CMN 577 Unit 2 exam with complete solutions, Exams of Public Health

Download CMN 577 Unit 2 exam with complete solutions and more Exams Public Health in PDF only on Docsity! CMN 577 Unit 2 exam with complete solutions In performing the PE on a patient with a neurological complaint, what is important to take note of? - ANSWER- General appearance and affect, Establish mental status, Oberve motor function/gain, Consider cranial nerves, reflexes, fundoscopic and sensory exam 10-20% of treatable causes of altered mental status include? - ANSWER- B12 deficiency, infection, polypharmacy, alcohol/drug abuse What may be psychosocial factors in altered mental status? - ANSWER- Depression, Anxiety, Grief, ? Elder Abuse STM loss is associated with? - ANSWER- B12 deficiency and Hypothyroidism What diagnostic tests should be performed in AMS? - ANSWER- UA, CBC, BMP, B12, RPR, ESR, and TSH——- Further tests dependent upon complaints/symptoms What test is the gold standard for a dementia work-up and is often useful for ruling out stroke, masses, etc...? - ANSWER- Head CT Scan Rhonda is a 68 y.o woman who has started having problems remembering things in the last few days (like where she put her keys). She comes to your clinic and you test a UA and see she has a raging UTI and fever. Is Rhonda demented or delirious? - ANSWER- Delirious Some acute mental status changes noted in delirium include? - ANSWER- Confusion, hallucinations, restlessness, and incoherent speech Onset of dementia is gradual and progressive, and usually occurs after age ?? - ANSWER- 60 Gil is a 62 y.o Male coming into the clinic today (with his daughter) with progressive loss of speech and memory problems, as well as angry outbursts. Upon investigation, Gil is found to have a build-up of Tau proteins in his neurons that have accumulated into silver-staining, spherical aggregations. What is Gil's diagnosis? - ANSWER- Pick's Disease What is the first noticeable difference between Pick Disease and Alzheimer's? - ANSWER- the personality change that hallmarks the onset of Pick's disease versus the short term memory loss of Alzheimer's Hillary has a recent diagnosis of dementia and comes into the clinic today with her daughter. Hillary has been talking to her deceased sister around the house and is increasingly drowsy. What type of dementia do you suspect? - ANSWER- Lewy Body Dementia Lewy body dementia and Parkinson's disease can result in? - ANSWER- Rigid muscles, slowed movements, and tremors In Lewy body dementia, protein deposits develop in nerve cells in regions of the brain involved in? - ANSWER- Thinking, memory, and movement What diagnostic tests are appropriate for Alzheimer's diagnosis? - ANSWER- CBC, CMP, TSH, B12, RPR, CT Head What is the name of the prescription medical food that is intended for the clinical dietary management of the metabolic processes associated with mild to moderate Alzheimer's disease? - ANSWER- Axona What are the treatment options for Alzheimer's Disease? - ANSWER- Cholinesterase Inhibitors (memantine (Namenda)) and antidepressants, diet and exercise What tests are helpful in evaluating/diagnosing Dementia? - ANSWER- MMSE (not used anymore), MoCa, SLUMS, and Mini-Cog The Mini-Cog should be used for initial testing. If (+), then move on to? - ANSWER- MoCa or SLUMS What is NPH? - ANSWER- Normal Pressure Hydrocephalus- It is an enlargement of the ventricles WITHOUT increased ICP- presents in >/= 60 y.o What is necessary for a definitive diagnosis of MS? - ANSWER- MRI + 2 episodes involving 2 CNS areas/symptoms or progression of symptoms over a six month period What are some symptoms of MS? - ANSWER- Blurred vision, diploma, loss of balance, weakness, parathesias, vertigo, slurred speech, extreme fatigue, Lhermitte sign, DTR's are often HYPER-reflexive with a + Babinski sign Trigeminal Neuralgia has an onset of after what age? - ANSWER- 40 - Peak onset is 60-70- Maxillary Branch is most commonly affected Post Herpetic Neuralgia occurs in females older than ? - ANSWER- 80- They experience prodromal Pain BEFORE rash Wernicke-Korsakoff Syndrome is caused by a deficiency of? - ANSWER- Thiamine What gene is a risk factor for Alzheimer's? - ANSWER- APO-e4 What are some medication classes that can cause delirium? - ANSWER- Steroids, Opioids, Digoxin, Diuretics, Anticholinergics, H2 Blockers What are some medications to avoid in patients > 65 y.o? - ANSWER- Benadryl, Macrobid, Alpha Blockers, Benzos, Digoxin (doses > 0.125mg), TCA's, estrogens, sliding scale insulin, Megace, etc..... The elderly should be screened and educated regarding risks/transmission of ? - ANSWER- HIV Prognosis is? - ANSWER- The likely course of a disease or an ailment- this is measured using "risk points". >10 points of risk factors translates into an increased risk of mortality in the next 4 years Function is? - ANSWER- A variable that depends on and varies w/ another (measured w/ Katz assessment tool and/or IADL tool) Frailty is? - ANSWER- Term used in describing elderly who have lost their functional reserve- consider them for rehabilitation to improve strength, walking, and ability to perform ADL's A score of less than ?? On the MoCa test is considered + for dementia - ANSWER- Less than 26 (per Turnham's Keynotes) Acetylcholinesterose inhibitors are indicated for treatment of? - ANSWER- Mild to moderate Alzheimer's- meds are donepezil, galantamine, and rivastigmine What medication is indicated for moderate to severe Alzheimer's? - ANSWER- Meantime (Namenda) What are SXS of depression in the elderly? - ANSWER- Altered LOC/memory, weight loss, fatigue, etc... What medication is generally discouraged in the over 65 age group in the treatment of depression? - ANSWER- Fluoxetine- d/t the long half-life of the medication How long should a medication be trialed before discontinuing or trialing another, in the tx of depression? - ANSWER- At least 8 weeks Once depression is being appropriately treated, how long should medication therapy continue? - ANSWER- At least 6 months The Confusion Assessment Method (CAM) requires the presence of what 4 factors? - ANSWER- 1. Acute onset of mental status change 2. Inattention and EITHER: 3. Disorganized thinking OR 4. Altered LOC The "up and Go test" or Tug Test is used to assess the patient's mobility. The process should NORMALLY take? - ANSWER- Less than 10 seconds Harry took the TUG test and his time was 34 seconds. What is important to know? - ANSWER- Harry is more likely to need assistance with ADL's (hands on assistance) Vera Mae fell at second 12 of the TUG test. What is important to know? - ANSWER- Vera Mae has some functional decline that needs to be improved upon What are possible treatments for urinary incontinence in the elderly? - ANSWER- Check for triggers (UA, PSA, Renal US), bladder training, Kegel exercises, reducing weight and caffeine intake may be helpful What are the most common causes of hospital-associated disability? - ANSWER- Infrequent ambulation and Bedrest What is the leading cause of disability among elders? - ANSWER- OA Older adults who are diagnosed w/ HIV/AIDS are also at greater risks for being diagnosed with? - ANSWER- Cancers A score of >/= ____ on the DSS is considered sensitive for depression and/or suicidality - ANSWER- 2 All Older persons should be screened how often for previous falls/balance problems? - ANSWER- Once a year What are some physiologic risk factors for extreme temperature related conditions? - ANSWER- Extremes of age, cognitive impairment, poor physical conditioning/sedentary lifestyle, immobility, poor acclimatization, concurrent injury, prior temperature-related injury, and underlying medical conditions What are some pharmacological risk factors for extreme temperature related conditions? - ANSWER- Medications, holistic/alternative treatments, illicit drugs, tobacco, or alcohol What are some medications that are associated with a particularly high likelihood of worsening temp.-related conditions? - ANSWER- Anticholinergics, stimulants, sedatives, and peripheral vasoconstrictors or vasodilators A heat stroke is? - ANSWER- Hyperthermia with cerebral dysfunction in a patient with head exposure (Classic and Exertional) Heat cramping results from? - ANSWER- Dilutional Hyponatremia, as sweat losses are replaced with water alone Heat exhaustion results from? - ANSWER- Prolonged strenuous activity in a hot environment without adequate water or salt intake; Characterized by dehydration, sodium depletion, or isotonic fluid loss with accompanying cardiovascular changes The hallmark of heat stroke is? - ANSWER- Core body temperature over 40 Celsius After ABCDE, management of the burn patient includes: - ANSWER- Pain control, Tetanus immunization, antibiotic coverage (nonsuperficial depth wounds should be covered w/ topical antibiotics), surgical management prn Complications from burns include: - ANSWER- Sepsis gangrene, or neurological, cardiac, cognitive, or psychiatric dysfunction In an electrical injury, the extend of damage depends on: - ANSWER- Voltage, current type, tissue resistance, moisture, pathway, duration of exposure, associated trauma/comorbidities **Current is the most important determinant of tissue damage** In the electrical injury, it is important to know that : - ANSWER- Skin damage does NOT correlate with the degree of injury Acute effects of radiation exposure include: - ANSWER- Mucositis, N/V, GI edema/ulcers, skin burns, bone marrow suppresion Delayed effects of radiation exposure include: - ANSWER- Malignancy, reproduction abnormalities, liver, kidney, and CNS/Immune system dysfunction Treatment of radiation exposure focuses on? - ANSWER- Decontamination, symptomatic relief, supportive care, and psychosocial support ______ ________ and _______ ___________ of decompression sickness are extremely important - ANSWER- Early recognition and prompt treatment A patient with dysbarism and/or decompression sickness must also be assessed for ? - ANSWER- Hypothermia, hypoglycemia, concurrent injuries, and medical conditions Dysbarism and decompression sickness are ? - ANSWER- Physiologic problems that result from altitude changes and the effects of environmental pressure on the gases in the body during underwater descent and ascent Dysbarism results from? - ANSWER- Barotrauma when gas compression or expansion occurs in parts of the body that are non compressible or have limited compliance What is one of the most serious and potentially fatal results of barotrauma? - ANSWER- Pulmonary Overinflation syndrome- d/t rapid ascent causing alveoli rupture and air bubble extravasated now into tissue planes or even the cerebral circulation Decompression sickness occurs when? - ANSWER- Ascent is too rapid and gas bubbles form and cause damage depending on their location What are some predisposing factors to decompression sickness? - ANSWER- Obesity, injury, hypoxia, lung/cardiac disease, right to left cardiac shunt, diver's overall health, dehydration, alcohol/med effects, and panic attacks ** may also occur in those who take hot showers after cold dives** Preventive measures for decompression sickness include: - ANSWER- Diver education, pre-dive medical screening, dive planning, strict adherence to dive course, timing, and depths, slow, controlled ascent plus proper control of buoyancy. Avoid high altitudes for 24 hours after surfacing from the dive What are the symptoms of decompression sickness? - ANSWER- Pain in the joints (the bends), skin pruritus or burning, cardiac symptoms, spinal/cerebral symptoms, etc... (pg. 1586) ________, administered continuously at 100% is indicated and beneficial for all patients being treated for decompression sickness/dysbarism. - ANSWER- Oxygen What is the definitive treatment for high-altitude cerebral edema and high-altitude pulmonary edema? - ANSWER- Immediate Descent Symptoms of AMS (Acute Mountain Sickness) include? - ANSWER- HA, lassitude, drowsiness, dizziness, chilliness, N/V, difficulty sleeping. Late symptoms include irritability, difficulty concentrating, anorexia, insomnia, and increased HA's. HACE (high altitude cerebral edema) usually occurs at elevations above _______ meters, but MAY occur at lower elevations - ANSWER- 2500 Hallmark SXS of HACE include: - ANSWER- Altered LOC, ataxia, severe lassitude, and encephalopathy ——- may progress to obtundation, coma, and death Other than immediate descent to 2000 feet or less, what is the initial treatment for HACE, HAPE? - ANSWER- Oxygen administration Acetazolamide- treats mild symptoms of AMS, Dexamethasone is most effective for moderate to severe AMS If HAPE SXS are present w/ HACE SXS, use nifedipine for pulmonary vasodilation What is the leading cause of death from high altitude illness? - ANSWER- HAPE (high altitude pulmonary edema) The hallmark of HAPE is? - ANSWER- Markedly elevated pulmonary artery pressure followed by pulmonary edema- usually occurs at 3000 meters- SXS include incessant dry cough, SOB disproportionate to exertion, HA, fatigue, dyspnea at rest, Chest tightness——— Late SXS include: wheezing, orthopnea, and hemoptysis Other than immediate descent, what is the treatment for HAPE? - ANSWER- Rest, reclined with head elevated. Supplemental oxygen, Nefedipine. All long-distance air travelers can reduce the risk of VTE by? - ANSWER- Avoiding constrictive clothing, staying well-hydrated, changing positions frequently, avoiding cramped position, avoiding leg crossing, engaging in frequent in-flight leg exercises (q1hour), walking for 5 minutes every hour What kind of headache (acute or chronic) is more likely to relate to an intracranial disorder? - ANSWER- Acute, New, Or Severe HA In HA's, to prevent medication overuse, the use of simple analgesics should be limited to? Combination analgesics should be limited to no more than? - ANSWER- Simple analgesics- 15 days of less/month Combination analgesics- No more than 10 days/month who should avoid ergotamine-containing preparations? - ANSWER- Pregnant women, patients with cardiovascular disease or its risk factors, and patient's taking potent CYP 3A4 inhibitors Triptans are contraindicated in? - ANSWER- Patient's with coronary or peripheral vascular disease Opioid analgesics should be avoided in the treatment of HA's b/c of? - ANSWER- The high rates of rebound headaches and the tendency to develop medication overuse headaches Allison is a middle-aged woman who has a new headache that is worse when laying down, waking her up at night, peaking in the morning, and she is not for What is a simple strategy in preventing head injuries in children? - ANSWER- Wearing helmets while riding wheeled recreational devices, playing contact sports, and participating in snowsports Head injury symptoms in children include: - ANSWER- HA, Dizziness, N/V, disorientation, amnesia, slowed thinking, and perseveration Matthew took a tumble on his bicycle, but did not lose consciousness, so his mom knew he was fine. Several days later he is c/o dizziness, n/v, and seems a bit slow to his mom. What is the probable diagnosis and what is important to communicate to his mother? - ANSWER- Concussion- Loss of consciousness is NOT necessary to diagnose a concussion. What are symptoms of acute intracranial hypertension in children? - ANSWER- Altered mental status, HA, vision changes, vomiting, gait difficulties, and pupillary abnormalities What is a cardinal sign of increased ICP? - ANSWER- Papilledema- Other signs may include stiff neck, cranial nerve palsies, and hemiparesis What is a late and ominous finding in acute intracranial HTN? - ANSWER- Cushing Triad (bradycardia, HTN, and irregular respiration's) Children with concussions can return to sports when? - ANSWER- when symptom-free at rest and during exercise w/out medication use, followed by a GRADUAL return to play protocol Persistent concussion symptoms indicate a need for? - ANSWER- Rehabilitation and/or neuropsychological referral An individual is considered frail when three of more of what features are present? - ANSWER- Weakness, Slow gait speed, decreased physical activity, weight loss, and exhaustion or low energy What are the most bothersome SE's of acetylcholinesterase inhibitors? - ANSWER- Diarrhea, Nausea, anorexia, weight loss, and syncope What patients should avoid the atypical antipsychotics? - ANSWER- Patient's with vascular risk factors (increased risk of stroke), they can cause weight gain and are associated w/ hyperglycemia in diabetic patients FDA has issued a warning against Citalopram, in doses > 40mg daily, because of the risk of? - ANSWER- Dysrhythmia from QT interval prolongation What are the medications of choice for management of episodes of delirium? - ANSWER- Antipsychotic agents (pg. 62) What is the leading cause of death from injury in persons over age 65? - ANSWER- Complications from falls What medication classes are most likely associated with falls? - ANSWER- Sedative/Hypnotics, antidepressants, and benzodiazepines What are the most common fractures result in from falls? - ANSWER- Wrist, Hip, Vertebrae Detrusor overactivity: Urge incontinence is the most common cause of established geriatric incontinence. What is the cornerstone of treatment? - ANSWER- Bladder training A complete eye examination should be performed how often in the elderly? - ANSWER- Annually or Biannually What are some suggestions for the delivery of serious news? (Pg. 75, box 5-1) - ANSWER- Prepare an appropriate place/time, address basic info, be direct, allow for silence and emotions, assess/validate patient reactions, respond to immediate discomforts/risks, listen actively, express empathy, achieve common perception of problem, reassure about pain relief, ensure f/u and make specific plans for future What are some clinician interventions that are helpful to families of dying patients? - ANSWER- Excellent Communication, Advance care planning and clear decision making, support for home care, empathy, attention to grief and bereavement What are some pharmacologic options for neuropathic pain? Pg. 94, table 5-9 - ANSWER- Nortriptyline, Desipramine, Gabapentin, Pregabalin, Duloxetine, Venlafaxine, opioids, lidocaine (transdermal), and tramadol In the treatment of acute pain in children, what med class is typically used? - ANSWER- NSAIDs- Acetaminophen is the most commonly used What are the side effects of Ketorolac? - ANSWER- Renal insufficiency, gastric irritability, and prolonged bleeding times d/t decreased platelet adhesiveness What are SXS of withdrawal in older children? - ANSWER- Agitation, irritability, dysphasia, tachycardia, tachypnea, nasal congestion, temperature instability, and feeding intolerance What are SXS of withdrawal in neonates? - ANSWER- Neurological excitability, GI dysfunction, autonomic signs, and skin excoriation secondary to excessive rubbing