TWU FHN 3 Test 1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Chronic illnesses are characterized by one or more of the following: | show 🗑
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| show | loss of control of illness
times of instability with need of medical/nursing assistance
increased dependence on family members
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| show | a limited functional ability as the result of an impairment; it is the term preferred over “handicap”
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| Sequelae of chronic conditions: | show 🗑
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| Major Chronic Conditions | show 🗑
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| show | 50
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| show | Related--HTN and CHF
Unrelated--HTN and arthritis
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| 1/3 of those with chronic illness have limitations in performing ADL’s | show 🗑
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| show | 31% of children under 18 years have chronic health condition
Incidence of chronic conditions have not changed (CDC, 2008)
Prevalence of children affected increased due to increasing survival and enhanced recognition
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| show | Children who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.
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| Children affected by large number of rare diseases , genetic, or prenatal conditions | show 🗑
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| Adults affected by relatively small number of common diseases that increase in morbidity with age. | show 🗑
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| show | Changes in family roles
Drains major power sources (income, self esteem, autonomy)
Taxes coping abilities of the person
Grief over loss of normal function
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| show | Unable to accept facts of illness
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| show | Aware of lifelong implications of illness
Depression
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| show | Family and patient provide mutual support in coping with reality of disease
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| Engel’s Theory of Loss Resolution | show 🗑
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| show | Pattern of coping strategies used in the past
Pathophysiology causing the disease
Visibility of disease
Degree and type of limitations
Relationship between the disease and person’s functioning in social roles
family support
Pain, fatigue, and fear
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| Societal Response to Chronic Illness | show 🗑
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| Living With Chronic Illness Managing a medical crisis | show 🗑
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| Living With Chronic Illness Carrying out prescribed regimens | show 🗑
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| show | Learning acceptance of limitations on lifestyle imposed by disease
Redesigning/timing activities and hobbies
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| show | Costly treatments
Limitations on ability to work
Worry, anxiety, depression
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| show | Variable, depending on predictability of illness and ability of patient to cope
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| show | Dependent on patient response to his/her tendency to withdraw from friends and society
Patient response to societal withdrawal from her/him
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| show | Not focused on seven problems of the disease itself
Involves working through above tasks
Occurs when patient and family accept new, realistic identities and roles
Achieves normalization-optimal level of functioning within the limits imposed by illness
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| Corbin & Strauss | show 🗑
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| Further refinement of Strauss’s earlier theory is applicable to | show 🗑
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| Corbin & Strauss Common phases Pre-trajectory | show 🗑
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| show | signs and symptoms
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| Corbin & Strauss Common phases Crisis phase | show 🗑
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| Corbin & Strauss Common phases Acute phase | show 🗑
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| Corbin & Strauss Common phases Stable phase | show 🗑
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| Corbin & Strauss Common phases Unstable phase | show 🗑
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| show | deterioration
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| Corbin & Strauss Common phases Dying phase | show 🗑
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| show | self-control and independence
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| show | Evaluate the patient’s self-care abilities
Help the patient adjust to limitations imposed by illness
Help the patient adjust to changes in body image
Work to increase self-esteem
Assist the patient to express feelings
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| show | General Management of chronically ill
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| Care at the End of Life Most persons will carry a chronic illness diagnosis at the end of life | show 🗑
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| show | Common term used to describe impaired cognition resulting in disturbed behavior and/or emotions
Symptom of underlying condition
Diagnostically challenging
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| show | Disease
Of the brain itself
Other organ systems
Medication problems
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| show | How abruptly it started
How long it has been going on
If the situation is progressing, and if so, how fast
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| show | a syndrome of a disturbance in consciousness with reduced ability to focus, sustain, or shift attention that occurs over a short period of time and tends to fluctuate over the course of the day
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| show | Acute effect of physical illness on brain function
Affects 10-52% of hospitalized elderly
Of those with dementia, the incidence of delirium is 32-82%
Often neglected as medical emergency
no history available, best to assume confusion is of new onset
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| Acute Delirium: Brain maladaptive reaction to acute stressor | show 🗑
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| show | Alter availability of amino acids from plasma to the brain
Modify cerebral neurotransmission
Increased secretion of cytokines
Induces neurotransmission state of cholinergic deficiency and dopaminergic excess
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| show | not accounted for by a dementia
Develops over hours to days
Fluctuates during the course of the day
Impaired ability to focus, sustain, or shift attention
Cognition impaired
or perceptual disturbance (misinterpretations, illusions, hallucinations)
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| show | Acute Delirium: DSM-IV Diagnostic Criteria
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| show | Acute change in mental status
Sleep disturb
Fluctuating course
Attention disturb
Memory disturb
Orientation disturb
Perceptual disturbance
Thought disturbance
Consciousness disturbance
Speech disturbance
Psychomotor activity disturbance
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| show | symptom fluctuation that occurs with delirium
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| Acute Delirium Mandatory search for underlying cause(s): | show 🗑
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| show | Acute systemic infection
Pneumonia, Urinary sepsis, Cholecystitis, Diverticulitis, Meningitis, Encephalitis
Head injury, subdural hematoma
Acute myocardial event
Rarely is one single factor responsible for onset of delirium
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| show | Predisposing or vulnerability factors (See Ham & Sloan Chap 16)
Precipitating or trigger factors
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| Precipitating Factor for acute delirium | show 🗑
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| show | In-vitro affinity to muscarinic receptor
Opinion of clinical expert regarding adverse effect
Serum anticholinergic activity
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| show | Ipratropium Bromide Inhaler
Meclizine
Oxybutinin
Meperidine
Paroxetine
Hydroxyzine
Chlorpheniramine
Amitriptyline
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| show | Acute change in mental status
Accompanying attention deficit
Disorganized thinking or change in alertness status
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| Acute and Fluctuating Changes in Mental Status as demonstrated by one of the following | show 🗑
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| show | Nurse interview
Patient inability to spell first name backward
Patient inability to repeat a phone number
Patient inability to count backward from 20 to 1
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| Disorganized Thinking as demonstrated by one of the following | show 🗑
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| show | Nurse interview
Chart review
Patient sleepiness
Patient restlessness
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| Agitation | show 🗑
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| show | Active screening to identify patients with high vulnerability (Delirium vulnerability scale)
Educating clinicians on recognizing and diagnosing delirium and identifying triggers
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| Alzheimer’s Disease A progressive, neurodengerative condition characterized by memory loss and cognitive decline. | show 🗑
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| show | Language (aphasia)
Function (apraxia)
Perception (agnosia)
Executive function-interpersonal relationships, ADL’s
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| Pathologic markers for AD have been identified; however, these features also occur in the brains of cognitively intact persons | show 🗑
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| AD affects the 3 processes that keep neurons healthy | show 🗑
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| show | one of the hallmarks of AD
protein fragments that the body produces normally
Healthy brains are able to break down and eliminate the protein fragments. In AD the fragments accumulate for form hard insoluble plaques
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| Brain Changes in Alzheimer’s Neurofibrillary Tangles | show 🗑
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| Alzheimer’s Genetic Factors | show 🗑
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| show | Advancing age
Family history of APOE genotype
Obesity
Insulin Resistance
Dyslipidemia
Hypertension
Inflammatory Markers
Traumatic Brain Injury
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| Trisomy 21 predisposes to Alzheimers in late life Down’s syndrome (late 40’s or 50’s) | show 🗑
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| Mild Alzheimer disease Signs of mild AD can include the following: | show 🗑
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| Moderate Alzheimer disease | show 🗑
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| show | Moderate Alzheimer disease
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| Patients with severe AD cannot recognize family or loved ones and cannot communicate in any way. They are completely dependent on others for care, and all sense of self seems to vanish. Other symptoms of severe AD can include the following: | show 🗑
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| History for Dementia 5 areas that require assess/reassessment | show 🗑
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| Functional Activities Questionnaire (FAQ) | show 🗑
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| Preparing balanced meal Awareness of current events Understand/discuss TV program, book, article Remembering and keeping appointments Driving, taking bus, walking to familiar places | show 🗑
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| Screen for depression (US Preventive Services Task Force) | show 🗑
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| Identify primary caregiver and assess for | show 🗑
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| show | cholinesterase-inhibiting drugs may improve function and slow decline, however in clinical trials these drugs benefits fewer than 50% of patients.
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| show | to prolong daily function in patients with moderate-to-advanced AD
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| Acetylcholinesterase inhibitors Reversibly bind and inactive the enzyme that degrades acetylcholine, which is involved in memory. | show 🗑
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| show | The most common side effects are nausea, vomiting and diarrhea and dose related.
Rivastgmine (Exelon) patches my be better tolerated
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| Cholinestrase Inhibitors Donepezil (Aricept) Longer duration of inhibitory action; greater specificity for brain tissue Treatment of mild, moderate, and severe Second generation cholinesterase inhibitor | show 🗑
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| show | 1.5 mg twice daily
Can increase by 1.5 mg twice daily (3 mg/day) every 4 weeks
Max 6 mg bid
Side effects: Nausea, vomiting, diarrhea, h/a, abdominal pain, fatigue, anxiety, agitation
Reduce by taking with food
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| Cholinestrase Inhibitors Galantamine (Razadyne, previously Reminyl) Treatment of mild to moderate | show 🗑
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| show | (additive effective for ulcer formation)
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| NMDA Receptor Antagonist Memantine (Namenda) New class of medications N-methyl-D-aspartate (NMDA) receptor antagonists Indicated for moderate to severe AD | show 🗑
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| show | Dosing—
Use to be a gradual titration
Now changing to extended tabs: Namendia XR 28mg once a day-same apporx. Cost $300/month
May consider stopping in 3-6 months if no improvement-taper over 4 weeks to prevent rebounds
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| show | In some studies some improvement seen for 4-6 wks, no improvement after 6 weeks.
Rationale: slows progression of AD
Possible association of free radicals and oxidative stress contribute to neural degeneration.
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| show | Buspirone 5-7.5 mg bid up to 30 mg/day
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| Depression in AD | show 🗑
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| show | Good sleep hygiene
Pharmacologic as last resort
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| show | Older patients with dementia who are treated with atypical antipsychotics have a 2x higher mortality rate.
Federal law states that if antipsychotics used in treatment in nursing homes, drug reduction efforts must be made every 6 months or less
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| show | Evidence suggests that olanapine (Zyprexa) and risperidone (Risperdal) reduce aggression and risperidone reductes psychosis in patients with AD.
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| show | Balance environmental stimulation
Familiarize routines for security and predictability
Art and expressive recreation can improve mood
Exercise outdoors to improve mood and behavior
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| Ten Warning Signs of AD | show 🗑
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| show | Small breaks in the skull that are not associated with depressed bone fragments and underlying brain injury.
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| CONCUSSION | show 🗑
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| show | No loss of consciousness or amnesia.
Glasgow Coma Scale of 15.
Normal alertness and memory.
No focal neurological deficit.
No palpable depressed skull fracture.
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| show | Brief (<5 min.) loss of consciousness.
Amnesia for the event.
Glasgow Coma Scale score of 14.
Impaired alertness and memory.
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| show | Prolonged (>5 min.) loss of consciousness.
Glasgow Coma Scale score < 14.
Focal neurological deficit.
Post traumatic seizure.
Intra-cranial lesion detected on CT scan.
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| show | Falls
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| Head injuries in infants | show 🗑
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| How long after a head injury should an unhospitalized patient be observed? | show 🗑
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| show | Confusion, amnesia
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| normal BMI | show 🗑
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| overweight: | show 🗑
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| Class I: Obesity BMI | show 🗑
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| Class II: Obesity BMI | show 🗑
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| Class III Obesity BMI | show 🗑
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| show | More common in men
Associated with greater risk of most complications of obesity
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| show | More common in women
Tend to accumulate more fat in gluteofemoral region.
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| show | more hazardous to health than subcutaneous fat around abdomen
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| show | Men: >102 cm (40 in)
Females > 88 (35in)
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| show | > 1.0 in men
> .85 in women
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| Waist circumference and waist to hip ratio are both a better predictor than BMI for health risk | show 🗑
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| relative risk associated with obesity decreases with age | show 🗑
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| show | CVD
Type 2 diabetes
Degenerative joint disease (Osteoarthritis)
Hypertension
Hyperlipidemia
Certain cancers:
suppressed immune function
Digestive tract disease
Increased surgical and obstetric risks
Endocrine abnormalities
Proteinuria
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| 40-70% of obesity explained by | show 🗑
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| Obesity results from | show 🗑
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| Visceral abdominal adipose tissue associated with obesity appears to be act as an endocrine gland | show 🗑
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| Plasminogen Activating Inhibitor 1 (PAI-1) | show 🗑
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| Retinol-binding protein 4 (RBP-4) Reported to be associated with visceral-fat accumulation and parameters of the metabolic syndrome (MetS). | show 🗑
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| Adipokinases affect insulin action in obesity: Tumor Necrosis Factor alpha | show 🗑
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| Peptide resistin | show 🗑
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| Leptin (1994) protein (leptin = Greek for thin) Leptin is released from fat cells in response to changes in body fat | show 🗑
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| Leptin replacement | show 🗑
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| show | Also seems to increase sensitivity to insulin by increasing hepatic responsiveness
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| Angiotensinogen | show 🗑
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| Serotonin | show 🗑
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| show | Normal process involves use of calories by converting food to heat
In obese, energy is stored, not converted to heat
Less sympathetic nervous system activity
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| 60% of obese individuals have metabolic syndrome as defined by NCEP ATP III: | show 🗑
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| show | High insulin levels
Elevated FBS or post prandial glucose
+2
Of the NCEP ATP III Guidelines
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| patients with Metabolic Syndrome have | show 🗑
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| Most obesity is the result of | show 🗑
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| Major endocrine disorders that may manifest with obesity are: | show 🗑
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| OBESITY IN CHILDREN | show 🗑
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| show | defined as a sex and age specific BMI at or above the 95th percentile based on revised growth charts by the CDC
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| show | defined as a mean weight above the 120th percentile for height. Some sources use the 125th percentile and some use 130th. BMI >85 percentile.
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| show | Cardiovascular disease
Type 2 Diabetes-
Weight related orthopedic problems
Skin disorders
Psychiatric problems
Sleep apnea
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| Factors influencing weight in Children | show 🗑
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| show | 80-90
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| show | Modification of child and family’s diet
Regular exercise
Family-based behavior modification programs
Establish treatment plan with the family
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| Obesity assessment | show 🗑
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| show | Normalize child’s weight within his genetic potential
Reduce health risks through improved diet and activity
Support treatment of underlying biological and psychosocial contributors.
View obesity as a symptom with diverse contributors
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| Contraindications to weight loss | show 🗑
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| show | Lowest weight the patient can comfortably maintain- initial goal is 5-10% of total body weight
Cosmetic goals should be discouraged
Prevention of weight gain
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| Alternative goals for management of obesity: | show 🗑
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| Weight loss requires creating a calorie deficit | show 🗑
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| show | body uses only 3 calories to store 100 calories of fat.
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| show | calories to convert 100 calories of protein into body fat
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| show | 30%
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| Fiber: | show 🗑
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| show | Raises metabolic rate
Helps keep weight down that was lost
Walking briskly for 20-30 minutes a day
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| show | Not all that on market are safe and effective
Herbal products still largely unregulated
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| show | Mineral-key role in increasing cell sensitivity to insulin
Lowers body wt, yet increases lean body mass
Recommended dosage 400-600 mcg/day.
no reported significant adverse effects
Refined sugars, white flour, and lack of exercise deplete chromium
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| Thermogenic Formulas Ephedrine ( also ma huang) | show 🗑
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| Guggul: | show 🗑
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| Pantothenic Acid (vit B5) used in energy production of fats and carbohydrates | show 🗑
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| Coenzyme Q10: | show 🗑
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| FORMULA DIETS | show 🗑
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| Obesity PHARMACOTHERAPY | show 🗑
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| Orlistat (Xenical) approved for long term use <2 years | show 🗑
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| Belviq: a serotonin 2C receptor agonist FDA approved 2012 Schedule IV 10 mg BID for up to 12 weeks Contraindicated in pregnancy | show 🗑
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| show | Phentermine, a sympathomimetic: (Schedule IV)
Appetite suppressant
Topiramate, an antiepileptic
Increases feelings of fullness, blunts taste, and increases calorie burning
BEST USE BY BARIATRIC MD
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| Appetite suppressants-most controversial and less used today due to rebound weight gain & CVD risk | show 🗑
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| Both glucophage (Metformin) and Byetta (exenatide) have been shown to | show 🗑
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| show | Consultation with health care provider or nutritionist or other support source
Adhering to stable diet
Monitoring weight
Eating breakfast
Regularly exercising
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| show | to a consistent regimen
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| show | Establish social support
avoid disinhibited eating
Avoid binge eating
Avoid eating in response to negative emotions/stress
Be accountable for one’s decisions
Foster sense of autonomy, internal motivation and self-efficacy toward wt loss maintenance
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| show | Disinhibited eating
Binge eating
Periods of excessive hunger
Eating in response to negtive emotions/stress
Passive reactions to problems
Less assumption of responsibility in life
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| show | According to National Institute of Diabetes and Digestive and Kidney Diseases GI surgery most effective treatment for severely obese persons who fail to lose weight through diet and exercise.
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| show | >40 or >35 with comorbid conditions
Include: vertical-banded gastroplasty and gastric bypass
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| show | decreases the amount of food that can be ingested, as well as calories and nutrients.
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| show | reduce stomach size: adjustable gastric banding and vertical banded gastroplasty
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| Gastric bypass patients | show 🗑
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| Anorexia Nervosa Definitions | show 🗑
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| Anorexia Nervosa Etiology | show 🗑
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| Anorexia Nervosa Predispositions | show 🗑
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| Anorexia Nervosa Signs & Symptoms | show 🗑
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| show | Anorexia Nervosa Signs & Symptoms
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| Diagnostic Criteria for Anorexia Nervosa | show 🗑
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| show | Restricting type: not regularly engaged in binging or purging behaviors
Binge-Eating/Purging type: regularly engaged in binging or purging behaviors
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| Anorexia Nervosa History | show 🗑
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| Anorexia Nervosa Initial lab should include | show 🗑
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| Anorexia Nervosa Hospitalize | show 🗑
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| show | Imperative to build trust and treatment alliance
Involve client in establishing target weight
Achieve gradual weight gain
Weigh weekly at first; monthly when progress is evident
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| Focus on overall indices of health, rather than wt gain alone Challenge fear of wt gain Family therapy for adolescents; couples therapy for older clients When conditioning is chronic, goal may be to achieve a safe wt rather than a healthy wt | show 🗑
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| Anorexia Nervosa Medication Treatment Medications should not be used as sole or primary treatment of this disorder; however: | show 🗑
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| Bulimia: Diagnosis | show 🗑
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| Types of Bulimia Nervosa | show 🗑
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| show | Young, white, middle and upper class women
More difficult to detect than anorexia due to the typically normal weight for age and height
Some individuals may have above normal weight range however
As high as 19% of college-age women
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| show | Premeditated, secretive episodes of binging
Consume large quantities of easily ingested high-calorie foods
Fast eating with inability to slow down or stop
Eat until painfully full
Typically occurs separately from regular meals
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| Purging | show 🗑
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| show | Fasting
Excessive exercise
Defined as taking precedence over other important activities
Ritualistic
Less secretive than other compensatory behaviors, so can serve as red flag to clinicians
Strict dieting
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| show | History of premorbid obesity
Greater incidence of cathartics and diuretics
More impulsive or anti-social behavior
Menstruation is usually preserved
Symptoms usually related to mechanism of purging
Abdominal pain
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| Bulimia Nervosa pt complain of Abdominal pain due to | show 🗑
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| show | Dehydration
Orthostatic hypotension
Enlargement of parotid glands
Oral cavity
Abdominal tenderness
Abrasion of finger joints (PIPs) due to scraping of fingers against teeth to induce vomiting
Tachycardia and hypertension
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| Bulimia Laboratory findings Vomiting | show 🗑
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| Bulimia Laboratory findings laxative overuse | show 🗑
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| Bulimia Laboratory findings | show 🗑
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| show | Gastric dilatation
Pancreatitis (check amylase)
Poor dentition
Pharyngitis
Esophagitis and esophageal rupture
Aspiration pneumonia
Electrolyte imbalance and dehydration
Severe constipation with withdrawal of laxatives
Hemorrhoids
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| Diet pill side effects | show 🗑
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| Bulimia Hospitalization If failure in outpatient management If medically unstable | show 🗑
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| Chronic dehydration in bulimia | show 🗑
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| Psychotherapy and nutrition counseling in Bulimia | show 🗑
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| show | SSRIs recommended (FDA approved in higher doses than for depression)
Fluoxetine (Prozac) 60 mg/day
Blackbox warning: risk of suicide in children and adolescents
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| show | Electrolyte monitoring periodically
Drug therapy
Treatment for reflux and gastritis
Parotid gland swelling and pain
Sucking on tart candy
Application of heat
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| show | Prognosis is better if younger age of onset and shorter duration of illness
Prognosis worse if coexisting psychiatric conditions
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| show | Depression and anxiety
Obsessive-compulsive disorders
Suicidal ideation and attempt
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| NP role is in recognizing, diagnosing, and appropriately referring cases of bulimia nervosa. | show 🗑
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| Depression Definition: illnesses that affect mood and results in a range of feelings and symptoms. | show 🗑
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| DSM-IV Criteria | show 🗑
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| show | Alzheimer’s
End-stage renal failure
Parkinson’s disease
CVA
Cancer
Chronic fatigue, chronic pain+
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| show | of depression or related illnesses
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| show | changes
in brain neurochemistry and function demonstrated by research,
including sleep electroencephalographic studies, positron-emission
tomography, single-photon-emission CT, or CSF catecholamine metabolite
levels.
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| Medications that Cause Depression | show 🗑
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| Mixtures of environmental/biologic factors underlying severe mood disorders. | show 🗑
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| Major Depressive Disorder: | show 🗑
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| show | Usually
do not require hospitalization due to less acute symptoms. Talk
psychotherapy needed along with pharmacotherapy. Pts. at risk for
suicide and substance abuse.
🗑
|
||||
| Substance-Induced Depressive Disorder: Consider DX when symptoms emerge as result of use of illegal drugs, medications, or toxins. | show 🗑
|
||||
| Adjustment Disorder (Situational depression): | show 🗑
|
||||
| Seasonal Affective Disorder: Episodes of MDD emerge in fall and last through winter and cannot be attributed to other biologic or psychosocial stressors. | show 🗑
|
||||
| Postpartum Depression: Onset occurs within 4 weeks after birth of infant. Symptoms similar to MDD, but in addition mother often has psychotic symptoms that involve delusional thoughts about the infant. | show 🗑
|
||||
| show | (PMDD): Depressive symptoms during the late luteal phase of the menstrual cycles may occur throughout the year.
🗑
|
||||
| show | Exhibits all S&S of MDD as well as psychotic symptoms. May include delusions and/or hallucinations.
Associated with high incidence of suicide and commonly warrants inpatient care.
Meds include antidepressants and antipsychotics.
🗑
|
||||
| show | Episodes of mania and depression, or extreme highs and lows.
4 or more episodes/yr are “rapid cyclers”
Psychotic features may or may not be present during manic episodes.
Generally manic phase is shorter than depression phase
🗑
|
||||
| Bipolar characterized by excesses: | show 🗑
|
||||
| Treatment of Bipolar Disorder | show 🗑
|
||||
| Depression - Any type | show 🗑
|
||||
| Depression - Management | show 🗑
|
||||
| show | after age 40 or one episode after age 50.
🗑
|
||||
| show | Takes 4-6 weeks to yield significant reduction or remission of symptoms.
Small percentage are unresponsive to existing treatments.
🗑
|
||||
| Depression Nonsedating medication: | show 🗑
|
||||
| show | Available since the 1950’s
All have similar effects, dosing, & efficacy
Major advantage over newer agents is sedation potential and cost
Start at low doses and increase gradually
🗑
|
||||
| Side Effects of Tricyclic medications | show 🗑
|
||||
| show | Few side-effects
Major reason for stopping is libido/ejaculatory problems
Tolerated by elderly, but start at low doses
Monitor for worsening of Parkinson’s symptoms
SSRI’s inhibit various isoenzymes of the cytochrome P-450 system of the liver
🗑
|
||||
| show | SSRI and combinations have now been given a warning in pregnancy due to risk of congenital problems.
🗑
|
||||
| show | Long half-life
Well tolerated
Main reason for stopping: decreased libido/ejaculatory problems (true for all SSRIs)
Stigma associated with Prozac
Now available in generic-may be less cost
🗑
|
||||
| Zoloft (Sertraline) 50-100mg x 1 | show 🗑
|
||||
| show | SSRI for Depression
Less effect on libido
🗑
|
||||
| show | FDA approval for anxiety, panic, OCD
🗑
|
||||
| show | Wellbutrin, should use SR
Less weight gain-warning with eating disorders.
Low toxicity
Lower risk of sexual dysfunction
Useful with bipolar and ADHD
Disadvantage-raises threshold for seizures
🗑
|
||||
| Norepinephrine/serotonin Reuptake Inhibitors | show 🗑
|
||||
| show | Warning: MAO derivative-drug interactions
Interacts with oral contraceptives
🗑
|
||||
| Exercise combined or alone | show 🗑
|
||||
| show | young adults
🗑
|
||||
| No clinical significance in effectiveness between different kinds of antidepressants. | show 🗑
|
||||
| ECT involves passing electrical current through brain to induce series of generalized seizures. | show 🗑
|
||||
| Current research suggests ECT is one of safest treatments for MDD and psychotic depression. | show 🗑
|
||||
| show | At risk for suicide
Inability to care for oneself
Diagnosis of Bipolar Disorder
Initiation of ECT
Evaluation and treatment with psychotherapy and/or cognitive therapy
Education and support for family members
🗑
|
||||
| show | Children/adolescents do have depression, Counseling is an important component. SSRI’s frequently used.
Children with severe symptoms should be referred.
🗑
|
||||
| show | Elderly:
Side effects more of an issue
Start with 1/4 to 1/2 average dose
At higher risk for suicide
🗑
|
||||
| Depression Follow-up | show 🗑
|
||||
| show | psychotic or delusional depression or for patients who are actively suicidal or who will not eat or drink, but societal and legal prejudice limits its use.
🗑
|
||||
| A signed “contract” may be an option to utilize in a clinic setting for a patient that is waiting for appointment at a psychiatrist, especially if they have suicidal ideation. | show 🗑
|
||||
| DEFINITION of ANXIETY: | show 🗑
|
||||
| show | Persons seek medical attention because attribute symptoms to serious physical problems
Anxiety disorders frequently unrecognized
🗑
|
||||
| show | Panic disorder
Generalized anxiety disorder (GAD)
Adjustment disorder with anxious mood
Post traumatic stress disorder (PTSD)
Simple phobia
Social phobia
Obsessive-compulsive disorder (OCD)
🗑
|
||||
| show | Stimulation of locus ceruleus increases anxiety.
Benzodiazepines stimulates GABA receptors and reduces anxiety symptoms. GABA receptors in cerebral cortex are inhibitory.
May have a genetic component
🗑
|
||||
| Panic Disorder EPIDEMIOLOGY: | show 🗑
|
||||
| Panic Disorders SYMPTOMS: | show 🗑
|
||||
| show | Initial attack-spontaneous, unexpected
Attacks occasionally follow excitement, emotional trauma, or exertion and do not necessarily represent panic disorder
Ingestion of caffeine, alcohol, or nicotine or drugs may precede attack
🗑
|
||||
| Panic disorders Typical attack: begins with 10-15 minute period of accelerating symptoms Entire attack lasts about 30 minutes | show 🗑
|
||||
| Panic Disorders DSM-IV diagnostic criteria: Recurrent unexpected panic attacks At least one of attacks has been followed by at least 1 month of one or more of following: | show 🗑
|
||||
| show | Basic tests and studies needed to rule out associated disease: thyroid studies, serum electrolytes, blood glucose, ECG, CXR.
Other tests based on clinical judgment
🗑
|
||||
| show | Relaxation training
Exposure therapy in PD with agoraphobia
Cognitive therapy
🗑
|
||||
| show | Antidepressants-effective. Imipramine-improvement in symptoms in 70-90% of pts after 6 weeks of therapy. Tricyclics, SSRIs used in full therapeutic antidepressant doses
🗑
|
||||
| Benzodiazepines effective in reducing anticipatory anxiety. Xanax results in marked improvement in 50% of pts. | show 🗑
|
||||
| show | Most effective form is combination of pharmacologic agent and cognitive behavioral therapy
🗑
|
||||
| show | DIET: Avoid caffeine, nicotine, and ETOH.
Stress management !!!!!!
Relaxation Techniques: Yoga!
Exercise: 30 minutes aerobic exercise per day
Desensitization to triggers
🗑
|
||||
| show | Restlessness
Fatigue
Trouble concentrating
Irritability
Sleep disturbance
Muscle tension
🗑
|
||||
| show | Cardiac: chest pain, palpitations, tachycardia, tachypnea
Pulmonary: hyperventilation, smothering sensations, dyspnea
Gastrointestinal: indigestion, abdominal pains, flatulence, diarrhea, constipation
🗑
|
||||
| show | Recurring thoughts such as fear of exposure to germs.
Anxiety may be alleviated by ritualistic performance-frequent hand washing, hair pulling, in severe forms may perform self mutilation-cutting
May present with an eating disorder
🗑
|
||||
| SYMPTOMS COMMON TO ANXIETY AND DEPRESSION: | show 🗑
|
||||
| SYMPTOMS ESPECIALLY CHARACTERISTIC OF ANXIETY | show 🗑
|
||||
| show | Early morning awakening
Pain syndromes-chronic, dull
Pts unaware of their illness, want to be left alone
Mood may be depressed
Anhedonia
Suicidal thoughts
🗑
|
||||
| Depression combined with Anxiety TREATMENT: Psychotherapy | show 🗑
|
||||
| Depression/Anxiety TREATMENT- Pharmacotherapy(agents) | show 🗑
|
||||
| show | Hypnotics:
Scheduled drugs CIV
CYP 34A inhibitors
🗑
|
||||
| show | Zolpidem (Ambien) CR version is delayed release
Eszopiclone (Lunesta)
🗑
|
||||
| show | Elavil 10-50 mg at hs
Trazedone 50-100 mg at hs
Pamelar (Nortriptyline 50-100mg
🗑
|
||||
| 5.2 Million with CHF in the United States | show 🗑
|
||||
| 200,000 patients die from CHF per year | show 🗑
|
||||
| show | 1. Accounts for 5-10% of all hospital admissions
2. Annual U.S. Cost: $38.1 billion ($44.6 billion by 2015)
🗑
|
||||
| show | 1. Heart Failure is a final common pathway
2. Maximize treatment of the underlying causes
3. Control the causes and prevent end organ damage
🗑
|
||||
| Heart failure (cardiac insufficiency, ventricular failure) | show 🗑
|
||||
| show | Blood backs up into the left atrium and into the pulmonary veins.
Increasing pressure in the pulmonary capillary bed causes congestion, result in respiratory distress.
Increasing pulmonary pressure results in increased pressure on right side of heart.
🗑
|
||||
| Right-sided failure (cor pulmonale). Results from failure of the right ventricle to maintain adequate output. | show 🗑
|
||||
| show | However, right-sided failure may occur alone for an extended period of time. Frequently associated with chronic lung problems.
🗑
|
||||
| show | when these mechanisms become in- effective, cardiac decompensation or failure will occur.
🗑
|
||||
| In children, HF occurs most often as the result of | show 🗑
|
||||
| show | Decreased cardiac output leads to decrease in renal perfusion, the kidneys respond by increasing the retention of sodium and water. Resulting in pitting dependent edma
🗑
|
||||
| Pulmonary congestion (left-sided failure). | show 🗑
|
||||
| Systemic congestion (right-sided failure). | show 🗑
|
||||
| 1. Systolic Dysfunction (60-70% of Heart Failure cases) | show 🗑
|
||||
| 2. Diastolic Dysfunction (30-40% of Heart Failure cases) | show 🗑
|
||||
| show | Echocardiogram
🗑
|
||||
| NYHA Classification Class I | show 🗑
|
||||
| show | Symptoms with minimal activity
1. Class IIIa: No Dyspnea at rest
2. Class IIIb: Recent Dyspnea at rest
🗑
|
||||
| NYHA Classification Class II | show 🗑
|
||||
| NYHA Classification Class IV | show 🗑
|
||||
| Stroke or brain attack is the disruption of the blood supply to an area of the brain, | show 🗑
|
||||
| show | frequently precedes the development of a stroke
🗑
|
||||
| Ischemic stroke | show 🗑
|
||||
| show | Associated with hypertension and diabetes.
(2) Produces ischemia of the cerebral tissue.
🗑
|
||||
| Embolic stroke: occlusion of a cerebral artery by an embolus. | show 🗑
|
||||
| Hemorrhagic stroke. | show 🗑
|
||||
| Transient ischemic attack (TIA, silent stroke). a. Brief episode, less than 24 hours, of neurologic dysfunction; usually resolves within 30-60 minutes. | show 🗑
|
||||
| show | Symptoms similar to TIA.
b. Neurologic symptoms last longer than 24 hours, but less than a week.
🗑
|
||||
| Stroke: | show 🗑
|
||||
| PVD • Symptoms 1. Presentations | show 🗑
|
||||
| show | 2. Pain worse with exertion
3. Pain relieved within 10 minutes rest
4. Pain relieved with rest and dependent position
🗑
|
||||
| show | 1. Tissue loss or gangrene
2. Chronic rest pain
🗑
|
||||
| show | 1. Exertional pain: 70% arterial pain
2. Nocturnal pain: 70 to 90% arterial stenosis
3. Ischemic rest pain: 90% arterial stenosis
🗑
|
||||
| show | 1. Abdominal aorta bruit
2. Femoral artery pulse
3. Dorsalis pedis pulse (absent in up to 3% of normal patients)
4. Posterior tibial pulse
5. Carotid Artery pulse and bruit (for comorbid Carotid Stenosis)
🗑
|
||||
| show | 1. Critical in determining Acute Limb Ischemia degree (see Rutherford Classification)
2. Extremity Motor Exam
3. Extremity Sensory Exam
🗑
|
||||
| 1. Most reliable signs of Peripheral Vascular Disease | show 🗑
|
||||
| 1. Posterior tibial artery doppler Ultrasound | show 🗑
|
||||
| 2. Dorsalis pedis AND posterior tibial pulse absent test for PAD | show 🗑
|
||||
| show | 1. Test Sensitivity: 29%
2. Test Specificity: 95%
🗑
|
||||
| show | 1. Test Sensitivity: 35%
2. Test Specificity: 87%
🗑
|
||||
| show | Dry, scaly, shiny atrophic skin
Skin hairless over lower extremity
Dystrophic, brittle Toenails
Non-healing ulcers or other wounds on legs or feet Decreased skin Temperature
Decreased Capillary Refill Time
Distal extremity color change with position
🗑
|
||||
| show | 1. Skin rubor when leg dependent
2. Skin pallor when leg elevated >1 minute
1. Color returns within 15 seconds in mild cases
2. Delay >40 seconds suggests severe ischemia
🗑
|
||||
| show | 1. Early finding
1. Pain
2. Late findings
1. Pulselessness
2. Pallor
3. Paresthesias
4. Paralysis
🗑
|
||||
| FOUR HEART LAYERS | show 🗑
|
||||
| PERICARDIUM | show 🗑
|
||||
| EPICARDIUM | show 🗑
|
||||
| MYOCARDIUM | show 🗑
|
||||
| show | Innermost layer
Thin layer of endothelium is continuous with blood vessels
Lines inner chambers of heart and valves.
Disruption can lead to infection
🗑
|
||||
| show | Thin walled receiving chamber, 2mm thick.
Receives blood from SVC, IVC and coronary sinus.
Atrial contraction (atrial kick) contributes 30 % to ventricular filling.
O2 Sat about 75%
🗑
|
||||
| show | Most anterior chamber
Lies directly below the sternum
3-5mm thick
Blood enters via tricuspid valve during diastole, (resting phase).
Ejected into the pulmonary circulation through pulmonic valve
🗑
|
||||
| show | Most posterior chamber
Receives oxygenated blood from the lungs via R/L pulmonary veins.
3mm thick
O2 Sat about 98%
🗑
|
||||
| LEFT VENTRICLE (LV) | show 🗑
|
||||
| show | Prevent regurgitation from one chamber to another – blood flows in ONE direction.
Flexible, fibrous tissue, covered with endocardium
Open/Close in response to pressure gradients
4 valves- tricuspid, pulmonic, mitral, aortic.
🗑
|
||||
| show | Mitral – 2 cusps
Tricuspid – 3 cusps
Separates atriums from ventricles.
Cusps are attached by the chordae tendinae and papillary muscles.
These are at risk for damage with an anterior MI.
🗑
|
||||
| show | Aortic and pulmonic
Separates the ventricles from their outflow arteries.
Smaller than the AV valves
Aortic cusps are thicker than the pulmonic
Composed of fibrous supporting ring – ANNULUS.
🗑
|
||||
| show | RCA – supplies posterior septum, left papillary muscle, sinus and AV nodes.
🗑
|
||||
| show | LCA – divides into LAD and LCX. Supplies anterior ventricular wall, anterior septum, papillary muscle and apex.
🗑
|
||||
| show | CX – supplies inferior and posterior portions of LV in some people (left coronary dominance)
🗑
|
||||
| show | Systole – ventricles depolarized, blood ejected from the ventricles
Amount of blood ejected with each heart beat.
Comprised of;
Preload
Afterload
Contractility
🗑
|
||||
| show | ratio of blood ejected to blood present in ventricle (N = 50-100%)
🗑
|
||||
| FRANK-STARLING LAW | show 🗑
|
||||
| show | Amount of blood expressed in liters or per minute.
Determined by heart rate and stroke volume.
“Heart rate X Stroke volume = CO
Normal 4-8 liters /minute.
🗑
|
||||
| DETERMINANTS OF CARDIAC OUTPUT | show 🗑
|
||||
| HEART RATE Chronotropic | show 🗑
|
||||
| PRELOAD | show 🗑
|
||||
| show | Resistance (load) to ejection (after) of blood from the ventricles (the amount of pressure the ventricles must push against).
Clinical indicators; systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR)
🗑
|
||||
| CONTRACTILITY Inotropic | show 🗑
|
||||
| show | Relationship between cardiac output and body surface area.
Decrease indicates heart failure.
Increase indicates decreased SVR, (common in sepsis).
Calculate by dividing CO into body surface area.
Normal; 2.5 – 4.0 liters/min.
🗑
|
||||
| CHF | show 🗑
|
||||
| show | Inability of the heart to pump enough blood to meet the body’s metabolic requirements leading to discrepancies between myocardial oxygen supply and demand.
🗑
|
||||
| show | Malfunction of the contractile properties of the heart leading to decrease CO.
Heart rate
Stroke volume
🗑
|
||||
| show | (decreased CO=^ HR = short diastolic filling time and ^myocardial O2 demand.
🗑
|
||||
| STROKE VOLUME Preload Volume of blood in ventricles at end of systole. Volume causes maximal stretch. | show 🗑
|
||||
| show | Primary: cardiomyopathies, CAD or valvular disorders.
Aortic stenosis; narrow valve = hypertrophy, non-compliant ventricle.
Aortic regurgitation: back flow of blood = hypertrophy.
Mitral regurgitation; pulmonary congestion = RV failure.
🗑
|
||||
| show | Cessation of cardiac drugs.
Dysrythmias – tachycardia, atrial dysrythmias.
Viral and/or bacterial infections
Environmental, emotional or physical stress
🗑
|
||||
| show | ineffective (R) ventricular contraction or total (R) sided failure, ie; PE, right-sided MI, or blood backing up into the left ventricle.
🗑
|
||||
| show | inability of the (L) ventricle to produce adequate SV = decreased CO. ie; (L) ventricular MI, HTN and/or valvular disease.
🗑
|
||||
| Systolic vs. diastolic failure | show 🗑
|
||||
| show | High-conditions that increase CO i.e.; fever, thyrotoxicosis
Low: insufficient ejection that results in inadequate CO.
🗑
|
||||
| show | inability of the ventricles to pump blood into the systemic and pulmonary circulation. (afterload)
🗑
|
||||
| show | Inadequacy of the ventricles to empty the blood into the arterial circulation.
🗑
|
||||
| Acute CHF | show 🗑
|
||||
| Chronic CHF | show 🗑
|
||||
| IMPROVE CONTRACTILITY Positive inotropic agents. | show 🗑
|
||||
| DECREASE Cardiac PRELOAD AND AFTERLOAD | show 🗑
|
||||
| Carvedilol (Coreg) | show 🗑
|
||||
| show | Reduces the possibility of sudden death in patients with LV dysfunction from AMI.
Effective in atrial fibrillatio
Anti-ischemic effects
Does not increase mortality
Half life – 40-50 days.
🗑
|
||||
| show | coronary artery disease (CAD), damage after a heart attack (which stems from coronary artery disease), high blood pressure, diabetes, obesity, heart valve disease, viruses, chemotherapy agents, chronic alcohol use and abuse, & drug abuse.
🗑
|
||||
| show | excess fluid accumulation that may occur in the lungs and symptoms associated with reduced cardiac output that worsens with exertion.
🗑
|
||||
| show | This is one of the earliest symptoms of heart failure. The patient gets winded and fatigued more quickly than before, just by doing regular daily activities or even lying in bed.
🗑
|
||||
| LEFT-SIDED HEART FAILURE | show 🗑
|
||||
| show | SWELLING IN FEET, ANKLES, LEGS, AND STOMACH
BLOATING, ASCITES
DEPRESSED APPETITE, ANOREXIA, NAUSEA, CONSTIPATION
WEIGHT GAIN OF > 2 POUNDS IN ONE NIGHT
LOSS OF MUSCLE MASS
🗑
|
||||
| CHF NONSPECIFIC FINDINGS | show 🗑
|
||||
| The normal pumping ability of our left ventricle is | show 🗑
|
||||
| show | A normal BNP level is about 98% accurate in ruling out the diagnosis.
🗑
|
||||
| show | Effective therapy reduces the backup of blood in the heart. The heart chambers get smaller, and as the muscle cells recover from being stretched, they produce less BNP
🗑
|
||||
| Right Heart Catheterization (RHC). | show 🗑
|
||||
| show | is performed to determine if you have coronary artery disease. A catheter is inserted in your right groin and guided to your heart. blockages in the coronary arteries are shown on x-ray.
🗑
|
||||
| Heart failure is usually a chronic condition that has taken years to develop and worsen. Treatment for heart failure is generally designed for three purposes: | show 🗑
|
||||
| CHF lifestyle changes | show 🗑
|
||||
| show | Salt substitutes vary in their composition, but their main ingredient is always potassium chloride.
🗑
|
||||
| Patient education specific to CHF that should be included: | show 🗑
|
||||
| Agonist | show 🗑
|
||||
| Antagonist | show 🗑
|
||||
| show | myocardial contraction (positive increases contraction, negative decreases contraction)
🗑
|
||||
| Chronotropic Action- | show 🗑
|
||||
| Alpha Receptors- | show 🗑
|
||||
| show | Beta 1- increases heart rate, cardiac contractility, conduction and irritability
Beta 2- vasodilation in skeletal and smooth cardiac muscle and bronchodilation
🗑
|
||||
| Dopaminergic Receptors | show 🗑
|
||||
| The diuretics most commonly used for heart failure are loop diuretics. These diuretics are usually taken by mouth on a long-term basis | show 🗑
|
||||
| Thiazide diuretics, which have milder effects and can lower blood pressure, may be prescribed particularly for people who also have high blood pressure | show 🗑
|
||||
| show | These drugs not only reduce symptoms and the need for hospitalization but also prolong life.
🗑
|
||||
| show | (which causes the heart to pump faster and more forcefully), these drugs produce long-term improvement in heart function and survival.
🗑
|
||||
| show | In people with heart failure due to diastolic dysfunction, beta-blockers are used to slow the heart rate and relax the stiff or thickened muscle allowing for complete filling.
🗑
|
||||
| Digoxin is the only oral inotrope available. It has been used to treat heart failure since the 1700's. However, modern science recommends the treatment of heart failure should now begin with the prescribing of | show 🗑
|
||||
| Digoxin does NOT reduce mortality rates, but it improves | show 🗑
|
||||
| Lacunar Infarction | show 🗑
|
||||
| Klippel-Trenaunay syndrome | show 🗑
|
||||
| “Tracheal tug” is palpable pull from midline with breathing | show 🗑
|
||||
| Digital clubbing | show 🗑
|
||||
| show | COPD
🗑
|
||||
| show | Blue Bloater due to obstruction-term not used today
🗑
|
||||
| Emphysema | show 🗑
|
||||
| Pulmonary Function Tests will determine severity of both obstructive and restrictive pulmonary dysfunction | show 🗑
|
||||
| COPD Treatment | show 🗑
|
||||
| show | only other drug therapy that is documented to alter natural history of COPD in pts with resting hypoxemia
Prolongs life and improves quality
🗑
|
||||
| Ipratropium bromide (Atrovent) | show 🗑
|
||||
| Tiotropium (Spiriva) | show 🗑
|
||||
| show | in COPD
🗑
|
||||
| Oxygen Criteria | show 🗑
|
||||
| Consider COPD, and perform spirometry, if any of these indicators are present in an individual over age 40. Spirometry is required to establish a diagnosis of COPD | show 🗑
|
||||
| show | the presence of a postbronchodilator FEV 1
/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD.
🗑
|
||||
| Classification of Severity of Airflow Limitation in COPD (Based on Post-Bronchodilator FEV1) Gold 1 | show 🗑
|
||||
| show | Moderate
50%≤FEV1< 80% predicted
🗑
|
||||
| show | severe
30% ≤ FEV1< 50% predicted
🗑
|
||||
| Classification of Severity of Airflow Limitation in COPD (Based on Post-Bronchodilator FEV 1)Gold 4 | show 🗑
|
||||
| FVC (Forced Vital Capacity): | show 🗑
|
||||
| FEV1 | show 🗑
|
||||
| FEV1/FVC: | show 🗑
|
||||
| Screening for Lung Cancer | show 🗑
|
||||
| Low dose helical (spiral) computed tomography (LDCT) evaluated in randomized clinical trial by NLST* | show 🗑
|
||||
| show | Squamous cell carcinoma (25-35%)
Adenocarcinoma (35-40%)
Large cell carcinoma (5-10%)
Small cell carcinoma (15-20%)
🗑
|
||||
| show | Early hematogenous spread
Agressive course
Untreated survival of 6-18 weeks
Not amenable to surgical resection
🗑
|
||||
| show | Includes other 3 types
Spread more slowly
Cure in early stages following resection
Respond similarly to chemotherapy
🗑
|
||||
| Squamous Cell Carcinoma | show 🗑
|
||||
| show | Probably arise from the goblet cells in the major bronchi.
Most often found in nonsmokers.
Bronchoalveolar cell carcinoma:
subset of adenocarcinoma
can mimic an infectious or inflammatory pneumonia.
🗑
|
||||
| Large-Cell Carcinoma | show 🗑
|
||||
| Horner’s Syndrome | show 🗑
|
||||
| Horner’s Syndrome Cause: | show 🗑
|
||||
| show | Physical description of neoplasm
T --size and location of primary tumor
N --presence and location of nodal metastases
M --presence or absence of distant metastases
🗑
|
||||
| show | Unexpected finding, usually incidental on chest radiograph
Referred to as a “coin lesion”
Isolated , round opacity,< 3 cm
No mediastinal adenopathy
No associated infiltrate or atelectasis
Important because carries significant chance of malignancy
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|
||||
| show | Peak incidence 3rd decade
Fatigue, fever, weight loss, anemia
Peripheral lymphadenopathy
May involve the thorax
Radiation and chemotherapy
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|
||||
| Non-Hodgkin’s | show 🗑
|
||||
| show | alveolitis or inflammation
fibrosis of interalveolar septum
🗑
|
||||
| show | 1 per 10,000 per year
Age 20-40
North American blacks
Women > men
Blacks have 3-4 times incidence of whites
Northern European whites
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|
||||
| show | Unknown
Granulomatous inflammation of lungs
Resolves in 2/3
15-20% lung damage
5% will die
🗑
|
||||
| Sarcoidosis Pathophysiology | show 🗑
|
||||
| Children with chronic illnesses in general are affected by a ________ number of common diseases. | show 🗑
|
||||
| show | How long have the symptoms been present?
🗑
|
||||
| The most common cause of progressive dementia is: | show 🗑
|
||||
| show | Idiopathic
🗑
|
||||
| Carbidopa is added to levodopa for which of the following reasons: | show 🗑
|
||||
| show | active vomiting and associated pancreatitis.
🗑
|
||||
| What should be the practitioner's initial goal in the treatment of anorexic clients? | show 🗑
|
||||
| Which of the two conditions anorexia nervosa and bulimia nervosa carry the poorest long-term psychiatric prognosis? | show 🗑
|
||||
| The regional distribution of body fat is helpful in determining risk for complications of obesity. Which of the following body shapes is associated with the highest risk: | show 🗑
|
||||
| A female patient presents with severe depressive symptoms that occur nearly monthly around her menstrual cycle. You suspect: | show 🗑
|
||||
| A person with chronic depressive symptoms of sadness, loss of interest, and withdrawal from activities over a period of 2 or more years with a relatively persistent course is MOST likely diagnosed with: | show 🗑
|
||||
| show | CT brain scan.
🗑
|
||||
| In the management of depressive disorders the plan always includes: | show 🗑
|
||||
| show |
Acute-sharp pain syndromes.
🗑
|
||||
| show | Bipolar Disorder
🗑
|
||||
| Symptoms of palpitations, tachycardia, chest pain, hot flashes, & chills in an otherwise healthy 21 year old is most consistent with the diagnosis of: | show 🗑
|
||||
| Which of the following statements concerning Panic Disorders is true? | show 🗑
|
||||
| show | Persistence of symptoms for a period of at least 2 weeks
🗑
|
||||
| Calcium channel blockers should be used with extreme caution to treat angina or hypertension in a patient with congestive heart failure for the following reason: | show 🗑
|
||||
| show | Stable patients with congestive heart failure should be treated with beta blockers unless there is a noncardiac contraindication.
🗑
|
||||
| Inhibition of what system is important in preventing progression of congestive heart failure? | show 🗑
|
||||
| show | Coronary artery disease.
🗑
|
||||
| show | Significant obstruction.
🗑
|
||||
| The decline in stroke incidence over the last four decades has been MAINLY attributed to the management of which of the following risk factors for stroke. | show 🗑
|
||||
| show | Thrombolytic therapy.
🗑
|
||||
| show | Defined as excessive secretion of bronchial mucous and productive cough 3 month or more in at least 2 consecutive years.
🗑
|
||||
| show | Augmentin 500 mg PO tid X 10 days.
🗑
|
||||
| show | Bronchodilators are not as effective in emphysema as in asthma.
🗑
|
||||
| One of the most common complications of an acute exacerbation of chronic bronchitis is: | show 🗑
|
||||
| show | FEV1/FVC ratio is < 70%.
🗑
|
||||
| Your 76 year old male patient is complaining of increased dyspnea at rest. You note his SaO2 is 86% while sitting in your office. You know that the only drug therapy that is documented to alter this patient's hypoxemia is: | show 🗑
|
||||
| Screening for lung cancer: | show 🗑
|
||||
| show | Small cell carcinoma
🗑
|
||||
| show | Watchful waiting with serial radiographs every 3 months for a year then every 6 months for a second year.
🗑
|
||||
| A benign neoplasm that is thought to be congenital and comprises about 5% of all lung neoplasms is: | show 🗑
|
||||
| show | sweating of the ipsilateral (same side) of the forehead
🗑
|
||||
| Hodgkin's disease typically: | show 🗑
|
||||
| show | Stage IV
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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To hide a column, click on the column name.
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You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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