BOARD EXAM Flashcards
Treatment for patient dx with bronchitis?
breathing tx, nebulizer, albuterol, SABA
First line Treatment for CAP in healthy patient?
Macrolide
First line tx for child with CAP?
Amoxicillin (high dose) if presumed bacterial (s. pneumonia)
Azithromycin if presumed atypical
(atypical - mycoplasma; chlamydiphilia)
Auscultation with emphysema reveals
hyper-resonance
decreased tactile fremitis
What do you test if changing an asthma med?
PFT, Spirometry
Child with 104 fever for 4-5 days, peeling skin on hands and feet, strawberry tongue; what is it?
Kawasakis
What is treatment for Kawasaki’s? (2)
- High Dose ASA
2. IVIG
What diseases would you see a strawberry tongue?
Scarletina and Kawasakis
What disease would you see a sand paper rash?
Scarletina
What compound is common migraine trigger?
tyramine (aged/fermented foods)
Patient presents with unilateral pain behind one eye, light sensitivity, n/v? what do you suspect?
migraine
Abortive tx for migraine?
Triptans (Imitrex)
Prophylactic TX for migraine (2)
- TCA
2. Propranolol
Older white male with pain in head same time every day; what is it and what is TX (2)?
cluster;
- high dose O2 therapy
- CCB (needs vasodilation)
What CCB would you give to pt presents with cluster H/A?
Verapamil
What causes papilledema?
Increased ICP
What is this? swelling of optic disc, blurred edges of optic disc?(blurry vision?)
papilledema
Cause of papilledema?
HTN
Where does Weber lateralize?
Affected ear
Where do you test Rinne?
Rinne under the pinne
What is NL Rinne?
AC>BC
ABN Rinne?
BC>AC
What is THE most common organism in Otitis Media?
Streptococcus pneumoniae
In addition to s.pneumo, what other organisms cause AOM?
- haemophilus influenza
2. moraxella catarrhalis
What is first line TX Otitis Media?
Amoxicillin
If Amoxicillin TX failed in AOM, what is second line?
Augmentin
3rd line TX for AOM if Amox, Aug. fail?
Omnicef?
Beyond 3rd line TX for AOM?
Ceftin, Levoquin
What is TX for OME?(2)
- Antihistamine
2. decongestant
How long can OME last?
8 weeks
UTI TX in 1-2nd trimester? (weeks 1-28)
Macrobid (Nitrofurantoin)
UTI TX in 3rd trimester (weeks 29-40)?
Cephalosporin (Keflex)
PCN allergy, what do you give?
Macrolide (Azithromycin, erythromycin, clarithromycin)
IF allergy to PCN, intolerant of erythromycin, what would you give?
an different macrolide OR doxy
What is order of treatment (classes) if PCN allergy?
Macrolide -> Doxy -> Fluoroquinoline
Prophylaxis for Malaria? (PT traveling to tropical, etc.)
Doxycycline
WHAT IS INR GOAL IF ON COUMADIN?
2-3
WHAT IF INR IS 1.2 (low) on COUMADIN
adjust the dose (increase)
What if INR is 5.0 on coumadin (high)
HOLD DOSE
What foods to avoid on coumadin?
green leafy;
grapefruit
VIT K
What nerve is involved in Trigeminal Neuralgia?
CN V
What is another name for Trigeminal Neuralgia?
Tic Douloureux
What might this patient have: pain in face that is burning, electric shock, intense, lightening like, stabbing, intermittent?
Trigeminal Neuralgia/Tic Douloureux
What class of medications used for Tic Douloureux?
anticonvulsants
What is an example of an anticonvulsant used for trigeminal neuralgia?
Tegretol (carbamazepine)
If female patient has migraine with aura, what BC do you avoid?
estrogen (COC)
What kind of BC do you give pt. who has hx of migraine with aura?
progesterone only (progestin only)
Young adolescent male hit head; neurology exam is negative; what might he have?
concussion
Pt hit head and neurology exam has positive findings. what might be problem? What is next step?
subdural hematoma
ED
Protocol for PE? (TX, ST and LT therapy)
- heparin
- ST 2-3 mo
- LT 6+ mo
GOAL A1C for T2DM?
<7%
A1C goal for elderly?
<8
1st line TX T2DM?
metformin
A1c to start insulin?
9 or double digits
A1c greater than 9; what insulin do you start on?
Basal, long-actin (Lantus, Levimir)
What is #1 side effect/complaint with Metformin?
SSX of GI upset
What can happen to PT on metformin if receives contrast media for procedure?
Lactic acidosis
How long do you hold Metformin before procedure?
How long do you hold Metformin after procedure?
- before - 24 hours
2. after - 48 hours
What blood test can be run that is expensive but valuable?
fructosamine test
If pt is on Digoxin and Cr level increased, what does the NP do?
decrease the Digoxin (don’t stop)
If suspect patient has SLE, what lab do you run?
ANA
What are copper and silver wire finding associated with
HTN
What are cotton wool spots associated with?
DM
What are micro aneurysms assoc with?
DM
What is AV nicking assoc with?
HTN
What are retinal hemmorages assoc with?
HTN and DM
Your patient has papules, pustules on nose, mouth and chin; what could this be?
Rosacea
T/F - you would also see papules on cheeks and forehand in rosacea?
????- just nose, mouth, chin
what are the treatment for Rosacea? (3)
- Topical metrogel - flagyl
- Azelex
- low dose tetracycline (doxy)
What is this:
small flat topical bumps, grey and white streaks?
Lichen planus
Treatment for lichen planus?
Steroid
Most common skin CA?
BCC
What is this? waxy, pearly papule; may or may not be ulcerated in center?
BCC
Why might BCC bleed easily?
telangiectasia
Another name for Eczema?
Atopic dermatitis
Special instructions for Eczema?
avoid hot water no harsh soaps tepid water cool water pat dry cream based moisturizer: Eucerin, vaseline, aquifer
Where do you see atopic dermatitis
Flexural folds (excess)
How to treat flair of eczema?
Steroids
SSX of testicle torsion?
absent cremasteric reflex
pain
N/V
How much time in Testicular torsion before damage?
6 hours
Find patches/discolor on back of pt?
tinea versicolor
TX for tinea versicolor:
anti fungal - azole selsun blue (selenium sulfide)
how long tx tinea versicolor
everyday - daily for 2 weeks
What kind of exercise if pt has DJD?
isometric
example of isometric exercises in DJD?
swimming
aquatic
DJD is also known as
osteoarthritis
What is FIRST line TX in DJD/osteoarthritis?
Tylenol
What nodes are seen in DJD on hands?
Bouchards (PIP)
Heberden (DIP)
What type of exercise should patient with osteoporosis do?
weight bearing;
What is first line tx for osteoporosis?
bisphosphonates
what is most common bisphosphonate?
Fosomax
What are instructions for Fosomax?
sit up for 30 min after taking (even go for walk)
take with full glass of H2)
Do not lie down
Why specific instructions for Fosomax?
avoid esophageal erosion
What is recommended daily amount of Ca++?
1200 mg
What is recommended daily amount of Ca++ in a pregnant patient?
1200 + 1000 mg = 2200
(add 1000 mg)
What is the daily recommended vitamin D per day?
800 units/day
newer say 600
If patient needs vitamin D replacement, what is it?
50,000 units weekly X 7 - 10 weeks
After treating a patient with Vitamin D, what is daily maintenance dose?
800 units qd
newer regs say 600
When to start screening for osteoporosis ?
How often to screen?
Start at age 65
Screen every 2 years
What is used to screen for osteoporosis?
DEXA
What is name of fall risk assessment?
Get up and GO
Patient presents with bilaterally/symetrically swollen joints of wrists, fingers, that lasts longer than 60 min in the a.m. what is it?
RA
Which hand nodes are affected in RA?
PIP
Bouchard
What other appearance will you see in fingers of RA pt?
Swan neck
sausage like joints/fingers
tender
What is 1st line TX for RA?
NSAIDS
If pt has back pain, and sitting feels better, what might dx be?
spinal stenosis
Sciatica and disc problem always hurt
What is GOLD Standard to DX back problem?
MRI
What test do you perform if you suspect pt has sciatica?
Straight leg test
What is the name of the test you do for scoliosis?
Adam forward bend test
Patient presents with burning, numbness between 3 and 4 metatarsal; what is this?
Morton’s neuroma
also described as pebble
What is test for Morton’s neuroma?
Mulder Test/ squeeze test
Patient complains of chronic back, sacra-iliac night pain;
Imaging of back appears as bamboo spine
What is this?
Ankylosing Spondylitis
Etiology of ankylosing spondylitis?
auto-immune
Why ankylosing spondylitis flair/pain at night
not moving
What eye problem is associated with ankylosing spondylitis?
iritis/uveietis (inflammation of iris)
Patient presents with NV, diarrhea, fever, chills, stomach pain; works in post office/mail man? fine yesterday; what does he have?
Antrax exposure/bioterrorism
Treatment for Anthrax?
Cipro for 60
500 X 60 days
cloasma = ?
melasma = pregnancy mask
what labs are ordered if suspect HIV (2)?
- Elisa
2 Western blot to confirm
(Newer guidelines say P24 antigen)
What 3 antipsychotic/atypical meds need to monitor and why??
1. zyprexa 2 seroquil 3. respirodol Weight gain - monitor BMI Blood glucose (also lipids???)
Pt. has BMI < 18.5 what is DX?
anorexia
SSX of anorexia
amenorrhea, brittle nails, lanugo,
palpitations, peripheral edema due to low albumin and cardiac issues
what ages does autism ssx appear?
18 mo - 24 months
Medication contraindicated with seizures?
Wellbutrin
- lowers seizure threshold
Medication contraindicated with anorexia?
Wellbutrin
weight loss is associated with
T/F - ADHD is behavioral according to DSM-5
True
How many setting must ADHD be document in for DX?
two (school and home, etc.)
What size is MCV in microcytic anemia?
< 80
What size is MC in macrocytic anemia?
> 100
What anemias are microcytic?
IDA
Thalassemia
What do you check if have microcytic anemia?
RDW
What is RDA elevation in IDA?
> 15%
What is ordered and checked for in anemia panel to look for IDA?
TIBC
Ferritin
Pt presents with ataxia and persthesia; what suspected?
B12 deficiency
another name for B12 deficiency?
Pernicious anemia
What does tongue look like in anemia (B12/folate)
glossitis - beefy/red
What blood problem mimics IDA?
Lead poisoning
what year houses for lead poisoning?
before 1978
Why no cows milk before 1 year old and what cause?
causes IDA due to GI bleeding
what deficiency is seen with macrocytic anemia?
B12/folate
What is toxic level for lead?
> 5 or >10
Level for lead poisoning?
> 80
What is concern for lead poisoning?
irreversible neurotoxicity
GOLD standard test for Sickle Cell and Thalassemia?
hemoglobin electrophoresis
First intervention in SSA crisis?
HYDRATE (reduce blood viscosity)
Patient treated with Iron for 6 months and no change; what do you check?
reticulocyte count
How do you treat IDA?
Fe
What do you take IDA with to improve absorption?
Vit C
What is long term maintenance drug used for gout?
allopurinol
what medications are used to treat gout flairs?
NSAIDS (colchicine and indomethacin)
T/F - use steroids to tx gout?
false
If patient is put on allopurinol and has flare within 4 weeks what does the NP do? (3)
- Stop the allopurinol
- Give NSAID through flair
- restart allopurinol
(pt starts allopurinol likely to have flare)
If pt on allopurinol for 3 months and has flare, what does NP do?
- continue allopurinol
2. NSAIDS
What foods to avoid in Gout? (3…)
- ETOH - beer
- red meat
- shell fish
(organ meat, processed food)
What is hearing loss in an older person called?
presbycussis
what is vision loss in an older person called?
presbyopia
What is another name for PPD
Mantoux
What patients are considered positive with 5mm induration on PPD?
HIV or immunocompromised
What pt considered positive with 100 mm induration?
healthcare, migrant worker (farmer), immigrant
What part of lobes are affected on CXR in Pneumonia?
middle to lower
What lobes of lungs affected in TB on CXR?
upper
patient with SSX of night sweats, productive cough, upper lobes consolidation on CXR; what is it?
TB
Dull aching pain in rt or left shoulder which doesn’t go away and interrupts sleep. What is it?
Rotator cuff tear
Who has highest rate of suicide?
elderly white males
What is most common STI in adolescents?
clamydia
treatment for clamydia?
Azithromycin 1 g
Treatment for ghonorrea?
Ceftriaxone
What is no. 1 killer in US?
cardiovascular disease
what is no. one cancer killer?
lung
what is no. 2 ca in women? men?
breast; prostate
What is 1st line TX for GERD?
- PPI
2. H2 (used to be first line)
Steps in TX of GERD if recurs:
- PPI
2. H2
Velvety skin on neck is what and what causes?
acanthosis nigracans; insulin resistance
You would see acanthosis nigracans in what female population?
PCOS
what med is given to PCOS pt trying to get pregnant?
Metformin
If pt. doesn’t want to get pregnant and have PCOS, what do you give them?
COC
If a child has acanthosis nigoracans, what might you tell parents?
Teach about possible DM
What labs do you get for pt with PCOS, if having difficulty getting pregnant?
TSH, LH, FSH
COPD patient - always talk about _________ if applicable
smoking cessation
T/F patient with enlarged prostate has severe pain
false; no pain
what does prostate feel like?
tip of nose
what are the signs and symptoms of acute prostatitis?
FLU like:
fever, N/V, chills
this is an infection
How to distinguish flu from acute prostatitis?
suprapubic pain
perineal pain
hurts to poop
lasts longer than flu
What labs for prostatitis?
UA/CBC
What lab findings if prostatitis?
UTI, (blood maybe)
Acute prostatitis, what does prostate feel like?
warm and boggy
Why do you Not do a real exam on prostate if suspect prostatitis?
introduce septicemia or bacteremia
What is treatment for prostatitis?
CIPRO
Levaquin
Bactrim
How long do you treat prostatitis?
4-6 weeks
think - prostate is hard to penetrate - like a nut
If 30 y/o patient presents with six similar to prostatitis (fever, perineal pain, N/V), what would you do?
run STI panel
what might you find on lower back of black pt. looks like bruises?
mongolian spots
what drugs do you use to treat sinusitis?
amoxicillin or augmentin
where does sinusitis pain radiate?
maxillary; jaws, teeth, mouth
when should strabismus be gone?
6 months
if baby has strabismus at 7 months, what do you do?
refer
what is name of test for strabismus?
cover/uncover
where is most vascular place for nose bleeds?
anterior
Keisselbach plexus
what virus causes GI issues/pooping in kids?
rotavirus
When does baby double weight?
6 mo
when does baby triple weight?
12 mo
how young to start gardisil?
9 y/o
how young to give flu shot?
6 mo
Do not give TDap in a patient younger than
7 years
Don’t give MMR to a patient younger than
12 months
How long to wait if give varicella before give MMR?
28 days if not given on same day together
what is care for varicella?
supportive: calamine, oatmeal baths
when can pt go back with varicella
when lesions have crusted over
when do you give acyclovir?
shingles in older person (altho think you give to young adult/teen with varicella)
What is this: tingling on forehead and on tip of nose?
herpetic keratosis
T/F: herpetic keratosis is emergency
TRUE - don’t want vesicles to form; result in blindness
What is test for mono?
monospot
heterophile antibody
How long does mono last?
4-6 weeks
When can pt with mono return to contact sports/ativities?
when spleen is normal verified by US
If patient had mono and returns 3 months later, do you think it is mono or something else?
something else - possibly due to decreased immune system making them susceptible; fatigue can last a while
Where is stood schlatter ?
tibial tuberosity/knees
What disease has sudden, violent, paroxysmal cough?
pertussis
what is the worrisome sign of GERD?
dysphasia - cannot swallow
what is the worrisome sign of GERD?
dysphasia - cannot swallow
green, frothy vaginal d/c is what?
trichomoniasis
what is defining lab for trichomoniasis?
Wet mount/wet prep/wet smear
what herbal medication useful for migraine and H/A?
fever few
what herb for prostate in male?
saw palmetto
what her for memory in older pt?
“Ginko!”
What herb to manage anxiety and insomnia?
kava kava
what herb to boost immune system in children (URI SSX)?
echinacea
male patient presents with scrotum that feels like bag of worms; what is this?
varicocele
baby’s testicle illuminated by flashlight; what is this?
hydrocele
when should hydrocele resolve in baby?
12 mo
Pt presents with coughing for 3 weeks; no fever, no chest pain, no productive cough, no wheezing; what is it?
mycoplasma pna (this is an atypical presentation due to atypical pathogen)
middle age lady presents coughing for 3 weeks; what should rule out?
pna
T/F patient coughing for 3 weeks, but no fever has pneumonia
NOT SURE; no fever no pan
no fever no URI
bronchitis has cough but no fever
what do you give pt dx with bronchitis?
breathing treatment; nebulizer, albuterol, SABA
cough suppressant, tesslon pears,
patient presents with fever, coughing for 3 weeks; you treated her for bronchitis but now has cough - what do you suspect?
PNA - CAP; atypical/walking/mycoplam/
when do you see rust colored sputum?
pneumonia!
Best tx for PNA (if DRSP)
Levoquin
TX for PNA in healthy pt?
Macrolide
