SM NP review psych, respiratory, endo, musc

Question 1

What are some common screening tools for depression?

Answer 1

PHQ-2
PHQ-9

Question 2

Why do most patients stop their psych medications at home?

Answer 2

sexual dysfunction and weight gain

Question 3

How long can it take to see effects of antidepressants

Answer 3

4-6 weeks, then increase dose or switch meds. always double check compliance and underlying causes

Question 4

How long will your patient be on SSRI>

Answer 4

taper off after 6 months

Question 5

What is depression commonly treated with?

Answer 5

SSRI, SNRI

Question 6

What herbal supplement can be used?

Answer 6

St John’s Worts (increases risk of serotonin syndrome)

Question 7

What do we tell patients about GI complaints related to antidepressants?

Answer 7

They will go away in a few weeks

Question 8

How do we approach suicidal ideation?

Answer 8

very straightforward, educate, ask for plan

Question 9

Which SSRI should we avoid in the elderly?

Answer 9

Prozac (long half life)

Question 10

What are some other medications that be given for depression?

Answer 10

TCAs- Nortitlyine

Question 11

Which two antidepressants are safest in the elderly?

Answer 11

Zoloft and Lexapro

Question 12

Which SSRI is most sedating?

Answer 12

Paxil

Question 13

Which SSRI would likely be avoided in anxious patients?

Answer 13

Prozac

Question 14

What do we need to consider before we prescribe an atypical antipsychotic?

Answer 14

Zyprexa, seroquel
weight gain and increased lipids increased glucose

Question 15

What signs and symptoms would we see in bipolar?

Answer 15

phases between mania and depression

Question 16

What is bipolar treated with

Answer 16

Lithium
Side effect: hypothyroidism

Question 17

What signs/symptoms would you see with PTSD?

Answer 17

night mares, hypervigilance, exaggerated startle, flashbacks, insomina

Question 18

What is PTSD commonly treated with

Answer 18

SSRIs

Question 19

What is seasonal affective disorder

Answer 19

changing of seasons effects the patient’s circadian rhythm treated with sunlight

Question 20

What is the most predominant symptom of asthma

Answer 20

cough

Question 21

How do we know if treatment is successful

Answer 21

peakflows

Question 22

What is the FeV1 with airflow limitation

Answer 22

decreased

Question 23

What are the stages of asthma

Answer 23

intermittent, mild, moderate, severe

Question 24

What medication do we never give alone?

Answer 24

LABA

Question 25

What is the cornerstone of our treatment for asthma

Answer 25

Low dose inhaled corticosteriods (decrease mortality)

Question 26

What three things impact peak flow?

Answer 26

height age gender

Question 27

What is the go to treatment for acute asthma attacks

Answer 27

ICS + LABA

Question 28

Common low dose ICS and LABA

Answer 28

budesonide-formoterol (Symbicort)

Question 29

Steps of asthma treatment

Answer 29

1. ICS-LABA PRN 2. L-ICS daily 3. ICS - LABA daily 4. Referral

Question 30

How do we diagnose COPD?

Answer 30

FEV1/FVC ratio less than 0.70 or 70%

Question 31

What do we expect to see in COPD

Answer 31

barrel chest, clubbing of fingers, chronic cough, percussion --> hyperresonant

Question 32

Group A treatment of COPD

Answer 32

Bronchodilator (SABA or LABA)

Question 33

Group B treatment of COPD

Answer 33

LABA or LAMA long acting bronchodilator

Question 34

Group C treatment of COPD

Answer 34

LAMA

Question 35

Group D treatment of COPD

Answer 35

LAMA or combo (ICS-LAMA)

Question 36

What signs and symptoms do we expect with pneumonia

Answer 36

cough, fever, chills, rhonchi, wheezes, tactile fremitis

Question 37

How will you decide treatment for pneumonia with no comorbidities or recent antibiotic use

Answer 37

M- macrolide A- amoxicillin D- doxycycline

Question 38

How will you treat pneumonia with comorbidities or antibiotic use in last 90 days

Answer 38

fluoroquinolones or Augmentin + macrolide

Question 39

What is the CURB 65 criteria

Answer 39

C- Confusion U- Urea- BUN > 19 R- Respiratory rate > 20 B- Blood pressure < 90/60 Age>65 2 points = consider admission 3 points= must be admitted

Question 40

Where is TB seen in the lungs?

Answer 40

Upper lungs

Question 41

When is >5 mm diagnostic for TB

Answer 41

CD4>200, HIV, immunocompromised, immigrant with exposure

Question 42

When is >10mm diagnostic for TB

Answer 42

immigrant, healthcare worker

Question 43

When is >15 mm diagnostic for TB

Answer 43

general public

Question 44

How do you confirm TB diagnosis

Answer 44

Sputum culture

Question 45

Why must we always treat strep throat with antibiotics

Answer 45

scarlet fever, rheumatic fever

Question 46

Why can we not treat a patient with strep and mono with Amoxicillin

Answer 46

Morbiliform rash; use macrolide or sporin

Question 47

What is the key finding of peritonsillar abscess

Answer 47

deviated uvula

Question 48

Most cases of bronchitis are

Answer 48

nagging cough 95% viral

Question 49

Do we treat bronchitis with antibiotics?

Answer 49

no unless it is pertussis to reduce how contagious it is

Question 50

What signs and symptoms do we expect to see with sinusitis

Answer 50

recurrence of symptoms tooth ache hurts bending down

Question 51

What do we treat sinusitis with

Answer 51

Augmentin/ Amoxicillin

Question 52

What is our screening tool for thyroid disorder

Answer 52

TSH

Question 53

If TSH is high and T3/T4 are low

Answer 53

Hypothyroidism

Question 54

First line meds for hypothyroidism

Answer 54

Levothyroxine

Question 55

First line medication for hyperthyroidism

Answer 55

Beta blockers tapazole PTU

Question 56

What is the parathyroid's purpose in the body

Answer 56

calcium and phosphorus high calcium think malignancy

Question 57

Somogyi Effect

Answer 57

dip in the middle of the night before it rises in the morning

Question 58

Dawn phenomenon

Answer 58

blood glucose steadily increases all night

Question 59

When do you screen for diabetes

Answer 59

45; q 3 years unless you have BMI > 30, family hx, PCOS

Question 60

How we diagnose T2DM?

Answer 60

Hemoglobin A1C > 6.5 fasting glucose random glucose

Question 61

Which medications are most notorious for hypoglycemia? Cardioprotective?

Answer 61

SGLT2 inhibitors GLP1 agonist

Question 62

When do we discontinue metformin

Answer 62

GFR less than 30

Question 63

What do you expect to see in Addison's?

Answer 63

decrease cortisol, hyperpigmentation, increased potassium

Question 64

What are safety concerns with Addison's?

Answer 64

Emergency kit of steriods

Question 65

What do we expect to find in cushings?

Answer 65

increased cortisol, decreased potassium, moon face, trunkal obesity, purple striae

Question 66

How do we diagnose Lupus?

Answer 66

anti-nuclear steriod test and symptoms

Question 67

What organ can Lupus really affect

Answer 67

Kidneys

Question 68

How can you diagnose osteoporosis?

Answer 68

DEXA scan -2.5 or below

Question 69

How do you diagnose osteopenia?

Answer 69

-1- -2.5

Question 70

How do we prevent osteoporosis?

Answer 70

calcium & vitamin D weightbearing exercise

Question 71

What are the risk factors associated with osteoporosis?

Answer 71

use of Depo long term steriods long term PPI smoking

Question 72

What are some treatment options for osteoporosis?

Answer 72

Bisphosphonates (-dronate)

Question 73

What is a good medication to give to a patient with osteoporosis and hypertension

Answer 73

Thiazides

Question 74

Heberden's node

Answer 74

joint closest to the tip of the fingers

Question 75

Bouchard's

Answer 75

Closet to the hands

Question 76

Characteristics of RA

Answer 76

can begin at any age faster onset bilaterally stiffness > 1 hour systemic symptoms Bouchard's nodes Swan neck deformity

Question 77

Characteristics of OA

Answer 77

Occurs with age Slower onset unilateral stiffness < 1 hour no systemic symptoms Heberdens and Bouchards nose

Question 78

What would you see on a Xray for arthritis

Answer 78

joint space narrowing

Question 79

What are treatment options for arthritis

Answer 79

DMARDS

Question 80

What are some common signs/symptoms of ankylosing spondylitis

Answer 80

lower back up to her neck autoimmune inflammatory disease

Question 81

What does ankylosing spondylitis look like on an xray

Answer 81

bamboo spine

Question 82

When does a scaphoid fracture/ navicular fracture show up on an X-ray? How is it treated?

Answer 82

2 weeks thumb spica cast

Question 83

Phalen's

Answer 83

backwards prayer hands

Question 84

Tinel's

Answer 84

tap the inner wrist

Question 85

How would a patient describe Morton's Neuroma

Answer 85

"pebble in their shoe between 3rd and 4th toe with numbness and tingling"

Question 86

Lateral epicondylitis

Answer 86

painful and inflamed tendon on outer elbow

Question 87

medial epicondylitis

Answer 87

Golfer's elbow

Question 88

McMurray Test

Answer 88

Meniscus

Question 89

Apley test

Answer 89

Meniscus

Question 90

Continued knee popping

Answer 90

Meniscus

Question 91

Lachman test

Answer 91

ACL

Question 92

Anterior drawer test

Answer 92

ACL

Question 93

Valgus

Answer 93

MCL

Question 94

Varus

Answer 94

LCL

Question 95

What is a positive straight leg test

Answer 95

reproduction of pain between 30-70

Question 96

L4 pain:

Answer 96

squat and rise exam knee jerk diminished

Question 97

L5 Pain:

Answer 97

heel walking numbness at big toe

Question 98

S1 painL

Answer 98

walk on toes absent ankle jerk