Review Flashcards
When viewing the chest x-ray film of a 25 year-old adult male recently diagnosed with pulmonary tuberculosis, which lobe of the lung is most likely to be affected: a lower lobes b middle lobes c upper lobes d lateral lobe
c. upper lobes
A 60 year-old obese female with hx of DM type 2 is seen by the NP. She has been taking metformin 500 mg PO BID with sitagliptan (Januvia) 10 mg in the morning. She is complaining of a tingling sensation with some numbness on both her lower legs, which has been present for several months. Which of the following is recommended for his patient:
A. A1C, serum B12 level, serum folate level
B A1C, CBC with differential, creatinine
C Serum potassium, serum sodium, serum magnesium
D Fasting blood glucose, eGFR, SED rate
A. A1c, serum B12 level, serum folate level
A 13 year-old is brought in by his mother. She reports that her son has rashes on his left arm for several weeks that do not itch or hurt. During the skin examination, the NP notices several 2 mm discrete smooth papules with central umbilication on the adolescent's left hand and arm. The lesions do not appear irritated. Which is the most likely diagnosis?: A Verruca vulgaris B Molluscum contagiosum C Condyloma acuminatum D Folliculitis
B Molluscum contagiosum
An 18 year-old presents to the college health clinic with a two-day history of fever, malaise, myalgia, and dry cough. During the physical exam, the pharynx was erythematous with mild tonsillar hypertrophy with no exudate. There are bluish white small spots on the buccal mucosa by the second molars bilaterally. Which of the following conditions is most likely? A Rubella B Rubeola C Varicella D Herpes simplex type I
B Rubeola
They are describing KOPLIK spots
A 62 year-old Asian woman is complaining of episodes of tinnitus in both ears. She denies hearing loss and vertigo. Which of the following should the NP perform initially?
A Prescribe Antivert and advise the patient to return for follow-up in one week
B Refer the patient to an ENT specialist
C Review the patient’s current medications including OTC drugs
D Perform a careful examination of the head, eyes, ears, and neck
C. Review the patient’s current medications including OTC drugs
*Remember “SOAPE” - Follow the steps and do NOT jump ahead.
Subjective - Review meds
Objective - Perform exam
Assessment - tinnitus
Plan - Prescribe Antivert
Evaluation - Make referral if pt does not respond or is worse
A 40 year-old woman presents with swelling behind her left knee after running a 5K race. She deines problems with walking and bending her knees. Upon physical exam, the NP palpates a soft round cystic mass in the posterior popliteal space that is not tender to palpation. Which of the following conditions is most likely? A Baker's cyst B DVT C Lymphedema D Venous insufficiency
A Baker’s cyst
A 17 year-old male college athlete presents with a complaint of a sore throat with enlarged “glands” on his neck for the past 3 weeks. He denies coryza. On PE, the posterior pharynx is bright red color with no exudate. The tonsils appear erythematous. The uvula is at midline. There is posterior cervical lymphadenopathy. The rapid strep test is positive. The NP suspects that the pt may have mono. Which of the following antibiotics is indicated for this patient?:
A Amoxicillin
B Clarithromycin
C Doxycycline
D Levaquin
B Clarithromycin
Never give Amoxicillin to someone with mono due to 80-90% risk for non-allergic amoxicillin drug rash.
Mrs S is a 35 year-old female with a hx of ADD and COPD. She is complaining of headaches and nervousness. The pt is taking prescription medications and herbal teas. Which of the following is the most likely cause?:
A Isosorbide mononitrate
B Atrovent
C St John’s Wort
D Ritalin
D Ritalin
This is 1st line for ADD
EYES:
_______ are larger than _______ and are darker in color
veins
arteries
The ______ (and ____ ______) are responsible for central vision; Are the areas with the sharpest vision
macula; fovea centralis
The ______ (CN__) contains rods and cones (photoreceptors)
retina; II
The ______ of the retina are responsible for color.
cones
The ______ of the retina are responsible for night vision and black and white contrast
rods
Blurred disc margins are called ___________ and are a sign of increased ______ as seen in severe HTN, bleeding, tumor, swelling in the brain
papilledema
ICP
Papilledema is a sign of increased ICP. Manifestations of ICP are changes in ______, _____, & _______, and _____, seizures, & ____
LOC, behavior, vision
headache; vomiting
Blepharitis presents with bilateral ______ and _____ edge of the eyelids.
May have fine _______.
Is more common with seborrheic dermatitis.
red; swollen
scales
Blepharitis treatment includes to ______ _____ in _____ ____ & _____ ______.
scrub eyelids
warm water baby shampoo.
If an infection is suspected with blepharitis, treat with __________ _________ such as _________
antibiotic ointment
Cipro
EYES:
A __________ is a traingular-shaped white to yellowish superficial growth on the _______ side and is bilateral. Is caused by long term ____ damage. Prevention is to wear sunglasses,
pterygium
nasal
UV
EYES:
A ______ is a white to yellowish small round superficial lesion on EACH SIDE of the cornea, caused by long-term ____ damage. Prevention is to wear sunglasses,
pinguecula
UV
think of “ping-pong”. PINGuecula —> ping-pong —> BOTH SIDES of the cornea like a ping pong bouncing back and forth
EYES: A _______ is a small PAINLESS nodule on the upper and lower eyelids
chalazion
THINK - Being LAZy is PAINLESS
EYES:
There is ___ ______ needed for a chalazion. If it is large, a ____ _____ can be used QID. If persistent or recurring, refer to rule out basal cell/meibomian gland cancer, and refer to ophthalmologist.
No treatment
warm compress
EYES:
A _____ _____ is a bilateral white-gray ring on edge of cornea in elderly. It DOES / DOES NOT impede vision?
senile arcus
does NOT
EYES:
Senile arcus is due to _____ ______. It is a _____ finding in the elderly. If the age is > 50, check a _____ profile.
lipid deposits; normal
lipid
EYES:
A ________ is a soft yellow flat cholesterol plaque on the upper/lower lids by the inner canthus and/or palpebrum.
Order a _______ ______ profile to rule out hypercholesterolemia.
xanthelasma
fasting lipid
EYES:
A _________ can be removed by trichlorocetic acid, surgery, or lasers by a plastic surgeon.
xanthelasma
EYES: A \_\_\_\_\_\_\_ (or "\_\_\_\_") is an acute onset localized lesion on the eyelid that HURTS. It is a small abscess.
hordeolum or “stye”
THINK - “Hordeolum - Hurts” - H —> H
This is different from a chalazion that is painless.
EYES:
A hordeolum or “stye” is due to staph. Treatment is to avoid _____ _____ and to apply _____ ______ ____, as well as a possible prescription of topical eye antibiotics.
wearing makeup
warm compresses QID
EYES:
An acute onset of red eye with dried, yellow-green crusting on the eyelids upon awakening: _________ ________
bacterial conjunctivitis
EYES:
Treatment for bacterial conjunctivitis is topical ophthalmic __________ every 2-4 hours for 2 days.
fluoroquinolones
EYES:
A very contagious acute onset of red eye in one or both eyes that is itchy and has periauricular lymphadenopathy: __________ _________
viral conjunctivitis or “pink eye”
EYES:
Treatment for viral conjunctivitis is to keep away from ______ for ___ _____.
A fluoroscein exam IS/ IS NOT needed?
school; one week
IS NOT
EYES:
Allergic conjunctivitis features bilateral _____ eyes with increased __________ with __________ conjunctiva. May be seasonal or more frequent.
itchy
tearing; reddened
EYES:
Treatment for allergic conjunctivitis is to use ____ _____ _____ and to avoid allergens. _______ may be used for short-term use only, otherwise hyperemia may occur.
cool eyelid compresses
Visine
EYES:
Allergic conjunctivitis:
An antihistamine with mast cell stabilizer may be used, such as _________. Put the drops in the ________ for extra relief.
Patanol; refrigerator
What does Snellen 20/60 signify?
The patient can see at 20 feet what a person with normal vision can see at 60 feet
With a Snellen chart exam, the patient is always at ____ feet (the ____ of the result)
20
numerator
By age ____ a child should have 20/20 vision
6
An eye exam in a patient with diabetic retinopathy will show _______ _____ ______. These are neovascularization (new and fragile arterioles) and ____________ due to the neovascularization that result in “dot and blot” hemorrhages.
cotton wool spots
microaneurysms
Cotton wool spots are a symptom of ________ _________.
diabetic retinopathy
Symptoms of diabetic retinopathy are _____ vision, ______, and ___________ (blind spot on visual field)
blurred
floaters
scotoma
AV nicking is caused by ________ __________ and is where an ________ is pressing down on a _____.
hypertensive retinopathy
arteriole; vein
_______ and _______ _____ arterioles are seen in hypertensive retinopathy
Copper; silver-wire
EYES:
_______ _______ is caused by a Herpes simplex virus or shingles of the _________ nerve (CN5) affecting the ophthalmic branch.
herpes keratitis
trigeminal
Herpes keratitis:
Classic scenario is one where the patient complains of acute onset of blurred _____, _______, and _____ in one eye.
blurred, tearing, pain
Herpes keratitis:
Physical exam with fluorescein stain shows a _____-____ _____ on the cornea on the affected eye
fern-like lesion
Herpes keratitis:
Treatment is to ______ to _____ ASAP or ____.
Herpes culture. Will be on acyclovir for a few weeks.
refer to ophthalmologist or ER
EYES:
A ______ _____ has an acute onset of severe eye pain, foreign body sensation, tearing, and injected sclera. Physical exam is with ________ (lower lids).
corneal abrasion
fluorescein —> “Floor-lower” - FLUORescein to LOWER lids.
NPs never ______ an eye - send to ophthalmologist.
patch
Treatment for a corneal abrasion is topical _____ therapy with __________ ointment, or a _________ eye drop. For severe eye pain, narcotics can be given.
antibiotic
erythromycin; fluroquinolone
Contact lens abrasions have a higher risk of infection with _________, and this is why they need to be removed every night. Topical antibiotic therapy with a __________ is recommended, and ____ patching!
pseudomonas
fluoroquinolone
NO
In open-angle or “primary open angle” glaucoma, ______ _______ is seen on physical exam.
disc cupping.
Think that CUPS are OPEN to help remember.
Open-angle glaucoma is rarely __________. It is caused by high _____. It is seen in those of _________-_________ descent.
symptomatic
IOP
African-American
Think of “when things are OPEN, you DON’T have symptoms. But when things are closed down, you’re going to see symptoms” to help remember the difference between open and closed-angle glaucoma.
Treatment for open-angle glaucoma is ____ ______ _____.
beta blocker eyedrops
Acute angle-closure glaucoma is a __________ ________.
ophthalmologic emergency
Angle closure glaucoma, in contrast to open-angle glaucoma, is symptomatic. Symptoms are ______ _____ ____ with decreased visual acuity, N/V, and _______ around lights.
severe ocular pain
halos
angle-closure glaucoma:
Drainage of aqueous fluid is ________, causing increased _____ which results in ischemic damage to the retina.
blocked
ICP
angle-closure glaucoma - Things (in vision) are ______. Treatment is to send to _________.
hazy
ED
________-_______ _______ _______ is a PAINLESS loss of central vision which often affects both eyes.
age-related macular degeneration
Age-related macular degeneration:
The macula is for ______ _______ and the ______ _____ is used to test for this condition.
central vision
Amsler grid
The red reflex test is a screening test for ________. No glow, dull, or white reflection are abnormal. In childhood, this could indicate a _______ _______.
cataracts
retinal blastoma
Cataracts: Affects the lens of the eyes and are common in the elderly. The lens becomes progressively cloudy which affects vision. The ____ ____ will be missing from the affected eye.
red reflex
Cataracts:
Classic presentation is where someone presents with ______ vision, increased sensitivity to _______, poor night vision, problems with ______ while driving at night, and sees
______ around lights.
blurred;
glare
headlights
halos
Allergic rhinitis:
Nasal turbinates are _____, ______, ______ and _____ with mucus discharge.
boggy, bluish, pale; swollen
Allergic rhinitis: First-line treatment is ________ _______ sprays such as _______ and ________
intranasal steroid
Nasocort and Flonase
Allergic rhinitis: Use ______ _____ in home
HEPA filters
Nasal polyps: Avoid _______ (increased sensitivity)
ASA
Epistaxis: Two types: anterior and posterior. _______ are more common. Anterior nosebleeds are caused by bleeding at _________ __________ (lower one-third of anterior nose)
anterior
Kiesselbach’s plexus
Posterior nosebleeds are more _____ and the patient should go to ____.
severe
ED
Treatment for nosebleeds includes instructing the patient to sit and _____ _____ and _____ _____ half of nose for ___ to ___ minutes.
lean forward; pinch lower
15 to 20
Nosebleeds treatment:
Apply topical nasal _________ such as
_______.
decongestant
Afrin
Nasal septum perforation:
The cartilage does not _______.
Refer to _______.
regenerate
ENT
Vertigo has many causes (benign to life-threatening conditions): __________ ______, vestibular neuritis, acoustic neuroma, multiple sclerosis, brainstem timors and bleeding
Meniere’s disease
Meniere’s disease has recurrent attacks of ________ with N/V that may last several hours
vertigo
Meniere’s disease is a TRIAD of:
_______
_______
_______ ______
vertigo
tinnitus
HEARING LOSS
*These are the 3 cardinal S&S of Meniere’s. MUST have HEARING LOSS to have Meniere’s!
To have Meniere’s, the patient MUST have ______ ______
hearing loss
Meinere’s disease can be treated with low-salt diet, avoidance of alcohol & caffeine, and meds such as ______, dimenhydrinate, ______, Promethazine, and antiemetics
meclizine; antihistamines
Acoustic neuroma has a ______ onset of one-sided hearing loss with _______ that is insidious.
gradual
tinnitus
Acoustic neuroma is a ______ tumor causing compression of CN 8. Treatment is _________.
benign
surgery
________ is recurrent vertigo lasting under one minute caused by sudden changes in head position (looking up, lying down, getting up/rolling over in bed). May lose balance and fall.
BPPV
BPPV is characterized by vertigo caused by _____ _____ in _______ ________
sudden changes
head position
BPPV can be remedied by adjusting the _________ ________ in the vestibular system of the ear (cochlea). This is called the _______ ______.
canalith crystals
Epley maneuver
BPPV is the only vertigo that can be cured _______.
quickly
via the Epley maneuver
Vestibular neuritis and labrynthitis are caused by _____ _______. Treatment is with ________ taper, meclizine, and _________.
viral infection.
methylprednisolone
scopolamine
Vestibular neuritis and labrynthitis have a sudden onset of severe vertigo with N/V for _____ days, with gradual lessening of symptoms.
1-2
A normal Weber test is where the person hears sound ______ in ______ _______
equally; both ears
no lateralization
Rinne test:
Bone
Better
Blockage
When bone is better than air, there is a blockage, which means conductive hearing loss
The blockage is either serous otitis media, a foreign body, or cerumen
Rinne test:
____ conduction should be better than _____ conduction
Air; bone
Weber test: _________ to one side is abnormal
lateralization
A negative Rinne test is always considered _______.
abnormal.
A Rinne test that is negative means that BC > AC, which is ________.
abnormal
A positive Rinne test is ________ and means that ____ > ____.
normal; AC > BC
A “positive” Rinne test means that it is _______.
normal
Weber test: Example:
If sound lateralizes to the right ear, it means that the patient either has _________ hearing loss in the right ear, or ___________ hearing loss in the left ear
conductive
sensorineural
Acute otitis media:
The most objective finding is _______ ______ per ______ _______ _______.
Decreased mobility
tympanogram flat line
Acute otitis media:
Treatment for children and adults is _________.
Amoxicillin
THINK - “AOM - AMO”
Acute otitis media - AMOxicillin
Acute otitis media:
If the person had antibiotics in the past month, treat with __________.
Augmentin
Otitis media with effusion (serous otitis media):
The TM is not ______. It may look translucent but filled with clear serous fluid and you may see fluid level and ______ ________. Mild hearing loss with ________ sounds.
red
air bubbles
popping
A complication of otitis media:
Acute ___________. Pain, swelling, redness behind affected ear accompanied by fever and AOM symptoms. Refer to ER for hospitalization.
mastoiditis.
A cauliflower-like or round white growth draining purulent and foul-smelling discharge with hearing loss, due to chronic OM. Refer to ENT. Needs antibiotics and surgical debridement. What is this? ___________
cholesteatoma
What is the most common bacteria of Otitis externa or “swimmers ear”?
pseudomonas aeruginosa
Swimmer’s ear or otitis externa has ________ _____ discharge and a swollen and red ear canal. There is pain with manipulation of the pinna and/or tragus of the ear.
purulent green
treatment for otitis externa is ______ ______ and _________ combination such as ________ or Cipro HC. Keep water out of ear.
topical steroid
antibiotic; Cortisporin
Acute bacterial rhinosinusitis:
Hx of persisent URI symptoms for 10+ days, or a cold that resolved, but symptoms return and worsens. Complains of unilateral facial pain or pressure or toothache (upper molar pain) with nasal congestion, purulent nasal discharge and/or postnasal drip.
Pathogens are strep pneumoniae and H. influenzae most of the time.
Frontal sinusitis presents with _______ _______ or pain ________ ______ eye.
frontal headache
behind one
Maxillary sinusitis presents with ______ pain and ____ ______ _____ pain
facial
upper molar tooth
1st-line treatment for acute bacterial rhinosinusitis is ___________. If they are allergic to PCN, then give ________. May also give symptomatic relief such as saline irrigations, nasal steroids, and NSAIDs for pain.
Augmentin
doxycycline
Infectious mono: Classic case: Teenager presents with hx of: 1 \_\_\_\_\_\_\_\_\_\_ 2\_\_\_\_\_\_\_\_\_\_ 3\_\_\_\_\_\_\_\_\_\_ for several weeks.
1 sore throat
2 enlarged posterior cervical nodes
3 fatigue
The etiology of mono is the ______-______ _____.
Epstein-Barr virus
Epstein-Barr virus (cause of mono): EBV infection can cause __________ and _________ cancers, as well as ________ and __-____ _______. It can infect other organs such as the brain, spinal cord, optic nerve, and heart.
nasopharyngeal; oral
Hodgkins; T-cell lymphoma
Mono: Testing
Monospot test is not recommended for general use b/c it produces both false positives and false negatives.
____ _____ are usually not needed for typical cases, but are the gold standard.
A _____ shows increased WBCs and __________.
Peripheral smear is _________ with the presence of atypical lymphocytes with lymphocytosis .
_____ are elevated in most patients.
EBV titers
CBC; lymphocytosis
abnormal
LFTs
With mono, suspect ___________/__________.
splenomegaly/hepatomegaly
With mono, do a _______ abdominal exam with palpation and percussion. Order an _______ ______ of the __________.
gentle
abdominal ultrasound
spleen
Mono treatment:
Symptomatic.
______.
Avoid _____ ______ and ______ ______.
Rest.
contact sports; heavy lifting
Mono treatment:
Patient should avoid contact sports and heavy lifting for a minimum time of _____ to ____ _______.
4 to 6 weeks
Oral leukoplakia:
White colored thick patch, can be cheeks, gum, tongue, etc. It is _________. If on tongue, rule out cancer of the tongue by a _________.
painless
biopsy
sialolithiasis:
Salivary duct stone/calculi. White colored nodule under the tongue. Usually asymptomatic. May c/o pain _____ ______. Refer to ENT.
before meals
Aphthous stomatitis (canker sores)
A ______ ______ ______ ulcer on the tongue or cheeks. complains of pain with eating or drinking acidic foods.
Treatment is _______ _________ swish and swallow.
painful shallow annular Magic mouthwash (viscous lido, Benadryl, Maalox ina 1:1:1 ratio)
Peritonsillar abscess/cellulitis:
Has a _____ _________ with red mass on area of tonsils. Has a high fever. Severe sore throat and _______ with _______. Refer to ER ASAP. It is a complication of pharyngitis.
displaced uvula
pain; swallowing
Diphtheria:
Presents with a ____-to _______ colored _______ that is ______ to _________. Swollen neck. Refer to ER.
Notify _________ ______ department for contact tracing.
gray to yellow; pseudomembrane
hard to displace
State health
Diphtheria: Treatment is 1\_\_\_\_\_ 2\_\_\_\_ 3\_\_\_\_\_
1 antibiotic
2 antitoxin
3 strict isolation
Diphtheria:
For close contacts such as household members:
Obtain _______/_______ swabs for C. diphtheriae cultures
nasal/pharyngeal
Benign findings of mouth/pharynx:
______ _______: A bony protuberance/growth on the hard palate at midline
_______ _________: Uvula that is split into two sectionsn
Torus palatinus
Fishtail uvula
Most common skin cancer is _______ ________ ________
basal cell carcinoma
Basal cell carcinoma appears ______ or _______ (___-tone) with ______ edges and __________
waxy; pearly (flesh-tone)
raised TELANGIECTASIA
Actinic keratosis:
Multiple dry scaly lesions that do not heal on areas of the skin ________ to _______ ______.
exposed; chronic sunlight
Actinic keratosis is treated with ______
5-Flouracil
Actinic keratosis is a precursor lesion of ______ _____ skin cancer
squamous cell
Squamous cell cancer:
Chronic _______ _______ rough textured lesion with ______ borders. Sometimes crusting or bleeding. Common locations are rim of the ears, lips, nose, face and tops of the hands. The precursor lesion is actinic keratosis.
red scaly
irregular
Squamous cell cancer:
Treatment is _____ ________ if on face/cartilage.
Moh’s microsurgery
An important risk factor for skin cancer (both non-melanoma and melanoma) is:
_______ ________ as a child.
History of _________.
_____ skin.
Excessive chronic exposure to UV light from sun and tanning beds.
Moles.
Positive family history.
blistering sunburn
sunburns
Light
Important risk factor for skin cancer:
Avoid sun exposure at the time of day when the sun is most damaging, which is from ____ to _____
10 AM to 3 PM
Melanoma: Remember the ABCDE rule: A B C D E
Asymmetry Border Color Diameter Evolving
Acral lentiginous melanoma is the most common type of melanoma in ______-_____ individuals. Most common locations are the ______, _______ surface, and ______ areas. Remove shoes to inspect.
Remove shoes.
Palms.
Soles of feet.
dark-skinned
palms, plantar; subungal
Acral lentiginous melanoma:
Look for _______ _______ to ____ bands on the nailbed.
longitudinal brown black
___________: a darkened band under or within the nail plate located on a fingernail that may be seen in Blacks, Latinos, and Asians. It can resemble subungal melanoma which can be fatal if not caught early. In Whites, rule out subungal melanoma. If this is only in ONE nail, it is _______.
melanonychia
ABNORMAL
Bacterial meningitis: Has an acute and rapid onset of the classic triad of: \_\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_, and rapid change in \_\_\_\_\_\_\_ \_\_\_\_\_\_
high fever
nuchal rigidity
mental status
bacterial meningitis:
has generalized rashes ranging from ______ to ________ to purple-colored lesions (purpura)
petecchiae
ecchymosis
Bacterial meningitis:
For close contacts exposed to it, give ______ as early as possible after exposure to patient’s oral secretions.
Rifampin
Bacterial meningitis:
______ (treatment) changes color of urine to reddish orange and can stain contacts. Do not give to pregnant women.
Rifampin
Diagnosing bacterial meningitis:
_______ sign is for nuchal rigidity. Patient supine. Raise _______ and flex _____ toward ______.
Brudzinski
head chin chest
Brudzinski sign for bacterial meningitis:
Positive result if patient automatically _______ ______ ____
bends both hips
Diagnosing bacterial meningitis:
_______ sign is for the hip. Patient supine. Flex patient’s hips and knees in a right angle, then slowly straighten/extend the leg. Positive result is when the patient complains of pain during ___________ or ______.
Kernig’s
extension
resisting
MCV4 (Menactra, Menveo):
Give one dose of Menactra or Menveo at age ___ to ___ years
11 to 19
MCV4 (Menactra, Menveo)
First year living in college residence halls, military recruits: Give one dose of Menactra or Menveo if never had a dose, age ___ to ___.
19 to 21
Rocky Mountain Spotted Fever:
Onset of fever, HA, myalgia, N/V, and anorexia. Spot-like red rashes (______) start within 2 to 5 days of fever onset, located on the ________/_______ and on the _____/_____, which spread toward the ______ and becomes generalized. Can be life-threatening.
petechiae
hands/palms
feet/soles
trunk
Rocky Mountain Spotted Fever:
Due to the deer/dog tick bite infected with _______ _______. States where 60% of cases are found are North Carolina, Tennessee, Oklahoma, Arkansas, and Missouri.
rickettsia ricketsii
Rocky Mountain Spotted Fever:
Treatment is with ___________
doxycycline
Rocky Mountain Spotted Fever:
______ ____ ______ for rash to appear, start doxycycline immediately if RMSF is suspected. >20% fatality rate if not treated.
Do not wait!
The ticks that cause Rocky Mountain Spotted Fever are in _____ _____/____ of TN, NC, Oklahoma, Arkansas, Missouri
grassy areas / fields
Erythema Migrans aka Lyme Disease:
Acute onset target rash or “______-_____” shaped red-colored rash that feels hot to touch on the extremities or trunk. Some have migratory oligoarthritis (swollen red and painful joints) - the ____ _____ of the knee.
bulls-eye
bulge sign
Lyme Disease (erythema migrans):
Treatment is _______.
Use DEET.
For clothing, use ________.
Doxycycline
permethrin
Rosacea (acne rosacea):
Fair skinned Celtic (Irish, Scot, English) middle-aged woman with history of chronic symmetric redness, small pustules, papules, and telangiectases on central areas of the face. Easy flushing with ETOH and spicy foods.
First-line treatment is to _____ ______ of flushing.
Afterward, ________ _____ once to twice daily is indicated.
Avoid triggers (ETOH, excessive sun) metronidazole gel
Rosacea (acne rosacea):
A patient with rosacea has been taking metronidazole gel for her acne rosacea and it is not working. What is the next step?
Put her on PO ___________ or ___________ daily
tetracycline or doxycycline
Derm Review: Primary Lesions:
Changes in skin color (flat and non-palpable), < 1 cm. Example are freckles. What are these? _______
macules
Derm Review: Primary Lesions:
Palpable solid lesions < 1 cm in diameter
Ex. Comedones, acne
What are they?
papules
Derm Review: Primary Lesions:
Raised solid lesions > 1 cm
Ex. Basal cell cancer, hydradenitis suppurativa nodule
What are these?
nodules
Derm Review: Primary Lesions:
Circumscribed elevated lesions that contain pus
ex. acne pustules
pustules
Derm Review: Primary Lesions:
Elevated superficial blister filled with serous fluid - larger than 1 cm in size
Ex. bullous impetigo, 2nd degree burn
bulla / bullae
Derm Review: Primary Lesions:
Elevated raised skin lesion <1 cm in diameter and filled with serous fluid.
Ex. herpes simplex, herpes zoster
vesicle
Derm Review: Primary Lesions:
Solid raised lesion with flat top > 1 cm in diameter
Ex. psoriasis
plaque
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Thickening of the epidermis with exaggeration of normal skin lines (due to chronic itching): _____________
Lichenification
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Flaking skin: _______
scale
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Results from drying of exudate: ________
crust
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Eroding of epidermis and dermis (if deep, can involve subQ tissue): ___________
ulceration
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Permanent fibrotic change following damage to the dermis: ________
scar
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Overgrowth of scar tissue common in Blacks, Asians: ______
keloids/ hypertrophic scars
Thermal burns:
Red to bright red skin and tenderness/pain:
_________ degree (___________)
first degree (superficial)
Thermal burns:
Painful red skin, bullae (blisters), redeened/weepy skin:
_________ degree (________ ________)
second (partial thickness)
Thermal burns:
Pain sensation absent.
Pale/white color, charred skin, leather-like texture.
_____ degree (_____ _________)
third (full thickness)
For treatment of burns in someone allergic to sulfa, an alternative to Silvadene is ________.
Bacitracin
If a patient presents with thermal facial burns with soot around the nose/mouth, singed eyebrows/nasal hair/eyelashes, facial burns, and/or black particles in sputum, hoarseness, suspect _____ ______ ______. Assess for airway patency, breath sounds, wheezing, respiratory distress. ABCs are always the priority! Refer to ED. On exam will be given 4 people and asked who should be seen right away - go by ABCs!
smoke inhalation injury
American Burn Association defines minor burns as:
Age 10 to 50 years: < ____ % TBSA ____ _____ burns
Age < 10 or > 50 years: < ____ % TBSA ______ ____ burns
10; partial thickness
5; partial thickness
Minor burns should meet these criteria:
Does not involve the _____, _____, _____, _____
Face, perineum, hands, feet
Minor burns should meet these criteria:
Does not cross ______ _____.
Is not ________.
major joints
circumferential
A restaurant cook who is 22 years old is in the urgent care center for burns due to spilling hot cooking oil. On PE, the NP notes bright red skin with several bullae on the patient’s left arm and chest and bright red skin on the right thigh.
- What is the patient’s diagnosis?
- What is the TBSA?
- Partial thickness thermal burns (2nd degree) of the left arm and chest with superficial thickness (1st degree) burns on the right lower leg and foot.
- 36% (serious burn)
All of the following are true statements about thermal burns except:
- If debris, jewelry, and/or clothing is stuck to the skin, it can be removed gently.
- Avoid ice-cold water when cooling the skin.
- Do not rupture intact blisters.
- Saran wrap plastic can be used as temporary dressing for large burns until patient reaches the hospital.
- If debris, jewelry, and/or clothing is stuck to the skin, it can be removed gently.
For thermal burns, do not forget to check _________ status. Analgesics can be given PRN for pain.
Td/Tdap
Cellulitis: The causative bacteria is ________ or _______.
streptococcus; staph aureus incl. MRSA
Cellulitis: Acute skin infection. Localized skin _____ with _______ __________. Skin feels warm/hot and tender.
erythema
diffused margins
Lymphangitis:
Look for ______ _______ that follow _______ ________ deep under the skin emerging from the infected area (cellulitis). Go to hospital for ____ ____.
red streaks
lymphatic channels
IV abx
Erysipelas:
Bright red plaque or induration with sharp or well-demarcated elevated margins on the _____ or _____ ____. Uncommon. If located on the _____, refer to ER for IV abx.
face; lower legs
face
Also known as a boil or skin abscess - due to an infection of a hair follicle (staph, MRSA, group A strep). Red, tender, dome-shaped lesion that drains purulent discharge when it ruptures. Patient will say they have a spider bite.
________
furuncle
“For uncle” - one spot
(carbuncle - a “car full of uncles” - more than 1 furuncle)
A cluster of coalesced boils which are connected subcutaneously. Tender to palpation. Common location is the area behind the neck. Purulent discharge.
__________
carbuncle
Furuncles and carbuncles treatment:
First-line tx of abscesses is _____ with ___ ______.
If at risk for bacterial endocarditis, give abx prophylaxis. Check _____ ______ status.
If abscess is < ____ cm in size, no PO abx needed.
I&D local anesthesia
tetanus vaccine
< 5
For nonpurulent cellulitis (mild), give ______ or ____ (antibiotic).
Keflex dicloxacillin
For purulent cellulitis (probably MRSA), do a _____ _____. Follow up within 48 hours.
Give ______ x 10 days or _________.
If osteomyelitis is suspected, or a MRI. Infections in joint spaces are NOT GOOD
would culture
Bactrim; Clindamycin
Human bites:
_____ bites have the highest rate of infection (anaerobic and aerobic bacteria). Can cause infection especially if over a joint.
Hand
What antibiotic is used for human bites?
Early: ___________
Later: ___________ (route of administration)
Augmentin
IV antibiotics
what antibiotic is used for cat and dog bites?
_________ or _________
Augmentin Bactrim
Animal bites:
_____ bites have a higher rate of infection compared to ____ bites.
Evaluate need for ________ prophylaxis.
_____ booster if > 5 year interval.
Cat
dog
rabies
Tetanus
Bite wounds are best to have heal by _____ ______ instead of suturing, and other wounds at higher risk of infection, such as puncture wounds, crush injuries, wounds > ____ hours old, immunocompromised, diabetics, venous stasis.
secondary intention
12
Bite wounds treatment:
________ COPIOUSLY, debride, dress wound, check ____ (how often?) for infection
Irrigate
daily
Tetanus vaccination:
The initial series for infants up to age 6 includes _____ doses.
Is needed every _____ years for lifetime.
5
10
Tetanus vaccination:
Common reaction is ______ at _____ ______ in ____-____ hours.
pain injection site
24-48
Tetanus vaccination:
Clean minor wounds. If last tetanus dose was 10+ years ago, give one booster of ___ or _____.
For contaminated wounds, give one dose if last dose was given ____+ years ago.
Td; Tdap
5
Tetanus vaccination:
If the patient has a clean wound but the last tetanus vaccine was given > 10 years ago, give the _____ booster to “catch up”
Tdap
Natural disaster emergency wound management:
Give ____ or ____ vaccine if needed
Td Tdap
Impetigo: Acute onset of round red rash with fragile bullae, when breaks, ______ ______ ______ form from dried exudate. Very pruritic and contagious. Usually caused by strep or staph.
honey-colored crusts
Impetigo treatment:
Give _________ if patient has few lesions (3 or 4).
Give __________ PO QID or _________ otherwise.
PhisoHex solution when showering
Restrict athletes from contact sports until healed (especially ________.)
Bactroban
Keflex; Azithromycin
wrestlers
For mildest form of acne, (non-inflammatory, open and closed comedones), first-line treatment is _________ _______
topical retinoids (all topicals, like tretinoin (Retin-A)
For 2nd mildest stage of acne (mild papulopustular and mixed (mild papules, pustules, comedones), give
_______,
a ______ ________,
and a ______ ________
BP (benzoyl peroxide); topical antibiotic; topical retinoid
For moderate acne (moderate papulopustular and mixed acne, moderate papules, pustules, and comedones):
Give Topical retinoid,
AND ________ _________
AND topical benzoyl peroxide
oral antibiotic (tetracycline, minocycline)
For severe acne (nodular), refer to dermatologist, consider ________.
Accutane
Acne treatment:
Category C drugs are _______ ________
topical retinoids
Topical retinoid side effects:
Irritation, dry skin, flaking, redness during first ____ weeks. After washing face, wait _____ minutes before applying.
4
30
Acne treatment:
Tetracycline is a Category ____ drug due to staining of tooth enamel in infants/children. Avoid before age ____. Do not mix tetracycline with ______, _____, or _____.
D
8
antacids, dairy, iron
Pressure ulcers:
Stage I: ___________. NO breaks on skin. Skin may feel warm or cold.
Nonblanchable
Pressure ulcers:
Stage II: Loss of _______ and _____. Is a _____ ulcer.
epidermis; dermis
superficial
Pressure ulcers:
Stage III: Full thickness. Damage extends down to _____
_____ and _____ layer. _____ is present.
SubQ tissue; fat; Slough
Pressure ulcers:
Stage IV: Full-thickness skin loss. Ulcer with undermining and extends down to _____, ____, and _______. Wound has ______ and ______.
muscle, bone, tendon.
eschar; slough
Pressure ulcers:
If eschar or slough is present, you will be unable to _____ it until it is removed.
stage
A decubitus wound appears “infected”. What is the best method to obtain a culture and sensitivity of the wound?
tissue biopsy - punch biopsy
Dressing types for pressure ulcers:
Alginates are used for ______ ulcers (moderate to heavy). The rope-like form turns to gel-like substance. It is derived from _______ ________.
exudative
brown seaweed
Heel eschar:
____ _____ ______ stable, hard, dry eschar in ischemic limbs. Do not remove intact and stable eschar that is adherent, dry, and without redness or moisture.
Do not debride
If eschar becomes ______ (wet, drains, boggy, loose), it should be debrided. Otherwise, never debride stable eschar. Use _____ ______ to offload pressure on the heel.
unstable
heel protectors
Skin tears or flaps on elderly:
- _____ with ____ ______.
- Afterward, approximate wound edges. Apply topical abx cream/ointment. Depending on size and location, secure with ________ _______ or use hydrogels, alginates, foam dressings, or skin glue.
Irrigate normal saline
butterfly strips
Recurrent episodes of painful large, tender, red nodules, abscesses and pustules in the axilla, groin, perianal, or inframammary areas due to occlusion of the hair follicles and pilosebaceous glands. Results in multiple scars and sinus tracks in the skin and odor. Adversely effects the quality of life. Has exacerbations and remissions. What is this?
Hidradenitis suppurativa
Hidradenitis suppurativa treatment:
Avoid skin trauma. wear loose clothes. avoid excessive heat, friction.
Stop _______ and ______ _____.
Stop using __________.
smoking; lose weight
deoderant
Hidradenitis suppurativa treatment:
For mild to moderate: ________ QD to BID for several months (due to their anti-inflammatory effects).
Topical _________ for showering daily
doxycycline or a “cycline”
chlorhexidine 4%
Immune-modulated inflammatory skin disease with hx of chronic and recurrent itchy rashes that are erythematous plaques covered with fine silvery scales located over lower back and gluteal folds, scalp, elbows, knees, extensor surfaces. What is this?
psoriasis
Psoriasis:
The _______ sign is when you scrape off plaque and it increases pinpoint areas of bleeding
Auspitz
Psoriasis:
The _________ _______ is when a skin injury produces new psoriatic plaques
Koebner phenomenon
Psoriasis often manifests with ________ ______
pitting fingernails
“Pitting fingernails —> Psoriasis” (P and P)
A skin manifestation of nummular, coin-shaped lesions is ______________.
psoriasis
Psoriasis treatment:
_______ _________. Beware that they can cause skin atrophy and with high potency can cause _____ _____ ________.
topical corticosteroids
HPA axis suppression
Psoriasis treatment:
Adults: Initially a moderate potency such as _______.
Infants, face, intertriginous areas: low-potency such as _____________
Kenalog
hydrocortisone 1%
Psoriasis treatment:
For thicker-skin areas such asa scalp and soles of feet, use a ______-potency topical steroid such as ________ in solution/foam/shampoo
high
flucocinonide
Psoriasis treatment:
Topical retinoids: Tazorac is a Category ___ drug
X
Psoriasis treatment:
PUVA is a combo of psoralen oral med (derived from ____) combined with _____ ____ therapy
tar
UVA light
Psoriasis treatment:
Systemic Cat X drugs: ________ and Acetritin
Methotrexate
Psoriasis treatment:
TNF-a inhibitors such as Enbrel suppress immunity and there is a risk of ___ _______, severe bacterial infection, etc. Check chest-x-ray, CBC, avoid _____ vaccines.
TB reactivation
live
Eczema vs atopic dermatitis:
Eczema is always _________. Contact dermatitis can be located anywhere on the body.
Eczema is on the classic locations of hands, _____ side of elbow/knees, neck, face.
symmetrical/bilateral
flexural
Eczema:
Avoid ____ clothes.
Avoid _____ skin. Use emollients immediately after taking a shower.
Avoid bathing in _____ _____.
Use kitchen rubber gloves when dishwashing.
wool
dry
hot water
What is Rhus dermatitis?
Contact dermatitis caused by poison ivy. Has lots of blisters. Zanafel.
Severe generalized pruritis that is WORSE AT NIGHT and family members have the SAME SYMPTOMS is _____.
scabies
Scabies:
Locations on the body include sides and _____ of _____, ______,
__________ area, and
________
web of fingers
wrist - flexor aspect
periumbilical
penis
Scabies in an immunocompromised person can involve entire skin. ________ scabies involves crusting and is very infectious but not pruritic, and can look like psoriasis. For this type, treat with ________ PO with topical permethrin
Norwegian
invermectin
A _____ rash appears serpenginous, excoriated, crusted, scaly, and vesicular.
serpenginous
Scabies:
______ contacts must be treated
close
Scabies - permethrin -
Leave on for ____ to ____ hours, then rinse off. Repeat in ___ to ____ _____.
8 14
one to two weeks
Scabies:
_________ lotion is neurotoxic and contraindicated in pregnancy, infants, children <10 yrs old, seizures.
Lindane
A “herald patch” which is round to oval pink with fine scales from 2 to 5 cm in size, and in 1-2 weeks smaller rashes appear on the trunk area that follows a “Christmas tree” pattern, and is asymptomatic, is ________ ______. It resolves in 1-2 months.
Pityriasis rosea
dermatophytes (____ _____) cause superficial skin infections. The name is based on the location of infection. Scrape lesions and send for fungal C&S. KOH smear will show _______ and _____.
Tinea fungi
hyphae; spores
______ ______ is a fungal infection on the scalp. It’s scaly round patches that itch. The hair becomes fragile at roots and break (black dot sign). May have inflamed lesions which can result in permanent patchy alopecia (kerion).
Tinea capitis
Tinea capitis is treated with __________.
Griseofulvin
_______ ______ is a fungal infection on the body with annular red rash with scaling that slowly enlarges with central clearing. Pruritic.
tinea corporis
Tinea corporis (ringworm) is treated with _______ ________ treatment.
azole topical
______ _______ is a fungal infection of the groin. It is erythematous annular that sometimes extends to the buttocks. Usually associated with tinea pedis. It is treated with ______ _______ treatment.
Tinea cruris
azole topical
______ ______ is a fungal infection of the feet/hands with scaling on the soles. There is another type where skin feels wet, strong odor vesicles and bullae that rupture “two feet and one hand” disease (dominant hand that is used for scratching the feet becomes infected too)
Tinea pedis
Tinea pedis is treated with either ______ or ______ creams.
terbinafine; miconazole
___________ ________ is a rash caused by a superficial fungal infection (dermatophytes). Areas are HYPOPIGMENTED or light brown color. Located on the chest, shoulders, and back. May itch.
tinea versicolor.
Think “versiCOLOR” - hypoPIGMENTED
Tinea versicolor - on lab microscopy with KOH slide, look for _______ and _____.
Is treated with ketoconazole shampoo.
***Tinea versicolor is also treated with _________ _______ (______ _____ lotion)
hyphae; spores selenium sulfide (Selsun Blue)
Herpes whitlow (herpes simplex) HSV 1 or HSV 2 infection is an abrupt onset of small red papules/bumps which become vesicular. Extremely painful, tingling, burning sensation. Usually located on the index finger or thumb. Treated with rest, elevation, and NSAIDs. The cheapest antiviral to treat this is _____ _____.
ORAL acyclovir.
NOT topical cream! It is very expensive!
Paronychia with abscess: Acute infection of the cuticle or soft tissue around the fingernail. The infected area appears red and swollen with purulent exudate trapped under the cuticle area. Treatment is ______ with ____ ____ to drain abscess. Soak finger TID with _____ ____.
I&D; #11 scalpel
epsom salt
How is subungal hematoma treated?
By ________.
trephination.
Use #18 gauge needle and heat up tip. Position straight at 90 degrees and apply steady pressure until blood starts to drain. Remove. Press nail gently to evacuate the blood. May lose nail, but it usually grows back.
Systemic lupus erythematosus:
Chronic autoimmune multisystem disease that affects nearly all organs of the body. Cause is unknown. More common in women. May have concurrent Raynaud phenomenon. Presents with a ____ (____) _____. The ANA is usually positive. Usually has lymphadenopathy and joint swelling, pain, optic neuritis.
malar (butterfly) rash
Systemic lupus erythematosus:
Is treated with SPF ___ or >, and _________.
55; Plaquenil
A skin condition caused by the poxvirus. Has DOME-SHAPED LESIONS WITH CENTRAL UMBILICATION (WHITE PLUG). More common in children, spread by skin to skin contact. Can be an STD in sexually active teens/adults if found in genitals (test for STDs). What is this?
_________ ________
molluscum contagiosum
Treatment for molluscum contagiosum is ________ _______
watchful waiting
Rubella (3-day measles or “German measles”):
Can cause major birth defects if the mother is infected in the first 12 weeks of ehr fetus’s development.
A pregnant woman has a negative rubella titer. When should the MMR be administered?
Only in the postpartum period or later! NEVER during pregnancy!
Rubeola:
About 2-3 days before onset of rash (prodromal period), tiny white spots or small white papules appear on the buccal mucosa, called _______ ________.
Koplik’s spots
*** Think rubeOla - kOplik —> both have an O.
Rubella does not have an “O”.
Name this infection/condition:
About 2-3 days before onset of rash (prodromal period), tiny white spots or small white papules appear on the buccal mucosa. About day 3-5, a papulosquamous rash appears first on the face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. When rash appears, fever may spike to 104.
Rubeola
Auscultation areas for murmurs:
Aortic valve area:
2nd ICS, RIGHT sternal border
Auscultation areas for murmurs:
Pulmonic valve area:
2nd ICS, LEFT sternal border
Auscultation areas for murmurs:
Erb’s point (diastolic murmurs):
3rd ICS, LEFT sternal border
Auscultation areas for murmurs:
Mitral area: (diastolic)
5th ICS by the MCL
the APEX!!!!
First-line diagnostic test for murmurs:
echo with doppler
Systolic murmurs: Pneumonic is MR ASS is an MVP" which stands for: MR: AS: S: MVP:
mitral regurgitation
aortic stenosis
systole
mitral valve prolapse
Name the cardiac murmur:
Blowing or high-pitched holosystolic/pansystolic murmur that may radiate to the LEFT AXILLA. Is at the apex of the heart, 5th ICS by the MCL:
mitral regurgitation
***Name the cardiac murmur:
A SYSTOLIC ejection murmur. May radiate to the NECK.. At the 2nd ICS by the right upper sternum, at the base (top) of heart:
Aortic stenosis
Name the cardiac murmur:
Mid-SYSTOLIC click with late systolic murmur at the apex, 5th ICS by the MCL:
Mitral valve prolapse with regurgitation
Diastolic murmurs: Pneumonic is "MS ARD-e" which stands for: MS: AR: D: e:
mitral stenosis
aortic regurgitation
diastole
Erb’s point
Name the cardiac murmur:
Low-pitched diastolic rumbling murmur that is loudest at the apex. Dyspnea is the most common symptom. A-fib is common. At the 5th ICS by the MCL.
Mitral stenosis
Name the cardiac murmur:
Early diastolic decrescendo blowing murmur. Best heard at 3rd and 4th ICS at the left sternal border (Erb’s point).
Aortic regurgitation
A 70 year-old reports a history of rheumatic fever as a child. She reports being short of breath when climbing up the stairs during the past few months. During the cardiac exam, the NP hears a low-pitched diastolic rumbling murmur with a loud S1 heart sound that is best heard in the apex. Which of the following is most likely? 1 Aortic regurgitation 2 Mitral stenosis 3 Mitral regurgitation 4 tricuspid regurgitation
2 Mitral stenosis
During the routine physical exam of a 60 year-old female, the NP notices a late diastolic murmur. It is a high-pitched decrescendo murmur that is located on the 3rd ICS at the left sternal border (Erb's point). Which of the following is most likely? 1 Aortic regurgitation 2 mitral stenosis 3 mitral regurgitation 4 tricuspid regurgitation
1 Aortic regurgitation
A medium-pitched harsh mid-systolic murmur best heard at the right side of the sternum at the second ICS of the chest. It radiates into the neck. Which of the following is most likely? 1 Aortic stenosis 2 pulmonic stenosis 3 aortic regurgitation 4 mitral stenosis
1 Aortic stenosis
Heart sounds: S1 to S4:
S1= Systole
S2= Diastole
S3 = _____ _______ (_______ _______)
Early diastole (ventricular gallop)
S3 indicates _____ ________. It is more common in ________/______ _______.
HEART FAILURE
CHILDREN/YOUNG ADULTS
S3 (early diastolic heart sound) is a ____ ______ during pregnancy. It is abnormal after the age of ____.
normal finding
40
S4 indicates ____ ______. The most common cause is _____. Can be a normal finding in the elderly.
late diastole.
LVH
S3 and S4 - how to remember who they are common in:
“3 is less than 4” - S3 is the ______, S4 is the ______.
children; elderly
Children are younger than elderly
***Murmurs: Grading system:
Important to focus on just grades I - IV for exam.
Grade I: Heard only at ________ _______ (no thrill)
Grade II: _____ to _____ murmur (no thrill)
Grade III: _____ murmur that is ______ _____ (no thrill)
Grade IV: ______ ______ _____ is _______
optimal conditions
mild to moderate
loud; easily heard
First time thrill is palpated
** A-fib:
Evaluate each patient for need of antithrombotic therapy (____ ____ _____ raises risk).
**INR SHOULD BE ___ to ____!
heart valve abnormality
2 - 3
*** A-fib:
Classic presentation is someone who complains of sudden onset of heart palpitations accompanied by weakness, dizziness, fatigue, dyspnea. They may complain of chest pain and feeling like passing out (pre-syncope to syncope). Rapid and irregular pulse may be more than 110 per minute with hypotension. Is the _____ _______ arrhythmia in the US. People with a-fib should NEVER take __________!
most common
stimulants
A-fib:
Use the _________ score to assess for a-fib stroke/emboli risk.
CHA2D2-VASc
A-fib and the CHA2D2-VASc score: (see p. 39)
What are the highest risk factors to start anticoagulation?
________ history and ______
stroke/TIA/thromboembolism hx
Age 75 or older
A-fib and the CHA2D2-VASc score:
If score equal to or > ____, (moderate to high risk), recommend chronic anticoagulation with coumadin, Pradaxa, Xarelto, or Eliquis. Those with valvular problems can ONLY have ________.
2
warfarin
A-fib and chronic anticoagulation:
Factor Xa inhibitors do not require regular blood testing or dietary restrictions (Pradaxa, Xarelto, Eliquis). Warfarin not only requires INR monitoring (needs to be 2-3), but also has drug interactions. People in warfarin CANNOT take _______ durgs!
Sulfa
Factor Xa inhibitors drug interactions:
________, _________, and _____ reduce absorption
Antacids, H2 blockers, PPIs
Warfarin drug interactions:
______ drugs
_______
NSAIDS
Sulfa
macrolides
What is warfarin used for?
Valvular and non-valvular A-fib
Warfarin: It takes ___ to ___ days for INR to change.
2 to 3
Warfarin:
_______ is an antagonist
Vitamin K
Warfarin education: Too much vitamin K will decrease INR. High vit K foods are B C B G M
broccoli cabbage brussel sprouts green leafy vegetables mayonnaise
Warfarin dosing - Adjustments of maintenance dose:
INR 3.1 to 4.0 without presence of bleeding - decrease maintenance dose by ____% per week.
INR 4.1 to 5.0 without presence of bleeding -
_____ ____ dose. ______ weekly dose by ____%.
10%
Hold one; Decrease 10%
PSVT: Abrupt onset of palpitations that end abruptly. Initial treatment is usually ______ _______. Attacks last a few seconds or several hours. Heart rate of ____ to ____ beats/minute.
vagal maneuvers
160 to 240
pulse deficit:
Count the ____ and ____ radial pulses at the same time, then subtract the difference between the two.
apical; radial
Pulsus paradoxus:
Defined as a decrease in the systolic BP of > ___ mmHg during _______.
10
inspiration
pulsus paradoxus:
Certain pulmonary and cardiac conditions that compress the chambers of the heart (impair diastolic filling) can cause exaggerated decrease of the systolic pressure of more than 10 mm Hg (a drop of less than _____ mmHg is NOT pulsus parodoxus.
Cardiac cause: cardiac tamponade, pericardial effusion, acute MI, constrictive pericarditis
Pulmonary cause: severe _______, tension pneumo, emphysema
10
asthma
Orthostatic hypotension:
A decrease in the systolic BP of at least ____ mmHg or the diastolic BP of at least ____ mm Hg within ___ minutes upon standing which may be accompanied by symptoms such as lightheadedness, dizziness. The best way to check BP to detect orthostatic hypotension is in the ______ and _____ positions
20
10
3 minutes
supine and standing
Impending AAA rupture;
Elderly male who is a _____ or ___-______. C/O sudden onset of severe abdominal pain accompanied by severe ___ ____ pain
smoker; ex-smoker
low back
What is the most common cause of sudden death in young healthy athletes?
hypertrophic cardiomyopathy
During sports physical ask if there is a family hx of _______
cardiomyopathy
Acute infective endocarditis (bacterial endocarditis):
_____ presents in 90% of patients, chills, anorexia, malaise, night sweats, weight loss. About 95% have _____ _____.
Fever
heart murmurs
Acute infective endocarditis (bacterial endocarditis):
Some patients have petechiae, splinter hemorrhages in nailbed, _______ ____, ____ ____, or ____ ____.
Janeway lesions
Osler’s nodes
Roth spots
Endocarditis PROPHYLAXIS:
1st-line: _______ __ hour before procedure
PCN-allergic: Either _____, ____, or ______.
Is post-treatment prophylaxis recommended?
Amoxicillin; 1
Keflex; Cleocin, Zithromax
NO
Endocarditis prophylaxis for high-risk patients:
______ ____ ____, hx of infective endocarditis, many cyanotic congential heart diseases, ______ _____, or other stigmata of endocarditis (Osler’s nodes, etc)
Prosthetic heart valves
heart failure
Endocarditis prophylaxis procedures:
D
A
B
dental work
adenoidectomy (and tonsillectomy)
bronchoscopy (or any invasive resp. tract procedure)
HTN is a major risk factor for stroke, MI, vascular disease, an d CKD. Rule out SECONDARY HTN if:
A
T
R
Age (< 30 when diagnosed) or > 50
Target organ damage
Renovascular cause
HTN target organ damage: P U L C H K
PVD UA with protein, RBCs LVH Carotid plaques Heart failure Kidneys
HTN secondary hypertension causes:
______ ______ stenosis
renal artery
Renal artery stenosis (causes of secondary hypertension - NEVER use ____ or _____ (antihypertensives)
Presents with a ____ in the _____ _____/flank or ____ kidneys
ACEIs or ARBS
bruit; upper abdomen
enlarged
Renal artery stenosis:
Diagnostic testing includes ______ _____ ultrasound, creatinine, and renal function.
The ____ kidney is always lower than the left.
Duplex doppler
right
Secondary hypertension:
Pheochromocytoma:
Triad: ______, _______, and ______. Random episodes. Gradually resolves within hours.
headache, sweating; tachycardia
Secondary hypertension:
Cushing’s:
Classic findings of abdominal obesity with proximal muscle wasting (large abdomen with skinny arms and legs) with roundish face and acne. Striae red to purple color on the breasts, abdomen, arms, thighs, dorsal hump. Ask patient if taking __________.
Labs are late-night salivary ______ and 24-hour _____ _______ _______.
steroids
cortisol
urinary free cortisol
Addison’s disease causes the opposite of HTN. It is aka primary adrenal insufficiency, hypocortisolism. Severe loss of cortisol and aldosterone. Craving of ______ foods, ______ face, knuckles, palmar creases, wrists. Fatigue, N/V, diarrhea, weak muscles, ________.
salty
hyperpigmented
hypotension
Addison’s disease:
Labs show elevated ______, low ________. Dx lab is morning serum ______, salivary cortisol, ______ stimulation tests, basal renin, and aldosterone levels.
potassium; sodium
cortisol; ACTH
Coarctation of the aorta can cause secondary hypertension. Normally, the SBPs of the legs are higher than arms. In coarctation of the aorta, the BP is ______ in the legs.
lower
Other causes of secondary HTN: S E N D
Stimulants
Estrogens
NSAIDs
Diet
American College of Cardiology (ACC) vs JNC-8 for staging of HTN:
ACC JNC-8
normal < ____ normal < ______
elevated (preHTN) ___-___ ____ to _____
Stage 1 ___ to ____ _____ to _____
Stage 2 ____ to ____ ____ to _____
ACC JNC-8
normal < 120 <120
elevated 120 - 129 120 - 139
Stage 1- 130 - 139 140 - 159
Stage 2- > or equal to 140 > 160
How should BP be measured?
Measure after patient has _____ ____ _____.
Support arm (resting on a table)
Measure BP in ___ ____, and use _____ reading arm for measurements afterward.
Take 2 readings per visit 1-2 minutes apart and _____ readings.
emptied their bladder
both arms; higher
average
How to diagnose HTN:
Two readings taken at least one minute apart and average them, taken on __ to ___ separate visits.
If BP is > _____/_____ or higher, the patient has HTN.
The goal BP for most patients is < ____/____
2 to 3
130/80
130/80
ACC recommendations for HTN:
1st-line treatment is _________.
Lifestyle
ACC recommendations for HTN: 1st line treatment is lifestyle to include: weight loss heart healthy diet (DASH) restrict sodium increase \_\_\_\_\_ reduce alcohol exercise
potassium
Lifestyle plus medication for tx of HTN:
Diabetic, CKD, hx of MI, ACS, stroke, CKD
High risk of ASCVD (10 year ASCVD risk of ___% or higher).
Pay more attention to _______ status and psychosocial stress as risk factors for HTN.
10
socioeconomic
What drugs should be avoided with patients who have HTN, arrhythmias, seizures, stroke, mania, post-MI?
Any _________.
stimulants
JNC-8 HTN tx guidelines:
For CKD and diabetes BP of 140/90, include _____ or ____
ACEI or ARBs
JNC8 guidelines in treating BPs 140/90 in
Blacks: _____ and ______
Non-blacks: ______, _____, ____, and ____. (____ work for everyone)
CCBs and thiazides
thiazides, ACEIs, ARBs, CCBs. (CCBs work for everyone)
ACC’s goal for BP is < ____/_____ (this is their definition of HTN)
130/80
BP treatment for HTN in someone with SOB and JVD (heart failure) is ______ or ______ once stable.
ACEI or ARB
If question asks about treatment for HTN with heart failure, pick ____ or _____
ACEIs or ARBs
ACC recommends an ______ for tx of HTN in those with a-fib
ARB
ACC recommends ______, ______, and/or _____ in treating HTN in pregnancy.
Avoid ACEI, ARB
methyldopa, nifedipine, and/or labetalol
Thiazide diuretics work by increasing excretion of Na+, K+, and chloride, and decreasing ______ _______ excretion
urinary calcium
Thiazides:
________ is a longer-acting choice
Chlorthalidone
Side effects of thiazide diuretics: H H H H
hyperglycemia (careful with DM)
hyperlipidemia
hyperuricemia (can precipitate gout)
hypokalemia and hyponatremia
Thiazide diuretics help with osteoporosis by ______ ______ ____ _____ of ________. It has a favorable effect on bone mineral density and long-term use decreases risk of _______ fractures.
slowing down urinary excretion; calcium
hip
Thiazide diuretics:
Do not use in people with severe _______ allergy
sulfa
Thiazide diuretics:
Contraindicated in those with _______.
gout
Loop diuretics examples:
________ and ________
Lasix, Bumex
Potassium-sparing diuretics:
S_________
A_______
T_________
spironolactone
amiloride
triamterene
Potassium-sparing diuretics:
Contraindications:
________
hyperkalemia
Avoid combining potassium-sparing diuretics with _____/_____.
ACEI/ARBs
Can you give a patient with a true sulfa allergy HCTZ?
NO. Use a K+-sparing diuretic like triamterene
An adverse effect of spironolactone includes
__________ and hyperkalemia
galactorrhea
All ______ should be on an ACE
diabetics
What is a rare adverse event with ACEI/ARBs that may be life-threatening?
Angioedema
Beta 1 receptors are in the ______ and ______
heart; kidneys
“ONE heart”
Beta 2 receptors are in the ______, liver, GI tract, uterus, muscle
lungs
TWO lungs
Beta blockers: Do NOT ________ ________.
discontinue abruptly; wean slowly.
beta blockers: acute withdrawal can cause exacerbation of _______ symptoms
ischemic
Beta blockers: Adverse effects: B B E D
bronchospasm (b/c lots of beta receptors on lungs)
bradycardia
exacerbation of PAD
depression, fatigue, ED
HTN and COPD - do NOT use ____ _____!
beta blockers
Beta blockers contraindications:
H
H
B
Heart failure.
heart block
bradycardia
***Diabetic patients on beta blockers: Can blunt or worsen the __________ ________.
hypoglycemic response
Calcium channel blockers are indicated for HTN, ________ HTN, _________, cardiomyopathy, and ______ ______ prophylaxis.
pulmonary; Raynaud’s
migraine headache
Calcium channel blockers:
______ are more potent vasodilators and have little to no negative effect on cardiac contractility or conduction. Used for HTN and chronic stable angina.
Suffix: PINE
Dihydropyridines
Calcium channel blockers:
___________ have a greater depressive effect on cardiac conduction and contractility. Less potent vasodilators. Used for HTN, chronic stable angina, arrhythmias. Ex. Verapamil, diltiazem.
non-dihydropyridines
Calcium channel blockers:
Contraindications:
_____ _____
____ _____
heart block
heart failure
Calcium channel blockers:
Side effects:
______ and ________
edema; constipation
alpha-1 blockers: blocks alpha receptors in peripheral arterioles resulting in profound peripheral vasodilation
Relaxes smooth muscles in the ______ and _____ & can therefore treat both HTN and ______.
prostate; bladder
BPH
BPH can be treated with both ______ and _______
terazosin; doxazosin
Do NOT mix CCBs with _______ _______, b/c it can elevate serum levels of verapamil, felodipine, nifedipine, nicardipine, etc
grapefruit juice
Dizziness and postural hypotension can result after starting _______ __ _______.
Alpha 1 blockers
Peripheral arterial disease or Chronic venous insufficiency?
Shiny pale skin on the lower leg. Hairless and dry skin.
peripheral arterial disease
Peripheral arterial disease or Chronic venous insufficiency?
brawny to brown color. thicker skin. lymphedema. pitting edema. pigmentary changes (hemosiderin). varicose veis, spider veins in lower extremity
chronic venous insufficiency
Peripheral arterial disease or Chronic venous insufficiency?
Pedal and posterior tibial pulse decreased to non-palpable. Increased cap refill time
Peripheral arterial disease
Peripheral arterial disease or Chronic venous insufficiency?
palpable pusles
no gangrene.
Venous leg ulcers esp on the medial malleolus delayed healing
Chronic venous insufficiency
Peripheral arterial disease or Chronic venous insufficiency?
Intermittent claudication. Painful. If severe, rest pain, gangrene, LE ulceration
Peripheral arterial disease
Peripheral arterial disease or Chronic venous insufficiency?
Aching sensation and lower extremity heaviness that worsens as day progresses
Chronic venous insufficiency
Peripheral arterial disease diagnosed when ankle-brachial index on duplex ultrasound is < ____.
1.0
Peripheral arterial disease or Chronic venous insufficiency?
Treatment is CV risk reduction (statins), smoking cessation, long-term antiplatelet treatment, revascularization surgery
Peripheral arterial disease
Peripheral arterial disease or Chronic venous insufficiency?
Treatment is ASA 300 mg daily, pentoxifylline, horse chestnut extract, compression hose therapy, elevate legs above heart x 30 min 3-4 times daily
Chronic venous insufficiency
***Peripheral arterial disease or Chronic venous insufficiency?
Exercise by walking daily helps develop collateral circulation
Peripheral arterial disease
With peripheral arterial disease, exercising by walking daily helps ______ ______ ______.
develop collateral circulation
Chronic venous insufficiency: Elevate legs to decrease swelling. Leg exercises such as ______ and _____ ____- (not prolonged)
walking
ankle flexion
Peripheral arterial disease:
Do NOT ___ _____ ____!
wear compression hose
What is the ankle brachial index used for?
To evaluate the severity of _____ ________ in ___.
arterial blockage; PAD
How is the ankle brachial index performed?
BP cuff measures the resting _______ of the ankle compared to the _____ of the brachial artery.
Anything < ____ is abnormal.
SBP
SBP
1.0
DVT:
Classic presentation is swelling of affected limb accompanied by erythema. May be painful or asymptomatic. Lower leg/calf circumference difference of > ___ cm.
> 3 cm
If a person has a positive _______ sign, then they have a DVT! (for the exam only)
Homan’s (pain on dosiflexion of foot)
How is calf circumference measured?
Measure ____ ___ below the ______ _____.
10 cm; tibial tuberosity
Superficial thrombophlebitis:
Venous inflammation caused by thrombosis of a superficial vein. More common on the LE. Caused by IV catheter, injury, septic. Usually benign/self-limiting. Classic case is red and ____-____ superficial vein (______, _____ _____) that is painful and tender to touch. May mimic cellulitis. If septic phlebitis, refer to ED.
cord-like
indurated, palpable cord
Superficial thrombophlebitis:
Treatment depends on causation. If septic, 50% mortality rate, large of severely inflamed, refer to hospital. Mild cases can be treated with ____ and ______. _____ _____ or ACE bandages.
NSAIDS; ASA
compression stockings
Primary Raynaud’s disease is mostly seen in _______.
females
Primary Raynaud’s disease:
Adult female complains of recurrent episodes of cold, numb, and painful fingertips triggered by _____ ____ and/or ______. Finger and toes change color (white, blue, red) which resolves ________. Higher risk with __________ ________.
cold weather
stress
spontaneously
autoimmune disorders
What med is used to treat Raynaud’s symptoms?
______ _______ _______ (long-acting) such as ____ or _______.
calcium channel blockers
nifedipine; amlodipine
Heart failure symptoms:
Left = ____ (orthopnea, PND, cough with pink, frothy sputum, edema)
lung
Heart failure symptoms: _____ = RUQ (GI)
right (side)
Heart failure - which side is failing - right or left?
Orthopnea, PND, cough with pink, frothy sputum, edema
left
Heart failure - which side is failing?
PE shows S3, crackles, decreased breath sounds, wheezing
Left
Heart failure - which side is failing?
PE shows JVD, enlarged liver, enlarged spleen
CXR shows enlarged heart size, interstitial edema
right
Heart failure - which side is failing?
symptoms of anorexia, nausea, RUQ pain and lower extremity edema
Right
Preferred treatment (1st line) for heart failure is _____ ______ once patient is stabilized.
ACE inhibitor
***NYHA Functional Capacity for patients with heart disease:
Fill in the symptoms for each classification:
Class I:
Class II:
Class III:
Class IV:
Class I: NO limitations of physical activity by symptoms
Class II: Ordinary physical activity results in fatigue, dyspnea, or other symptoms
Class III: Marked limitation in normal physical activity
Class IV: Has symptoms at rest or with any physical activity
What is the “gold standard” for diagnosing STEMI or NSTEMI?
EKG
Which leads correspond to anterior wall (in diagnosing MI)?
V2 and V3
Hypercholesterolemia:
Total cholesterol goal is < ____. Value of ____ is high.
< 200; 240
Lipid profile: LDL should be < ____
For DM, goal should be _____.
If no risk factor, LDL < ____ is acceptable.
100
70
129
Lipid profile:
HDL goal is > ____ for men and > ____ for women
40; 50
Triglycerides: should be < ____
150
When triglycerides are > ____, the primary goal is to LOWER THEM FIRST to prevent pancreatitis before addressing the ___ cholesterol
500
LDL
What is 1st-line tx for dyslipidemia?
Therapeutic ______ ________, avoid alcohol, weight loss, exercise. If trigs >800, consider drug therapy
lifestyle changes
What are first-line MEDS for high triglycerides?
fibrates
Statins and fish oils are more for LDLs
Fibrates:
fenofibrate, gemfibrozil. Do not combine gemfibrozil with _________ due to risk of _______ failure
statins; hepatic
Avoid or be very careful with combination of statins and ______ it increases risk of hepatotoxicity and rhabdomyolysis
niacin
A contraindication to fibrates is ________ dysfunction, _________ disease, severe _____ disease
hepatic; gallbladder; renal
Bile acid sequestrants:
Common side effects are _______, bloating, _____ pain
flatulence; abdominal
Which drug class is best at lowering LDL levels?
statins
The test for rhabdomyolysis is ______ _______
creatine kinase
For a patient with VERY high LDL (190 or > but no ASCVD risk), or ASCVD or equivalents such as hx of MI, CAD, CVA, TIA, the treatment is with a ______ ________ ______ such as _______ or _________
high intensity statin
Lipitor or Crestor
Moderate-intensity statins are indicated for those with ________, LDL ____ to ______, or older than 75 years or not a candidate for high-intensity statin
diabetes
70 to 189
The most common cause of death for diabetics is ______ _______
heart disease
What is this?
Sudden onset of dyspnea and cough, which may be productive with pink-tinged sputum. Tachycardia, pallor, feelings of impending doom.
pulmonary emboli
How is anaphylaxis treated in the outpatient clinic?
epi 1:1000 IM or subQ before calling 911 if NP is alone.
*** anaphylaxis is what type of allergic reaction?
Type I IgE-mediated
Right lung has ___ lobes
Left lung has ___ lobes
3
2
Normal respiratory drive responds to _______ in _____ ____
changes arterial CO2
Lung Auscultation:
Base/lower lobes have ____ breath sounds
Bronchi/upper airways have _____ to _____ breath sounds
vesicular
bronchial to bronchovesicular
Lung percussion:
Resonant is ________.
Dull indicates _____ _____ or over _____, _____, or ____.
Hyper-resonant indicates _________.
normal
lobar pneumonia
bones, liver, heart
emphysema
Name this physical exam technique:
Patient will say “99” - palpate both sides on the back - use finger pads (one hand over each lung and compare sides)
tactile fremitus
upper airways:
More fremitus (vibrations) in the lower lobes is _________.
Increased fremitus on one lobe indicates:
Decreased fremitus indicates:
normal
lobar pneumonia
emphysema/COPD
Egophony is when the patient says “____” and it sounds like “___”. This is _______.
eee
aaa
abnormal
The patient says “eee” and it sounds like “aa”. This is ______ egophony and indicates ______ ______ over affected lobe (_________).
positive; lobar pneumonia
consolidation
USPTF recommendation lung cancer screening recommends Adults age ____ to ____ years old with a ___ pack-year or __ - __ pack year history have an annual screening
55; 80
30; 40 - 50
A 30 pack-year history means a person smoked ___ pack per day for ____ years
one
30
***USPTF recommendation for lung cancer screening is a ___-_____ ____ ___ ____ for adults aged 55 to 80 with a 30 or 40-50 pack-year history
low-dosed helical CT scan
What is a pack-year?
Multiply the number of packs smoked per day by the # of years the person has smoked.
***What is the definition of COPD?
What is the O2 sat in COPD?
A FEV1/FVC ratio of < 70% of expected diagnostic
< 92%
How does COPD look on a chest x-ray?
hyperinflation/hyperexpansion with increased chest size and flattened diaphragms
Name the condition:
Irreversible loss of elastic recoil of the lungs and alveolar damage.
COPD
Severity of airflow limitation is staged for COPD using the _____ criteria.
GOLD Global Strategy of the Diagnosis, Management, and Prevention of COPD
Chronic bronchitis: Defined as chronic _____ with increased _____ _____ on most days for at least ____ months per year for at least ____ consecutive years
cough
mucus production; 3
2
Chronic bronchitis has a copious amount of ____ to ____ color sputum
whitish
yellow
Emphysema has an increased _____ ____, and ____ breath and heart sounds.
Expiratory phase is markedly ______.
_____-_____ breathing is helpful.
AP diameter; decreased
prolonged;
Pursed-lip
Physical exam findings in emphysema include:
Percussion: _______
tactile fremitus:__________
Egophony: ______
hyperresonant
decreased
decreased
Name the condition:
Acute onset fever/chills with productive cough of yellow to green to rusty colored sputum and pleuritic chest pain
Community-acquired pneumonia
with community acquired pneumonia, rusty/blood-tinged sputum is indicative of: ________ ________
streptococcus pneumoniae
with community acquired pneumonia, on physical exam the lung sounds will be ______/_____, _______, and ______ sounds
crackles/rales; wheezing
bronchial
With ccommunity-acquired pneumonia, if consolidation is present, there will be positive ______ ______,
______, and
____ _______
tactile fremitus
egophony
whispered pectroliquy
***A pneumonia with lobar consolidation is indicative of _______ pneumonia
bacterial
The gold standard in diagnosing pneumonia is a ______ ____ with ____ and/or _____ _____ accompanied by clinical signs and symptoms
chest x-ray; infiltrates; lobar consolidation
After treating pneumonia, repeat chest x-ray in ___ _____ especially in high risk patients like _______.
6 weeks; smokers
In a RML pneumonia, there will be _______ (_____ _____ color) at middle lobe of right lung.
consolidation (white opaque)
Labs for pneumonia will show a WBC > 11.0 and elevated ________ (> ___%) with a ____ ____ (>__% increase) in _____ cells
neutrophils; 70%; left shift; 6%
band
For pneumonia, the ______ score is used to determine if the patient should be treated inpatient or outpatient. If score is > ___, should be hospitalized.
CURB65
1
CURB65 score for determining inpatient vs outpatient treatment: C U R B \_\_\_\_ years or older
Confusion Urea - BUN > 19 Resp rate > 30 BP - systolic < 90 Age 65
*** The most common causes of community-acquired pneumonia are:
1.
2.
- strep pneumoniae
2 H. influenzae
Pathogens of community-acquired pneumonia:
Most common cause of death is:
_______ ______
strep pneumoniae
Pathogens of community-acquired pneumonia: \_\_\_ \_\_\_\_\_ (smokers, COPD)
H. influenzae
Community-acquired pneumonia OUTPATIENT treatment:
1st-line: ________
macrolides - Azithromycin, clarithromycin
Community-acquired pneumonia OUTPATIENT treatment IF patient had abx within last 3 months:
______/______ PLUS __________/________
Alternative:
______
azithromycin/clarithromycin
amoxicillin/Augmentin
doxycycline
Atypical pneumonia/Mycoplasma pneumonia:
Top 2 atypical bacteria are:
1
2
1 mycoplasma pneumoniae
2 chlamydia pneumoniae
Name the process identified by this classic case scenario.
Presents with malaise, fever, headache, myalgias, non-productive cough sometimes accompanied by sore throat, sinus congestion, or acute AOM. Chest x-ray shows bilat infiltrates. Breath sounds progress to rales/rhonchi, and/or wheezes within a few days
atypical pneumonia
According to the Infectious Disease Society of America and the American Thoracic Society Treatment Guidelines, all of the following are false statements regarding the diagnosis of outpatient cases of CAP except:
- Demonstrate infiltrate on CXR is necessary to diagnose CAP.
- An increase in the neutrophils and a shift to the left is necessary to diagnose CAP
- A positive sputum culture is necessary to diagnose CAP
- Routine microbiologic diagnostic testing to identify the causative organism is mandatory for outpatient cases of CAP per IDSA.
- Demonstrate infiltrate on CXR is necessary to diagnose CAP
To diagnose pneumonia, the CXR must show:
demonstrable infiltrate on chest radiograph
The gold standard to diagnose pneumonia is the _____
CXR
Most common bacteria in pneumonia post-influenza is _____ ______ & ______ _______
strep pneumoniae & staph aureus
A viral URI (the ____ ____) is of the nose and pharynx only. Duration of __ to __ days with spontaneous resolution.
Physical exam: Lungs are clear; rhinitis with _____ mucus
common cold
7; 10
clear
Treatment for the common cold includes symptomatc only. Includes dextromethorphan for cough, ________ for nasal congestion, and ______. Increase fluids and rest.
pseudoephedrine
guiafenesin
Acute bronchitis:
Recent hx of common cold. Paroxysmal or severe coughing x __ ______ or longer.
Cough is dry or sometimes productive of _____ phlegm. Caused by adenovirus, flu, chlamydia pneumoniae
2 weeks
clear
Bronchitis: Symptomatic treatment - no antibiotics!
Antitussives: dextromethorphan, Tessalon Perles, honey
Wheezing: albuterol inhalers
Mucolytic: __________
guiafenesin
Name the condition:
Chronic airway inflammation that results in hyperresponsive airways and bronchoconstriction which is REVERSIBLE
asthma
