D118 Unit 2 Lecture

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What is anaphylaxis?

An acute life-threatening systemic event

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

Page 183 of the primary care textbook

How quickly can an anaphylactic reaction occur after exposure?

Within seconds to minutes

What is the main cause of an anaphylactic reaction?

Rapid release of immunoglobulin E

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

Cardiovascular, respiratory integumentary, gastrointestinal, and central nervous systems

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

Bronchospasm, hypoxia

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

Infection with H. pylori

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

E. coli

How long can travelers' diarrhea typically last?

3-7 days

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

Ciprofloxacin

How can travelers avoid contracting travelers' diarrhea?

Drinking sealed beverages

What are the main routes of transmission for infectious diarrhea?

Foodborne, waterborne, and person to person

Which diagnostic tests are available to detect H. pylori?

Stool test, breath test, and serology tests

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

Second leading cause worldwide

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

1 day

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

1 milligram per milliliter

What is the primary goal of treating vertigo?

Managing the underlying causes

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

0.01 milligrams per kilogram

Which of the following is a peripheral cause of vertigo?

Monir disease

What defines absolute bradycardia?

Heart rate less than 60 beats per minute

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

Lyme disease

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

Onset time after hospital admission

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

Immediate referral

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

Fatigue and lethargy

Which organization recommends atropine for unstable patients with bradycardia?

The American Heart Association

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

Clear sensation of spinning or tilting

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

Continued monitoring

What defines healthcare-associated pneumonia as per the text?

Pneumonia linked to recent extensive healthcare interactions

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

'Block' in the heart's electrical system

Which diagnostic tests are mentioned for vertigo in the text?

Webber and Ryan tests

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

Meclizine

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

Evaluation of underlying cause and hemodynamic stability

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

Haemophilus influenzae

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

After 3 episodes in 6 months or 4 episodes in a year

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

Amoxicillin-clavulanate

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

Ear rubbing

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

Webber and Rinne tests

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

Fluid in the middle ear without symptoms

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

Infections such as Lyme disease

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

Watchful waiting with close follow-up within 48 to 72 hours

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

Staphylococcus aureus

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

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.

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