Unit 3 Study Guide.docx

Unit 3 What laboratory test would you use to confirm an allergic reaction? To confirm allergic reactions, serum IgE levels are measured, indicating exposure to allergens like animal dander, foods, pollens, and drugs. Elevated IgE suggests an allergic response. IgE testing is especially useful when s...

Unit 3 What laboratory test would you use to confirm an allergic reaction? To confirm allergic reactions, serum IgE levels are measured, indicating exposure to allergens like animal dander, foods, pollens, and drugs. Elevated IgE suggests an allergic response. IgE testing is especially useful when skin testing is impractical or risky. It's valuable for patients with difficult skin conditions or infants. Besides IgE, IgG antibody testing is available, often done in panels for cost-effectiveness. These tests help identify allergens and guide treatment strategies, including allergen avoidance and medication use like bronchodilators and antihistamines. They also assist in identifying latex allergies, increasingly common among certain professionals and patients. Discuss the causative factors and treatments for traveler’s diarrhea. What symptoms would the patient present with? The primary bacterial culprits include Enterotoxigenic Escherichia coli (ETEC), often found in areas with poor sanitation, where symptoms typically manifest as sudden onset profuse watery diarrhea accompanied by abdominal pain, cramping, malaise, and occasionally, a low-grade fever. Campylobacter jejuni, prevalent in undercooked poultry and unpasteurized milk, presents with bloody, mucoid diarrhea, abdominal cramping, and fever. Shigella species, transmitted person-to-person via fecal-oral route, induce fever, bloody diarrhea, and tenesmus. Non-typhoidal Salmonella species, commonly found in raw or undercooked eggs and poultry, incite profuse watery diarrhea with abdominal pain and fever. Among viral causes, Norovirus and Rotavirus, prevalent in crowded or inadequately sanitized environments, provoke sudden vomiting, diarrhea, abdominal cramps, and low-grade fever. Parasitic agents like Giardia lamblia, found in contaminated water, evoke foul-smelling, greasy diarrhea, abdominal cramps, and bloating, whereas Cryptosporidium, also transmitted through contaminated water, leads to watery diarrhea, stomach cramps, nausea, and fever. Treatment strategies for traveler's diarrhea typically involve oral rehydration therapy to prevent dehydration, dietary adjustments such as a BRATY diet (bananas, rice, applesauce, toast, yogurt) to ease symptoms and provide easy-to-digest nutrition, and the use of antimotility agents like loperamide 2 mg after loose stools (max dose 16 mg/day)to decrease the frequency of diarrhea episodes. However, antimotility agents should be avoided in cases of severe bloody diarrhea with fever. In moderate to severe cases or when symptoms persist, antibiotics like Azithromycin 500 mg once daily for 3 days, is standard. It's essential for individuals experiencing traveler's diarrhea to promptly address symptoms and seek medical attention if diarrhea persists, worsens, or if signs of dehydration or systemic illness develop. By understanding the likely pathogens and associated symptoms, travelers can take preventive measures and seek appropriate treatment when needed. Review the clinical practice guidelines for pneumonia. How do these guidelines differ for CAP vs nosocomial? Community-acquired pneumonia (CAP) presents as an active acute infection of the pulmonary parenchyma (with at least 2 symptoms), primarily affecting individuals who have not been hospitalized or resided in long-term care facilities for 14 days from onset of symptoms. Streptococcus pneumoniae is a common culprit, although other organisms like Mycoplasma pneumoniae and Legionella can also cause CAP. Symptoms of CAP include: - Tachypnea, especially prominent in the elderly - Fever, malaise, myalgia - Cough with or without sputum - Exertional dyspnea, chest pain with inspiration, hypoxia - Anorexia, possible gastrointestinal symptoms - Decreased breath sounds, crackles, wheezing - Egophony, pleural friction rub, dullness to percussion - Decline in functional and mental status, particularly in the elderly. Diagnostic criteria: Sudden onset of fever, chills, productive cough, pleuritic chest pain, and signs of lobar consolidation on imaging. Atypical causes may manifest with interstitial infiltrates on chest X-ray. Treatment: Based on patient factors and comorbidities, antibiotics such as doxycycline, azithromycin, or clarithromycin are prescribed for patients without comorbidities. Those with comorbidities may require moxifloxacin, gemifloxacin, or levofloxacin. Duration of antibiotics ranges from 5 to 7 days, with adjustments based on individual cases. Pharmacologic adjuncts like oxygen therapy, NSAIDs, and bronchodilators are considered as needed. 1. Doxycycline 100 mg bid 2. Azithromycin 500 mg qd x 3 days 3. Clarithromycin 250 mg q12h Nosocomial pneumonia, also known as hospital-acquired pneumonia, occurs 48 hours or more after hospital admission and is often associated with multidrug-resistant organisms due to exposure within healthcare environments. Diagnostic considerations: Similar clinical manifestations as CAP, but with a higher suspicion for multidrug-resistant organisms. Diagnostic tests include blood cultures, sputum cultures, and imaging studies to determine lung involvement. Treatment: Broader-spectrum antibiotics are often required to cover resistant pathogens encountered in healthcare settings. Selection is guided by risk factors for multidrug-resistant organisms and previous antibiotic exposure. Infection control measures and antimicrobial stewardship play critical roles in managing nosocomial pneumonia to prevent transmission and mitigate resistance development. For what types of hearing loss and/or what situations related to hearing loss would you recommend an ENT referral? Immediate specialist referral to an otolaryngologist or neurologist is indicated for patients with sudden or rapidly progressive hearing loss. OR if the diagnosis is unclear ENT referral for tympanostomy tubes is indicated for recurrent AOM (three episodes in 6 months or four or more episodes in 1 year with one episode in preceding 6 months). Vestibular Neuritis: If symptoms persist over 4-6 weeks despite treatment, or severe bacterial infection is suspected. Tinnitus: Refer if persistent and affecting quality of life Otitis externa (OE): Consider referral for severe or recurrent outer ear infections causing otalgia, otorrhea, or swelling of the external auditory canal. Otitis media with effusion (OME): Refer for persistent fluid buildup behind the eardrum causing hearing difficulties, especially in children. Acute bacterial rhinosinusitis: Refer if symptoms persist over 10 days or worsen despite initial treatment. Chronic rhinosinusitis (CRS): Consider referral if symptoms persist despite medical management, or if there are complications like nasal polyps. Pharyngitis: Consider referral if symptoms persist despite treatment, or if concerns arise about conditions like tonsillitis or peritonsillar abscess. Hearing loss: Refer for significant or progressive hearing loss interfering with daily activities or communication for comprehensive evaluation and management. Review the clinical practice guidelines for otitis media with effusion. What are common clinical findings? Discuss you plan of care for a patient with OM. 1. Fluid in the middle ear: OME is characterized by the presence of fluid in the middle ear space, which may lead to symptoms such as hearing loss, a sensation of fullness in the ear, or a blocked sensation. 2. Conductive hearing loss: Patients with OME may experience difficulty hearing or may have complaints of muffled sounds due to the presence of fluid in the middle ear. 3. History of upper respiratory tract infections or allergies: OME may be associated with previous upper respiratory tract infections or allergic rhinitis. 4. Absence of acute inflammation: Unlike acute otitis media, patients with OME typically do not present with signs of acute inflammation such as ear pain, fever, or erythema of the tympanic membrane. Plan of Care for a Patient with Otitis Media with Effusion (OME): 1. Assessment: - Perform a thorough history and physical examination, including otoscopy to visualize the tympanic membrane. - Assess for symptoms such as hearing loss, ear fullness, or a blocked sensation. - Rule out acute otitis media or other causes of middle ear pathology. 2. Diagnosis: - Confirm the presence of fluid in the middle ear through otoscopic examination. - Consider additional diagnostic tests such as tympanometry and audiometry to assess the severity of hearing loss and to differentiate between conductive and sensorineural hearing loss. 3. Management: - Watchful waiting: In many cases, OME resolves spontaneously without intervention. Therefore, a conservative approach with observation is often recommended, particularly in children with mild or unilateral OME. - Symptomatic treatment: Address associated symptoms such as hearing loss or ear fullness. This may involve the use of decongestants or nasal steroids to alleviate nasal congestion and improve Eustachian tube function. - Antibiotic therapy: Antibiotics are not routinely recommended for the treatment of OME unless there is evidence of acute bacterial infection or significant systemic symptoms. - Referral: Consider referral to an otolaryngologist for patients with persistent or recurrent OME, hearing loss, or concerns regarding complications such as speech delay or developmental issues. 4. Follow-up: - Schedule regular follow-up appointments to monitor the resolution of OME and assess for any changes in symptoms or hearing status. - Reevaluate the need for intervention or referral based on the patient's clinical course and response to treatment. What is the first line treatment for bundle branch block? The first priority with cardiac arrhythmias is to establish the presence of a pulse. Determine hemodynamic stability (blood pressure and clinical symptoms) to differentiate the cause. Using ECG, Holter monitor and imaging along with a stress test. After the BBB becomes Chronic, it will be periodically monitored and usually remains astymptomatic. Pacemaker might be utilized. What are the diagnostic steps for a patient with suspected H. Pylori? What is the recommended treatment? Stool PCR test, Breath Urea Treatment: 1st Line PPI/ Ranitidine+Amoxicillin+Clarithromycin, 2nd line PPI, Bismuth, Tetracycline, Metronidazole How would you treat symptomatic bradycardia? Why? Mobitz Type 2 Second degree heart block or 3rd degree heart block. Give Atropine 0.5 mG, IV every 3-5 min up to 3 mg (approximately 18 but up to 30 minutes). Should be referrred to the ED. Common symptoms dizziness, fatigue and syncope. Check glucose levels. Atropine is used to treat symptomatic bradycardia because it blocks the action of acetylcholine, increasing heart rate and improving conduction through the heart's electrical system. This helps alleviate symptoms like dizziness and fatigue. If symptoms persist or adverse effects occur, referral to the Emergency Department is necessary. Glucose levels should be checked to rule out hypoglycemia, which can mimic bradycardia symptoms. What is Curb-65 criteria? How is it used and how do you interpret it? The CURB-65 tool aids in assessing disease severity, guiding decisions on admission. Confusion, Uremia [blood urea nitrogen >20 mg/dL], Respiratory rate >30 breaths per minute, Blood pressure low [<90 mm Hg systolic or 60 mm Hg diastolic] 65 years of age or older) Scores of 2 or higher need hospitalization or home health services What medications and dosages are appropriate for treating Vertigo? Why? Meclizine, 25 to 50 mg every 6 hours, is commonly used and acceptable in pregnancy. Meclizine is the least sedating option and therefore the most common therapy.