AANP EXAM NOTES 8 Flashcards
Acne Vulgaris is AKA
COMMON ACNE
MILD ACNE VULGARIS IS TREATED ONLY WITH
TOPICALS
High androgen levels, bacterial infection, follicular
hyperproliferation, & genetic influences contribute to what skin condition?
Acne
What medication is 1st line TX for mild acne?
Tretinoin topical (Retin A) 0.25% cream or benzoyl peroxide gel (AAFP)
What term describes a clogged hair follicle in the skin.
Comedo
What is 1st line tx for comedones
Topical Retinoids (Retinol, Tretinoin)
Your PT has comedones which have not improved with topical cream or gel. What is the next step?
Oral Antibiotics (Tetracycline, minocycline, doxy, erythromycin)
What CONDX includes acne vulgaris symptoms plus painful indurated nodules, cysts, abscesses, & pustules over face, shoulders, & chest?
Severe cystic acne
What is TX for Severe cystic acne
Isotretinoin (Accutane)
Isotretinoin (Accutane) is presecribed for severe cases of cystic acne. This prescription is only available through what program?
iPledge
PT presents with discolored patches on the chest neck, arms and back. What lab would you order?
KOH
PT presents with discolored patches on the chest neck, arms and back. KOH slide shows hyphae and spores. What is your DX?
PITYRIASIS VERSICOLOR
WHAT CONDX IS CAUSED BY MITE INFESTATION?
SCABIES
A PT WITH SCABIES MAY BE ASYMPTOMATIC FOR HOW LONG AFTER INFESTATION?
4-8 WEEKS
IS SCABIES CONDITION TYPICALLY WORSE DURING DAY OR NIGHT?
NIGHT
PRURITIS MAY PERSIST FOR HOW LONG IN SCABIES PT?
2-4 WEEKS
PERMETHRIN 5% (AKA ELIMITE) IS APPLIED TO A SCABIES PT WHEN?
AFTER BATHING OR SHOWER
A Black Box Warning exists for Lindane lotion 1% (Kwell). Why should this medication be avoided for the TX of scabies?
Severe neurologic toxicity
What is gold standard test for Varicella Zoster Virus Infection?
Polymerase chain reaction (PCR)
PCR TEST INDICATES PT IS INFECTED WITH VARICELLA ZOSTER VIRUS. YOU TREATED PT WITH ACYCLOVIR BUT PHN PROPHYLAXIS HAS EMERGED. WHAT IS NEXT STEP?
TX WITH TRICYCLIC ANTIDEPRESSANTS (TCA) SUCH AS AMITRIPTYLINE (ELAVIL)
What is the preferred ABT for human, dog, cat bite?
Augmentin
PT reports dog bite. Who must you notify?
Animal Control
What medication would you RX for a dog bite?
Amoxicillin clavulante (Augmentin) 875 mg/125 mg po BID x 10 days.
A dog/cat bite wound should be sutured. T/F
FALSE. NEVER SUTURE DOG/CAT BIT WOUND D/T HIGH RISK OF INFECTION.
PT REPORTS CAT BITE. TETANUS PROPHYLAXIS BOOSTER SHOULD BE GIVEN IF THE LAST BOOSTER WAS GIVEN MORE THAN … YEARS AGO.
5 YEARS
PT REPORTS CAT BITE. WHAT DETERMINES IF A TDAP PROPHYLAXIS BOOSTER SHOULD BE GIVEN?
TDAP BOOSTER IS GIVEN IF PT IS > 7 YEARS OR HAS NEVER HAD TDAP
IF A PT IS BITTEN BY A DOMESTIC ANIMAL THAT IS SUSPECTED OF HAVING RABIES, HOW LONG MUST THE ANIMAL BE QUARANTINED?
10 DAYS
IF A PT IS BITTEN BY A DOMESTIC ANIMAL THAT IS SUSPECTED OF HAVING RABIES, WHAT 2 VACCINES MAY BE REQUIRED?
RABIES IMMUNE GLOBULIN
RABIES VACCINE
WHO WOULD YOU CALL FOR ADVICE REGARDING A POTENTIAL RABIES CASE?
LOCAL HEALTH DEPT
PT IN OFFICE WITH TICK BITE. P/E REVEALS TICK EMBEDDED IN PT’S SKIN. HOW DO YOU REMOVE TICK?
REMOVE TICK BY PULLING IT OUT WITH TWEEZERS, THEN WASH WITH SOAP & WATER
TICKS SHOULD BE REMOVED FROM PT WITH NAIL POLISH, PETROLEUM JELLY OR HEAT. T/F
FALSE. FALSE. FALSE!
WHAT IS THE DIAGNOSTIC TEST FOR LYME DISEASE?
ELISA
10 YO FEMALE PT IN OFFICE WITH TICK BITE. YOU REMOVE TICK FROM SKIN. WHAT IS NEXT TX STEP?
RX DOXYCYCLINE
WHAT IS THE “DIRTIEST” BITE OF ALL
HUMAN BITE
SHOULD A LACERATION CAUSED BY A HUMAN BITE BE SUTURED?
ABSOLUTELY NOT. DOING SO IS NEGLIGENCE
Anthrax is an infection caused by Bacillus anthracis. What 3 diagnostic tests should be ordered?
Tissue biopsy with gram stain, culture, & immunohistochemical stain
What medication is used to TX anthrax?
Doxycycline BID, Ciprofloxacin BID
Diabetic PT in office with c/o frequent urination while taking lithium. What may be underlying cause?
, insipidus may be an underlying cause
Name 3 risk factors for TYPE 2 DM
- BMI of 25 (31) or >,
- Sedentary lifestyle,
- Sibling with Type 2 DM
- h/o gestational diabetes
What is fasting glucose level for prediabetes?
100-125
What is fasting glucose level for normal non diabetic?
< 100
What is NON -FASTING glucose level for normal non-diabetic?
<125
What is normal Random glucose
<200
What is normal A1C goal for older adults with multiple comorbidities
<8
A PT returns to office for lab review. Fasting glucose is above 126. What is next step?
Perform Hgb A1c test
As Hgb A1C decreases, triglycerides increase/decrease?
decrease
A PT tests positive for Anthrax. Who must be notified?
CDC
A microscopic skin lesion presenting with hyphae suggests what type of infection?
fungal
A PT has elevated urinary albumin to creatinine ratio. What should you do?
Repeat test in 3-6 months
What is normal Urinary albumin to Creatinine ratio?
NORMAL UACR is 30MG/gm
What is first line TX for DM2 in addition to diet/exercise?
Metformin
If max dose of Metformin does not improve DM2 PT CONDX, WHAT CAN BE ADDED?
SULFONYLUREA (GLUCOTROL xl 20 MG/DAY
Metformin is contraindicated in what type of dz?
Renal dz, Hepatic dz,
Metformin is contraindicated n alcoholics. T/F
TRUE
During hypoxia, hypoperfusion, renal insufficiency, THERE IS AN INCREASED RISK OF …
LACTIC ACIDOSIS
If DM PT complains of profound diarrhea, what should you do?
Stop the metformin until the diarrhea stops, then restart it once daily. Evaluate response in 2 weeks.
Name at least 3 labs that can help you carefully monitor a PTs renal dysfunction
Serum creatinine, eGFR, LFTs, ALT/ AST, UA.
Does metformin need to be held if PT is undergoing IV contrast dye test? If so, for how long?
Hold metformin on day of procedure and 48 hours after.
What must be normalized before metformin can be restarted in a PT who has had IV contrast dye testing?
baseline creatine must be normalized
Pioglitazone (ACTOS) and Rosiglitazone (Avandia) are what type of drug?
Thiazolidinediones
Pioglitazone (ACTOS) and Rosiglitazone (Avandia) are to be taken with which meals?
1 daily with meal at breakfast
Pioglitazone (ACTOS) and Rosiglitazone (Avandia) have a black box warning for pats with what kind of Dz?
Heart Dz class 3 or 4, CHF
Do Alpha Glucosidase Inhibitors typically cause PTs to gain/lose weight?
NEIGHTER. They are Weight Gain neutral.
Glucagon is like peptide 1 because it is a receptor agonist/antagonist?
Agonist
Name 2 Glucagon medications
Exenatide (Byetta)
Liraglutide (Victoza)
Name 1 SGLT 2 inhibitor
Empagliflozin (Jardiance)
Do insulins cause weight gain or loss?
Gain
Regular human insulin is short/long acting
short
Regular human insulin lasts how long?
meal to meal
Human NPH is long/short/intermediate
Intermediate NPH
Intermediate NPH lasts how long?
breakfast to dinner
What is a premixed insulin that typically lasts about 24 hours
humulin
As T4 falls, TSH rises/falls?
Rises
Treat PT if TSH decreases to what level?
10 mU/L
What is the most common form of hyperthyroidism in US?
GRAVES DZ