Leik Review Flashcards
1
Q
A 14 year old girl with short stature, swollen hands and feet, and a webbed neck presents to the primary care clinic. She is in Tanner Stage I. What test should be ordered to confirm a diagnosis?
A
Karyotype! This is Turner syndrome and needs to be confirmed by genetic testing.
X-ray of Left hand is for estimated bone age in the assessment of delayed puberty, however symptoms indicate Turner Syndrome.
2
Q
What is lentigines?
A
liver spots - benign skin condition, brown-colored macules on hands and forearms of older adults
3
Q
Skin lesion: What are soft, wartlike lesions that appear on back and trunk of older adults?
A
Seborrheic keratoses
4
Q
Skin lesion: What are rough, scaly patches that develop from years of sun exposure found on the face, lips, ears, back of hands, forearms, scalp or neck? What may this progress to?
A
Actinic keratosis
Most common precancerous lesion of squamous cell carcinoma
5
Q
What are expected findings of Cushing’s syndrome, especially in children?
A
Delayed puberty and growth failure
Excess of androgens
Gynecomastia - excess cortisol
6
Q
What is pseudogynecomastia?
A
breast budding caused by deposition of fat
7
Q
What are findings commonly found with polycythemia vera? Risk factors
A
Chronic hypoxia causing an increase in erythropoietin
Risk factors - chronic cigarette smokers, Budd-Chiari Syndrome, >40 years old
8
Q
What test should be ordered to rule out cauda equine syndrome?
A
MRI, patient will need to see a neuorlogist as well with these symptoms
9
Q
What are expected findings of cauda equine syndrome?
A
new onset numbness to perineal area (saddle anesthesia)
Worsening sciatica/back pain
Decreased LE deep tendon reflexes on affected side
Bladder/bowel dysfunction - bladder retention
Leg weakness
10
Q
A Snellen chart finding indicates a visual acuity as 20/80. What does this mean?
A
What a patient sees at 20 feet, is what a person with normal vision sees 80 feet away.
Top number is patient’s distance in feet from chart. Bottom number is distance a normal vision test can read at the same line
11
Q
What is presbyopia?
A
loss of elasticity of the lenses, which makes it difficult to focus on close objects
typical with aging - hardening of the lens.
12
Q
What are possible complications of PCOS?
A
coronary heart disease, type 2 diabetes mellitus, metabolic syndrome, and infertility (high androgens)
13
Q
What diagnostic tool is gold standard for diagnosing bacterial pneumonia?
A
chest x-ray - findings of infiltrates and/or lobar consolidation
14
Q
Skin lesion: Presents in fair-skinned people of older age as small, translucent papule with central ulceration, telangiectasis and rolled borders. What do you suspect?
A
Basal cell carcinoma
pearly white, light pink, brownish or flesh colored
15
Q
A cauliflower like growth with foul-smelling discharge on otoscopic exam of an 8-year old with a history of chronic otitis media. What do you suspect?
A
Cholesteatoma - abnormal skin growth in middle ear behind eardrum. Develops as cysts or pouches that shed layers of old skin leading to build up. May destroy bones of middle ear leading to hearing loss.
16
Q
What SSRI is most likely to cause erectile dysfunction?
A
Paroxetine (paxil)
17
Q
What SSRI is most likely to cause serotonin syndrome?
A
Escitalopram (Lexapro)
18
Q
What is a major complication of temporal arteritis (giant cell arteritis)?
A
Amaurosis fugax = transient blindness of affected eye!
Other findings of temporal arteritis include jaw claudication, elevated ESR and elevated CRP but Amaurosis fugax is the most threatening/worrisome.
19
Q
A 6 year old with a systolic murmur that sounds like a musical vibration and becomes louder in the supine position. The murmur is Grade I/II in intensity with minimal radiation. What is your next step?
A
Record in patient’s chart to monitor on annual physical exam.
This is a Sill’s murmur Benign and common in school-age children, resolves in adolescence. Most appropriate action is to record and monitor. No need for ECHO or referral.
20
Q
What would require you to delay testing a patient’s prostate-specific antigen (PSA)?
A
urinary retention = false-elevation
UTI = false-elevation
after DRE = false-elevation
Ejaculation within 48 hours may falsely elevate
Vigorous exercise IS ACCEPTABLE/does not need to be stopped - although discouraged before testing per Leik.
21
Q
Infant’s eye presents with discharge, swelling, and redness of lacrimal ducts. Mother reports crusting. What do you suspect?
A
Dacryostenosis - an obstruction of lacrimal duct. Culture discharge and treat.
22
Q
What antimicrobial should NOT be selected for the treatment of pertussis in an individual with myasthenia gravis?
A
Erythromycin and Telithromycin are contraindicated in patients with myasthenia gravis = potential respiratory collapse!
(Macrolides are the antimicrobial of choice for pertussis)
23
Q
What part of the kidney is affected by polycystic kidney disease?
A
Renal tubules within the nephrons
24
Q
What parts of the kidney is affected by disorders such as glomerulonephritis and diabetic nephropathy?
A
Glomerulus and Bowman’s capsules - filter blood and re-absorption back into bloodstream.
25
What disease commonly presents with Heberden's nodes?
Osteoarthritis - DEGENERATIVE JOINT DISEASE.
Found on the DIP joints
26
What is the treatment of Fitz-Hugh-Curtis syndrome in the evaluation of STI? What if the patient is pregnant with this finding?
Ceftriaxone x Doxycycline x Metronidazole.
This is a complicated gonorrheal/chlamydia infection.
Pregnancy = NO tetracyclines. Ceftriaxone x Azithromycin
27
What are the expected findings of deep vein thrombosis? What sign are you going to assess for?
Swollen LE that is red and tender to touch, no recent injury, history of prolonged sitting.
Homan's sign = calf pain with dorsiflexion of affected limb
TX: ultrasound, cbc, chest x-ray, and possible hospital for heparin therapy.
28
What is the treatment of a superficial thrombophlebitis?
warm compresses, elevation of affected limb, and NSAIDs
look for symptoms of tender/painful area over affected vein, redness, swelling - palpable cord-like mass for several weeks.
29
A chest x-ray with findings of cavitation (round black holes due to local loss of lung tissue), fibrosis, lymphadenopathy, and calcifications is mostly likely due to what finding?
Mycobacterium tuberculosis
30
What are common findings of infective endocarditis?
chills, fever, and malaise. New murmur. Nontender red spots on palms of both hands and soles of the feet (Janeway lesions, Osler nodes). Splinter hemorrhages on nail beds.
31
What presents as a sudden onset of severe, sharp, excruciating pain in the abdomen, back or flank area? Differences in upper extremity blood pressure findings and pulse findings. What syndrome may have this?
Aortic dissection
Marfan syndrome, ehlers-danlos syndrome
32
What ear drops are NOT considered to be ototoxic and therefore safe if the tympanic membrane is ruptured?
Ofloxacin
(aminoglycoside otic drops are TOXIC - gentamycin, tobramycin, neomycin)
33
A patient presenting with a low-grade fever and single eschar on his back. Complaints of burning at the sites and states, "The area was white, then red. Now there is a red spot in the center." He recently traveled for a camping trip. What do you suspect?
Brown recluse spider bite
34
A tick-borne disease that has a petechial rash starting on the wrists, hands, forearms and feet and rapidly progresses up toward the trunk. What is this?
Rocky Mountain spotted fever
**expect abrupt onset of high fever, chills, severe headache, photophobia, and N/V**
35
How will early lyme disease present? Most common in what states?
early lyme = circular red rash that slowly expands as a "target" or "bulls-eye" (erythema migrans). Northeastern states.
36
What maculopapular rash presents with koplik spots on the mucosa, cough, coryza, conjunctivitis?
Measles
37
What cranial nerve is affected by bell's palsy?
CN VII (7)
38
A high-pitched murmur with a loud blowing and radiation to the axilla. What murmur is this? A history of what condition may affect this heart valve?
Mitral regurgitation
Rheumatic fever - untreated strep throat
39
A patient complaining of painful sexual intercourse, pain with urinating, fever, and CVA tenderness. What do you suspect? What diagnostic tool may help confirm this?
Endometritis associated with PID.
Cervical culture - vaginal culture might be contaminated and ultrasound imaging would be most useful if the patient were postpartum
40
What are expected findings of tic douloureux type 1?
Trigeminal neuralgia - extreme, shock-like facial pain that lasts from a few seconds to 2 minutes per event and up to 2 hours total.
41
What are expected findigns of tic douloureux type 2? What are associated and common risk factors?
Trigeminal neuralgia - a constant, aching, burning facial pain with less intensity.
Type 2 = women, age/60s, multiple sclerosis or HSV-1
42
What are expected findings of osteoarthritis?
if in the hip its associated with joint pain
Always worsen with activity
Diminished ROM
Joint crepitus
Difficulty arising after long periods of rest
43
Finding of a raised iliac crest present on one side, is a warning sign for what condition?
Scoliosis
44
Erythema without induration on a PPD or tuberculin skin test indicates what?
no significance
45
An induration of ___mm or more in diameter indicates a positive reaction of a PPD for patient with a very high risk condition or exposure (HIV, transplant recipent, immunosuppressed, contact with TB patient).
5 mm is positive for those with high risk conditions or exposures to TB
46
What patient education should be included for the female patient with bacterial vaginosis on a 5-day course of metronidazole vaginal gel?
To abstain from sexual intercourse during treatment
47
What is the first line treatment for acne vulgaris? If this does not work/does not improve the condition over 3-6 months, what is the next recommendation?
1st line = OTC medicated soap/water with topical antibiotic gels.
2nd therapy if fails = PO tetracycline
48
Spirometer readings are used to assess a patient's personal best - What is the green zone, yellow, and red?
Green is 80-100%
Yellow is 50-80%
Red <50%
49
What do you suspect of a patient presenting with elongated papilla of the lateral aspects on the tongue? What causes this condition?
Oral hairy leukoplakia
Epstein-Barr virus
50
What do you suspect of a patient presenting with complaints of bald, red areas of varying sizes surrounded by irregular white borders on the top and sides of their tongue?
Geographic tongue
51
What is cheilosis?
a painful inflammation and cracking of the corners of the mouth
52
What is the most sensitive test used to evaluate a patient for active H. pylori infection?
Urea breath test, may be repeated after treatment
53
What condition is treated with alpha-linolenic acid?
Ankylosing spondylosis
54
A pediatric patient uses a sliding scale in conjunction with a long acting insulin for management of type 1 diabetes. What insulin is best for elevated blood sugar between breakfast and lunch?
Rapid-acting insulin
Lispro (Humalog)
Aspart (NovoRapid)
Glulisine (Apidra)
no LAG! - onset 10-15 minutes, peak 1-2 hours, duration 3-5 hours
55
What type of insulin is a mixture of intermediate and short-acting?
Insulin Isophane and insulin regular
Not appropriate for sliding scale
56
How many days of antibiotic treatment should be prescribed for a 72-year old female with a complicated urinary tract infection?
minimum of 7 days - any complicated UTI, uncontrolled diabetic, pregnant, elderly, or immunocompromised patients need a minimum of 7 days.
**10 days or more may causes adverse effects like C.diff**
57
A patient presents with lethargy, weight gain, bradycardia, and a goiter, what mineral lab finding would you anticipate the patient to be deficient in?
Iodine - regulates thyroid hormones, growth, development, and metabolic rate
58
What should be monitored as possible side effects in a patient taking hydrochlorothiazide?
Hyperglycemia, Hypokalemia, Hyperuricemia, and Hypertriglyceridemia/hypercholesteremia, hyponatremia and hypomagnesemia
59
What are biguanides?
Metformin is a biguanides oral hypoglycemic medication
60
What cranial nerve is infected with herpes zoster opthalmicus?
CN V - Trigeminal nerve
61
What are 4 empiric antibiotics best for the treatment of community acquired pneumonia in a patient WITHOUT comorbid conditions?
Macrolides - Azithromycin or Clarithromycin
Tetracycline - Doxycycline
PCN - Amoxicillin
62
What should be the next step for a 65-year old woman who has had type 2 diabetes for 20 years and is concerned about her kidneys? She has had 3 UTIs in the past 8 months, but is currently asymptomatic.
Recheck urine during this visit, send for a culture and sensitivity, and REFER to a nephrologist.
**Diabetics are at higher risk for UTIs which can lead to bladder damage and nephropathy**
63
Decreased sperm production, is this normal with male aging?
YES! - sperm production decreases as men age as a result of decreased testosterone levels. Low testosterone is associated with low estrogen levels as well - normal.
64
What are 3 common risk factors of medial tibial stress syndrome? How will this present?
RF: runner, pes planus (flat feet), females especially with eating disorders and amenorrhea.
Presents as progressive bilateral leg pain due to overuse of muscles and tendons
65
A painful condition affecting the ball of the foot, most commonly between the third and fourth toes?
Morton's Neuroma
66
What is necessary for management of atypical pneumonia (walking pneumonia)?
(select antibiotic drug class, intervention, and PRN med)
Macrolide antibiotic therapy, increased fluids/rest, and antitussives PRN
**albuterol nebulizer is not routine**
67
A thrill initially presents at what grade level of a heart murmur?
Grade IV
a thrill is a palpable murmur
68
What is the recommended treatment for Bowen's disease?
Curettage and electrodessication - low complication rates, especially for the elderly
69
What antibiotic is best for gram negative bacteria found on a urine culture?
Trimethoprim-sulfamethoxazole (Bactrim) - appropriate for E. coli (gram negative) and patients >2 months old
70
A wedge-shaped, superficial, yellow, triangular mass on the nasal side of one eye presents on a patient. No pain or vision changes. PERRLA normal. What do you suspect?
Pterygium - thickening of conjunctiva that extends across the cornea on the nasal side
71
What is a chronic inflammation of the meibomain gland?
Chalazion - meibomain cyst, meibomain is the oil gland
72
What is an abscess of a hair follicle and sebaceous gland on the eyelid?
Hordeolum - painful
73
What assessment findings are high-risk factors for hearing loss in infants? (mnemonic)
HEARS
Hyperbilirubinemia
Ear infection frequency
low APGAR scores
exposure to Rubella
Seizures, CMV or toxoplasmosis
74
What are the USPSTF recommended guidelines for breast cancer screening?
Baseline mammogram at age 50 and repeat every 2 years until 74 - DOES NOT apply to women with genetic mutations, familial breast cancer, or a history of chest radiation/previously diagnosed with high-risk breast lesion
75
What assessment finding is associated with a diagnosis of proximal hypospadias?
Chordee - ventral shortening and curvature of the penis
76
A 10-year old with external ear pain, swelling and decreased hearing in the left ear. Child is on the swim team and practices daily. What should be included in care/treatment?
Aluminum Acetate solution PRN
No water in the ear during treatment
Polymyxin B-neomycin-hydrocortisone drops and/or Ofloxacin otic drops (if no findings of TM ruptured for neomycin)
77
What medication is used for acute flare-up of gout?
Colchicine - best for acute phase of gout flares
78
A harsh systolic murmur in the right upper border of the sternum and radiation to the neck
Aortic stenosis - MR ASS
79
What 3 things are measured in a 24-hour urine collection for a patient with suspected kidney disease?
proteinuria, albuminuria, and GFR
80
What medication can manage both hypertension and benign prostatic hyperplasia (BPH)?
Terazosin (hytrin)
Doxazosin, Tamsulosin, Prazosin, etc alpha adrenergic blockers
81
McMurray test is for assessment of?
a meniscus tear
82
Chronic use of NSAIDs may increase the risk of damage in what organ systems?
GI, Renal, Respiratory (asthma/underlying aspirin sensitivity), CV (heart attacks, CV damage, strokes)
83
What first line antimicrobial given by mouth is best for any child under the age of 24 months for a suspected UTI?
Trimethoprim-sulfamethoxazole (Bactrim).
Other first line choices for ORAL tx include first generation cephalosporins and amoxicillin-clavulanate. IM/IV is ceftriaxone. Complicated UTI is ciprofloxacin
84
What condition presents as abscesses and pustules in the axilla and groin and under the breasts, which burst and drain purulent green discharge? BMI is >30
Hidradenitis Suppurativa - most common in women, smokers and obese
85
A 40-year old female with complaints of dizziness and palpitations that have a sudden onset. EKG shows P waves before every QRS and a heart rate of 170 bpm. Carotid massage decreases heart rate to 80 bpm. What do you suspect?
Paroxysmal atrial tachycardia
86
What gram positive pathogen most commonly causes meningitis?
Gram-positive = Streptococcus pneumonia
Gram-negative = N. meningitidis, H. Influenzae, K. pneumoniae
87
What would an EKG exhibit for an older adult that has had an accidental overdose of amitriptyline?
Sinus tachycardia
88
HBsAg is a marker of _________. If positive this indicates what?
stays Always growing = infection
acute or chronic hepatitis B infection
89
Anti-HBs is a marker of _________. If negative this indicates what? Positive?
Marker of immunity (by previous disease or vaccination)
Negative = no immunity to hepatitis B
Positive = immunity
90
School age child with low grade fever, suspected hearing loss with erythema and bullae on bulging tympanic membrane. What do you suspect?
Bullous myringitis - small, fluid filled blisters on eardrum
91
What condition is a core disorder on the recommended uniform screening panel (RUSP) for newborns?
Congenital adrenal hyperplasia
92
A man complaining of right eyelid pain for 24 hours. No vision change or discharge. There is a painful, swollen red abscess on the upper right eyelid. What do you suspect?
Hordeolum - stye - abscess of hair follicle and sebaceous glad on eyelid
93
___________ is a yellowish, raised growth on the conjunctiva.
Pinguecula
94
What are absolute contraindications of oral contraceptive use?
Women >35 years that smoke
Pregnancy - sexually active and amenorrhea
Liver tumors or impaired liver function/hep C
History of emboli
95
What is the initial dose of Warfarin (Coumadin) for patients older than 70 years with Atrial Fibrillation?
2.5 mg
96
What are some conditions that may present with microscopic hematuria?
kidney stones
bladder cancer
acute pyelonephritis
*these are some examples per Leik - there are more conditions with microscopic hematuria*
97
A 13-year old with back pain and nausea and vomiting for the past 24 hours. He reports a dull pain and muscle spasms in the back after a direct hit to the side during football practice. BP 140/84, 99.1F temp, 98 bpm and RR 26. What should you suspect?
Bruised kidney
Appendicitis is anorexia, n/v 12-24 hours, abd pain is a LATE sign and is diffuse. RLQ pain.
98
First line medication for tinea unguium?
Oral terbinafine for 12 weeks - unguium (onychomycosis) is an infection of the nails, usually the great toe.
Toe nail will be yellow, thickened and may separate from nail bed.
Mild to moderate infections may use Efinaconazole 10% solution - this is not first line.
99
What is the best treatment for a partial thickness burn if total surface area is <5%? What if they have an allergy?
partial thickness is a second degree burn.
Silver sulfadiazine
Allergy = bacitracin zinc
100
A 14-year-old male patient presents with acute pain in his left testicle radiating to the lower abdomen lasting for 2 hours. Which of the following is the best intervention?
Color Doppler ultrasonography
testicular torsion is a medical emergency - this type of US is preferred and needs to be performed immediately for detrosion
101
A 67-year-old female patient complains of progressive dyspnea, minimal cough, and a 10-lb weight loss over the past 3 months. The nurse practitioner notes decreased posterior breath sounds, the use of accessory muscles to breathe, temperature of 98.8°F, and respirations of 24 breaths/minute. The nurse practitioner suspects?
Emphysema - pursed lip breathing and accessory muscle use are key findings
Chronic bronchitis would have a productive cough, wheeze and coarse crackles. Infection/Pneumonia would have fever and new onset symptoms.
102
A middle-aged patient with a history of cluster headaches should be treated for acute pain with what?
initial treatment is 100% oxygen 12L/min via mask and intranasal 4% lidocaine
103
What is the treatment for trigeminal neuralgia?
Phenytoin (Dilantin) - anticonvulsant
104
What is gold standard for diagnosis of Hashimoto's thyroiditis?
Thyroid peroxidase (TPO) = elevation confirms diagnosis
105
What is a gram-negative pathogen that will cause infection after a patient steps on a nail in her shoes?
Pseudomonas aeruginosa - may be caused by puncture wounds of the foot from the foam material in shoes
106
What is a gram-negative pathogen caused by eating raw oysters or clams?
Vibrio vulnificus
107
What is a gram-negative pathogen present in dog or cat bites?
Pasteurella multocida
108
A patient with Pick’s disease fell out of bed and hit her head on the table. The patient is not on anticoagulant therapy and is alert and oriented upon arrival to the clinic. The patient’s vital signs are blood pressure of 188/90 mmHg, pulse of 43 beats/minute, and respirations of 7 breaths/minute. Which diagnosis is most likely?
Increased ICP - CUSHING'S TRIAD!
increased systolic BP, decreased pulse and respirations
109
A patient with right eyelid pain for 24 hours, no vision changes, no discharge. Eye has a painful, swollen red abscess. What do you suspect? How should you treat this?
Hordeolum (stye)
start with hot compresses, may drain spontaneously within 48 hours
110
What is the initial treatment recommended for a patient experiencing mild allergic conjunctivitis?
Topical antihistamines/mast cell stabilizers
Allergic conjunctivitis often presents with less/inadequate tears and DRYNESS. Do not give oral antihistamines without artificial tears
111
First line treatment for COPD category C?
LAMA
112
First line treatment for COPD category B?
LABA or LAMA
113
First line treatment for COPD category A?
bronchodilator - SABA or SAMA
114
First line treatment for COPD category D?
LAMA or LAMA and LABA or ICS and LABA
115
An infant has a faun tail nevus at the lumbosacral area. What diagnostic procedure will the nurse practitioner order first?
Ultrasound - assess for any neural tube defects first
116
Budding spores and pseudohyphea on KOH prep help diagnose conditions caused by?
fungal infections
117
What are normal breath sounds of the chest wall? Vesicular, Bronchial, Tracheal
Vesicular is best heard in the lower lobes
Bronchial is best heard at second and third intercostal spaces
Tracheal is best heard over the trachea
118
What life threatening complication may develop in a patient that forgets to take thyroid replacement therapy?
Myxedema coma
119
What lab value is a predictor of menopause?
Anti-mullerian hormone
look for an absent period for 12 months. Diagnosis is made clinically without lab work.
FSH is recommended for women under 40 years and not recommended in women over 45. High FSH indicates impending menopause.
120
What is Lubiprostone (Amitiza)? Treats?
chloride channel activator - FDA approved to treat IBS with constipation in adults
121
What is prescribed for patients with IBS diarrhea?
Alosetron (Lotronex)
122
Inability to raise a straightened leg against gravity?
Patellar tendon rupture
123
First line treatment for polymyalgia rheumatica?
Oral prednisone - corticosteroids
124
What are expected developmental milestones of a 4 year old?
trace simple objects
run, jump
climb steps
throw a ball - CANNOT catch
stack objects
125
What heart condition is safe to be prescribed a calcium channel blocker?
First degree block - regular rate and rhythm, equally spaced P waves before QRS
NEVER give to patients with bradycardia <60bpm, second or third degree blocks
126
The nurse practitioner notes that an 82-year-old male patient’s penile gland and foreskin are inflamed. A reddened, moist macular lesion is present on the prepuce. The patient is being treated for a urinary tract infection with amoxicillin. The nurse practitioner will do what first? What is suspected?
obtain a swab of the lesion for a potassium hydroxide (KOH) prep
Balanoposthitis - common after use of antibiotics
127
A 45-year-old gardener is seen as a walk-in patient in a private clinic. He reports stepping on a nail that morning. He received a Td vaccine 9 years ago. What vaccine is recommended?
Tdap - CDC recommends that one of the tetanus boosters (Td) be replaced with Tdap once in a lifetime. Then Td form is given every 10 years after.
DTaP and DT are not give after age 7 years.
128
An infant is born with microcephaly, narrow eyes, a flat nasal bridge, a thin upper lip, and underdeveloped ears. What diagnosis is most likely?
Fetal alcohol syndrome
Fragile X syndrome presents with a long and narrow face, prominent forehead and chin, and large ears
129
What is the Meares-Stamey 2-glass test used for?
to assess inflammation and presence of bacteria in lower urinary tract - common symptoms associated with Chronic Prostatitis
130
What are expected findings of Crohn's disease? What distinguishes Crohn's from Ulcerative Colitis?
fistula formation, anal disease
Bloody diarrhea with mucus
Abdominal mass - anorexia, weight loss, dehydration, fatigue
Periumbilical to RLQ pain (UC is LLQ)
CD - transmural inflammation in skip lesion throughout intestines
UC - inflammation in colon/mucosal layer of colon
131
What is a positive Kernig's sign?
A resistance to leg straightening when the hip is flexed as a result of painful hamstrings from lumbar root inflammation.
Meningitis - pt in supine position, you lift one leg to 90 degrees of hip flexion and patient cannot keep opposite leg straight
132
What is a positive Brudzinski sign?
When a patient's neck is passively flexed, the hips and knees flex to relieve pressure and pain
patient is supine position, you pull head to chin/chest motion and the patient pulls knees up to stay out of pain.
Meningitis
VS nuchal rigidity is chin to chest causes pain
133
The nurse practitioner is examining a 56-year-old male who presents with a tophus of the right great toe. History reveals a previous attack of gout 2 years ago. The patient was not prescribed preventive medication. What is appropriate first-line treatment for the patient?
Colchicine - also NSAIDs for acute attack
Allopurinol is CHRONIC gout tx
134
A 13-year-old male visits the clinic with his mother. The patient’s chief complaint is persistent unilateral knee pain for several weeks. A history reveals no traumatic injury or health issues. He has a painful, bony bump below the affected knee. Upon movement, there is no laxity, but the patient feels pain. The mother reports that a recent x-ray was negative. What do you suspect?
Osgood-Schlatter disease - inflammation of the anterior tibial tubercle
Caused by overuse, usually in prepubescent boys
135
What is a contraindication of Topiramate (Topamax) when treating migraines?
A history of kidney stones
136
What is a contraindication of Sumatriptan (Imitrex) when treating migraines?
History of MI or ischemic heart disease, coronary vasospasm, uncontrolled HTN
given to abort migraines (acute)
137
An adolescent female’s areola, nipple, and breast tissue develop and become elevated as one mound. What tanner stage is this?
Tanner III - one mound vs IV is areola and nipple separate to form a distinct mound or secondary mound
138
Which assessment finding is expected in a 3-year-old male with penopubic epispadias?
urine leakage with stress - urethral meatus is found near the pubic bone. Penis is curved up
139
A decreased mobility of the tympanic membrane as measured by tympanogram, you suspect?
suppurative otitis media
140
A patient presents to the office with complaints of asthma 1 or 2 days a week and sleeps routinely 8 to 9 hours a night with rare occurrences of nighttime asthma symptoms. Forced expired volume in one second (FEV1) is >80%, and respirations 20 breaths/minute. What asthma classification protocol should the nurse practitioner follow?
Step 1 - symptoms 1-2 days/week, rare nighttime symptoms, FEV1 >80%
>12 years SABA, new GINA guidelines are low dose ICS and LABA prn
141
What are interventions for Raynaud's disease?
avoid cold objects, cold weather, smoking, stimulants
142
A 73-year-old patient complains of recent episodes of acute-onset left-sided facial asymmetry, slurred speech, weakness, and dizziness, accompanied by weakness of the left arm and left leg. She reports that the episodes occur at random and last from 30 minutes to about 2 hours. Each episode resolved completely. The patient has type 2 diabetes with hyperlipidemia, peripheral arterial disease, hypertension, and osteoporosis. Her symptoms suggest:
Transient ischemic attack - needs MRI within 24 hours of onset, strokes occur within 90 days of this
143
A 73-year-old male patient presents with bilateral edema in the legs and feet, weight gain of 15 lb, and decreased urine output. The nurse practitioner will order?
24 hour creatinine level - assess for acute renal failure. The symptoms suggest ARF.
Then MRI or intravenous pyelogram for further evaluation
144
What is a possible complication of Bell's palsy?
Corneal Ulceration - paralysis of CN VII, eyelid does not close voluntarily = dry = ulcer
145
A statin medication given with vitamin B3 or niacin increases risk of what?
drug induce hepatitis and rhabdomyolysis
146
Sudden onset cough with light pink-tinged sputum, tachycardia, tachypnea, and sligh hypoxia suggest what?
pulmonary emboli
especially those on estrogen therapy and smoker
147
A middle-aged male visits the clinic with complaints of swelling of the right leg and pain upon dorsiflexion. Upon examination, the nurse practitioner finds the right leg to be larger than the left, along with redness and warmth to the calf. Which questions will the nurse practitioner ask the patient?
Recent travel?
Inherited blood disorders? (factor C, Leiden)
Broken any bones or surgery recently?
Walk or exercise regularly?
148
An 81-year-old patient is brought to the primary care clinic for dysuria, urinary frequency, nocturia, and fever of 100.6°F. The patient is diagnosed with complicated cystitis. What antibiotic will the nurse practitioner prescribe? (3 total answers)
What are the options if this was UNCOMPLICATED cystitis?
Levofloxacin or Ciprofloxacin (if low risk of multidrug resistant organisms)
Consider Nitrofurantoin (Macrobid) as well
Uncomplicated = Fosfomycin, Bactrim, or Augmentin
149
What is the first line treatment for bipolar disorder I?
Lithium carbonate
BP 1 is alternating periods of euphoria and high energy levels with periods of extreme depression and exhaustion
150
The treatment of HIV includes Dolutegravir, Abacavir, and Lamivudine. What is the black box warning? What should be monitored?
BBW = severe hepatomegaly and hepatitis B exacerbation, can lead to steatosis
Monitor liver enzymes, cholesterol levels. Follow low fat diet.
Monitor PVL plasma viral load every 4-8 weeks, CD4 count every 3 months
151
What diagnostic test is best to identify kidney stones because it has the highest sensitivity and specificity? What is usually ordered as the initial test for suspected kidney stones?
BEST test = noncontrast CT scan
Initial test = renal ultrasound, if negative/no evidence but pt still has c/o int. flank pain, then order CT
152
Upon review of the chest x-ray results of a 4-year-old patient, tiny white spots in a distinctive pattern are noted throughout the lungs. Which diagnosis is most likely to manifest in this manner?
Miliary TB
common in children under 5 years and the elderly
Reactivated - lesions, nodules, cavitation
Latent - lymph nodes, not contagious, calcification and fibrosis on XRAY
Pleural - very contagious, indicated by a mass with obtuse angles on XRAY
153
What heart sound is also known as an "atrial kick"? What is this caused by? If the patient has no symptoms of heart disease, what is it considered?
S4 - late diastole heart sound
caused by decreased VENTRICULAR compliance with age.
No s/s of heart disease = normal variant
154
Healthy women age 18-65 years with an uncomplicated UTI may be treated with ____ for __ days.
Trimethoprim-sulfamethoxazole (Bactrim), 3 days
155
Patients taking Hydrochlorothiazide and Nifedipine should be monitored for what?
acquired neutropenia
156
A 15-year-old male who became lightheaded and “passed out” in class is being examined by the nurse practitioner. Pulse is tachycardic at 150 beats/minute, and EKG exhibits peaked QRS complex with P waves present. The nurse practitioner will do what next? What is presenting on the EKG?
determine underlying etiology.
Paroxysmal supraventricular tachycardia (PSVT)
TX is vagal maneuvers, hold breath/strain, massage carotid sinus, splash cold water on face
157
What is the treatment plan for a patient with acute diverticulitis?
Take amoxicillin-clavulanate BID
Report fever immediately
once acute episode resolves then teach high-fiver diet, supplemental psyllium fiber
158
The nurse practitioner is assessing a 56-year-old patient and notes diffuse reddish-brown, pigmented lesions on the back, trunk, abdomen, chest, and arms. A sample of the skin scrapings on a potassium hydroxide (KOH) wet mount reveals short hyphae and budding cells. Which medication will the nurse practitioner prescribe? What disease is this?
RX = PO fluconazole
Pityriasis Versicolor - dx by appearance and KOH skin sample
159
What is the mechanism of action of probenecid (Probalan)?
increases uric acid excretion
160
A left-hand-dominant high-school tennis player presents with a concern of left elbow pain. Which signs and symptoms suggest that the patient is suffering from tennis elbow?
Lateral elbow pain with tenderness at lateral epicondyle
Elbow pain with grasping movement
161
A patient presents with epigastric pain and intermittent diarrhea that worsens with food. She has a history of multiple ulcers. The nurse practitioner reviews the results of a serum fasting gastrin level and finds there is no inhibition of gastrin levels. Which diagnosis is most likely?
Zollinger-Ellison Syndrome - neuroendocrine tumor, increases gastrin secretion and peptic ulcer formation
162
Timolol (Betimol) ophthalmic drops are used for open-angle glaucoma. What are diseases are contraindicated for this medication?
NO heart failure/bradycardia, hx asthma/COPD, or AV block patietns
