HS 320 Chapter 1-4 Test

Marge comes to the clinic complaining of fever, malaise, fatigue, muscle aches and swollen lymph glands. She reports that she has a "bullseye" rash on her right thigh. You ask her about recent activities and she tells you she recently returned from a 5-day hike in Vermont.

Lyme Disease

Ray is a 21 year old male. He presents to the clinic with a sudden onset of fever, headache, vomiting, stiff neck and drowsiness. You see countless mosquito stings on his trunk, arms, legs, and back. As you continue to work with the patient you notice that Ray is becoming disorientated.

West Nile Virus

Vincent is a 27 yo M. He has recently returned from a 3-week mission trip to sub-Saharan Africa. Vincent is currently suffering from extreme fever, shaking, and chills. Is has also suffered from nausea, vomiting, diarrhea and profuse sweating. When asked about sleeping conditions, Vincent mentioned frequently "sleeping under the stars."

Malaria

Roger is a 61 yo M. He is one of the largest sheep farmers in Idaho. After recently harvesting the wool from many of his sheep, he developed a raised red bump on his left hand. Initially Roger believed this was a flea bite (fleas are common in sheep), however the bump quickly progressed into a vesicle then a painless ulcer.

Anthrax

Matt is a 27 year old male with fever, chills, headache and severe enlargement of inguinal lymph nodes. Upon exam, his enlarged lymph nodes are hemorrhaging, leading to a dark color on appearance. Matt is admitted to the hospital and develops a productive cough with a frothy, blood-tinged sputum, and labored breathing.

Plague

Ron is a 61 yo male. Ron has severe abdominal cramping and diarrhea for 4 days. He felt this was a routine gastritis until he began to notice diarrhea with pus and blood in his stool.

Upon further questioning the doctor finds out that Ron's wife recently passed away, and "for the first time in my life I have had to prepare my own food." Ron also admits to "nearly never" washing his hands.

E Coli

Tiffany 4 yo Female presents to you clinic with her mother. The mother is frantic. She states Tiffany "can't breathe." While the physician attends to Tiffany, the nurse collects Tiffany's history from her mother. Tiffany has had some vomiting and diarrhea for two days Mom attributed to the flu. Yesterday she noticed Tiffany was falling over and had difficulty maintaining her balance.

The very alert nurse asked Mom about ingestion of home-canned items. Tiffany mother reports she cans frequently and a large part of the family's diet is home canned food. After the initial work-up and brief discussion with his nurse, Tiffany was started on oxygen, a IV was started and the doctor calls the ambulance.

Botulism

Sara is a 2 yo F. Her mother brings her to the clinic concerned about "constant" diarrhea. Mother has noticed blood in the stool. The patient has also had recurrent vomiting and appears dehydrated.

Upon further questioning, mother reports 3 other children at Sara's day-care has had similar symptoms.

Infectious Diarrheal Disease

Jeremy has come home from work early today. When his wife asks why he is home he reports he has nasal congestion, a sore throat (pharyngitis ), and malaise. Jeremy's wife takes his temperature and it is currently 100.1.

Common Cold

Fran is a 54 yo F. She presents to her primary care physician with her husband. See looks very ill. She reports a rapid onset of fever, chills, muscle aches, and cough. Upon further questioning she also reports severe headaches and a sore throat. Her temperature is currently 103.5. When asked about immunizations, she reports she has not had a vaccine in years.

Influenza

Brian is a 18 yo M. He is avid skateboarder. Recently Brian lacerated his left hand (digit number 5) while skateboarding. Brian is used to injuries and thought nothing of the lesion and continued to skate. Three days later Brian's cut finger has worsened. He is now experiencing a very painful, swollen finger. It is warm to the touch and the entire finger is inflamed. Upon closer examination there is a purulent discharge from the lesion.

MRSA

Paul is a 24 yo M who presents to the clinic complaining of a 25 lb weight loss in the last two months. Upon further questioning Paul reports he has recently experienced recurrent episodes of 'being sick.' Paul recounts symptoms including fevers, swollen lymph nodes, and fatigue. When asked about his sexual history Paul reports he has unprotected sex with both males and females. He reports having at least one unprotected sexual encounter with a new partner each week.

HIV/AIDS

Aden is a 7 yo male who presents to your clinic with his mother. Mother is very concerned. She reports Aden has had a rash on his face and trunk for 3 days. He is also experiencing fevers (treated with Tylenol and Motrin), a runny nose, cough, and anorexia. Upon your examination, you notice reds spots on the inside of his mouth. The red spots have a very characteristic blue/white center. No history of immunizations.

Rubeola (Measles)

Your daughter, Kyle, is 5 years old. She has been fighting what you thought was a cold for 2 days. Her symptoms have included malaise, fever, and earache. You have treated her with Ibuprofen will some relief. However, this morning she woke up and you noticed swelling the right side of her face. She is very tender in this region and her earache has worsened. The patient is not currently up-to-date on her immunizations.

Mumps

Matt is your 4 yo neighbor. He loves to play with your son, Brandon. One day Matt comes over to your house to play Legos with Brandon. However, you notice Matt has a rash on his face and arms. You look closely and notice lesions in multiple stages. Some are red spots, others are vesicles (fluid-filled), and others are scabs (crusts). You say to Matt, "It looks like you have a rash." He responds, "yeah, I got them from Tom (his brother), and they itch like crazy."

Varicella (Chickenpox)

You and your spouse are in church on Sunday. You are excited because this will be Katie's (your daughter) first day to go to nursery. When you get to the nursery you see Sister Smith's child, Will. He looks different than normal. You look closely and Will has bright red cheeks, and a rash on his arms. You ask Sister Smith about Will and she says, "That has just come on recently. Sometimes he gets a fever, sometimes he doesn't. I think he is just sensitive to heat, because I have to take his church sweater off every Sunday."

Erythema Infectiosum (Fifth Disease)

Lilly is a 4 yo F. She is being raised by her grandmother. Her mother is in prison and her father has never been a part of her life. Lilly has developed a severe cough. Grandmother reports that she coughs up a thick mucus and the cough has caused vomiting twice. During physical examination you hear a high-pitched inspiratory whoop. Grandmother reports that Lilly's symptoms started 2 weeks ago as mild cough and fever, but now she is having difficulty breathing.

Pertussis (Whooping Cough)

You are part of the Doctors Without Borders organization serving an underserved population in the former Soviet Union. A 3 yo M, Vladimir, is brought to your clinic. Through an interpreter you gather the patient suffers from a fever, sore throat, rasping cough and loss of voice. Upon examination you see a very characteristic thick, patchy, grayish mucus membrane. This pseudomembrane causes airway restriction causing the patient difficulty breathing.

Diphtheria

5 year-old Pam is brought to the ER. She is accompanied by her mother. Pam's mother tells you Pam has a unhealed wound on her leg. She said this happened when she rolled over onto a tooth-pick that was hidden in the carpet. Mother said she removed the object, and has been watching the area. Now the lesion has surrounding rigidity, Pam is having painful involuntary contractions, and "her stomach is hard as a rock." Upon further examination you notice pam's altered voice due to contracted facial muscles. When asked, Mom says she does not know if she has ever had immunizations.

Tetanus (Lockjaw)

5 Steps of Inflammation Cascade

1) Injury Infection

2) Dilation of Blood Vessels

3) Permeability Increases

4) Leukocytes Leave the Blood Vessel (Diapedesis)

5) Phagocytosis (Destroying Foreign Material)

Exposure - Body Produces Antibodies is an example of which kind of immunity?

Active Natural Immunity

Vaccination is an example of which kind of immunity?

Active Artificial Immunity

Mother to baby; placenta or being breast fed. Which kind of immunity is this?

Passive Natural Immunity

Inoculation with Antibodies is what kind of immunity?

Passive Artificial Immunity

What are the 4 external barriers of the body?

1) Skin

2) Mucus

3) Bodily Fluids

4) Friendly Bacteria

What are the 2 non-specific types of immunity

1) External Barrier

2) Inflammation

What causes to lure the WBCs to the site of infection?

Histamine

What are the 6 chains for the chain of infection? (be sure to know examples for each)

1) Pathogen

2) Reservoir

3) Portal of Exit

4) Transmission

5) Portal of Entry

6) New Host

Present in soil, air, or water. Thrive in warm, dark, moist environments.

Fungi

Bacteria-like organisms transmitted through bites of fleas, lice, ticks, mosquitoes, and mites.

Rickettsiae

Smallest disease agents which uses our body cells to reproduce.

Viruses

Single celled organisms. Most are harmless, even beneficial.

Bacteria

Sudden onset pain

Acute Pain

Severe pain that erupts while a patient is already medicated with a long-acting painkiller.

Breaking Through Pain

Pain that continues beyond then normal expected time for resolution.

Chronic Pain

Tissue pain

Nociceptive Pain

Neural pain. Shooting pain.

Neuropathic Pain

Chest pain

Angina Pain

Pain associated with cancer

Malignant Pain

Pain in a missing limb

Phantom Limb Pain

Physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors.

Psychogenic Pain

What is the assessment of pain?

Place, Amount, Interactions, Neutralizers

Immune system identifies harmless substances as potentially harmful.

Hypersensitivity (allergies)

Potentially life-threatening reaction to an antigen.

Anaphylaxis

Round, transient elevations of the skin (wheals) surrounded by redness.

Urticaria (Hives)

B lymphocytes (b-cells) produce antibodies that protect against parasites (antigens) such as bacteria and viruses.

Humoral Immunity

T-cells produce lymphokines which protect against bacteria, viruses and tumors.

Cell-mediated Immunity

Temporary neural dysfunction. No bleeding in the skull. Symptoms range from feeling dazed, or a very brief loss of consciousness to prolonged loss of consciousness and a delayed return to normal.

Concussion

Bruise of brain tissue, bleeding into skull. Loss of consciousness persistent vomiting, blurred vision, staggered walk, hemorrhage, even death.

Cerebral Contusions

Accompanied by scalp wounds and profuse bleeding, pain, tenderness, and swelling.

Skull Fracture

Insertion of sharp objects into the ear canal, severe blow to the head, infection, changes in air pressure.

Perforated Eardrums

Penetrating wounds like knife, gunshot. Blunt-force trauma (car accident).

Chest Trauma

May cause hemorrhages of the interal organs including liver, spleen, pancreas, kidneys, stomach. Blood loss is a concern. Surgery is used to correct the injury.

Abdominopelvic Trauma

Fractures, dislocations, contusions, and compressions of the vertebral column. Could cause paralysis.

Neck and Spine Trauma

Sprains, strains, and fracture of arms or legs

Extremities Trauma