Final Exam: NR511 / NR 511 Differential Diagnosis and Primary Care Final Exam Review () | Already Rated A |Questions and Verified Answers | Chamberlain

Final Exam: NR511 / NR 511 Differential Diagnosis and Primary Care Final Exam Review () | Already Rated A |Questions and Verified Answers | Chamberlain Q: Discuss an appropriate treatment for prophylaxis or treatment of traveler's diarrhea Answer: -empirical antimicrobial therapy: Trimethoprim-sulfamethoxazole (Bactrim) 1 PO BID ×3d -ciprofloxacin (Cipro) 500 mg -norfloxacin (Noroxin) 400 mg -ofloxacin (Floxin) 300 mg Q: Identify at least one effective treatment for Irritable Bowel Syndrome (IBS) Answer: - For IBS - C o Psyllium (fiber) o docusate (softner) o bisacodyl/senna (stimulant/irritant) o loperamide (antidiarrheal) For IBS - D o dicyclomine (bentyl), hycosamine sulfate (Levsin) phenobarb/hycosamine (donnatal) anticholenergics - decrease motility of smooth muscle tone/decrease cramping, relaxes muscles in stomach/intestines o Linzess (linaclotide), Trulance (plecanatide), and Amitiza (lubiprostone): drugs work by acting locally on the apical membrane of the GI tract to increase intestinal fluid secretion and improve fecal transit Antidepressants for depression/anxiety component Q: Identify at least one prescription medication for the treatment of chronic constipation Answer: Linzess (linaclotide), Trulance (plecanatide), and Amitiza (lubiprostone): drugs work by acting locally on the apical membrane of the GI tract to increase intestinal fluid secretion and improve fecal transit - Movtantik (naloxegol) and Relistor (methylnaltrexone) for Opioid induced Miralax is a gentle but effective laxative that is safe for long-term use - OTC Q: Discuss at least one treatment for Meniere's disease Answer: Low salt diet and a diuretic pill Anti-vertigo medications Intratympanic injection with dex or gentamicin Air pressure pulse generator Surgery Q: Discuss that the majority of dyspnea complaints are due to cardiac or pulmonary decompensation Answer: -2/3 of symptomatic patients the etiology is due to cardiopulmonary disease -1/3 of all cases the cause of dyspnea is multifactorial -Common cardiopulmonary conditions: Q: Explain the differences between intra-thorax and extra-thorax flow disorders Answer: Flow Disorders -Intrathorax -Obstruction of distal/smaller airway -Extrathorax -Obstruction of proximal/larger airway Q: Identify at least three examples of flow disorders (intra and/or extra thorax) Answer: Intrathorax flow disorders: originate from obstruction of distal/smaller airways -asthma -bronchiolitis -vascular ring -solid foreign body aspiration -lymph node enlargement pressure -These types of disorders cause expiratory effort in infants and also in children less than 5 years of age (bronchiolitis) -Extrathorax flow disorders: originate from obstruction of the larger airways -rhinitis with nasal obstruction, nasal polyp -cranio-facial malformation -obstructive sleep apnea -tonsil-adenoid hypertrophy -laryngo-tracheo-malacia -larynx papilloma -Diphtheria -croup, epiglottitis -thymus hypertrophy -Infants or children ages 5 and younger are affected, and they have clinical findings of inspiratory stridor Q: Identify at least three examples of volume disorders (intra and/or extra thorax) Answer: -Intrathorax volume disorders include lung parenchyma disorders -pneumonia (infection, aspiration) -atelectasis -pulmonary edema -near drowning -These disorders affect inspiratory effort -Extrapulmonary volume disorders -pneumothorax, pneumomediastinum -cardiomegaly, heart failure (perfusion) -pleural effusion (including empyema, hematothorax) -hernia diaphragmatica -diaphragmatica eventration -intra-thorax mass (nonpulmonary) -chest trauma (rib fracture, lung contusion) -thorax deformity (pectus excavatum, scoliosis) -These disorders also affect inspiratory effort -Extrathorax volume disorders due to lung compliance issues -neuromuscular disorders (CP, GBS, MG) -gastritis, peptic ulcer -extreme obesity -peritonitis, appendicitis, acute abdomen -aerophagia, meteorismus -ascites -hepato-splenomegaly -abdominal solid tumor -These disorders cause inspiratory constraint -Extrathorax volume disorders that are due to respiratory center disorders -anemia -metabolic acidosis -CNS infections: meningitis, encephalitis -encephalopathy (typhoid, DHF, metabolic) -psychologic (anxiety, usually adolescent) -poisoning (salycylate, alcohol) -trauma capitis -CNS disease sequelae -These disorders cause deep rapid breathing Q: Discuss diagnosis for asthma Answer: Essential elements to consider- HX- cough (especially nocturnal), recurrent wheeze, recurrent episodic dyspnea, recurrent chest tightness Symptoms worsen in relation to specific factors- changes in weather, exercise, environmental allergens, GERD, Beta blockers, sensitivity to ASA, strong emotional expression To establish the diagnosis of asthma, episodic symptoms of airflow obstruction must be present, airflow obstruction must be at least partially reversible, and must rule out other diagnoses. Spirometry measurements are helpful in diagnosis & in evaluation of management The diagnosis is made by demonstrating the reversibility of the airway obstruction from the pre- and post- PFTs. Reversibility is defined as a 15% or greater increase in the FEV1 after 2 puffs of a beta-adrenergic agonist have been inhaled. When spirometry is non-diagnostic, bronchial provocation testing maybe useful with histamine, methacholine, or exercise. Q: Discuss risk factors and for asthma Answer: Risk Factors Family or personal history- allergic rhinitis, eczema/atopic diseases Residing in urban area Exposure to smoke or air pollution Cockroaches and dust Viral respiratory infections Cold air intolerance obesity Q: Discuss diagnosis treatments for asthma Answer: *Short acting bronchodilator (albuterol) is a mainstay of treatment for ALL asthma patients Intermittent---Short-acting bronchodilator (albuterol): for exacerbations (inhaled or nebulized) Mild Persistent--Short acting bronchodilator + Preferred tx- Low-dose inhaled corticosteroids (fluticasone/Flovent, budesonide/Pulmicort, mometasone/asmanex Moderate Persistent--Short acting bronchodilator + Preferred tx- low to medium dose inhaled corticosteroid AND Long acting inhaled bronchodilator (salmeterol/serevent, formoterol/Foradil) Alternative tx-low to med dose inh. Corticosteroid AND Either leukotriene blocker (Montelukast/singulair) OR theophylline Severe Persistent--Short acting bronchodilator + High dose inhaled corticosteroids AND Long acting inhaled bronchodilator AND If needed, oral corticosteroids (2mg/kg/day, 60mg/day max) Q: Classifications of asthma severity Answer: Mild Intermittent Symptoms 2 days per week OR 2 nights per month. Exacerbations brief Mild Persistent Symptoms 2 times per week, but not daily; OR 3-4 times per month at nighttime Moderate Persistent Daily symptoms OR 1 night per week but not nightly Severe persistent Symptoms throughout the day; often 7 nights per week Q: Describe appropriate tests in the work up for dyspnea Answer: -CXR: rule out tumors, TB, pneumonia, and other major pulmonary disorders -CBC with differential: rule out anemia and infection -Peak expiratory flow test (in office): to determine the degree of expiratory airflow obstruction in patients with asthma and COPD -EKG, Echo -Spirometry: to determine obstructive, restrictive and mixed lung disease Q: Discuss clinical findings and PFTs for asthma Answer: o Subjective: c/o breathlessness, unable to talk, short sentences, profuse sweating, c/o air hunger. In patients who are severely obstructed, there may be no wheezing and only cough may be present. Wheezing, persistent and recurrent cough, difficulty breathing, tightness in chest, endurance problems during exercise. Symptoms are usually worse at night. o Objective: Nasal discharge, mucosal swelling, frontal tenderness, nasal polyps, and allergic "shiners" (dark discoloration beneath both eyes). Allergic rhinitis and eczema often accompany the dx of asthma. - Asthma PFTs o Mild intermittent asthma- FEV1: 80%, PFT 20% o Mild persistent asthma- FEV1: 80%, PFT 20%-30% o Moderate persistent asthma- FEV1: 60%-80%, PFT 30% o Severe persistent asthma- 60%, PFT 30% Q: Discuss clinical findings and PFTs for chronic bronchitis, emphysema, and COPD Answer: