SM Review questions Flashcards
What is the treatment for acute otitis media if the patient has a beta-lactam allergy?
Azithromycin
true allergy 2nd line options include Cefdinir and Cefuroxime
How many wet diapers should an infant have?
6-8 wet diapers/day
Why would a female infant present with pink-red blood in the diaper and no signs of dehydration, constipation, weight loss - normal otherwise.
false menses - a drop in maternal hormones, this resolves in about 3-4 days and is benign
What are possible signs and symptoms of Alzheimer’s disease?
sleep disturbances
meaningless word repetition
seizures - focal are the most common type.
What is apathy?
lack of interest, enthusiasm, concern
No care for what is going on around them
What is apraxia?
difficulty with skill movements - loss of voluntary motor skills
What is agnosia?
when the five senses cannot receive or correctly process information - unable to understand information in relation to their senses
agNOSia - NO Sense
What is aphasia?
Loss of the ability to express or understand speech, impaired communication
2 forms - expressive and receptive, cannot express the words/says them incorrectly, cannot understand/interpret
What sign is positive when a patient is supine, the hip is flexed to 90 degrees, and the patient is unable to extend the knees without significant pain?
Unable to straighten/extend leg when hip is flexed at 90 degrees
Kernig
When flexing a patients neck with them in the supine position, the patient flexes knees and hips. What sign is this?
Brudzinski’s sign - meningitis
What are the components of the “female athlete triad?”
Irregular menstruation/amenorrhea
Restrictive eating
Decreased bone density/osteoporosis
What is the most common presenting symptom of lung cancer?
chronic cough
Lentigines can progress to what? What is the preferred treatment of lentigines?
seborrheic keratosis - a stuck-on, wart like lesion
TX with laser therapy or cryotherapy - refer to dermatology
What are treatment options of actinic keratosis?
Fluorouracil (Efudex) topical - first line option
cryosurgery, chemical peels - first line options
other choices 2nd/3rd
imiquimod, diclofenac
Name some medications in the LABA class.
Salmeterol
Formoterol
Vilanterol
Olodaterol
-TEROL
Name some medications in the LAMA class.
Tiotropium
Glycopyrronium
Aclidinium
Umeclidinium
-IUM except Ipratropium (SAMA)
Name some medications in the ICS class.
Budesonide
Fluticasone
Mometasone
Beclomethasone
-NIDE or -ASONE
Name some medications in the SABA class.
Albuterol
Levalbuterol
Salbutamol
Metaproterenol, Pirbuterol, Bitolterol
Name some medications in the SAMA class.
Ipratropium
Oxitropium
What type sound is expected on percussion in a patient with COPD?
hyper-resonant or hyperresonance on percussion
hyperinflated air in lungs - COPD and ashtmatic patients in an acute attack
Skin lesion found on sun-exposed areas present as scaly, ulcerated, raised lesion that may itch or bleed easily is best known as?
Squamous cell carcinoma - refer to derm for further evaluation and treatment
Name three medications that increase the risk for nephrolithiasis (renal calculi)
Acyclovir
Sulfadiazine
Indinavir
When assessing for tactile fremitus in a suspected bacterial pneumonia patient, what type of vocal sounds are palpatited on the chest?
Increased vocal sounds during palpation of the chest indicates consolidation or inflamed lung tissue is present, indicative of pneumonia
“ninety-nine” test
A middle school child with a severe sore throat for the last three days, fever, and malaise. He states it is painful to swallow and feels extremely fatigued. Tonsils are 3+ bilaterally. What do you suspect? What may confirm diagnosis?
Infectious mononucleosis - fever, fatigue, tonsillar exudate, and adenopathy
CBC and EBV profile (Epstein bar virus)
Spleen US before returning to sports
this is VIRAL - no abx
The alpha-fetoprotein (AFP) is made in what part of the body? High levels indicate what? Low levels?
the fetal liver - this is why it is expected to have slightly higher AFP levels in a patient that has multiples.
high = incorrect dates, multiples, or neural tube defects. low = incorrect gestational date or Down Syndrome
What are recommendations for treatment of rosacea?
Sun protection with SPF, avoiding/wear hats
Avoid triggers like wine
Topical antibiotics - Metronidazole gel
What are expected symptoms during a COPD exacerbation?
Dyspnea
Increased sputum production and/or purulence
Coughing/wheezing
in test questions, remember to rule out causes of other diseases like heart failure (orthopnea - unable to breathe when lying flat)
What is the most common type of skin cancer?
Basal cell carcinoma
What drug classes that may lead to a high risk of developing osteoporosis?
PPIs
Depo-provera - not a class, but increases osteoporosis
SSRI medicaitons
Antiepileptic drugs - phenytoin, phenobarbital, carba.
Tinea cruris vs tinea corporis
Cruris = jock itch, fungal infection in the groin
Corporis = ringworm
PO fluconazole
The combination of what drug classes can increase serotonin syndrome?
SSRIs given with Triptans or MAOIs
What are two best treatment options for nonpurulent cellulitis?
Cephalexin (Keflex) or Penicillin if nonpurulent cellulitis
purulence = IV antibiotics
other options are Dicloxacillin or Clindamycin
What is the earliest and most common sign of osteoarthritis found on XRAY?
Joint space narrowing on XRAY
look for DIP joint, Heberden’s nodes - only seen in OA
When should genu valgum resolve in children?
by age 7 years, refer to orthopedic surgeon if >7 years
GUM = knock-knees
What age should genu valrum resolve in children?
by age 2
RUM = bow-legged
List the types of topical agents from least potent to most potent.
Solution
Lotion
Cream
Ointment - highest percentage of oil
An accidental burn injury on reassessment is now scarred with erythema and is raised above the normal level of skin and confined to the original burn area. The patient reports moderate pain. What is this?
Hypertrophic scar
What is pterygium colli? What condition is this seen with?
“webbed neck”
Turner’s syndrome
What are 4 causes of hidradenitis suppurativa?
Smoking
Obesity
Family history/genetics
Female gender
WBC casts on urinalysis indicate what?
MEDICAL emergency!
Pyelonephritis - worsening back pain, sweating, dizzy
A person with endometriosis may start hormone replacement therapy for menopausal symptoms?
NO!! Absolute contraindications
HRT - no endometriosis, DVT, vaginal bleeding of any kind
smoking is NOT a contraindication
What test may confirm peripheral arterial disease?
Ankle brachial index
assess for symptoms of increased pain during activity, relief with rest
How is the Weber test performed? What is this used for?
tuning fork midline on patient’s forehead
Sensorineural hearing loss - sound lateralizes to UNAFFECTED ear
Conductive hearing loss - sound lateralizes to the AFFECTED ear
When is RhoGam given?
at 28 weeks and again 72 hours post delivery (if baby is confirmed as positive blood type)
give to a mother with a negative blood type
When is Group B Streptococcus assessed in the pregnant female?
between 35 to 37 weeks gestation
When is the 2 hour glucose tolerance test completed during pregnancy?
between 24 to 28 weeks gestation
What is covered on Medicare Part B program?
Emergent ambulance services Durable medical equipment Second opinions Outpatient visits Certain health prevention measures
What is covered on Medicare Part C program?
supplemental coverage for hearing, vision, dental
What is diclofenac? When is this contraindicated?
NSAID
Avoid in patients with heart failure - EXACERBATES sodium retention! May decrease effectiveness of antihypertensives
Vaccines and medication coverage are covered under what part of Medicare program?
Part D
Medicare Part A covers what?
inpatient care
hospice
skilled nursing facilities
What are alternative options for treatment of acute mastitis if the patient is allergic to beta-lactam antibiotics?
Erythromycin
Clindamycin
anaphylactic reaction to PCN = NO cephalosporins can be given
What are the most common side effects of tricyclic antidepressants? (Amitriptyline)
anticholinergic-type side effects
dry mouth, constipation, blurred vision
Also causes CNS depression = increased drowsiness, delirium, and weight gain
What are E&M codes utilized for?
Evaluation and Management
used for what level the patient’s visit can be billed based on the complexity of the visit
What are CPT codes utilized for?
Current Procedure Terminology
document and bill medical procedures such as L&D, venipuncture, EKG
Probable signs (for pregnancy) are
Positive pregnancy tests, positive serum hCG
Chadwick’s sign, Hegar’s sign, Goodell’s sign
Braxton Hicks contractions
Presumptive signs (for pregnancy) are
subjective data - common complaints of pregnancy
n/v, amenorrhea, quickening, uterine enlargement, pigmentation changes/breast changes, fatigue
Positive signs (regarding pregnancy) are
objective findings from the provider - fetal heart tones, palpation of fetus, ultrasound
When is HPV testing recommended by guidelines?
any woman over 30 years during routine pap smear
any woman with ASCUS noted on pap REGARDLESS of age
What cranial nerve may be damaged by cholesteatomas?
CN VII - (7) Facial paralysis may occur if not removed
Refer to ENT as soon as identified
May cause hearing loss which is conductive NOT sensorineural (CN VIII)
What is a black box warning of Carbamazepine (Tegretol)?
Agranulocytosis as well as Steven-Johnson Syndrome
possible liver toxicity
A 30-year old with neck pain that has progressed down the spine. Pain is keeping him awake at night. He has extremely limited range of motion and a hunched back appearance forming. No history of injury or medical history. What do you suspect?
Ankylosing spondylitis - xray is best “bamboo spine”
Referral to Rheum, NSAIDs, etc
A patient comes in today with complaints of an abnormal growth on both of his eyes. He states that it is causing some discomfort and blurry vision more recently, prompting the visit. Upon examination, you note mild erythema bilaterally as well as bilateral 3.1 mm, flat, white growths encroaching onto the cornea. What is the most likely diagnosis?
Pterygium - benign overgrowths of conjunctiva, GROWS ONTO THE CORNEA (most distinguishing feature - encroaching)
What are the increased potential risks (7) of Turner syndrome? (Confirmed pt dx)
Hearing loss Elevated liver enzymes Hypertension Diabetes Osteoporosis Renal Abnormalities Hypothyroidism
What are classic symptoms of a cluster headache?
Unilateral, excruciating pain around the orbital
Peaks within minutes, lasts 15-180 minutes
Pain is constant, sharp, piercing, burning, pulsating, or pressing
Lacrimation, Rhinorrhea
N/V, photophobia, phonophobia
What are treatment options for an acute cluster headache in a person without cardiovascular disease? With CV disease? COPD? Prophylaxis?
Sumatriptan - intranasal or subcutaneous, no CV dx Oxygen - unless they have COPD Intranasal lidocaine - for CV disease Ergotamine Systemic steroids
Prophylaxis - Verapamil
What motion causes a ACL injury? The patient will complain of what?
A sudden twisting motion
pt c/o hearing a “pop” in the knee, instability, and excess range of motion
An angle greater than ____ degrees on xray is indicative of hallux valgus.
> 15 degrees
hallus valgus is a bunion - first MTP join is deviated inwards
Low back pain that is relieved by sitting is a sign of? Patient may also have weakness or “foot drop,” burning in the buttocks and thigh, and abnormal reflexes.
spinal stenosis
> 50 years, related to osteoarthritis
A patient with a knee injury presents after playing soccer. He c/o feeling a pop in his right knee and since this has felt sharp pain and is unable to fully extend his leg. There is a palpable “click” when extending and flexing the affected knee. What is your suspected diagnosis?
Medial meniscus tear - common knee injuries, results from twisting, cutting, pivoting, or being tackled
Delayed swelling
Produce a locking/clicking of the knee, inability to flex/fully extend
use McMurray test
What antibiotic is first line in prophylaxis for pneumocystis jirovecii pneumonia in patients with AIDs (CD4 <200)?
Trimethoprim/sulfamethoxazole (Bactrim) - cost effective and ease of use
On eye exam there are new formations of small blood vessels along with tiny red dots throughout the retina. What should be suspected? What is important to check in this patient today?
Neovascularization and microaneurysms - diabetic retinopathy
A1C today
What is a positive Chvostek’s sign and what CN is being assessed? What electrolyte imbalance causes this?
CN VII - facial
tapping over the facial nerve causes a twitching response
Low calcium/hypocalcemia
What diagnostic tool evaluates for a corneal abrasion? What are expected findings of a corneal abrasion?
Dx = Fluorescein test
S/S = recent Bell’s palsy episode, “gritty” feeling of eye, light sensitivity, tearing
Contact lens use, eye trauma
What are classical symptoms of hyperparathyroidism?
Bone pain Muscle weakness Abdominal pain N/V Fatigue Confusion
How will arcus senilis present? Causes? What should the provider consider ordering?
presents as a GREY HALO around the iris - or an arc above and below the cornea
Caused by lipid deposits/fat, high cholesterol/family history, age
order CBC, CMP, lipid panel
What is meniere’s disease? What is the treatment?
A buildup of fluid in the inner ear causing interference in the receptors that help with balance and hearing (labyrinth)
Causes vertigo
NO CURE! - diet changes, therapy, meds for symptoms (diuretic, steroid, antidepressant, antiemetic)
What are two ways to test conductive hearing loss? What are causes?
Rinne test BC>AC - through the mastoid bone (never for sensorineural)
Weber will lateralize to the AFFECTED ear
Causes are conditions that can be seen - OM, perforation, cholesteatoma
What is the difference between a Hordeolum and a Chalazion?
Hordeolum is a stye - painful
Chalazion is always PAINLESS, may get bigger
A patient presents complaining of sudden eye pain, tearing, and blurry vision unilaterally. While using a black lamp in the darkened exam room, the nurse practitioner notices a fern-like line in the corneal surface. Which diagnosis is most likely?
herpes keratitis
What condition is a risk factor to developing testicular cancer?
Cryptorchidism - undescended testicle
According to JNC 8 HTN guidelines, patients less than 60 years old should be treated with antihypertensives once their blood pressure is >____/_____.
<60 years = >140/90, continue lifestyle modifications
>60 years = >150/90
diabetes and CKD varies the guidelines/has a lower threshold for BP
On a urinalysis, red blood cell casts indicate what condition? Whereas white blood cell casts?
RBC = Glomerulonephritis
WBC casts = pyelonephritis
What antibiotic commonly used for UTIs should be AVOIDED in patients taking Warfarin (coumadin)?
Trimethoprim/sulfamethoxazole (Bactrim)
CYP2C9 inhibitor - delays metabolism = INCREASED risk of bleeding
consider completely holding dose of warfarin or decreasing dose of warfarin if this is necessary to give to patient.
What is otosclerosis? What hearing loss is common? Best treatment option?
a bony overgrowth of the footplate of the stapes bone in the ear.
Conductive hearing loss, usually before age 50
Best tx is referral for surgery
What assessment finding is the earliest sign of a bowel obstruction?
high pitched bowel sounds
