CH 23 Supplemental concepts/q's Flashcards
1
Q
CN 1
A
olfactory - (1 nose) smell
2
Q
CN II
A
optic (2 eyes)
3
Q
CN III
A
Oculomotor - eyelid movement
upward, medial, downward eye movements
4
Q
CN IV
A
trochlear - innervates superior oblique turns eyes down and laterally
5
Q
CN V
A
trigeminal - chewing, face, mouth, touch/pain
touch forehead, cheek, clench teeth
6
Q
CN VI
A
Abducens - look side to side
turns eye laterally
7
Q
CN VII
A
facial - facial expression
-secretion of tears, saliva, taste
taste of anterior 2/3 of tongue, smile
8
Q
CN VIII
A
acoustic
hearing and equilibrium
9
Q
CN IX
A
glossopharyngeal - taste, tenses carotid blood pressure, posterior 1/3 of tongue
10
Q
CN X
A
vagus - slowed HR, defecation stimulate digestive organs, taste
11
Q
CN XI
A
spinal accessory - controls trapezius and sternocleidomastoid, swallowing movements
-shrug shoulder
12
Q
CN XII
A
hypoglossal - control tongue movements
13
Q
which CN is puffing out cheeks?
A
CN VII Facial nerve
14
Q
which CN is, w/o moving head follow fingers with your eyes?
A
CN III Oculomotor
15
Q
Matthew is a 29-year-old man who presents with a 6-hour history of sudden onset of inability to raise his eyebrow or smile on the right side. He also reports decreased lacrimation in the right eye and difficulty closing the right eyelid. The
rest of his health history and physical examination is otherwise unremarkable.
This likely represents paralysis of cranial nerve (CN):
A. III.
B. VIII.
C. IV.
D. VII
Which of the following is the most appropriate next step in Matthew’s care?
A. Urgent referral for neuroimaging
B. Initiating a course of oral corticosteroids
C. Prescribing a short course of high-dose antiviral therapy
D. Referral to a neurology specialist within the next 24‒48 hours
A
SUDDEN onset
- and the rest is unremarkable (good bc no headaches, or unilateral body weakness)
CN VII 7 - Facial - bells palsy
- only seen on face only.
Bell’s palsy is a clinical diagnosis (only on hx and exam)
C. Start oral corticosteroids!
16
Q
Bell’s palsy aka IDIOPATHIC facial paralysis, patho:
A
acute paralysis of CN VII (facial) in absence of brain dysfunction
-largely unknown, inflamed CN d/t viral infection
17
Q
Bell’s palsy presentation
A
think CN 7 not working..
Sudden onset of unilateral facial paralysis including inability to raise the eyebrow
or smile on the affected side
decreased lacrimation/tears of affected eye with inability
to close eyelid
18
Q
Bell’s palsy Diagnosis
A
clinical dx (HPI/PE)
-tests to r/o other conditions, lyme disease serology, electromyography
neuro imaging if sx’s don’t improve over time
19
Q
bell’s palsy treatment
A
start systemic oral corticosteriods (PO prednisone) asap!
-eye care for eyelid closure/reduced tears
-recover w/in 3 months
-facial PT if not recover
20
Q
A. Zoster (shingles)
B. Varicella (chickenpox)
C. Both
- Presents with primary and secondary lesions including
vesicles and crusts - Usually unilateral dermatomal pattern
- Mild to moderately systemically ill with fever
- Miserable with pain, itch, usually without fever
5.Risk of disease development significantly reduced by
immunization.
- Treatment to minimize severity of disease or
complications includes oral acyclovir
A
- C
- A
- B (ppl with shingles are miserable but NOT sick. with varicella, is miserable (ITCHY) AND sick)
- A
- C
- C. high dose acyclovir for shingles and varicella but needs to be EARLY on disease
21
Q
varicella (chicken pox) presentation
A
2–3 mm vesicles that start on trunk then
appear on limbs 2–3 days later
- Nonclustered
lesions at a variety of stages, crusts (high rate of complication=bacterial suprainfection of lesions)
myalgia, FEVER, itchy!
22
Q
zoster (shingles) presentation and complications
A
Vesicles unilateral dermatomal pattern, slowly resolving with crusting, with pain and/or severe itch (no fever)
postherpetic neuralgia,
ophthalmologic involvement,
superimposed bacterial infection
23
Q
varicella treatment and prevention
A
Acyclovir EARLY! w/in 24-48 hours of eruption = reduces severity
NO aspirin (Reyes syndrome)
NO NSAIDS (necrotizing fasciitis risk)
Varivax - 80% lifetime immunity with 1st dose, 99% 2nd dose
24
Q
herpes zoster treatment and prevention
A
high dose acyclovir EARLY w/in 72 hrs of onset!
-analgesia
-for itch: ice pack, calamine lotion, avoid clothes rubbing (put emollient over)
-Zostavax, Shringrix
25
(T/F) Across North America, brown recluse spider bites are the most common reason for
new-onset ulcerating skin lesions
false
26
brown recluse spider bite presentation
"red, white, and blue"
Central blistering with surrounding gray- to -purple discoloration at bite site surrounded by ring of blanched skin surrounded by large area of redness
27
Treatment of brown recluse spider bite
Local debridement, elevation, loose immobilization.
-When bitten, use ice to limit venom spread helpful.
- Dapsone (not that effective)
- Check before putting body part into area where
spiders hide (footwear, boxes)
28
A. Seborrhea
B. Psoriasis
C. Dandruff
1. Lesions in scalp, eyelid margins, nasolabial folds
2. Usually limited to the scalp only
3. Most frequently encountered in teen, adult years
4.First-line treatment includes topical antifungal therapy
5.First-line treatment for milder disease is topical corticosteroid
therapy.
6.Lesions most commonly located over the knees and tips of the
elbows
7.With forced removal of a lesion, pinpoint bleeding, quickly stops
(Auspitz sign)
8.Usually mildly symptomatic with feelings of itch, irritation
1. Seb
2. dan
3. Seb, Psoriasis, dandruff
4. Seb (ketoconazole is antifungal) & dan
5. Psoriasis (medium potency)
6. Psoriasis
7. Psoriasis
8. seb, ps, dan -MILD SX but NOT systemically ill
29
auspitz sign
With forced removal of a lesion, pinpoint bleeding, quickly stops
seen in psoriasis plaques
ask pt's and they'll tell you
30
when do you start putting on sunscreen in children?
until they are 6 months or OLDER
(more prone to side effects of sunscreen < 6 mo: clothing, hat, shade)
31
seborrhea (seborrheic dermatitis) locations
sebum areas: scalp, eyelids, ears, nasolabial folds, upper trunk
32
seborrhea lesions
itchy, patchy SCALES and crusts over red, inflamed skin
hypopigmentation and
oozing can occur
plaques rare
“I have areas of burning,
itchy and scaly skin around
my nose, eyebrows, and in
my ear canals that gets
worse then gets better.”
33
psoriasis locations
extensor (elbows, knees, scalp, trunk, limbs)
34
psoriasis lesions
raised silvery
scales and underlying red
plaque with well-defined
margins
Auspitz sign: pinpoint bleeding common with forcible
removal of plaques
“I have itchy, red areas of
skin on my elbows, knees
and trunk, with scaling,
peeling, and sometimes
bleeding if I pick at them.
35
seborrhea tx
Topical antifungal (ketoconazole);
low potency
topical corticosteroids
topical immune modulators
(e.g., pimecrolimus,
tacrolimus, sulfonamide) can be helpful
Class IV or lower topical
corticosteroid for acute flares
For severe/unresponsive
cases, systemic fluconazole
36
psoriasis tx
mild: topical corticosteroids on specific skin areas
if more generalized areas: UV A light therapy, systemic retinoids, cyclosporin, methotrexate
37
A 63-year-old man who resides at the homeless shelter is brought to urgent
care with a chief complaint of chronic cough and intermittent sharp, localized
chest pain that worsens with cough or deep breath. T=102.3°F (39.1°C), HR=112
bpm, RR=45 bpm, BP=135/85 mm Hg. Which of the following findings would best
support a diagnosis of active tuberculosis infection?
Choose two that apply.
A. Erythematous plaques on the extremities
B. Hemoptysis
C. Dry cough with bronchospasm
D. Macrocytic anemia
E. Chest x-ray demonstrating right upper lobe infiltrate.
Hemoptysis &
chest xray of UPPER lobe infiltrate
Tb tends to affect upper lobes of lung while other bacterial are lower lobes
TB: wet cough
38
active tuberculosis clinical presentation
Congested, productive/wet, cough with white, yellow, and/or blood streaked sputum
hemoptysis * (only 8% has it; can rule in but absence doesn't rule out)
chest pain
fever
unexplained weight loss/anorexia
night sweats
fatigue
39
Tb risk factors
HIV infection
History of positive PPD tuberculin
skin test (TST) result
History of prior TB treatment
Known or suspected active TB
exposure
Travel to or emigration from an
area where TB is endemic
Homelessness, shelter-dwelling,
incarceration
40
TB diagnostic testing
Mantoux tuberculin skin test or QuantiFERON-TB Gold test (QTF-G) (screening method)
Acid-fast bacilli (AFB) smear or culture from sputum sample
Enzyme-linked immunospot
(ELISpot®) assay for mycobacterial
ribosomal RNA
Chest radiograph or thoracic CT
HIV testing if status unknown
41
The typical international normalized ratio (INR) goal during warfarin therapy for
a 65-year-old woman with atrial fibrillation is:
A. 1.0‒2.0.
B. 1.5‒2.5.
C. 2.0‒3.0.
D. 2.5‒3.5.
C. 2-3
42
The use of which of the following potentially increases bleeding risk during warfarin use.
(Y/N) Amoxicillin
(Y/N) St. John’s wort
(Y/N) Naproxen
(Y/N) Gingko biloba
(Y) Amoxicillin - ALL antibiotics bc they alter gut flora. Warfarin works against vitamin K. Vit K comes from gut flora and if it's altered with antibiotics = INR goes up/bleeding risk
(N) St. John’s wort = cytochrome P 450 inducer. No it reduces INR bc it causes warfarin to be kicked out quicker
(Y) Naproxen - NSAID - yes due to antiplatelet effect but not alter INR
(Y) Gingko biloba = Yes due to antiplatelet effect
43
Match each tx option with STI diagnosis. can be used more than once.
A. External genital warts in a 25-year-old adult
B. Pelvic inflammatory disease in a 22-year-old adult
C. Syphilis in a 45-year-old adult
D. External genital warts in a 28-year-old pregnant woman
1. Injectable penicillin
2. Imiquimod cream
3. Trichloroacetic acid (TCA)
4. Ceftriaxone plus oral 5. doxycycline with oral
metronidazole
1. syphilis
2. imiquimod (Aldara) for 25 year old adult. DON'T use during pregnancy
3. TCA (tricholoracetic acid) - external genital warts for 25 & 28 year old pregnant woman
4. ceftriaxone (1 shot) + oral doxy + oral metronidazole = PID
-cef takes care of gonococcal, doxy takes care of chlamydia, metronidazole takes care of anaerobes
44
A. External genital warts
B. Pelvic inflammatory disease
C. Primary syphilis
1. Fever, abdominal pain
2. Verruca-form lesions
3. Painless genital ulcer with indurated margins
1. pelvic inflammatory disease: infection of uterus, endometrium, fallopian tubes. Female version of Epididymitis. Upper repro infection
2. external genital warts
3. primary syphilis
45
syphilis:
primary stage
secondary stage
latent stage
primary: chancre (painless ulcer) on genital or anal with clean base, indurated margins, localized lymphadenopathy, ~ 3 weeks, resolves w/o therapy
secondary: non itchy skin rash (palms, soles, mucus membranes, w/o genital lesions).
-systemic sx's (fever, diffuse lymphadenopathy, sore throat, patchy hairloss, headaches, weight loss, muscle aches, fatigue)
-resolves w/o tx possible
latent: varies, occurs when primary & sec sx's resolve
46
syphilis treatment
1st line: penicillin injection
if allergy: PO doxycycline
47
genital warts (condyloma acuminata) orgs
HPV 6, 11
GU cancer a/s HPV: 16, 18, 31, 33, 45, 52, 58
can be infx w/ multiple
48
condyloma accuminata clinical findings & tx
verruca form lesions
-trichloracetic acid (TCA; ok in pregnancy), bichloracetic acid, surgical removal, imiquimod (Aldara; only external warts; no pregnancy)
topical podofilox, liquid nitrogen, cryoprobel
49
pelvic inflammatory disease orgs and tx
*think PID = 3 orgs = 3 drugs
N. gonorrhoeae, C. trachomatis,
bacteroides, Enterobacterales,
streptococci = to cover, 1st line:
1.ceftriaxone IM 1 shot
2. doxycycline x 2 weeks
3. metronidazole x 2 weeks
50
PID diagnosis and sequeles
bimanual exam
≥ 1 of:
-uterine tenderness
-adnexal tenderness
-cervical motion tenderness (Chandelier sign)
plus
Irritative voiding symptoms, fever, abdominal pain, vaginal discharge, elv CRP, elv WBC
- tubal scarring = increased risk for ectopic pregnancy and/or infertility.
51
Which of the following is a worrisome finding noted during pelvic examination on a 62-year-old woman?
A. Flattening of the vaginal rugae
B. Vaginal pH=5.6
C. Ovary palpable on bimanual examination
D. Scant white vaginal discharge
-menopause, normal to have flattening and thinning of walls
-estrogen leaves = lacto bacilli leaves = higher pH = more alkaline
C. ovary should NOT be palpable (ESP) post menopausal (except super thin young women)
GET pelvic ultrasound for possible ovarian mass or cyst
52
Brian is a 14-year-old who presents for a sick visit with 4-hour history of sudden onset of left-sided scrotal pain. He has had mild intermittent unilateral
testicular pain in the past but not as severe as this current episode. He has
vomited once since the onset of the pain and is without fever or history of recent
scrotal trauma. Confirmation of testicular torsion would include all of the following findings except:
A. Unilateral loss of the cremasteric reflex on the affected side.
B. The affected testicle held higher in the scrotum.
C. Testicular swelling.
D. Relief of pain with scrotal elevation.
no fever = no infection
A. Yes, stroke inside of thigh and cremaster retracts
B. Yes.
C. Yes. Tesicle is ischemic
D: NO! elevating doesn't decrease pain with torsion but with Epididymitis (Prehn sign)
uro emergency! need surgery w/in few hours
53
For scrotal pain, you want to evaluation for tesicular torsion by using what screening?
TWIST score
1. Testicular swelling = 2pts
2. Testicle HARD = 2 pts
3. Testicle high riding= 1 pt
4absent cremaster reflex = 1 pt
5. nausea or vomiting = 1 pt
5‒7 points= Prompt urology consult, scrotal ultrasound unlikely provide significant additional information, detorting procedure needed.
1‒4 points=Promptly check scrotal ultrasound to determine if urology consult required.
54
1. Linda is a 54-year-old woman who presents with complaints of a disfigured toenail on her right great toe that developed over the past 4 months. She also reports some discomfort that is affecting her gait, and will no longer wear opentoed shoes due to embarrassment. The NP notes nail thickening and a yellowish
color involving the full nail bed. Suspecting onychomycosis, the NP realizes:
A. This is primarily a clinical diagnosis.
B. A KOH prep should be performed.
C. A blood culture is necessary.
D. A Gram stain should be performed.
2. Appropriate treatment for Linda can include:
A. Topical 8% ciclopirox olamine for 4 weeks.
B. Oral fluconazole for 7–10 days.
C. Oral terbinafine for 12 weeks.
D. Laser therapy
1. C: No. Blood culture for blood sepsis.
D: No. Onychoycosis is fungal so no gram stain.
answer: B! best practice is to get KOH prep on toe nail scrapings to verify
2. 1st line: oral terbinafine QD x 12 weeks (3 months). need antifungal on board until full nail grows out (3 months)
55
nail fungal infection/onychomycosis patho
-Fungal infection involving the nail plate, matrix, and/or bed.
-Most commonly by dermatophytes (Trichophyton rubrum and Trichophyton
mentagrophytes).
NOT Candida infection
56
Nail Fungal Infection (Onychomycosis) presentation
-asymptomatic at early stages
- progresses to cause paresthesia, pain, discomfort, and loss of dexterity.
- Disfigurement can impact selfesteem and quality of life.
- Nail shows subungual hyperkeratosis with yellow streaks or yellow-white onycholytic areas; thickening of the nail, separation of nail from the bed.
57
Nail Fungal Infection (Onychomycosis) diagnosis
-NEED Laboratory studies to confirmation to rule out other disorders & insurance won't pay for meds
- get KOH prep to visualize hyphae; culture of pulverized nail scraping to identify
pathogen
58
Nail Fungal Infection (Onychomycosis) treatment
Topical therapy:
-Reserved for MILD cases (<1/2 of nail plate) or cannot tolerate oral meds; generally poor penetration to nail bed (8% ciclopirox olamine, 10% efinaconazole); can be combined with laser therapy
-tea tree oil, vix rub not much evidence
Full nail = Oral therapy:
-Fingernail: Terbinafine 250 mg QD for 6 weeks, or itraconazole 200 mg QD for 3 months or 200 mg BID for 1 week/month for 2 months
-Toenail: Terbinafine 250 mg QD for 3 months or itraconazole 200 mg QD for 3 months or 200 mg BID for 1 week/month for 3–4 months
59
Sue is a 34-year-old woman who is being evaluated for fibromyalgia consisting
of a 6-month history of widespread pain and tenderness. During the patient
history, which of the following findings would be least expected?
A. Reports of poor sleep
B. Depression
C. Fatigue
D. Unexplained weight loss
Which of the following would be considered a first-line treatment to manage
pain and tenderness for Sue?
A. Naproxen
B. Pregabalin
C. Clonazepam
D. Oxycodone
answer: D.
if generalized aches, differentials are RA, systemic lupus. RA & lupus HAS unexplained weight loss. (always document intended or unintended). Fibro is NOT systemic like RA & Lupus
1st line: Pregabalin (Lyrica), gabapenin (Neurontin) = PREVENTS pain. Naproxen is an adjunct for acute pain. Benzo and opioids avoided with fibromyalgia! not effective
60
fibromyalgia patho
Not completely understood
- considered a disorder of central pain processing or syndrome of central sensitivity.
- Common in young and middle-aged women, but can be all ages
-1/3 identify a specific event (illness, injury) triggered fibromyalgia symptoms.
61
fibromyalgia presentation & diagnosis
Chronic (>3 months continuously) widespread pain and tenderness
- fatigue,
-unrefreshed sleep
-cognitive dysfunction, along with somatic symptoms
dx of exclusion, thoro pt hx, PE, lab analysis
-use Widespread Pain Index (WPI) and Symptom Severity (SS) Scale
-get Fibromyalgia Intensity Score (FIS) from scoring pain at 18 tender points
62
fibromyalgia treatment
-No cure
-patient education and lifestyle mod (physical activity)
- FDA-approved: pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). TCAs common to use
-Psychological therapy (depression, anxiety, stress, and sleep disturbance)
-Avoid opioids, hypnotics, anxiolytics, and muscle relaxants due to abuse
potential. NSAIDs and acetaminophen have limited effect on fibromyalgia pain.
63
You see a 55-year-old woman with type 2 diabetes mellitus, hypertension, and
dyslipidemia. Evaluation today reveals a BMI=36 kg/m2. She states, “I just do not
know where to start in trying to lose some weight.” Which of the following is the
most appropriate response to this statement?
A. “How much weight do you want to lose?”
B. “How do you feel about your weight?”
C. “What barriers do you see to losing weight?”
D. “Your blood sugar control will likely improve if you lose some weight.”
C.
motivational interviewing
64
motivational interviewing techniques
Express empathy
Develop a discrepancy
Roll with resistance
Support self-efficacy
Reflective listening
Change talk (examples)
* Explore pros and cons of behavior change
* Look back to a previous time—how were things different?
* Explore values
* Explore negative side of ambivalence
Ask open-ended questions
Affirming statements: Recognize patient’s strengths
Summarize: Review of session
Provide information
* Ask-provide-ask
65
Greg is a 45-year-old man with type 2 diabetes mellitus and a BMI of 29 kg/m2.
He asks about using pharmacotherapy for weight loss. The NP advises:
A. He does not meet the criteria for use of weight-loss pharmacotherapy.
B. Typically, individuals taking weight loss medications lose approximately 10% of
their starting weight.
C. The use of many of weight-loss medications can result in micronutrient deficiency.
D. Weight-loss medication use seldom results in significant BMI reduction.
B. he DOES meet criteria for med weightless med: overweight (BMI >25) with a comorbid condition .
-true, will lose 10% of starting weight
-GLP1 Agonists
C. not true
D. not true
66
Which of the following would be the best candidates for bariatric surgery?
(Select two correct answers)
A. A 29-year-old woman with BMI 32 kg/m2 and history of bulimia nervosa
B. A 26-year-old man with BMI 36 kg/m2 and who has not attempted any lifestyle
modifications
C. A 43-year-old man with BMI of 38 kg/m2 and with type 2 diabetes mellitus
D. A 39-year-old woman with BMI 42 kg/m2 and has had inadequate response to
lifestyle modifications and pharmacotherapy
answer: C & D
caution with those with eating disorder
-gastric sleeve/bypass is NOT 1st line if no lifestyle mod / med hasn't tried
67
obesity management according to BMI? when is bariatric surgery recommended?
BMI 25-29= overweight
BMI 30-39= obesity
BMI 40+ = morbid obese
-BMI > 25: lifestyle, diet, PA, behavior mod
-BMI >27 + comorbidity OR BMI >30: phentermine + topiramate and buproprion plus naltrexone = suppress appetite and cravings, increase energy
GLP 1 agonist (semaglutide, liraglutide): decrease appetite and calorie intake
Orlistat (Xenical) blocks pancreatic lipase action, dec trig absorb
ALL THERAPIES AS ADJUNCT TO CALORIE RESTRICTION, INCREASE EXERCIES, BEHAVIOR MOD
Bariatric surgery: individuals with BMI >35 + comorbidity, or with BMI >40)
68
bariatric surgeries
for BMI >35 AND comorbidity or with BMI >40
Gastroplasty (gastric sleeve, vertical sleeve)
-reduces 50% excess body weight in 1 year
Gastric bypass (Roux-en-Y gastric bypass)
-reduces 60% excess body weight over 2 years
-Can result in micronutrient deficiencies including calcium, vitamin B12, folate,
and iron
69
1. Josh is a 14-year-old basketball player who presents with anterior knee pain
that has occurred intermittently over the past 3 months. The pain worsens with
squatting and walking up or down stairs, and is better with rest. He denies fever,
weight loss, joint redness, or skin rash. Physical examination reveals a Tanner 3
male in no acute distress with a tender, swollen tibial tuberosity in the affected
knee. Pain can be reproduced with resisted active extension and passive
hyperflexion of the knee. No effusion is present. Josh’s presentation is most
consistent with:
A. Osgood-Schlatter disease.
B. Prepatellar bursitis.
C. Meniscal tear.
D. Reactive arthritis
2. Intervention for Josh should include information about:
A. Curtailing his participation in sporting activities.
B. Avoiding sports that involve heavy quadriceps loading or deep knee bending.
C. The benefit of intraarticular corticosteroid injection for the control of discomfort.
D. The likely need for surgical correction of the defect.
Tanner 3 is growth spurt
1. A. Osgood Schlatter disease
-usu teens going through growth spurt
B: would see huge effusion on knee
C: played basketball and knees SUDDENLY hurt with injury
D: aka reiters syndrome, infectious inflammatory arthritis, expect multiple joints affected
2. B. avoid sports with heavy quad loading or deep knee bending. will eventually outgrow it in a year with PT. want to encourage but NOT curtail
70
osgood schlatter disease
irritation of patellar tendon at tibial tuberosity
71
Which of the following statements regarding the COVID-19 vaccines is most
accurate?
A. Individuals with severe allergy to eggs should not receive any of the COVID-19
vaccines.
B. Nearly all individuals in the appropriate age groups can receive a currentlylicensed COVID-19 vaccine.
C. The risk of myocarditis is higher with vaccination than with COVID-19 infection.
D. Most COVID-19 vaccines contain live SARS-COV-2 virus.
B.
no contraindications to covid vaccines
72
A 47-year-old woman tests positive for COVID-19 after her son returned home
from college. She is generally healthy with no co-morbidities and has not received
any COVID-19 vaccine. She reports cough and low-grade fever for the past 3 days.
She does not report any breathing difficulties and her oxygen saturation is 98%.
You recommend:
A. Oral doxycycline.
B. Inhaled short-acting beta2-agonist.
C. Oral corticosteroid.
D. Supportive care only.
D. just like any viral illness. z pack, ivermectin, hydroxychloroquine NOT in treatment for covid
73
Which of the following individuals diagnosed with COVID-19 would most likely
require hospitalization?
A. A 22-year-old who reports a loss of taste and smell at day 2 of illness
B. A 37-year-old with BMI of 38 kg/m2 reporting fever, cough, and difficulty catching
his breath at day 10 of illness
C. A 27-year-old female in the second trimester of pregnancy with cough, sore
throat, and SaO2 of 97% on day 5 of illness
D. A 59-year-old with fatigue, muscle aches, and a lingering cough at day 20 of
illness
B. day 10-15 most likely to be admitted
concerned with pregnant with her but doesn't mention she's SOB. risk of preterm labor
74
covid presentations in adults
mild (~81%) OUTPATIENT: Mild fever, cough, sore throat, nasal congestion, malaise, headache, new loss of taste or smell, muscle pain, and/or mild pneumonia
* Severe disease (~14%): Dyspnea, hypoxia, or >50% lung involvement on imaging;
consider hospitalization with SaO2 <94%
* Critical disease (~5%): Respiratory failure, shock, multiorgan system dysfunction
75
covid outpatient treatment
supportive (nsaid/tylenol, guaifenesin), hydrate, no antibiotics
monocolonal antibody for high risk of severe disease and hospitalization. most effective given w/in 10 days of sx onset. no SABA/SAMA unless have asthma or COPD
F/u day 5 (for low risk), or day 4,7,10 (high risk pts)
dev ARDS/ICU admin is 8-12 days after sx onset
76
The NP demonstrates fulfillment of the advanced practice nursing leadership
role by participating in which of the following activities?
A. Teaching a 56-year-old man with newly-diagnosed type 2 diabetes mellitus about
the importance of self-glucose monitoring
B. Volunteering to teach a class on contraceptive methods to a group of teen
mothers
C. Discussing barriers to achieving blood pressure control with a 65-year-old woman
with hypertension who “does not want to take any medicine”
D. Collaborating with the regional public health department on an initiative to combat
obesity through a community-based exercise program
answer D. looking for activites that have the MOST WIDE REACHING INFLUENCE!!
A: it's 1-1 but anyone can do it
C: can delegate to someone else
77
Rank the following from highest to lowest level of research design.
____ Case reports
____ Meta-analysis
____ Randomized controlled trials
____ Expert opinion
1. meta analysis: study of a bunch of studies/trials
2. RCT
3. Case reports (reports of x patients)
4. Expert opinion
78
The NP practice acts provide protection of the public at which level?
A. National
B. Regional
C. State
D. County/municipal
C. State level
to keep others that aren't qualified to practice
-have to have met qualifications, licenses
-an employer can restrict what an NP does in practice but never require more than NP is allowed to
79
1. Refers to the ability of a test to correctly
identify those with a condition
2. Refers to the ability of a test to correctly
identify those without a condition
3. Proportion or number of individuals with a
condition at a given time
4. Number of new cases occurring within a
period of time
A. Prevalence
B. Incidence
C. False positive
D. False negative
E. Specificity
F. Sensitivity
1. F
2 E
3. A
4. B
80
A 37-year-old woman with ulcerative colitis with poor symptom control without
rectal bleeding presents with the following hemogram:
– Hb=9.9 g/dL (12–14 g/dL) (99 g/L [120–140 g/L])
– MCHC=33 g/dL (31–37 g/dL) (330 g/L [310–370 g/L])
– MCV=86 fL (80–96 fL)
– RDW=12% (11%–15%) (0.12 proportion [0.11–0.15 proportion])
These findings are most consistent with:
A. Iron deficiency.
B. Beta thalassemia minor.
C. Anemia of chronic disease.
D. Pernicious anemia.
can figure out hematocrit (if not given) if u have hb. hb x 3 = hc. 9.9 round up to 10. 10x 3 = 30 hc
shes not actively bleeding so there's no acute blood loss
ulcerative colitis - chronic disease
answer C
microcytic microchromic with elev RDW = iron def anemia
if beta that minor: fine healthy and would have given hx of condition and would have been told of ethnic group with microcytic normochromic with high RDW
pernicious anemia with neuro changes and older with macro normo ele vRDW
81
A 67-year-old man taking NSAIDs daily for back pain and reporting fatigue
presents with the following hemogram:
– Hb=8.4 g/dL (12–14 g/dL) (84 g/L [120–140 g/L])
– MCHC=26 g/dL (31–37 g/dL) (260 g/L [310–370 g/L])
– MCV=69 fL (80–96 fL)
– RDW=19% (11%–15%) (0.19 proportion [0.11–0.15 proportion])
These findings are most consistent with:
A. Iron deficiency.
B. Beta thalassemia minor.
C. Vitamin B12 deficiency.
D. Drug-induced macrocytosis.
microcytic hypochromic elev RDW = new cells differ from old cells
daily Nsaid induced gastritis = ooze blood
answer A: iron def (chronic low volume blood loss)
older adults more likely to get nsaid induced gastropathy than a 25 year old
get ferritin levels and fecal occult blood test x3
refer to GI for upper and lower endoscopy to make sure no other bleeding and stop nsaid. put on ppi
82
causes of drug induced macrocytosis
heavy alcohol, older anti-epileptic drugs (carbamazepine, phenytoin)
83
A 54-year-old man of Asian ancestry presents with the following hemogram:
– Hb=11.6 g/dL (12–14 g/dL) (116 g/L [120–140 g/L])
– Hct=37% (42–48%) (0.37 proportion [0.42–0.48 proportion])
– MCHC=24 g/dL (31–37 g/dL) (260 g/L [310–370 g/L])
– MCV=64 fL (80–96 fL)
– RDW=14% (11%–15%) (0.14 proportion [0.11–0.15 proportion])
– RBC=6.6 million/mm3 (4.7–6.1 million/mm3)
These findings are most consistent with:
A. Folate deficiency.
B. Acute blood loss.
C. Alpha thalassemia minor.
D. Iron-deficiency anemia.
mildy anemic
LOTS of rbc (elv)
hypochromic
microcytic
normal RDW (new and old cells same cells)
answer: C. asian descent. live long and full lives. option for genetic counseling with 2 parents with it, 1 in 4 having in child alpha MAJOR (life threatening)
Not A: macorcytic normochrom elev RDW and told he drinks alcohol heavily
not b: toilet lots of toilet and dizzy, normocytic, normochromoc, normoRDW
not D; decreased RBC and elev RDW and some risk factor for iron def
84
When evaluating a patient for a potential thyroid disorder, which of the
following is the least informative test to be used during evaluation?
A. Free T4
B. Total T4
C. Free T3
D. TSH
B. Total T4 useless!
measures total t4, protein bound inactive + active and can go up and down in thyroid conditions and altered for any condition
best test: TSH (if normal, then ruled out thyroid disease)
85
Examination of a 56-year-old woman identifies a palpable thyroid mass of
relatively fixed position. TSH level is within normal limits. Ultrasound reveals a
solid mass of approximately 5 cm in size. Which of the following is the most
appropriate next course of action?
A. Watch and wait with rescan in 6 months
B. Initiate levothyroxine therapy
C. Refer for fine-needle aspiration biopsy
D. Refer for radioiodine ablation
if TSH normal, it's inactive and not throwing out excess T4
C. biopsy asap! consist with cancer cus bigger and FIXED
thyroid cancer is very slow growing
86
You see a 56-year-old woman with hypothyroidism who is currently being
treated with levothyroxine at 100 mcg/d. She insists that she takes her medicine
every morning. A laboratory test reveals that her TSH is 0.3 mIU/L (NL=0.4–4.0
mIU/L). You recommend:
A. Maintaining the levothyroxine dose and reevaluate in 2 months.
B. Increasing the levothyroxine dose and reevaluate in 2 months.
C. Decreasing the levothyroxine dose and reevaluate in 2 months.
D. Discontinuing levothyroxine therapy and reevaluate in 6 months.
TSH is low meaning hyperthyroid
C. decrease levo and reeval in 2 months
87
TSH=13 mIU/L (0.4‒4.0 mIU/L);
free T4=13.2 pmol/L (10‒27 pmol/L)
hypothyroidism, hyperthyroidism, subclinical hypothyroidism?
subclinical hypothyroidism
autoimmune process that is causing thyroid to be destroyed. still enough live thyroid tissue with a little extra TSH, u can be euthyoid
88
TSH <0.2 mIU/L (0.4‒4.0 mIU/L);
free T4= 68 pmol/L (10‒27 pmol/L)
hypothyroidism, hyperthyroidism, subclinical hypothyroidism?
hyperthyroidism
89
TSH=79 mIU/L (0.4‒4.0 mIU/L);
free T4=4 pmol/L (10‒27 pmol/L)
hypothyroidism, hyperthyroidism, subclinical hypothyroidism?
hypothyroidism
90
When counseling a patient about lifestyle modifications to prevent migraines,
the NP recommends:
A. Using tinted glasses to minimize glare and bright lights.
B. Substituting artificial sweeteners for cane sugar.
C. Avoiding regular exercise for at least one week after each migraine episode.
D. Moving to a high-altitude environment.
answer: A.
hydration and regular scheduled sleep! and eat
91
Which of the following agents can be considered for migraine controller
therapy in a 54-year-old with a history of hypertension?
A. Sumatriptan
B. Topiramate
C. NSAIDs
D. Ergotamine
comorbidity HTN
-controller therapy PREVENT migrains not treat it
B: Topiramate
acute treatment meds; AVOID ergotamine (vasoconstrictor effects), use sumatriptan
nsaids can minimize BP meds except for CCB meds, nsaids can be used but not daily
92
Reasonable goals for using headache prophylactic therapy include all of the
following except:
A. Reduce the frequency of headaches.
B. Reduce the severity of headaches.
C. Eliminate the incidence of headaches.
D. Allow headache medications to work more effectively
answer C
reduce # , severity, and allow h/a meds to work better
can't completely eliminate h/a
primary h/as are genetics so can't get rid and environmental factors
93
Which of the following WBC response would be most consistently noted in an
25-year-old adult with acute appendicitis?
A. WBC 5000/mm3, neutrophils 32%, bands 4%
B. WBC 17,500/mm3, neutrophils 72%, bands 10%
C. WBC 14,000/mm3, neutrophils 24%, bands 3%
D. WBC <1000/mm3, neutrophils 52%, bands 6%
acute appendicitis = can be any serious bacterial infection like pyeloneph
answr B: leukocytosis, neutorphils go after bacterial, bands range 1-4%: 10% (young neutrophils) = LEFT SHIFT
94
irritable bowel
syndrome (IBS) or inflammatory bowel disease (IBD)?
(IBS/IBD) Intestinal ulceration present
(IBS/IBD) Absence of rectal bleeding
(IBS/IBD) CRP and ESR levels are elevated
(IBS/IBD) Surgical intervention often needed
(IBD) Intestinal ulceration present
(IBS) Absence of rectal bleeding
(IBD) CRP and ESR levels are elevated
(IBD) Surgical intervention often needed
IBD: UC + Chrohns disease ; common with flares = life threatening
IBS: life altering
95
Of the following imaging studies, place in rank order from greatest to least
amount of ionizing radiation burden to the patient.
_____ Abdominal ultrasound
_____ Abdominal CT
_____ Abdominal flat plate
1. Abdominal CT
2. Abdominal flat plate
3. Abdominal ultrasound (ZERO ioning radiation; solid vs liquid but no detail with CT )
96
Juan is a 30-year-old man with a 10-year history of asthma who presents for a
routine visit, requesting refills of his low-dose budesonide per DPI and albuterol
per MDI. He states, “I am doing great, no complaints here.” His blood pressure,
heart rate, temperature, and respiratory rate are within normal limits, he is in no
distress, and his physical exam reveals no evidence of wheezing or crackles. You
consider that:
A. His current treatment regimen should be continued.
B. Due to patient report and today’s objective findings, his asthma appears to be
well-controlled.
C. His asthma therapy should be intensified.
D. More information is needed to determine his level of asthma control.
D. need to measure airflow status with EACH asthma related visit for objective measurement
-blow a peak flow
97
Which of the following medications can be considered for patients at risk for
heart failure but without structural heart disease (Stage A)?
A. Beta-blockers
B. Thiazide diuretics
C. ARB or ACEI
D. Digitalis
C. ACE/ARB. PREVENTION rather than intervention
for HTN, dyspli, metabolic syndrome
98
A 32-year-old woman is diagnosed with a urinary tract infection. She reports
never having a UTI previously. Her records indicate that she is allergic to sulfa
medications. You recommend treatment with:
A. Amoxicillin (Amoxil).
B. Nitrofurantoin (Macrobid).
C. Moxifloxacin (Avelox).
D. Ceftriaxone (Rocephin).
B. nitrofurantoin Macrobid
Ecoli is resistant to amoxicillin
cipro is NOT 1st line med
99
Which of the following is likely to cause cardiac dysrhythmia and seizures
when taken in an intentional ingestion equivalent to a typical adult therapeutic
dose?
A. A 4-week supply of fluoxetine
B. A 2-week supply of nortriptyline
C. A 3-week supply of venlafaxine
D. A 3-day supply of diazepam
B. TCA use is less now bc unsafe in over dose
fluoxetine = risk of serotonin syndrome but not life-threatening
SNRI venalfaxine 3 week supply not fatal
3 day supply diazepam, use benzos to prevent seizures
100
You see a 26-year-old college student diagnosed with major depressive
disorder. He has been treated with a SSRI for the past 6 months with minimal
clinical effect. You recommend as the next course of action:
A. Adding a benzodiazepine.
B. Adding a second-generation antipsychotic (SGA).
C. Switching to a SNRI.
D. Switching to a tricyclic antidepressant (TCA).
answer C. best choice for more resistance depression
benzo for anxiety but addictive
SGA need more info then bigger strong class
TCA - work well but lots of neg side effects, dry mouth constipation, cardiac, OD effects
101
Indicate whether each event is likely due to normal age-related mental changes
(N) or is a possible warning sign of Alzheimer-type dementia (W).
(N/W) Occasionally adding the wrong amount of an ingredient when following a
recipe
(N/W) Getting lost while driving to usual house of worship
(N/W) Placing the house keys in the freezer
(N/W) Forgetting a son’s birthday until late in the day
(N/W) Incorrectly identifies the current US President
(N/W) Cannot immediately remember what they had for dinner the night before but
remembers this later
N Occasionally adding the wrong amount of an ingredient when following a
recipe
(W) Getting lost while driving to usual house of worship
(W) Placing the house keys in the freezer (need to put keys in same place every time)
(N) Forgetting a son’s birthday until late in the day
(W) Incorrectly identifies the current US President
(N) Cannot immediately remember what they had for dinner the night before but
remembers this later
102
Jane is a 56-year-old woman who undergoes DXA testing of the spine and
reveals a T-score of ‒2.9. Based on current clinical recommendations, the NP
recommends which of the following?
A. No treatment is needed at this time.
B. Initiating treatment with alendronate.
C. Initiating treatment with estrogen therapy.
D. Initiating treatment with raloxifene.
answer: start alendronate (lowest cost)
raloxifene and systemic estrogen (but breast cancer and endometrium cancer risk) MAINTAINS bone density than bulding bone density
103
For a woman initiating bisphosphonate therapy for osteoporosis, treatment
should continue:
A. Until BMD improves by 25%.
B. For 1‒2 years.
C. For 2‒5 years.
D. Indefinitely.
C. for 2-5 years
once alendronate in the bone, it stays there for years. it's not needed to stay for many more years
104
For the majority of women being treated for osteoporosis, follow-up BMD
(bone mass density) studies should be conducted:
A. If a fragility fracture occurs.
B. At 6 months following initiation of treatment, then annually thereafter.
C. Every 2 years.
D. At the completion of therapy.
want to see bone changes every 2 years. not earlier bc won't see it change too soon
fragility fracture is seen at a time when u don't expect a fracture
105
All of the following are characteristics of knee osteoarthritis except:
A. Limited range of motion.
B. Morning stiffness.
C. Erythema surrounding the joint.
D. Crepitus.
C. no erythema
OA should be a COOL joint. smooth cool joint, no redness. bu limited ROM, morning stiffness, and crepitus
106
The preferred technique for initial diagnosis of osteoarthritis of the knee is:
A. X-ray.
B. MRI.
C. CT scan.
D. Arthroscopy.
A Xray. see joint space narrowing! bone on bone
107
All of the following are recommended by the American Academy of
Orthopaedic Surgeons (AAOS) for the management of OA of the knee except:
A. Weight loss if BMI ≥25
B. Use of hyaluronic acid injection.
C. Low-impact aerobic exercise.
D. Strengthening exercises (esp quadraeps)
B. hyaluronic acid injection not helpful / not enough evidence.
108
Identify at which age each of the following characteristics would indicate a
potential problem with a child’s development.
A. By 9 months
B. By 12 months
C. By 16 months
1.Fails to return a smile or other facial expression
2Lack of any spoken words
3Shows no response to his/her name
1. 9 months C (6-9 months they're joyous, and often big smiles)
2. 16 months
3. by 12 month, should know name
109
A 6-year-old boy returns to the clinic with his mother 2 months following an
episode of acute otitis media that was treated with a regimen of amoxicillin
(Amoxil®). Examination reveals persistent effusion and mild bulging of the
tympanic membrane, but there is no observed redness. The patient reports littleto-no pain in the affected ear and he is without fever. The most appropriate
management option for this patient is:
A. Watchful waiting.
B. A course of an oral decongestant.
C. 1 week therapy with amoxicillin-clavulanate (Augmentin®).
D. Cefpodoxime (Vantin®) at a therapeutic dose for 5 days.
he has otitis media with effusion (no redness)
-answer:A. effusion is normal up to 3 months.
otitis media diagonsis criteria: red and bulging TM AND pain
110
When counseling the parents of a healthy 2-week-old boy about supervised
tummy time, you recommend slowly building up to a total of _______ per day.
A. 15 minutes
B. 30 minutes
C. 1 hour
D. 2 hours
B. 30 mins per day. can be in diff intervals of 5 mins etc a day. SUPERVISED all the time
encourage tummy time = lifts head up and stimulates different parts of the brain. enhance neuro developing and minimizing positional plagiocephaly (flattening of head)
111
A breastfeeding mother brings in her 5-month-old son experiencing an episode
of gastroenteritis. She reports that he has had 3 loose stools in the past 24 hours
and vomited twice. Evaluation reveals that pulse and skin turgor are all within
normal limits and he is wearing a wet diaper. The NP recommends:
A. Temporarily switching to soy-based formula.
B. Initiating therapy with oral rehydration solution.
C. Supplementing with 50% diluted fruit drink or sports drink.
D. Continuing breastfeeding.
D. continue breastfeeding
mild gastroenteritis.
NO diluted fruit drinks
112
Which of the following patients with acne is the best candidate for oral
isotretinoin (Accutane®)?
A. A 15-year-old with 10–15 comedones and has not responded adequately to
benzoyl peroxide
B. A 17-year-old with type 1 diabetes and a total lesion count of 80–100 and has a
sulfa allergy.
C. An 18-year-old with 5–10 nodules and ~60 inflammatory lesions who has not
responded to multiple prior therapies
D. A 19-year-old woman with severe acne (>125 total lesions) who does not wish to
initiate contraceptive therapy
answer C.
not B bc not enough info. sulfa allergy distractor
not D, need 2 contraceptive methods to start accutane
113
As part of a well-child visit, you advise the parents of a well 6-month-old that a
mild fever of 1–2 days in duration is most likely to occur after the baby receives:
A. Inactivated polio virus (IPV) vaccine.
B. Haemophilus influenzae type B (Hib) vaccine.
C. Pneumococcal conjugate vaccine.
D. Injectable influenza vaccine.
C. pneumococcal conjugate most likely to make baby off for a day or 2. cranky or off.
the rest are remarkable well tolerated
114
when is Td booster vaccine recommended if it's been longer then...
5 years since last Td for recent injuries
115
koilonychia
116
podagra is form what condition?
gout
-pain in the joint of the great toe d/t accumulation of uric acid and salts in joint
117
difference between hepatitis B vaccine and Hepatitis B immunoglobuin?
hep b vaccine is prophylaxis lng term to prevent infection.
Hep b immunoglobulin is when you're directly exposed and to provide prevention of hep b infection. doesn't provide long term prophylaxis
118
bronchiolitis
viral infection by RSV seen during winter/spring months in infants and young children
fever, inspiratory, expiratory wheezing, clear drainage
119
anergy
when immune system unable to perform healthy normal immune response when body is challenged with a particular antigen
ie Tb screening in immunocompromised pt. apply candida or mumps antigen to right forearm and PPD on left forearm, read result in 2-3 days
120
scotch tape test
tests for enterobiasis infection (pinworms) in the small intestines
-itching around anus (worse at night)
apply scotch tape on anal area in morning, worms come out at night and stick to tape
121
when do you premedicate asthma before exercise induced asthma?
20 mins before exercise via proventil inhaler to prevent vasospasm of bronchioles and SOB with exercise
-lasts ~4 hours
122
is nipple soreness/tenderness normal for breastfeeding?
yes for 1-2 weeks then soreness goes away
123
normal FEV between exacerbations FEV:
mild persistent: FEV:
moderate persistent FEV
severe persistent:
normal FEV between exacerbations FEV > 80%
mild persistent: FEV <80%
moderate persistent FEV 60-80%
severe persistent: FEV< 60%
124
kernig sign
KErnig Sign "Knees Extension" is painful
meningitis
125
brudinski sign
brudiNsKi skign "Neck flexes, Knee flexes passively"
126
when is Rhogam given and MOA?
when mom is Rh- and fetus is Rh + (from dad)
Rhogam destroys the Rh+ RBC's in mother's blood system and prevents the development of antibodies
127
breath sound locations:
vesicular :
bronchial:
tracheal:
vesicular : base of lungs ; soft/blowing
bronchial: over bronchi, loud/high pitch
tracheal: over trachea
128
fordyce spots
large sebaceous glands, small painless, yellow-white spots 1-2 mm on lips, oral mucosa
-normal variant
-present after puberty
129
torus palatinus
bony growth on roof of mouth
-harmless
130
fishtail uvula
cleft uvula; uvula split in 2
131
suppurative vs nonsuppurative otitis media
suppurative otitis media = fluid buildup with pus in ear
non suppurative = no pus
132
weber test
tuning fork on head and should have NO lateralization to either ears (if does = hearing impairment)
132
weber test
tuning fork on head and should have NO lateralization to either ears (if does = hearing impairment)
133
left sided vs right sided HF symptoms
left sided: DROWNING
-Difficult breathing
-Rales/crackles
-Orthopnea
-Weakness
-Nocturnal Paroxysmal dyspnea
-Increased HR
-Nagging cough
-Gaining weight
right sided: SWELLING
-Swelling legs feet abd
-Edema (pitting)
-Large neck veins
-Lethargic
-Irregular heart beat
-Nausea
-Girth abd increased
134
which antihypertensive medication needs weaning off to avoid severe hypertension rebound?
beta blockers
135
how to diagnose gonorrheal pharyngitis or proctitis?
thayer martin culture isolates neisseria gonorrhoeae
136
when does toilet training start?
starts ~2 years old and may take 1-2 years to complete
-males who are not toilet trained by 3 may still be developing normally
137
blue dot sign
- tender nodule with blue discoloration on the upper pole of the testis
torsion of testicular appendage
NOT an emergency
138
blue dot sign
- tender nodule with blue discoloration on the upper pole of the testis
torsion of testicular appendage
NOT an emergency
139
what test to diagnostic testicular torsion?
absent of cremaster reflex
140
which class of drugs mask/blunt the signs and symptoms of hypoglycemia in diabetics?
beta blockers
masks tachycardia and tremor
141
tanner 1-5
tanner 1: prepuberty
tanner II: breast bud
tanner III : breast and areola 1 mound
tanner IV: breast and areola secondary mound
tanner V: adult
142
absolute vs relative contraindications for hormonal contraception
Absolute:
My CUPLETS
-Mygraines with focal neuro aura
-CVA or CAD
-Undiagnosed genital bleeding
-Pregnancy or sus preg
-Liver tumor or active liver disease
-Estrogen dependent tumor
-Thrombus or emboli
-Smoker 35 or older
Relative contraindication:
-migraines (>35 yrs)
-smoker <35
-fracture or cast on lower extremities
-adequate controlled HTN
143
disseminated gonorrheal infection
Sx's of PID: painful swollen joints of EXTREMITIES and if left untreated, can lead to septic arthritis
144
if CD4 count < 200, start
preventative therapy for pneumocysitis carinii pneumonia:
Use antimicrobial agents:
-bactrim, dapsone, aersolized pentamidine (antimicrobial tx for prevention)
145
which medication does NOT interfere with OCPs?
ciprofloxacin
146
precocious puberty starts at what age in girls and boys?
onset of secondary sexual characteristics by age 8 in girls and 9 in boys
147
cholesteatoma
abnormal cauliflower like growth, foul smelling discharge in middle ear, can cause hearing loss
-difficulty hearing
148
UTI's in men
rare in young men with normal urinary tracts
-urethritis mimics UTI (r/o chlam/gonor)
-need culture before starting antib = refer to urologist for eval/tx if recurrent UTI's
149
giant cell arteritis vs migraines/headache
giant cell causes LOSS OF VISION! with scalp tenderness and bad h/a on left temple
150
finasteride (proscar) class
5 alpha reductase inhibitor
-lower testosterone = decrease prostate size and helps with male pattern baldness
151
terazosin and tamulosin class
alpha blockers
-relax smooth muscle of prostate = enlarges diameter of urethra for sx control
152
bartholins gland abscess
on labia minora
-provides moisture for vestibule. if gets clogged/infected, abscess forms and becomes painful and enlarges
153
which lab value will be elevated ALONE in those with alcohol abusers/alcoholism?
serum GGT (gamma glutamyl transaminase)
-also elev in liver disease and biliary obstruction
154
larva migrans
infection with the eggs of parasites from dogs and cat intestines.
-children high risk of in contact with contaminated dirt with dog/cat feces or eating contaminated soil/feces and raw liver
-red, serpiginous shaped rash, very itchy
155
larva migrans
infection with the eggs of parasites from dogs and cat intestines.
-children high risk of in contact with contaminated dirt with dog/cat feces or eating contaminated soil/feces and raw liver
-red, serpiginous shaped rash, very itchy
156
sentinel nodes (virchow's nodes) are found where?
superclavicular area of chest. they're the 1st lymph nodes a cancer lesion will drain too = biospy to see if cancer has spread to lymph system
157
cautions with cimetidine (tagamet)
mental confusion in older adults
158
who should be screened for lung cancer and how?
routine not rec unless high risk (20 pack year AND current smoker or have quit w/in 15 years) AND between 50 and 80 years old
CT!!!!!!!!!!!
159
normal vs abnormal Rinne test result
normal: Air conduction > bone conduction
if there is conductive hearing loss (wear wax, otitis media), bone conduction is > air conduction since sound traveling through the air is blocked
160
osler nodes
subcutaneous red painful nodes on finger pads
bacterial endocarditis!
also subungual splinter hemorrhage's on nail bed
janeway lesions (bleeding under skin palms and soles)
get 3 blood cultures at sep times 1 hour apart to find org
161
pulmonary function test in COPD
reduction of FEV1 and FVC
increase in TLC (total lung capacity) and RV (residual volume) = lungs full of air but can't be squeezed out/recoiled
162
how does the prostate feel in prostatitis?
tender boggy and warm
163
how does the prostate feel in BPH?
firm and enlarged symmetrically
164
antipsychotic adverse effects
orthostatic hypotension
sedation
anorexia
weight gain (monitor glucose, lipids, weight)
sudden death in frail eldrs
165
first line med for c diff
metronidazole (flagyl) 500 mg x 10 days
166
where is the spleen located and can u palpate it?
NOT palpable in healthy adults
Left upper quad abdomen, protected under lower ribcage.
longest axis is 11-20cm (if >20 = enlarged)
Abd ultrasound fo revaluation
-splenomegaly from mono, sickle cell, CHF, bone marrow cancers
167
how is cholchine taken?
1 pill every hour to every 2 hours until relief or until GI side effects hpapne
suppresses gouty attack
168
mutiple myeloma is a cancer of
plasma cells of bone marrow
-bone pain, fractures, hypeRCalemia, depressed immunity, anemia
-mostly african Americans
-get CBC, FOBT, chemistry panel, UA
169
polymyagia rheumatica (PMR) is also a/s with
a high risk of giant cell arteritis or temporal arteritis
*new onset vision loss and pain in neck, both shoulders/hip*
-involves joints and arteries
ESR & CRP very high!
170
Polymyaglia rheumatica 1st line med
oral prednisone x 2-3 years taper off once sx's under control
171
seasonale birth control
extended cycle pill
-levonoregesterel and ethinyl estradiol
-take 1 pill for 84 days (pink active pills) and 7 white inert pills
- 4 periods per year
-more spotting w/ first few months
