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Nurse Practitioner Exam > Set 1 > Flashcards

Set 1 Flashcards

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1
Q

Temporal arteritis labs/tx

A

ESR elevated; needs biopsy; ophtho for mgmt

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2
Q

Elevated WBC >12,000

A

Neutrophilia

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3
Q

Neutrophilia with bands

A

Left shift

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4
Q

Avulsed tooth

A

Transport in cold milk or commercial “Save-a-tooth”

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5
Q

Sensitivity

A

Ability of a test to detect a person with a disease

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6
Q

Specificity

A

Ability of a test to detect a person who is healthy

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7
Q

Cohort study

A

Follows a group who share some common characteristics: try to observe development of disease over time

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8
Q

Keisselbach’s plexus

A

Anterior epistaxis

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9
Q

Initial action

A

Interview

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10
Q

Gold standard test: sickle cell, thalasemia, G6PD

A

Hemoglobin electrophoresis

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11
Q

Allergy to PCNs: gram+ infection

A

Macrolide or clindamycin

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12
Q

Acute mononucleosis

A

usually teen with fatigue, sore throat, cervical LAD; if older patient may be mono reactitvation

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13
Q

Alpha thalasemia

A

Southeast Asians Filipinos

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14
Q

Iron deficiency anemia

A

Pica or spoon shaped nails

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15
Q

SLE

A

butterfly or malar rash

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16
Q

Polymyalgia rheumatica (PMR) tx

A

1st: long term steroids *long term risk for temporal arteritis

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17
Q

Finkelsteins

A

de Quervain’s tenosynovitis: pain aggravatted by passively stretching thumb tendons over the radial styloid in the flexion

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18
Q

Anterior drawer

A

+in ACL tear

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19
Q

McMurrays

A

Checks for meniscal injury: with patient lying flat (supine), knee fully flexed; grasp heel; leg is rotated on the thigh with the knee in full flexion and out of flexion; internally and externally rotate checking for a click

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20
Q

Diabetic retinopathy eye sx

A

neovascularization, hard exudates, cotton wool spots, microaneurysms

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21
Q

HTN retinopathy

A

AV nicking, silver wire/copper wire arterioles

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22
Q

DTR grading

A

0=absent; 1=hypoactive; 2=normal; 3=hyperactive; 4=clonus

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23
Q

S4

A

Benign in some elderly

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24
Q

Cutaneous anthrax

A

Cipro 500mg PO BID x 60 days or doxy 100 PO BID

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25
Q

Primary prevention

A

“prevention” performing actions to prevent a condition from occuring

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26
Q

Secondary

A

“detection” screenings: breast exam; genital self-exam

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27
Q

tertiary

A

“rehab” preventing complications, education, support groups, med side effects, limiting further harm

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28
Q

Bacterial vaginosis

A

alkaline ph (normal vag ph =4.0)-BV only vag condition with alkaline ph

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29
Q

Clue cells

A

BV: “mature squamous epithelial cells with numerous bacteria noted on cell borders”

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30
Q

Candida

A

Yeast: DC white curdlike with redness and itching; see WBCs, psseudohyphae, spores “spaghetti and meatballs”

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31
Q

Trichomonas

A

copious discharge, bubbly, green; +inflammation, itching, redness; considered STI–> treat partner

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32
Q

HCTZ side effect

A

hyperuricemia and hyperglycemia

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33
Q

CAP 1st line tx

A

macrolides

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34
Q

mortality

A

most common cause of death

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35
Q

morbidity

A

most common cause of disease

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36
Q

most common cancer death

A

lung cancer

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37
Q

most common cancer

A

skin

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38
Q

CDC mortality: dz most deaths

A

CVD

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39
Q

cancer highest mortality

A

lung

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40
Q

most common cause death adolescents

A

MVA

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41
Q

Cancer prevalence: female

A

breast; not considered a gyn cancer

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42
Q

cancer prevalence male

A

prostate

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43
Q

most common skin cancer

A

basal cell

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44
Q

highest skin cancer mortality

A

melanoma

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45
Q

GYN cancers

A

vulva, vaginal, cervix, uterine, ovary

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46
Q

most common gyn cancer

A

uterine; ovarian #2

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47
Q

torus palatinus

A

bony growth midline at hard palate of mouth, covered with normal oral skin; painless; does not affect function

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48
Q

geographic tongue

A

multiple fissures; irregular smoother area on surface; looks like topo map; benign

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49
Q

leukoplakia

A

not benign: slow growing white plaque that has a firm hard surface—> precancerous lesion requires biopsy: cause poorly fitting denturs or chewing tobacco

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50
Q

oral/hair leukoplakia

A

painless white patch: appears corrugated on lateral tongue: HIV/AIDS, EBV of tongue

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51
Q

breast screening

A

mammo w/wo CBE start age 50, then every 2 years until age 75; women 40-49 mammo based on individual risk factors and history

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52
Q

ovarian cancer screening

A

no recommended regular screening

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53
Q

ovarian cancer

A

older female c/o abd or pelvic symptoms, stomach bloating, low back ache, constipation: palpate ovary; must r/o ovarian cancer in any woman with palpable ovary

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54
Q

population for ovarian cancer workup

A

early menarche, late menopause, endometriosis, PCOS, fam hx, +BRCA 1/2; initial CA125; intravag US

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55
Q

AAA screenign

A

1 time (male 65-75) with 30+ pack year smoking history

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56
Q

Barretts esophagitis

A

precancerous lesion of esophagus

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57
Q

Tanner stage 1 male and female

A

pre-puberty

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58
Q

Tanner stage 2 female

A

breast bud/areola start to develop

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59
Q

Tanner stage 3 female

A

breast bud/areola continue to grow (one mound no separation)

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60
Q

Tanner stage 4 female

A

nipples/areola become elevated from breast (secondary mound)

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61
Q

Tanner stage 5 male and female

A

adult characteristics

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62
Q

Tanner stage 2 male

A

testes with scrotum enlargement (scrotal skin starts to darken with more ruggae)

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63
Q

Tanner stage 3 male

A

penis grows larger (length) scrotum continues to enlarge

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64
Q

Tanner stage 4 male

A

penis wider

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65
Q

physiologic gynecosmastia

A

disc-like breast tissue, mastitis, asymetrical,

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66
Q

pseudogynecomastia

A

increased risk with overweight/obese

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67
Q

high potassium foods

A

potatoes, apricots, brussel sprouts

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68
Q

high tyramine foods

A

aged cheese, red wine, chocolate (increased reactions with MAOIs)

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69
Q

Gluten

A

avoid in celiac disease (wheat, rye, barley, oats)

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70
Q

Gluten free

A

corn, rice, potato, soy, tapioca

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71
Q

High mag foods

A

(decrease BP, dilates blood vessels): some nuts, beans, whole wheat

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72
Q

asthma child outcome

A

ability to attend school full-time and to play normally every day

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73
Q

Anaphylaxis tx primary care

A

epi 1:1000 o.3mg IM then 911

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74
Q

anaphylaxis in ED

A

oxygen, IV, epi, H2 blockers, H1 blockers, bronchodilator, systemic glucocorticoids

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75
Q

anaphylaxis

A

type 1 IgE mediated; may have biphasic reaction–>reoccurs within 8-10 hours. prescribe medrol dose pack

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76
Q

Elderly patient with weight loss

A

high rate of complications and increased risk death

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77
Q

Pathologic weight loss

A

unintentional weight loss >10%

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78
Q

maculopapular

A

has color and texture-small papules on red or raised skin lesions

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79
Q

varicella

A

maculaopapular with papules, vesicles, and crusts

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80
Q

fifth dz

A

maculopapular rash in lace-like pattern

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81
Q

pityriasis rosea (PR)

A

herald pathc; christmas tree pattern

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82
Q

vesicular rash on erythematous base

A

herpes simplex, genital herpes

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83
Q

scabies

A

nighttime pruritic rash, family members with similar symptoms, finger wens, waist, penis; treat all family members same time, wash all clothing, linen in hot water; high heat

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84
Q

S3 heart sound best heard

A

pulmonic area; pathognomic for heart failure

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85
Q

PPD

A

measure induration

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86
Q

pulmonary tb gold standard

A

sputum cx; treat with 3 drug regimin; reportable

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87
Q

INH therapy (isoniazid)

A

baseline lft and repeat monitoring

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88
Q

DJD

A

OA

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89
Q

atopic dermatitis

A

eczema

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90
Q

senile arcus

A

arcus senilis

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91
Q

acute otitis media (AOM)

A

purulent OM

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92
Q

serous OM

A

OME

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93
Q

group A beta strept

A

strept pyogenes

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94
Q

tinea corporis

A

ringworm

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95
Q

enterobiasis

A

pinworms

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96
Q

vitamin B12

A

cobalamin; cyanocobalamin

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97
Q

vitamin b1

A

thiamine

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98
Q

scarlet fever

A

scarletina

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99
Q

otitis externa

A

swimmer’s ear

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100
Q

condyloma acuminata

A

genital warts

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101
Q

tic doloureaux

A

trigeminal neuralgia

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102
Q

tinea cruris

A

jock itch

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103
Q

thalassemia minor

A

thalassemia trait (alpha/beta)

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104
Q

giant cell arteritis

A

temporal arteritis

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105
Q

psoas sign

A

ilipsoas sign

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106
Q

tinea capitas

A

ringworm of scalp

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107
Q

light reflex

A

Hirscberg test

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108
Q

sentinel nodes

A

Virchow’s nodes: left supraclavicular fossa

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109
Q

erythema migrans

A

early stage of lyme disease

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110
Q

SSRI

A

1st line MDD/OCD

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111
Q

benzos

A

anxiety/insomnia

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112
Q

mood stabilizer (lithium)

A

bipolar

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113
Q

TCAs

A

2nd line for depression; prophylactic for migraines, chronic pain, neuropathic pain *no TCA for SI–OD risk

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114
Q

carbamazepine

A

tegretol: anticonvulsant also used for chronic pain and trigeminal neuralgia

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115
Q

CAGE

A

screening for ETOH; cut down. annoyed by comments, guilt about drinking, early AM drinking

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116
Q

HTN JNC7 Stage 1 treatment

A

THiazide: good for osteopenia/osteoporosis: decreases calcium excretion by kidneys and stimulates osteoclast activity resulting in bone formation

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117
Q

ACEI

A

HTN with DM

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118
Q

HTN with migrains

A

beta blockers (without lung diseases)

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119
Q

Diverticula

A

usually asymptomatic, small polyps on colon wall diagnosed via colonoscopy, cause low intake of fiber, rare for those less than 50. mild cases managed OP: ABX cipro 500mg PO BID with flagyl 500mg PO TID x 10-14 days; recommend fiber and psyllium; diverticulitis if develops can be life-threatening

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120
Q

Rocky Mountain Spotted Fever

A

Emergent condition (Rickettsia Rickettsia): south central US, outdoor activities; presents classic rash wrists/ankles spreading centrally with involvement of palms/soles. systemic sx high feverm HA, myalgia, nausea. treat w/in forst 8 days or fatal. refer to ED. may be difficult to distinguish between meningococcemia and RMSF before BCx and LP. Doxycycline 100mg PO /IV x 7days

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121
Q

Lyme disease

A

Mid atlantic/new england states; erythema migrans rash; ixodes-deer tick bite; Spirochette Borrelia; doxycycline x 21 days

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122
Q

Menarche

A

cycle is irregular: months -2 years before

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123
Q

Leading causes of death in teens

A

1 cause of death in teens MVA; Homicide #2

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124
Q

Emancipated minor

A

<18: has full legal rights of adult; minors who are parents are not emancipated unless married. Criteria for emancipation: married, enlisted, legal emancipation

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125
Q

Angina

A

classic presentation CP precip by exertion, relieved by rest; history: several episodes of the same plus risk factors age, gender, lipids

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126
Q

AAA

A

pulsatile mass mid abd with bruit; older white male with hx smoking; rupture is abrupt, severe abd pain with low back pain, abd distension and shock sx

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127
Q

Tay-Sachs

A

Ashkanazi Jewish: progressive fatal disease, inherited, build up of plaques in brain-fatal

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128
Q

eGFR

A

sensitive indicator of renal function: <60 =kidney damage; affected by age, less sensitive in elderly; males higher; increased in african americans

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129
Q

BUN

A

waste products of protein intake: increased intake=increased levels; dehydration =increased BUN

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130
Q

Warfarin interaction

A

Bactrim; sulfa drugs interact with warfarin (increased levels=increased INR=inreased bleeding risk)

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131
Q

oral drugs 1st pass metabolism

A

drug swallowed-gi tract absorbs-portal circulation-liver metabolizes/biotransforms-releases systemic circ

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132
Q

1st pass metab

A

lowers amount of active drug available to body; drugs with high first pass effect-mostly deactivated and cannot be used by body; example is swallowed insulin-broken down in GI tract-bypassed by injection

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133
Q

drug metabolism

A

biotransformation: most active in liver (cytochrome p450 enzyme system) kidneys, gi, liver

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134
Q

drug excretion

A

liver-excreted in bile, urine, feces, resp gas (CO2), and sweat, most drugs are excreted in 2 or more systems

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135
Q

1/2 life

A

amount of time drug content decreased by 50%

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136
Q

area under curve

A

average amount of drug in blood after a dose given-measure of bioavailability after drug administered

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137
Q

minimum inhibitory concentration

A

lowest concentration of antibiotic that will inhibit growth of organisms

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138
Q

max concentration

A

highest concentration of drug after dose

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139
Q

trough

A

minimum concentration of drug after dose

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140
Q

problematic drugs-potent inhibitors of cytochrome p450

A

inhibits or slows drug clearance: increased risk of OD; macrolides, antifungals, cisapride, cimetidine, citalopram

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141
Q

narrow therapeutic index drugs

A

warfarin, digoxin, theophylline, carbamazepine, phenytoin, levothyroxine, lithium (check blood levels and TSH)

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142
Q

Pioglitazone (Actos)

A

a TZD: exacerbates CHF; do not use if CHF class 3 or 4, stop if develops SOB, weight gain, cough

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143
Q

atypical antipsychotics

A

resperidal, olanzapine, quietipine: increased weight gain, dm; monitorweight; black box for increased mortality in elderly; monitor tsh, lipids, bmi

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144
Q

bisphosphonates

A

alendronate; jaw pain/necrosis, CP diff swallowing, burning back pain; perfed viscous; take solo upon awakening with 8oz water (no juice), remain upright for 30 min

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145
Q

Statins

A

no mixing with grapefruit juice, drug induced hepatitis/rhabdo, high dose zocor highest risk rhabdo,

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146
Q

digoxin

A

ti 0.5-2; dig toxic/od anorexia, nausea, vomiting, arrythmias, confusion, visual changes (yellow-green)-digibind for severe toxicity

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147
Q

coumadin od

A

inr 5-9 w/o bleeding: hold warfarin 1-2 doses, recheck inr in 2-3 days until stable 2-3, once stable recheck monthly

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148
Q

coumadin and inr <2

A

stroke risk increased 6x;

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149
Q

thiazide diuretics

A

uncomp 1st line HTN agent; avoid with sulfa allergies; beneficial in osteoporosis; advers hyperglycemia, increased trigs, increased uric acid, hypokalemia

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150
Q

potassium sparing diuretics

A

alt to thiazides if sulfa allergic; black box warning for hyperkalemia; increased risk if renal impariment, dm, elderly; monitor serum k. advise no salt substitutes or k supplements, caution with ACEI/ARB increased risk hyperkalemia

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151
Q

Loop diuretics

A

Lasix/Bumex; indication for edema 2/2 chf; cirrhosis, renal disease, htn; excreted via loop of henle; more potent than hctz; adverse electrolyte changes hypokalemia, hyponatremia, decreased chloride; hypovolemia; hyponatremia; pancreatitis, jaundice, rash, ototoxic

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152
Q

Aldosterone antagonists

A

spironolactoneL indicatedhirsutism, htn, severe chf; advers galactorrhea, hyperkalemia; rare use in primary care 2/2 adverse affects; increased risk of cancers; black box increased risk of benign and malignant tumors

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153
Q

Beta blockers (beta antagonists)

A

indication: htn, post mi, angina, arrythmias, migraine prophylaxis; adjunct hyperthyroid, thyrotoxicosis; glaucoma=timolol; cardioselective =B1 only; adverse =bronchospasm, bradycardia, depression, fatigue, ercetile dysfunction, blunts hypoglycemic response (caution with DM patients)

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154
Q

ACEI/ARB

A

indication: HTN, DM, CKDavoid in pregnancy; adverse angioedema and anaphylaxis; ACEI=cough, hyperkalemia; cough usually in the first few months dry and hacking

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155
Q

CCB

A

indications: HTN, raynauds phenom; DHP vs non-dhp; do not give verapamil with erythromycin or clarithromycin; avoid with grapefruit juice; adverse is headache, peripheral edema, bradycardia, heart block, hypotension, qt prolongationconstipation most common side effect

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156
Q

Alpha blockers

A

indication: htn with coexisting BPH; terazosin (hytrin) 1mg PO qHS, not first line treatment except htn with bph; potent vasodilator; side effect dizzy/hypotension; severe fall risk at night–advise elderly

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157
Q

pharyngitis

A

Group A beta strept (pyogenes) 1st line=amoxicillin or pcn vk; if allergic give clarithromycin 250mg PO BID x10days (alternative to pcns is macrolides=azithromycin or clarithromycin)

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158
Q

Mono with strept throat

A

+mono spot and +cx GAS; avoid using amoxicilin or ampicillin 2/2 rash; use pcn vk or macrolide

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159
Q

atypical pneumonia

A

erythromycin-n/v common-not an allergy–>switch to azithromycin (z-pack); if allergic to macrolides swiitch to doxycycline; consider macrolide resistant strept pneumo if patient on macrolide within last 90 days

160
Q

pneumovax

A

primary prevention in all COPD patients

161
Q

bacteriocidal

A

kills bacteria

162
Q

bacteriostatic

A

inhibits bacterial growth and replication

163
Q

tetracycline

A

preg cat D; permanent discoloration of teeth (yellow-brown) and skeletal defects; treats acne age 13-14; doxycycline 1st line chlamydia/atypical bacteria; minocycline (more se and ae),

164
Q

acne

A

tetracycline 1st line mod severe acne/rosacea; adverse=photosensitivity; esophageal ulceration; ci pregnancy or children <8; do not give tetracycline for mild acne (comedomes) only topicals; mild-mode not responsive to topicals then topicla prescription agents like retin-a or benzamycin; consider adding tetracycline if moderate acne not responsive to topical prescription; tetracycline binds to some minerals (calcium, dairy products, iron, mg, zinc) best taken on empty stomach; may decrease OCP

165
Q

Doxycycline

A

1st line chlamydia (cervicitis, PID, atypical pneumonia); atypicals include mycoplasma

166
Q

side effects minocycline

A

dizziness and vertigo-advise patient to discard all expired tetracycline-degrades and becomes nephrotoxic or Fanconi’s syndrome

167
Q

Macrolides

A

cat B; associated with more drug interactions; erythromycin and clarithromycin-potent cyp34A inhibitors-increased interactions; erythromycin is not cyp34a therefore less interactions; carfeul using with MG, coumadin, ccb, benzos, salmeterol, anticonvulsants, or statins; adverse effects: GI distress, ototoxic, cholestasis, jaundice, qt prolongation

168
Q

cephalosporins

A

cat B: beta lactam family; bacteriocidal inhibists cell wall synthesis

169
Q

1st gen cephalo

A

gram + cellulitis/mastitis

170
Q

2nd gen cephalo

A

more broad spectrum_gram +and neg (sinusitis.OM

171
Q

3rd gener cephal

A

decreased against gram +, but increased gram -; n.gonorrhea, enteric bacteria

172
Q

rocephin

A

1st line gonorrhea

173
Q

mrsa skin

A

bactrim or clida 5-10 days

174
Q

anaphylaxis

A

type 1 ige mediated response

175
Q

penicillins

A

cat b: risk of cross-reactivity with cephalosporins; amoxicillin and ampicillin extended spectrum; gram + and some gram - (h.influenzae, e.coli, proteus mirabilis) advers=diarrhea, c diff, vaginitis; amoxicillin given to mono–>rash; use pcn vk

176
Q

fluorquinolones

A

gram neg and some atypicals (chlamydia, mycoplasma, legionella) newer gerations cipro, moxi, gata; levo and moxi are resp:strept pneumo**increased risk of achilles tendon ruptures); interacts with other qt prolonging drugs (amio, macrolides, TCA, antipsychotics); avoid with electrolyte disturbances (mag/K)–>increased risk of torsades; if admin with antacids/sucralfate decreased absorption; CI <18-reduces cartilage formation; MG; pregnant or breastfeeding; advers: CBS dizziness HA insomnia mood changes, qt prolong

177
Q

anthrax inhalation

A

cipro 500mg PO BID x 60 days

178
Q

cutaneous anthrax

A

cipro 500mg PO BID x 7-10 days

179
Q

travelers diarrhea

A

cipro 500mg PO BID x 3 days

180
Q

drug with hishest risk tendon rupture

A

steroid if older than 60

181
Q

Sulfonomides

A

cat c: gram neg (e. coli, klebsiella, h. influ); bacteriostatic-bactrim; other sulfa medications: diuretics (furosemide/hctz); sulfonylureas ( glyburide/glipizide); cox-2 inhibitors (celecoxib/celebrex); dapsone -for HIV
CI: G6PD anemia-hemolysis; newborns/infants <2months old; pregnancy late 3rd trimester-increased risk of hyperbili and kernicterus
interactions: warfarin increased INR
adverse: skin rash, stevens-johnsons
note: uti on coumadin do not give bactrim
HIV: high risk for sulfa related stevens-johnson
G6PF: AA with presenting hemolysis and jaundice 2/2 treatment with sulfa=decreased H/H and jaundice

182
Q

topical nasal congestants

A

oxymetazoline (afrin); phenyephrine (neo-synephrine)-short term use BID pRN 3 days max; rhinitis medicamentosa -chronic use >3 days

183
Q

antihistamines

A

avoid benadryl in elderly
elderly-use loratadine (claritin) decreased incidence of sedation
zyrtec: more potent and longer acting

184
Q

ketoralac

A

maintain 5 days or less

185
Q

salicylate

A

aspirin post MI=tertiary prevention
ASA IRREVERSIBLY inhibits platelet function for 7 days
DC ASA of c/o tinnitus; long term =81mg/day
not for use if less than 16: reyes syndrome

186
Q

acetaminophen

A

max 1g/4hours or 4g/day; avoid in chronic hepatitis; dehydration, cirrhosis; 1st line in OA; antidote is acetylcysteine

187
Q

Glucocorticoids

A

steroids: RA, autoimmune, polymyalgia rheumatica, asthma, temporal arteritis, uveitis, skin (eczema, psoriasis, contact derm); if PO and short term (<3weeks) no need for taper

188
Q

Topical steroids

A

class 1-7; low potency face, genitals, children; mod thicker skin (scalp, soles, palms) plaques-still need to taper topicals if long term

189
Q

acute inflamed joints

A

intraarticluar triamcinilone (kenalog); max 3xper year; SE HPA suppression, cushings dz, osteoporosis, immune suppression, chronic skin changes (atrophy, striae, teleangist, acne

190
Q

poison oak/ivy

A

may require 14-21 days of oral steroids

191
Q

drugs requiring eye exam

A

digoxin, corticosteroids, fluorquinolones, ED drugs, accutane, topamax, plaquenil

192
Q

DEA schedules

A

1-5; 1 is heroin, ecstasy, PCP, etc-illicit; 5 is cough meds with less than 200mg codeine

193
Q

FDA category X drugs

A

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.- finasteride, isotretinoin, warfarin, misoprostol, androgenic hormones, live virus vaccines (MMR, varicella, flu mist, rotavirus), thalidomide (DES)

194
Q

FDA category A drugs

A

Category A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

195
Q

FDA category B drugs

A

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

196
Q

FDA category C drugs

A

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

197
Q

FDA category D drugs

A

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

198
Q

FDA category N drugs

A

not studied

199
Q

OA CAM med

A

glucosamine with or without chondroitin; no evidence to support use

200
Q

CAM PMS sx

A

black cohosh, wild yam root

201
Q

isoflavones

A

soy beans-estrogen like effect

202
Q

saw palmetto

A

BPH sx; no better than placebo

203
Q

kava kava; valerian root

A

anxiety/insomnia

204
Q

St John’s wort

A

mild depression: do not use concurrently with SSRI, triptans, or HIV protease inhibitors

205
Q

homeopathy

A

law of similars; substances diluted

206
Q

Leading causes of death US

A

heart dz, cancer, chronic lung

207
Q

cancer mortality

A

leading cause of cancer death: lung

208
Q

teen leading causes of death

A

male rate>female rate in teens; accidents and injuries #1; homicide#2; suicide#3; unintentional injuries (accidents) #1 in 1-19 yr olds

209
Q

Life expectancy

A

78.5 yrs

210
Q

most common cancer

A

skin; most common skin cancer basal cell; melanoma causes 75% of deaths from skin cancer

211
Q

cancer by gender

A

male: prostate
female: breast

212
Q

sensitivity

A

highly sensitive test have increased risk of false positives. example HIV Elisa has 99% sensitivity–too sensitive with high rate of false positives-must confirm with Western blot

213
Q

specificity

A

detects individuals who do not have the disease: HIV Elisa has high specificity (99%) which increases risk for false positive; confirm with western blot which has high specificty -r/o people who do not have the disease

214
Q

primary prevention

A

preventing disease and injury: individual actions of healthy individuals: nutrition, diet, exercise, seatbelts, helmets, gun safety, national programs (immunization, safety laws, environmental), youth centers, habitat for humanity

215
Q

secondary prevention

A

early detection of disease to minimize bodilty injury: screening tests -pap. mammo, cbc for anemia, screening for depression, sti/etoh screening

216
Q

tertiary prevention

A

rehab, support groups, education of equipment, breast cancer support, hiv support, alcoholics anonymous; education for patient with preexisting disease (DM/HTN); education to avoid drug interactions; cardiac/pulm rehab, PT/OT, exercise program for obesity

217
Q

USPSTF breast cancer

A

baseline mammo age 50 and then every 2 years; age 40-49 individualize based on risk factors-ACS recommends starting age 40; age 75 stop unless life expectancy >10 years

218
Q

HPV testing

A

not for less than 30 years old

219
Q

cervical cancer screening

A

pap/cytology age 21 then every 3 years until age 65; or after age 30 Pap with HPV every 5 years; no screening after age 65

220
Q

colorectal screening

A

baseline age 50 thru 75; 76-85 based on individual risk factors; >85 none; options include FOBT x3 every year or flex sig every 5 years or colonoscopy every 10 years

221
Q

lipid profile

A

9 hour fasting; male at 35 and oldre; 20-35 if increased risk; female start age 45 or 20-45 if risk factors; increased risk is htn, fam hx, +stroke

222
Q

prostate

A

USPSTF recommends against PSA based screening except diagnosed or undergoing treatment for prostate cancer (surveillance)

223
Q

skin cancer counseling

A

children, adolescnet, young adults, with fair skin; avoid sunlight 1000-1600; spf 15 or higher, protective clothing, hats

224
Q

no routine screenings

A

lung cancer, ovarian cancer, oral, prostate, testicular

225
Q

breast cancer risk factors

A 
older age >50 (most common RF)
previous hx breast cancer
2 or more first degree relatives with BC
early menarche, late menopause, nulliparity (increased exposure to estrogen)
obesity:adipose synthesizes estrogen
226
Q

cervical cancer

A

multiple sex partners (>4 lifetime)
younger age 1st sex (immature cervix easy to infect)
immunosuppression/smoking

227
Q

colorectal cancer risk factor

A

familial history polyposis; first degree relative; crohns or ulcerative colitis

228
Q

prostate cancer risk factor

A

increased age >45, african american, +FH, +BRCA1/2

229
Q

STI risk factors

A

multiple sex partners/new partners (<3months)
early age onset sex
STI hx
homeless

230
Q

Hep B vaccine

A

3 doses: if not completed don’t restart entire series; catch up until all 3 doses complete

231
Q

Influenza vaccine

A

start oct/november to cover fall/winter;
live attenuated vaccine intranasal 2-49 years
safety: no aspirin for children w/i 4 weeks
avoid antivirals 48 hours before and 14 days after

232
Q

LAIV contraindications

A

pregnancy, chronic disease (asthma, COPD, RF, DM, immunocompromised)

233
Q

Flu injectable

A 
trivalent inactivated (IM), fluzone (intradermal)
CI: severe anaphylaxis (allergy to previous dose or egg protein)
youngest age for flu vaccine is 6 months (IM); flu mist 2-49 years
234
Q

tetanus vaccine

A

q 10 years; booster give for wounds sustained if last booster >5years
CI: severe allergy previous dose
pertussis may cause encephalopathy
precaution if mod/severe illness w or wo fever; GBS w/in 6 wks of last dose

235
Q

unknown tetanus vaccine

A

if patient wound give immediate Td with tetanus immune globulin

236
Q

pneumococcal vaccine

A

pneumovax 23-IM; 65 and older (1 dose lifetime); if vaccinated before 65 then give booster dose 5 years after initial dose

237
Q

pneumoccocal infection risk

A

highest fatality for alcoholics, Dm, CSF leak, asthma, chronic hep, asplenial, immunocompromised, malignancies, CA blood, renal dz, organ/bone marrow transplant

238
Q

zoster vaccine

A

one time age 60; SC; earliest at age 50; can give even if hx of chickenpox or shingles; may increase risk of asthma or polymyalgia rheumatica;
CI: pregnancy and breast feeding; cancer; immunocompromised or on meds for a condition

239
Q

varicella vaccine

A

2 doses; 4-8 weeks between; live attenuated; SC for exposure to chickenpox (post exposure prohylaxis) give within 5 days; if born before 1980 then no vaccine

240
Q

health care personnel vaccine

A

Td/Tdap; MMR; Varicella; Hep B; Influenza

241
Q

BCG vaccine

A

TB-live attenuated used in asia and africa; follow up for clinical sx; r/o latent infx with chest xray; symptoms: chronic cough, wt loss, night sweats

242
Q

herpes keratitis

A

acute onset severe eye pain, photophobia, blurred vision in affected eye;
dx: fluorscein dye =ferning pattern versus corneal abrasion which is linear
infection will permanently damage corneal epithelium

243
Q

acute-angle closure glaucoma

A

emergency elderly, acute onset severe eye pain with headache, nasua, vomiting, “halos”, decreased vision. mildly dilated pupil-oval shaped; “cloudy cornea”–cupping of optic nerve

244
Q

scotoma

A

retinal detachment

245
Q

eye pain

A

uveitis, glaucoma

246
Q

cholesteatoma

A

hx chronic otitis media; cauliflowerlike growth-not ca-can erode bones and damage cn7; foul smelling DC; PE: no visible TM/ossicles 2/2 destruction by tumor; tx abx and surgical debridement…refer ENT

247
Q

Battle sign

A

bruise behind ear over mastoid; fracture basilar skull

248
Q

Clear golden fluid DC from nose or ear

A

basilar skull fracture CSF leak; test with urine dipstick (+glucose if CSF); mucous = neg glucose

249
Q

Cavernous sinus thrombosis

A

rare but life-threatening; h/o sinus/facial infection; severe HA with high temp; rapid decline in LOC-coma-death**refer to ED

250
Q

Peritonsilar abscess

A

PTA: one sided swelling of peritonsilar area and soft palate; severe sore throat/dysphagia;odonophagia; trismus; “hot potato voice”; +malaise, fevers, chills, marked swelling, uvular displacement
ED for I/D

250
Q

HMO and PPO are

A

Managed care systems. Managed care systems integrate delivery of health care with financing of health care. Typically done through a series of contracts with health care providers, diagnostic groups, and other support services

251
Q

Diptheria

A

“Corynebacterium Diptheriae”: sore throat, fever, swollen neck “Bull neck”; hoarseness, dysphagia

Post pharynx coated with **pseudomembrane” =tissue necrosis; incubation 2-7 days
systemic manifest: resp, neuro, cardiovasc collapse, death
need antitoxin
resp and/or contact isolation

251
Q

Mononucleosis cbc

A

Increased lymphocytes and decreased total wbc; viral infx increased lymphocytes and decreased neutrophils; atypical lymphocytes

252
Q

Normal eye fundoscopy

A

viens>arteries; macula is central area for central vision; fovea is set in middle (has cones) responsible for sharpness (20/20)

cones: for color vision and sharpness
rods: light/shadow, night vision, depth perception

252
Q

Sexual development female

A

By 16 years with or without secondary sexual characteristics should begin menses especially if tanner 5; refer if not

253
Q

presbyopia

A

age related visual changes; decreased ability to accomodate; stiffening lens; starts age 40; difficulty focusing and decreased ability to read close print

253
Q

Hormone replacement therapy

A

3 leading causes of morbidity and mortality in women influenced by female hormones. HRt may not be beneficial to many, it is not recommended for all postmenopausal women.

254
Q

Ears normal exam

A

TM: off-white to grey= “cone of light”

tympanogram: most objective measure of fluid in middle ear
auricle: external portion (high in cartilage) does not regenerate

254
Q

Ulcerative colitis

A

Amenable to surgical resection, usually a total colectomy. Surgery for crowns is not curable, but may be indicated in some situations.

255
Q

Nose normal exam

A

inferior turbinate is visible: upper and mid need equipment

bluish, pale, or boggy=allergic rhinitis

255
Q

Innocent murmur in pediatrics

A

Innocent or functional murmurs are common clinical findings esp in 3-7 year olds. Functional murmurs are audible when the child is supine, are diminished or absent when the child is sitting or standing. Grade 1-3, brief, blowing, with medium pitch, and auscultation in systole at left eternal border 2nd ics. Patient gender has no bearing on whether murmur is functional or not

256
Q

leukoplakia

A

leukoplakia: white, raised, feathery area usually on side =HIV, AIDS, tobacco: increased risk oral cancer

256
Q

Heberdens and Bouchard

A

Osteoarthritis: heberdens DIP; Bouchards PIP

257
Q

apthous stomatitis

A

canker sores: shallow ulcers of soft tissues

257
Q

Ida assessment of adequacy if supplementation

A

Check hemoglobin and hct one month after starting iron; if not improved consider other sources of bleeding like gi or menstrual. Serum ferritin is an indicator of tissue iron stores and should be near normal 4-6 months after supplements

258
Q

avulsed tooth

A

store in cold milk-no ice: see dentist asap

258
Q

Chronic bacterial prostatitis tx

A

Fluoroquinolone daily x3-4 months. Bactrim cure rate too low for use 30-40%

259
Q

tonsils

A

butterfly shaped porous glands: purulent exudate=tonsillitis

259
Q

Complications of gestation dm

A

Cephalopelvic disproportion, microsomia, hypoglycemia

Does not increase risk of placenta previa

260
Q

post pharynx

A 
postnasal drip (acute sinusitis;allergic rhinitis)
posterior pharyngeal LAD-allergic rhinitis 
cobblestoning: inner conjunctiva with mildly elevated lymphoid tissue=atopy
260
Q

Antifungal safe during pregnancy

A

Miconazole “Monistat”cream not absorbed systemically

261
Q

geographic tongue

A

benign: map-like appearance; patches may move

261
Q

Findings to warrant np investigation of child abuse

A

Overly compliant, withdrawn, or apathetic behavior should be investigated for possible abuse. Small teeth marks often from other children. Multiple bruises on child’s knees and elbows are typically associated with unintentional injuries that occur during break childhood activities. Nocturnal enuresis is normal in 2 yr old

262
Q

torus palatinus

A

benign: painless bony protuberance midline hard palate; asymmetrical, skin should be normal

262
Q

2 year old with uncircumcised unable retract foreskin over glans

A

Reassure mother normal. Phimosis unable to retract over foreskin. Normal in uncircumcised usually resolves by 5 years.

263
Q

Fishtail, split uvula

A

benign: may be sign of occult cleft palate

263
Q

Alzheimer’s disease influences

A

Environmental and genetic. One treatable factor is estrogen deficiency. Because women live longer than men more women develop Alzheimer’s disease. Some experts believe that women have higher risk of Alzheimer’s related to estrogen production stoppage while men keep producing testosterone

264
Q

Nystagmus

A

a few lateral is normal;

**vertical always abnormal

265
Q

papilledema

A

optic disc swelling; increased ICP 2/2 bleeding, tumor, abscess, pseudotumor cerebri

266
Q

htn retinopathy

A

copper or silver wire arterioles

267
Q

diabetic retinopathy

A

microaneurysms 2/2 neovascularization

cotton wool spots

268
Q

cataracts

A

opacity of corneas

can result from chronic steroid use

269
Q

Koplik’s spots

A

measles; small red papules with blue-white centers inside cheek by lower molars

270
Q

hairy leukoplakia

A

elongated papilla=lateral

EBV, HIV

271
Q

palpebral conjunctiva

A

mucosal lining inside eyelid

272
Q

bulbar conjunctiva

A

mucosal lining covering eye

273
Q

soft palate

A

uvula, tonsils, ant throat

274
Q

snellen

A

test vision; test with and without glasses
abnormal-2 line difference between eyes
ou=both; os: left; od: right
line counts if gets 1 more than 1/2 of line; ex (out of 6 ust get 4)

275
Q

peripheral confrontation

A

checks for blind spots (scotomas)

276
Q

color blindness test

A

Ishihara chart

277
Q

legal blindness

A

best corrected vision >20/200 or visual field <20 degrees (tunnel vision)

278
Q

Weber

A

tuning fork to forehead

normal =NO lateralization; +lateralization=abnormal

279
Q

CHL

A

Weber will lateralize to imparied

280
Q

SHL

A

Weber will lateralize to good

281
Q

Rinne

A

tuning fork to mastoid

282
Q

Rinne CHL

A

BC greater or equal to AC

283
Q

Rinne SHL

A

AC greater or equal to BC

284
Q

herpes keratitis

A

emergent, damages corneal epithelium 2/2 herpes virus (shingles); acute onset eye pain, photophobic, blurred vision; affected side check for herpetic rash; fernlike pattern on fluorescien; zovirax and valtrex-avoid steroids

285
Q

corneal abrasion

A

acute, foreign body sensation, increased tearing, contact lens increased risk bacterial infx; topical ophthalmic abx -erythromycin/polytrim

286
Q

hordeolum

A

stye; pain, bacterial infection of hair follicale; pustule; treatment warm moist compresses; can give abx drops or ointment

287
Q

chalazion

A

chronic inflammation of hte mebomian gland of eyelid; gradual onset of small superficial nodule, discrete and movable on upper eyelid, feels like bead; painless, benign; treatment is surgical removal r/o SCC

288
Q

pinguecula

A

yellow triangular thinckiening of bulbar conjunctiva-inner and outer margins of cornea; caused by UV damageof collagen; tx: if inflames weak steroids; sunglasses/surgery

289
Q

pterygium

A

yellow triangular (wedge-shaped) thickening of conjunctiva extending to cornea-UV damaged cornea; tx: if inflamed weak steroid; sunglasses/surgery

290
Q

primary open angle glaucoma

A

gradual increased IOP >22mm hg 2/2 blocked drainage of aqueous humor inside eye; retina and optic nerves (CN 2) show ischemic changes and permanent damage
**most common 60-70% of cases
usu elderly african american with DM; usu asympto; gradual visual changes
LOSE PERIPHERAL VISION FIRST!
fundo: CUPPING
meds: timolol (beta blocker)

291
Q

normal IOP

A

10-22

292
Q

primary angle closure glaucoma

A

sudden blockage of aqueous humor resulting increased IOP and ischemia/permanent damage to CN2
Case: elderly acute frontal headache; eye pain; tearing; blurred vision; nausea/vomiting
HALOS AROUND LIGHTS
PE: fixed, dilated cloudy pupil-may be oval shaped-conjunctival injection with increased tearing
REFER TO ED

293
Q

Anterior uveitis

A

Iritis: increased with autoimmune disorders; c/o red, sore eyes, increased tearing
**no purulent discharge–>refer to ophtho

294
Q

Age-related macular degeneration

A

atrophic (dry) versus exudative (wet); atrophic less severe-more common; exudative usu vision loss; caused by gradual damage to pigment of macula

  • *LEDING CAUSE OF BLINDNESS IN OLDER ADULTS** higher rate in smokers
  • *PAINLESS, CENTRAL VISION LOSS; starts with distorted lines in vision
295
Q

Sjogren’s syndrome

A

chronic autoimmune; decreased function of lacrimal and salivary; may occur alone or with other disorder
Sx: dry eyes, mouth >3 months
PE: swollen and inflamed salivary glands
Tx: OTC tear substitutes; refer rheum and ophtho

296
Q

Blepharitis

A

chronic, bare eyelashes/inflammation; c/o pruritus, inflammation, redness, crusting,
tx: baby shampoo/warm water scrub
ABX ointment

297
Q

epistaxis

A

posterior worse than anterior; tilt head forward-pressure; use afrin pledgette to shrink tissue and then place packing

298
Q

Group A beta strept

A

strept pyogenes; sequalae=scarlet fever, rheumatic fever, post strept glomerulonephritis
treatment: pcn vk 250 mg PO QID x 10 days; if pcn allergic give zpackx5days

299
Q

strept throat complications

A

scarlet fever: sandpaper like rash
rheumatic fever: may affect heart valves, joints, brain
Peritonsillar abscess

300
Q

AOM organisms

A

strept pneumo (gram +)-high beta lactam resistance
H. influenzae (gram -)
M. catarhalis (gram -)

301
Q

AOM complications

A

cholesteatoma; mastoiditis; preorbital/orbital cellulitis; meningitis, cavernous sinus thrombosis

302
Q

OME

A

follows AOM; chronic; tm may bulge or retract but not red; fluid level with bubbles.
Tx: oral decongestant; steroid nasal spray

303
Q

OE

A

usually bacterial but can be fungal; warm humid weather; pseudomonas vs staph; pain with manipulation of tragus
Tx: cortisporin otic QIDx7 days
complications: if diabetic can spread into cellulitis or osteo

304
Q

Infectious mono

A

epstein barr virus: peak 15-24 years; after acut einfection can lay dormant in tissue and reactivate
TRIAD fatigue, pharyngitis, LAD; fatigue can last months
-may have abd pain with +HSM
CBC–>lymphocytosis with atypical lymphs>50%
Heterophile Ab test: MONOSPOT +
Tx: abdominal US if +HSM; avoid sports 4-6 weeks otherwise symptomatic treatment
**avoid amoxicillin and ampicillin (rash)
Complications: splenic rupture; ariway obstruction (ED high dose steroids); neuro: GBS; aseptic meningitis; optic neuritis; blood dyscrasias (atypical lympho)

305
Q

Ceilosis

A

skin fissures/macerations corners of mouth
causes: oversalivation, IDA, secondary bacterial infx; vitamin deficiency
TX: apply triple antibiotic ointment BID-TID until healed; treat underlying cause

306
Q

Rocky mountain spotted fever

A

classic rash: petechiae hands/feet/palms/soles progressing to trunk-generlized
rash on 3rd day after abrupt high fever (103-105) leading to HA, myalgias, conjunctival injection, N/V, arthralgia
FATAL
US: southeast southcentral, spring early summer

307
Q

aK

A

actinic keratosis: elderly, sun exposed area-rough, scaly, precancerous

308
Q

meningococcemia

A

sore throat, cough, fever, HA, stiff neck, photophobia, change in LOC, toxic, petechial rash
fulminant death within 48 hours; increased risk college dorms–vaccine
rimfampin as prophylaxis

309
Q

erythema migrans

A

early lyme disease: expanding red rash with central clearing; 7-14 days after bite
deer tick; lesion resolves after a few weeks; flu like sx

310
Q

Herpes zoster ophthalm

A

shingles of trigeminal nerve CN5

if herpetic rash on tip of nose assume shinglesREFER TO ED

311
Q

Melanoma

A

> 6mm; uneven, irregular, multiple colors

312
Q

BCC

A

most common; supperficial pealry domed, waxy
atrophic: ulcerated center
may be multiple colors

313
Q

acral lentiginous melanoma

A

most common melanoma in AA asians, dark brown/black, nailbeds, palmar, plantar surfaces

314
Q

subungal hematoma

A

direct trauma to nailbed-trapped blood; if >25% of nail area, risk permanent ischemic damage to nail matrix–>drain

315
Q

Stevens-Johnsons Syndrome

A

Erythema multiforme major; classic lesions target-like or bulls-eye, abrupt eruption, multiple, blisters, petechiae, purpura, hemorrhagic; prodrom fever and flu-like symptoms
-rare hypersensitivity to meds: pcn, sulfa, phenytoin, barbituates; high mortality 25030; increased risk HIV with bactrim

316
Q

vitamin D

A

darker skin requires more sun exposure for vitamin D; def of vit D in pregnancy results in infantile rickets, brittle bones, skeletal abnormalities

317
Q

bulla

A

elevated superficial blister>1cm; fluid filled

Ex: impetigo, 2degree burn, SJS

318
Q

vesicle

A

elevated, superficial, <1cm, fluid filled

Ex: herpetic lesion

319
Q

pustule

A

elevated, superficial <1cm, purulent filled

Ex: acne pustules

320
Q

macule

A

flat, nonpalpable, <1cm

Ex: freckles, small cherry hemangiomas

321
Q

papule

A

palpable solitary, <0.5cm

Ex: nevi, acne

322
Q

plaque

A

flattened, elevated lesions, variable shape >1cm diameter

Ex: psoriatic lesions

323
Q

seborrjeic keratoses

A

soft, round, wart-like fleshy growths

324
Q

xanthelasma

A

yellow-like plaques-eyelids; hyperlipid if <40

325
Q

melasma

A

mask of pregnancy; brown tar stain cheeks and forehead pregnancy or on estrogen OCP; usu permanent but can lighten

326
Q

vitiligo

A

hypopigmented patches of skin

327
Q

cherry angioma

A

1-4mm small, red, smooth papule; nest of multiformed arterioles

328
Q

nevi

A

moles

329
Q

xerosis

A

inherited skin disorder, extreme dry skin

330
Q

topical steroids

A

infants, children, or adults with thin facial skin; no fluorinated topicals -use 0.5-1% hydrocortisone
Prolonged use: HPA axis suppression-striae, atrohpy, telangietasia, acne, hypopigmentation

331
Q

psoriasis

A

inherited, squamous, epitelial cells undergo rapid mitotic division/abnormal maturation
**KOEBNER Phemom: new psoriatic plaques over skin trauma
AUSPITZ signL pinpoint areas of bleeding remain in skin where plaque removed
Sx: classic pruritic erythematous plaques, fine silvery, white scabs, pitted nails; scalp, elbows, knees, sacrum, intergluteal folds

332
Q

psoriatic arthirits

A

includes joint manifestations

333
Q

AK treatment

A

5FU or chryotherapy

334
Q

tinea versicolor

A

superficial skin infection; yeasts P. Tyrosporium
c/o multiiple hypopigmented round macules on chest, shoulders, or back appearing after sun exposure
LABS: KOH; +hyphae and spores; spaghetti and meatballs
MEDS: selenium sulfide or ketoconazole (nizoral) topical BID x 2 weeks

335
Q

atopic dermatitis

A

eczema: chronic inherited, pruritus; hand, flexural folds, neck; increased with stress, environmental (winter); associated with atopic conditions
rash: start multiple small vasicles; can be lichenified from chronic itching-fissures; may develop secondary bacterial infx
meds: topical steroids; lubricnats

336
Q

superficial candidiasis

A

yeast candida albicans; external sx: bright red/shiny lesion with itch
intertriginous areas: uner breast, axilla, abd, groin, may have satellite lesions
-if oral=thrush
Nystatin – HIV esophageal Candida-need sytemic antifungal (fluconozole)

337
Q

cellulitis

A

skin infection deep dermis or underlying tissues-usu gram+; 2 forms purulent or nonpurulent

338
Q

clenched fist injury

A

send to ED; check for foreign body; nec fascititis; group A strept; reddened/purple lesion will increase rapidly

339
Q

furuncle

A

boil: infx of hair follicle filled with pus

340
Q

carbuncle

A

coalesced boil

341
Q

erysipelas

A

dermis/lymph-CLEAR DEMARKATED AREA strept

342
Q

Bites

A

augmentin x10days; no suturing of punctures, wound>12 hours or 24 hours to face

343
Q

rabies

A

rabies IG and and vaccine; quarantine animal for 10 days checking for rabies symptoms

344
Q

hidradenitis suppurativa

A 
bacterial infx (staph) of axilla and groin, chronic, eventually leaves scars, tracts, with scarring
tx: augmentin; mupoirocin ointment-nares, fingernails BID x 14 days-no deodorants; antibiotic soap
345
Q

impetigo

A

superficial skin infection: gram +; staph/strept; very contagious; common in humid weather; “honey colored crusts”; keflex; clinda

346
Q

meningococcemia

A

neisseria meningitides-gram neg; resp droplets; refer to ED
Labs: LP, CSF, BCx, throat cx, CT/MRI brain
tx: rocephin2 grams IVx12 hours +vanco IV q 8-12 hours
isolation
complications: tissue infarction, necorsis

347
Q

brudzonski’s

A

meningeal irritation: With patient supine, flex head and neck toward chest. Note resistance or pain, and watch for flexion of hips and knees B=BEND the neck

348
Q

kernigs

A

flex one of the patients legs at hip and knee, then straighten leg. note resistance or pain

349
Q

Lyme disease

A

Borrelia Burgdorfori
labs: serum Ab, Igm, Igg
Doxycycline
comp GBS, arthritis, fatigue

350
Q

rocky mountain spotted fever

A 
Rickettsia Rickettsii (parasite)
Labs: Ab titer to R. Rickettsii
biopsy skin lesion, CBC, LFT, CSF
Med: Doxy
Comp: death, neuro sx, hearing loss, neuropathy
351
Q

varicella zoster

A

chickenpox: prodrome fever, pharyngitis, malaise

rash in different stages starting head/face-trunk-extrem; 1-2 weeks crusting- fall off

352
Q

varicella vaccine

A

no pregnancy w/in 3 months
CI: AIDS, high-dose steroids, radition, chemo, immunocompromised
-only a person who has had chickenpox can get shingles

353
Q

herpetic whitlow

A

viral skin infection of finger (herpes simplex 1/2) from direct contact with cold sore or genital herpes lesion
c/o red lesions side of finger/cuticles/terminal phalanx; may have recurrent outbreaks
mgmt: self-limiting, NSAIDs, if severe give acyclovir

354
Q

pityriasis rosea

A

cause unknown; self-limiting 4-8 weeks; asymptomatic
c/o “Herald Patch” 1st lesion is largest 2 weeks before full rash
oval lesions with fine scales follow skin lines “Christmas Tree Pattern”; salmon pink color
no meds
r/o syphillis with RPR, check STD

355
Q

scabies

A

infestation by mite; female burrows and lays eggs; asymptomatic first 2-6 weeks; close contact transmission; may remain pruritic even after treatment for 2-4 weeks

sx: interdigital pruritus, worse at night, serpenginous (snakelike) in linear patterns; labs wet mount-mites/egg;
meds: permethrin 5% (Elimite)-apply cream head to toe wash 8-14 hours; treat all family members; wash laundry in hot water; pruritus should improve in 48 hours; benadryl or topical steroids for severe itch

356
Q

tinea infections

A

dermatophytes-yeast
infection of superficial keratinized tissue
gold standard is fungal culture; KOH slide-pseudohyphae/spores
Meds: OTC topical azoles/allylamines

357
Q

tinea capitas

A

ringworm of the scalp;
black dot sign-broken hair shaft leaves dot like pattern on scalp
meds: baseline LFTs 2 weeks after systemic griseofulvin
complication: kerion (inflammation/indurated lesion that permanently damages hair follicle)

358
Q

impetigo

A

“honey colored” crusts, fragile bullae

359
Q

measles

A

“kopliks spots”

360
Q

scabies

A

Increased night, intersigital webs, waist, axilla, penis

361
Q

scarlet fever

A

“sandpaper rash” sore thraot. strept

362
Q

tinea versicolor

A

hypopigmented round-oval macular rashes; mostly upper shoulders/back-not pruritic

363
Q

pityriasis rosea

A

“christmas tree” pattern rash on linear skin lines; HERALD PATCH 2 weeks before rash

364
Q

molluscum contagiosum

A

smooth papular 5mm dome shaped, central umbilication with a white plug

365
Q

erythema migrans

A

red target-like lesion, grow is size with some central clearing; early lyme

366
Q

meningococcemia

A

purple to red painful skin lesions, acute onset high fever, HA, LOC changes

367
Q

rocky mountain spotted fever

A

hand/palm/soles

368
Q

tinea pedis

A

athletes foot; 2 types; scaly dry or moist (odorous)

369
Q

tinea corporis

A

ringworm of body

ringlike with collatrette of fine scales; slowly enlarges with central clearing; if large number give oral antifungal

370
Q

tinea cruris

A

jock itch

371
Q

tinea barbae

A

beard

372
Q

onychomycosis

A

nails, yellow, thickened, opaque; great toe most common

373
Q

antifungal meds

A

pulse therapy-systemic AF; baseline LFT; oral fluconazole 150-300mg weekly

374
Q

acne vulgaris

A

inflammation or infection sebaceous glands; multifactorial high androgen, bacterial (propionbacterium acnes); genetics, face, shoulders, chest, back; puberty and adolecents

375
Q

mild acne

A

open comedones (blackheads), closed/small papules, small pustules: prescription isotretinoin (retin-a); benzoyl peroxide with erythromycin (benzamycin), clindamycin topical

376
Q

moderate acne

A

increased papules/pustules) prescription topicals (benzamycin) plus PO tetracycline or minocycline
tetracyclines can start age 13; after permanent teeth except wisdom-may decrease effect of OCP (use 2 methods)

377
Q

severe cystic acne

A

all of the mild and moderate plus painful indurated nodules and cysts over face, shoulders, chest
meds: isotrtinoin (Acutane) plus cat x (tetracycline)
must enroll in ipledge program to prevent pregnancy-2 forms contraception; prescribe one month at a time-monthly preg testing and 1 month after discontinuing
DC if depression, visual disturbance, hearing loss, tinnitus, GI pain, rectal bleed, uncontrolled hypertrig, pancreatitis, hepatitis

378
Q

rosacea

A

(acne rosacea)-chronic relapsing skin inflammatory disorder; no cure; symptom control and avoid triggers; usually light-skinned, chronic/small acne like papule patches around nose, mouth, chin
metronidazole topical, low dose tetracycline/minocycline
complications: rhinoplyura-hyperplasia of tip of nose; ocular rosaacea

379
Q

The most common place for indirect inguinal hernias to develop is:

A

The internal inguinal ring is the most common site for development of an indirect inguinal hernia. These can occur in men and women. Though most are probably congenital, symptoms may not be obvious until later in life. Indirect hernias are more common on the right side. Direct inguinal hernias occur through Hesselbach’s triangle.

380
Q

Ankle sprains

A

Ankle sprains are generally graded based on clinical signs. A grade I sprain results from minimal stretching or small tears in the ligament. There is mild tenderness and edema, and the patient is able to bear weight. A grade II sprain is more significant. The clinical signs are more severe stretching and tearing of ligament(s) with moderate pain, edema, tenderness, and ecchymosis. Weight bearing is painful, but the patient can walk. A grade III sprain is the most severe. It involves complete tear of a ligament. There is joint instability, severe pain, edema, tenderness, and ecchymosis. Patients usually are unable to bear weight due to pain. An avulsion fracture could produce the same symptoms described above. This patient needs an x-ray to rule out fracture.

381
Q

bipolar mania

A

During a period of mania, common symptoms are inflated self-esteem and grandiosity (like a buying a baby grand piano), decreased need for sleep, hyper verbosity (excessive talking), racing thoughts and flight of ideas, distractibility, and excessive involvement in pleasurable activities that can be associated with very painful consequences later.

382
Q

therapeutic relationship

A

A therapeutic relationship with a patient can be established in many different ways. One way is to ask open-ended questions. This allows the patient to discuss what is most important to him; personal concerns may be vocalized by the patient. Telling the patient that he can trust you probably does little to establish trust. Actions that establish trust are more therapeutic than this statement. Touching the patient during the interview may be perceived as inappropriate by many patients. In contrast, touching the patient during the exam is different. Finally, telling the patient that you enjoyed taking care of him (if this was true) does little to establish trust.

383
Q

Question:

Which reflexes might a one month-old infant be expected to exhibit?

A

Your Answer is Correct

Moro, stepping, rooting
Stepping, rooting, tonic neck
Babinski, Moro only
Fencing, stepping, rooting
Explanation:
A one month old infant would be expected to exhibit the Moro, stepping, rooting, and Babinski reflexes. The tonic neck, or “fencing” reflex isn’t exhibited until about 2-3 months of age. This is assessed by lying the baby on his back and turning his head to one side. If the reflex is present, he should extend his arm on the side that his head is turned. The opposite arm assumes a flexed position. This pose mimics a fencer and thus, the name.

Nurse Practitioner Exam (1 decks)

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