Prev med exam 3 - Jacked and Edited

@Kayceedcross

stimulates appetite (weight gain)

Moderate alcohol consumption….

depresses appetite (weight loss = gaunt)

Chronic alcohol consumption…

Decrease production of mucosal enzymes → Disaccharides, lipases, dipeptidases impaired transport of nutrients into the cells → Facilitated diffusion, active transport

Describe the effects of chronic alcohol abuse on digestion and absorption

Decreases protein synthesis in the pancreas → Reduces production of pancreatic enzymes; Inhibits glucose uptake and glycogen synthesis in muscle → Impairs utilization of glucose for energy, especially under anaerobic conditions

Describe the effects of chronic alcohol abuse on nutrient metabolism

hematologic problems

folate deficiency leads to…

suppressed appetite, nutrient content of the diet is often poor, interferes with ability to absorb & utilize nutrients

3 reasons for malnutrition due to alcohol abuse

Folate, Thiamin, B12, calcium, magnesium, (macrocytic anemia) and ADEK

What are some examples of malabsorption in chronic alcohol abuse

macrocytic anemia

What type of anemia is common in alcoholics

thiamine deficiency

Wernicke's encephalopathy =

visual disorders, confusion, ataxia and coma

Wernicke's encephalopathy s/sx

Dermatitis, Diarrhea, Dementia, Death

Signs of Pellagra (B3)

Fatty liver (steatosis), Alcoholic hepatitis, Cirrhosis

What are the 3 forms of EtOH liver

Niacin (B3)

Treatment plan for Pellagra

short term memory issues

Korsakoff's syndrome s/sx

malabsorption issues with thiamin and B6

peripheral neuropathy is due to _______ in chronic alcohol users

30%

Alcoholic hepatitis occurs in ____ of chronic alcohol users

80%

Fatty liver is seen in more than ____ of all cases of chronic ETOH abuse

Portal hypertension, Fluid retention (Ascites, LDH above 60%, diagnose and treat w/ a para), Bleeding varices (Esophageal Varices)

Severe cases of steatosis (fatty liver) in chronic alcohol users may show evidence of?

Result of Liver failure and ETOH abuse → scar tissue can block the flow of blood through the liver → Portal HTN → pushes blood to smaller vessels → acute rupture → Death

Etiology of Esophageal varices with hemorrhages

Fatigue, Weakness, Fever, Hepatomegaly

s/sx of ETOH hepatitis

Cancer, Pregnancy, Liver disease

What conditions is there no safe level of ETOH consumption?

Be Careful! It’s impossible to conclude that ETOH improved outcomes are directly related to alcohol consumption

Should we ever recommend alcohol use

risk of short-term harm, long-term chronic health problems

Drinking at levels above the moderate drinking guidelines significantly increases

5 (males)/4 (females) or more drinks on an occasion

Binge Drinking defined as?

15 or more drinks per week for males; 8 (females)

Heavy Drinking defined as?

17% (Binge Drinking); 6% (Heavy Drinking)

Prevalence of Binge/Heavy Drinking in the US adult population (based on reports)

18-34 🥇, 34-44 🥈 , High School students (14-18) 🥉

What is the most common age group that engages in binge drinking?

1 (females unless pregnant then 0), 2 (males)

Guidelines for moderate drinking (women, men, pregnant)

40%

What percentage of teens think Rx meds are safe relative to street drugs?

2nd 🥈

Unintentional drug poisonings are now the ________ leading cause of accidental death in the US

30%

How many teens think Rx drugs are not addictive?

600%

Since 2000, admission to treatment centers for opioid/street opioid dependence has increased _______

Marijuana, then pain relievers (opioids)

Teens tend to abuse

10%

____ of 12th graders have taken a Vicodin (opioid) without prescription in the last year

learning to change the way they take the drug (Crush it/Snort it) leading to more drug all at once

What is leading to higher drug abuse OD fatalities in teens

opioids, stimulants, benzos

Major Class of Rx drug use

OxyContin® (oxycodone), Percocet ® (oxycodone and acetaminophen), Duragesic (fentanyl), Vicodin ® (hydrocodone and acetaminophen), Codeine

Major opioids that are being abused

Adderall ® (amphetamine/dextroamphetamine), Concerta ® (methylphenidate), Ritalin ® (methylphenidate)

Major Stimulants that are being abused

Valium ® (diazepam), Xanax ® (alprazolam), Klonopin ® (clonazepam), Rohypnol ® (flunitrazepam - roofie)

Major Benzos that are being abused

fentanyl, methadone, tramadol

Synthetic opioids include

50x, 100x (synthetic opioids are extremely potent)

fentanyl is ____ more potent than heroine and _____ more potent than Morphine

Single exposure OD

Lacing of street drugs is leading to an increase in

Moderate to severe pain

Tramadol (Ultram) used for

synthetic opioid in clinics for chronic addicted individuals

Methadone used as a

Overlapping prescriptions, Mental illness, Other substance abuse, Needing high doses, Low SES, Rural areas, Inner city situations, Fixated on treatment early in the encounter

Risk factors for Rx opioid abuse

Hormonal, Barrier, IUD

Types of contraceptives

Injectable contraceptives, IUD, Subdermal progestin implants

Highly effective contraceptive methods

Vaginal Rings, Transdermal patches, OCs

Moderately effective contraceptive methods

Condoms, Diaphragms, Cervical Caps, Spermicides, Sponges

Less effective contraceptive methods

Stops Ovulation, Thins the Uterine Lining, Thickens cervical mucus

What are the functions of OCPs?

Pregnancy avoided, menstrual cramps lessened, Truncates and regulates period, Decreases incidence of ovarian cysts, Decreases ovarian and uterine cancer risk (kinda), Decreases Acne

What are the benefits of OCPs?

Abdominal Pain, Chest pain (SOB), HA, Eyeballs (blurred vision, flashes etc), Severe leg pain

define ACHES (Red flag symptoms for OCP use)

no → worry about DVT/PE

Should you smoke on OCPs?

72 hours

emergency contraceptive pill must be taken within ____ hours

IM birth control shot given q3 months

Depo-Provera is a

Stops Ovulation, Stops cycles, Thickens cervical mucus

Functions of Depo-Provera

OTC for above 17; Rx for below 17

Plan B - ages (yeah okay bro)

75%

How effective is emergency contraception in preventing pregnancy?

Spermicides, Male Condom, Female Condom, Diaphragm, Cervical Cap

Sex barrier methods

design and human error

Barrier methods have higher failure rates than hormonal methods due to ________?

88% by itself; 99% with Spermicides

Efficacy rates of condoms

T-shaped object placed in the uterus to prevent pregnancy

What is an intrauterine device (IUD)?

Low maintenance method, Ideal for long-term contraception, Most cost effective method when used 2 years or longer, Must check string before sex and after shedding of uterine lining.

Pros of IUDs

Extremely effective without using hormones (99%)

How effective are IUDs?

copper and levonogestrel

2 types of IUDs

spermicide

Copper IUD acts as a ______

Progestin thickens cervical mucus and suppresses endometrium

Levonogestrel IUD function

lab testing

What is the only way you can tell for sure if a patient has an STI

ASX (most are), acutely in infected individuals, or they may not show up for weeks or months or even years, wax and wane

Describe the Symptom Patterns for STI - always infective tho

12%

How many people in the US are unable to name a single STI

17%

How many people in the US think STIs are all curable

56%

How many people in the US are unaware of the link between STI and HIV?

12%

Percent of Women who discussed STI and HIV during their first visit with a new OB/GYN or PCP

Cervicitis, urethritis, Proctitis, LGV, PID, Potential vertical transfer to newborn via delivery (Conjunctivitis, pneumonia)

Complications of chlamydia

Azithromycin or doxy (concomitant tx for gonorrhea → ceftriaxone)

Treatment plan for chlamydia

Dysuria and urethral discharge (5% asymptomatic)

Symptoms of gonorrhea in men

Gram stain urethral smear (+) > 98% culture

Sensitivity and technique for diagnosing gonorrhea in men

Asymptomatic (most common), maybe vaginal discharge, dysuria, urination, labial pain/swelling, abdominal pain

Symptoms of gonorrhea in women

Gram stain smear (+) 50-70% culture

Sensitivity and technique for diagnosing gonorrhea in women

vesicles → painful ulcerations → crusting

Symptoms of Herpes (progression through stages)

HSV

Which STD can infect with asx shedding?

Primary infection commonly asymptomatic (58% without viral shedding or hx of sx) Symptomatic cases can be severe, prolonged, systemic manifestations

genital herpes simplex virus

HSV 2 (80-90%)

Which one is more common: HSV 1 or 2?

No, only treated

Can herpes be cured?

Direct Culture, Serology (Western blot), PCR (DNA preferred for Ocular and CNS infection)

diagnostic tests for genital HSV

neonatal transmission, enhanced HIV transmission, psychosocial issues, Transmitted subclinical infection, Confusion on if they can spread disease

complications of genital HSV?

92.4%

What percentage of patients want to know if they were infected with an STI?

90.8%

What percentage of patients want to know if their partners were infected with an STI?

65%

What percentage patients expect the test as a part of their STD screening?

detection of HPV DNA

HPV and cervical cancer is detected by

cervical cancer and anogenital squamous cell cancers, anal, penile, vulvar, vaginal

HPV infection is causally associated with what cancers?

99%

__ of cervical cancers have HPV DNA detected within the tumor

Routine Pap smear screening (early detection and treatment of pre-cancerous lesions)

How can we detect HPV and cervical cancer early?

15-30% of patients (resolves in 1-5 weeks)

Primary syphilis goes unnoticed in ____% of patients

HIGHLY INFECTIOUS

Primary syphilis is

spirochetes

Secondary syphilis represents hematogenous dissemination of ________

2-8 weeks after chancre appears

Secondary syphilis occurs ____ weeks after ____ appears

rash (includes palms/soles), mucous patches, condyloma latum. (HIGHLY INFECTIOUS), constitutional symptom

Symptoms and Signs of secondary syphilis (resolves in 2-10 weeks)

Greater infectiousness (prevalence and increased HIV shedding - treatment reduces it back to baseline levels)

STI roles in HIV transmissions

40%

____ reduction in HIV incidence achieved in a RCT of treatment of symptomatic STDs