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Simmons NURP 530 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q
A

urticaria - wheals on a erythematous base which is blanchable suggesting inflammation, may be pruritic, red, or skin-colored. May last a few minutes to 24 hours and may need antihistamine to alleviate the burning/itching.

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2
Q
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Nonbullous impetigo - well-localized area of papules and pustules with surrounding erythema and thick, adherent, golden-colored crust located on the chin.

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3
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Diaper candidiasis - diffuse, confluent erythema with discrete erythematous papules and plaques, superficial scale and satellite lesions to the inguinal area

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4
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Miliaria Rubra: Scattered vesicles on an erythematous base, usually on the face and trunk

Result from obstruction of the sweat gland ducts

Disappears spontaneously within weeks

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5
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A

Malignant melanoma - think ABCDE-EFG - assymetry, irregular borders, different colors especially blue and red, diameter > 6 mm, evolving or changing, elevation, firm to palpation, growing rapidly over several weeks

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6
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squamous cell carcinoma - keratoacanthomas are SCCs that arise rapidly and have a crateriform center, often have a smooth but firm border, SCCs can become quite large if left untreated. Highest sites of metastasis are the scalp, lips and ears.

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7
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A

herpes zoster “shingles” - grouped vesicles on erythematous base usually in a dermatomal distribution that does not cross the midline (unilateral)

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8
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A

solar lentigo - happens on sun-exposed skin. Light brown and uniform in colr but may be assymetric

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9
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A

Slate blue patches: A dark or bluish pigmentation over the buttocks and lower lumbar regions

Common in newborns of African, Asian, and Mediterranean descent

Result from pigmented cells in the deep layers of the skin

They become less noticeable with age and usually disappear during childhood

Document these pigmented areas to avoid later concern about bruising

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10
Q
A

acanthosis nigricans - dark, velvety patches appearing in creases and folds of the body, i.e. axillae, neck, groin, occurring in people who are obese, have DM or metabolic syndrome. May be corrected with weight loss and resolution of underlying condition.

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11
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A

Coxsackie Virus (hand, foot, and mouth disease) - common in summer and fall, generally not painful and is contagious (person-to-person, touching of surfaces, droplet, touching fecal matter of infected individual). It happens mostly in children under 5 years of age but anyone can get it. It may consist of vesicles on a erythematous base on the soles and palms. The person may also have mouth sores, anorexia, sore throat, be fussy. It will go away with supportive treatment.

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12
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A

Seborrheic keratosis - often verrucous texture, appear like flattened ball of wax, may crumble or bleed if picked, may be erythematous if inflamed, common in older adults, non-cancerous and may appear as brown, black or skin-colored, appears on face, back, shoulders and chest

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13
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A

Molluscum contagiosum - caused by pox virus, pearly colored dome-shaped papules with umbilication, may appear in clusters or linear fashion (likely due to scratching)

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14
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A

Cutis marmorata - seen in normal children and and congenital hypothyroidism and Down syndrome. Vasomotor response to cooling or chronic exposure to radiant heat.

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15
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A

actinic keratosis - often easier to feel than see, superficial keratotic papules “come and go” on sun-damaged skin, pre-cursor to SCC

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16
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A

Dermal nevi - brown dome-shaped papule. Uniformly round and symmetric. Elevated and smooth, approximately 7 mm in diameter.

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17
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A

Tinea corporis of face: round, annular lesion with advancing red, scaly border noted on left cheek. Border is raised. Central hypopigmentation with red papules noted in center.

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18
Q
A

Café-au-lait spots: Pigmented light-brown lesions (<1 to 2 cm at birth)

Isolated lesions have no significance, but multiple lesions with sharp borders may suggest neurofibromatosis

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19
Q
A

plaque psoriasis - scattered erythmatous to bright pink well-circumscribed flat-topped plaques on extensor knees and elbows with overlying silvery scale

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20
Q
A

varicella “chicken pox” - dew drop on a rose petal appearance, now less common due to vaccinations. Lesions consist of a vesicle on erythematous base. Signs and symptoms include pruritis, fever, unwell symptoms.

Wild chicken pox (presently more common), is more virulent, lesions may become infected causing sepsis and death

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21
Q
A

basal cell carcinoma - pearly pink plaque with central depression and overlying arborizing telangiectasias on left cheek. It is the most common type of skin cancer, often appearing on sun-exposed areas.

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22
Q
A

Erythema infectiosum “fifth disease” - caused by parvovirus B19, starts with mild fever, rhinitis, headache (contagious) followed in 3-5 days with rash, no longer contagious. Appearance includes slapped cheek red rash on face and lacy rash on arms, legs and trunk.

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23
Q
A

acrocyanosis - a blue cast to the hands and feet when exposed to cold is very common in newborns for the first few days and may recur throughout early infancy. If acrocyanosis does not disappear within 8 hours or with warming, cyanotic congenital heart disease should be considered.

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24
Q
A

Physiologic jaundice in newborn - may appear in days 2-3, peaks at day 5. Jaundice within 24 hours of birth is concerning for pathologic cause. Description is based on its extension which happens from head down, i.e. “jaundice to nipple line”

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25
Q
A

Erythema toxicum - Diffuse rash which happens only in newborns. Consists of erythematous macules with central pinpoint yellow or white pustules. It appears in first few days of life and disappears within a week. Can appear on face, chest, arms, legs but not on palms/soles.

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26
Q

Abnormally large head

A

macrocephaly due to hydrocephalus, subdural hematoma or rare causes like brain tumor or inherited syndromes

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27
Q

Acrocyanosis

A

Normally disappears after 8 hours or with warming. If not, then consider cyanotic congenital heart disease

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28
Q

activities of daily living

A

toileting, dressing, grooming, transferring, continence, feeding

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29
Q

adolescent (11-20 years) development

A

Onset of puberty avg age for girls 10, boys 11

Concrete to operational thinking, wide variability in cognitive development, increasing autonomy and peer influence, struggle for identity, independence, eventually intimacy leads to stress, health-related problems and often high-risk behaviors

Concrete to formal operational thinking: acquiring an ability to reason logically and abstractly and to consider future implications of current actions

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30
Q

adolescent (11-20 years) growth

A

girls growth spurt by age 14, boys by age 16

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31
Q

Alcohol in older adults

A

No more than 3 drinks per day or seven drinks per week

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32
Q

Apgar score

A

heart rate, respiratory effort, muscle tone, reflex irritability, color

Normal 1 min score: 8-10

Some nervous system depression score 5-7

Normal 5 min score: 8-10

High risk CNS and other organ dysfunction score 0-7

Ex. Skin, all blue, score = 0

pink trunk with blue hands/feet, score = 1

all pink, score = 2

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33
Q

Assess for aortic regurgitation

A

Patient sits, leans forward and exhales, use diaphragm over left sternal border at the apex (MCL at 5th ICS), listen for a soft diastolic decrescendo murmur

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34
Q

Assessing for mitral stenosis

A

Patient rolls to left side and listen with the bell of the stethoscope for S3 at apex (MCL at 5th ICS)

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35
Q

Assessment (SOAP)

A

analysis and interpretation

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36
Q

Auscultation

A

Use bell or diaphragm of stethoscope to detect heart, lung and bowel sounds

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37
Q

Basal cell carcinoma

A

translucent nodule that spreads and leaves a depressed center with a firm elevated border

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38
Q

Blood pressure in children

A

start measure at age 3, sooner if an issue is present

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39
Q

BMI

A

weight (kg)/height (m squared)

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40
Q

BMI in children

A

Measure in children older than 2

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41
Q

Bulla

A

Fluid-filled, > 1 cm

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42
Q

CAGE (for alcohol/drug use and abuse)

A

Concern/Cut

Apparent/Annoyed

Grave/Guilty

Evidence/Eye-opener

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43
Q

Causes of weight loss

A

GI disease, endocrine d/o, chronic infection, HIV/AIDS, malignancy, chronic cardiac/pulmonary or renal failure, depression, anorexia, bulima

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44
Q

Central cyanosis

A

concern for congenital heart disease; best place to check is tongue, oral mucosa

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45
Q

Chief complaint

A

Use quotes, use patient’s own words

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46
Q

coarctation of aorta and occlusive aortic disease

A

systolic hypertension in upper extremities and lower bp in legs, diminished or delayed femoral pulses referred as femoral delay

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47
Q

Common geriatric syndromes

A

falls, delirium, cognitive impairment, functional dependence, urinary incontinence

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48
Q

Cutis marmorata

A

prominent in premature infants and in infants with congenital hypothyroidism and Down syndrome

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49
Q

Diphtheria

A

Bacteria

S/S: Affects mucus membrane, insidious onset of pharyngitis, within 2-3 days membrane forms which can cause respiratory obstruction, fever usually not high but patient appears toxic

Dx: Culture of site, membrane formation, low-grade fever, toxic look of patient

Tx: Antitoxin, erythromycin/procaine PCN G

Vaccine: IM in DTaP, DT, Td, or Tdap

Schedule:

DTaP: 3 or 4 doses plus booster (entering school, under age 6)

Tdap: 11 or 12 yrs

Td or Tdap (preferred booster): q 10 years

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50
Q

Drugs associated with weight gain

A

TCA, insulin, sulfonylurea, contraceptives, glucocorticoids, progestational steroids, mirtazapine, paroxetine, gabapentin and valproate, propanolol

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51
Q

early childhood (1-4 years) development

A

walk by 15 months, run well by 2 yrs, pedal tricycle and jump by 4 years, sensorimotor learning, drive for independence, impulsive, poor self-regulation, temper tantrums, preoperation (lack of sustained, logical thought process)

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52
Q

early childhood (1-4 years) growth

A

physical growth slows by 50% growth of 3.5 inches and gain 4 pounds avg more leaner, muscular preschoolers

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53
Q

Extremely low birth weight

A

< 1000 grams (2.2 lbs)

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54
Q

Family History

A

Elaborate on HTN, CAD, elevated cholesterol, stroke, DM, thyroid/renal disease, arthritis, asthma, mental illness, suicide, substance abuse and allergies, cancer (ovarian, breast, colon, prostate), genetic disorders

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55
Q

Fatigue

A

non-specific, many causes, loss of energy, common symptom in anxiety and depression, also caused by other conditions such as infections, endocrine disorders and others.

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56
Q

Five critical domains of pediatric development

A

gross/fine motor, cognitive, communication, personal/social domains

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57
Q

Full description of symptoms

A

Begin with open-ended questions, then specific questions and finally yes/no questions

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58
Q

general survey

A

apparent state of health, LOC, signs of distress, skin color and lesions, dress, grooming, hygiene, facial expressions, body/breath odor, posture, gait, motor activity, ht, wt, BMI, waist circumference

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59
Q

gold standard

A

best measure of presence of disease

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60
Q

Haemophilus influenzae

A

Bacteria

S/s: Meningitis, epiglottitis, pneumonia, arthritis, and cellulitis

Dx: Culture in chocolate agar media, serotype using slide agglutination and real-time PCR

Tx: 3rd generation cephalosporin or chloramphenicol plus ampicillin

Vaccine: Hib

Schedule:

4-dose series at age 2,4,6, 12-15 months

3-dose series at age 2, 4, 12-15 months

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61
Q

Head circumference in children

A

Measure until age 24 months

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62
Q

Hepatitis A

A

RNA virus

S/s: Abrupt onset of fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and jaundice

Dx: Serologic testing, detectable IgM anti-HAV 5-10 days before onset of symptoms and persist for up to 6 months

Tx: Supportive management, post-exposure prophylaxis with IVIg

Vaccine: IM Hepatitis A vaccine
Schedule:

2 doses, first age 12-23 months, 2nd dose 6 months later

Over 24 months, also receive 2 doses

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63
Q

Hepatitis B

A

double-shelled virus

S/S: Preicteric: insidious onset of malaise, anorexia, n/v, RUQ abdominal pain, fever, h/a, myalgia, skin rashes, arthralgia and arthritis and dark urine

Icteric: 1-3 weeks and c/b jaundice, light or gray stools, hepatic tenderness and hepatomegaly (splenomegaly is less common)

Dx: Serologic testing: HBsAg (infectious), anti-HBc (past infection), IgM anti-HBc (recent HBV infection), anti-HBs (vaccine)

Tx: Supportive in acute infection, for chronic HBV (interferon alpha) and nucleoside or nucleotide analogues: lamivudine, adefovir, entecavir telbivudine and tenofovir

Vaccine: IM hepatitis B

Schedule:

3 doses, booster not routinely recommended

Infants: birth, p 4 weeks (1-2 months), p 8 weeks (6-18 months)

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64
Q

herpes zoster (shingles)

A

vesicular lesions occurring in a dermatomal distribution

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65
Q

History of Present Illness

A

summary, OLDCART, relevant risk factors, symptom history, medications, allergies, tobacco/alcohol/drug use

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66
Q

Vaccine schedule: HPV

A

If first dose given at age 9-14 years, second dose at least 5 months apart

If first dose given 15 years +, 3 dose-series

1st dose

2nd dose: >=4 weeks from dose 1

3rd dose: 12 weeks from dose 2 and 5 months from dose 1

67
Q

Human papillomavirus

A

small, double-stranded DNA virus

S/S: Anogenital warts, respiratory papillomatosis, cervical/anal/vaginal/vulvar/penile cancers

Dx: Pap tests (cervical cancer screening)

Tx: Supportive treatment of genital warts

Vaccine: HPV

Schedule:

Age 11-12 yrs, or females 13-26 yrs, males 13-21 yrs

(2-dose series if first given prior to age 15, 3-dose series if given if older than 15)

68
Q

Hypertension

A

average of 2 readings on 2 separate occasions > 140/90

69
Q

Immunization in older adults

A

influenza, pneumonia PPSV23 and PCV13, herpes zoster, tetanus/diphtheria and pertussis

70
Q

Infant at 3 months

A

Able to lift head, clasp hands, coo

71
Q

Infant at 6 months

A

able to roll over, reach for objects, turn to voices, babble and sit with support

72
Q

Infant at 9 months

A

neat pincer grasp, indicate wants, developed “stranger danger”

73
Q

Influenza

A

Helically-shaped RNA virus

S/S: Abrupt onset of fever, myalgia, sore throat, nonproductive cough and h/a

Dx: Clinical esp in context of community patterns, nasopharyngeal swabs within 3 days of onset of illness, serologic rise in influenza IgG (< 5 days of onset), hemagglutination inhibition test >= 4-fold rise in antibody titer

Tx: zanamivir, oseltamivir (given within 72 hours of onset of symptoms), otherwise supportive measures

Vaccine: inactivated (min age 6 months) or live attenuated vaccine (min age 2 years)

Schedule: 2-dose series for children under age 8, given 4 weeks apart

then annual, no live attenuated version after age 65

74
Q

Influenza vaccine

A

Through age 8, first time and less than 2 years old - 2 doses of inactivated influenza vaccine (IIV), 4 weeks apart

LAIV has minimum age of 2 years old - also 2 doses prior to age 8

After age 8 - 1 annual dose

Live attenuated (intranasal) OK through age 50

75
Q

Inspection

A

observing details in appearance, behavior, movement, gait, hygiene

76
Q

instrumental activities of daily living

A

shopping, paying bills, cooking, using a telephone, doing laundry, transportation, taking medication and managing money

77
Q

Interval between live vaccines

A

If not given on same day, minimum interval ins 4 weeks

78
Q

LGA

A

> 90th percentile (usu. due to diabetic mothers, tall parents, genetic syndromes)

Common complications: hypoglycemia

79
Q

Listening

A

single-most important part of health history, 90% of diagnosis comes from history

80
Q

Live attenuated viral vaccines

A

Immune response resembles natural immunity

Usually require one vaccine

Can be given together with other live vaccines

If unable to give together must separate by at least 4 weeks

Examples of live vaccines: measles, mumps, rubella, vaccinia, varicella, zoster, yellow fever, rotavirus and intranasal influenza

Contraindicated in pregnancy, after age 65, immunocompromised

81
Q

Live zoster virus vaccine

A

1 dose, after age 60

Separate from recombinant zoster vaccine by at least 2 months

82
Q

Low birth weight

A

< 2500 grams (5.5 lbs)

83
Q

Macule

A

flat, < 1 cm

84
Q

Measles

A

paramyxovirus with a core of single-stranded RNA

S/S: Fever, onset of cough, coryza, conjunctivitis, Koplik spots, maculopapular eruption

Dx: Measles virus from urine, nasopharynx, blood, throat, rise measles IgG by any standard serologic assay, positive sero

Tx: Supportive, vitamin A to reduce complications

Vaccine: MMR/MMRV

Schedule:

2 doses

Infants: age 12-15 months, age 4-6 months (prior to attending school)

Additional dose for increased risk: college students, healthcare workers, international travelers

85
Q

melanoma

A

dark, raised asymmetric lesion with irregular borders

86
Q

Meningococcal disease

A

Bacteria

S/S: Sudden onset of fever, h/a, stiff neck, n/v, photophobia and AMS, petechial rash

Dx: Isolation of N. meningitidis from a normally sterile site (CSF)

Tx: Empiric therapy with broad-spectrum antibiotics, e.g. third-generation cephalosporin, vancomycin started promptly after cultures obtained, also penicillin

Vaccine: MenACWY (Menactra), MenB (both IM)

Schedule: 2 doses, 1st age 11-12, booster at 16

MenB, 1 dose at age 16-18 years

87
Q

middle childhood (5-10 years) development

A

improvement of strength and coordination, concrete operation, school family and environment influence learning, self-efficacy, language more complex, more independent, guilt and self-esteem emerge, clear sense of right and wrong

88
Q

middle childhood (5-10 years) growth

A

grow steadily but more slowly

89
Q

MMRV in adults

A

1 dose if no evidence of immunity (titers are low) for non-pregnant women of childbearing age

2-dose series given at least 4 weeks apart for:

HIV (CD4>=200), ESRD, HCW, MSM, DM, asplenia, heart/lung disease, liver disease, ETOH

Contraindicated in pregnancy and severely immunocompromised (incl CD4<200), over age 65

90
Q

Mononucleosis in adolescent

A

persistent fever, tonsillar pharyngitis, cervical lymphadenopathy

91
Q

Mumps

A

Paramyxovirus

S/S: Myalgia, malaise, h/a, low-grade fever, orchitis, parotitis

Dx: Based on clinical manifestations and serum mumps IgM, rise in IgG antibody titer in acute and convalescent-phase positive mumps virus culture or detection of virus by rRT-PCR), specimens from parotid duct (preferred), salivary gland ducts (preferred), throat, urine and CSF

Tx: Supportive

Vaccine: MMR

Schedule:

At least 2 doses

Infants: 12-15 months of age

Children: age 4-6 years, prior to attending school (at which point MMRV is preferred)

92
Q

Newborn development

A

habituation, attachment, state regulation, perception

93
Q

Newborn growth: late preterm

A

34-36 weeks

94
Q

Newborn growth: preterm # of months

A

< 34 weeks

95
Q

OBGYN history

A

GPML (gravida, para, miscarriages, living) I am 4-3-1-3

96
Q

Objective data

A

Signs Vital signs Physical exam findings Diagnostic tests

97
Q

OLDCART

A

onset, location, duration, characteristics, aggravating/relieving factors, timing

98
Q

Older adult: approach to primary care

A

observe for geriatric syndromes, be aware of community resources, review advanced directives, be familiar and reference Beers Criteria, adopt an evidence-based approach to health screening

99
Q

Palpation

A

tactile pressure from fingers or fingerpads

100
Q

Papule

A

Raised, < 1 cm

101
Q

Parts of a comprehensive health history

A

Identifying Data, Reliability, Chief Complaint, Present illness, Past illnesses, Family history, Personal and social history, Review of systems

102
Q

Past History

A

Childhood illnesses, medical, surgical, OBGYN, psychiatric, health maintenance

103
Q

Patch

A

Flat, > 1 cm

104
Q

Pediatric Growth: need further evaluation

A

variations more than 2 std dev for age, below 5% or above 95% percentile for ht/wt/head circumference, reduced growth velocity, drop > 2 quartiles in 6 months,

105
Q

Pediatric health promotion and supervision (in general)

A

AAP guidelines, immunizations, age-specific screening, anticipatory guidance, development, discuss parental concerns, physical exam

106
Q

Percussion

A

Striking plexor finger against pleximeter finger on chest, back, abdomen to elicit resonance or dullness

107
Q

Personal and social history

A

occupation, education, home situation, significant other, religious/spiritual beliefs, ADLs, exercise, diet, safety, sexual orientation and practices, alternative health care practices

108
Q

Pertussis

A

Gram-negative rod

S/S: Onset of coryza, low-grade fever, mild occasional cough which starts mild then more severe, paroxysmal cough, high-pitched whoop

Dx: Clinical history (cough > 2 weeks with whoop, paroxysms or posttussive vomiting), culture (gold standard), PCR (high false-positive rate)

Tx: Supportive, antibiotics are of some value, i.e. azithromycin, clarithromycin and erythromycin, SMZ-TMP can also be used.

Vaccine: DTaP, dTaP

Schedule:

DTaP: age 2 months, 4 months, 6 months, 15-18 months, 5th dose if 4th dose given before age 4

Tdap: age 11 years, in each pregnancy weeks 27-36, healthcare personnel, q10 year booster

109
Q

Pityriasis rosea

A

oval lesions on trunk, in older children, often in a Christmas tree pattern, somteimes a herald patch (a large patch that appears first)

110
Q

Plan (SOAP)

A

patient education, changes in meds, needed tests, referrals, return visits, patient response to plan

111
Q

Plaque

A

Raised, > 1 cm

112
Q

Pneumococcal disease

A

Bacteria

S/S: Abrupt onset of fever and chills/rigors, pleuritic chest pain

Dx: Isolation of organism in blood or otherwise sterile body sites, sputum specimens, urinary antigen test

Tx: Penicillin

Vaccine: PCV13, PPSV23

Schedule:

PCV13 - 3 doses age age 2,4,6 months, booster at age 12-15 months

adults age 65+

PPSV23 - 1 dose, 12 months from PCV13, revaccinate at least 5 years after 1st dose

113
Q

Pneumococcal vaccine

A

If not vaccinated during childhood, give PCV13 first

then PPSV23, 12 months later

Never give them together

If PPSV23 given before age 65, revaccinate in 5+ years

In chronic medical conditions: PCV13 followed in 8 weeks with PPSV23, then PPSV23 in 5 years, after age 65, PPSV23 at least 5 years from last dose

In asplenia/functional asplenia - separate from meningococcal vaccine, give only after the youth series is finished

114
Q

Poliomyelitis

A

RNA enterovirus

S/S: Most are asymptomatic, minor, nonspecific illness, stiff neck/back/legs, flaccid paralysis
Dx: Two specimens separated by 3 weeks, serology with four-fold rise in antibody titer, in poliovirus infection of CF, fluid will have increased WBC and mildly elevated protein

Tx: Supportive including physical therapy

Vaccine: IPV

Schedule: Infants - 3 doses @ age 2,4,6-18 months

Child- age 4-6 years

115
Q

Problem List

A

List most active/serious first with date of onset

116
Q

Pustule

A

small, palpable collection of neutrophils or keratin that appears white

117
Q

Review of systems (ROS)

A

general, skin, HEENT, neck, breasts, respiratory, CV, GI, PV, urinary, genital, MSK, psychiatric, neurologic, hematologic, endocrine

118
Q

Risks of postterm

A

increased risk for mortality/morbidity r/t asphyxia and meconium aspiration

119
Q

Risks of preterm/late preterm

A

Many including respiratory, cardiovascular and neurodevelopmental

120
Q

Rotavirus

A

Double-stranded RNA virus

S/S: Self-limited watery diarrhea, severe dehydrating diarrhea with fever, vomiting, fever > 102F
Dx: Rotavirus antigen in stool by EIA (preferred), also in serum 3-7 days after disease onset

Tx: Rehydration, replacement of electrolytes, supportive care

Vaccine: Rotavirus (oral)

Schedule: Infants max age 8 months,

3 doses @ age 2,4,6 months

121
Q

Rubella

A

Togavirus

S/S: 1-5 day prodrome with low-grade fever, malaise, lymphadenopathy, URI symptoms, rash that is maculopapular and occurs 14-17 days after exposure, starts at face then progressing to feet, occasionally pruritic rash

Dx: Positive viral culture by PCR, presence of rubella-specific IgM antibody or significant rise in IgG antibody from paired acute- and convalescent-phase sera.

Tx: Supportive care

Vaccine: MMR/MMRV

Schedule: 2 doses

age 12-15 months, 4-6 years

122
Q

Screening for alcohol use disorder

A

Men: <=4 drinks per day or 14 drinks per week

Women: <=3 drinks per day or 7 drinks per week

1 drink = 12 ounces of beer, 5 ounces of wine, 1.5 ounces of spirits

123
Q

Screening questions for depression

A
  1. Over the past 2 weeks, have you felt down, depressed or hopeless? 2. Over the past 2 weeks, have you felt little interest or pleasure in doing things?
124
Q

sensitivity

A

probability person with a disease has a positive test (true positive rate)

125
Q

SGA

A

< 10th percentile (usu. due to nutritional issues/smoking/illicit drug use and placental issues)

126
Q

Skin findings components (#8)

A

Number, Size, Color, Shape, Texture, Primary lesion, Location, Configuration

127
Q

Skin scraping with KOH

A

The skin lesion KOH (potassium hydroxide) exam is a simple test that helps doctors identify fungal infections on a person’s skin, hair, and nails. If negative, lesion is not due to fungus or may have to test again.

128
Q

Small head size

A

from premature suture closure or microcephaly due to chromosomal abnormalities, congenital infections, maternal metabolic disorders and neurologic insults

129
Q

SnNOUT

A

Sensitive test with negative result rules out disease

130
Q

SOAP

A

subjective, objective, assessment, plan

131
Q

specificity

A

probability non-diseased person has a negative test (true negative rate)

132
Q

SpPIN

A

Specific test with positive result rules IN disease

133
Q

squamous cell cancer

A

firm reddish-appearing lesion often emergin in a sun-exposed area

134
Q

Subjective data

A

Symptoms, What the patient tells you, Data source/reliability, Chief complaint, History of present illness (HPI), Past history, Family history, Personal and social history, Review of systems

135
Q

Tdap

A

given during pregnancy weeks 27-36 and child’s caregivers, given with injury/wounds and every 10 years

136
Q

Telogen effluvium

A

Diagnosed after hair pull test - grab 50-60 strands of hair, using thumb and index finger pull away from scalp. If hair is removed and contains the bulb, test is positive for telogen effluvium

137
Q

Temperature in infants

A

rectal temp most accurate in symptoms

138
Q

Tetanus

A

Bacteria

S/S: Trismus or lockjaw, stiffness of neck, difficulty swallowing, abdominal muscle rigidity, elevated temp/bp, sweating, episodic rapid HR, spasms x 3-4 weeks

Dx: Clinical, may be recovered from wound in only 30% of cases

Tx: Wound care, supportive care and maintenance of adequate airway, tetanus immune globulin (TIG) to help remove unbound tetanus toxin (one IM dose, or IV)

Vaccine: DT, DTap, Tdap

DTaP @ ages 2,4,6, 15-18 months, 4-6 years,

DT/Td/Tdap: q10 boosters

139
Q

Timing and spacing between vaccines and antibody

A

first vaccine, wait 2 weeks to give antibody

first antibody, wait 3 months to give vaccine

Exception is post-exposure such as tetanus/hep B/rabies antibody and vaccine can be given at same time

140
Q

Vaccination @ 12 months

A

MMRV

141
Q

Vaccination @ 1-1.5 years

A

MMR, Hepatitis A, DTap, Hib, PCV13, Varicella

142
Q

Vaccination: @ 2 months

A

Hepatitis B, DTaP, Rotavirus, Hib, IPV, PCV13

143
Q

Vaccination: @ 4 months

A

DTaP, Rotavirus, Hib, IPV, PCV13

144
Q

Vaccination: @ birth

A

Hepatitis B

145
Q

Vaccinations: 11-12 years

A

Tdap, HPV, Meningococcal

146
Q

Vaccinations: 16-18 years

A

Meningococcal booster

147
Q

Vaccinations: 4-6 years

A

Varicella, DTaP, IPV, MMR

148
Q

Vaccinations: @ 6 months

A

Influenza, Hepatitis B, DTaP, Rotavirus, Hib, IPV, PCV13

149
Q

Varicella zoster

A

DNA virus

S/S: Varicella: Mild prodrome may precede onset of vesicular rash which appears first on head, to trunk and then extremities, 1-4 mm, may rupture and crust, dew drop on rose petal appearance

Shingles: vesicular eruption in the distribution of a sensory nerve, involves trunk or 5th CN, 2-4 days prior to eruption, may have pain and paresthesia at involved area, few systemic symptoms

Dx: Clinical symptoms, Varicella virus from vesicular fluid, rapid virus identification using PCR or DFA, significant rise in varicella IgG by any standard serologic assay

Tx: Supportive care, if high-risk antiviral therapy such as oral valacyclovir or acyclovir

Vaccine: MMRV, V, zoster recombinant, live zoster

Schedule: MMRV - 2 doses, @age 12-15 months, 4-6 years

and in persons without proof of immunity, 2 doses separated by 4 weeks

Adults age 50+: 2 doses of zoster recombinant vaccine (2-6 months apart)

Age 60+: 1 dose live zoster vaccine

150
Q

Very low birth weight

A

< 1500 grams (3.3 lbs)

151
Q

Vesicle

A

Fluid-filled, < 1 cm

152
Q

Weakness

A

Denotes demonstrable loss of muscle power

153
Q

Weight and height at 12 months

A

Triple birth weight, 50% length

154
Q

Weight loss

A

Pounds lost over a 6-month period

155
Q

When is a comprehensive health assessment done?

A

new patients, in-depth knowledge of patient, provides a baseline for future visits, health promotion and education, comprehensive exam

156
Q

When is a focus/problem-oriented health assessment done?

A

Appropriate for established patients, addresses focused concerns or symptoms, addresses symptoms related to specific body systems, focused exam utilizing specific techniques or maneuvers

157
Q

Why should pneumococcal and meningococcal vaccines be separated in asplenia/functional asplenia?

A

In addition to being at increased risk for meningococcal disease, children with functional or anatomic asplenia are also at increased risk invasive disease caused by Streptococcus pneumoniae. Data show that the MenACWY-D may interfere with the immunologic response to PCV13 if these two vaccines are given too close together. So ACIP recommends that MenACWY-D not be administered until at least 4 weeks after completion of the age-appropriate PCV13 series. MenACWY-CRM (Menveo) does not affect the immune response to pneumococcal vaccine so can be given at any time before or after PCV13.

158
Q

Zoster recombinant vaccine

A

2 doses, 2-6 months apart - after age 50

159
Q

Passive immunity

A

Antibodies are transported across the placenta during the last 1–2 months of pregnancy. As a result, a full-term infant will have the same antibodies as its mother. These antibodies will protect the infant from certain diseases for up to a year. Protection is better against some diseases (e.g., measles, rubella, tetanus) than others (e.g., polio, pertussis).

160
Q

Immunity from inactivated vaccines

A

Inactivated vaccines always require multiple doses. In general, the first dose does not produce protective immunity, but “primes” the immune system. A protective immune response develops after the second or third dose.

161
Q

Sensitive interviewing re IPV

A

Begin with normalizing statements such as “Because abuse is common in many women’s lives, I’ve begun to ask about it routinely.”

Followed by probing questions and then in-depth questioning.

162
Q

Boraching sensitive topics

A

The single most important rule is to be nonjudmental. Explain why you need to know certain infromation. Find opening questions for sensitive topics and learn the specific kinds of information needed for your shared assessment and plan.

163
Q

Hypothyroidism

A

High TSH, low T3, T4

S/S: fatigue, bradycardia, thin hair, dry skin

164
Q

Hyperthyroidism

A

Low TSH, high free T4, high free T3

S/S: increased basal metabolic rate, exophthalmos, restlessness, sweating, heat intolerance, weight loss, flushing of face and hands, smooth, moise and warm skin, fine, soft and thinned scalp hair

Simmons NURP 530 (4 decks)

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