3 Components of Asthma - Answer-Bronchoconstriction
Airway inflammation (wall thickening + secretions)
REVERSIBLE airflow limitation
.3 Steps in asthma Management - Answer-1. Evaluate asthma severity
2. Initiate treatment with stepwise approach
3. Assess control and adjust treatment as needed
.ABCD assessment tool - Answer-1. Spirometry confirmed diagnosis = FEV1/FVC <70
2. Airflow limitation = FEV1 predicted...
Gold 1 >80, Gold 2 50-80, Gold 3 30-50, Gold 4 <30
Exacerbation history 0-1/yr with no hospitalization = A & B
MRC 0-1 or CAT <10 = A
MRC >2 or CAT >10 = B
Exacerbation history >2 or >1 leading to hospital = C & D
MRC 0-1 or CAT <10 = C
MRC >2 or CAT >10 = D
.ABD - imaging - Answer-KUB - May detect some renal stones, look for stool in colon,
free air in perforation, dilated loops of bowel in obstruction
ABD ultrasound - look for gallstones, ovarian cysts or ectopic pregnancy,
hydronephrosis due to renal stone, high specificity for appendicitis but not as sensitive
as CT
CT - most sensitive test for diagnosing acute ABD pain. Useful for appendicitis,
abscesses, AAA, diverticulitis, bowel obstruction, tumors, renal CT for renal stones.
.ABD pain - Lab tests - Answer-CBC w/ diff - look for infection and blood loss
CMP - hydration status with BUN, Cr, electrolytes, check LFT's for hepatitis or biliary
disease
Amylase/Lipase - elevated in pancreatitis
UA - nitrates, leukocytes, RBS's, WBC's, may indicate UTI
Stool for occult blood - cancer, IBD, diverticulitis, PUD
Pregnancy test on alllllll childbearing age
.ABD pain assessment - Answer-Look: distension, surgical scars, visable peristalsis,
pulsations, engorged veins, skin tugor, hernias
Listen: bowel sounds, renal aortic bruits
Feel: palpate painful areas last, distract patient, assess size of spleen/liver, rigidity,
masses, pulsations, rebound tenderness
Percuss: ascites, CVA tenderness, hepatospleenomegaly
,.ABD pain special exams - Answer-Rectal exam on most patients with abd pain, check
for stool in vault, guiac stool or occult blood
GYN exam on females of reproductive age, pregnancy, ovarian cysts, dysmenorrhea,
endometriosis, and PID all present with abdominal pain
Testicular exam on males: hernia, testicular torsion can have pain in lower abdomen
radiating to the groin
.Abdominal pain - Answer-One of most frequent complaints in primary care
Most patients have minor non-surgical causes
.Acute Bacterial Rhinosinusistis: Common pathogens - Answer-Strep pneumoniae
H influenzae
M Catarrhalis
B hemolytic strep
.Acute Bacterial Rhinosinusistis: Course - Answer-Onset may be gradual or sudden.
Lasts <30 days and symptoms resolve completely
.Acute Bacterial Rhinosinusistis: diagnosis - Answer-Should not be made until
symptoms last longer than 10 days without improvement or worsening of symptoms
within 10 days after initial improvement.
If patient presents with focal signs such as periorbital edema, severe sinus tenderness,
or severe headache - DO NOT wait 10 days to treat with antibioitics.
Routine sinus xrays are not recommended.
.Acute Bacterial Rhinosinusistis: symptoms - Answer-nasal congestion, purulent nasal
discharge, facial pain/pressure, cough, headache, fever
.Acute Bacterial Rhinosinusistis: Treatment - Answer-Pediatrics: Mild symptoms first line
Amoxicillin or Augmentin. Non type 1 PCN allergy = cephalosporin. Poor response after
3 or more days second line ABX. Severe symptoms = Beta lactamase stable abx.
Adults: Younger than 65, first line augmentin 500/125 or 800/125 x5-7d. (5-10). With
severe symptoms high dose augmentin 200/125 BID 7-10d.
Type I PCN allergy or hepatic imparment = doxycycline or clindamycin
.Acute Bacterial Rhinosinusistis: Treatment cont. - Answer-All patients should receive
pain/ fever control
Short term (<3d) nasal decongestants may help symptoms
OTC nasal decongestants and cough/cold preps- not recommended for children <4,
cautiously in older children, okay in adults for symptomatic relief.
Intranasal corticosteroid sprays
.Acute Cystitis - Definition - Answer-Infection of the bladder commonly due to coliform
bacteria (e coli) and gram positive (enterococci)
.Acute cystitis signs - Answer-UA - pyuria, bacteriuria, hematuria
,.Acute cystitis symtoms - Answer-irritative voiding
suprapubic discomfort
hematuria
.Acute cystitis treatment - Answer-Uncomplicated in women: cephalexin, nitrofurantoin,
trimethoprim-sulfamethaxazole
Restrictive use of fluoroquinolone
Refer if - radiographic abnormality evidence of urolithiasis or recurrent cystitis due to
bacterial persistence.
.Acute Otitis Media (AOM) - Answer-Acute infection of the middle ear space with
inflammation and effusion
.Acute Postinfectious Glomerulonephritis - Answer-May follow recent group A B-
hemolytic strep infection (pharyngitis or impetigo)
.Acute pyelonephritis - definition - Answer-Infectious inflammatory disease of the kidney
parenchyma and renal pelvis.
Gram negative bacterial most causative agents - e coli, proteus, klebsiella,
enterobacter, pseudomonas
.Acute pyelonephritis - signs - Answer-CBC- leukocytosis and a left shift
UA - pyuria, bacteriuria, hematuria
White cell casts
Renal ultrasound may show hydronephrosis
differentials include acute cystitis or a lower urinary source
.Acute pyelonephritis - symptoms - Answer-fever, flank pain, shaking chills, irritative
voiding symptoms
.Acute pyelonephritis - treatment - Answer-Outpatient setting empiric therapy -
ampcilillin, ciprofloxacin, levofloxacin, trimethoprim-sulfamethaxazole
CT or Ultrasound
Catheter or nephrostomy drain
refer - complications, urolithiasis, obstruction
Admit for parenteral antibiotics, complicating factors, sepsis
.Acute Viral rhinitis - Answer-Most common pediatric infectious disease.
Known as the common cold.
Sudden onset of clear or mucoid rhinorrhea, nasal congestion, and fever. May also
have sore throat and cough with erythematous nose, throat, and TM.
.Acute/abortive treatment of headaches in children - Answer-Simple OTC analgesics
mainstay, limit to 2-3 days/week
Almotriptan - 12-17
, Rizaatriptan - 6-17
Migraine specific meds limit to 1-2 days/week
Biobehavioral techniques (rest, relax, cold/hot packs) Cool dark room.
.Alarm sign in dyspepsia - Answer-ANEMIA
.Albumin - Answer-Use: eval edema, liver disease, suspected malnutrition
Increased - most common cause is dehydration
Decreased - malnutrition, liver disorder, chronic diseases, burns, nephrotic sundrome or
chronic renal failure
.Alkaline Phosphatase (ALP) - Answer-Use: Detect biliary obstruction, assess response
to vit D tx of rickets, detect paget's and the like
Increase - commonly with obstructed bile ducts (conjugated or direct bili also goes up),
new bone formation as in with children or paget disease
.Allergic rhinistis: Treatement - Answer-Avoidance of triggers, nasal irrigation, non
sedating antihistamines, intranasal corticosteroids, mast cell stabilizers, montelukast.
.Allergic rhinitis: "the triad" - Answer-Allergic rhinitis is accompanied by asthma and
eczema, esp. in redheads.
.Allergic Rhinitis: Diagnosis - Answer-PE: nasal turbinates are pale, boggy, and swollen.
Can sometimes be red, clear nasal secretions.
Conjunctival injection, tearing, periorbital edema.
Enlarged tonsils.
.Allergic rhinitis: Symptoms - Answer-Sneezing, rubbing of the nose, allergic shiners,
clear nasal drainage, Eye symptoms such as tearing and redness.
.Aminotransferases (AST and ALT) - Answer-Diagnosing and monitoring liver disease,
screening for pts on meds that can cause liver damage
ALT specific to liver, AST also for cardia & Skeletal injury
BOTH elevated hepatic problems likely and ALT higher, except in alcoholic hepatitis
AST higher
Decreased in advanced cirrhosis or hepatitis
.Amylase - Answer-Use: diagnose acute pancreatitis, diff d abd pain, evaluate
pancreatic injury from trauma/surgery, r/o pancreatic damage form peptic ulcer perf
Increased in pancreatitis, chronic renal failure, rare benign condition called
macroamylasemia
Decreased - usually insignificant, chronic pancreatitis, pancreatic cancer, liver disease,
toxemia of pregnancy
.Antipyretic - Answer-Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours)
Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day)
Airway inflammation (wall thickening + secretions)
REVERSIBLE airflow limitation
.3 Steps in asthma Management - Answer-1. Evaluate asthma severity
2. Initiate treatment with stepwise approach
3. Assess control and adjust treatment as needed
.ABCD assessment tool - Answer-1. Spirometry confirmed diagnosis = FEV1/FVC <70
2. Airflow limitation = FEV1 predicted...
Gold 1 >80, Gold 2 50-80, Gold 3 30-50, Gold 4 <30
Exacerbation history 0-1/yr with no hospitalization = A & B
MRC 0-1 or CAT <10 = A
MRC >2 or CAT >10 = B
Exacerbation history >2 or >1 leading to hospital = C & D
MRC 0-1 or CAT <10 = C
MRC >2 or CAT >10 = D
.ABD - imaging - Answer-KUB - May detect some renal stones, look for stool in colon,
free air in perforation, dilated loops of bowel in obstruction
ABD ultrasound - look for gallstones, ovarian cysts or ectopic pregnancy,
hydronephrosis due to renal stone, high specificity for appendicitis but not as sensitive
as CT
CT - most sensitive test for diagnosing acute ABD pain. Useful for appendicitis,
abscesses, AAA, diverticulitis, bowel obstruction, tumors, renal CT for renal stones.
.ABD pain - Lab tests - Answer-CBC w/ diff - look for infection and blood loss
CMP - hydration status with BUN, Cr, electrolytes, check LFT's for hepatitis or biliary
disease
Amylase/Lipase - elevated in pancreatitis
UA - nitrates, leukocytes, RBS's, WBC's, may indicate UTI
Stool for occult blood - cancer, IBD, diverticulitis, PUD
Pregnancy test on alllllll childbearing age
.ABD pain assessment - Answer-Look: distension, surgical scars, visable peristalsis,
pulsations, engorged veins, skin tugor, hernias
Listen: bowel sounds, renal aortic bruits
Feel: palpate painful areas last, distract patient, assess size of spleen/liver, rigidity,
masses, pulsations, rebound tenderness
Percuss: ascites, CVA tenderness, hepatospleenomegaly
,.ABD pain special exams - Answer-Rectal exam on most patients with abd pain, check
for stool in vault, guiac stool or occult blood
GYN exam on females of reproductive age, pregnancy, ovarian cysts, dysmenorrhea,
endometriosis, and PID all present with abdominal pain
Testicular exam on males: hernia, testicular torsion can have pain in lower abdomen
radiating to the groin
.Abdominal pain - Answer-One of most frequent complaints in primary care
Most patients have minor non-surgical causes
.Acute Bacterial Rhinosinusistis: Common pathogens - Answer-Strep pneumoniae
H influenzae
M Catarrhalis
B hemolytic strep
.Acute Bacterial Rhinosinusistis: Course - Answer-Onset may be gradual or sudden.
Lasts <30 days and symptoms resolve completely
.Acute Bacterial Rhinosinusistis: diagnosis - Answer-Should not be made until
symptoms last longer than 10 days without improvement or worsening of symptoms
within 10 days after initial improvement.
If patient presents with focal signs such as periorbital edema, severe sinus tenderness,
or severe headache - DO NOT wait 10 days to treat with antibioitics.
Routine sinus xrays are not recommended.
.Acute Bacterial Rhinosinusistis: symptoms - Answer-nasal congestion, purulent nasal
discharge, facial pain/pressure, cough, headache, fever
.Acute Bacterial Rhinosinusistis: Treatment - Answer-Pediatrics: Mild symptoms first line
Amoxicillin or Augmentin. Non type 1 PCN allergy = cephalosporin. Poor response after
3 or more days second line ABX. Severe symptoms = Beta lactamase stable abx.
Adults: Younger than 65, first line augmentin 500/125 or 800/125 x5-7d. (5-10). With
severe symptoms high dose augmentin 200/125 BID 7-10d.
Type I PCN allergy or hepatic imparment = doxycycline or clindamycin
.Acute Bacterial Rhinosinusistis: Treatment cont. - Answer-All patients should receive
pain/ fever control
Short term (<3d) nasal decongestants may help symptoms
OTC nasal decongestants and cough/cold preps- not recommended for children <4,
cautiously in older children, okay in adults for symptomatic relief.
Intranasal corticosteroid sprays
.Acute Cystitis - Definition - Answer-Infection of the bladder commonly due to coliform
bacteria (e coli) and gram positive (enterococci)
.Acute cystitis signs - Answer-UA - pyuria, bacteriuria, hematuria
,.Acute cystitis symtoms - Answer-irritative voiding
suprapubic discomfort
hematuria
.Acute cystitis treatment - Answer-Uncomplicated in women: cephalexin, nitrofurantoin,
trimethoprim-sulfamethaxazole
Restrictive use of fluoroquinolone
Refer if - radiographic abnormality evidence of urolithiasis or recurrent cystitis due to
bacterial persistence.
.Acute Otitis Media (AOM) - Answer-Acute infection of the middle ear space with
inflammation and effusion
.Acute Postinfectious Glomerulonephritis - Answer-May follow recent group A B-
hemolytic strep infection (pharyngitis or impetigo)
.Acute pyelonephritis - definition - Answer-Infectious inflammatory disease of the kidney
parenchyma and renal pelvis.
Gram negative bacterial most causative agents - e coli, proteus, klebsiella,
enterobacter, pseudomonas
.Acute pyelonephritis - signs - Answer-CBC- leukocytosis and a left shift
UA - pyuria, bacteriuria, hematuria
White cell casts
Renal ultrasound may show hydronephrosis
differentials include acute cystitis or a lower urinary source
.Acute pyelonephritis - symptoms - Answer-fever, flank pain, shaking chills, irritative
voiding symptoms
.Acute pyelonephritis - treatment - Answer-Outpatient setting empiric therapy -
ampcilillin, ciprofloxacin, levofloxacin, trimethoprim-sulfamethaxazole
CT or Ultrasound
Catheter or nephrostomy drain
refer - complications, urolithiasis, obstruction
Admit for parenteral antibiotics, complicating factors, sepsis
.Acute Viral rhinitis - Answer-Most common pediatric infectious disease.
Known as the common cold.
Sudden onset of clear or mucoid rhinorrhea, nasal congestion, and fever. May also
have sore throat and cough with erythematous nose, throat, and TM.
.Acute/abortive treatment of headaches in children - Answer-Simple OTC analgesics
mainstay, limit to 2-3 days/week
Almotriptan - 12-17
, Rizaatriptan - 6-17
Migraine specific meds limit to 1-2 days/week
Biobehavioral techniques (rest, relax, cold/hot packs) Cool dark room.
.Alarm sign in dyspepsia - Answer-ANEMIA
.Albumin - Answer-Use: eval edema, liver disease, suspected malnutrition
Increased - most common cause is dehydration
Decreased - malnutrition, liver disorder, chronic diseases, burns, nephrotic sundrome or
chronic renal failure
.Alkaline Phosphatase (ALP) - Answer-Use: Detect biliary obstruction, assess response
to vit D tx of rickets, detect paget's and the like
Increase - commonly with obstructed bile ducts (conjugated or direct bili also goes up),
new bone formation as in with children or paget disease
.Allergic rhinistis: Treatement - Answer-Avoidance of triggers, nasal irrigation, non
sedating antihistamines, intranasal corticosteroids, mast cell stabilizers, montelukast.
.Allergic rhinitis: "the triad" - Answer-Allergic rhinitis is accompanied by asthma and
eczema, esp. in redheads.
.Allergic Rhinitis: Diagnosis - Answer-PE: nasal turbinates are pale, boggy, and swollen.
Can sometimes be red, clear nasal secretions.
Conjunctival injection, tearing, periorbital edema.
Enlarged tonsils.
.Allergic rhinitis: Symptoms - Answer-Sneezing, rubbing of the nose, allergic shiners,
clear nasal drainage, Eye symptoms such as tearing and redness.
.Aminotransferases (AST and ALT) - Answer-Diagnosing and monitoring liver disease,
screening for pts on meds that can cause liver damage
ALT specific to liver, AST also for cardia & Skeletal injury
BOTH elevated hepatic problems likely and ALT higher, except in alcoholic hepatitis
AST higher
Decreased in advanced cirrhosis or hepatitis
.Amylase - Answer-Use: diagnose acute pancreatitis, diff d abd pain, evaluate
pancreatic injury from trauma/surgery, r/o pancreatic damage form peptic ulcer perf
Increased in pancreatitis, chronic renal failure, rare benign condition called
macroamylasemia
Decreased - usually insignificant, chronic pancreatitis, pancreatic cancer, liver disease,
toxemia of pregnancy
.Antipyretic - Answer-Acetaminophen: 10-15mg/kg Q 4-6 Hrs (Max 5 doses in 24 hours)
Ibuprofen: 5-10mg/kg Q 6-8hrs (max 40mg/kg/day)
