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FNP > 1 > Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Exercise & A1C

A

8+ weeks of exercise shown to decrease A1C by 0.6% in T2DM even if no weight loss occurs.

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2
Q

DM Exercise Recommendations

A

light activity q30 mins while awake for BGC

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3
Q

Initial T2DM Management

A

1) Set A1C goal
2) Reduce CV RFs
3) Evaluate use of metformin
4) PE & monitoring

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4
Q

Which medications are associated with an increased r/f development of T2DM?

A
  1. Glucocorticoids
  2. HCTZ
  3. Atypical antipsychotics
  4. HMG Co-A reductase inhibitors
  5. & more!
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5
Q

ADA goals for A1C in T1DM

A

< 6%

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6
Q

Fibromyalgia body sites

widespread pain index

A 
neck
jaw
shoulder girdle
upper & lower arm
chest
abdomen
upper & lower back
upper & lower leg
hip (trochanters)
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7
Q

Kyphosis

A
  • Older adults can lose 1-3” of height
  • Height loss c/b compression fractures of vertebrae
  • Most commonly occurs after 70 y/o
  • Generally caused by osteoporosis of vertebrae
  • Appears as “hump” in thoracic region
  • Most common in elderly females
  • Sx that may occur with severe cases include: difficulty breathing, fatigue, and back pain.
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8
Q

Scoliosis

A

abnormal lateral curvature that occurs most often during the growth spurt just before puberty

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9
Q

Lateral Epicondylitis

A

AKA “tennis elbow”
• Inflammation of tendon insertion of the extensor carpiradialis brevis muscle.
• Associated with lateral tenderness at insertion site
• Pain worsens with grasping or
twisting

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10
Q

Medial Epicondylitis

A

AKA golfer’s elbow

• Associated with pulling pain

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11
Q

hyperextension

A

Elbow pain with extension is indicative of hyperextension

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12
Q

Probenecid (Probalan)

A
  • Uricosuric agent used to increase renal excretion of uric acid in you patients.
  • Does not affect formation of uric acid.
  • Uric acid is not metabolized; it is excreted.
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13
Q

Scoliosis Curvature

A
  • Curvatures >40° requires surgical implant of Harrington rod.
  • Curvatures 5-20° should be monitored for changes.
  • Curvatures 20-40° require bracing.
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14
Q

Avascular necrosis

A

lack of blood flow to bone(s) causes bone death

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15
Q

Colles’ fracture

A
  • Most common type of wrist fracture

* AKA “dinner fork fracture” because of the appearance of arm and wrist fracture.

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16
Q

Diagnostics for ankylosing spondylitis (AS)

A

• MRI & XR to assess for changes in joints and bones.
• HLA-B27 is a genetic marker present in 95% of those with the disorder.
• CRP & ESR = markers of inflammation; however, not present in all AS cases
patients.

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17
Q

Baker’s cyst

A

swelling caused by fluid from the knee joint protruding to the back of the knee

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18
Q

positive Kernig’s sign

A

Patient will resist leg straightening when hip is flexed as a result of painful hamstrings from lumbar nerve root inflammation.

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19
Q

positive Brudzinski sign

A

patient’s neck is passively flexed and there is flexing of the hips and knees to relieve pressure and pain

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20
Q

Nuchal rigidity

A

touching the chin to the chest causes pain

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21
Q

positive Babinski reflex

A

toes fan when the plantar surface is stroked from the heel to the great toe. Adults should have a negative Babinski reflex

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22
Q

Polymyalgia Rheumatica

A

• Treated with oral corticosteroids s/a prednisone.
• A hallmark of the disorder is dramatic improvement of sx after starting oral prednisone.
• Usually, sx can be controlled with long-term (2-3 years) low-dose oral prednisone, which can be tapered when sx are under
control.
• Usually a self- limiting illness (a few months to 3 years).

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23
Q

The fat pads on an infant’s feet can mimic ___ ______.

A

pes planus

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24
Q

Bruised kidney

A 
S/S: 
• back pain
• Muscle spasms
• N/V
• Direct hit to the side of the body
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25
Q

Appendicitis

A

Typically begins with anorexia and N/V for the first 12-24h. Diffuse abdominal pain = late sign. Usually diffuse at first and gradually localizes to RLQ.

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26
Q

ruptured vertebral disc

A

Manifests as pain and muscle spasm without N/V

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27
Q

Suspected cauda equine

syndrome

A 
• New-onset saddle anesthesia
• Worsening sciatica
• Decreased DTRs of lower extremity on affected side. 
• Initial action = order MRI ASAP
• Patient needs to f/u with a
neurologist ASAP
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28
Q

pain medication for a child <12 years

A

Regular-strength Tylenol = safest

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29
Q

Grade III ankle sprain

A 
• Possible complete rupture
of some of the ligaments. 
• Unable to bear weight and walk
• Lots of ecchymoses with malleolar
tenderness. 
• Needs XR plus possible US and/or MRI). 
• Refer to ED
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30
Q

most common RFs for development of polyneuropathy

A

DM and ETOH abuse

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31
Q

Transillumination of hydrocele

A

will show that light glow is much larger and brighter on the affected scrotum, compared with the unaffected one

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32
Q

drugs that cause ED

A

1) SSRI (Paxil = worst)
2) ACEIs
3) CCBs
4) BBs
5) benzodiazepines
6) antihistamines

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33
Q

Risk factors for breast CA

A
  • obesity (BMI of 30+
  • older age
  • moderate-to-high intake of ETOH
  • first pregnancy at age 30 or older
  • early menarche (before age 12)
  • late menopause (55 or older)
  • hx of breast mass w/ atypical hyperplasia
  • positive FMH
  • genetic mutations (BRCA 1 & 2)
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34
Q

Etonogestrel implant (Nexplanon)

A

progesterone-only

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35
Q

What is the is priority action when a patient presents with any eye complaint that is not an emergent situation?

A

Snellen (visual actuity)

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36
Q

Aspirin toxicity

A
  • vomiting, confusion, and tinnitus

- immediately discontinue

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37
Q

presbycusis

A
  • Normal, age-related hearing loss

- sensorineural hearing loss

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38
Q

Sensorineural hearing loss would show as a Weber test that lateralizes to the __________ ___.

A

unaffected ear

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39
Q

Acute closed angle glaucoma

A
  • Sudden, severe onset unilat. eye pain + decreased visual acuity
  • Blurry / impaired vision
  • Eye is firm to touch
  • DX = tonometry to test for increased IOP
  • Refer to ED ASAP if suspected b/c of r/f permanent vision loss
  • May see halos or rings
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40
Q

pterygium

A
  • Overgrowths of conjunctiva
  • Frequently present as eye redness and irritation.
  • **Encroaches onto the cornea
  • Patients usually don’t seek tx until discomfort or vision changes
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41
Q

In conductive hearing loss, sound lateralizes to the ________ ___ during a Weber test.

A

affected ear

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42
Q

chalazion

A
  • presents as painless, localized eye swelling.
  • distinguishing factor b/t a chalazion and hordeolum: chalazion = painless, without erythema
  • Tx = moist, warm compresses to the area several x/day
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43
Q

What ABX route is needed to tx MRSA?

A

oral (at least)

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44
Q

Contact dermatitis is usually _____ onset and not usually ___________.

A

acute; symmetrical

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45
Q

Varicella vaccine, like most vaccines is not

A

100% effective at prevention.

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46
Q

What can Kerley B lines on XR indicate?

A

pulmonary edema or malignancy

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47
Q

Who should consider getting varicella titers drawn?

A
  • HCPs and their families

- immunocompromised persons

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48
Q

Clostridium tetani

A
  • gram positive

- found in soil (esp. manure)

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49
Q

Hep A

A
  • transmitted fecal-oral (shed in stool)
  • vaccine is not live
  • peak infectivity = 2 weeks before jaundice onset or increase in liver enzymes
  • RFs = MSM, travel (food prep)
  • usually self-limiting
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50
Q

Polio transmission

A

fecal-oral

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51
Q

Major s/e of Chantix (varenicline)

A
  • mood changes
  • depression
  • agitation
  • suicidal ideation
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52
Q

Bells’ Palsy is r/t viruses such as:

A
  • HSV
  • Herpes zoster
  • EBV
  • cytomegalovirus
  • adenovirus
  • Rubella
  • mumps
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53
Q

Hypochromic anemia

A
  • Hypochromic RBCs = pale in color

- microcytic anemias are hypochromic in nature

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54
Q

How does metformin improve sx of PCOS?

A

Metformin decreases insulin resistance and increases insulin sensitivity. This leads to hormone reduction, thus improved cycles.

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55
Q

What condition will show “string of pearls” on US?

A

PCOS: characteristic multiple small follicles seen on TVUS while visualizing ovaries

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56
Q

Speed’s test assesses what 2 conditions?

A
  • labral tears

- biceps tendonitis

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57
Q

What are we concerned about in a patient with a hx of smoking who has new onset throat pain and hoarseness lasting longer than 3 weeks?

A

Laryngeal CA; Refer them to ENT.

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58
Q

Anemia of chronic disease

A

Usually normochromic, normocytic.

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59
Q

normal MCV level

A

80-100 fL

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60
Q

What interventions can help prevent the osteopenia from developing into osteoporosis?

A
  • Aldrenonate (Fosamax) to increase bone density
  • Lifestyle interventions (WB exercise)
  • Calcium 1200mg + Vit D 800-1000IU daily
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61
Q

DEXA scans

A

Start @ 65 (younger in pts w/ incidence of low-trauma frax)

Normal: > -1.0
Osteopenia: -1.0 to -2.5
Osteoporosis: < -2.5

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62
Q

weight-bearing exercises

A

Walking or jogging / weight lifting / yoga

What doesn’t count? Biking and swimming

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63
Q

dopamine agonists (medications that increase dopamine)

A

Pramipexole, Ropinirole, or Rotigotine

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64
Q

Heberden’s nodes

A
  • Seen at DIPJs

- Only seen in OA

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65
Q

Test to evaluate RCT:

A

Drop-arm test: abduct arm laterally to 90° and have patient lower it back down to waist slowly. Positive if arm drops suddenly to side (weakness).

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66
Q

Test to evaluate shoulder impingement:

A

Neer’s test: stabilize patient’s scapula w/ 1 hand, while passively flexing arm while it is internally rotated. Positive if pain in this position.

Hawkin’s test: place patient’s arm in 90° of shoulder flexion w/ the elbow flexed to 90° and then internally rotate the arm. Positive if pain with internal rotation.

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67
Q

Oral Steroids for COPD Exacerbations

A
  • Shorten recovery time
  • Improve lung fx (FEV,) & arterial hypoxemia (PaO2)
  • Reduce the r/f early relapse, tx failure, and hospital LOS
  • Recommended 40 mg pred qd x5d
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68
Q

goal INR of a patient who has had a

stroke

A

2.0 to 3.0

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69
Q

Goal INR of a patient with A-Fib

A

2.0 to 3.0

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70
Q

goal INR of a patient with prosthetic valve

A

2.5 to 3.5.

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71
Q

AHA/ACC Dyslipidemia Recommendations

A

1) Hx CHD/CVA need 50% reduction
2) LDL > 190 need 50% reduction
3) DM; 40-75 y/o; LDL 70-189 need 30-49% reduction
4) ASCVD 10y risk score ≥ 7.5% need 30-49% reduction

50+% = High potency
30-49% = Moderate potency
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72
Q

Thiazides drop SBP by _________.

A

≈ 2-8 points.

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73
Q

Systems adversely affected by NSAIDs:

A
  • CV
  • Integumentary (e.g., SJS)
  • Hematopoietic (b/c ASA affects platelets)
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74
Q

ABX & myasthenia gravis

A

Contraindicated:
•E. Mycin & telithromycin
• b/c of r/f respiratory collapse

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75
Q

Birth control & tetracycline

A

• Use backup method when taking
and for one pill cycle afterward
• The meds don’t have to be
taken separately

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76
Q

Avoid prescribing these drug classes to patients with sulfa allergies:

A
  • thiazides
  • loop diuretics
  • some protease inhibitors (e.g., darunavair, fosamprenavir),
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77
Q

Reye’s syndrome

A

A rare condition that can develop in
children & young adults recuperating from febrile viral infections who ingest ASA or salicylate meds.

The condition can progress quickly.

Stage 1) sx = severe vomiting, diarrhea, lethargy, stupor, and elevated ALT + AST.

Stage 2) personality changes, irritability, aggression, and HYPERactive reflexes.

Stages 3-5) confusion, delirium, cerebral edema, coma, seizures, and death.

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78
Q

Side effects of thiazide diuretics

A
  • hyperglycemia,
  • hyperuricemia
  • hypertrigs
  • renal dz
  • hypokalemia
  • hyponatremia
  • hypomagnesemia
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79
Q

Chlamydia trachomatis

A
  • positive NAAT
  • Treat both the patient & partner
  • Preferred tx = azithromycin 1g PO x single dose

Can also do: doxycycline 100mg PO BID ×7 days

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80
Q

digoxin toxicity

A

• N/V, confusion, and yellowish
green halos in the patient’s vision.

• Can cause hypokalemia and
hypercalcemia.

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81
Q

Lithium toxicity

A
  • Seizures
  • Slurred speech
  • Increased urination
  • Increased thirst

“Seizing & slurring, drinking & peeing”

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82
Q

Phenytoin (Dilantin) toxicity

A
  • nystagmus
  • ataxia
  • confusion
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83
Q

Carbamazepine (Tegretol) toxicity

A

skin rash & jaundice

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84
Q

Thiazide diuretics ________ calcium
excretion by the kidneys and _________
osteoblast production.

A

decrease; stimulate

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85
Q

Which med can be prescribed to manage both HTN and BPH?

A

Terazosin (Hytrin) = a quinazoline

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86
Q

Chronic use of NSAIDs is associated with increased risk of:

A 
• ulcers
• perforation
• bleeding of the GI tract
• heart attacks
• CV damage
• strokes
• acute interstitial nephritis & kidney injury
• liver damage.
• can also affect lungs in those w/ asthma or underlying ASA
sensitivity, causing bronchospasm
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87
Q

Levothyroxine (Synthroid) interactions

A
  • anticoagulants
  • tricyclic antidepressants
  • antacids
  • calcium, iron, multivitamins
  • PPIs
  • estrogens
  • statins
  • metformin.

Certain foods interfere with
absorption. Avoid taking them together and space these
foods and drugs several hours apart:

  • calcium-fortified foods
  • dietary fiber
  • walnuts
  • soy
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88
Q

ABX for cat/dog/human bite in patient w/ PCN allergy:

A

Bactrim

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89
Q

combination of a statin with niacin raises the risk of:

A

drug-induced hepatitis & rhabdomyolysis

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90
Q

first-line ABX tx for an infant with pertussis:

A

macrolides

(azithromycin, erythromycin,
clarithromycin)

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91
Q

Tx for first episode of primary genital herpes

A

Acyclovir (Zovirax)

400 mg PO tid x7-10 days

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92
Q

Tx for primary syphilis (chancre),

secondary syphilis, or early latent syphilis (<1 year):

A

Benzathine penicillin G 2.4

mU IM in a single dose

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93
Q

Podofilox (Condylox) 0.5%

A 
• gel or cream
• recommended tx for condylomata
acuminata (genital warts), which may
appear on the vagina, external genitals, urethra, anus, penis, nasal mucosa, oropharynx, or conjunctivae.
• BID x 3 consecutive days
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94
Q

Hydrochlorothiazide (Procardia XL) can cause________________________, leading to ___________.

A

bone marrow suppression; neutropenia

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95
Q

Average benzodiazepine half-lives:

A

Triazolam (Halcion) ≈ 2h
Alprazolam (Xanax) ≈ 12h
Lorazepam (Ativan) ≈ 15h
Clonazepam (Klonopin) ≈ 34h

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96
Q

best choice for an elderly patient with insomnia

A

Zolpidem (Ambien)

Quick onset (15 min)
Short half-life (2h)
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97
Q

What type of electrolyte should an

individual with primary HTN increase in their diet?

A

Potassium: aim for 3,500-5,000mg per day preferably from dietary sources.

Foods high in potassium include: • avocados
• sweet potatoes (yams)
• coconut water
• bananas
• oranges
• watermelon / cantaloupe /honeydew
•apricots 
• grapefruit
• dark leafy vegetables (spinach / broccoli)
• edamame
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98
Q

After antihypertensive therapy is initiated, when should a patient’s BP be rechecked?

A

F/u in 1 month after initiating/adjusting an antihypertensive.

When under control, f/u can be in 3 months.

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99
Q

Ethnic groups at higher risk for heart disease & T2DM:

A

Mexican Americans
African-Americans
South Asians (e.g., India, Pakistan)

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100
Q

most common cause of death for

people with DM

A

Heart disease

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101
Q

Common to hear a _____ __ heart sound over the ________ ____ of the heart with ___________. As long as it disappears with _________, with no other abnormal sx, this is a normal finding.

The sound is caused by the splitting of the ______ & _________ components.

A

split S2; pulmonic area; inspiration; expiration

aortic & pulmonic

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102
Q

Initial Warfarin dosing for A-fib:

A

patients > 70 years = 2.5 mg,

younger patients = 5 mg

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103
Q

Still’s murmur

A
  • benign murmur, common in school-age children, usually resolves by adolescence
  • murmur sound = musical quality with minimal radiation
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104
Q

Homan’s sign

A

calf pain at dorsiflexion of the affected limb

A sign of a DVT, but not definitive.

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105
Q

S4 sounds like…

A

“Tennessee”

S4 is aka atrial gallop or atrial kick

best heard @ apical area using the bell

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106
Q

S3 sounds like…

A

“Kentucky.”

S3 is aka ventricular gallop or S3 gallop

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107
Q

In coarctation of the aorta, BP is higher in the _______ than in the _______ because of the _______ in the aorta.

A

Arms; legs; narrowing

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108
Q

Test to evaluate SLAP tears:

A

O’Brien’s test:

1) Patient can sit or stand. Arm is placed in 90° of shoulder flexion and 10-15° of horizontal adduction.
2) Patient fully internally rotates shoulder & pronates elbow.
3) Examiner provides a distal stabilizing force as patient is instructed to apply an upward force.
4) Repeat in a neutral shoulder and forearm position.

Positive when pain is reproduced or clicking in the shoulder with the first position and reduced/absent with the second position.

Superficial pain usually = ACJ sx
Deep pain usually = labral sx

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109
Q

Keratosis pilaris is often d/t skin getting too dry and follicles getting plugged. What do you do?

A

Exfoliate (with something like a karyolitic) to prevent clogging

&

moisturize to prevent dryness

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110
Q

Siolithiasis can cause:

A
  • pain and swelling of face, jaw, and neck tht is worse before/during eating (when saliva production increases)
  • dry mouth
  • foul taste/smell
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111
Q

Parotitis can occur with:

A
  • mumps
    -sialolithiasis
    bulimia
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112
Q

S/S of erysipelas

A
  • fever
  • chills
  • h/a
  • malaise

are may be raised and/or have central clearing

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113
Q

Anthrax

A

Starts off as small, itchy bumps that progress to painless ulcer with black center that scabs over.

TX = ABX x7-10 days (cipro or doxy)

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114
Q

When do you close face wounds?

A

within 24h

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115
Q

When do you close extremity/trunk wounds?

A

within 12-18h

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116
Q

Tx for cat/dog/human bites

A
  • clean
  • empiric ABX (augmentin)
  • do not close
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117
Q

When can you close a wound?

A
  • Once you’ve ensure there are no RFBs (check with XR if unable to visualize fully)
  • Once they’re clean
  • If they do not involve deep structures (tendons, joints, etc.)
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118
Q

What type of acne are closed comedones without papules/pustules?

A

non-inflammatory / mild

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119
Q

How do you treat non-inflammatory / mild acne?

A

Benzoyl peroxide

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120
Q

Blepharitis

A

Inflammation of eyelids. They become red & itchy. Often produce scales on lashes.

Usually r/t inflammatory processes s/a rosacea, AD, seborrheic derm

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121
Q

Tx for bacterial conjunctivitis

A
  • otic macrolide (e-mycin): ointment or drops
  • once on ABX x24h, no longer contagious
  • wash everything thoroughly
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122
Q

Lifestyle changes for macular degeneration

A
  • quit smoking
  • control BP
  • Mediterranean diet
  • weight loss to tx correlating dz processes
  • utilize larger print and brighter lights
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123
Q

Corneal abrasion sx

A
  • acute onset eye pain
  • excessive tearing
  • photophobia
  • “something is stuck in my eye”
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124
Q

Corneal abrasion dx

A

fluorescein stain = orange dye put in eye and blue ligt used to detect damage/FB

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125
Q

Corneal abrasion tx

A

NSAIDs & moisturizing drops

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126
Q

Iritis, aka…

A

“anterior uveitis”

  • inflammation of uvea (middle layer of eye)
  • pupil might be painful and firm to touch
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127
Q

“Dry” ARMD

A
  • slow
  • unilateral or bilateral
  • notice most change when driving
  • need brighter lights, larger prints
  • blurry spots
  • straight lines look bent/wavy (metamorphosia)
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128
Q

“Wet” ARMD

A
  • often sudden vision changes/loss
  • usually starts unilateral
  • metamorphosia typically more severe
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129
Q

Herpes zoster (shingles) outbreak on face and near eyes. What is our concern?

A

CN5 has an ophthalmic branch that when infected with shingles virus can l/t permanent blindness

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130
Q

Examples of cholinesterase inhibitors:

A

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

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131
Q

What do cholinesterase inhibitors do and when do we use them?

A

Prevent breakdown of acetylcholine (works in PNS)

Used to tx mild to moderate dementia

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132
Q

What is ginkgo biloba used for?

A

memory and cognition

**sometimes menopause sx

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133
Q

What is evening primrose used for?

A

Menopause sx

***sometimes in pregnancy to soften cervix

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134
Q

What is kava kava used for?

A

anxiety

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135
Q

What is valerian root used for?

A

insomnia

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136
Q

What is echinacea used for?

A

immune support

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137
Q

What area of the brain controls balance and coordination? What are some tests to evaluate it?

A

Cerebellum

Romberg / rapid arm movement

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138
Q

CN1

A

olfactory

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139
Q

CN2

A

otic

visual acuity (snellen)

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140
Q

CN3

A

oculomotor

focus / EOM motor / pupillary response

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141
Q

CN4

A

trochlear

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142
Q

CN5

A

trigeminal

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143
Q

CN6

A

abducens

outward EOM by LR muscle

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144
Q

CN7

A

facial

puff out cheeks, raise eyebrows, smile, etc.

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145
Q

CN8

A

vestibulocochlear

hearing & balance

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146
Q

CN9 & CN10

A

9) glossopharyngeal: innervates tongue and throat
10) vagus

9&10 often tested together by watching uvula rise and fall with pronation

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147
Q

CN11

A

accessory

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148
Q

CN12

A

hypoglossal

movement of tongue

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149
Q

Why should people with GI disorders be cautious when taking anticholinergics?

A

They slow down gastric emptying and can further aggravate GI dz

ex: PUD, UC, etc.

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150
Q

Wellbutrin is an ____

A

NDRI

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151
Q

What is one serious s/e of Wellbutrin?

A

can in crease likelihood of seizures

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152
Q

Which BBs are lipophilic?

A

Propranolol and metoprolol

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153
Q

Which BBs are hydrophilic?

A

Atenolol and sotalol

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154
Q

Initial tx for SVT

A

Valsalva: stimulates vagus nerve and slows down conduction through AV node, which lower overall HR

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155
Q

Cardiac causes of pulsus parodoxus:

A
  • cardiac tamponade
  • severe hypovolemia
  • pericarditis
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156
Q

Pulmonary causes of pulsus parodoxus:

A
  • COPD exacerbation
  • PE
  • OSA
  • status asthmaticus
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157
Q

Aortic regurge

A
  • high-pitched
  • early diastolic crescendo
  • LICS #3
  • at end expiration when leaned forward
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158
Q

What do all newborns get at birth?

A

vitamin K & HBV vaccine

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159
Q

Who gets surfactant and why?

A

Primis born before 32 weeks that weigh less than 1300g get surfactant at birth to help with lung development (open alveoli).

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160
Q

What can we give to pregnant moms of primis to help stimulate surfactant in baby?

A

injectable betamethasone

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161
Q

false menses

A
  • pink-red spotting in diaper
  • d/t drop in maternal hormones
  • usually resolves in 3-4 days
  • benign
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162
Q

Varicella vaccine

A
  • Life vaccine
  • 2 doses: 1 @ 12 mos. & again @ 4-6 yrs.
  • If rash develops after vax, stay away from immunocompromised/pregnant people until it clears
  • primary prevention for shingles later
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163
Q

TDaP indications

A
  • 11 to 12 y/o who previously completed DTaP
  • 7 y/o if missed some or all of DTaP
  • adults > 19 get it when:
  • – pregnant or going to be around newborn
  • – 65+
  • – HCP
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164
Q

Female athlete triad

A

1) irregular menses/amenorrhea
2) decreased bone density (osteoporosis)
3) restrictive eating

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165
Q

Levels of prevention

A

P = “P”rimary: action to “P”revent a dz/dx

S = “S”econdary: “S”creening and early dx

T = “T”ertiary: “T”reatment/actions after dx is established

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166
Q

Sabbath

A
  • sundown Friday to sundown Sunday
  • no work or technology
  • only worship and rest
  • Orthodox Jews
  • 7th Day Adventists
167
Q

ASA pregnancy category

A

D

positive fetal risk, but sometimes B > R

168
Q

Cipro pregnancy category

A

C

fetal affects in animals, but unknown in humans

169
Q

Threatened abortion

A

vaginal bleeding w/in 1-20 weeks

cervical os = closed

170
Q

Inevitable abortion

A

vaginal bleeding w/in 1-20 weeks

cervical os = open

171
Q

Incomplete abortion

A

vaginal bleeding w/in 1-20 weeks

cervical os = open
partial passage of products of conception

172
Q

Complete abortion

A

vaginal bleeding w/in 1-20 weeks

cervical os = closed
complete passage of products of conception
uterus = contracted

173
Q

Septic abortion

A

spontaneous abortion w/ infected uterus

cervical os = open
purulent cervical discharge
none or incomplete passage of products of conception
uterus = tender to palpation

174
Q

GDM puts patient at risk for:

A
  • large gestational baby (macrosomia)
  • HTN (preeclampsia)
  • stillbirth / neonatal morbidity
  • increased risk for mom developing T2DM
  • increased risk for obesity and development of DM of child
175
Q

A patient with HF should be advised to restrict sodium to________ and fluids to________.

A

2 to 3g/day

1.5 to 2L/day

176
Q

S3 heart sound is sometimes referred to as an opening snap

A
  • occurs early in diastole

* normal variant in children, healthy young adults, and athletes

177
Q

Bibasilar crackles in lung bases and the presence of S3 heart sounds

A

classic findings of CHF

178
Q

Calculate ABI

A

ABl = highest SBP of certain ankle divided by highest SBP of both arms

179
Q

Guidelines for lipid screening

A

q2-3years in patient over 40

180
Q

Acute bacterial endocarditis

A
  • serious bacterial infection of the heart valves and the endocardial surface.
  • usual bacteria = Staph & Strep

• 3 blood cultures obtained at
separate sites 1h apart are used to
identify the causative organism.

•RFs: damaged prosthetic valves, hx of rheumatic fever, injection drug use

181
Q

CMs Acute bacterial endocarditis

A
  • Osler’s nodes = SQ red, painful nodules on finger pads
  • Subungual splinter hemorrhages on the nail beds c/b microemboli.
  • Janeway’s lesions c/b bleeding under skin (usually on palms and soles) = painless red papules and macules.
  • conjunctival hemorrhages
  • petechia
  • cardiac friction rubs
  • arrhythmias
  • murmurs
182
Q

Mitral valve prolapse (MVP)

A

• systolic murmur accompanied by
midsystolic click located at apical area
• most cases asymptomatic
• detect with echo with Doppler imaging

183
Q

PMI

A 
• loudest point of the heartbeat
• heard at left ventricle
• to auscultate place stethoscope
at left side of chest, midclavicular line down to 5th ICS
• PMI is relevant for kids >7 years
184
Q

recommended statins for patients >75 years with ASCVD

A

moderate-intensity

185
Q

recommended statins for patients

21 - 75 years with ASCVD

A

high-intensity statins like
atorvastatin (Lipitor) or rosuvastatin
(Crestor).

186
Q

Grade I murmur

A

very quiet and can be heard in quiet conditions

187
Q

Grade II murmur

A

mildly to moderately loud
murmur that can be heard in
normal environments

188
Q

Grade III murmur

A

loud murmur that is easily heard when the stethoscope is placed on the chest

189
Q

Grade IV murmur

A

louder, and a thrill is present

upon palpation

190
Q

Approximately ____ of children have murmurs, ____ of which are benign.

A

50%; 90%

191
Q

notifiable diseases

A
  • Pertussis
  • Anthrax
  • Lyme disease

NOT herpes simplex

192
Q

Most cases of cervical cancer are caused by HPV ____ & ____.

A

16 & 18

193
Q

Trichomoniasis symptoms

A
  • dysuria
  • severe vaginal pruritus
  • malodorous vaginal discharge.
  • wet prep shows pear-shaped trichomonads with several flagella that have whiplike tails at one end
194
Q

trichomoniasis tx

A

single-dose metronidazole

195
Q

Sufficient Paps must have:

A

both squamous epithelial cells and endocervical cells

If lacking either type of cell, specimen is incomplete, must be repeated.

196
Q

Sperm and aging

A

Sperm production decreases

volume of the semen produced decreases

relative concentration of sperm remains consistent in the semen

197
Q

What can falsely elevate PSA?

A
  • urinary retention
  • UTI
  • after a DRE

vigorous exercise and Ejaculation w/in 48h should be discouraged before testing because they will also falsely elevate the PSA levels.

198
Q

Fitz-Hugh-Curtis syndrome

A

complicated GC/CT infection

Treat with

Ceftriaxone 500mg IM once +
doxycycline 100mg BID x14d +
metronidazole 500mg BID x14d

199
Q

How do you treat a pregnant patient

with confirmed uncomplicated gonorrheal & chlamydial infections?

A

ceftriaxone 500mg IM once + azithromycin 1g PO once

200
Q

two types of antibodies that are positive in Hashimoto’s thyroiditis

A

Antithyroid peroxidase antibodies &

antithyroglobulin antibodies

201
Q

most common cause of hypothyroidism in the US

A

Hashimoto’s thyroiditis

202
Q

Vaginal douching

increases risk of

A

pelvic inflammatory disease (PID)

203
Q

What things increase the risk of

UTIs in women?

A 
• frequent sexual intercourse
(honeymoon bladder)
• pregnancy,
• spermicide use (w/ diaphragm or alone)
• immune compromise
• diabetes
204
Q

Wilms’ tumor

A

• congenital tumor of kidney that should never be palpated once dx to avoid spread of the tumor
cells.
• May see microscopic or gross hematuria
• mass is nontender and smooth, and rarely crosses midline of abdomen.

205
Q

Pregnancy-induced HTN (preeclampsia)

A

Classic triad =
[HTN+ proteinuria+edema]
that occur after 20 wks & up to 4wks PP

• Rapid weight gain of 2-5# per week and edema is most obvious in the face around the eyes and on hands.

206
Q

CCs are contraindicated in patients with ___________ and ___________.

A

bradycardia; 2° or 3° heart blocks

207
Q

sinus bradycardia

A

HR <60 bpm
Regular rate.
P wave is identical before each QRS

208
Q

first-degree heart block

A

regular rate and rhythm
PR >0.20 second
QRS >0.12 second

209
Q

second-degree heart block

A

P waves are intermittent
PR is increasingly prolonged
QRS falls into a repeated pattern

210
Q

third-degree heart block

A

No PR interval
QRS is not applicable
No relationship between P and QRS

211
Q

paroxysmal atrial tachycardia

A

rapid, regular heart rate that begins and ends very quickly.

atria are beating at a very fast rate, but it is not life-threatening.

212
Q

Ventricular tachycardia

A

usually associated with heart disease

occurs when ventricles are beating
rapidly and inefficiently

can lead to death if not treated

213
Q

V-fib

A

occurs when the heartbeat is

rapid and chaotic, and death will occur if the condition is not treated

214
Q

“Worst headache of my life!”

A

Subarachnoid hemorrhage

EMERGENT

215
Q

After receiving the inactivated influenza injection, how much time does it take for antibodies to develop in the body?

A

Takes up to 2 weeks to build immunity

after flu vaccine.

216
Q

RFs for colon cancer

A
  • IBDs s/a UCA and Crohn’S
  • overweight and obesity
  • tobacco use
  • positive FMH
  • low-fiber, high-fat diet
217
Q

sensitivity

A

high sensitivity is very good at identifying individuals who have the
disease; therefore, fewer cases of the disease are missed.

218
Q

Specificity

A

high specificity = ability of

the test to correctly identify an individual who does not have the disease.

219
Q

An infant with a cold can be immunized as long as the infant’s temperature is not higher than _____

A

100.4°F

220
Q

What does a “clunk” sound mean when heard while performing the Ortolani maneuver?

A

positive finding and signifies a possible hip abnormality (hip dysplasia)

Refer to pediatric orthopedist.

221
Q

When do babies learn to “ cruise” or hold onto furniture while walking?

A

12 months

222
Q

salmon patches

A

Flat pink patches found on forehead, eyelids, and the nape of the neck
of infants

typically fade by 18 months.

223
Q

Condylomata acuminata

A

aka genital warts

c/b HPV

spread by skin-to-skin contact

224
Q

Confirmation of Turner’s syndrome is done with:

A

karyotype analysis to confirm the partial or complete absence of the second sex chromosome

225
Q

live attenuated influenza vaccine (LAIV)

A 
• administered via nasal spray for patients 2-49yrs 
• not recommended for those
with a hx of wheezing in last 12 mos. 
or those with underlying lung
disease.
226
Q

6 month vaccines

A

Hep B
Hib
rotavirus (PRV, RV5)

227
Q

Lupus is 2-3x more prevalent

among women of:

A

African American, Asian, Hispanic, and Native American

228
Q

Cancer Mortality Rate in Adults (All Ages/Genders) from

Highest (1) to Lowest (4)

A

1) lung
2) colorectal
3) pancreatic
4) breast

229
Q

Puncture wounds of the foot may become infected with ________ (gram negative) by the foam material from sneakers, ultimately causing_______.

A

P. aeruginosa; cellulitis

230
Q

What lifestyle modifications should be recommend to an overweight young adult?

A

• 30 min of daily aerobic exercise

• healthy balanced diet (veggies/fruits/lean proteins/complex
carbs/low in sodium/low fat)

  • limit red meat
  • control portions
  • strength training 3-4 days per week, not daily.
231
Q

4-year-old milestones

A
  • trace simple objects
  • run
  • climb steps
  • throw a ball, maybe catch
  • stack objects
  • perform several ADLs with little or no assistance
232
Q

Fetal alcohol syndrome

A

microcephaly
narrow eyes
thin lips
smooth philtrum

Ranges from severe intellectual disability to ADHD

233
Q

Down syndrome

A

flat, round face
low-set ears
macroglossia
hypotonia

234
Q

FTT is most likely diagnosed:

A

in the first few months of life when there is a weight decrease over 2 or more major percentile lines (90th, 75th, 50th, 25th, and 5th).

235
Q

FTT can be caused by

A

inadequate nutritional intake
neglect
poor maternal bonding

236
Q

Abnormally low levels of alpha fetoprotein and estriol and high levels of HCG

A

Do US to evaluate Down’s and/or

fetal demise

237
Q

Signs and symptoms of Klinefelter’s

syndrome

A
  • gynecomastia
  • long limbs
  • lack of secondary sex characteristics
  • testes usually small
  • infertility is major concern

If treated early, may have normal sexual/reproductive system in future.

238
Q

TORCH

A 
Toxoplasma gondii
Other infections
Rubella
Cytomegalovirus
Herpes
239
Q

What test detects the presence of

antibodies to HCV, indicating exposure to HCV?

A

HCV RNA

qualitative and used to distinguish between a current and past infection

may also be ordered after tx is complete to see whether the virus has been eliminated

240
Q

most common type of cancer in children

A

Acute lymphoblastic leukemia

a malignancy of the bone marrow

more common in boys aged 2-4

241
Q

Aplastic anemia

A

bone marrow suppression (not

cancer) usually caused by medications or a viral infection

242
Q

ELISA and Western blot tests are used to detect:

A

HIV antibodies

243
Q

hordeolum tx

A

begin with hot compresses to the affected eye until the abscess drains

Many will spontaneously drain within the first 48h

244
Q

Peritonsillar abscess

A 
severe sore throat
difficulty swallowing
trismus
muffled "hot potato" voice
displaced uvula
245
Q

high-risk factors for hearing loss

A

(HEARS)

Hyperbilirubinemia
Ear infection frequency
low Apgar scores
exposure to Rubella/cytomegalovirus/toxoplasmosis
Seizures
246
Q

risk of DM is 2-3x higher in ________ Americans than in________ Americans.

A

Mexican; non-Hispanic

247
Q

minimum number of days to quarantine an animal suspected of rabies

A

10 days

248
Q

carbuncle

A

group of abscesses that form a large boil with several heads

Treat with doxy or
minocycline PO BID x10d
or
clinda TID-QID x10d if MRSA is suspected.

Patient should return within 48h, to ensure improvement

249
Q

Persistent urinary and vaginal infections may indicate

A

underlying glucose metabolism disorders and DM

250
Q

acne rosacea

A

chronic inflammatory disease of the
cheeks, chin, and nose, with dry, reddened eyes.

1° tx = determine triggers such as spicy foods and alcohol.

251
Q

RMSF

A

caused by the bite of a dog tick that is infected with the parasite Rickettsia ricksettsii.

252
Q

Larva migrans

A

results from infection with the eggs of parasites (worms) that are commonly found in the intestines of dogs & cats

Children are at high risk of developing this infection if they come in contact with dirt that is contaminated with
dog or cat feces.

Eating foods that are grown in contaminated soil and / or raw liver are other means of transferring the infection.

253
Q

Roseola infantum

A

common viral rash that is caused by HSV

most common ages of onset are b/t
6 mos & 2 years

rashes are maculopapular that first appear on the trunk and spread to the extremities.

254
Q

Lice nits that are more than ¼ inch from the scalp

A

nits that are more than ¼ inch from the scalp are usually not viable

use a nit comb after spraying the child’s hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair

255
Q

BPPV (benign paroxysmal positional

vertigo)

A

most common cause of vertigo in US

caused by calcium carbonate crystals in the semicircular canals

initial tx is the Epley maneuver

256
Q

Dix-Hallpike

A

gold-standard test for BPPV

Positive if classic rotary nystagmus
seen with latency (limited duration)

257
Q

1° tx for allergic rhinitis

A

topical nasal steroid spray, once or twice per day.

258
Q

Presbycusis initially affects

A

ability to hear higher-pitched sounds of speech (or high frequency)

gradual onset, and over time it affects lower frequencies.

259
Q

subconjunctival hemorrhage

A

blood that is trapped between the sclera and conjunctiva

RFs = anticoagulation, HTN, DM

260
Q

first permanent teeth to develop

A

first molars; appear at ≈ 6 years

261
Q

normal pathway of sound wave

transmission (hearing) through the ear

A 
1) Sound waves are collected in the
pinna
2) Nerve impulses are stimulated in
the inner ear
3) Transmission of vibrations
through the hammer, anvil, and
stirrup
4) Vibrations are transmitted to the
cerebral cortex auditory center
5) Sound is interpreted by the
cerebral cortex
262
Q

Hand, foot, and mouth disease (HFMD)

A

caused by the coxsackievirus

virus is found in the saliva, sputum, nasal mucus, feces, and blister fluid

transmitted through direct contact of the secretion or in fomites

263
Q

Sx of Pathologic GERD

A
  • Heartburn
  • Dysphagia
  • Hoarseness
  • Chest pain
  • Nausea
  • Excessive salivation
  • Feeling of lump in throat (“globus”)
264
Q

Infectious Diarrhea

A
  • Acute = < 2 weeks
  • usually viral
  • Incubation usually 48-72h
  • D, N, V, HA, abdominal cramps, malaise, fever
  • Self-limiting
265
Q

Bacterial Infectious Diarrhea

A
  • Usually: Staph aureus (creamy foods) •Onset sx = 6h
  • Duration ~ 12h
  • D, N, V, HA, cramps, malaise, fever

Watery diarrhea: Salmonella typhi,
C. difficile (History is important!)

266
Q

Otitis Media with Effusion (OME)

A
  • TM is often retracted and full
  • usually occurs after AOM resolves or is d/t poor eustachian tube function
  • usually does not require ABX
  • refractory/recurrent cases should be referred to ENT
267
Q

Visual acuity (Snellen)

A
  • should be 20/20 by 6 years old

- difference of > 2 lines b/t eyes = referral

268
Q

strabismus

A

can be normal until 4-6 mos.

269
Q

Nasal FB

A
  • unilateral foul smelling drainage
  • epistaxis
  • sneezing
  • facial swelling and pain
  • mouth breathing
270
Q

Rupture TM can cause

A

acute suppurative drainage (purulent)

271
Q

VUR Grading

A

1) reflux fills ureter
2) reflux fills ureter & collecting system, but doesn’t cause dilation
3) mild dilation begins

1&2 usually self-resolve by 5y
Refer out grade 3+

272
Q

Fragile X

A
  • genetic disorder d/t changes in FMR1 gene
  • FMR1 gene makes protein FMRP needed for brain development
  • Sx = macrognathia (large jaw), scoliosis, pectus excavatum
273
Q

Functional constipation (Rome IV Criteri)

A

Must meet 2+ criteria for dx

  • hx of withholding stool
  • hx painful/large BMs
  • hx large diameter stool
  • large fecal mass in abdomen
  • 2 or less BMs in toilet per week
  • 1+ episodes of fecal incontinence per week
274
Q

Hemolytic anemia

A
  • premature destruction of RBCs
  • Dx w/ direct Coomb’s test
  • commonly seen in Lupus
275
Q

Immune Thrombocytopenia (ITP)

A
  • usually s/p URI
  • usually in 2-6 y/o
  • no splenomegaly
  • rash/petechiae (usually legs)
  • mild gum bleeding
276
Q

Hemochromotosis

A
  • genetic
  • presents in middle age
  • l/t iron overload, then severe organ damage
  • complications = DM, hyperpigmentation, arthritis
  • tx = phlebotomy
277
Q

HIV testing

A

Used to be ELISA + Western blot

Now we use HIV1/HIV2 antigen/antibody immunoassay
If pos. f/u with HIV1/HIV2 antibody differentiation immunoassay

Can also confirm w/ NAT (nucleic acid test)

278
Q

What are beta-lactams?

A

ABX with beta-lactam rings

ex: PCN and cephalosporins

279
Q

Augmentin is a/an_________ & ___________. It does ________ cover MRSA.

A

extended-spectrum PCN &
beta-lactamase

Does not

280
Q

Sx of polycythemia vera (PCV)

A
  • h/a
  • parasthesias
  • distended retinal veins
  • plethora (flushing)
  • erythromelalgia (burning sensation)

***gait is usually normal (not unsteady) despite other neuro sx

281
Q

Pneumocystits jirovecii pneumonia (PJP)

A

Life-threatening infection occurring in immunocompromised pts.

Bactrim = ABX of choice b/c it’s cheap and effective

Other options: Mepron, Aczone, Pentam

282
Q

MAIN gram positives

A

Staph
Strep
Enterococcus

283
Q

Staphylococcus

A

GRAM POSITIVE

Aureus (skin)
MSSA (skin)
MRSA (skin)
epidermis (skin)

saprophyticus (GU)

284
Q

Enterococcus

A

Faecalis & Faecium (UTI)

do not confuse w/ E. Coli, that is different

285
Q

Atypical gram positives

A
  • Listeria
  • diphtheria
  • botulism
  • tetani
  • C. Diff
  • Anthrax
  • Acne
286
Q

What will TB XR show?

A

consolidation in upper lobes

287
Q

Is TB a reportable dz?

A

Yes

288
Q

How long is someone being treated for TB contagious?

A

No longer contagious (usually) after 2 weeks of ABX

289
Q

Latent TB

A
  • asymptomatic
  • perform PPD + CXR (XR may or may not show anything)
  • no need for sputum culture
  • not contagious
  • treat with multi-drug regimen to prevent turning into active TB
290
Q

Multi-drug TB regimen options

A

***usually will require 3 agents, for at least 6-9 mos.

Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)

291
Q

S/S hyperparathyroid

A
  • abdominal pain
  • N/V
  • confusion
  • fatigue
  • muscle weakness
  • bone pain
292
Q

TX for hyperthyroidism while waiting to start radioactive iodine or other?

A

BBs

293
Q

S/S Addison’s Dz

A
  • fatigue
  • weight loss
  • N/V
  • abdominal pain
  • myalgia
  • hypoTN
  • hyperpigmentation
  • most all labs are low except potassium & BUN
  • low sodium, low sugar
294
Q

Addison’s dx test

A
  • Midnight cortisol
  • Steroid suppression
  • 24h urine cortisol
295
Q

Cushing’s S/S

A
  • irregular menses
  • weight gain
  • “moon face”
  • hirsutism
  • HTN
  • fatigue
  • muscle weakness
296
Q

Most sensitive dx test for appendicitis?

A

CT

297
Q

Diverticulitis

A
  • mild cases can be treated OP
  • sx that don’t improve in 48-72h on ABX and clear liquid diet need to report ED
  • S/S = LLQ pain, bowel changes, N/V
  • Choice ABX = augmentin, OR cipro + flagyl
298
Q

Giardia

A

-common s/p visit to rural area or exposure to human/pet who has it

  • Sx can last 2-4 weeks
  • –N/V/D
  • –abdominal pain
  • –gas
  • –decreased appetite

Dx w/ stool sample

299
Q

Ulcerative colitis (UC)

A
  • only affects colon
  • bloody diarrhea (often w/ mucus)
  • abdominal pain
  • weight loss
  • fatigue
300
Q

When should asymptomatic patients be screened for Celiac dz?

A

Those with PMH or FMH in FDR of:

  • T1DM
  • Down’s
  • Thyroiditis
  • Turner’s
  • Selective IgA deficiency
301
Q

Trichomanias s/s

A

***strawberry cervix
lower abdominal pain
green, yellow, frothy, malodorous discharge
pain and itching around vagina

302
Q

Describe clue cells

A

“epithelial cells w/ blurred edges”

“fuzzy w/out sharp edges”

“stippled/speckled” (resemble peppered eggs)

303
Q

BV tx

A

Flagyl 500 mg PO bid x7 days

304
Q

Drugs that increase r/f kidney stones

A
  • topiramate
  • Rocephin
  • cipro
  • ephedrine
  • antivirals
  • sulfa ABX
305
Q

Painless hematuria can indicate what?

A

bladder CA

306
Q

S/S nephrolitiasis

A

colicky flank pain that is intermittent, lasting 20-60 minutes

307
Q

Tx for kidney stones

A
  • hydrate
  • NSAIDs
  • strain urine to catch, then bring stone to office for eval
  • can do Tamulosin maybe
  • ED for severe sx (these should pass in 48h)
308
Q

Ankylosing spondylitis on XR

A
  • continuous spine lesions
  • vertebral squaring
  • joint space stenosis
  • sacroiliitis (usually first finding, usually symmetrical & bilateral)
309
Q

Primary tx for Ankylosing spondylitis

A

NSAIDs and steroids as adjunct PRN

DMARDs = second line

310
Q

Anatomic snuff box

A

triangle shaped depression on lateral aspect of back of hand

best seen/felt when thumb is extended

311
Q

Valgus stress

A

Assess MCL

Place one hand on ankle and one hand over femur while trying to rotate tibia externally

312
Q

Positive SLR

A
  • probable LS root nerve irritation

- highly sensitive for low lumbar disc herniation

313
Q

Piriformis screen

A

Piriformis is muscle that rotates femur when hip extends.

Tests for tightness of muscle across sciatic nerve.

314
Q

Tx for RCT

A

PT
Oral NSAIDs
steroid injections

surgery reserved for full-thickness tears

315
Q

Polymyalgia rheumatic (PMR)

A
  • inflammatory (will see elevated CRP & ESR)
  • affects women more than men
  • stiff/sore hips and shoulders
  • tx = prednisone (rapid results)
316
Q

Bursitis

A

fluid-filled sac b/t bone and soft tissue

often resolve w/ RICE and anti-inflammatories

317
Q

Ankle sprains

A

ankle = most commonly sprained spot

usually an inversion sprain (ankle rolls inward)

318
Q

Grade 1 ankle sprain

A

microscopic tear

mild, resolves w/ rest

319
Q

Grade 2 ankle sprain

A

larger, partially through ligament

320
Q

Grade 3 ankle sprain

A

complete tear of ligament, cannot WB

refer

321
Q

Watson’s test

A

evaluates instability in wrist near scaphoid

322
Q

Waddell’s sign

A

developed to evaluate lumbar pain

positive set is indicative of psychogenic cause of pain

323
Q

Atopic dermatitis (eczema):

A

Chronic inherited skin disorder marked by extremely pruritic rashes that are located on the hands, flexural folds, and neck (older child to adult)

324
Q

class II heart disease

A

(Ordinary physical activity results in fatigue, exertional dyspnea)

325
Q

First-line medication for stable HF

A

ACEI or ARB

326
Q

An adult (21–75 years) with any type of ASCVD (e.g., CAD, PAD, stroke, TIA) is given _________ statins such as .

A

high-intensity

atorvastatin 40-80 mg or rosuvastatin 20-40 mg

327
Q

An adult with LDL >190 mg/dL (without ASCVD or DM) is a candidate for _________ statin dosing.

A

high-intensity

328
Q

For a patient who has markedly high triglycerides (500+), do what?

A

lower triglycerides first (niacin or fibrate) before treating the high cholesterol and LDL

329
Q

metabolic syndrome criteria

A

abdominal obesity
HTN
hyperlipidemia or elevated triglycerides and low HDL
elevated fasting glucose >100

330
Q

NAFLD is associated with _________________. Look for slight elevation of ____________ (not related to alcohol or medications) and negative ____________.

A

metabolic syndrome and/or obesity

ALT and AST

hepatitis A, B, and C.

331
Q

Abdominal obesity in males

A

> 40 inches [102 cm]

332
Q

Abdominal obesity in females

A

> 35 inches [88 cm]

333
Q

If SABA are not controlling symptoms, next step is to:

A

start patient on a long-acting (LAMA or LABA) based on patient preference. Continue using SABA as needed.

334
Q

top 2 bacteria in CAP are:

A

S. pneumoniae

H. influenzae

335
Q

top 2 bacteria in atypical pneumonia are:

A

Think “AMC, like the movies. It’s very atypical of me to want to go to the movies.”

Atypical
Mycoplasma
Chlamydia

336
Q

Rust-colored or blood-tinged sputum

A

likely from S. pneumoniae

337
Q

COPD/smoker with pneumonia:

A

More likely to have H. influenzae bacteria

338
Q

Outpatient CAP: Diagnosis is based on

A

presentation, S/S, and CXR.

Do not order sputum for C&S; instead, order CXR.

339
Q

CXR of a person with healed pulmonary TB

A

pulmonary nodules and/or cavitations (round black holes) on the upper lobes with or without fibrotic changes (scars).

340
Q

For CXR of right middle-lobe pneumonia, look for

A

consolidation (white-colored area) on the right middle lobe, which is located at about the same level as the right breast on the front of the chest.

341
Q

factors needed to figure out PEF

A

height + age + gender

use HAG mnemonic

342
Q

Severe respiratory distress:

A 
Tachypnea
disappearance of or lack of wheezing
accessory muscle use
diaphoresis
exhaustion
343
Q

What do PCR tests test for?

A

presence of viral RNA (s/a hep C or HIV)

positive result means that the virus is present.

***NOT antibody tests

344
Q

How do we prevent hepatitis D?

A

A person must have hep B to become infected with hep D. There is no vaccine for hep D, but hep B vaccination will prevent acquisition of hep B and therefore hep D

345
Q

What do large numbers of squamous epithelial cells in the urine sample mean?

A

contamination

346
Q

What is hemoglobin electrophoresis dx for?

A

thalassemia and sickle cell anemia

347
Q

Pernicious anemia results in:

A

Vitamin B12–deficiency anemia
Macrocytic
normochromic
Neurologic symptoms

348
Q

Pernicious anemia is

A

macrocytic

349
Q

Ketorolac (Toradol)

A

NSAID
limited to 5 days of use.
first dose is given IM or IV

350
Q

signs and symptoms of depression

A

SIG-E-CAPS

o	Sleep
o	Interest
o	Guilt
o	Energy
o	Concentration
o	Appetite
o	Psychomotor
o	Suicide
351
Q

Cushing’s syndrome

A

associated with delayed puberty and growth failure
excess of androgens
Gynecomastia

352
Q

When evaluating a patient with polycystic kidney disease, pay close attention to which area of the kidney?

A

basic functional units of the kidney are nephrons containing glomeruli and renal tubules

353
Q

Pyuria

A

increased presence of white blood cells in urine

354
Q

Amaurosis fugax

A

temporary loss of vision in one or both eyes due to a lack of blood flow to the retina

355
Q

Anomia

A

language specific disturbance arising after brain damage whose main symptom is the inability of retrieving known words

356
Q

xerosis

A

Dry skin

357
Q

Trigeminal neuralgia, aka

A

tic douloureux

358
Q

lifestyle factor associated with secondary polycythemia vera

A

Smoking b/c secondary PCV is associated with chronic hypoxia

359
Q

most common cause of bacterial pneumonia is

A

Streptococcus pneumoniae

360
Q

Rovsing’s sign

A

deep palpation of the lower left quadrant of the abdomen

361
Q

Markle test involves

A

having the patient raise their heels and drop them suddenly

362
Q

Psoas test

A

positive when the patient experiences abdominal pain while flexing the hip and knee

indicates appendicitis

363
Q

Basal cell carcinoma

A

small
translucent papules with a central ulceration
telangiectasis
rolled borders

364
Q

amaurosis fugax

A

major complication temporal arteritis (giant cell arteritis) causing transient blindness of the affected eye

365
Q

Still’s murmur

A

Still’s Murmur = SM

“Systolic, School-age, Self-resolves”

&

“Musical, Minimally radiates, Monitor”

benign murmur common in school-age children; usually self-resolves by adolescence

musical quality with minimal radiation

monitor on annual physical exam

366
Q

Heberden’s nodes

A

nodules on DIPJs

only with OA

367
Q

Which topical ear medications should be avoided in patients with perforation of the TM?

A

Aminoglycoside drops s/a (gentamycin, tobramycin) b/c they are are ototoxic

ear drops with alcohol, benzocaine, or olive oil should be avoided

Swimming or water inside the ear should be avoided until the TM is healed

368
Q

Which topical ear medications can be given in patients with perforation of the TM?

A

topical quinolone drops

369
Q

brown recluse spider bite

A

begin with burning at the site, followed by blanching with a red halolike center

reddened skin area that may be followed by a blister that forms at the bite site

mild-to-intense pain and itching for 2-8h after bite

central area of the bite becomes necrotic, and black eschar forms

370
Q

Cardiac complication of rheumatic fever

A

damage to mitral valve, leading to mitral valve regurgitation early or late in life

371
Q

EndomeTRITIS: subjective and objective findings associated with

A

painful sexual intercourse
pain when urinating
healthy appearance of the internal and external genitalia
lower abdominal and cervical motion tenderness in response to palpation

372
Q

EndomeTRITIS:

A

most commonly associated PID or invasive gyn procedures in nonobstetric pts

to determine the appropriate tx, obtain cervical culture to identify bacteria

373
Q

Type 1 tic douloureux (trigeminal neuralgia)

A

extreme, shock-like facial pain that lasts from a few seconds to 2 mins per event and can last up to 2h total.

374
Q

Type 2 tic douloureux (trigeminal neuralgia)

A

constant, aching, burning facial pain with less intensity
more common in women and peaks in their 60s
can also be r/t secondary neurologic disease s/a MS or HSV-1

375
Q

symptom of occipital neuralgia

A

Shooting pain at the base of the head

376
Q

Is there an association between lead poisoning and iron deficiency in children?

A

Yes

both diagnoses are common in patients of lower socioeconomic status

Iron deficiency has also been shown to increase lead retention in the tissues, leading to increased absorption and toxicity

377
Q

Normocytic anemia results from

A

long-term chronic disease; generally occurs in older adults rather than children

378
Q

Spirometer readings are used to:

A

assess a patient’s personal best

379
Q

Spirometer readings zones:

A

Green zone =80% - 100% expected volume
Yellow zone = 50% - 80% expected volume
Red zone = below 50% of expected volume

380
Q

Reiter’s syndrome

A

immune-mediated reaction secondary to chlamydia

causes red, swollen joints; ulcers on the skin of the glans penis; and urethritis

resolves on its own

Tx = NSAIDs, comfort measures, and ABX for underlying chlamydia

381
Q

insulin used on a sliding scale to work from meal to meal

A

Lispro (rapid-acting)

382
Q

Minimum duration of tx of complicated UTIs in males, uncontrolled DM, immunocompromised, and pregnant or elderly women

A

minimum of 7 days

383
Q

Meglitinides

A

stimulate pancreatic release of insulin and are indicated for patients with postprandial hyperglycemia

384
Q

Thiazolidinediones should not be used with patients who have a history of

A

bladder cancer or heart failure

385
Q

Tx for atypical pneumonia in patient with no comorbidities or antibiotic resistance

A

azithromycin (Z-Pak) daily × 5 days

386
Q

Tx for atypical pneumonia in patient with possible comorbidity and/or those at risk for antibiotic resistance

A

monotherapy with a fluoroquinolone (e.g., levofloxacin or moxifloxacin)
or
combination therapy of Augmentin + a macrolide or doxycycline

387
Q

UTI is defined as

A

presence of 100,000 organisms/mL of urine in asymptomatic patients

or

> 100 organisms/mL of urine w/ pyuria (>7 WBCs/mL) in a symptomatic patient

388
Q

reticulocyte count reflects

A

the efficiency of the bone marrow’s response to illness in a patient with sickle cell disease

389
Q

Bowen’s disease

A

squamous cell cancer (SCC) of epidermis that has not yet invaded the dermis

Curettage & electrodessication is an efficient, cost-effective method with low complication rates

390
Q

Doxycycline should not be prescribed for children younger than

A

9 years

391
Q

quinolones and should not be administered to children younger than

A

18 years

392
Q

Bactrim DS

A

appropriate for treating gram-negative bacteria s/a Escherichia coli

also appropriate for patients older than 2 mos.

393
Q

CHD screening O2 sat of ≥95% in the right hand or foot with a ≤3% absolute difference between the right hand and foot is considered a ______ screen, and screening would _____.

A

passed; end

394
Q

A failed CHD screen is if

A

any O2 saturation measure is <90% (in initial screen or in repeat screens)

or
O2saturation is <95% in the right hand and foot on 3 measures, each 1 hour apart

or

a >3% absolute difference exists in O2 saturation b/t right hand and foot on 3 measures, each 1 hour apart

395
Q

A failed CHD screen is if

A

any O2 saturation measure is <90% (in initial screen or in repeat screens)

or
O2saturation is <95% in the right hand and foot on 3 measures, each 1 hour apart

or

a >3% absolute difference exists in O2 saturation b/t right hand and foot on 3 measures, each 1 hour apart

396
Q

Common s/s of pregnancy-induced HTN

A 
edema of face and the upper extremities
weight gain
blurred vision
elevated BP
proteinuria
h/a
397
Q

Chordee

A

presence of ventral shortening and curvature of the penis

commonly associated with a more proximal urethral defect

398
Q

Initiate phototherapy in NB whose

A

bilirubin level is >5 mg/dL,

399
Q

Tx for OE

A

Use aluminum acetate solution PRN

Keep water out of the ear during treatment

Apply polymyxin B–neomycin-hydrocortisone suspension drops QID × 7 days
and/or ofloxacin otic drops BID × 7 days

400
Q

betablocker

A

contraindicated for a patient with emphysema

401
Q

contraindicated in patients with sulfa allergies

A

Thiazides (hydrochlorothiazide and indapamide)

loop diuretics (furosemide and bumetanide)

402
Q

24-hour urine collection measures

A

creatinine clearance to assess for proteinuria, albuminuria, and glomerular filtration rate

403
Q

Restrictive airway diseases

A

Trouble filling lungs on inspiration

TB
Pneumonia
PE
Sarcoidosis

404
Q

Obstructive airway dz

A

Difficulty exhaling

Asthma
CF
COPD (or emphysema/ chronic bronchitis separately)
Bronchiolitis

405
Q

Diabetes insipidus

A

overproduction of antidiuretic hormone

does not create ketones in the blood

406
Q

False-positive results in ovulation tests that detect the urinary luteinizing hormone (LH) can occur w/

A

menopause
PCOS
endometriosis
ovarian insufficiency

407
Q

When a nurse practitioner percusses over the lungs, resonance is heard over

A

normal lung tissue

408
Q

Hyperresonance is heard wit

A

emphysema

409
Q

Recommended empiric treatment of suspected UTI children younger than 24 months

A

bactrim

410
Q

pathogen that commonly causes meningitis

A

gram-positive

Streptococcus pneumonia

411
Q

EKG reading for someone who took too much amitriptyline (Elavil) would show

A

sinus tachycardia

412
Q

Recommended care for women diagnosed with preeclampsia includes

A

bed rest with bathroom privileges
weight and BP monitoring
closely following urine protein and serum protein, creatinine, and platelets

***oral meds are not used first-line

413
Q

What condition is coming to see with ankylosing spondylitis?

A

UC

15-40%

FNP (4 decks)

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