symptoms, anorexia
-distaste for smoking may occur early
-Nausea and vomiting are frequent and constipation\/diarrhea may occur
-Low grade fever
-Defervescence and fall in pulse rate coincide with onset of jaundice
-Abdmoinal pain mild\/constant in RUQ or epigastrium — aggravated by jarring\/exer- tion
-Jaundice occurs 5-10 after initial symptoms<\/li>\n<\/ul>\n\n\n\n
QUESTION
Hepatitis A: Signs and Symptoms with jaundice
Answer:
-Prodromal symptoms worsen followed by progressive clinical improvement
-stools may be acholic
-hepatomegaly
-splenomegaly
-soft, enlarged lump nodes- esp. cervical & epitrochlear
QUESTION
Hepatitis A: Acute illness timeframe
Answer:
-Subsides over 2-3 with complete clinical and laboratory recovery by 9 weeks
-May have 1-2 relapses
-Can be complicated by acute cholecystitis
QUESTION
Hepatitis B
Answer:
-Transmitted by inoculation of infected blood or blood products or by sexual contact
-Present in saliva, semen, vaginal secretions
-can be transmitted during delivery
QUESTION
Hepatitis B: Incubation period
Answer:
-6 weeks to 6 months
-Average 12-14 weeks
QUESTION
Hepatitis B: signs and symptoms<\/p>\n\n\n\n
Answer:
-ranges from asymptotic without jaundice to acute liver failure and death
-onset may be abrupt or insidious
-Low grade fever
-fall of pulse with onset of jaundice
-Acute illness subsides over 2-3 weeks with complete clinical\/laboratory recovery by
16 weeks
-May become chronic
QUESTION
Acute Cholelithiasis (Gallstones)
Answer:
-more common in women
-over age 60
-classified according to chemical composition as cholesterol or calcium bilirubinate stones
QUESTION
Acute Cholelithiasis: Signs and Symptoms (asymptomatic)
Answer:<\/p>\n\n\n\n
- \n
- Asympto- matic, normal lab feature, no treatment
QUESTION
Acute Cholelithiasis: Signs and Symptoms (symptomatic gallstones)
Answer:
-Bil- iary pain, normal lab features, dx via US, tx with laparoscopic cholecystectomy
QUESTION
Acute Cholelithiasis: Signs and Symptoms (cholesterolosis of gallblad- der)
Answer:
Powered by https:\/\/learnexams.com\/search\/study?query=<\/a><\/li>\n<\/ul>\n\n\n\n![\"exam-3-nsg554-nsg-554-new-2023-2024-nurse-practitioners-in-primary-care-i-exam-review-100-correct-complete-guide-with-verified-answers\"](\"https:\/\/learnexams.com\/blog\/wp-content\/uploads\/2023\/12\/exam-3-nsg554-nsg-554-new-2023-2024-nurse-practitioners-in-primary-care-i-exam-review-100-correct-complete-guide-with-verified-answers-725x1024.png\")
<\/a><\/figure>\n\n\n\nSigns and symptoms of a MI
-substernal chest pain or discomfort that radiates to the jaw, left shoulder or arm
-Dyspnea, nausea, diaphoresis, syncope<\/p>\n\n\n\nDiagnostics to confirm MI
-Cardiac myocyte necrosis (myoglobin, CK-MB and troponin I and T)
-without ST-elevation, abnormal CK-MB or troponin=MI
-ECG changes (new Q waves, ST elevation\/depression, T-wave flattening\/inversion<\/p>\n\n\n\nGouty arthritis
Sudden onset and frequently nocturnal
Common precipitants are alcohol (beer)<\/p>\n\n\n\nGouty arthritis diagnostics
-Serial measurements of serum uric acid
-Increased WBC
Sodium urate crystals in joint fluid aspirated from tophus
-xray later in dx=punched-out erosions with an overhanging rim of cortical bone develop “rat bite” adjacent to soft tissue tophus
-Smaller tophi imaged by US<\/p>\n\n\n\nAcute gout tx<\/p>\n\n\n\n
- \n
- NSAIDS- full dose of naproxen 500 mg BID or indomethacin 25-50 mg Q8 until symptoms resolve (contraindicated in PUD, decreased kidney function)<\/li>\n\n\n\n
- Colchicine-Good if duration of attach is less than 36 hours<\/li>\n<\/ol>\n\n\n\n
-Loading dose=1.2mg then 0.6 mg 1 hour later for prophylaxis<\/p>\n\n\n\n
-0.6mg BID<\/p>\n\n\n\n
- \n
- Corticosteroids- IV or PO, 5-10 days with taper<\/li>\n\n\n\n
- Interleukin-1 inhibitors- anakinram canakinumab, and rilonacept not FDA approved<\/li>\n<\/ol>\n\n\n\n
Rheumatoid arthritis: Signs and Symptoms-
Joints
-joint symptoms: symmetric swelling of multiple joints with tenderness and pain<\/p>\n\n\n\n-stiffness longer than 30 mins in the morning<\/p>\n\n\n\n
-may reoccur after daytime inactivity or be more severe after strenuous activity<\/p>\n\n\n\n
-fingers, wrists, knees, ankles, MTP joints<\/p>\n\n\n\n
Rheumatoid arthritis: Signs and Symptoms-
Rheumatoid nodules<\/p>\n\n\n\n- \n
- subcutaneous nodules most common over bony prominences
-can also occur in the bursae and tendon sheaths
-lungs, sclerae, other tissue<\/li>\n<\/ul>\n\n\n\nRheumatoid arthritis: Signs and Symptoms-Ocular symptoms
-dryness of eyes, mouth, mucus membranes especially in advanced disease
-episcleritits, scleritis, scleromalacia d\/t nodule<\/p>\n\n\n\nRheumatoid arthritis: Signs and Symptoms-
Other symptoms
-interstitial lung disease
-pericarditits
-pleural disease
-palmar erythema
-felty syndrome=splenomegaly, neutropenia<\/p>\n\n\n\nRheumatoid arthritis: lab tests
-Anti-CCP antibodies= most specific
-rheumatoid factor (IgM)= can occur in other autoimmune disease
-ESR and CRP usually elevated based on disease activity<\/p>\n\n\n\nRheumatoid arthritis: imaging
-radiographic changes most specific
-1st 6 months of symptoms usually normal<\/p>\n\n\n\nRheumatoid arthritis: treatment categories
-Corticosteroids<\/p>\n\n\n\n-DMARDs:<\/p>\n\n\n\n
-Synthetic<\/p>\n\n\n\n
-Biologic DMARDs<\/p>\n\n\n\n
-Combination DMARDs<\/p>\n\n\n\n
RA: tx corticosteriods
-low-dose for anti-inflammatory (5-7.5 mg)
-“bridge” to reduce disease activity<\/p>\n\n\n\nRA: tx DMARDs Synthetic (Methotrexate)
Methotrexate: usually initial med, well tolerated, effects in 2-6 weeks<\/p>\n\n\n\n-7.5-10 mg PO weekly<\/p>\n\n\n\n
-increase if not response X 1 month<\/p>\n\n\n\n
-SE: gastric irritation\/stomatitis<\/p>\n\n\n\n
-Rare: cytopenia, hepatoxicity (decrease ETOH)<\/p>\n\n\n\n
-Monitor LFTs every 12 weeks with a CBC<\/p>\n\n\n\n
-SE can be reduced with daily folate or weekly leucovorin calcium<\/p>\n\n\n\n
-teratogenic<\/p>\n\n\n\n
RA: tx DMARDs Synthetic (Sulfasalazine)
Sulfasalazine: 2nd line agent, taper to 3g from 0.5g<\/p>\n\n\n\nSE: neutropenia, thrombocytopenia<\/p>\n\n\n\n
-hemolysis in patients with G6PD def so level should be checked before starting<\/p>\n\n\n\n
-CBC every 2-4 weeks for the first 3 months then every 3 months<\/p>\n\n\n\n
RA: tx DMARDs Synthetic (Leflunomide)
Leflunomide: Pyrimidine synthesis inhibitor, single daily dose of 20 mg<\/p>\n\n\n\n-SE: diarrhea, rash, reversible alopecia, hepatotoxicity<\/p>\n\n\n\n
-teratogenic, 1\/2 life 2 weeks<\/p>\n\n\n\n
RA: tx DMARDs Synthetic (Antimalarials)
Antimalarials: Hydroxychloroquine for mild dx, may be used in combination with other DMARDs<\/p>\n\n\n\n-need ophthalmologic exemptions every 12 months<\/p>\n\n\n\n
Janus Kinase Inhibitors tofacitinib or baricitinib for severe RA that is refractory of methotrexate<\/p>\n\n\n\n
RA: Biologic DMARDs- Tumor Necrosis Factor Inhibitors
-pro-inflammtory cytokine added to patients who have no responded adequately to methotrexate or as initial therapy with methotrexate for patients with poor prognosis
-increased risk of bacterial infections, granulomatous infections, reactivate of TB (screening is mandatory prior to starting)
*abatacept, rituximab, tocilizumab<\/p>\n\n\n\nRA: Combination DMARDs
most common used combination= methotrexate with a TNF inhibitor
or methotrexate, sulfasalazine and hydroxychloroquine<\/p>\n\n\n\nSystemic Lupus Erythematosus: Systemic S&S
-fever, malaise, anorexia, weight loss, “butterfly” rash, panniculitis (lupus profundus), alopecia, Raynaud phenomenon<\/p>\n\n\n\nSystemic Lupus Erythematosus: Joint S&S
with or without active synovitis as an early manifestation<\/p>\n\n\n\nSystemic Lupus Erythematosus: Ocular S&S
conjunctivitis, photophobia, transient or permanent monocular blindness, blurring vision
cotton-wool spots on the retina<\/p>\n\n\n\nSystemic Lupus Erythematous: Other
pleurisy, pleural effusion, cardiac arrhythmias, hematologic, neurologic complications<\/p>\n\n\n\nOsteoarthritis (DJD)
-most common joint dx
-increases with age
-characterized by degeneration of cartilage and by hypertrophy of the bone at the articular margins
-inflammation is minimal
-heredity and mechanical factors involved in pathogenesis
-Risk factors: obesity, recreational running, competitive contact sports, bending\/carrying objects frequently<\/p>\n\n\n\nOsteoarthritis medication: NSAIDs
-NSAIDs; celecoxib only selective cox-2 inhibitor
-SE: GI toxicity, renal, increased bleeding time<\/p>\n\n\n\nOsteoarthritis medication: Topical therapies
-topical NSAIDs
-knee and hand
-lower rates of systemic SE than oral
-early treatment with mild OA especially hand\/knee<\/p>\n\n\n\nOsteoarthritis medication: Acetaminophen
-mild OA
-not 1st line for hip\/knee<\/p>\n\n\n\nOsteoarthritis medication: Intrarticular injections
-moderate\/severe knee who do not respond to NSAIDs
-corticosteroid, hyalurate or platelet rich plasma
-not for LT pain or increasing function
-not for OA of hand<\/p>\n\n\n\nDiagnostic tests for carpal tunnel: Tinel sign
tingling or shock like pain on solar wrist percussion<\/p>\n\n\n\nDiagnostic tests for carpal tunnel: Phalen sign
pain or paresthesia in distribution of median nerve when patient flexes both wrists to 90 degrees for 60 seconds<\/p>\n\n\n\nDiagnostic tests for carpal tunnel: Carpal compression test
-numbness\/tingling induced by direct application of pressure over the carpal tunnel
-may be more sensitive and specific
-muscle weakness or atrophy especially of the thenar eminence can appear later than sensory disturbances<\/p>\n\n\n\nOlecranon bursitis
-bursitis presents with focal tenderness and swelling and is less likely to affect range of motion of the adjacent joint
-olecranon causes an oval swelling at the tip of the elbow and does not affect. joint motion
-tenderness, erythema and warmth, cellulitis, report of trauma, and evidence of a skin lesion are more common in septic bursitis but can be present with aseptic
-1\/3 with septic olecranon bursitis are afebrile<\/p>\n\n\n\nOlecranon bursitis: tests
-acute swelling\/redness needs to be aspirated to rule out infection (esp. if pt is febrile)
-most often staphylococcus aureus<\/p>\n\n\n\nolecranon bursitis: treatment
NSAIDs, heat, rest, local corticosteroid injection<\/p>\n\n\n\n-chronic bursa swelling does not require aspiration
-aspiration of site requires a zig zag approach by pulling skin over bursa before introducing it to reduce chronic drainage site<\/p>\n\n\n\nBouchard nodes and Herberden nodes
-bony enlargements of the distal interphalangeal joints of the fingers, thumb (Heberden)
and
-proximal interphalangeal joints (Bouchard)<\/p>\n\n\n\nLumbar spinal stenosis: common findings
-pain worsens with extension
-reproducible single or bilateral leg symptoms that are worse after walking and relieved with sitting (“neurogenic claudication”)
-limited extension of the lumbar spine which may reproduce symptoms radiating down the legs<\/p>\n\n\n\nReflexes and spinal involvement: L1 & L2
no reflex<\/p>\n\n\n\nReflexes and spinal involvement:L3 and L4
Knee jerk<\/p>\n\n\n\nReflexes and spinal involvement: L5
Babinski Reflex<\/p>\n\n\n\nReflexes and spinal involvement: S1
Ankle jerk<\/p>\n\n\n\nReflexes and spinal involvement: S2
knee flexor<\/p>\n\n\n\nReflexes and spinal involvement: S2-S4
Anal reflex, rectal tone<\/p>\n\n\n\nLachman test
-Performed with patient lying supine, knee flexed to 20-30 degrees. Examiner grasps distal femur from the lateral side and the proximal tibia with the other hand on the medial side
-with the knee in neutral position, stabilize the femur and pull the tibia anteriorly using a similar force to lifting 10-15 lb weight
-excessive anterior translation of the tibia compared with the other side indicated injury to the ACL<\/p>\n\n\n\nMcMurry test
-Patient lying supine; clinician flexes the knee until the patient reports pain
-this test is valid if pain free for beyond 90 degrees
-external rotation of patients foot then extends the knee while palpating the medial knee for “click” in the medial compartment or pain reproducing pain from a meniscus injury
-to test lateral meniscus: the same maneuver is repeated while rotating the foot internally<\/p>\n\n\n\nModified McMurry
-Performed with the hips flexed to 90 degrees
-Knee is flexed maximal with internal or external rotation of the lower leg
-Knee can be rotated with the lower leg in internal\/external rotation to capture the torn meniscus understand the condyles
-Positive test is pain over the joint line while the knee is being flexed and internally or externally rotated<\/p>\n\n\n\nSpurling Test
-Involves asking the patient to rotate and extend the neck to one side
-Apply a gentle axial load to the neck
-Reproduction of the cervical radiculopathy symptoms is a positive sign of nerve root compression<\/p>\n\n\n\nSubtalar tilt test
-foot in neutral position with the patient sitting
-one hand to fix the tibia and the other to hold and invert the calcaneus
-normal inversion at the subtalar joint is approx. 30 degrees
-A positive test consist of increased subtalar joint inversion greater than 10 degrees on the affected side with loss of endpoint for the calcanofibular ligament<\/p>\n\n\n\nUpper GI bleed
-hematemesis or melon
-bright red or brown “coffee grounds”
-melena, palpitations, dizziness, SOB.<\/p>\n\n\n\nUpper GI bleed causes
-Peptic Ulcer Disease
-Portal HTN (esophageal varices; gastric\/duodenal varices; portal hypertensive gastropathy)
-Mallory-Weiss Tears (lacerations of the gastroesophageal junction)
-Vascular Anomalies (most common: Angioectasias (angiodysplasias)
-Gastric neoplasms
-Erosive gastritis\/esophagitis<\/p>\n\n\n\nLower GI bleed
Bright red blood in stool or drips after BM<\/p>\n\n\n\nLower GI bleed causes
-Diverticulosis (most common cause; acute, painless, large-volume maroon or bright red blood hematochezia); angioectasias; neoplasms; inflammatory bowel disease (especially ulcerative colitis); anorectal disease (hemorrhoids\/fissures); ischemic colitis<\/p>\n\n\n\nCrohn Disease
-most cases involve small bowel and colon
-transmural process which results in mucosal inflammation and ulceration, stricturing, fistula development and abscess formation
-cigarette smoking strongly associated with development<\/p>\n\n\n\nCrohn’s Disease: Sign and Symptoms (Chronic inflammatory disease)
*Most common presentation
-Malaise, weight loss, loss of energy
-with ileitis\/ileocolitis = diarrhea (non bloody\/intermittent)
-with rectum\/left colon = bloody diarrhea, fecal urgency (mimics ulcerative colitis)
-Cramping\/steady right lower quadrant\/periumbilical pain
-On PE focal tenderness: usually RLQ, palpable tender mass that is thickened or matted loops of inflamed intestine<\/p>\n\n\n\nCrohn’s Disease: Sign and Symptoms (Intestinal obstruction)
-Narrowing of the small bowel as a result of inflammation, spasm or fibrotic stenosis
-Postprandial bloating, cramping, loud borborygmi
-occurs with active inflammatory symptoms or later in dx with chronic fibrosis<\/p>\n\n\n\nCrohn’s Disease: Sign and Symptoms (Penetrating disease & fistula)
-sinus tracts that penetrate though the bowel where they may be contained or form fistulas to adjacent structures
-Penetration through the bowel can result in iata-abdominal or retroperitoneal phlegm or abscess (fever, chills, tender abdominal mass, leukocytosis)
-Fistulas between the small intestine and colon are usually asymptomatic but can results in diarrhea, weight loss, bacterial overgrowth and malnutrition<\/p>\n\n\n\n- \n
- Fistulas to the bladder produce recurrent infection<\/li>\n\n\n\n
- Fistulas to the vagina produce malodorous drainage\/problems with personal hygiene<\/li>\n<\/ul>\n\n\n\n
Crohn’s Disease: Sign and Symptoms (Perianal Disease)
-1\/3 of patients with small or large bowel involvement develop perianal disease
-Large painful skin tags, anal fissures, perianal abscesses, fistulas<\/p>\n\n\n\nCrohn’s Disease: Sign and Symptoms (Extaintestinal Manifestations)
-Can be seen with CD and UC
-Arthralgia’s, arthritis, iritis or uveitis, pyoderma gangrenous or erythema nodosum
-Oral aphthous lesions common
-Increased prevalence of gallstones
-Nephrolithiasis<\/p>\n\n\n\nUlcerative Colitis
-Idiopathic inflammatory condition involving the mucosal surface of the colon
-Results in diffuse friability and erosions with bleeding
-Periods of symptomatic flare-ups and remission
-Bloody diarrhea is hallmark **
-Severity based on stool frequency, presence & amount of rectal bleeding, cramps, abdominal pain, fecal urgency, tenesmus and extra intestinal symptoms
-PE should focus on volume status (orthostatic BPs + pulse + nutrition status)
-Abdominal examination look for tenderness, evidence of peritoneal inflammation; red blood may be present on digital rectal examination<\/p>\n\n\n\nUlcerative colitis: Mild
< 4 stools per day
< 90 HR
Normal hematocrit & albumin, no weight loss, normal temperature
< 20 ESR<\/p>\n\n\n\nUlcerative colitis: Moderate
4-6 stools per day
90-100 HR
30-40% hematocrit
1-10% weight loss
99-100 temperature
20-30 ESR
3-3.5 albumin<\/p>\n\n\n\nUlcerative colitis: Severe<\/p>\n\n\n\n
\n
6 mostly bloody stools per day
100 HR
< 30% hematocrit
10% weight loss
100 temperature
30 ESR
< 3 albumin<\/p>\n<\/blockquote>\n\n\n\nUlcerative Colitis: Signs and Symptoms – Mild to moderate disease
-Fewer than 4-6 bowel movements\/day
-mild to moderate rectal bleeding
-no constitutional symptoms
-stools may be formed or loose
-Rectal inflammation = fecal urgency & tenesmus
-LLQ cramps relieved by defecation
-No significant pain or tenderness
-Mild anemia and hypoalbuminemia<\/p>\n\n\n\nUlcerative Colitis: Signs and Symptoms – severe
-More than 6 bloody bowel movements\/day
-Severe anemia, hypovolemia, impaired nutrition with hypoalbuminemia
-Abdominal pain\/tenderness present
-“Fulminant colitis” subset of severe disease characterized by rapid worsening symptoms with signs of toxicity<\/p>\n\n\n\nDiverticulitis
-Macroscopic inflammation of a diverticulum that may reflect a spectrum from inflammation alone to micro perforation with localized paracolic inflammation to macroperforation with either abscess or vernalized peritonitis<\/p>\n\n\n\nDiverticulitis: Signs and Symptoms
-Localized inflammation\/infection= mild\/moderate aching abdominal pain usually LLQ
-Constipation or loose stools
-Frequent N\/V<\/p>\n\n\n\nDiverticulitis: Physical examination findings
-Low-grade fever
-LLQ tenderness, palpable mass
-Stool occult blood common (hematochezia is rare)
-Leukocytosis is mild\/moderate<\/p>\n\n\n\n- \n
- Pts with free perforation present with more generalized abdominal pain and peritoneal signs<\/li>\n<\/ul>\n\n\n\n
Irritable Bowel Syndrome
-Idiopathic clinical entity characterized by chronic (more than 3 months) abdominal pain that occurs in association with altered bowel habits
-Abdominal pain with at least 2 of the following 3:<\/p>\n\n\n\n- \n
- Related to defecation<\/li>\n\n\n\n
- Associated with a change in frequency of stool<\/li>\n\n\n\n
- Associated with a change in form of stool<\/li>\n<\/ol>\n\n\n\n
- \n
- abdominal pain should be present on average of at least 1 day\/week<\/li>\n\n\n\n
- other S&S include: abnormal frequency, form, passage, bloating, distention<\/li>\n\n\n\n
- women more likely<\/li>\n<\/ul>\n\n\n\n
IBS: Somatic\/psychological complaints
-Dyspepsia
-Heartburn
-Chest pain
-Headaches
-Fatigue
-Myalgias
-Urologica dysfunction
-Gynecologic symptoms
-Anxiety\/depression<\/p>\n\n\n\nIBS: Signs & Symptoms
-Abdominal pain that is intermittent, cramps and in lower abdominal region
-Associated with change in stool frequency\/form and may be improved or worsened with defecation
-PE is normal; abdominal tenderness in lower abdominal is common but not pronounced<\/p>\n\n\n\nIBS Categories<\/p>\n\n\n\n
- \n
- IBS with diarrhea<\/li>\n\n\n\n
- IBS with constipation<\/li>\n\n\n\n
- IBS with mixed constipation & diarrhea<\/li>\n\n\n\n
- IBS not subtyped<\/li>\n<\/ol>\n\n\n\n
IBS with constipation
-Infrequent BM of less than 3 per week
-Hard\/lumpy stools
-Straining<\/p>\n\n\n\nIBS with diarrhea
-Loose\/watery stools
-Frequent stools (more than 3 per day)
-Urgency
-Fecal incontinence<\/p>\n\n\n\nIBS “Alarm symptoms”
-Suggest a diagnosis other than IBS & warrant further investigation<\/p>\n\n\n\n- \n
- Acute onset esp. older than 40-50 yrs<\/li>\n\n\n\n
- Nocturnal diarrhea, severe constipation or diarrhea, hematochezia, weight loss, fever<\/li>\n<\/ul>\n\n\n\n
Hepatitis A
-transmitted by fecal-oral rout by either person to person contact or ingestion of contaminated food\/water<\/p>\n\n\n\nHepatitis A incubation period
-30 days; excreted in feces up to 2 weeks before clinical illness<\/p>\n\n\n\nHepatitis A: Signs and Symptoms
*more severe in adults than children (usually asymptomatic)<\/p>\n\n\n\n- \n
- onset abrupt & insidious with malaise, arthralgia, easy fatiguability, upper respiratory symptoms, anorexia
-distaste for smoking may occur early
-Nausea and vomiting are frequent and constipation\/diarrhea may occur
-Low grade fever
-Defervescence and fall in pulse rate coincide with onset of jaundice
-Abdmoinal pain mild\/constant in RUQ or epigastrium — aggravated by jarring\/exertion
-Jaundice occurs 5-10 after initial symptoms<\/li>\n<\/ul>\n\n\n\nHepatitis A: Signs and Symptoms with jaundice
-Prodromal symptoms worsen followed by progressive clinical improvement
-stools may be acholic
-hepatomegaly
-splenomegaly
-soft, enlarged lump nodes- esp. cervical & epitrochlear<\/p>\n\n\n\nHepatitis A: Acute illness timeframe
-Subsides over 2-3 with complete clinical and laboratory recovery by 9 weeks
-May have 1-2 relapses
-Can be complicated by acute cholecystitis<\/p>\n\n\n\nHepatitis B
-Transmitted by inoculation of infected blood or blood products or by sexual contact
-Present in saliva, semen, vaginal secretions
-can be transmitted during delivery<\/p>\n\n\n\nHepatitis B: Incubation period
-6 weeks to 6 months
-Average 12-14 weeks<\/p>\n\n\n\nHepatitis B: signs and symptoms
-ranges from asymptotic without jaundice to acute liver failure and death
-onset may be abrupt or insidious
-Low grade fever
-fall of pulse with onset of jaundice
-Acute illness subsides over 2-3 weeks with complete clinical\/laboratory recovery by 16 weeks
-May become chronic<\/p>\n\n\n\nAcute Cholelithiasis (Gallstones)
-more common in women
-over age 60
-classified according to chemical composition as cholesterol or calcium bilirubinate stones<\/p>\n\n\n\nAcute Cholelithiasis: Signs and Symptoms (asymptomatic)<\/p>\n\n\n\n
- \n
- Asymptomatic, normal lab feature, no treatment<\/li>\n<\/ul>\n\n\n\n
Acute Cholelithiasis: Signs and Symptoms (symptomatic gallstones)
-Biliary pain, normal lab features, dx via US, tx with laparoscopic cholecystectomy<\/p>\n\n\n\nAcute Cholelithiasis: Signs and Symptoms (cholesterolosis of gallbladder)
-Usually asymptomatic, normal lab features, dx with oral cholecystography, tx none<\/p>\n\n\n\nAcute Cholelithiasis: Signs and Symptoms
-Classic biliary pain “episodic”
-Infrequent episodes of steady\/severe pain in epigastrium or RUQ with radiation to right scapula
-Detected on US<\/p>\n\n\n\nAcute cholecystitis
Usually occurs when a stone become impacted in the cystic duct and inflammation develops behind the obstruction<\/p>\n\n\n\nAcute cholecystitis signs and symptoms
-Acute attack often precipitated by large\/fatty meal
-Sudden appearance of steady pain localized to the epigastrium or right hemochondrium which may subside in 12-18 hours
-Vomiting with variable relief
-Fever
-RUQ tenderness (often with Murphy Sign – inhibition of inspiration by pain on palpation of the RUQ); usually associated with muscle guarding\/rebound tenderness
-15% with palpable gallbladder
-25% jaundice (may suggest choledocholithiasis)<\/p>\n\n\n\nAcute Pancreatitis
-Abrupt onset of deep epigastric pain, often with radiation to the back (worsened with walking and laying supine; better with sitting and leaning forward)
-Often relates to alcohol intake
-Nausea, vomiting, sweating, weakness<\/p>\n\n\n\n- \n
- Abdominal tenderness and distention (usually without guarding, rigidity or rebound)
-Fever
-Leukocytosis, elevated serum amylase & serum lipase<\/li>\n<\/ul>\n\n\n\nPsoas Sign
-Pain on passive extension of the right hip
-indicative of appendicitis<\/p>\n\n\n\nObturator Sign
-Pain with passive flexion and internal rotation of the right hip
-indicative of appendicitis<\/p>\n\n\n\nArrhythmias after MI: Sinus Bradycardia
-Inferior infarctions or precipitated by medications
-Observation\/withdrawal of offending agents
-Accompanied by signs of low cardiac output, atropine IV is usually effective
-Temp pacing rarely required<\/p>\n\n\n\nArrhythmias after MI: Supraventricular tachyarrhythmias
-ST is common d\/t either increased adrenergic stimulation or hemodynamic compromise
-Electrolyte abnormalities\/hypoxia should be corrected and causative agents stopped (aminophylline)
-Afib controlled with IV beta-blockers, short acting esmolol, amiodarone ; CV os necessary<\/p>\n\n\n\nArrhythmias after MI: Ventricular arrhythmias
-Most common in the first hours after in fact and marker of high risks
-Sustained VT tx with lidocaine if pt is stable or CV if not
-Procainamide, amio,
-Vfib = shock
-accelerated idoventricular should not be treated with antiarrhythmics which can cause asystole<\/p>\n\n\n\nArrhythmias after MI: Conduction disturbances
-Block at the level of the AV node is more common than infra nodal block and occurs with inferior MIs
-1st degree: most common, no tx
-2nd degree: usually Mobitz type 1 (wenckebach)- tx only is assoc. with low HR
-Complete HB: IV atropine, temp pacing<\/p>\n\n\n\n- \n
- anterior infarcts= site of the block is distal, below the AV node and usually a result of extensive damage of His-Purkinje system
-urgent pacing or PPM if 2nd or 3rd degree block<\/li>\n<\/ul>\n\n\n\nSuperficial venous thrombophlebitis
-usually saphenous vein involved
-PICC\/venous catheterization may be cause
-Usually caused by staphylococcus aureus
-Can occur spontaneously often in pregnant\/PP women or those with varicose veins; can be secondary to abdominal cancer
-Can be associated with occult DVT<\/p>\n\n\n\nSuperficial venous thrombophlebitis: Signs and symptoms
-Dull pain in the region of the involved vein
-Local induration, redness, tenderness along course of vein
-inflammatory subsides in 1-2 weeks; firm cord may remain for longer
-edema is uncommon<\/p>\n\n\n\nSuperficial venous thrombophlebitis: Treatment
-Local heat and NSAIDs
-anticoagulation is not usually required (prophylactic low-molecular-weight heparin or fondaparinux recommended for 5cm or longer superficial thrombophlebitis of the lower limb veins
-full anticoagulation reserved for concern of extension into the deep system or rapid progression<\/p>\n\n\n\nSuperficial venous thrombophlebitis: Treatment (septic superficial thrombophlebitis)
-intavasulcar abscess require urgent tx with heparin or fondaparinux to limit thrombus formation
-Abx, if positive cultures therapy for 7-10 days or 4-6 weeks with endocarditis
-surgical excision if necessary to control infection<\/p>\n\n\n\nDVT treatment<\/p>\n\n\n\n
abdominal aortic aneurysms: general
Diameter exceeds 3cm – rarely rupture unless diameter exceeds 5cm<\/p>\n\n\n\nAAA: signs and symptoms
-asymptomatic: usually discovered on US or CT as part of screening
-Pain: expansion may be accompanied by mild-severe mid abdominal pain, exacerbated by gentle pressure
-Rupture: severe pain, palpable abdominal mass, hypotension<\/p>\n\n\n\nAAA: imagine
US is diagnostic study of choice for initial screening
-CT assessment of diameter
-Routine screening of 2 years for smaller than 4 cm, 6 month for 5cm<\/p>\n\n\n\nAAA: Screening via US
65-75 men
current\/past smokers<\/p>\n\n\n\nAAA: treatment
Elective repair if larger than 5.5cm<\/p>\n\n\n\nThoracic aneurysms
D\/T atherosclerosis
usually asymptomatic
Substernal\/back of neck pain may occur
DX with CT<\/p>\n\n\n\nDoppler\/vascular findings
Ankle-brachial index- below 0.9
Levels below 0.4 = critical limb ischemia<\/p>\n\n\n\n
- anterior infarcts= site of the block is distal, below the AV node and usually a result of extensive damage of His-Purkinje system
- Abdominal tenderness and distention (usually without guarding, rigidity or rebound)
- Asymptomatic, normal lab feature, no treatment<\/li>\n<\/ul>\n\n\n\n
- onset abrupt & insidious with malaise, arthralgia, easy fatiguability, upper respiratory symptoms, anorexia
- Pts with free perforation present with more generalized abdominal pain and peritoneal signs<\/li>\n<\/ul>\n\n\n\n
- subcutaneous nodules most common over bony prominences