COMMON PROBS/CULTURE/RISK Flashcards
Your 24M patient has been out hiking on vacation. He shows you the following rash, (circle red rash) and thinks he has Rocky Mountain Spotted Fever. What is his diagnosis?
Lyme Disease (Erythema Migrans/Bullseye rash) (both are treated with Doxycycline)
Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to?
A sign of respect
Your patient speaks only Spanish and you need to evaluate his pain. What do you do?
Use a visual pain scale (less $$ than interpreter)
Question where the patient spoke a foreign language and you wanted to get consent from him. The options were to give him the consent form in his own language, use the hospital’s telephone interpreter service, have a family member translate, and then an obviously wrong option.
58yo Japanese M with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the ED warrant admission?
Ethnicity (underestimates pain, taught to be stoic. Pain is probably much more severe)
A 77M patient’s wife cares for him at home. Which statement by the wife indicates a need for a SNF?
My husband needs more help with his ADLs
Which psychiatric disorder is most commonly diagnosed, yet least commonly treated?
Depression
Your pt w/PNA is noted to have a heavy drinking habit. 2 days p admit he becomes combative/agitated. What is Tx?
po Librium
Your patient has developed a fever of unknown origin. What is the next step?
Do nothing until diagnosis is confirmed
How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed?
2 days
The patient has been in a bar fight and has a human bite on his hand. What should you do next?
Order PO abx
Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication?
Osteomyelitis
What is the strongest predictor of functional impairment prior to discharge of the elderly pt?
Cognitive impairment
Your pt has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.92), what should you do next:
Give IVF (flush it out. This is neuroleptic malignant syndrome)
You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention?
Stop the TPN, Remove the line, and place a new line for TPN
Your patient has a fever 3 days post op, WBC are 15,000, Blood Cx (-), and Eos 9%. What is the dx?
Drug fever (eos – allergic rxn. Normal is 1-4%)
What are protein supplements best used for?
Aid in post-op healing
Which macronutrient of TPN significantly increases the osmolality of the solution?
Dextrose
Which electrolyte are you most concerned about monitoring in a cachexic patient?
K (refeeding syndrome. hypokalemia. also hypophosphatemia)
Which lab do you monitor daily in a patient on nutritional supplements?
BMP (And monitor LFTs weekly) The answer had some other things in it, but it was the only one with BMP.
What alternative therapy can you order to relax the pt prior to a procedure?
Music
There was a question about what to do for the patient to help/distract their pain during a procedure, and the answer was guided imagery.
Which helps a Parkinson’s pt. with coordination
Tai Chi (also helps prevent falls in elderly)
Which 2 headaches can be treated with triptans?
Migraines and cluster.
What kind of dressing do you use on a decubitus ulcer with necrotic tissue?
Hydrocolloid
45 yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site.
Neuropathic pain
Pt has a post-op fever. what do you do
give fluids
pain medication for breakthrough cancer pain
fentanyl patch
Best pain indicator
pt self report
Best alternative therapy to decrease pain in clavicle fracture
therapeutic touch/reiki
(Reiki: hand or palm-healing that transfers ‘universal energy’, has been used for cancer, emotional, or physical healing)
Picture of Gunshot wound to the R lung area: you purpose of dressing.
The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration. Another answer was to let air blow out during inhalation.
Cocaine induced psychosis
s/s: paranoia, delusions, hallucinations ‘cocaine bugs’ under skin, mydriasis
Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms w/dilated pupils
Sympathomimetic (which is cocaine or meth)
Antidepressant OD signs and symptoms and treatment
s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension, (can’t see, can’t pee, can’t spit, can’t shit), TX: ICU if CNS or cardio toxic, activated charcoal, NaHCO3 for dysrhythmias and maintain PH, Benzos (valium) for Sz (if serotonin syndrome: dantrium/dantrolene sodium)
ASA overdose signs and symptoms and treatment
s/s: n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis. Tx: activated charcoal, NaHCO3 for severe acidosis of <7.1. MONITOR ABGs
How do you treat group A strep on skin:
TMP/SMX or Doxy/Mino + beta lactam (1st gen ceph, PCN or Amoxil)
Pt has cellulitis of lower extremity with a wound, what do you treat with?
Based on the hospital sensitivity
Mallampati grades for visualization of oral cavity:
(I complete soft palate, II complete uvula, III uvula base only, IV none)
Osteomalacia
softening of bones, rickets
Osteomalacia most common cause
Deficient VitD (also Phos, Ca, UV-B light)
Hospice vs palliative care:
Palliative are still receiving Tx. Hospice is no curative treatment, has death dx, and ≤6mos to live
Venous stasis ulcer
use compression stocking
The patient has had a dog bite and 3 doses of Tetanus in the past. The NP knows the recommendation for tetanus is that the:
patient gets a booster if they have a dirty wound and haven’t had a tetanus shot in five years.
Tdap vaccine is an example of what type of immunity?
Active immunity
How often should a woman between the ages of 20-39 have a PAP with HPV?
Q5 years, PAP with cytology Q3 years
If born on or after what year is it indicated to receive 2 doses of mumps vaccine?
1957
What age does an individual receive Zostavax?
50, one time dose
At what age do males start colonoscopy every 10 years?
50
When should PSA levels be initiated and how often?
PSA levels every year >50 (and DRE)
Annual PSA and DRE are indicated in what group?
African-American >40 and family hx of prostate CA
Pt has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to DC?
65-70
35 yo Asian-american is in good health. He is worried about life-prolonging measures. What is the most likely cause of death for a man like him?
Unintentional injury (if he’s African American, it’s Homicide < 35 and heart dz at 35)
What is the leading cause of death in African Americans M ages 40-59?
CAD
What is the leading cause of deaths in Hispanics in the US?
Heart disease
