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NCC Exam - WHNP > Primary Care > Flashcards

Primary Care Flashcards

12% of exam, ~21 questions 1. Problem Recognition, Management, & Referral (Evaluation, Diagnosis, Treatment, Referral) 2. Health Screening, Education, Counseling (Risk Assessment, Disease Prevention, Counseling, National Screening Guidelines)

1
Q

two meds for mild acne treatment?

A

benzoyl peroxide

retinoic acid derivatives (tretinoin)&raquo_space; avoid during pregnancy

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2
Q

3 meds for moderate acne treatment?

A

benzoyl peroxide
retinoic acid derivative
antibx (clindamycin, erythromycin)

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3
Q

2 meds for mod-severe acne treatment (oral)

A

antibx (doxy/minocycline)

COCs (w/ low androgenic content)

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4
Q

treatment for severe cystic acne?

A

isotretinoin (accutane) oral
C/I DURING PREGNANCY & LACTATION
can refer for management if isotretinoin is needed

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5
Q

what is the hallmark of most plant dermatoses?

A

linear eruption

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6
Q

examples of irritant contact dermatitis

A

hot/cold
chemical
friction

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7
Q

examples of allergic contact dermatitis

A

poison ivy/oak
nickel
rubber compounds
some topical meds

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8
Q

pharm tx for contact dermatitis?

A

topical corticosteroid
systemic corticosteroid if severe/widespread (avoid 1st trimester)
antihistamines for allergic pruritus

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9
Q

how is eczema characterized on exam?

A

pruritis, erythamous, dry, scaly, excoriated, possibly lichenified patches of skin

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10
Q

what tests might you order for a pt with eczema at risk for a significant bacterial infection?

A

CBC. herpes culture

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11
Q

pharm tx options for eczema? (7ish)

A

1) topical or PO antibx considered if at risk (bactroban)
2) PO antihistamine (benadryl) for pruritus at night
3) daytime histamine
4) maybe topical corticosteriod during exacerbation
5) last option is a PO steroid if widespread
6) could mayyybe consider PO immunosuppressant
7) can also consider vitamin D 2000 IU for symptom relief

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12
Q

what do we see symptomatically in patients with basal cell or squamous cell carcinoma?

A

painless, slow-growing lesion that will not heal (areas of sun exposure or burns or chronic inflammation)

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13
Q

what do we see symptomatically in patients with malignant melanoma?

A

nevus change: color, diameter increase, border
pruritus early
bleeding/ulceration/discomfort later

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14
Q

BCC lesion

A

waxy, semitransluscent nodule w/ rolled borders

central ulcerations, telangiactasias

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15
Q

SCC lesion

A

re/reddish brown plaque/nodule

scaly/crusted surface w/ erosions or ulceration

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16
Q

ABCDEs of metastatic melanoma

A 
asymmetry
border irregularity
color variant
diameter >6 mm
elevation
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17
Q

dx of malignant skin lesions?

A

biopsy

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18
Q

tx for BCC/SCC (4)

A 
excising lesions (Mohs')
cryo
curettage
fluorouracil or imiqimod
**referral
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19
Q

tx for MM

A 
excising lesion
lymph node dissection
chemo/radiation/excising metastasis
f/u long term
**referral
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20
Q

tinea is what type of infection?

A

fungal
ringworm, athlete’s foot, jock itch
CONTAGIOUS

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21
Q

symptoms of tinea

A

itching, burning, inflamed rash, hair loss, nail thickening

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22
Q

tinea lesion presentation

A

lesion with central clearing surrounded by red, scaly border

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23
Q

2 dx moves for tinea

A

KOH microscopy + for hyphae

fungal culture

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24
Q

options for treating tinea corporis, cruris, pedis

A

topical antifungals: azoles and allylamines (lamisil)

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25
Q

options for treating tinea capitis, unguium

A

PO antifungals (not during pregnancy): griseofulvin, itraconazole

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26
Q

psoriasis is what type of condition?

A

chronic immune-mediated disorder

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27
Q

symptoms of psoriasis? (5)

A

red papules/plaque on elbows, knees, scalp most common
pruritus in folds (groin, axillae, antecubital/popliteal)
joint pain
fever
chills

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28
Q

4 characteristic features of psoriasis on physical exam

A

clear borders
erythemous plaque base
overlapping silvery scales
Auspitz sign (removal of scales = blood droplets)

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29
Q

fingernail psorias sign?

A

pittling/stippling

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30
Q

if uncertain, how to dx psoriasis?

A

biopsy

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31
Q

nonpharm option for psoriasis?

A

phototherapy

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32
Q

pharm options for mild psoriasis? (3)

A

topical steroids
retinoid gel (C/I pregnancy)
vit D3 analogs

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33
Q

pharm options for severe psoriasis (3)

A

biologic immune modulators
methotrexate (c/i pregnancy, lactation)
cyclosporine (c/i pregnancy, lactation)

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34
Q

who might we refer a psoriasis pt to?

A

derm if symptoms not controlled w/ topical meds or if severe

rheum if arthritic symptoms

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35
Q

what kind of condition in vitiligo?

A

progressive, decreased production of melanin, skin becomes depigmented

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36
Q

if vitiligo is present in an older woman, what else should be considered? (4)

A

thyroid, RA, DM, alopecia

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37
Q

vitiligo symptoms

A

discoloration patches on skin, sun-exposed areas often show first
maybe graying of hair

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38
Q

tx for vitiligo?

A

not really, can do UVB to repigment or photochemotherapy

maybe topical steroids early to help with re-pigmentation

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39
Q

what is the Koebner phenomenon

A

new patch of vitiligo appears 10-14 days after getting a tattoo

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40
Q

allergic rhinitis produces which kind of antibodies?

A

IgE along with histamine release

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41
Q

symptoms of allergic rhinitis (5)

A

congestion, clear rhinorrhea, sneezing, itchy eyes/throat/nose, sore throat/cough from postnasal drip

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42
Q

PE findings allergic rhinits (5)

A 
pale, boggy mucosa
clear, thin rhinorrhea
nasal crease from rubbing nose
allergic shiners (dark discoloration below eyes)
injected conjunctiva/tearing
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43
Q

gold standard test for determining specific allergens

A

skin tests

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44
Q

tx for allergies

A

avoid the allergen!

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45
Q

1st line pharm tx for allergies

A

antihistamine (1st benadryl, and 2nd gens claritin)

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46
Q

other pharm tx for allergies (4)

A

decongestants
nasal corticosteroids
mast cell stabilizers/intranasal cromolyns (prophylaxis)
montelukast

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47
Q

what is conjunctivits?

A

inflammation of conjunctiva

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48
Q

types of conjunctivitis?

A

viral (adenovirus)
bacterial (staph, strep, GC, CT)
allergic (type 1, IgE mediated

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49
Q

differentiating conjunctivitis by symptoms

A

V: acute, uni or bi lateral w/ watery discharge
B: acute, uni THEN bi lateral with mucopurulent discharge (sticky eyelids)
A: chronic, bilateral, stringy/clear/watery discharge, tearing, itching

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50
Q

which bacterial conjunctivitis poses risk to eyesight?

A

gonoccoal

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51
Q

tx for viral conjunctivits?

A

none, cold compresses, symptom management

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52
Q

tx for bacterial conjuncitivits?

A

broad-spectrum antibx: erthromycin

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53
Q

tx for gonococcal or chalmydial infection?

A

systemic antibx, ceftriaxone, azithromycin, doxy, erythromycin base

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54
Q

when would you refer a conjunctivitis patient?

A

pain, photophobia, blurred vision, herpes simplex/zoster infx

55
Q

pharm treatment for allergic conjunctivitis?

A

topical antihistamines and vasoconstrictor

56
Q

PE findings for otitis media?

A

full/bulging TM
absent/obscured landmarks
decreased mobility of TM
distorted light reflex

57
Q

first line antibiotic tx for otitis media

A

amoxicillin, if it doesn’t work, augmentin or zithromax or bactrim if allergic to penicillin

58
Q

when would you refer an otitis media pt?

A

extended infx, mastoiditis, perfed TM
hearing loss
recurrent infx

59
Q

acute sinusitis is caused by…

A

virus or bacteria (h. influ, strep pneumonia)

60
Q

chronic sinusitis…

A

prologned infection, incomplete treatment, reinfection

61
Q

PE findings of sinusitis (4)

A

low grade fever or afebrile
mucopurulent discharge
swollen, gray/dull red, pale nasal mucosa
pain on palpation of sinuses

62
Q

when do you consider antibx for sinusitis? (3)

A

sxs > 10 days
sxs worsen after 5-6 days after initial improvement
high fever & facial pain or purulent discharge for 3 or more days

63
Q

first line antibx tx for sinusitis?

A

augmentin (or doxy or levo if allergic to penicillin)

64
Q

other pharm tx options for sinusitis (symptom management)

A

decongestant

steroids

65
Q

(4) when to refer a sinusitis pt?

A

periorbital swelling/severe facial pain
failure to respond to 2 courses antibx
suspected anatomic abnormality
chronic sinusitis or >3 episodes of sinusitis in a year

66
Q

types of pharyngitis?

A

viral (rhinovirus, adenovirus)

bacterial (GABHS, N. gon)

67
Q

differentiating viral vs bacterial pharyngitis on PE?

A

V: mild erythema of throat, little/no exudate
B: erythema of throat, exudate, ANTERIOR CERVICAL LYMPHADENOPATHY tender

68
Q

when is a rapid strep test indicated?

A 
2+ of:
fever
no cough
tonsillar exudate
tender anterior cervical adenopathy
69
Q

pharm tx for GABHS?

A

penicillin, erythromycin in penicillin allergy

70
Q

pharm tx gonococcal pharyngitis

A

ceftriaxone, azithromycin if penicillin allergic

71
Q

when would you refer a pharyngitis patient?

A

suspected peritonsillar abscess

epiglottis

72
Q

what is the definition of asthma?

A

a chronic inflammatory disorder of the airways (REVERSIBLE) resulting in obstruction of the airways

73
Q

what are the 4 classifications of asthma?

A

intermittent
mild persistent
moderate persistent
severe persistent

74
Q

intermittent asthma: daytime symptoms

A

2xweekly or less

75
Q

intermittent asthma: nocturnal symptoms

A

2xmonthly or less

76
Q

intermittent asthma: use of SABA

A

2xweekly or less

77
Q

mild persistent asthma: daytime symptoms

A

more than 2xweekly but not daily

78
Q

mild persistent asthma: nocturnal symptoms

A

3-4xmonthly

79
Q

mild persistent asthma: use of SABA

A

more than 2xweekly, not daily, no more than once daily

80
Q

moderate persistent asthma: daytime symptoms

A

daily

81
Q

moderate persistent asthma: nocturnal symptoms

A

more than 1xweekly but not nightly

82
Q

moderate persistent asthma: use of SABA

A

daily

83
Q

severe persistent asthma: daytime symptoms

A

continual daily

84
Q

severe persistent asthma: nocturnal symptoms

A

frequent

85
Q

severe persistent asthma: use of SABA

A

continuous daily

86
Q

when can asthma symptoms worsen?

A

at night!

87
Q

symptoms (4) of asthma

A

SOB, cough, wheeze, chest tightness

88
Q

what might you find on exam for a pt with asthma? (3)

A

hyperresonance to percussion
wheezing
prolonged expiratory phase

89
Q

dx test for asthma?

A

pulmonary function test and spirometry and peak expiratory flow

90
Q

meds for stage 1 asthma

A

SABA PRN

corticosteroids for severe exacerbation

91
Q

meds for stage 2 asthma

A

low dose inhaled corticosteroids

SABA PRN

92
Q

meds for stage 3 asthma

A

low/med dose inhaled corticosteroids
LABA
SABA PRN

93
Q

meds for stage 4 asthma

A

high does inhaled corticosteroids
LABA
SABA PRN

94
Q

how is constipation typically defined?

A

less than 3 BMs per week

95
Q

6 red flags of constipation

A 
pain (abdominal/rectal), n/v
weight loss
melena, rectal bleeding
fever
new onset older than 50 years
96
Q

drug of choice for prevention/chronic constipation

A

bulk-forming agent (psyllium husk)

97
Q

second drug of choice for chronic constipation

A

osmotic laxative

98
Q

choice treatment for acute constipation

A

milk of magnesia

99
Q

when should you NOT use a stool softener or laxative

A

suspected obstruction or impaction

100
Q

symptoms of internal hemorrhoids?

A

painless

bright red bleeding with defecation

101
Q

symptoms of external hemorrhoids?

A

itching, pain, bleeding with defecation

102
Q

nonpharm tx for hemorrhoids if symptomatic

A

fiber/bulk/fluids
sitz baths
witch hazel

103
Q

pharm tx for symptomatic hemorrhoids

A

topic anesthetic/steroid ointments/suppositories
bulk-formers
stool softeners

104
Q

what is IBS?

A

chronic functional disorder characterized by abdominal pain and change in bowel habits

105
Q

Rome criteria frequency of pain/discomfort for IBS?

A

3xmonthly for 3 consecutive months

106
Q

Rome criteria for IBS associated with 2+ of:

A

improvement with defection
onset associated with change in stool frequency
onset associated with change in stool form

107
Q

alarm symptoms of ibs (5)

A 
pain/diarrhea that interferes with sleep
recurrent n/v
evidence of GI bleed
unintentional weight loss
persistent diarrhea or severe constipation
108
Q

what is PUD?

A

chronic ulcerative disorder of upper GI tract

109
Q

what infx is common causative agent of PUD?

A

h pylori

110
Q

peptic ulcer pain

A

1-3 hrs after meal
typically relieved with food
early morning pain common

111
Q

gastric ulcer pain

A

food can worsen symptoms

112
Q

alarm symptoms for gastric cancer/complicated PUD (5)

A 
bloody/black stools
unintended weight loss
dysphagia
persistent pain
bloody/coffee ground vomit
113
Q

pharm treatment for PUD not w/ h. pylori

A

histamine-2 receptor antagonist

PPIs

114
Q

pharm treatment for PUD from h pylorti

A

either:
triple therapy: PPI, amoxicillin, clarithromycin
quad therapy: bismuths ub, mentronidazole, tetracycline, PPI

115
Q

when would you refer PUD pt?

A

alarm symptoms, new onset pain in pts older than 45

116
Q

what is cholecystits?

A

acute or chronic inflammation of the gallbladder

117
Q

symptoms of cholecystitis?

A

RUQ pain

118
Q

PE findings of cholecycstitis

A

fever

murphy’s sign (deep palpation of right subcostal region causing inspiratory arrest)

119
Q

gold standard for dx gallstones/cholecystitis?

A

US

120
Q

tx for sympomatic gallstones

A

cholecystectomy

121
Q

tx for asymptomatic gallstones

A

expectant

122
Q

what is GERD?

A

recurrent episodes of reflux where gastric contents move from stomach to the esophagus

123
Q

symptoms associated with GERD

A 
heartburn
acid regurg
occur 30-60 min after eating
nocturnal aspiration
hoarseness/cough/bronchospasm
124
Q

pharm tx for GERD

A

antacid
H2 receptor antagonists
PPIs

125
Q

when would you refer a GERD pt?

A 
dysphagia
weight loss
blood loss
n/v
early satiety
anorexia
126
Q

most common cause of lower UTIs?

A

E coli

127
Q

what is bacterial colony count for dx infx

A

100,000

128
Q

first line tx for UTI

A

bactrim 3 day

nitrofurrantoin 5 day

129
Q

how is recurrent UTI defined?

A

2 in 6 mo

3 in 1 year

130
Q

symptoms of pyelonephritis (7)

A 
chills/fever
dysuria
frequency
urgency
n/v
flank/abdominal pain
hematuria
131
Q

PE findings for pyelonephritis

A

CVA tenderness

fever

132
Q

tx for pyelonephritis

A

PO fluroquinolone 7 days or bactrim 14 days

133
Q

PE urolithiasis

A

hematuria

134
Q

gold standard for dx urolithiasis

A

non contrast CT

NCC Exam - WHNP (6 decks)

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