PCM exam III flashcards.txt

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PCM exam III flashcards.txt
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PCM EXAM III
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  1. What is the 3/3 rule of constipation?
    It is normal to go 3 times per week or 3 times per day or anything in between
  2. What are the 3 Fs?
    Fiber, fluid and fun
  3. What are the drugs that can cause constipation
    • analgesics and anticholinergics
    • antihistamines, antispasmodics, antidepressants, antipsychotics
    • Cation containting supplements: iron, calcium, aluminum
    • neurally active agents: opioids antihypertensives
  4. What is an Enterocele?
    Weakness in the tissue that holds the bowel in place and the bowel falls down behind the uterus and into the vagina
  5. What are some things that can weaken the wall and cause an enterocele?
    Straining, manual labor, child birth
  6. What is an anterior rectocele?
    Rectum that pushes the wall of the vagina, pelvic floor dysfunction
  7. What are the Alarm symptoms for constipation that might be colon cancer?
    • Over 50
    • unexplained weight loss
    • anemia
    • evidence of GIB
    • perisistent or progressive pain
    • FH colon cancer
    • fasting nocturnal or large volume diarrhea
  8. what are B symptoms
    • wt loss
    • low grade fever
    • night sweats
  9. A Gaping or asymetric anal opening (i.e. a �gaping asshole�) is a sign of what type of disorder?
    Neurologic disorder impairing sphincter function
  10. Having the patient strain during the rectal exam is useful for diagnosing patients with what?
    Dyssynergic defication, rectal prolapse
  11. How do you do a physical examination for a rectocele?
    Have female patient strain with the examining finger oriented anteriorly
  12. In a patient with constipation you can do a barium X ray to identify what 4 disorders
    obstruction, megarectum, megacolon, hirshsprungs disease
  13. Atonic Colon
    loss of normal colonic relfexes and sensation
  14. Adynamic colon
    colon that is dialated and the patient is unable to move through the colon, thus they are dependent on more and more laxitives for defecation
  15. Dyssynergistic defication
    • in coordination of contraction of colonic and rectal muscles and internal and external sphincters
    • leads to attempts to defecate against closed anal sphincters
    • with or without difficulty deficating strain even with soft stools
    • on examination they are inable to voluntarily relax the external sphincters on request
  16. Megacolon
    • Lifelong constipation
    • occasional passage of an enormous formed stool
    • causes are congenital (hirschsprung disease) or aquired defects in the intrinsic innervation of the colon
  17. What are some bowel diseases that can cause constipation
    IBS, slow colonic transit, pelvic floor dysfunction
  18. what are some neurological conditions that can cause constipation?
    Parkinson's, MS, colon surgery, spinal cord injury, diabetes mellitus, pseudo-obstruction
  19. What are some complications of chronic constipation
    • urinary obstruction/infection
    • spontaneous perforation
    • stercolar ulcer � ischemia on bowel wall
    • fecaliths- appendix
  20. What anticonstipation medications should be avoided unless nessisary?
    Prokinetics, lubricating agents, routine enemas
  21. What medications should be used for constipation
    • stool softeners/ bulking agents
    • osmotic agents
    • stimulating agents
  22. what are some lifestyle/diet modifications that can help constipation
    • fiber fluids fun
    • D/C or change offending meds if possible
    • bowel retraining
    • educations and reassurance
  23. What must you give with fiber/bulk laxitives?
    WATER
  24. How do surfactants work?
    Lower stool surface tension and soften so that more water enters more easily not as good as laxatives
  25. What are osmotic agents?
    • Non-absorbable agents to promote fluid shift
    • intestinal water secretion increases
    • increases stool frequency
  26. Name some osmotic agents
    PEG, Lactulose, Saline
  27. How do stimulant laxatives work?
    Alter electrolyte transit at mucosa and increase motor activity
  28. What is a fecal impaction?
    • Large mass of bulky dry hard stool in the rectum secondary to chronic constipation
    • watery stool may form higher in the bowel and leak around the impaction causing soiling or diarrhea
  29. What are some complications of fecal impaction
    • dilitation- toxic megacolon
    • rectal tears
    • rectal tissue necrosis
  30. What are some symptoms of fecal impaction?
    • Urge to deficate without ability to have a BM
    • abdominal pain
    • bloated or hard abdomen
    • anorexia
    • nausea and vomiting
    • rectal discomfort
    • generally ill feeling
    • confusion
    • leakage of wet stool or thin/pencil stool
  31. What is a contraindication to manual disimpaction, suppositories and enemas for fecal impation?
    Patients who are myelosuppressed or have altered bleeding times
  32. What are some motility tests that can be done for a patient with chronic constipation
    • anorectal manometry
    • defecography
    • pelvic floor electromyography
    • anal endosonography
  33. Anal fissures found on the sides of the anus are indicative of what diseases?
    • Chron's disease
    • ulcerative colitis
    • syphillis
    • TB
    • leukemia
    • cancer
    • HIV
  34. Anal fissures that are in the verticle plain of the rectum (the top and bottom) are indicative of what?
    Acute and chronic anal fissures
  35. Your patient has a tearing pain with defecation and sometimes a throbbing pain following defecation. They also report blood on the toilet paper after they go. You diagnose
    Anal fissure
  36. Hematochezia
    blood on toilet paper or stool
  37. Chronic fissures
    • can ulcerate with internal sphincter fibers seen at base
    • may develop sentinel pile or sentinel tag
    • may require surgery
  38. Which hemorrhoids are painful internal or external
    external
  39. what are some risk factors for hemorrhoids
    pregnancy, obesity, chronic diarrhea, loss of muscle tone, chronic constipation, portal hypertension, professions with lots of sitting
  40. First degree hemorrhoids
    dont prolapse
  41. second degree hemorrhoids
    prolapse through anus on straining but spontaneous reduction
  42. Third degree hemorrhoids
    Prolapse and may require manual/digital reduction
  43. Fourth degree hemorrhoids
    Cannot be reduced just hang out all the time
  44. What are some treatments for internal hemorrhoids
    • rubber band ligation
    • infrared coagulation
    • bipolar diathermy
    • laser photocoagulation
    • sclerotherapy
    • cryotherapy
  45. Treatment for a bleeding hemorrhoid
    fiber
  46. Treatment for a iritation and pruritus from a hemorrhoid
    analgesic creams hydrocortisone suppositories sitz baths
  47. Treatment for thrombosed hemorrhoids
    acute may require surgical intervention if significant symptoms
  48. Define Orthostatic intolerance
    Family of disorders that produce symptoms of cerebral hypoperfusion in response to postural challenge; they involve the dysfunction or disregulation of postural reflexes
  49. What 4 syndromes cause Orthostatic intolerance?
    • Orthostatic hypotension
    • delayed orthostasis
    • postural orthostatic tachycardia syndrome
    • neurally mediated hypotension (vasovagal reflex or reflex syncope)
  50. What are the symptoms of orthostatic Intolerance
    • Dizziness or lightheadedness
    • Visual blurring
    • Darkening of visual fields
    • Generalized weakness
    • Loss of conciousness
  51. immediate orthostasis is defined as a postural decrease in BP of >____mmHg for systolic BP and a decrease of >____ mmHg for diastolic BP
    • SBP>20 mmHg
    • DBP>10 mmHg
  52. Immediate Orthostasis can occur with ______ insufficiency where there is inadequate tachycardial compensation or with ____ depletion where the patient becomes tachycardic but not enough to compensate.
    • Autonomic insufficiency
    • Volume depletion
  53. What are 4 classes of medications that can cause Euvolemic orthostatic hypotension
    • antihypertensive agents
    • tricyclic agents
    • monoamine oxidase inhibitors
    • dopamine agonists
  54. What are 2 endocrine diseases that can cause Euvolemic orhtostatic hypotension?
    • Adrenocortical deficiency
    • Pheochromocytoma
  55. What are some Neurological conditions that can cause euvolemic orthostatic hypotension?
    • Parkinson's disease
    • multisystem failure
    • CNS tumor
    • Myelopathy
    • Dementia/multi-infarct
  56. What are 3 things you can educate an orthostatic hypertension patient to do in order to reduce episodes?
    • Orthostatic precautions � pause at the side of the bed
    • Small, frequent, low carbohydrate meals- increased shunt to internal organs with large meals or meals heavy on carbs which are vasodilitory
    • Avoid alcohol- vasodilitor and diuretic
  57. What type of clothing can a person with orthostatic hypotension wear to decrease symptoms?
    Compressive stockings
  58. What physical maneuvers can help prevent falls in an orthostatic hypotension pt.?
    • Leg crossing
    • isometric hand gripping
    • respiratory manuvers pursed lip or sniff
    • Exercise
    • Elevate the head of the bed at night (activates the RAS reducing nocturnal diuresis)
  59. What dietary changes would you make for a patient with orthostatic hypotension?
    Increase sodium in diet
  60. What medication can you perscribe for an OH patient with anemia?
    Erythropoietin- use in anemic patients less than 35% aim for normal hct
  61. How does caffeine help pts with orthostatic hypotension?
    Inihibits vasodilating effects of adenosine and increases sympathetic tone
  62. What medications could you give a patient with OH to improve their symptoms? (5)
    • Florinef
    • Midodrine
    • NSAIDs
    • Caffeine
    • Erythropoietin
  63. What med for OH should you avoid in a patient with urinary retention?
    Midodrine (also dose while pt is awake)
  64. How do NSAIDs help to raise BP?
    Prostacyclin inhibition, vasoconstrictor and activation of RAS
  65. What NSAIDs are used for OH?
    Indomethacin
  66. What is the biggest problem with medical management of OH?
    BP effects of therapy are posture independent so when the patient moves to sitting or laying position their BP jumps to hypertensive state
  67. The Goals of OH therapy are a standing SBP > ___ mmHg and a Supine BP of <___ mmHg which can be achieved with timing of midodine dosing, HOB and nocturnal nitrates
    90mmHG and 180 mmHG
  68. What med can you add at night to a patient with OH who is hypertensive at rest?
    Nocturnal nitrates
  69. Your patient is a 78 year old female who reports feeling faint at different times of the day she does not think it occurs with postural change because it never occurs directly after standing. She also has not noticed any abnormal heart flutters or palpitations, anxiousness or neurological changes. You suspect...
    Delayed Orthostasis
  70. Delayed orthostasis can be __ -__ mins after postural challenge
    10-45 mins
  71. True or false Delayed orthostasis is more likely to be associated with vasovagal symptoms
    True
  72. _____ should be considered when lightheadedness in an older individual is recurrent, consistent, persistent, but does not occur with immediate postural challenge, the patient may not recognize the postural connection
  73. What is the most prevalent form of orthostatic intolerance
    POTS
  74. What age range does POTS present in
    14-45 years old
  75. What does POTS stand for
    Postural orthostatic tachycardia syndrome
  76. Who is more likely to get POTS men or women?
    Women
  77. What are the 4 possible pathophysiologies of POTS?
    • Reduction in effective circulating blood volume (ECBV) � (peripheral venous sympathetic denervatino with preserved cardiac innervation, dynamic orthostatic hypovolemia)
    • Acutal reduction in effective circulating blood volume- (possible renal sympathetic denervation decreased activation of RAAS, reduction in red cell mass)
    • Parasympathetic insufficency leading to attenuated baroreceptor responses
    • Primary sympathetic excess
  78. What are some symptoms of POTS
    racing heart, palpitations, anxiety, tremulousness, irritability, difficulty concentrating, difficulty focusing, sleeplessness, headache, lightheaded, fatigue, SOB, Exercise intolerance, nausea, bloating, abdominal cramping, constipation, diarrhea, cutaneous mottleing, dependent rubor, cold intolerance, heat intolerance, hear fainting, fainting, sweats, good days, bad days (I'm having a bad day b/c of this exam)
  79. What are some common misdiagnoses of POTS
    anxiety disorders, ADHD, depression, somatization, deconditioning
  80. What are some Hyperadrenergic symptoms of POTS
    • anxiety, fight of flight hyperactivity, overfocused concentration, mimicking ADHD, Inability to shut down at night or sleeplessness
    • Gastrointestinal dysmotility, Raynaud's symptomatology, cutaneous vasomotor abnormalities
  81. What are some hypoperfusion symptoms of POTS?
    • Postural
    • fatigue
    • headache
    • lightheadedness
  82. What are some cardiopulmonary symptoms of POTS?
    Exertional fatigue and breathlessness
  83. What are some of the POTS symptoms that are due to cardiac ventricular baroreceptors?
    • Postural neurocardiogenic symptoms
    • nausea
    • diaphoresis
    • pallor
    • profound episodic fatigue
  84. What are dome superimposed situational depression symptoms of POTS
    • patients feel miserable
    • misunderstood
    • often ridiculed
    • depondent about normal functioning
  85. What are the diagnostic criteria for POTS?
    30 point orthostatic rise in heart rate or maximum orthostatic heart rate >120/min and less than 10 mmHg drop in SBP
  86. 3 diagnostic tests for pots
    • bedside postural vital signs
    • tilt table testing
    • holter monitor
  87. Accelerated heart rate of __ -___ bpm due to postural challenge or daily activities is diagnostic of POTS
    130-150
  88. ____ POTS is a milder form of the disaease with partial recovery in several years
    idiopathic
  89. POTS caused by ______ is chronic and potentially progressive
    Mitochondrial disease
  90. What are the treatments for POTS?
    • High sodium diet
    • Florinef
    • Midodrine
    • NSAIDs
    • periodic saline infusion
    • Beta blockers
    • Clonadine
    • SSRIs
    • Erythropoeitin
  91. What medications are used in POTS to correct hyperadrenergic tone?
    Beta blockers
  92. What type of beta blockers are used in POTs and why?
    • Hydrophilic agents to minimize risk of fatigue
    • Nadolol
    • Bisprolol
    • Atenolol
    • Metoprolol
  93. What agent is used for Insomina and BP in POTS?
    • Clonidine
    • very helpful for insomnia, reduces supine BP but not upright BP
    • Beta blockers before bed
  94. Why are SSRIs used for POTS?
    Serotonergic pathoways appear to mediate between vagal afferens and sympathetic efferents
  95. what two methods can you use to enhance preload in POTS patients?
    • Erythropoietin
    • continuous saline infusion
  96. How do you enhance cardiovagal tone in a POTS patient?
    Pyridostigmine- therapy is limited by gastrointestinal hypermotility symptoms
  97. What would you do to optimize preload in a POTS patients
    • High sodium diet
    • florinef
    • midodrine
    • indomethacin
  98. What are the 3 types of shock
    • Hypovolemic
    • Cardiogenic
    • Distributive
  99. Does preload increase or decrease in cardiogenic shock?
    Increase
  100. Define Cardiogenic Shock
    decrease in CO with evidence of insufficient tissue perfusion in the presence of adequate intravascular volume
  101. What are the Hemodynamic criteria (Forrester class 4) for cardiogenic shock?
    • Sustained hypotension (SBP < 90 mmHg for >30min)
    • Increased LV filling (PCWP >15mmHg)
    • Reduced systolic cardiac function
  102. What are some MI causes of Cardiogenic shock
    • Severe LV dysfunction
    • Extensive RV infarction
    • Mechanical complications
    • acute mitral regurgitation
    • VSD
    • Free wall rupture
    • Conduction abnormalities
  103. What are some non MI causes of Cardiogenic shock?
    Myocarditis, end stage cardiomyopathy, myocardial contusion, LVOT obstruction, Obstructive tumor, septic shock with myocardial depression, pulmonary embolism, aortic dissection with acute AR or tamponade, stress cardiomyopathy (broken heart syndrome)
  104. What is the median time from MI to shock?
    7 hours
  105. What are the risk factors for development of CS?
    • Elderly age 70 and up
    • diabetes
    • anterior infarction
    • prior MI
    • 3 vessel left main disease
    • early use of beta blockers in large infarcts (can cause hypotension that may lead to shock)
  106. What are the potential therapies for Cardiogenic shock
    • Rx- pressors and inotropes
    • temporary pacing
    • Intra-aortic balloon pump (IABP)
    • Fibrinolytics
    • Revascularization: CABG/PCI
    • Ventricular assist devices (VADs)
    • Cardiac tranplantation
  107. Action of Norepinephrine
    vasoconstriction and inotropic stimulant
  108. Action of dopamine
    • at low doses � renal vascular dialation
    • at medium doses- chronotropic/inotropic (beta)
    • at high doses- vasoconstriction (alpha)
  109. Dobutamine action
    positive inotrope, vasodilates- decreases afterload so hard to give to a shock patient
  110. Explain how an IABP works
    • temporary balloon that is inserted through the aorta into the arch and is programmed to inflate during diastole which fills the coronary arteries and deflate during systole to decrease afterload
    • Systole: decreases afterload, decreases cardiac work, decreases myocardial oxygen consumption, increases cardiac output
    • Diastole: aucmentation of diastolic pressure, increases coronary perfusion
  111. What is PCI
    • Percutaneous coronary interventions
    • is a stent in the coronary artery establishing patency
  112. What is a CABG
    • Coronary Artery bipass graft
    • uses the internal mammary artery or saphenous vein to bypass coronary circulation and feed the heart
  113. What is an Impella device?
    Pump that runs from the ventricle to the aorta
  114. Which generally does better LV failure or mechanical complications
    LV failure
  115. What is a LVAD?
    Left ventricular assist device, pump that vaccumes out blood from the ventricle into the aorta
  116. you have a post MI patient with symptoms of confusion, lungs bibasialr rhales, no JVD, new high pitched holosystolic murmur at the 3rd and 4th intercostal space and an apical thrill, their extremities are ice cold. Their vitals are: Temp- 98.7, BP 68/40, HR 120, O2 sat- 97% What do you think is wrong with this patient?
    Post infarction ventricular septal defect
  117. Postinfarct VSD
    • uncommon, mostly due to a posterobasal septum or ami apical septum, ECHO best diagnostic test
    • IABP, dobutamine for acute stabilization100% mortality without surgery only 87% with surgery closure device
  118. a 73 year old female presents with acute respiratory failure, (batwing edema) her BP is 68/40 despite fluid her HR is 120, her O2 sat is 68% she is intubated her lungs have diffuse rhales, increased JVP a new holosystolic murmur no apical thrill and her extremities are ice cold what do you think this patient has?
    Acute Mitral regurgitation
  119. What is the treatment for Acute mitral regurgitation
    immediate repair or replacement with or without CABG ASAP surgical delay increases mortality
  120. Other than surgery how would you treat an acute mitral regurgitation patient
    • majority require mechanical ventilation
    • IABP, nitroprusside, dobutamine, LVAD, emergent coronary angiography
  121. You have a patient with an enlarged heart on CXR who presents with a BP of 68/40 and a HR of 120 O2 sat of 91% he is confused his lungs are clear he has increased JVP the heart sounds are not distant and there are no obvious murmurs the extremities are cool what do you suspect?
    • RV infarction
    • pulmonary embolism
    • Cardiac tamponade
    • constrictive pericarditis
  122. How would you manage a RV infarction?
    • Fluids to achieve PCWP of 15-18 mmHG
    • Dobutamine
    • IABP
    • Revascularization improve in hospital M and M
    • pRVAD
  123. What is you differential for an increased JVD with clear lungs
    • RV infarction
    • pulmonary embolism
    • tamponade
    • constrictive pericarditis
  124. What is your differential for new holosystolic murmur with no thrill
    Acute mitral regurgitation
  125. What is your differential for a new holosystolic murmur with apical thrill
    VSD
  126. What is Diastasis recti?
    Not a true hernia, represents a weakened abdominal fascia, usually happens post pregnancy or with obesity
  127. What type of �hernia� causes tenting when you have the patient lie on their back and put their head up?
    Diastasis Recti
  128. What is the pathogenesis of diastasis recti?
    The abdominal muscles bow outward because of abdominal girth
  129. What is the treatment for diastasis recti?
    Reduce obesity and PT for abdominal muscle strengthening
  130. Where is pilonidal disease usually found?
    Intergluteal cyst, abscess or sinus tract of the upper part of the natal cleft
  131. Is pilonidal disease more common in men or women?
    Men
  132. What is the peak incidence of pilonidal disease?
    35 to 45 rare over 45yo
  133. what is the major complication of pilonidal disease?
    Can form absess and follow sinus tract to form bigger abcess
  134. Your patient is having trouble sitting recently, they have minor discomfort around the anus. The patient said they looked at it with a mirror and were surprised to see that it was swollen and red, they also ruefully tell you that they are �hairy back there� as they drop their pants for the rectal exam before looking at the rectum what do you think is the diagnosis?
    Pilonidal disease
  135. What are some signs and symptoms of Acute abscess in a patient with pilonidal disease?
    • Sudden onset of severe pain and swelling
    • acutely inflamed mass noted overlying the sacrum or coccyx
    • fever is unusual unless cellulitis is present
    • may occur following trauma
  136. Describe a Chronic pilonidal cyst
    persistent drainage from the sinus connected to the cyst 1 or more sinus openings with drainage of mucoid or purulent fluid
  137. What are the treatment options for patients with Pilonidal cysts?
    • Sitz baths/donuts
    • surgical treatments- I and D if acute
    • Surgical excision cysts and tracts = definitive treatment with primary or secondary closure
    • Antibiotic to cover skin flora if exacerbated- no indication for long term use
    • can recur Prevention is shaving hair of gluteal area
  138. A common western diet with low fiber puts a person at risk of what disease?
    Diveriticular disease
  139. Where do diverticula form?
    Where blood vessels penetrate the colon
  140. What part of the colon are diverticula most common in?
    Sigmoid colon
  141. Divriticulosis
    silent disease where patient has diveraticula but they don't cause a problem they are silent
  142. Diverticulitis-
    when those diverticuli get infected or perforate or abscess or become inflammed
  143. Diverticulum-
    sac like protrusion of the colonic wall
  144. What are some concerns/complications of diverticular disease?
    • Diverticulitis
    • abscess
    • PERITONITIS
    • fistula formation- openings to bladder or vagina
    • bleeding
  145. What will you find on history and physical of a patient with diveraticular disease
    • often asymptomatic
    • crampy LLQ pain
    • alternating diarrhea constipation
    • with or without fever
    • can develop lower gi bleed
  146. What diagnostic tests would you run on a patient who you suspect has diverticulitis
    • none if asymptomatic
    • occult blood and stool leukocytes
    • abdominal plain film free air for perforation
    • CT of abdomen- if they don't respond to treatments
    • Other- barium enema but only if not acute b/c you risk perfing their colon same with colonoscopy
  147. What are 4 complications of Diverticulitis?
    • Perforation- secondary to incresed intraluminal pressure insipissated food particles or inflammation necrosis and infection
    • Peritonitis- purulent or fecal
    • abscess or fistula- can cause communication
    • stricture- from scarring predisposition to obstruction
  148. What is the Treatment/Prevention for Diverticulitis
    • Prevention: high fiber diet, exercise, adequate liquids
    • Treatment: bowel rest, antibiotics if diverticulitis, surgical repair of any damage
    • Other strategies: treat constipation, increase exercise, increase fiber
  149. Genetic disorder that has an increased gastric polyp incidence and thus an increased risk of colon cancer require frequen colonoscopies 1-2 scopes per year starting at age 10
    Familial polyposis syndrome
  150. Clinical symptoms of colonic polyps
    • generally asymptomatic
    • constipation, flatulence, rectal bleeding
  151. What diagnostic tests do you do for a patient with colonic polyps?
    Colonoscopy, Occult blood test, biopsy of the polyp
  152. This type of colonic polyp has a higher risk of cancer and tend to be on the right side and very large
    hyperplastic and inflammatory
  153. These types of colonic polyp are on the left side and generally have a lower risk of cancer
    adenoma and adenomatous polyps
  154. What are some risk factors for colon cancer?
    • Pts over 50 y.o.
    • Diet rich in red and processed meats
    • inflammatory bowel disease
    • inherited disorders (FAP, hereditary non-polyposis colon cancer)
    • Obesity
    • Smoker
    • Heavy EtOH
    • Diabetes
  155. List the six type of hernia
    epigastric, incisional, umbilical, direct inguinal, indirect inguinal, femoral
  156. Name the 3 ventral hernias
    epigastric, umbilical, incisional
  157. Where does the weakness occur in a ventral hernia?
    In the anterior abdominal wall
  158. Where does an epigastric hernia occur?
    Area between the breastbone to the umbilicus
  159. Are epigastric hernias mostly congenital or aquired?
    Congenital
  160. What is the most common type of incisional hernia?
    Midline incisions
  161. Which are better upper incisions or lower incisions
    upper incisions
  162. which are better verticle incisions or transverse incisions?
    Verticle
  163. 3 post surgical factors that contribute to hernia risk
    tension, technique, infection
  164. True or false once a hernia is fixed it will never rupture again
    False recurrence rate after surgical repair is 25-50%
  165. Weak muscle next to the opening of inguinal canal, occurs in men over 40 years aging or injury, or weakness in Hesselbach's triangle
    Direct inguinal hernia
  166. �weakness in Hesselbach's triangle�
    Direct inguinal hernia
  167. Most common type of hernia in men
    Indirect inguinal hernia
  168. When a loop of intestine and/or fat goes through or into the inguinal canal
    Indirect inguinal hernia
  169. Most common inguinal hernia in women
    Femoral
  170. Weakness in the femoral canal area of the groin
    Inguinal hernia
  171. What type of inguinal hernia is most likely to become incarcerated or strangulated?
    Femoral hernia
  172. What are some risk factors for a femoral hernia
    • Female especially older
    • prior childbirth
    • muscle weakness
    • prior inguinal repair
  173. What are some symptoms of inguinal herniation
    • asymptomatic
    • heaviness or dull sense of discomfort
    • worsens with strainign lifting end of day or with prolonged standing
    • manual/physically active professions are aware before more sedentary workers
    • incarceration and strangulation
    • pain in area of hernia
  174. What is a sports hernia ?
    Unilateral pain in the groin without demonatrated hernia
  175. Who is more likely to get a sports hernia men or women?
    Men
  176. Sports hernia are more common in sports that involve what motion?
    Leaning forward and bending (hockey, soccer, rugby, football)
  177. What are some causes of sports hernias?'
    • repetitive strain in the inguinal area
    • tear external oblique with illioinguinal nerve injury
    • osteitis pubis
    • myotendinous strain- adductor rectus
  178. You have a hockey player who presents to you with groin pain especially increased with coughing and sneezing what do you diagnose?
    Sports hernia
  179. What kind of imaging do you get for a sports hernia?
    • Osteitis pubis is possible so bone scan
    • MRI/US- occult hernias
  180. What is treatment for a sports hernia?
    Rest, NSAIDs, Ice packs, surgical consult if it fails conservative exploratory and repair
  181. Richters Hernia
    occurs when the antemesenteric wall of the intestine protrudes through a defect in the abdominal wall. If such a herniation becomes necrotic and is subsequently reduced during hernia repair, perforation and peritonitis may result. A Richter's hernia can result in strangulation and necrosis in the absence of intestinal obstruction. It is a relatively rare but dangerous type of hernia.
  182. Spigelian Hernia
    • �Lateral Ventral hernia�
    • developse through the spigelian fascia
    • occurs between the muscles found in the abdominal wall
    • Linea semilunaris on each side of the rectus abdominus
    • osften little outward evicence of swelling so may go undetected longer
    • occur in men and women equally
  183. Underweight BMI
    <18.5
  184. Normal BMI
    18.5-24.9
  185. Overweight BMI
    25-29.9
  186. Obese
    >/= 30
  187. How do you calculate BMI?
    Weight in pounds/ heigh in inches squared X703
  188. Waist Circumference is a good indicator of the risk for what two diseases?
    CV and DM2
  189. A bad waist circumference for women is
    >35 inches
  190. A bad waist circumference for men is
    >40 inches
  191. A good cholesterol level is under
    200
  192. A good LDL level is under
    100
  193. A good HDL level is over
    60
  194. According to Choose my plate how what should be the main make up of a typical dinner
    Fruits and veggies should take up the majority with grains an protein making up a smaller portion
  195. What patients are at risk for malnutrition
    • weight
    • weight changes
    • dysphagia
    • food intolerance
    • reflux
    • abnormal lab values
  196. What diet do you give a patient with dysphagia?
    Thickened liquids, mechanical soft grount and pureed food
  197. What diet do you give a patient on Hemo/peritoneal dialysis?
    Sodium, potassium, phosphorus and fluid and protein
  198. What diet do you give to a CHF patient?
    2 gm sodium, fluid restrictions
  199. What diet do you give a pt on coumadin?
    Avoid foods with high potassium levels
  200. What are the 4 thicknesses of fluids?
    • Thin
    • nectar thick
    • Honeylike
    • spoon thick
  201. Describe thin liquids and name some examples
    • regular liquids, no adjustment needed
    • buttermilk, tomatoe juice
  202. Describe nectar thick liquids and name some examples
    falls slowly from a spoon can sip through a straw
  203. Describe a honey thick liquid and name some examples
    • drops from a spoon too thick to sip from a straw
    • Example: tomato sauce
  204. Spoon
    • Maintains shape needs spoon too thick to drink
    • pudding
  205. Describe a dysphagia diet level one
    • Pureed
    • bread- pureed or pre gelled, slurry
    • fruits- pureed/well mashed no seeds etc
    • Veggies pureed
  206. Describe a dysphagia diet level 2
    • mechanically altered
    • soft testured so can form a bolus
    • beverages have suspended pulp, bits of texture
    • moist well cooked veggies cut in half
  207. Describe a dysphagia diet level 3
    • advanced
    • near normal texture
    • exclude crunchy sticky or very hard foods
    • moist breads, cereals, desserts potatoes soups
  208. 4 conditions where you really want to monitor the patients electrolyte intake...
    Edema, HTN, CHF, Renal impairment
  209. Name a disease that elevates potassium
    Renal failure
  210. Name some drugs that can elevate potassium
    beta blockers, potassium supplements, ACE/ARBs
  211. Name some high potassium foods
    green beans, iceburg lettuce, 1 egg, one small banana, one orange, potatoe with skin
  212. What is the dietary goal cholesterol for cholesterol reduction diet?
    <200 mg/qd
  213. Name some high saturated fat foods
    • Meat
    • Whole milk/butter/cream
  214. What do you limit with a cholesterol reduction diet?
    • Trans fat
    • cholesterol
    • sodium
    • fat all types
  215. What are some examples of trans fat foods
    margarine, shortening, fried foods, packaged foods made with hydrogenated oils, french fries, doughnuts, baked goods including pastries and pie crust, biscuits, pizza dough, cookies and crackers
  216. Name two foods that will improve your dietary cholesterol
    • Omega-3 fats
    • Dietary fiber
  217. What are some examples of Omega 3 Fats?
    Salmon, tuna, mackerel, sardines, walnuts, canola, soybean, flaxseed oil or ground
  218. What is the recommendation on Dietary Fiber and what can you eat to get it?
    • 20-30 grams per day
    • fruits, veggies, whole grains, dried beans
    • 5 cups of fruit/veggie or 3 ounces of whole grain foods
  219. Name some conditions that are indications for a low sodium diet
    • heart failure
    • hypertension
    • renal disease
    • conditions of fluid retention or swelling
  220. ADA guidelines on sodium suggest that you limit your sodium intake to how many mg per day?
    2000
  221. what 5 things should you monitor intake of with a patient who has chronic kidney disease
    Sodium, Potassium, protein, phosphorus, calcium
  222. What is Lactose Intolerance
    Inability to digest sugar found in dairy
  223. What causes lactose intolerance
    lactase deficiency
  224. Is lactose intolerance more common in white children or black children
    white
  225. What are the symptoms of lactose intolerance
    bloating, flatus, diarrhea, cramps, delayed growth in children
  226. How soon after eating dairy to lactose intolerance symptoms appear?
    30 mins to 2 hours
  227. What are some secondary causes of lactose intolerance?
    Bacterial overgrowth, infectious enteritis, giardiasis, mucosal injury (celiac, IBC, Drug and radiation induced)
  228. How do you test for Lactose intolerance?
    Test for the presence of hydrogen after lactose load (urea breath test)
  229. Treatment for lactose intolerance includes:
    • avoid milk products
    • alternatives: yogurt, buttermilk, aged cheese, ingest lactase
  230. What are some food sources with high vitamin A
    Liver, fish oils, fortified milk, eggs
  231. Who gets deficiencies in vitamin A?
    Elderly, achoholism, liver disease, night blindness, dry skin
  232. Sx of Vitamin A toxicity
    skin disorders, hair loss, poss teratogenic
  233. Vitamin C food sources include:
    citrus fruits, strawberries, broccoli, mixed green veggies
  234. What are some functions of vitamin C in the body
    neurotransmitter synthesis, collagen synthesis
  235. Who is at risk for Vitamin C deficiencies
    elderly men, alcholism, college students and sailors
  236. What happens to pts with Vitamin C deficiencies?
    Poor wound healing, bleeding gums, petechiae, scurvey
  237. What happens with levels of Vitamin C that are too high?
    Diarrhea
  238. What is a food source of Vitamin D?
    Fortified milk
  239. What is the function of Vitamin D in the body
    calcium regulation, cell differentiation
  240. Who is at risk for Vit D deficiencies?
    Elderly, those with low sun exposure
  241. What happens to patients with Vit D deficiencies?
    Osteomalacia, ricketts
  242. What happens with toxic levels of Vit D>?
    hypercalcemia, renal calcuil, soft tissue calcium deposits
  243. What are some food sources of Vitamin K
    spinach, broccoli, asparagus
  244. What cartoon character is �strong to the finish� and is NOT at risk of vitamin K deficiency? Bonus question what vitamin deficiency is this cartoon character at risk of?
    • Poppy the sailor man!
    • Because he is a sailor traditionally he would be at risk of ricketts because of a vitamin C deficiency however college students have passed sailors as the group of people most at risk for Vit C defic.
  245. What can Vitamin K deficiency cause?
    Bleeding deficiencies effects in factors VII, IX, X and prothrombin
  246. Is vitamin K fat or water soluble?
    Fat
  247. Riboflavin (B2) is found in what foods?
    Meat, fish, eggs, milk, green veggies, enriched foods
  248. Deficiencies of Riboflavin lead to what manifestations?
    Cheilitis, glossitis stomatitis, mucosal edema
  249. Thiamine (B1) is found in what foods?
    Pork, grains, peas, dried beans, brewer's yeast,
  250. What is Thiamine's function in the body?
    CHO metabolism, nerve functioning
  251. What patient population is at risk for thiamine deficiency?
    Poverty, alcoholics
  252. What are some consequences of thiamine deficiency?
    • Beriberi- tingling poor coordination, weakness, edema possible cardiac dysfunction
    • Wernikes encephalopathy
  253. Wernike's encephalopathy- name the deficiency
    thamine deficiencies
  254. Beriberi- name the deficiency
    Thamine deficiency
  255. Chelitis, glossitis, stomatitis mucosal edemal name the deficiency
    riboflavin
  256. Bleeding problems � name the deficiency
    Vitamin K
  257. Osteomalacia name the deficiency
    Vitamin D
  258. Scurvy � name the deficiency
    Vitamin C
  259. Ricketts- name the deficiency
    Vitamin D
  260. night blindness � name the deficiency
    Vitamin A

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