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NURS 5410: Common and Chronic Health Problems 2 > Exam 1: Lectures > Flashcards

Exam 1: Lectures Flashcards

1
Q

A 27-year-old pregnant woman with type 1 diabetes mellitus and microalbuminuria previously had photo laser ablation for retinopathy. She may be at risk for which of the following?
A. Neuropathy
B. Gastroparesis
C. Nephropathy
D. Proliferative retinopathy

A

D. Proliferative retinopathy

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2
Q

A 24-year-old man presents with a headache and bilateral visual decline. Visual acuity in each eye is 20/40. Fundus examination is similar in both eyes, and an ultrawide-field fundus image of the left eye is shown. What is the most appropriate initial investigation?
A. Fasting blood glucose level.
B. Blood pressure measurement.
C. Rapid HIV antibody screening.
D. Brain MRI

A

B. Blood pressure measurement.

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3
Q

A 17-year-old boy presents with a watery discharge from his eyes for the past 3 days. Associated symptoms include itching and redness. He reveals a history of upper respiratory tract infections. Vital signs are blood pressure 120/80 mm Hg, heart rate 80 bpm, respiratory rate 14 breaths/min, and temperature 98.6° F (37° C). Ocular examination findings are shown in the image. A polymerase chain reaction (PCR) test confirms the diagnosis. What is the most common causative organism?
A. Adenovirus
B. Herpes simplex
C. Herpes zoster
D. Enterovirus

A

A. Adenovirus

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4
Q

A 17-year-old girl presents with a 3-day history of bilateral itching, burning, crusting, and matting of her eyelids, which worsens when she awakens in the morning. The patient has no prior history of a similar event. On physical exam, there is crusting of the eyelashes at the bases, erythema of the eyelids, clear conjunctiva, and cornea. There are small ulcers on the eyelid margins. The meibomian glands appear normal. Which of the following is not first-line treatment?
A. Warm compresses and lid margin scrubs with a cotton swab dipped in diluted baby shampoo
B. Avoidance of eye makeup
C. Erythromycin ophthalmic ointment
D. Oral doxycycline

A

D. Oral doxycycline

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5
Q

Common cause of viral conjunctivits

A

Adenovirus

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6
Q

Burning, sandy, gritty sensation of the eye is seen with…

A

viral conjuncitivis

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7
Q

Your pt presents s/p URI x1 week ago. They have been noticing a watery discharge from their eyes, worse in the morning. Throughout the day they feel their eyes are dry, burning, almost like they have sand in them. They have been wearing their contacts with daily changes. What is your most likely diagnosis?

A

Viral conjunctivitis.

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8
Q

Your pt presents s/p URI x1 week ago. They have been noticing a watery discharge from their eyes, worse in the morning. Throughout the day they feel their eyes are dry, burning, almost like they have sand in them. They have been wearing their contacts with daily changes. You diagnosis them with viral conjunctivitis. What would you recommend as part of their management plan?

A

Avoid contact wearing
Cold compresses to to the eyes
Topical antihistamine eye drops
Would also consider HSV testing if needed for antivirals

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9
Q

Your patient comes in with c/o burning eye sensation. They have noted mucoserous drainage from their L eye. You complete a woods lamp exam with a +ulceration on they L eye and noted injections. What is your most likely diagnosis?

A

HSV viral conjunctivitis

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10
Q

What is the primary treatment for HSV viral conjunctivitis?

A

Ophthalmology referral and antiviral gel such as Ganciclovir

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11
Q

What is the primary treatment for VSV viral conjunctivitis?

A

Ophthalmology referral and antiviral gel such as Acyclovir

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12
Q

Your 30 y/o patient comes in with c/o burning, sandy, gritty sensation of both eyes. They have noted injections bilaterally and endorse watery discharge throughout the day. They have a PMH of seasonal allergies, have been using OTC Allergra daily, flonase daily, and OTC Zaditor eye drops as needed. They wear contacts, started with contacts at 13 y/o, wear time is about 14 hours/day. You note cobblestoning of the eyelids on exam. What is your primary concern for lead diagnosis?

A

Giant papillary conjunctivitis

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13
Q

How would you treat your patient with giant papillary conjunctivitis?

A

Referral to ophthalmology

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14
Q

Pt presents today with mild erythema and edema of the R eye. They have noticed intermittent blurred vision and mucoid discharge. They work as a farmer and are outside often, not always with a hat or sunglasses. On an exam you notice a small discolored bump in their cornea. You diagnose a pinguecula. What is your primary treatment plan?

A

Observe overtime
Lubricants for symptom management
Avoid sun exposure, wear hats/sunglasses in the sun

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15
Q

Your patient comes in with a noted foreign body in their eye. What do you do?

A

Refer to ophthalmology STAT for removal

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16
Q

Are antibiotics indicated for corneal abrasion?

A

Yes if you suspect foreign body as cause to reduce infection risk

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17
Q

A patient with traumatic corneal abrasion, foreign body abrasion, or recurrent erosion should be treated with which topical antibiotic?

A

Erythromycin or Sulfacetamide 10%

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18
Q

A patient with a contact lens corneal abrasion should be treated with which antibiotic topical?

A

Oflaxacin, Cipro, or tobramycin

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19
Q

45 y/o M presents with FB sensation of his R eye. He notes that he has crusting and matting around his upper eyelashes with some pain. The has had decreased vision in his R eye, L eye vision unchanged. He denies photophobia at this time, endorses one episode of photophobia last week. Exam shows erythema of R eyelid, noted inflammation at the upper lash bases. What is your lead diagnosis?

A

Blepharitis

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20
Q

Your patient with Blepharitis is asking for antibiotic treatment. What would you suggest for a treatment plan?

A

Warm compresses and gentle massage of the area with follow up in 1 week. This is not an infectious process and does not need antibiotic drops unless unresolving

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21
Q

14 y/o F comes in with her mother today for a tender nodule on her L eyelid. You note erythema to the L upper eyelid. Pt endorses occasional pain, mild decrease in vision field on the L side. She has tenderness to the area with touch. The nodule is mobile with erythema. You diagnosis a Hordeolum. What is your treatment plan?

A

Lid hygiene
Warm compressees
If unresolved in 1-2 weeks, reassess and would consider an antibiotic ointment with concern for blepharoconjuncitivitis

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22
Q

12 y/o M comes in with mother today for painless, swollen nodule to the R eye for 1 month. Pt no change in vision, no hx of similar nodules. You note a palpable, mobile, nontender, 7 mm nodule on the R upper eyelid. What is your lead diagnosis?

A

Chalazian (sty)

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23
Q

What is the primary management of a chalazian?

A

Warm compresses
Lid hygiene
Gentle massage
Washing the eyelids with warm, gentle soapy water

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24
Q

When concerned for viral conjunctivitis, what is a Dx test that can be used?

A

POCT AdenoPlus

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25
Q

When concerned for dry eye disease, other then symptom presentation, are there any diagnostics?

A

Yes, POCT InflammaDry

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26
Q

When using antihistamine/decongestant eye drops and mast cell stabilizer/antihistamine drops, what is an important piece of education for contact lens wearers?

A

Wait 10-15 minutes from drop installation to lens placement

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27
Q

When assessing for age-related macular degeneration, what is a tool that is useful in this assessment and what would you expect the findings to be?

A

Amsler grid with distortion of the grid lines in the area of degeneration

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28
Q

Central vision loss is significant with what eye disorder?

A

Macular degeneration

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29
Q

On fundoscopic exam, you see bright spots and pigmentary mottling. Your patient has central vision loss and you are determining if they have dry or wet type ARMD. Which is the most likely diagnosis?

A

Dry ARMD

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30
Q

Your patient has acute onset central vision loss. What is your lead diagnosis?

A

Wet ARMD

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31
Q

Your patient comes in c/o of seeing flashes of light and “floaters”. Symptoms are specific to R eye only. They are concerned for diabetic retinopathy with the floaters. What would your lead diagnosis be?

A

Detached retina evidenced by the flashing lights and floaters without considerable vision loss at this point

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32
Q

53 y/o M presents today with visual changes, new HA, mild low grade fever, and pain in his jaw. On exam you appreciate tenderness over the temporal artery on the L side. What is your lead diagnosis?

A

Giant Cell arteritis

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33
Q

Pt with R eye with pain, redness and mild vision loss if concerning for….

A

Anterior uveitis

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34
Q

Pt with R eye reduced visual acuity and floaters, painless and no redness noted is concerning for…

A

Posterior uveitis

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35
Q

Dx:
Slow onset d/t drainage area in the eye becoming clogged causing a build up in pressure
Peripheral vision decreases gradually
Most common form of this dx process

A

Open-angle glaucoma

36
Q

Dx:
Eye pressure builds up rapidly 2/2 drainage area becoming suddenly blocked
S/S blurred vision, rainbow halos, HA, severe eye pain

A

Angle-closure glaucoma

37
Q

60 y/o F with PMH MS presents today for L eye vision loss, pain with eye movement and noticing colors have dulled recently. Exam shows blurred optic disk margins. What is your lead dx?

A

Optic neuritis

38
Q

23 y/o M presents today after recent viral URI diagnosis. He is concerned because he thinks his eye is bleeding. Exam shows bright red conjunctivae in the R eye, primarily lower eye. You diagnose a subconjunctival hemorrhage. What is the next step?

A

Consider PT/INR
Reassure pt this is generally self limiting

39
Q

Your 10 y/o pt comes in with mom today. She noticed R eyelid redness. Pt has been in school daily, no drainage from the eye, no recent outbreak of conjunctivitis in the school. Pt denies pain, there is R eyelid edema today. The infection appears external, there is no vision changes. Your lead is preseptal cellulitis. You know the primary organisms that cause this are:

A

S. Aureus, strep PNA, anaerobes

40
Q

You 9 y/o pt presents with dad after noted L eyelid and tearduct redness and swelling with limited ability to open eye. On vision exam, you notice the patient is having trouble with peripheral vision on the L inner eye, has pain with EOMI. There is a very subtle proptosis and tenderness on eyelid palpation. Pt has a low grade fever today. You send them to the ED for imaging and workup with concern for…

A

Orbital cellulitis and concern for brain abscess

41
Q

A patient has vision </= 20/200 with corrective lenses. Can they drive?

A

No, this is deemed legally blind

42
Q

What are the primary symptom management treatment options for URIs?

A

Hydration, rest, healthy diet
Decongestants (phenylephrine)
Expectorants (guaifenesin)
Cough suppressants (Dextromethorphan)
Nasal steroid spray (flonase)
Nasal saline spray

43
Q

What are the 2 antiviral medications approved for COVID in high risk patients?

A

Molnupiravir (Lageviro)
Paxlovid

44
Q

You have a patient with perennial allergy symptoms of sneezing, rhinorrhea and pruritus with intermittent loss of smell. You had them complete prick testing with an allergist that is negative. You collect a nasal smear and send it out for eosinophil testing, it comes back positive. What is the diagnosis?

A

Non-allergic rhinitis with eosinophilia

45
Q

In a pt with cough > 3 weeks, consider what testing?

A

Peak flows x3 in office

46
Q

Pt comes in with low grade fever, mild oropharyngeal erythema, and a low Centor score. Your primary diagnosis is viral pharyngistis. How would you treat this?

A

Symptom management:
saline gargles, honey, tylenol/advil, lozenges

47
Q

19 y/o F comes in to see you when home on fall break from college. She has been extremely fatigued x2 weeks and thought it was r/t school stress. You note that she has obvious swelling around her neck and palpate very tender anterior cervical LAN. Oropharynx has bright red petechiae, abdomen is soft with no hepatosplenomegaly noted. What is your lead diagnosis?

A

Mono

48
Q

19 y/o F comes in to see you when home on fall break from college. She has been extremely fatigued x2 weeks and thought it was r/t school stress. You note that she has obvious swelling around her neck and palpate very tender anterior cervical LAN. Oropharynx has bright red petechiae, abdomen is soft with no hepatosplenomegaly noted. Would you test for mono today with a monospot?

A

Yes, symptoms have been present for >1 week so monospot should pick up on this

49
Q

Your patient presents with symptoms of group A strep, however rapid strep is negative. You send a throat culture for high strep suspicion. It comes back negative for Group A strep, positive for Group G strep. What is primary management?

A

Symptom management as this is primarily a self-limiting disease

50
Q

Your patient is diagnosed with mycoplasma pneumoniae, what is your first line treatment?

A

Z-pack or doxy

51
Q

10 y/o M presents with strep-like symptoms. You notice a large scattered rash that is patchy, erythematous, no central clearings. You diagnosis the rash as a scarlatiniform rash. You also note cervical anterior LAN. You diagnosis your patient with arcanobacterium haemolyticum. What is your treatment?

A

Erythromycin or azithromycin

52
Q

Your patient comes in c/o sore throat. On assessment you noted a R deviation of the uvula, eyrthema of the oropharynx and R tonsil > L tonsil. What is the next step?

A

Refer to ENT for probably tonisllar abscess
If acute symptoms, send to ED

53
Q

Pt c/o fullness, R sided hearing loss. On exam you note a fluid bubble behind R TM. What is your lead diagnosis?

A

OM with effusion

54
Q

Pt c/o fullness, R sided hearing loss. On exam you note a fluid bubble behind R TM. What is your treatment plan?

A

Decongestants and symptom management

55
Q

Pt c/o L hearing loss and ear fullness. On exam you note obscured TM landmarks 2/2 bullae in the ear canal. You diagnosis bullous myringitis. What is the first line abx?

A

PNC (Amoxicillin)

56
Q

Your patient c/o L ear itching and decrease in hearing. They deny discharge. On exam you ilicit pain when touching the auricle to perform the exam. You diagnose OE. The edema is significant. How will you treat this case?

A

Insert ear wick to keep gtts in place
Antibiotic and steroid combination drops

57
Q

57 y/o M s/p URI x1 week ago comes in with lingering cough. He has PMH asthma. On exam you note mild wheezing however no change in peak flows. What is your lead diagnosis?

A

Reactive airway

58
Q

How would you treat reactive airway?

A

SABA with spacer

59
Q

Your pt with new diagnosis of COVID has a FEV1 >/= 80%. What GOLD level will you use for treatment?

A

GOLD 1

60
Q

Your pt with new diagnosis of COVID has a FEV1 <80% but >/= 50%. What GOLD level will you use for treatment?

A

GOLD 2

61
Q

Your pt with new diagnosis of COVID has a FEV1 <50% but >/= 30%. What GOLD level will you use for treatment?

A

GOLD 3

62
Q

Your pt with new diagnosis of COVID has a FEV1 <30%. What GOLD level will you use for treatment?

A

GOLD 4

63
Q

OSA risk factors:

A

Neck circumference (>43 cm in men, >37cm in women)
Obesity
Tonsillar hypertrophy
High arched palate
Long uvula
Post-menopausal

64
Q

Epworth Sleepiness Scale is effective with screeing for…

A

OSA

65
Q

Pt 50-80 y/o with 20 pack/year smoking history
Current smoker or have smoked w/in the past 15 years

A

Grade B for low-dose CT for lung CA

66
Q

Primary viral PNA causes are:

A

Adenovirus, rhinovirus, COVID, flu

67
Q

Atypical PNA causes are:

A

Mycoplasma, Psittacosis, Q Fever

68
Q

Your pt with viral PNA has a causative agent of RSV, parainfluneza, adenovirus, or measles. What is the 1st line?

A

Ribavirin

69
Q

What is commonly seen with Q Fever?

A

Endocarditis

70
Q

What skin changes may be seen with Psittacosis and Q Fever?

A

Horder’s Spots
Erythema Multiforme

71
Q

Your patient is being worked up for aspiration PNA. CXR shows RLL infiltrate. What position was the patient in?

A

Supine, sittiing, standing

72
Q

Your patient is being worked up for aspiration PNA. CXR shows RUL infiltrate. What position was the patient in?

A

R side-lying

73
Q

Your patient is being worked up for aspiration PNA. CXR shows LUL infiltrate. What position was the patient in?

A

L Side-lying

74
Q

Your patient is being worked up for aspiration PNA. CXR shows RML infiltrate. What position was the patient in?

A

Prone

75
Q

Your 67 y/o M pt with PMH CHF presents with cough and green/yellow sputum production, malaise, and dyspnea x3 days. Exam shows reduced peak flows, LAN and wheezing. Pt VS show a temp of 101F. Should you treat with abx?

A

Yes as he is >65, has CHF

76
Q

TST >/= 5mm is concerning for:

A

HIV+
Recent contact with TB+ pt
CXR nodular or fibrotic changes
Transplant pt
Immunosuppresed pt

77
Q

TST >/= 10mm concerning for…

A

Move </= 5 years from high risk country
IVDU
High risk work settings/living arrangement
Micro lab personnel
High risk conditions (DM, steroid use, leukemia, malabsorption, low weight, ESRD)
<4 y/o

78
Q

Can a patient with Zika take NSAIDS or ASA?

A

Not until Dengue is r/o

79
Q

C/O disequilibrium, unsteady, fear of falling, off-balance

A

Dizziness

80
Q

C/O feeling faint, giddiness, woozy, shaking

A

Lightheadedness

81
Q

C/O tilting/spinning, revolving in space, propulsion, motion sickness

A

Vertigo

82
Q

Pt presents with sudden onset unsteadiness, lasts for 3 hours. This is the 2nd occurrence of this. During episode pt has noticed senstivity to loud noises, ear pressure, and mild nausea. Symptoms seem to appear with stress, not precipitated by motion. Exam is benign today. You diagnosis Meniere’s disease. What would you recommend for treatment?

A

Salt restricted diet
Diuretics
Steroids
Meclizine

83
Q

Pt presents with vertigo. Dix-Hallpike is negative, not precipitated by movement. Symptoms are intermittent for the past 3 months. Workup has been unremarkable. You consider neurology referral for concern for what lead?

A

MS

84
Q

Dizziness the resolves with sitting/lying is considered:

A

Disequilibrium/dizziness disorders

85
Q
A

NURS 5410: Common and Chronic Health Problems 2 (6 decks)

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