BOARD EXAM Flashcards
1
Q
Treatment for patient dx with bronchitis?
A
breathing tx, nebulizer, albuterol, SABA
2
Q
First line Treatment for CAP in healthy patient?
A
Macrolide
3
Q
First line tx for child with CAP?
A
Amoxicillin (high dose) if presumed bacterial (s. pneumonia)
Azithromycin if presumed atypical
(atypical - mycoplasma; chlamydiphilia)
4
Q
Auscultation with emphysema reveals
A
hyper-resonance
decreased tactile fremitis
5
Q
What do you test if changing an asthma med?
A
PFT, Spirometry
6
Q
Child with 104 fever for 4-5 days, peeling skin on hands and feet, strawberry tongue; what is it?
A
Kawasakis
7
Q
What is treatment for Kawasaki’s? (2)
A
- High Dose ASA
2. IVIG
8
Q
What diseases would you see a strawberry tongue?
A
Scarletina and Kawasakis
9
Q
What disease would you see a sand paper rash?
A
Scarletina
10
Q
What compound is common migraine trigger?
A
tyramine (aged/fermented foods)
11
Q
Patient presents with unilateral pain behind one eye, light sensitivity, n/v? what do you suspect?
A
migraine
12
Q
Abortive tx for migraine?
A
Triptans (Imitrex)
13
Q
Prophylactic TX for migraine (2)
A
- TCA
2. Propranolol
14
Q
Older white male with pain in head same time every day; what is it and what is TX (2)?
A
cluster;
- high dose O2 therapy
- CCB (needs vasodilation)
15
Q
What CCB would you give to pt presents with cluster H/A?
A
Verapamil
16
Q
What causes papilledema?
A
Increased ICP
17
Q
What is this? swelling of optic disc, blurred edges of optic disc?(blurry vision?)
A
papilledema
18
Q
Cause of papilledema?
A
HTN
19
Q
Where does Weber lateralize?
A
Affected ear
20
Q
Where do you test Rinne?
A
Rinne under the pinne
21
Q
What is NL Rinne?
A
AC>BC
22
Q
ABN Rinne?
A
BC>AC
23
Q
What is THE most common organism in Otitis Media?
A
Streptococcus pneumoniae
24
Q
In addition to s.pneumo, what other organisms cause AOM?
A
- haemophilus influenza
2. moraxella catarrhalis
25
What is first line TX Otitis Media?
Amoxicillin
26
If Amoxicillin TX failed in AOM, what is second line?
Augmentin
27
3rd line TX for AOM if Amox, Aug. fail?
Omnicef?
28
Beyond 3rd line TX for AOM?
Ceftin, Levoquin
29
What is TX for OME?(2)
1. Antihistamine
| 2. decongestant
30
How long can OME last?
8 weeks
31
UTI TX in 1-2nd trimester? (weeks 1-28)
Macrobid (Nitrofurantoin)
32
UTI TX in 3rd trimester (weeks 29-40)?
Cephalosporin (Keflex)
33
PCN allergy, what do you give?
Macrolide (Azithromycin, erythromycin, clarithromycin)
34
IF allergy to PCN, intolerant of erythromycin, what would you give?
an different macrolide OR doxy
35
What is order of treatment (classes) if PCN allergy?
Macrolide -> Doxy -> Fluoroquinoline
36
Prophylaxis for Malaria? (PT traveling to tropical, etc.)
Doxycycline
37
WHAT IS INR GOAL IF ON COUMADIN?
2-3
38
WHAT IF INR IS 1.2 (low) on COUMADIN
adjust the dose (increase)
39
What if INR is 5.0 on coumadin (high)
HOLD DOSE
40
What foods to avoid on coumadin?
green leafy;
grapefruit
VIT K
41
What nerve is involved in Trigeminal Neuralgia?
CN V
42
What is another name for Trigeminal Neuralgia?
Tic Douloureux
43
What might this patient have: pain in face that is burning, electric shock, intense, lightening like, stabbing, intermittent?
Trigeminal Neuralgia/Tic Douloureux
44
What class of medications used for Tic Douloureux?
anticonvulsants
45
What is an example of an anticonvulsant used for trigeminal neuralgia?
Tegretol (carbamazepine)
46
If female patient has migraine with aura, what BC do you avoid?
estrogen (COC)
47
What kind of BC do you give pt. who has hx of migraine with aura?
progesterone only (progestin only)
48
Young adolescent male hit head; neurology exam is negative; what might he have?
concussion
49
Pt hit head and neurology exam has positive findings. what might be problem? What is next step?
subdural hematoma
| ED
50
Protocol for PE? (TX, ST and LT therapy)
1. heparin
2. ST 2-3 mo
3. LT 6+ mo
51
GOAL A1C for T2DM?
<7%
52
A1C goal for elderly?
<8
53
1st line TX T2DM?
metformin
54
A1c to start insulin?
9 or double digits
55
A1c greater than 9; what insulin do you start on?
Basal, long-actin (Lantus, Levimir)
56
What is #1 side effect/complaint with Metformin?
SSX of GI upset
57
What can happen to PT on metformin if receives contrast media for procedure?
Lactic acidosis
58
How long do you hold Metformin before procedure?
| How long do you hold Metformin after procedure?
1. before - 24 hours
| 2. after - 48 hours
59
What blood test can be run that is expensive but valuable?
fructosamine test
60
If pt is on Digoxin and Cr level increased, what does the NP do?
decrease the Digoxin (don't stop)
61
If suspect patient has SLE, what lab do you run?
ANA
62
What are copper and silver wire finding associated with
HTN
63
What are cotton wool spots associated with?
DM
64
What are micro aneurysms assoc with?
DM
65
What is AV nicking assoc with?
HTN
66
What are retinal hemmorages assoc with?
HTN and DM
67
Your patient has papules, pustules on nose, mouth and chin; what could this be?
Rosacea
68
T/F - you would also see papules on cheeks and forehand in rosacea?
????- just nose, mouth, chin
69
what are the treatment for Rosacea? (3)
1. Topical metrogel - flagyl
2. Azelex
3. low dose tetracycline (doxy)
70
What is this:
| small flat topical bumps, grey and white streaks?
Lichen planus
71
Treatment for lichen planus?
Steroid
72
Most common skin CA?
BCC
73
What is this? waxy, pearly papule; may or may not be ulcerated in center?
BCC
74
Why might BCC bleed easily?
telangiectasia
75
Another name for Eczema?
Atopic dermatitis
76
Special instructions for Eczema?
```
avoid hot water
no harsh soaps
tepid water
cool water
pat dry
cream based moisturizer: Eucerin, vaseline, aquifer
```
77
Where do you see atopic dermatitis
Flexural folds (excess)
78
How to treat flair of eczema?
Steroids
79
SSX of testicle torsion?
absent cremasteric reflex
pain
N/V
80
How much time in Testicular torsion before damage?
6 hours
81
Find patches/discolor on back of pt?
tinea versicolor
82
TX for tinea versicolor:
```
anti fungal - azole
selsun blue (selenium sulfide)
```
83
how long tx tinea versicolor
everyday - daily for 2 weeks
84
What kind of exercise if pt has DJD?
isometric
85
example of isometric exercises in DJD?
swimming
| aquatic
86
DJD is also known as
osteoarthritis
87
What is FIRST line TX in DJD/osteoarthritis?
Tylenol
88
What nodes are seen in DJD on hands?
Bouchards (PIP)
| Heberden (DIP)
89
What type of exercise should patient with osteoporosis do?
weight bearing;
90
What is first line tx for osteoporosis?
bisphosphonates
91
what is most common bisphosphonate?
Fosomax
92
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
93
Why specific instructions for Fosomax?
avoid esophageal erosion
94
What is recommended daily amount of Ca++?
1200 mg
95
What is recommended daily amount of Ca++ in a pregnant patient?
1200 + 1000 mg = 2200
| (add 1000 mg)
96
What is the daily recommended vitamin D per day?
800 units/day
| newer say 600
97
If patient needs vitamin D replacement, what is it?
50,000 units weekly X 7 - 10 weeks
98
After treating a patient with Vitamin D, what is daily maintenance dose?
800 units qd
| newer regs say 600
99
When to start screening for osteoporosis ?
| How often to screen?
Start at age 65
| Screen every 2 years
100
What is used to screen for osteoporosis?
DEXA
101
What is name of fall risk assessment?
Get up and GO
102
Patient presents with bilaterally/symetrically swollen joints of wrists, fingers, that lasts longer than 60 min in the a.m. what is it?
RA
103
Which hand nodes are affected in RA?
PIP
| Bouchard
104
What other appearance will you see in fingers of RA pt?
Swan neck
sausage like joints/fingers
tender
105
What is 1st line TX for RA?
NSAIDS
106
If pt has back pain, and sitting feels better, what might dx be?
spinal stenosis
| Sciatica and disc problem always hurt
107
What is GOLD Standard to DX back problem?
MRI
108
What test do you perform if you suspect pt has sciatica?
Straight leg test
109
What is the name of the test you do for scoliosis?
Adam forward bend test
110
Patient presents with burning, numbness between 3 and 4 metatarsal; what is this?
Morton's neuroma
| also described as pebble
111
What is test for Morton's neuroma?
Mulder Test/ squeeze test
112
Patient complains of chronic back, sacra-iliac night pain;
Imaging of back appears as bamboo spine
What is this?
Ankylosing Spondylitis
113
Etiology of ankylosing spondylitis?
auto-immune
114
Why ankylosing spondylitis flair/pain at night
not moving
115
What eye problem is associated with ankylosing spondylitis?
iritis/uveietis (inflammation of iris)
116
Patient presents with NV, diarrhea, fever, chills, stomach pain; works in post office/mail man? fine yesterday; what does he have?
Antrax exposure/bioterrorism
117
Treatment for Anthrax?
Cipro for 60
| 500 X 60 days
118
cloasma = ?
melasma = pregnancy mask
119
what labs are ordered if suspect HIV (2)?
1. Elisa
2 Western blot to confirm
(Newer guidelines say P24 antigen)
120
What 3 antipsychotic/atypical meds need to monitor and why??
```
1. zyprexa
2 seroquil
3. respirodol
Weight gain - monitor BMI
Blood glucose
(also lipids???)
```
121
Pt. has BMI < 18.5 what is DX?
anorexia
122
SSX of anorexia
amenorrhea, brittle nails, lanugo,
| palpitations, peripheral edema due to low albumin and cardiac issues
123
what ages does autism ssx appear?
18 mo - 24 months
124
Medication contraindicated with seizures?
Wellbutrin
| - lowers seizure threshold
125
Medication contraindicated with anorexia?
Wellbutrin
| weight loss is associated with
126
T/F - ADHD is behavioral according to DSM-5
True
127
How many setting must ADHD be document in for DX?
two (school and home, etc.)
128
What size is MCV in microcytic anemia?
< 80
129
What size is MC in macrocytic anemia?
>100
130
What anemias are microcytic?
IDA
| Thalassemia
131
What do you check if have microcytic anemia?
RDW
132
What is RDA elevation in IDA?
>15%
133
What is ordered and checked for in anemia panel to look for IDA?
TIBC
| Ferritin
134
Pt presents with ataxia and persthesia; what suspected?
B12 deficiency
135
another name for B12 deficiency?
Pernicious anemia
136
What does tongue look like in anemia (B12/folate)
glossitis - beefy/red
137
What blood problem mimics IDA?
Lead poisoning
138
what year houses for lead poisoning?
before 1978
139
Why no cows milk before 1 year old and what cause?
causes IDA due to GI bleeding
140
what deficiency is seen with macrocytic anemia?
B12/folate
141
What is toxic level for lead?
> 5 or >10
142
Level for lead poisoning?
>80
143
What is concern for lead poisoning?
irreversible neurotoxicity
144
GOLD standard test for Sickle Cell and Thalassemia?
hemoglobin electrophoresis
145
First intervention in SSA crisis?
HYDRATE (reduce blood viscosity)
146
Patient treated with Iron for 6 months and no change; what do you check?
reticulocyte count
147
How do you treat IDA?
Fe
148
What do you take IDA with to improve absorption?
Vit C
149
What is long term maintenance drug used for gout?
allopurinol
150
what medications are used to treat gout flairs?
NSAIDS (colchicine and indomethacin)
151
T/F - use steroids to tx gout?
false
152
If patient is put on allopurinol and has flare within 4 weeks what does the NP do? (3)
1. Stop the allopurinol
2. Give NSAID through flair
3. restart allopurinol
(pt starts allopurinol likely to have flare)
153
If pt on allopurinol for 3 months and has flare, what does NP do?
1. continue allopurinol
| 2. NSAIDS
154
What foods to avoid in Gout? (3...)
1. ETOH - beer
2. red meat
3. shell fish
(organ meat, processed food)
155
What is hearing loss in an older person called?
presbycussis
156
what is vision loss in an older person called?
presbyopia
157
What is another name for PPD
Mantoux
158
What patients are considered positive with 5mm induration on PPD?
HIV or immunocompromised
159
What pt considered positive with 100 mm induration?
healthcare, migrant worker (farmer), immigrant
160
What part of lobes are affected on CXR in Pneumonia?
middle to lower
161
What lobes of lungs affected in TB on CXR?
upper
162
patient with SSX of night sweats, productive cough, upper lobes consolidation on CXR; what is it?
TB
163
Dull aching pain in rt or left shoulder which doesn't go away and interrupts sleep. What is it?
Rotator cuff tear
164
Who has highest rate of suicide?
elderly white males
165
What is most common STI in adolescents?
clamydia
166
treatment for clamydia?
Azithromycin 1 g
167
Treatment for ghonorrea?
Ceftriaxone
168
What is no. 1 killer in US?
cardiovascular disease
169
what is no. one cancer killer?
lung
170
what is no. 2 ca in women? men?
breast; prostate
171
What is 1st line TX for GERD?
1. PPI
| 2. H2 (used to be first line)
172
Steps in TX of GERD if recurs:
1. PPI
| 2. H2
173
Velvety skin on neck is what and what causes?
acanthosis nigracans; insulin resistance
174
You would see acanthosis nigracans in what female population?
PCOS
175
what med is given to PCOS pt trying to get pregnant?
Metformin
176
If pt. doesn't want to get pregnant and have PCOS, what do you give them?
COC
177
If a child has acanthosis nigoracans, what might you tell parents?
Teach about possible DM
178
What labs do you get for pt with PCOS, if having difficulty getting pregnant?
TSH, LH, FSH
179
COPD patient - always talk about _________ if applicable
smoking cessation
180
T/F patient with enlarged prostate has severe pain
false; no pain
181
what does prostate feel like?
tip of nose
182
what are the signs and symptoms of acute prostatitis?
FLU like:
fever, N/V, chills
this is an infection
183
How to distinguish flu from acute prostatitis?
suprapubic pain
perineal pain
hurts to poop
lasts longer than flu
184
What labs for prostatitis?
UA/CBC
185
What lab findings if prostatitis?
UTI, (blood maybe)
186
Acute prostatitis, what does prostate feel like?
warm and boggy
187
Why do you Not do a real exam on prostate if suspect prostatitis?
introduce septicemia or bacteremia
188
What is treatment for prostatitis?
CIPRO
Levaquin
Bactrim
189
How long do you treat prostatitis?
4-6 weeks
| think - prostate is hard to penetrate - like a nut
190
If 30 y/o patient presents with six similar to prostatitis (fever, perineal pain, N/V), what would you do?
run STI panel
191
what might you find on lower back of black pt. looks like bruises?
mongolian spots
192
what drugs do you use to treat sinusitis?
amoxicillin or augmentin
193
where does sinusitis pain radiate?
maxillary; jaws, teeth, mouth
194
when should strabismus be gone?
6 months
195
if baby has strabismus at 7 months, what do you do?
refer
196
what is name of test for strabismus?
cover/uncover
197
where is most vascular place for nose bleeds?
anterior
| Keisselbach plexus
198
what virus causes GI issues/pooping in kids?
rotavirus
199
When does baby double weight?
6 mo
200
when does baby triple weight?
12 mo
201
how young to start gardisil?
9 y/o
202
how young to give flu shot?
6 mo
203
Do not give TDap in a patient younger than
7 years
204
Don't give MMR to a patient younger than
12 months
205
How long to wait if give varicella before give MMR?
28 days if not given on same day together
206
what is care for varicella?
supportive: calamine, oatmeal baths
207
when can pt go back with varicella
when lesions have crusted over
208
when do you give acyclovir?
shingles in older person (altho think you give to young adult/teen with varicella)
209
What is this: tingling on forehead and on tip of nose?
herpetic keratosis
210
T/F: herpetic keratosis is emergency
TRUE - don't want vesicles to form; result in blindness
211
What is test for mono?
monospot
| heterophile antibody
212
How long does mono last?
4-6 weeks
213
When can pt with mono return to contact sports/ativities?
when spleen is normal verified by US
214
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
215
Where is stood schlatter ?
tibial tuberosity/knees
216
What disease has sudden, violent, paroxysmal cough?
pertussis
217
what is the worrisome sign of GERD?
dysphasia - cannot swallow
218
what is the worrisome sign of GERD?
dysphasia - cannot swallow
219
green, frothy vaginal d/c is what?
trichomoniasis
220
what is defining lab for trichomoniasis?
Wet mount/wet prep/wet smear
221
what herbal medication useful for migraine and H/A?
fever few
222
what herb for prostate in male?
saw palmetto
223
what her for memory in older pt?
"Ginko!"
224
What herb to manage anxiety and insomnia?
kava kava
225
what herb to boost immune system in children (URI SSX)?
echinacea
226
male patient presents with scrotum that feels like bag of worms; what is this?
varicocele
227
baby's testicle illuminated by flashlight; what is this?
hydrocele
228
when should hydrocele resolve in baby?
12 mo
229
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)
230
middle age lady presents coughing for 3 weeks; what should rule out?
pna
231
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
232
what do you give pt dx with bronchitis?
breathing treatment; nebulizer, albuterol, SABA
| cough suppressant, tesslon pears,
233
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/
234
when do you see rust colored sputum?
pneumonia!
235
Best tx for PNA (if DRSP)
Levoquin
236
TX for PNA in healthy pt?
Macrolide
