D118 Unit 2 Lecture

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Questions and Answers

What is anaphylaxis?

A common cold symptom

A chronic skin condition

An acute life-threatening systemic event (correct)

A mild allergic reaction

Where can the list of most common potential allergens be found?

Page 150 of the clinical practice guidelines textbook

Page 183 of the primary care textbook (correct)

Page 200 of the primary care textbook

Page 210 of the clinical practice guidelines textbook

How quickly can an anaphylactic reaction occur after exposure?

Within weeks to months

Within hours to days

Within seconds to minutes (correct)

Within days to weeks

What is the main cause of an anaphylactic reaction?

Rapid release of immunoglobulin E Signup and view all the answers

Which body systems can be affected by manifestations of an anaphylactic reaction?

Cardiovascular, respiratory integumentary, gastrointestinal, and central nervous systems Signup and view all the answers

What is the potential consequence of an anaphylactic reaction in the airway?

Bronchospasm, hypoxia Signup and view all the answers

What is the primary risk factor in the development of gastric cancer?

Infection with H. pylori Signup and view all the answers

Which bacteria is the most likely pathogen causing travelers' diarrhea?

E. coli Signup and view all the answers

How long can travelers' diarrhea typically last?

3-7 days Signup and view all the answers

What is the recommended treatment for travelers' diarrhea if it persists beyond 1 week?

Ciprofloxacin Signup and view all the answers

How can travelers avoid contracting travelers' diarrhea?

Drinking sealed beverages Signup and view all the answers

What are the main routes of transmission for infectious diarrhea?

Foodborne, waterborne, and person to person Signup and view all the answers

Which diagnostic tests are available to detect H. pylori?

Stool test, breath test, and serology tests Signup and view all the answers

How do infectious diarrheal diseases rank in terms of global morbidity and mortality?

Second leading cause worldwide Signup and view all the answers

What is the duration reduction caused by antibiotic treatment in diarrhea cases?

1 day Signup and view all the answers

What is the recommended dose of epinephrine for adults in the treatment of anaphylaxis?

1 milligram per milliliter Signup and view all the answers

What is the primary goal of treating vertigo?

Managing the underlying causes Signup and view all the answers

What is the max recommended dose of epinephrine for children in the treatment of anaphylaxis?

0.01 milligrams per kilogram Signup and view all the answers

Which of the following is a peripheral cause of vertigo?

Monir disease Signup and view all the answers

What defines absolute bradycardia?

Heart rate less than 60 beats per minute Signup and view all the answers

What is a reversible cause of bradycardia mentioned in the text?

Lyme disease Signup and view all the answers

What is the key difference between community-acquired pneumonia and hospital-acquired pneumonia?

Onset time after hospital admission Signup and view all the answers

What does symptomatic bradycardia associated with Mobitz type 2 or 3rd degree heart block require?

Immediate referral Signup and view all the answers

Which group of symptoms is commonly associated with pneumonia in older adults?

Fatigue and lethargy Signup and view all the answers

Which organization recommends atropine for unstable patients with bradycardia?

The American Heart Association Signup and view all the answers

What is a characteristic feature of vertigo according to the text?

Clear sensation of spinning or tilting Signup and view all the answers

What is considered the initial management approach for stable and asymptomatic patients with bradycardia?

Continued monitoring Signup and view all the answers

What defines healthcare-associated pneumonia as per the text?

Pneumonia linked to recent extensive healthcare interactions Signup and view all the answers

What does 'bundle branch block' refer to in the context provided?

'Block' in the heart's electrical system Signup and view all the answers

Which diagnostic tests are mentioned for vertigo in the text?

Webber and Ryan tests Signup and view all the answers

What medication may be used as a vestibular suppressant for severe vertigo?

Meclizine Signup and view all the answers

What is the initial management approach for a patient with new-onset bundle branch block?

Evaluation of underlying cause and hemodynamic stability Signup and view all the answers

What is the most common bacterial pathogen associated with acute otitis media?

Haemophilus influenzae Signup and view all the answers

In patients with recurrent acute otitis media, when is a referral indicated?

After 3 episodes in 6 months or 4 episodes in a year Signup and view all the answers

What is considered the first-line antibiotic therapy for acute otitis media in children?

Amoxicillin-clavulanate Signup and view all the answers

What is the most common initial complaint in acute otitis media?

Ear rubbing Signup and view all the answers

What diagnostic tests can be used to assess for conductive or sensory neural hearing loss?

Webber and Rinne tests Signup and view all the answers

What is the main characteristic of Otitis Media with Effusion (OME)?

Fluid in the middle ear without symptoms Signup and view all the answers

Which of the following is NOT a potential cause of sudden hearing loss in adults?

Infections such as Lyme disease Signup and view all the answers

What is the recommended treatment approach for non-severe acute otitis media?

Watchful waiting with close follow-up within 48 to 72 hours Signup and view all the answers

Which bacterial pathogen is associated with causing conductive hearing loss in acute otitis media?

Staphylococcus aureus Signup and view all the answers

Study Notes

Anaphylaxis

Acute, life-threatening, systemic event associated with hypersensitivity reaction
Manifestations occur across multiple organ systems:
- Cardiovascular
- Respiratory
- Integumentary
- Gastrointestinal
- Central nervous systems
Reactions can occur within seconds to 2 days after exposure
Common potential allergens:
- Listed in primary care textbook, page 183
Anaphylactic reaction occurs due to:
- Rapid release of immunoglobulin E
- Immune hypersensitivity reaction
- Activation of mast cells and basophils
- Leading to potentially life-threatening upper or lower airway obstruction
Clinical presentations may vary in severity:
- Periodic rashes to severe systemic manifestations
Diagnosis is based on:
- Clinical presentation
- History
- Physical examination

Treatment of Anaphylaxis

Epinephrine is the 1st line treatment
Dosage for adults:
- 1:1000 dilution, 1 mg/mL, 0.2-0.5 mg, repeated every 5-15 minutes, max dose 1 mg
Dosage for children:
- 1:1000 dilution, 1 mg/mL, 0.01 mg/kg, repeated every 5-20 minutes, max dose 0.3 mg
Non-pharmacologic management:
- Maintenance of airway, breathing, circulation, and level of consciousness

Bradycardia

Defined as a heart rate of less than 60 beats per minute
Types:
- Absolute bradycardia
- Relative bradycardia
Causes:
- Trauma
- Hypovolemia
- Infectious process
- Drug toxicity
- Electrolyte abnormality
- Lyme disease
- Transient injury to the conduction system
Symptoms:
- Dizziness
- Fatigue
- Syncope
Diagnostic testing:
- Glucose levels
- Electrolyte values
- Blood urea nitrogen (BUN) level
- Creatinine concentration
- Liver function tests
- Complete blood count (CBC)
- Thyroid panel
- Chest X-ray
Initial management:
- Dependent on history and physical examination
- Intervention not necessary if patient is stable and asymptomatic
- Continued monitoring indicated for patient's wellbeing and safety

Bundle Branch Block

Disruption of conduction as it moves down the bundle branches
Causes:
- Structural heart disease
- Congenital conditions
- Cardiac disease
- Coronary artery disease
Symptoms:
- Similar to those discussed in previous slide
Diagnostics:
- 12-lead electrocardiogram
- Halter monitor
- Laboratory testing
- Cardiac imaging
- Stress test
Management:
- Focused on treatment of underlying cause
- Treatment of symptoms

Otitis Media

Characterized by fluid in the middle ear
Associated with inflammatory or infective processes
Bacterial positive agents:
- Streptococcus pneumoniae
- Hemophilus influenzae
Infections can be caused by both bacteria and viruses
Most common initial complaint:
- Sudden onset of ear pain, worse in the prone position
Diagnosis:
- Examination of the inner ear
- Tympanic membrane assessment
- Webber and Ryan tests
Management:
- Based on each person's medical history, physical examination, and presentation
- Initial observation includes a plan for treatment of associated symptoms
- Pain management and planned provider contact within 24 hours for follow-up assessment

Hearing Loss

Classified into 3 types:
- Conductive
- Sensorineural
- Mixed
Causes of sudden hearing loss in adults:
- Sudden idiopathic sensorineural hearing loss
- Infections
- Perry lymphatic fistula
- Schematic of the inner ear
- Retrocochlear structures
- Multiple sclerosis
- Autoimmune diseases
- Trauma
- Chronic renal failure
- Sickle cell anemia
Gradual hearing loss:
- Noise exposure
- Familial factors
- Retrocochlear neoplasm
- Chronic hepatitis
- Diabetes
- Chronic renal failure
Differential diagnosis:
- Titus media
- Perry lymphatic fistula
- Monir disease
- Multiple sclerosis
- Autoimmune disorders

Vertigo

Illusion of movement of oneself or the environment
Causes:
- Peripheral causes:
  - Benign paroxysmal positional vertigo
  - Vestibular nerve
  - Acute labyrinthitis
  - Ototoxicity
  - Head trauma
- Central disorders:
  - Brainstem or cerebellar
  - Hemorrhage
  - Tumors
  - Multiple sclerosis
  - Migraine syndrome
Associated symptoms:
- Nausea
- Vomiting
- Diaphoresis
- Disequilibrium
- Sadness
- Blurry vision
- Ear symptoms (pain or pressure)
Diagnostics:
- Shown in image on slide

Pneumonia

Leading cause of morbidity and mortality in the United States
Community-acquired pneumonia:
- Defined by the Infectious Diseases Society of America
- Frequently associated with at least 2 symptoms of active infection
- Occurs in individuals who have not been hospitalized or resided in a long-term care facility for 14 days before the onset of symptoms
Hospital-acquired pneumonia:
- Defined as pneumonia that occurs 48 hours or more after hospital admission
- Did not appear to be incubating at the time of admission
Health care-associated pneumonia:
- Defined as pneumonia that occurs in a non-hospitalized patient
- Has extensive health care contact
Clinical presentation:
- History of fever, chills, or rigors
- Malaise
- Cough with or without sputum production
Older adults may show:
- Fatigue
- Lethargy
- Decreased appetite
- Increased falls
- Mental status changes

H. Pylori

Gram-negative bacteria
Transmitted via the fecal-oral route in early childhood
Causes both peptic and ulcers
Primary risk factor in the development of gastric cancer
Diagnostic tests:
- Stool test
- Urea breath test
- Serology tests
Treatment:
- Discussed in d116
- General guidelines for treatment shown on slide

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Test your knowledge on halter monitor testing, cardiac imaging, stress tests, and bundle branch block conduction disruptions. Learn about the management of Brady, evaluation for coronary disease, and underlying causes of bundle branch block.