this lecture covered the conventional drugs used to treat respiratory conditions such as asthma. there are several classes of asthma treating drugs, including adrenergic agonists, anti-cholinergics, methylxanthines, etc. which can be grouped into 2 categories: drugs that reduce inflammation, and drugs that relax bronchial smooth muscle. bronchial smooth muscle tone is increased with increased sympathetic activity; epinephrine is a sympathetic neurotransmitter that decreases asthmatic symptoms by this mechanism. since it acts non-selectively, it also acts on beta-1 receptors, causing cardiac symptoms such as palpitations, and on alpha-1 receptors, causing dry mouth and hyperglycemia. in general, the bronchodilating group of asthma drugs are the type used for anaphylaxis / status asthmaticus, while the inflammation reducing drugs are better for longer term, less acute treatments.
then there are drugs that specifically bind to beta-2 agonists, and using the same mechanism above induces dilation of bronchial smooth muscle. these include albuterol, proventil, and salmeterol-- the latter is longer acting and is used more for chronic conditions. these drugs are mainly administered by inhalation, and delivery can be improved by the use of "spacers" which allow for smaller, slower velocity to reach the lungs.
anticholinergics are another class of asthma drugs that act by competitively inhibit the acetylcholine neurotransmitter at muscarinic receptor sites, inducing sympathetic bronchodilation. as opposed to epinephrine or beta-2 agonists, anticholinergics are best used for maintenance as opposed to acute conditions. atrovent and theophylline are two examples of anticholinergics; the former is chemically similar to atropine (from the plant belladonna) and the latter is similar to caffeine.
corticosteroids are also used as asthma treatment when bronchodilators are not effective by themselves. they are potent anti-inflammatories; blocking phospholipase A2, the enzyme which mediates the release of arachidonic acid, the precursor of inflammatory mediators such as leukotrienes and prostaglandins. thus, they decrease the activity of macrophages, eosinophils and t-lymphocytes, as well as decreasing capillary permeability and thus edema systemically (not specific for bronchial tissue). the main danger of corticosteroids is disruption of the body's natural cortisol production via the HPA axis; abrupt discontinuation of corticosteroids might result in an addisonian crisis due to the body's inability to produce ACTH.
corticosteroids also suppress immunity in general, leading to increased susceptibility to infection. one of the side effects of beclovent, an inhaled corticosteroid, is an increased incidence of oral thrush. prednisone is an oral corticosteroid which, compared to inhaled steroids, has more chance of producing systemic side effects, such as hyperglycemia, fat redistribution (same as in cushing's syndrome, a condition of excess cortisol production), osteoporosis, in addition to the potential for the addisonian crisis.
leukotriene inhibitors such as zafirlukast are a newer class of asthma drugs which block leukotriene receptors D4 and E4 in bronchial smooth muscle, thereby reducing inflammation and allowing for bronchodilation. it is also used in the treatment of chronic cases as opposed to anaphylaxis. side effects include headache, Gi upset, possibly increased respiratory infections.
antitussives such as codeine block the medullary centers that are involved in the cough response. the two antitussives that we discussed, codeine and dextramethorphan, are related to morphine: codeine is broken down into morphine while dextramethorphan is a synthetic morphine derivative. besides being addictive, these drugs have other side effects, drowsiness and constipation being among the chief complaints. dextramethorphan is milder than codeine in terms of constipation and and addictive properties.
another major category of respiratory drugs are drugs used to treat allergic rhinitis. antihistamines such as benadryl block histamine H1 receptors and cross the blood brain barrier, causing drowsiness, while medications such as claritin perform the same action while being large enough to not cross the BBB. both cause dryness of mucous membranes and thus are contraindicated in asthma, when a mucolytic (n-acetyl cysteine?) and moistening agent is preferred.
nasal corticosteroids can also be used to depress the inflammatory response locally, such as beconase or rhinocort, although can result in local irritation and nosebleeds, as well as increased susceptibility to nasal candidiasis. nasal alpha agonists are also used to combat allergic rhinitis, such as phenylephrine / afrin, but are highly addicting due to the rebound symptoms that occur as soon as the medication is stopped.
questions
intro...
1. describe the different roles of the autonomic nervous system in terms of bronchoconstriction and bronchodilation.
2. what are the two general mechanisms of action for asthma drugs?
3. epinephrine indications...
4. epinephrine mechanism of action?
5. side effects of epinephrine?
6. method of delivery?
beta-2 agonists...
7. albuterol, proventil mechanism of action?
8. methods of administration and timing of action for each?
9. inhaled administration might be improved by...
10. when is use of salmeterol / serevent indicated?
11. onset and duration of action of salmeterol?
12. side effects of salmeterol?
anticholinergics...
13. anticholinergics are similar in structure to...
14. action of anticholinergics?
15. when are anticholinergics indicated?
16. example of anticholinergic?
17. what is an example of an anticholinergic that has been replaced by beta agonists / corticosteroids?
18. what class of drug does [17] belong to?
19. what other substance is [17] similar to?
corticosteroids...
20. mechanism of action?
21. acute or chronic cases?
22. main side effect?
23. secondary side effects?
24. examples of inhaled corticosteroids?
specific corticosteroids...
25. indication for beclovent?
26. 2 mechanisms of action for beclovent?
27. beclovent's effect on bronchial smooth muscle?
28. oral side effect of inhaled beclovent?
29. indications for prednisone?
30. side effects of prednisone?
leukotriene inhibitors...
31. mechanism of action?
32. two examples?
33. indications for leukotriene inhibitors?
34. zafirlukast used more commonly in which population?
35. side effects?
36. inhibits which other enzyme?
antitussives...
37. mechanism of antitussives?
38. codeine is broken into...
39. side effects?
40. what does the DM in robitussin DM stand for?
41. what class of drug is DM?
42. how do DM antitussives compare to narcotic analgesic tussives in terms of side effects?
antihistamines...
43. MAO of benadryl?
44. benadryl relationship with BBB?
45. why is benadryl contraindicated for asthma?
46. example of a non-drowsy antihistamine?
47. MAO of [46]?
48. how is [46] non-drowsy?
49. common side effect of [46]?
nasal sprays...
50. two examples of nasal corticosteroids?
51. mechanism of action?
52. side effects?
53. two examples of nasal alpha-agonists?
54. most significant side effect?
answers
1. sympathetic= bronchodilation. parasympathetic= bronchoconstriction.
2. bronchodilators and inflammation suppressors.
3. emergent treatment of asthma, status asthmaticus, anaphylaxis.
4. beta-2 adrenergic receptor stimulation leads to increased cAMP levels leads to smooth muscle relaxation and bronchodilation.
5. B-1 agonist effects include tachycardia, anxiety, arrhythmias, palpitations. alpha-1 agonist effects include dry mouth and hyperglycemia.
6. subcutaneous, IV, IM, inhalation, endotracheal tube.
7. beta-2 agonist causes increased cAMP levels resulting in bronchial smooth muscle dilation.
8. periorally-- 30 minutes onset and 4-8 hour duration. inhaled-- 15 mins onset and 2-3 hour duration.
9. spacer which allows for smaller, slower velocity particles.
10. for long term treatment of asthma.
11. 20-30 min onset, 12 hour duration.
12. headache, cough.
13. atropine from belladonna.
14. competitively antagonize AcH at muscarinic receptor sites, resulting in sympathetic bronchodilation.
15. maintenance as opposed to acute cases.
16. ipratropium / atrovent.
17. theophylline.
18. methylxanthine / xanthines bronchodilators.
19. caffiene.
20. inhibition of phospholipase A2 which blocks the release of arachidonic acid, the precursor of inflammatory mediators. also inhibits histamine and kinin activity.
21. chronic.
22. starts to shut off the HPA feedback loop for cortisol production
23. increased susceptibility to infections, hyperglycemia, bone loss, insomnia.
24. beclomethasone / beclovent , vanceril.
25. when asthma can not be controlled by bronchodilators.
26. decreasing activity for inflammatory cells (macrophages, eosinophils, t lymphocytes), decreases capillary permeability.
27. no direct effect on smooth muscle.
28. oral thrush.
29. COPD, worsening asthma.
30. fat redistribution, hyperglycemia / diabetes, osteoporosis, addisonian crisis.
31. blocking leukotriene receptors (E4, D4) in bronchial smooth muscle.
32. zafirlukast / accolate, montelukast / singulair.
33. chronic asthma, prophylaxis.
34. pediatrics.
35. headache, GI upset, increased respiratory infections in older populations.
36. cytochrome p450 enzymes.
37. decreases sensitivity of medullary cough centers.
38. morphine.
39. drowsiness, constipation, GI upset, dependence.
40. dextromethorphan.
41. morphine derivative.
42. DM less addictive, less constipation.
43. blocking H1 receptors.
44. readily crosses BBB.
45. because benadryl will dry and thicken secretions and asthma needs moistening and mucolytics.
46. claritin / loratadine.
47. same as [43].
48. doesn't cross BBB.
49. dry mouth. dryness of mucous membranes.
50. beclomethasome / beconase
budesonide / rhinocort
51. decreases inflammatory mediators in nasal mucosa.
52. irritation, nose bleeds, sore throats, candidiasis.
53. phenylephrine / afrin
oxymetazoline / long acting afrin
54. rhinitis medicosum: rebound effect after taking nasal alpha agonists.
Showing posts with label asthma. Show all posts
Showing posts with label asthma. Show all posts
Monday, October 4, 2010
Wednesday, May 5, 2010
GPA prep- respiratory and HEENT
URI: upper respiratory infection caused either by bacteria or a virus, leading to congestion, sneezing, rhinorrhea, discharge, malaise. if bacterial in origin, a URI might be more likely to present with fever / chills and yellow/green mucopurulent discharge. if viral in origin a URI might present with clear rhinorrhea. diagnosis is by the jones criteria, rapid strep test, and microscopic smear of exudates.
asthma: can be extrinsic (allergic, to molds, pollens, etc), or intrinsic (infectious, emotional, etc.). usually results in coughing (worse at night), wheezing, dyspnea, sputum production. PE findings might include tachypnea, tachycardia, accessory muscle use, and if severe, pulsus paradoxus and muscle wasting. lung auscultation will reveal prolonged expiratory phase with expiratory wheezing, diminished breath sounds. a skin exam might also be performed to confirm signs of atopy (eczema, dermatitis).
sinusitis is an inflammation of the sinuses due to infection or allergies. it can result in a painful pressure in the sinus area from the swelling of the mucous membranes if associated with a URI. typical signs and symptoms might include swelling / tenderness over the affected sinus, malaise, toothache, severe frontal headache, swollen eyelids. on PE, one might find erythematous nasal mucosa and sinuses that do not transilluminate. labs might be useful to rule out periapical abscess (using xray) or to confirm chronic sinusitis (using CT scan).
bronchitis is an inflammation of the bronchial tree, either secondary to an infection, asthma, irritant, or primary/chronic. if infectious in origin, bronchitis is likely due to a bacterial URI, while common irritants might be organic solvents, ammonia, dust, chlorine. symptoms are similar to an infectious URI: coryza, malaise, f/c, myalgia, etc. the cough often progresses from a dry, non-productive, to a sputum producing cough. on a respiratory exam, one might hear scattered rhonchi, crackling/wheezing, moist rales.
pneumonia is an acute infection of the lung, and can be from a variety of different sources- bacterial, viral, or mycoplasmal. adults are more likely to get bacterial pneumonia, while young adults and children are more likely to get mycoplasmal or viral. risk factors include cigarette smoke, young/old age, immunocompromised, recurrent URI's, physical debilitation. patients might present with fever / chills, nausea / vomiting, pleurisy / dyspnea, productive cough with rusty colored sputum and an increased pulse and respiratory rate. a lung exam might reveal signs of lung consolidation: dullness to percussion, increased tactile fremitus, whispered pectriloquy, and bronchial breath sounds / crackles. ddx's might include bronchitis, goodpasture's, asthma, cystic fibrosis.
some notes on the different types of headaches. doing a good history is vital to determining the cause of the headache, as well as determining the location and radiation patterns. tension headaches are more likely to be described as a band-like pain around the occiput, whereas migraines are more frontal. pain around or in the eyes might be due to a cluster headache, and pain in the face is likely from trigeminal neuralgia. unilateral head pain on the side of the head could be from temporal arteritis. papilledema or A/V nicking on a fundoscopic can indicate serious conditions such as intracranial hemorrhage or malignant hypertension, respectively.
hay fever aka allergic rhinitis is inflammation of the mucosa of the eyes and nasal passageways, leading to rhinorrhea, itchy / burning eyes and nasal congestion. it is often due to seasonal allergens such as pollen and will present bilaterally. a skin test might be useful to check for signs of atopy in the form of dermatitis, etc. differentials might include sinusitis, acute rhinitis, vasomotor rhinitis, and cocaine use.
conjunctivitis is an inflammation of the conjunctiva of the eyes and can be bacterial, viral (pink eye), or allergic / irritant in nature. signs include conjunctival injection (superficial dilated vessels away from the iris), pruritis, discharge, hyperemic and swollen lids. if symptoms are bilateral, the origin is more likely to be infectious or allergic while unilateral symptoms suggest toxic/chemical/mechanical causes. a culture of secretions can be useful in differentiating the cause of conjunctivitis: bacterial related secretions would contain PMN's, viral would contain leukocytes, and allergic would contain eosinophils.
strep throat is the result of infection via type A beta-hemolytic strep. it manifests as swollen, sore throat with fever and L/A. the jones criteria, used to diagnose strep, requires at least 2 of the following: fever above 100.4F po, no cough, pseudomembrane, tonsillar exudate. strep can also be diagnosed via a rapid strep test or throat culture. ddx's might include pharyngitis, mono, peritonsilar abscess, and diptheria.
vertigo is more of a symptom and can be due to several different causes, including benign paroxysmal positional vertigo, meniere's vestibular neuronitis, and other CNS disorders. episodic vertigo is more likely to be BPPV, while vertigo that lasts for hours / days is more likely to be meniere's or vestibular neuronitis. vertigo can also be associated with symptoms such as nausea / vomiting, tinnitus, and nystagmus-- which if unilateral and horizontal indicates benign causes and if variable indicates CNS disorders.
questions
URI...
1. what is the etiology of a URI?
2. what are some typical signs / symptoms of a URI?
3. what are some features that might distinguish a URI of bacterial vs. viral origin?
4. what labs should be performed for the diagnosis of a URI?
asthma...
5. what are three major features of asthma?
6. what is the difference between intrinsic and extrinsic asthma?
7. what are the major signs and symptoms of asthma?
8. what are some typical PE findings for asthma?
9. what signs might indicate a severe case of asthma?
10. what are the common findings for a lung exam on a patient with asthma?
11. why might a skin exam be performed on a patient suspected of having asthma?
sinusitis...
12. what is sinusitis?
13. what are the typical signs and symptoms of sinusitis?
14. what are some typical PE findings for sinusitis?
15. which labs might be performed to aid in a diagnosis of sinusitis?
bronchitis...
16. what is bronchitis?
17. what are the most common etiological agents for bronchitis?
18. the symptoms of infectious bronchitis are similar to...
19. describe the progression of the cough in infectious bronchitis.
20. severe cases of bronchitis might also present with...
21. what might be heard on a respiratory exam for bronchitis?
22. where in the lung might these sounds be heard?
pneumonia...
23. what is pneumonia?
24. what are three different types of pneumonia?
25. which type is most common in adults? young adults / children?
26. what are some risk factors for pneumonia?
27. what are the signs and symptoms for pneumonia?
28. what are the signs one would expect to find on a lung exam of a pneumonia patient?
29. what are some ddx's for pneumonia?
headaches...
30. what are some causes of head pain?
31. where do tension headaches usually present? how is the sensation described?
32. a frontal headache is more likely what type of headache?
33. a periorbital or deep orbital pain is most likely due to what type of headache?
34. pain in the face is likely due to...
35. unilateral head pain on the side of the head is likely due to...
36. patients with temporal arteritis might also present with what concomitant symptom?
37. what are some physical exams that one should perform on a patient that presents with head pain?
hay fever...
38. what is hay fever?
39. what are two useful questions to ask a patient suspected of hay fever?
40. what are the signs and symptoms of hay fever?
41. why might a skin test be performed in patients suspected of hay fever?
42. what are the differentials for hay fever?
conjunctivitis...
43. "pink eye" is...
44. what are the signs and symptoms of conjunctivitis?
45. what do bilateral vs. unilateral symptoms suggest about the origins of conjunctivitis?
46. what PE exams would be useful in diagnosing conjunctivitis?
47. what labs would you order with a patient suspected of conjunctivitis?
strep throat...
48. what is the etiology of strep throat?
49. what are the signs/symptoms of strep throat?
50. what are the jones criteria for diagnosing strep throat?
51. what are the lab tests used to diagnose strep throat?
52. what are the ddx's for strep throat?
vertigo...
53. episodic vertigo is more likely to be...
54. vertigo that lasts hours or days is more likely to be...
55. vertigo that is sudden onset and lasts for minutes is more likely to be...
56. what are the signs and symptoms associated with vertigo?
57. how can the type of nystagmus differentiate between potential causes of vertigo?
answers
1. viruses or bacteria invading upper respiratory tract, causing inflammation of the mucosa.
2. congestion, sneezing, rhinorrhea, post-nasal drainage, malaise.
3. bacterial more likely to have fever / chills and yellow green mucopurulent discharge. viral more likely to have clear rhinorrhea.
4. rapid strep test if jones criteria met, microscopic smear of exudates.
5. airway obstruction
inflammation
irritability / hypersensitivity
6. extrinsic is to allergy to external factors such as mold, pollen, etc. intrinsic is non allergic- from infections or emotional or other internal causes.
7. coughing, especially at night
wheezing, shortness of breath, DOE
sputum production
8. tachypnea, tachycardia, diaphoresis, wheezing, accessory muscle use.
9. weight loss, wasting, pulsus paradoxus.
10. prolonged expiratory phase, expiratory wheezing and diminished breath sounds.
11. to look for signs of atopy: dermatitis, eczema, other allergic skin conditions.
12. inflammation of the paranasal sinuses due to infection or allergy.
13. swelling / tenderness
malaise
toothache
frontal headache
swollen eyelids
14. erythematous nasal mucosa, sinuses do not transilluminate.
15. CT scan for chronic sinusitis
xray of teeth apices to rule out periapical abscess
CBC
16. an infection of the bronchial tree, either secondary to an infection, asthma, irritant, or primary / chronic.
17. infectious: bacterial URI
irritant: organic solvents, ammonia, dusts, chlorine
18. infectious URI symptoms: coryza, malaise, fever/chills, myalgia, etc
19. begins as dry and non productive, then develops into a productive cough.
20. 101-102 degree fevers.
21. scattered rhonchi, crackling/wheezing, moist rales.
22. at the base for crackling / rales.
23. infection of the lung.
24. bacterial, viral, mycoplasma.
25. bacterial most common in adults, mycoplasma in young adults and children.
26. immunocompromised
young or old age
recurrent URI's
cigarette smoke
physical debilitation
27. fever / chills
pleurisy / dyspnea
productive cough with rusty sputum
tachycardia, tachypnea
N/V
malaise / myalgia
28. increased tactile fremitus
dullness to percussion
bronchial breath sounds
whispered pectriloquy
crackles
[touch dull bronchial whisper crackle]
[fremitus dullness whisper bronchial crackles] [touch the dull whisker to hear the bronchial crackles]
29. bronchitis
asthma
cystic fibrosis
goodpasture's
30. vasomotor instability
muscle tension
hypoglycemia
infection
trauma
mass lesion
cerebral hemorrhage
31. occiput, band-like.
32. migraine
33. cluster
34. trigeminal neuralgia.
35. temporal arteritis.
36. polymyalgia rheumatica.
37. vitals, M/S, eye exam, sinsuses, neurological exam.
38. also known as allergic rhinitis; an inflammatory process involving the nasal and throat mucosa, as well as the conjunctiva in response to various allergens.
39. do your symptoms appear seasonally? are they bilateral?
40. rhinorrhea
burning, itchy, watery eyes
nasal / sinus congestion
41. to check for signs of atopy: dermatitis, eczema.
42. sinusitis, acute rhinitis, vasomotor rhinitis, cocaine use.
43. viral conjunctivitis.
44. superficial dilated vessels in conjunctiva
pruritis
discharge
hyperemia, swelling of lids
45. bilateral more likely allergic / infectious. unilateral more likely toxic/chemical/mechanical.
46. vitals, lymph nodes, EENT, (heart, lungs)
47. culture of secretion: bacterial would contain PMN's, viral would contain lymphocytes, allergic would contain eosinophils.
48. pharyngitis caused by group A beta-hemolytic streptococcus.
49. sore throat
fever
no cough
cervical L/A
injected / erythematous mucous membranes
exudate / pseudomembrane
50. fever over 100.4 po, no cough, tonsilar exudate, pseudomembrane.
51. rapid strep test and throat culture.
52. viral / bacterial pharyngitis
infectious mononucleosis
diptheria
peritonsilar abscess
53. BPPV
54. meniere's, vestibular neuronitis
55. brain or vascular disease.
56. spinning sensation/disequilibirum
nystagmus
N/V
tinnitus
57. unilateral horizontal nystagmus is more likely benign, variable nystagmus likely due to a CNS disorder.
asthma: can be extrinsic (allergic, to molds, pollens, etc), or intrinsic (infectious, emotional, etc.). usually results in coughing (worse at night), wheezing, dyspnea, sputum production. PE findings might include tachypnea, tachycardia, accessory muscle use, and if severe, pulsus paradoxus and muscle wasting. lung auscultation will reveal prolonged expiratory phase with expiratory wheezing, diminished breath sounds. a skin exam might also be performed to confirm signs of atopy (eczema, dermatitis).
sinusitis is an inflammation of the sinuses due to infection or allergies. it can result in a painful pressure in the sinus area from the swelling of the mucous membranes if associated with a URI. typical signs and symptoms might include swelling / tenderness over the affected sinus, malaise, toothache, severe frontal headache, swollen eyelids. on PE, one might find erythematous nasal mucosa and sinuses that do not transilluminate. labs might be useful to rule out periapical abscess (using xray) or to confirm chronic sinusitis (using CT scan).
bronchitis is an inflammation of the bronchial tree, either secondary to an infection, asthma, irritant, or primary/chronic. if infectious in origin, bronchitis is likely due to a bacterial URI, while common irritants might be organic solvents, ammonia, dust, chlorine. symptoms are similar to an infectious URI: coryza, malaise, f/c, myalgia, etc. the cough often progresses from a dry, non-productive, to a sputum producing cough. on a respiratory exam, one might hear scattered rhonchi, crackling/wheezing, moist rales.
pneumonia is an acute infection of the lung, and can be from a variety of different sources- bacterial, viral, or mycoplasmal. adults are more likely to get bacterial pneumonia, while young adults and children are more likely to get mycoplasmal or viral. risk factors include cigarette smoke, young/old age, immunocompromised, recurrent URI's, physical debilitation. patients might present with fever / chills, nausea / vomiting, pleurisy / dyspnea, productive cough with rusty colored sputum and an increased pulse and respiratory rate. a lung exam might reveal signs of lung consolidation: dullness to percussion, increased tactile fremitus, whispered pectriloquy, and bronchial breath sounds / crackles. ddx's might include bronchitis, goodpasture's, asthma, cystic fibrosis.
some notes on the different types of headaches. doing a good history is vital to determining the cause of the headache, as well as determining the location and radiation patterns. tension headaches are more likely to be described as a band-like pain around the occiput, whereas migraines are more frontal. pain around or in the eyes might be due to a cluster headache, and pain in the face is likely from trigeminal neuralgia. unilateral head pain on the side of the head could be from temporal arteritis. papilledema or A/V nicking on a fundoscopic can indicate serious conditions such as intracranial hemorrhage or malignant hypertension, respectively.
hay fever aka allergic rhinitis is inflammation of the mucosa of the eyes and nasal passageways, leading to rhinorrhea, itchy / burning eyes and nasal congestion. it is often due to seasonal allergens such as pollen and will present bilaterally. a skin test might be useful to check for signs of atopy in the form of dermatitis, etc. differentials might include sinusitis, acute rhinitis, vasomotor rhinitis, and cocaine use.
conjunctivitis is an inflammation of the conjunctiva of the eyes and can be bacterial, viral (pink eye), or allergic / irritant in nature. signs include conjunctival injection (superficial dilated vessels away from the iris), pruritis, discharge, hyperemic and swollen lids. if symptoms are bilateral, the origin is more likely to be infectious or allergic while unilateral symptoms suggest toxic/chemical/mechanical causes. a culture of secretions can be useful in differentiating the cause of conjunctivitis: bacterial related secretions would contain PMN's, viral would contain leukocytes, and allergic would contain eosinophils.
strep throat is the result of infection via type A beta-hemolytic strep. it manifests as swollen, sore throat with fever and L/A. the jones criteria, used to diagnose strep, requires at least 2 of the following: fever above 100.4F po, no cough, pseudomembrane, tonsillar exudate. strep can also be diagnosed via a rapid strep test or throat culture. ddx's might include pharyngitis, mono, peritonsilar abscess, and diptheria.
vertigo is more of a symptom and can be due to several different causes, including benign paroxysmal positional vertigo, meniere's vestibular neuronitis, and other CNS disorders. episodic vertigo is more likely to be BPPV, while vertigo that lasts for hours / days is more likely to be meniere's or vestibular neuronitis. vertigo can also be associated with symptoms such as nausea / vomiting, tinnitus, and nystagmus-- which if unilateral and horizontal indicates benign causes and if variable indicates CNS disorders.
questions
URI...
1. what is the etiology of a URI?
2. what are some typical signs / symptoms of a URI?
3. what are some features that might distinguish a URI of bacterial vs. viral origin?
4. what labs should be performed for the diagnosis of a URI?
asthma...
5. what are three major features of asthma?
6. what is the difference between intrinsic and extrinsic asthma?
7. what are the major signs and symptoms of asthma?
8. what are some typical PE findings for asthma?
9. what signs might indicate a severe case of asthma?
10. what are the common findings for a lung exam on a patient with asthma?
11. why might a skin exam be performed on a patient suspected of having asthma?
sinusitis...
12. what is sinusitis?
13. what are the typical signs and symptoms of sinusitis?
14. what are some typical PE findings for sinusitis?
15. which labs might be performed to aid in a diagnosis of sinusitis?
bronchitis...
16. what is bronchitis?
17. what are the most common etiological agents for bronchitis?
18. the symptoms of infectious bronchitis are similar to...
19. describe the progression of the cough in infectious bronchitis.
20. severe cases of bronchitis might also present with...
21. what might be heard on a respiratory exam for bronchitis?
22. where in the lung might these sounds be heard?
pneumonia...
23. what is pneumonia?
24. what are three different types of pneumonia?
25. which type is most common in adults? young adults / children?
26. what are some risk factors for pneumonia?
27. what are the signs and symptoms for pneumonia?
28. what are the signs one would expect to find on a lung exam of a pneumonia patient?
29. what are some ddx's for pneumonia?
headaches...
30. what are some causes of head pain?
31. where do tension headaches usually present? how is the sensation described?
32. a frontal headache is more likely what type of headache?
33. a periorbital or deep orbital pain is most likely due to what type of headache?
34. pain in the face is likely due to...
35. unilateral head pain on the side of the head is likely due to...
36. patients with temporal arteritis might also present with what concomitant symptom?
37. what are some physical exams that one should perform on a patient that presents with head pain?
hay fever...
38. what is hay fever?
39. what are two useful questions to ask a patient suspected of hay fever?
40. what are the signs and symptoms of hay fever?
41. why might a skin test be performed in patients suspected of hay fever?
42. what are the differentials for hay fever?
conjunctivitis...
43. "pink eye" is...
44. what are the signs and symptoms of conjunctivitis?
45. what do bilateral vs. unilateral symptoms suggest about the origins of conjunctivitis?
46. what PE exams would be useful in diagnosing conjunctivitis?
47. what labs would you order with a patient suspected of conjunctivitis?
strep throat...
48. what is the etiology of strep throat?
49. what are the signs/symptoms of strep throat?
50. what are the jones criteria for diagnosing strep throat?
51. what are the lab tests used to diagnose strep throat?
52. what are the ddx's for strep throat?
vertigo...
53. episodic vertigo is more likely to be...
54. vertigo that lasts hours or days is more likely to be...
55. vertigo that is sudden onset and lasts for minutes is more likely to be...
56. what are the signs and symptoms associated with vertigo?
57. how can the type of nystagmus differentiate between potential causes of vertigo?
answers
1. viruses or bacteria invading upper respiratory tract, causing inflammation of the mucosa.
2. congestion, sneezing, rhinorrhea, post-nasal drainage, malaise.
3. bacterial more likely to have fever / chills and yellow green mucopurulent discharge. viral more likely to have clear rhinorrhea.
4. rapid strep test if jones criteria met, microscopic smear of exudates.
5. airway obstruction
inflammation
irritability / hypersensitivity
6. extrinsic is to allergy to external factors such as mold, pollen, etc. intrinsic is non allergic- from infections or emotional or other internal causes.
7. coughing, especially at night
wheezing, shortness of breath, DOE
sputum production
8. tachypnea, tachycardia, diaphoresis, wheezing, accessory muscle use.
9. weight loss, wasting, pulsus paradoxus.
10. prolonged expiratory phase, expiratory wheezing and diminished breath sounds.
11. to look for signs of atopy: dermatitis, eczema, other allergic skin conditions.
12. inflammation of the paranasal sinuses due to infection or allergy.
13. swelling / tenderness
malaise
toothache
frontal headache
swollen eyelids
14. erythematous nasal mucosa, sinuses do not transilluminate.
15. CT scan for chronic sinusitis
xray of teeth apices to rule out periapical abscess
CBC
16. an infection of the bronchial tree, either secondary to an infection, asthma, irritant, or primary / chronic.
17. infectious: bacterial URI
irritant: organic solvents, ammonia, dusts, chlorine
18. infectious URI symptoms: coryza, malaise, fever/chills, myalgia, etc
19. begins as dry and non productive, then develops into a productive cough.
20. 101-102 degree fevers.
21. scattered rhonchi, crackling/wheezing, moist rales.
22. at the base for crackling / rales.
23. infection of the lung.
24. bacterial, viral, mycoplasma.
25. bacterial most common in adults, mycoplasma in young adults and children.
26. immunocompromised
young or old age
recurrent URI's
cigarette smoke
physical debilitation
27. fever / chills
pleurisy / dyspnea
productive cough with rusty sputum
tachycardia, tachypnea
N/V
malaise / myalgia
28. increased tactile fremitus
dullness to percussion
bronchial breath sounds
whispered pectriloquy
crackles
[touch dull bronchial whisper crackle]
[fremitus dullness whisper bronchial crackles] [touch the dull whisker to hear the bronchial crackles]
29. bronchitis
asthma
cystic fibrosis
goodpasture's
30. vasomotor instability
muscle tension
hypoglycemia
infection
trauma
mass lesion
cerebral hemorrhage
31. occiput, band-like.
32. migraine
33. cluster
34. trigeminal neuralgia.
35. temporal arteritis.
36. polymyalgia rheumatica.
37. vitals, M/S, eye exam, sinsuses, neurological exam.
38. also known as allergic rhinitis; an inflammatory process involving the nasal and throat mucosa, as well as the conjunctiva in response to various allergens.
39. do your symptoms appear seasonally? are they bilateral?
40. rhinorrhea
burning, itchy, watery eyes
nasal / sinus congestion
41. to check for signs of atopy: dermatitis, eczema.
42. sinusitis, acute rhinitis, vasomotor rhinitis, cocaine use.
43. viral conjunctivitis.
44. superficial dilated vessels in conjunctiva
pruritis
discharge
hyperemia, swelling of lids
45. bilateral more likely allergic / infectious. unilateral more likely toxic/chemical/mechanical.
46. vitals, lymph nodes, EENT, (heart, lungs)
47. culture of secretion: bacterial would contain PMN's, viral would contain lymphocytes, allergic would contain eosinophils.
48. pharyngitis caused by group A beta-hemolytic streptococcus.
49. sore throat
fever
no cough
cervical L/A
injected / erythematous mucous membranes
exudate / pseudomembrane
50. fever over 100.4 po, no cough, tonsilar exudate, pseudomembrane.
51. rapid strep test and throat culture.
52. viral / bacterial pharyngitis
infectious mononucleosis
diptheria
peritonsilar abscess
53. BPPV
54. meniere's, vestibular neuronitis
55. brain or vascular disease.
56. spinning sensation/disequilibirum
nystagmus
N/V
tinnitus
57. unilateral horizontal nystagmus is more likely benign, variable nystagmus likely due to a CNS disorder.
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