Leik chp 2 Question Dissection & Analysis Flashcards
pearly, wax-like, shiny appearance with telangiectasia is “classic” for what dermatological pathology?
basal cell carcinoma
_______ melanoma has pigment such as brown or black color with irregular borders
nodular
________ __________ is a precancer of squamous cell carcinoma and is usually located on the scalp (males), face, and the back of the hands (dorsum); They appear as a crusty/scaly growth that slowly enlarges over time
actinic keratosis
The gold standard test for skin cancer is the ______ _______.
skin biopsy
Sudden-onset red rashes on left lower arm and hand. During the skin exam, the NP notes that there are a few blisters. When the NP touches one of the blisters, it ruptures and drains clear serous fluid. Which of the following 3 conditions should the NP consider in the differential diagnosis? A. Contact dermatitis B. Erysipelas C. Psoriasis D. Impetigo E. Thermal burn
A. Contact dermatitis
D. Impetigo
E. Thermal burn
Fragile, easily-ruptured blisters is a classic finding for _________ _________, an acute bacterial skin infection caused by Staphylococcus or Streptococcus
bullous impetigo
__________ _________ can present with just red skin or red skin with blisters. The rash can be located anywhere on the body and it may have a pattern (like a belt) or no pattern.
Contact dermatitis
________ is a type of cellulitis caused by strep. It resembles a bright-red, warm, raised rash (plaque-like) with discrete borders usually located on the face or the shins. Blistering is not present.
Erysipelas
Rust-colored sputum is associated with _______ ______ infection.
Streptococcus pneumoniae
Patients with _________ __________ may have chest congestion but not fever, chills, or productive cough with purulent sputum.
acute bronchitis
Legionella pneumonia (Legionnaire’s disease) is uncommon in primary care. Look for history of exposure to “nebulized” water sources such as air conditioners, fountains, etc. Patients present with signs/symptoms of pneumonia that are accompanied by _____ ________.
GI symptoms.
______ _________ and _______ ________ are 8 to 13 times more likely to develop liver cancer than other groups due to higher rates of chronic Hep B infection
Asian Americans & Pacific Islanders
In alpha or beta thalassemia trait or minor, the following results are found:
normal to high serum ________ and serum ______ levels
Normal _________
ferritin, iron
TIBC
the gold-standard test to diagnose any anemia involving abnormal hemoglobin (thalassemia, sickle cell, etc.) is the _________ _________
hemoglobin electrophoresis
The _____ is a measure of the variability in size of RBCs (or anisocytosis). An elevated _______ is one of the earliest indicators of iron-deficiency anemia.
RDW, RDW
The most common anemia in the world is _______ _______ anemia.
iron-deficiency
In clinical practice, rule out _____ _____ anemia first before ordering a hemoglobin electrophoresis.
iron deficiency
bacterial vaginosis: presence of ______ _____
clue cells
What type of cell is a mature squamous epithelial cell with numerous bacteria noted on the cell surface and borders?
clue cell
bacterial vaginosis: pH is ______.
alkaline
trichomonas is a ______ or ______ ______ organism
protozoan; unicellular flagellated
normal pH of vagina is acidic. normal acidity pH is ____ to ____
3.5 - 4.5
_____ is the only vaginal condition with an alkaline pH for the exam.
BV
_____ is not considered a STD. The sex partner does not need to be treated.
BV
_______ does not cause inflammation. The microscopy slide will have very few WBCs and a large number of clue cells.
BV
The vaginal discharge in _________ infection is a white color with a thick and curdlike consistency. Frequently causes itching and redness in the vulvovagina due to inflammation.
candida
The microscopy in candidiasis will show a large number of ______, ________, and ______
WBCs, pseudohyphae, and spores
_________ is normal flora of the GI tract and in some women’s vaginas.
candida
__________ infection vaginal discharge is copious, bubbly, and green in color. It causes a lot of inflammation, resulting in itching and redness of the vulvovagina. It is considered to be a STI. The sex partner does / does not need to be treated.
Trichomonas
does
______ (____ ____) is the gold standard of diagnosis for BV, candida vaginitis, and trichomoniasis for the exam.
microscopy (wet smear)
The first-line drug for treating for treating strep throat (streptococcal pharyngitis) is still ___________.
Penicillin VK
The first-line drug for treating for treating strep throat (streptococcal pharyngitis) is still ___________ for ___ days.
Penicillin VK; 10
Adverse side effects of the thiazide diuretics: ________ and __________
hyperuricemia and hyperglycemia
According to the IDSA and the ATS guidelines, outpatient treatment of CAP in healthy patients (no comorbidities) involves the __________
macrolides: Azithromycin, clarithromycin, or erythromycin
calcium channel blockers’ side effects include _______- _______ and _______
swollen ankles and headache
beta blockers’ side effects include _______ and ________
fatigue and depression
The most common cause of cancer DEATH overall (mortality) is _______ cancer
lung
The most common cancer overall (prevalence) is ______ cancer
skin
The most common type of skin cancer is _______ cancer
basal cell carcinoma
The most common cancer in females is _______ and the most common cancer in males is ________
breast
prostate
Mortality statistics:
Disease causing the most deaths overall is
heart disease
Mortality statistics:
Cancer with the highest mortality: _______ cancer
lung
Mortality statistics:
Cancer with the highest mortality in males (_____) and females (_______)
lung; lung
Mortality statistics:
Most common cause of death in adolescents:
_____ ________ _________
motor vehicle crashes
The most common cancer overall (males and females) (prevalence) is ______ cancer
skin
The most common type of skin cancer is _______ cancer
basal cell cancer
Prevalence
The most common cancer in females is _______ and the most common cancer in males is ________
breast
prostate
prevalence:
Skin cancer with the highest mortality: ______
melanoma
Prevalence:
What is the most common type of GYN cancer?
uterine/endometrial
Second most common GYN cancer?
ovarian
_______ cancer is not considered a GYN cancer
breast
___________ tongue is a benign physiological variant
geographic
A _________ tongue has multiple fissures and irregular smoother areas on its surface that make it look like a topographic map. The patient may complain of soreness on the tongue after eating or drinking acidic foods. Remember, this is a BENIGN physiological variant.
geographic
Leukoplakia is / is not a benign variant.
is not
___________ is a slow-growing white plaque that has a firm to hard surface that is slightly raised on the tongue or inside the mouth. It is considered a ________ lesion
Leukoplakia
precancerous
The causes of leukoplakia include poorly _______ _______, ________ ______, and other types of ______
fitting dentures
chewing tobacco
tobacco
Leukoplakia: Refer the patient for a _______ b/c it can sometimes become malignant.
biopsy
Oral ________ _______ of the tongue is a ______ white patch that appears corrugated. It is usually located on the ________ aspects of the tongue or other areas inside the mouth and is associated with _____ and _____
hairy leukoplakia
painless
lateral
HIV and AIDS
Oral hairy leukoplakia is caused by ______-____ virus infection of the tongue. It is / is not considered a premalignant lesion.
Epstein-Barr
is not
Always rule out ovarian cancer in a postmenopausal woman who has a _________ _______
palpable ovary
When ruling out ovarian cancer in a postmenopausal woman with a palpable ovary, the first step is to order a _______ and _________ ultrasound with ______, and refer to _________.
pelvic and intravaginal
oncologist
The strongest risk factors for ovarian cancer (or breast cancer) is _______ ________ such as BRCA1 or BRCA2 mutations and _______ ________ _______
genetic predisposition
positive family history
Patients with Barretts esophagus are treated with high-dose PPIs ______ ______
for life
The first-line treatment of mild, uncomplicated GERD is ______ _______
lifestyle changes
lifestyle changes in treatment of mild, uncomplicated GERD are avoid eating ___ to ____ hours before bedtime, _______ changes, ______ loss if _______
3 to 4
dietary
weight; overweight
Girls (and boys) Tanner stage I:
prepubertal pattern
Girls Tanner stage II:
breast bud and areola start to develop
Girls Tanner stage III:
breast continues to grow with nipples/areola (one mound/no separation)
Girls Tanner stage IV:
Nipples and areola become elevated from the breast (a secondary mound)
Girls (and boys) Tanner stage V:
Adult pattern
Boys Tanner stage II:
Testes and scrotum start to enlarge (skin starts to darken/more rugae
Boys Tanner stage III:
Penis grows longer (length) and testes/scrotum continues to become larger
Boys Tanner Stage IV:
Penis becomes wider and continues growing in length (testes are larger with darker scrotal skin and more rugae)
Remember, NEVER ________ a patient and/or family member. This will help rule out an incorrect answer
reassure
_________ ________ physical exam findings will show disk-like breast tissue that is mobile under each nipple/areola, the breast may be tender, and the breast can be assymetrical (one larger than the other)
Physiological gynecomastia
Overweight to obese males are at highest risk for ________
gynecomastia
Foods with high _______ content (aged cheeses, red wine, chocolate) can cause dangerous food-drug interactions with MAO inhibitors (Marplan, Nardil, Parnate)
tyramine
Foods and supplements containing stimulants, such as ________ and ________, are best avoided by patients with HTN, arrhythmias, high risk for MI, hyperthyroidism, albuterol use, and amphetamine use
caffeine and ephedra
Gluten/celiac disease: avoid _______, _______, and ______
wheat, rye, barley
Magnesium decreases BP, dilates blood vessels, and is found in nuts such as _____, _____, _____, some beans, ________ _______, also found in laxatives, antacids, milk of magnesia
almonds, peanuts, cashews
whole wheat
Potassium helps decrease BP and is found in most fruits, esp ______, _______, _______, ______ and in some vegetables (brussel sprouts, potatoes)
apricot, banana, orange, prune
folate decreases _______ levels and fetal neural tube defects, and is found in _________ ______ fortified with folate, ______ _____ vegetables, and liver
homocysteine
breakfast cereals
green leafy
Iron is found in beef, ______, _______ beans, and ______-_____ ______
liver, black
black-eyed peas
Vitamin K (should control intake if on anticoagulants) is found in _____ ______ vegetables, broccoli, and
green leafy
cabbage
high sodium content (increases water retention, can increase BP) is found in _____ ______, pickles, ________ foods, canned foods, hot dogs, chips
cold cuts
preserved
Celiac disease: lifetime avoidance of _____, _____, and ______
wheat, barley, rye
Gluten free: ______,
_______, ______. Most people with celiac disease can eat ______.
rice, corn, potatoes (are gluten free)
oats
Hypertension: Maintain an adequate intake of _________, _______, and _______.
calcium, magnesium, and potassium
Migraine headaches and MAOIs (Marplan, Nardil, and Parnate): avoid high _______ foods:
______ ______
_____ ______, fava beans, draft beer, anything fermented
tyramine
aged cheeses
red wine
Vitamin K decreases the effectives of ________
warfarin
ED treatment meds for anaphylaxis:
epi IM 100% O2 by face mask antihistamine such as Benadryl H2 antagonist such as ranitidine bronchodilator such as Albuterol systemic glucocorticosteroids such as prednisone
Patients with an atopic history (asthma, eczema, allergic rhinitis) with _______ ______ are at a higher risk for ______ and ________ allergies
nasal polyps
ASA and NSAID
Anaphylaxis is classified as a ____ ____, _____- _____ reaction
type I; IgE-dependent
Biphasic anaphylaxis occurs in up to 23% of cases (symptoms may recur within ___ to ___ hours after initial episode). This is why these patients are discharged with a Rx for ________ _____ ______ and a long-acting _________ from the ED.
8 to 10
Medrol Dose Pack
antihistamine
The most common triggers for anaphylaxis in children are _______. In adults, they are ______ _____ and ________.
foods
insect stings
medications
Those between the ages of _____ and ____ are “young gerontologicals”.
65 and 84
Those age _____ and older are “frail elderly”
85
______ are the first-line treatment for unipolar/major depression. They carry an FDA warning that they increase suicidality in children and young adults up to age 23.
SSRIs
________ (antidepressants) have many anticholinergic effects such as dry mouth, sedation, arrhythmias, confusion, and urinary retention
TCAs
________ (antidepressant class) have many anticholinergic effects such as dry mouth, sedation, arrhythmias, confusion, and urinary retention
TCAs
_________ (antidepressant class) have major food and drug interactions and are not first-line drugs
MAOIs
The differential diagnosis for an early morning cough includes _________ _______,
________ _________
__________
_______
postnasal drip
allergic rhinitis
sinusitis
GERD
Which of the following is most likely to be found in patients with a long-standing case of iron-deficiency anemia? A Pica B Fatigue C Pallor D Irritability
A Pica (also spoon-shaped nails is associated with iron-deficiency anemia)
____________: a skin rash that has both color, are circumscribed, and are small spots on the skin. They are not raised or depressed
Macular
__________: a skin rash with small raised lesions varying from red to bright pink
papular
___________: A skin rash that has both color and texture, small raised skin lesions
maculopapular
A maculopapular rash in a lace-like pattern is ______ ________.
Fifth disease
Maculopapular rashes with papules, vesicles, and crusts are ______ ______ and _______ _______
varicella zoster
herpes simplex
Maculopapular rashes that are oval shaped with a herald patch are __________ _________
pityriasis rosea
vesicular rashes on an erythematous base are _______ ______ and _______ _______
herpes simplex
genital herpes
Assume that a patient has _______ if excoriated pruritic rashes are located in the finger webs and the penis until proven otherwise.
scabies
High risk people for ______ are health care providers, those with large populations like school workers, nursing homes, group homes, prisons
scabies
True/false:
With scabies, All family members and close contacts must be treated at the same time as the patient.
true
The rash of _________ has a sandpaper-like texture and is accompanied by a sore throat, strawberry tongue, and skin desquamation (peeling) of the palms and soles. It is / is not pruritic.
scarlatina
is not
The rash of ________ initially appears as papules that develop into bullae. These rupture easily, becoming superficial, bright-red, weeping rashes with honey-colored exudate that becomes crusted as it dries. The rashes are very itchy and are located on areas that are easily traumatized (face, arms, legs).
impetigo
Cutaneous ______ _______ (creeping eruption) rashes are shaped like red raised wavy lines (snake-like) that are alone or a few may be grouped. They are very itchy and may become excoriated from scratching (appears maculopapular)
larva migrans
The preferred treatment for larva migrans is systemic treatment with either ______ daily for __ to ___ days or _________ for 3 days
ivermectin 1 to 2
albendazole
____________ is the preferred first-line antibiotic for both AOM and _______ _______ in children (for pts with no risk factors for resistant organisms like as in recent abx use)
amoxicillin
acute sinusitis
____________ is the preferred first-line antibiotic for both AOM and _______ _______ in children (for pts with no risk factors for resistant organisms like as in recent abx use - past THREE months)
amoxicillin
acute sinusitis
If pt with AOM or sinusitis is a treatment failure or was on an abx in the past 3 months, give second-line abx like _____ or _______ BID
Augmentin BID
Omnicef BID
For pts who are PCN-allergic and have AOM or acute sinusitis, an alternative is _________ and ________
azithromycin (Z-pack)
clarithromycin BID
Which of the following is the best location to auscultate a S3 heart sound? Aortic Pulmonic Tricuspid Mitral
mitral
Skin __________, not the red color, is the best indicator of a positive Mantoux reaction
induration
What is the gold standard test for pulmonary TB?
sputum culture
Is TB a reportable disease?
Noncompliant patients can be ___________
yes
quarantined
For pts on isoniazid, a baseline ______ level and follow-up testing are recommended.
LFT
degenerative joint disease is AKA ____
osteoarthritis
atopic dermatitis is AKA _______
eczema
lupus is AKA ____ ____ _____
systemic lupus erythematosus
enterobiasis is AKA _____
pinworms
vitamin B1 is AKA _____
thiamine
scarlet fever is AKA ______
scarlatina
otitis externa is AKA _______ _____-
swimmer’s ear
condyloma acuminata is AKA _______ ______
genital warts
trigeminal neuralgia is AKA ______ ______
tic douloureux
temporal arteritis is AKA ___- _______ ______
giant cell arteritis
Iliopsoas muscle sign is AKA ____ sign
psoas
Light reflex is AKA ________ _____
Hirschberg (corneal reflex) test
sentinel nodes are AKA ____ _______
Virchow’s nodes
erythema migrans is AKA ____ ____
Lyme disease
sinusitis is AKA ________
rhinosinusitis
major depression is AKA ________ ________
unipolar depression
All _______ patients should be screened for suicidal/homicidal ideation. Incorrect answers are statements that are judgmental, reassuring, vague, disrespectful, or do not address the issue of suicide in a direct manner.
depressed
When interviewing a ________, do it privately and with parents present
teen
SSRIs are the 1st line treatment for
D______
O_____
P_______
A_______
P______
S_______
depression
OCD
panic disorder
anxiety
PTSD
social anxiety disorder
TCAs are also used for prophylactic treatment of _______, _______ _______, and __________ pain
migraines
chronic pain
neuropathic
Do NOT give suicidal patients a Rx for ______ b/c of the high risk of hoarding the drug and overdosing, which can be fatal
TCAs
Anticonvulsants (Tegretol) are used for _____ _____ and ______ ______
chronic pain
trigeminal neuralgia
Abuse:
If a history is being taken, pick the ___-____ question first. Interview both the possible abuser and patient together, then interview the patient separately.
open-ended
CAGE: C \_\_\_\_\_\_ A \_\_\_\_\_\_ G \_\_\_\_\_\_ E \_\_\_\_\_\_
cut down
annoyed
guilty
early
The most common bacterial pathogen in otitis externa is __________ (bright green pus)
Pseudomonas
Differential diagnoses to consider for chronic cough are:
C_________ ________
A___ ______
T__
G_____
A________
L____ _______
Chronic bronchitis
Ace Inhibitors
TB
GERD
Asthma
Lung Cancer
Tay-Sachs (a rare and fatal genetic disorder) is most common among ______ ______
Ashkenazi Jews
