
What percentage of people with asthma suffer from exercise induced asthma?
What percentage of people with allergic rhinitis suffer from exercise induced asthma?
What are the two theories behind EIA?
1- Water loss theory
2- Heat exchange theory
What is the water-loss theory behind EIA?
Since with exercise, people tend to breathe through their mouths, the dry air entering the lungs still needs to be humidified. This results in a loss of water from the linings of the lungs, increasing airway osmolarity, and thus releasing histamine, prostaglandins, and leukotrients. This all results in bronchoconstriction.
What is the heat-exchange theory behind EIA?
Since with exercise, people tend to breathe through their mouths, the air entering the lungs is not warmed and humidified as if it would enter through the nose. This cools the respiratory epithelium which results in dialation of the bronchial vasculature. Because the bronchiovasculature dialtes, the bronchi become narrowed and the engorged vessels leak fluid. This causes a mediator response that then results in bronchoconstriction.
What are the signs and symptoms of EIA?
-shortness of breath with exertion
-out of shape (they never get "in shape")
-tired more easily than their peers
-cough (especially after exercise)
-history of asthma as a child
-symptoms get worse with cold/dry air, high pollen count, and if they're ill with a URI
What test can be used to diagnose EIA?
Exercise challenge test (7 minute run on treadmill hard with no warm-up) and then you check their peak flow meter...a significant result would be a 10-15% decrease in the peak flow readings
True or false:
Corticosteroids are effective for all types of asthma.
False...they are not effective for EIA
How is EIA treated?
-beta agonist 30 minutes prior to exercise and then as needed
-inhaler during exercise (but if using greater than 2 times per week, needs to be better controlled)
What are some non-pharmacologic treatments for EIA?
-Modifying their environment (warmer and moister air, scarf over face, sport change-swimming, avoid during pollen season or high pollution)
-inducing the refractory period
-avoid rapid thermal changes after workout
What is the refractory period for EIA?
Once a patient has a reaction, they are less likely to have symptoms over the next couple of hours
What are some differential diagnoses for EIA?
-vocal cord dysfunction (VCD)
-gastroesophageal reflux (GERD)
What is gastroesophageal reflux (GERD)?
When the stomach contents head into the esophagus and then are breathed into the lungs
What occurs with VCD?`
The vocal cords close during exercise and make breathing difficult
How could you differentiate between VCD and EIA?
VCD would not get better with EIA treatment.
What type of people are more likely to have VCD?
Overachievers, type A personalites, stress themselves out, etc.
How is VCD typically diagnosed?
It is a diagnosis of exclusion...all other possibilities are ruled out
What is acute bronchitits? What are the signs and symptoms?
Inflammation of the trachea and bronchi caused by a virus (most commonly)
S/S= productive cough, dyspnea and wheezing, but a normal pulmonary exam (lungs are clear, no pneumonia)
What is the condition characterized by inflammation of the lungs?
Pneumonia (aka pneumonitis)...this is most commonly due to an infection.
What are the five types of pneumonia?
1) Bacterial (streptococcus pneumoniae--pneumococcus, haemophilus influenza, staphylocuccus aureus, klebsiella pneumoniae)
2) Atypical pneumonia (mycoplasma pneumoniae, legionella, chlamydia)
3) Viral (varicella--chicken pox, RSV, and influenca)
4) Aspiration (anaerobic bacteria)--when the gag reflex is impaired and a person vomits, but swallows the vomit into the lungs
What are the symptoms of pneumonia? (x7)
-cough productive of rust or green sputum
-pleuritic chest pain
-fatigue-more sick than with bronchitis
**atypical pneumonia is often similar to bronchitits ("walking pneumonia")
What are the signs of pneumonia? (x
-signs of respiratory distress
-rales (bubbling) or bronchial (raspy) breath sounds
-signs of consolidation (decreased breath sounds, dullness to percussion, fremitus)
What is consolidation of the lungs?
Section of the lungs is so filled with pus that oxygen can't get to the section of lung
What is fremitus?
Vibration felt when placing hand on the chest (lung) and the person talks
How can you prevent pneumonia?
Get a vaccine (influenza vaccine, pneumovax, prevnar, varicella vaccine)
What is the treatment for a rib fracture for a noncollision sport? Collision sport?
Noncollision--observation and activities as tolerated
Collision--out a minimal of 3 weeks, nontender to palpation before exam, and protection
What is a flail chest?
Two or more rib fractures in 3 or more consecutive ribs...when the pt inhales, the rib segment is sucked in instead of expanding with the rest of the rib cage
What can a flail chest be associated with?
Pneumothorax and hemothorax
What condition is characterized by free air in the pleural cavity?
Pneumothorax (collasped lung)
What occurs in a tension pneumothorax?
A bronchial or alveolar injury (to the lung itself)...this injury acts as a valve and so air is let into the lungs with inspiration, but doesn't let air out with expiration. This causes pressure to build up in the pleural space, and then the mediastinum shifts to the side
What are the S/S of a tension pneumothorax?
Sudden onset of chest pain and dyspnea (radiating to the shoulder and gets worse with any movement), decreased breath sounds, and midline shift of the trachea
What are the S/S of a pulmonary embolus (PE)? (x8)
-sudden onset of dyspnea
-pleuritic chest pain
-apprehension ("I feel like i'm about to die")
What test can be used to identify a possible PE? How?
A V/Q scan (it identifies a mismatch between blood flow and ventilation of the lungs)
What is the most common cause of sudden death in a hospitalized patient?
What is inflammation of the rib joints?
What occurs when a patient has the "wind knocked out of them"?
A solar plexus injury (temporary paralysis of the diaphragm)
What is an acute abdomen?
An abdominal injury that requires surgery (infection, rupture of a hollow organ, or laceration/rupture of solid organ)
What are the S/S of an acute abdomen?
-decreased bowel sounds
-peritoneal signs (guarding and rebound tenderness)
If you suspect an abdominal wall strain or a possible intra-abdominal process, how can you potentially rule one out?
Palpate with and without straining...if there is less pain with straining, then it is intra-abdominal. If there is more pain with straining, then it is abdominal wall
What is GERD?
Gastroesophageal reflux...reflux of the stomach contents into the esophages (can lead to chemical burns in the distal esophagus because it doesn't have the protective lining like the stomach against acid)
What is a hiatal hernia?
Some of the stomach organ comes into the esophagus due to the esophageal sphincter and diaphragm not working together--the stomach moves up when the opening is too large
What are the S/S of a hiatal hernia? How is it diagnoses?
-worse when laying down
-symptoms occur after meals
-sour taste in mouth (bile)
**diagnosed with an upper GI or endoscopy
How can you treat a hiatal hernia?
-Behavioral modifications (smaller meals, don't lay down after eating, raising head of bed, decrease caffeine & nicotine, weight loss, looser clothing)
-Medication (anatacids, H2 blockers, PPIs, esophageal motility drugs)
-surgery for hernia
What do antacids work to do?
Relieve mild to moderate symptoms of GERD by decreasing gastric acidity...they work to provide daytime symptomatic relief for those who have mild to moderate symptoms
What is the function of the parietal cells?
Acid production (found in stomach)
What are the three main triggers of acid production?
Gastrin (hormone), histamine (neural), and acetylcholine (vagus nerve)
How do H2 receptors antagonists work?
They block histamine to help decrease gastric acidity
How to PPIs work?
Block the proton pump to help inhibit gastric acid secretion ...they block acid production more effectly that H2 blockers
What are prokinetics?
Esophageal motility drugs that are supposed to help increase movement throught the GI system and tighten the lower esophageal sphincter...however, they dont work as well as they should
What is peptic ulcer disease? What is gastritis? How can you differentiate between the two?
PUD- localized loss of tissue lining the stomach or duodenum
Gastritis- inflammation of the stomach lining
**You need imaging or an endoscopy to differentiate
What are the risk factors for PUD and gastritis?
Anti-inflammatory use, smoking, beverages that stimulate acid production (i.e. caffeine, juice), and stress (often the hospitalized patient)
How do NSAID induced ulcers occur?
They attack the protective environment of the stomach from both sides...attacking the layer of mucous and prostaglandins
What are the two types of PUD?
1) Classic (hyperacidity and injury to the stomach lining)
2) Infection (caused by H. pylori, recurrent or chronic cases)
What are the S/S of a PUD?
-epigastric pain or burning (substernal) that refers to the back or right shoulder
-exacerbating factors (stomach is empty, night, anxious, spicy foods)
-improves after eathing but worsens 2-3 hours later
-melena or hematochezia
-coffee ground emesis
What is the pathophysiology of appendicitis?
Obstruction --> swelling and ischemia --> infection
What are the early symptoms of appendicitis?
Vague abdominal pain (periumbilical area), nausea, low grade fever
What are the later signs and symptoms of appendicitis?
Worsening pain, localized to RLQ, worsening nausea and vomiting, high fever, tenderness at McBurney's point, peritoneal signs
What two tests can be used to help determine if a pt has appendicitis? How do they work?
Iliopsoas test and obturator test...the appendix may have an absess that has adheres to either the iliopsoas or obturator muscles, and thus these tests try to move the appendix by moving the muscles
How would you determine if the iliopsoas or obturator tests was positive or not?
The test would produce pain in the abdomen, not the hip
True or false:
The appendix can have an abscess that adheres to both the iliopsoas and obturator muscles, so both special tests can be positive.
False...it can't adhere in two places
What is the AT implication in the case of appendicitits?
In any pt with hip pain, it should be a differential, especially if there is no good reason for the hip pain.
What two diseases are included in inflammatory bowel disease (IBD)?
Ulcerative colitis and Crohn's disease
What it the pathogenesis for IBD?
They are both auto-immune diseases--the body attacks the GI tract itself
What is the pathophysiology with IBD?
(Ulcerative colitis & Crohn's disease)
-Inflammation of the intestinal wall--> limits absorption --> diarrhea (blood or mucous filled) and malnutrition
True or false:
IBD is a systemic disorder. Why or why not?
True...it can affect multiple other areas of the body other than the GI tract. It can affect the joints (migratory polyarthritis, sacroilitis, and spondyloarthropathy), the eyes (uveitis, iritis), and the skin
Of the IBD diseases, which has skip lesions? Which has continuous colon involvement?
Skip lesions= Crohn's diesease
Continuous colon= ulcerative colitis
Of the IBD diseases, which always affects the rectum and extends proximally?
Of the IBD diseases, which can occur anwhere in the GI tract?
Of the IBD diseases, which causes inflammation of the transmural? Inflammation of the mucosal?
Mucosal= Ulcerative colitis
Of the IBD diseases, which has a decreased risk of cancer development by having a bowel resection?
True or false:
IBD (both diseases) causes an increased risk for colon cancer?
Does having a bowel resection due to Crohn's disease decrease a pt's risk for colon cancer? Why or why not?
No because Crohn's disease can just come back in another part of the bowel
What are the S/S of IBD?
-bloody diarrhea with mucous
(Crohn's also could mimic appendicitis with terminal ileitis and iliopsoas abscess)
What could IBD have to do with ATs?
If a pt has arthritis or back pain symptoms, we should ask about GI symptoms because 25% of IBD pts present with musculoskeletal symptoms. Also, a key would be that their hip or back pain gets better after having a bowel movement or gas
What is irritable bowel syndrome (IBS)?
A functional disorder of bowel motility (there is no anatomical problem--the problem is with function and not structure)
What are the four areas of the multicomponent model of IBS?
1) Cognitive (illness behavior, coping styles)
2) Stress (behavior, environmental stress)
3) Anxiety (emotional, anxiety, depression)
4) Physiologic (decreased pain threshold, autonomic regulation of motility, neuroendocrine response)
What are the S/S of IBS?
-cramping abdominal pain (worse with stress)
-alternation between constipation and loose stools
-nonspecific abdominal tenderness
-their exam often changes (the pain and tenderness move around depending on what area is cramping)
What is the treatment for IBS?
-increase fluids and fiber
-avoid lactose and alcohol
-exercise (endorphins and enkephalins)
What are some causes of constipation in athletes? (x4)
-laxative abuse (wrestling, eating disorders)
How should constipation be treated?
Increase fluids and fiber (dietary, bulk-forming laxatives--benefiber, metamucil, etc--and prune juice), and other laxatives
What are the two types of laxatives?
Stool softeners and stimulant laxatives
What is intestinal gas caused by?
Malabsorption of carbohydrates and/or proteins
What occurs during ileus?
Part of the bowel is not functioning and thus there is a lack of peristalsis.
What causes ileus?
Intestinal obstuction, severe vpain (anywhere in the body), surgery (from the general anesthesia), and another intra-abdominal process (appendicitis, ruptured organ, etc)
What on an exam would possible indicate ileus?
Absent bowel sounds and tender abdomen
Why do we ask about passing gas after surgery?
Passing gas is a good sign because that means that the bowel is waking up
What is the runner's trots?
Diarrhea that occurs during running (especially races). The diarrhea could be watery with increased volume and frequency, or even bloody in 12% of cases (from the pounding of the run)
What percentage of 10k runners suffer from runner's trots?
What are some of the suggested causes of the runner's trots?
-altered intestinal motility
How could you treat or prevent runner's trots?
-try to have a BM before running
-light jog and light meal 2-3 hours prior to race (decreases fibers, sugars, caffeine 1 day before race)
What causes rectal bleeding after running?
Ischemia (the body has been pumping blood and oxygen to the muscles during the marathon, and less has gone to the rectum)
What are hemorrhoids? What causes them?
They are little blood-filled balloons or sacs that are formed at the rectal-anal junction. They are caused by anything that increases pressure in the portal system (anything from the distal 1/3 of the esophagus to the rectal-anal junction)..***constipation***
What is the portal circulation?
This circulation drains the GI tract so it can be detoxified before returning to the systemic circulation
What are the symptoms of hemorrhoids? What would you see upon observation of hemorrhoids and thrombosed hemorrhoids?
Pain and swelling near anus, itching, very painful if thrombosed...normal hemorrhoids= small, soft to hard masses near the anal ring; thrombosed= hard and tender masses
What are the functions of the liver?
-production of clotting factors
-metabolism and elimination of toxins
-filters blood from GI tract
What is another term for jaundice?
What causes jaundice?
An increase in bilirubin due r to liver disease
Describe bilirubin metabolism?
Bilirubin is a by-product of the breakdown of hemoglobin...this breakdown become conjugated in the liver and has sugar molecules attached to it so the glucose could be excreted. This then gives stool its color.
What are the thee main types of Hepatitis? What are the other types?
A, B, and C; there is also D, E G, mono, alcohol. and drugs
How does one get infected with hep A?
Oral-fecal route, poor hygeine, and travelers
How does one get infected with hep B?
Blood or blood products, sexual activity
How does one get hep C?
Blood or blood products, less likely with sexual activity
What is the worse form of hep?
C (it has the worst prognosis)
What is the most common form of hep?
What happens with hepatitis on a cellular level?
The hepatocytes become destroyed.
What are the symptoms of hepatitis?
Fatigue, malaise, RUQ pain, and nausea, but most are asymptomatic
What are the signs of hepatitis?
Fever, jaundice, RUQ tenderness, hepatomegaly, clay colored stools, dark urine
How is Hep A usually treated?
Rest, fluids, usually feel better after a couple of weeks
What is the general treatment for hepatitis B and C?
Supportive in most cases, rest, interferons, antiviral medications, and immunoglobulin
How can you prevent hep A? B? C?
A- improve sanitation, don't drink water or eat food that hasn't been washed or uncooked; get vaccine if traveling
B- universal precautions, screen blood products, avoid high risk activities, and hep B vaccine
C- universal precautions, screen blood products, avoid high risk activities
What is the MOI for a liver contusion or laceration?
A direct blow to the RUQ
What can a liver contusion or laceration lead to an increased risk for?
Hepatitis and lower right rib fracture
Where may the pain refer to if the liver is bruised or lacerated?
The right scapula
What percentage of adults suffer from gall stone disease or cholecystitis?
What are the risk factors for gall stones (cholecystitis)?
***The 5 F's
How are gallstones formed?
Because bile helps makes cholesterol soluble...when cholesterol concentrations exceed the ability of the bile to keep it soluble --> the extra cholesterol then precipitates as cholesterol crystals (makes stones)
When do symptoms occur when gallstones are present?
When the stone obstructs the cystic or common bile duct and the gallbladder contracts in response to a fatty meal, leading to a pressure buildup that causes pain
What are the S/S of gall stones?
-RUQ pain or epigastric pain
-pain radiating to right shoulder
-worse pain after meals or fatty/fried foods
-pain better on empty stomach
-fever and chills
What two functions does the pancreas serve?
Exocrine (digestive enzymes) and endocrine (glucose metabolism)
What occurs in gallstone pancreatitis?
Destruction of pancreatic cells --> release of pancreatic digestive enzymes --> auto destruction (the digestive enzymes are released and begin to eat away at the pancreas)
What are the S/S of gallstone pancreatitis?
-abdominal pain (epigastric)
-pain radiating to back
-nausea and vomiting
What two enzymes would be elevated on a blood test if gallstone pancreatitis was a diagnosis?
Amylase and lipase