Final exam new material Flashcards
What level of Hgb is considered anemia?
Men: 13.6
Women: 12
Iron deficiency anemia: Labs
Low Hgb
Low MCV, MCH
Low reticulocytes
High RDW
Thalassemia: Labs
High RBC
Low Hgb
Low MCV
Normal RDW
Vit B12 and folate labs
Low Hgb
Elevated MCV
Elevated RDW
Low reticulocyte
What type of anemia is methylmalonic acid elevated in?
B12
What type of anemia is homocysteine elevated in?
B12 & Folate
Anemia of chronic disease: Labs
Low Hgb Low reticulocytes Normal MCV Elevated RDW Elevated TIBC
What platelet level defines thrombocytopenia?
What level is there a risk of bleeding with surgery/trauma?
What level is there a risk for spontaneous bleeding?
Less than 150k
50k
10k
How do you manage lab levels with thrombocytopenia?
Recheck immediately if less than 50k
Recheck in 1-2 weeks if 50-100
Recheck in 1-2mo if 100-150
Name the condition:
Lack of iris color, hematuria, hypertension
unilateral abd mass that does not cross the midline (displaceable and painless)
Wilms Tumor
What type of WBC is most prevalent in leukemia?
Blasts (immature WBCs)
What are the B symptoms of lymphoma?
unexplained wt loss of 10% or greater of body weight in 6 months prior to dx
unexplained fever > 38
drenching night sweats
What type of lymphoma are B symptoms most common in?
Hodgkin lymphoma
What type of lymphoma are reed-sternberg cells most common in?
Hodgkin lymphoma
Where does Hodgkin vs. non-Hodgkin lymphoma begin and where do they metastasize to?
Hodgkin: starts in cervical lymph nodes; mets to liver, spleen
Non-Hodgkin: starts in intestinal lymph nodes; mets to CNS and bone marrow
When would the FNP perform a chest x-ray while working up acute bronchitis?
If respiratory distress s/s present - tachypnea, tachycardia; high fever
Definition of acute bronchitis
cough with or without sputum production persisting past 7 days
Atypical presentation of pneumonia
prodrome of headache and sore throat; dry cough
Typical presentation of pneumonia
fever, chills, malaise, productive cough
rales, consolidation
CURB 65 criteria
Confusion? BUN > 19 RR > 30 BP (SBP < 90, DBP < 60) 65 or older?
Management of pneumonia Previously healthy, no recent antibiotic use Atypical Significant comorbidities If suspect MRSA (recent abx use) Peds
Previously healthy, no recent antibiotic use: macrolide or doxycycline
Atypical: Macrolide
Significant comorbidities: Macrolide + Augmentin or respiratory fluoroquinolone (levofloxacin, moxifloxacin)
If suspect MRSA (recent abx use): vancomycin or linezolid
Peds: amoxicillin 1st line if presumed bacterial
Name the condition:
Sudden onset pleuritic chest pain, dyspnea
Tachycardia, tracheal deviation, hypotension
Pneumothorax
How does the FNP manage a pneumothorax?
Observation if asymptomatic/primary and < 2-3cm
Refer all patients to pulmonologist
Hospitalize if symptomatic or large pneumo
ALL tension and secondary pneumo need hospitalization
No air travel until after complete resolution
Name the condition:
Dyspnea, tachypnea, pleuritic chest pain
Pulmonary embolism
What are the Geneva score cut-offs for probability of DVT?
0 - 3 points indicates low probability (8%)
4 - 10 points indicates intermediate probability (29%)
11 points or more indicates high probability (74%)
Causes of URI vs. Croup vs. Bronchiolitis
URI: rhinovirus
Croup: parainfluenza virus
Bronchiolitis: RSV
Tx for moderate-severe croup sx
Dexamethasone
Screening guidelines for prostate cancer
Shared decision making starting at 55-age 69 with PSA & optional DRE
Prostatitis tx
Acute vs. STI concern vs. chronic bacterial
acute: fluoroquinolone
STI concern: ceftriaxone + doxy
chronic: fluoroquinolone or bactrim
What are considerations for patients taking PDE5 inhibitors for ED?
Make sure they are not high risk for CVD
If erection longer than 4 hours need to go to the ER
What condition is the Prehn sign associated with?
Epididymitis - pain partially relieved by elevating the scrotum
Tx for epididymitis
Sexually active men: Ceftriaxone + doxycycline
If enteric organisms: Levofloxacin x 10 days
Tx for uncomplicated UTI
Nitrofurantoin or fosfomycin or Bactrim
Tx for complicated UTI:
Men, pregnant women, upper UTI sx
Men: Bactrim, Nitrofurantoin or augmentin
Pregnant women: cephalexin, amoxicillin, augmentin
Complicated: Levofloxacin or cipro
Tx of urethritis
If unable to r/o gonorrhea: Ceftriaxone + doxycycline
Nongonococcal: doxycycline or azithromycin
Azithromycin if pregnant
Name the condition:
Persistent widespread pain - deep ache, throbbing, intense and persistent; generalized burning and tingling
Sleep issues, fatigue, emotional distress
Need to test point tenderness over many spots
Fibromyalgia
Tx for acute gout attacks vs. prevention
Acute: NSAIDs, colchicine, corticosteroids
Prevention: allopurinol
What lab is most sensitive for RA?
Anti-CCP
What condition is a/w heberden and bouchard nodes?
OA
Is OA or RA aggravated by activity?
OA
Is OA or RA a/w extended morning stiffness?
RA
What part of the body does PMR affect?
shoulder girdle, neck and pelvic girdle
What does PMR respond well to?
low dose corticosteroids
What is the presentation of giant cell arteritis?
head pain, jaw pain, vision problems
What part of the body does ankylosing spondylitis affect?
SI joint and spine - low back pain
What labs are elevated in ankylosing spondylitis?
inflammatory markers (CRP, ESR)
What is first line for ankylosing spondylitis?
NSAIDs
What is a classic sign of psoriatic arthritis?
sausage digits, enthesitis, nail changes
What are the s/s of SLE?
fatigue, malar rash, joint pain
What labs are indicated for SLE?
ANA (not specific)
Anti-Sm and anti-dsDNA autoantibodies
What referral needs to be made for patients taking hydroxychloroquine?
opthalmology
What color rash is often present in JIA?
salmon-colored
