homework (day 1)

7/29/2019 Homework (Day 1)

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BUGNA, Marvin Jino S. Clinical Clerk

Homework

ANTACIDS

Aluminum Hydroxide, Magnesium Hydroxide (Maalox)

are antacids used together to relieve heartburn, acid indigestion, and upset stomach. They may be used to treat these symptoms in patients with peptic ulcer, gastritis, esophagitis, hiatal hernia, or too much

acid in the stomach (gastric hyperacidity).

They combine with stomach acid and neutralize it. Chewable tablet and liquid to take by mouth.

Aluminum Hydroxide

constipation loss of appetite

Magnesium Hydroxide (Milk of Magnesia)

stomach cramps upset stomach vomiting diarrhea

Ranitidine/Famotidine

Ranitidine is used to treat ulcers; gastroesophageal reflux disease (GERD), a condition in which backward flow of acid fromthe stomach causes heartburn and injury of the food pipe (esophagus); and conditions where the stomach produces too

much acid, such as Zollinger-Ellison syndrome.

Over-the-counter ranitidine is used to prevent and treat symptoms of heartburn associated with acid indigestion and sourstomach. Ranitidine is in a class of medications called H2 blockers.

It decreases the amount of acid made in the stomach.Side Effects

headache constipation diarrhea nausea vomiting stomach pain

Esomeprazole/Omeprazole

Esomeprazole is used to treat gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from thestomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach).

Esomeprazole is used to treat the symptoms of GERD, allow the esophagus to heal, and prevent further damage to theesophagus. Esomeprazole is also used to decrease the chance that people who are taking nonsteroidal anti-inflammatory

drugs (NSAIDs) will develop ulcers (sores in the lining of the stomach or intestine).

It is also used with other medications to treat and prevent the return of stomach ulcers caused by a certain type of bacteria(H. pylori). Esomeprazole is also used to treat conditions in which the stomach produces too much acid such as Zollinger-

Ellison syndrome.

Esomeprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made inthe stomach.


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Side Effects

headache nausea gas constipation dry mouth

ECG REPORTS

With aid of an ECG, the occluded coronary can be identified. This is valuable information for the clinician, becausetreatment and complications of for instance an anterior wall infarction is different than those of an inferior wall infarction.

The anterior wall performs the main pump function, and decay of the function of this wall will lead to decrease ofbloodpressure, increase of heartrate, shock and on a longer term: heart failure.

An inferior wall infarction is often accompanied with a decrease in heartrate because of involvement of the sinusnode Long term effects of an inferior wall infarction are usually less severe than those of an anterior wall infarction. The heart is supplied of oxygen and nutrients by the right and left coronary arteries. The left coronary artery (the Left Main

or LM) divides itself in the left anterior descending artery (LAD) and the ramus circumflexus (RCX). The right coronary

artery (RCA) connects to the ramus descendens posterior (RDP). With 20% of the normal population the RDP is supplied by

the RCX. This called left dominance.

Below you can find several different types of myocardial infarcation. Click on the specific infarct location to see examples.HELP WITH THE LOCALIZATION OF A MYOCARDIAL INFARCT

LOCALIZATION ST ELEVATION RECIPROCAL ST DEPRESSION CORONARY ARTERY

Anterior MI V1-V6 None LAD

Septal MIV1-V4, disappearance of septum Q in

leads V5,V6none LAD-septal branches

Lateral MI I, aVL, V5, V6 II,III, aVF LCX or MO

Inferior MI II, III, aVF I, aVLRCA (80%) or RCX

(20%)

Posterior MI

V7, V8, V9

high R in V1-V3 with ST depression V1-V3 > 2mm

(mirror view) RCX

Right Ventricle

MIV1, V4R I, aVL RCA

Atrial MI PTa in I,V5,V6 PTa in I,II, or III RCA

CENTOR SCORE

The Centor Criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in patients complaining

of a sore throat. They were developed as a method to quickly diagnose the presence ofGroup A streptococcal infectionor diagnosis

ofStreptococcal Pharyngitisin "adult patients who presented to an urban emergency room complaining of a sore throat.

Criteria

The patients are judged on four criteria, with one point added for each positive criterion:[1]

History offever Tonsillarexudates Tender anterior cervicaladenopathy Absence ofcough
http://en.ecgpedia.org/wiki/Anterior_MIhttp://en.ecgpedia.org/wiki/Anterior_MIhttp://en.ecgpedia.org/wiki/Septal_MIhttp://en.ecgpedia.org/wiki/Septal_MIhttp://en.ecgpedia.org/wiki/Lateral_MIhttp://en.ecgpedia.org/wiki/Lateral_MIhttp://en.ecgpedia.org/wiki/Inferior_MIhttp://en.ecgpedia.org/wiki/Inferior_MIhttp://en.ecgpedia.org/wiki/Posterior_MIhttp://en.ecgpedia.org/wiki/Posterior_MIhttp://en.ecgpedia.org/wiki/Right_Ventricle_MIhttp://en.ecgpedia.org/wiki/Right_Ventricle_MIhttp://en.ecgpedia.org/wiki/Atrial_MIhttp://en.ecgpedia.org/wiki/Atrial_MIhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.wikipedia.org/wiki/Streptococcal_pharyngitishttp://en.wikipedia.org/wiki/Streptococcal_pharyngitishttp://en.wikipedia.org/wiki/Streptococcal_pharyngitishttp://en.wikipedia.org/wiki/Centor_criteria#cite_note-Centor-1http://en.wikipedia.org/wiki/Centor_criteria#cite_note-Centor-1http://en.wikipedia.org/wiki/Centor_criteria#cite_note-Centor-1http://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Exudateshttp://en.wikipedia.org/wiki/Exudateshttp://en.wikipedia.org/wiki/Exudateshttp://en.wikipedia.org/wiki/Adenopathyhttp://en.wikipedia.org/wiki/Adenopathyhttp://en.wikipedia.org/wiki/Adenopathyhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Adenopathyhttp://en.wikipedia.org/wiki/Exudateshttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Centor_criteria#cite_note-Centor-1http://en.wikipedia.org/wiki/Streptococcal_pharyngitishttp://en.wikipedia.org/wiki/Group_A_streptococcal_infectionhttp://en.ecgpedia.org/wiki/Atrial_MIhttp://en.ecgpedia.org/wiki/Right_Ventricle_MIhttp://en.ecgpedia.org/wiki/Right_Ventricle_MIhttp://en.ecgpedia.org/wiki/Posterior_MIhttp://en.ecgpedia.org/wiki/Inferior_MIhttp://en.ecgpedia.org/wiki/Lateral_MIhttp://en.ecgpedia.org/wiki/Septal_MIhttp://en.ecgpedia.org/wiki/Anterior_MI


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The Modified Centor Criteria add the patient's age to the criteria

Age 44 subtract 1 point

The point system is important in that it dictates management. Guidelines for management state:[1]

0 or 1 points - No antibiotic or throat culture necessary (Risk of strep. infection


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Burping Dysphagia -- a narrowing of your esophagus, which creates the sensation of food being stuck in your throat Hiccups that don't let up Nausea Weight loss for no known reason Wheezing, drycough, hoarseness, or chronic sore throat

How Is Acid Reflux Disease Diagnosed?

It's time to see your doctor if you have acid reflux symptoms two or more times a week or ifmedicationsdon't bring lasting relief.

Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acid-

blocking medications help reduce these symptoms.

If these steps don't help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check

for other problems. You may need one or more tests such as these:

Barium swallow (esophagram) can check forulcersor a narrowing of the esophagus. You first swallow a solution to helpstructures show up on an X-ray.

Esophageal manometry can check the function of the esophagus and lower esophageal sphincter. pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place

for 1 to 2 days to measure the amount of acid in your esophagus.

Endoscopy can check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tubedown your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you

more comfortable.

A biopsy may be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.ALVARDO SCORING

The Alvarado score is a clinical scoring system used in the diagnosis ofappendicitis. The score has 6 clinical items and 2 laboratory

measurements with a total 10 points.

The score

Elements from the patient'shistory, thephysical examinationand from laboratory tests:

Abdominal painthat migrates to theright iliac fossa Anorexia(loss of appetite) orketonesin theurine Nauseaorvomiting Pain on pressure in the right iliac fossa Rebound tenderness Feverof 37.3 C or more Leukocytosis, or more than 10000white blood cellsper microliter in theserum Neutrophilia, or an increase in the percentage of neutrophils in the serum white blood cell count.

The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six otherfactors are assigned one point each, for a possible total score of ten points.

A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a

score of 9 or 10 indicates a very probable acute appendicitis.

A popularmnemonicused to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia,

Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of

leukocytes to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado

score is sometimes referred to as the MANTRELS score.
http://www.webmd.com/cold-and-flu/tc/coughs-topic-overviewhttp://www.webmd.com/cold-and-flu/tc/coughs-topic-overviewhttp://www.webmd.com/cold-and-flu/tc/coughs-topic-overviewhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/digestive-disorders/understanding-ulcers-basic-informationhttp://www.webmd.com/digestive-disorders/understanding-ulcers-basic-informationhttp://www.webmd.com/digestive-disorders/understanding-ulcers-basic-informationhttp://en.wikipedia.org/wiki/Appendicitishttp://en.wikipedia.org/wiki/Appendicitishttp://en.wikipedia.org/wiki/Appendicitishttp://en.wikipedia.org/wiki/Medical_historyhttp://en.wikipedia.org/wiki/Medical_historyhttp://en.wikipedia.org/wiki/Medical_historyhttp://en.wikipedia.org/wiki/Clinical_examinationhttp://en.wikipedia.org/wiki/Clinical_examinationhttp://en.wikipedia.org/wiki/Clinical_examinationhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Right_iliac_fossahttp://en.wikipedia.org/wiki/Right_iliac_fossahttp://en.wikipedia.org/wiki/Right_iliac_fossahttp://en.wikipedia.org/wiki/Anorexia_%28symptom%29http://en.wikipedia.org/wiki/Anorexia_%28symptom%29http://en.wikipedia.org/wiki/Ketoneshttp://en.wikipedia.org/wiki/Ketoneshttp://en.wikipedia.org/wiki/Ketoneshttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Rebound_tendernesshttp://en.wikipedia.org/wiki/Rebound_tendernesshttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Leukocytosishttp://en.wikipedia.org/wiki/Leukocytosishttp://en.wikipedia.org/wiki/White_blood_cellshttp://en.wikipedia.org/wiki/White_blood_cellshttp://en.wikipedia.org/wiki/White_blood_cellshttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Neutrophiliahttp://en.wikipedia.org/wiki/Neutrophiliahttp://en.wikipedia.org/wiki/Mnemonichttp://en.wikipedia.org/wiki/Mnemonichttp://en.wikipedia.org/wiki/Mnemonichttp://en.wikipedia.org/wiki/Mnemonichttp://en.wikipedia.org/wiki/Neutrophiliahttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/White_blood_cellshttp://en.wikipedia.org/wiki/Leukocytosishttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Rebound_tendernesshttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Urinehttp://en.wikipedia.org/wiki/Ketoneshttp://en.wikipedia.org/wiki/Anorexia_%28symptom%29http://en.wikipedia.org/wiki/Right_iliac_fossahttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Clinical_examinationhttp://en.wikipedia.org/wiki/Medical_historyhttp://en.wikipedia.org/wiki/Appendicitishttp://www.webmd.com/digestive-disorders/understanding-ulcers-basic-informationhttp://www.webmd.com/drugs/index-drugs.aspxhttp://www.webmd.com/cold-and-flu/tc/coughs-topic-overview


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A useful mnemonic to remember the modified Alvarado score is: MAFLTRN - My Appendix Feels Likely To Rupture Now (2 points for

L and T, one for all the others).

Complementary value

The original Alvarado score describes a possible total of 10 points, but those medical facilities that are unable to perform a

differential white blood cell count, are using a Modified Alvarado Score with a total of 9 points which could be not as accurate as the

original score. The high diagnostic value of the score has been confirmed in a number of studies across the world. The consensus is

that the Alvarado score is a noninvasive, safe, diagnostic method, which is simple, reliable and repeatable, and able to guide the

clinician in the management of the case.

ABDOMEN

Rovsing Sign

If palpation of theleft lower quadrantof a person'sabdomenincreases thepainfelt in the right lower quadrant, the patient is said

to have a positive Rovsing's sign and may have appendicitis.

In acute appendicitis, palpation in the leftiliac fossamay produce pain in the right i liac fossa.

Obturator Sign

The obturator sign, also known as the Cope sign,[citation needed]

is an indicator of irritation to theobturator internus muscle.[1]

The technique for detecting the obturator sign, called the obturator test, is carried out on each leg in succession. The patient lies on

his back with the hip and knee both flexed at ninety degrees. The examiner holds the patient's ankle with one hand and knee with

the other hand. The examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to

move only inward. This is flexion and internal rotation of the hip.

In the clinical context, it is performed whenacute appendicitisis suspected. In this condition, the appendix becomes inflamed and

enlarged. The appendix may come into physical contact with the obturator internus muscle, which will be stretched when this

maneuver is performed on the right leg. This causes pain and is an evidence in support of an inflamed appendix.

The principles of the obturator sign in the diagnosis of appendicitis are similar to that of thepsoas sign. The appendix is commonly

located in the retrocecal or pelvic region. The Oburator sign indicates the presence of an inflammed pelvic appendix.

Evidence shows that the Obturator Test does not adequately diagnose appendicitis.[2]

Psoas Sign

The psoas sign is amedical signthat indicates irritation to theiliopsoas groupofhip flexorsin theabdomen, and consequently

indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal). It is elicited by

performing thepsoas testby passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to

actively flex his thigh at the hip.[1]

Ifabdominal painresults, it is a "positive psoas sign". The pain results because the psoas borders

theperitoneal cavity, so stretching (by hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes friction

against nearby inflamed tissues. In particular, the right iliopsoas muscle lies under theappendixwhen the patient issupine, so a

positive psoas sign on the right may suggestappendicitis. A positive psoas sign may also be present in a patient with apsoas abscess

It may also be positive with other sources ofretroperitonealirritation, e.g. as caused byhemorrhageof aniliacvessel

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