1-1 Tutoring ANCC

Infant mortality

# of deaths for infants under 1 year per 1,000 live births

isoflavones

(Soybean) mimic estrogen

What does a +titer mean/ - titer

+ = Immune - = not immune give immunization

+HBsAG -anti-HBs +IGM anti-HBc

+ HBsAG = have Hep B virus on board -anti-HBs = no immunity +IGM anti-HBc - active Hep B infection

What is the max dose of metformin

1,000 mg BID achieve max dose if pt on 2 meds before adding 3

Prioritize treatment steps for ACOS Colposcopy, LEEP, HPV

1. HPV, 2. Colposcopy, 3. LEEP

Patient with diarrhea x2 weeks with blood and mucus rank the most probably diagnosis from 1-3 Dumping syndrome, IBD, or Membraneous colitis

1. IBD (blood & mucous), 2.Colitis (C-diff have mucous) 3. Dumping Syndrome

ASCOS step seen in 20 year old, 23 year old, and 25 year old

20 - repeat cytology/pap in 12 months 21-24 - repeat cytology/pap in 12 months 25 or older- order HPV if +, but non oncogenic strains repeat cytology/pap in 1 year +HPV 16 & 18 refre for colposcopy and cervical biopsy

what ages is DTAP given

2mo, 4 mod, 6 mod, and then 15 months not 12

when do you screen a pregnant women for Group B Strep (GBS)

36 weeks

Youngest age to give Influenza

6 months

when is normal follow up for DM

6 months

What age should Strabysmus resolve

6 months if 7 months refer

Who qualifies for Medicare

>65 ESRD, DIsability

Presentationof klinefelter syndrome

A genetic condition in which a male is born with an extra copy of the X chromosome may have low testosterone and reduced muscle mass, facial hair, and body hair. Most males with this condition produce little or no sperm.

What BP are given to HTN/DM patient

ACEI/ARB

When do you order CT/US on the abdominal region

Above the belly button = US Below the belly button = CT

Validity

Accurate measure; measures what it is supposed to measure

Kaposi's Sarcoma

Affects the skin in HIV patients

What race has highest rate of breast cancer deaths

African Americans

Whats the step by step approach to treat moderate persistent asthma

Albuterol + increase dose ICS or Albuterol + Combo (ICS LABA) eg Advair or symbicort

Whats the step by step approach to treat mild persistent asthma

Albuterol + low dose ICS (flovent, asmanex, pulmicort)

What BP med given to a patient with BPH

Alpha-1 Blockers Terazosin (Hytrin)

1st line for acute bacterial sinusitis

Amoxicillin-clavulanate (augmentin) PCN allergy - doxycyline

PICK 3 characteristics of PAD

Ankle brachial index <9 Dang leg and feels better (circulation problem) Walk it hurts and feels better at rest Shiny with no hair

Confounding variable

Another variable that can alter results (eg. pt takes diet pills) when present it is a threat to internal validity

Step by approach for GERD if lifestyle changes don't work

Antacids (Maalox,Rolaids, Tums) H2 receptor antagonists (Ranitidine (zantac) or Famotidine(pepcid) PPIs (omeprazole etc)

A patient with COPD and BPH has urinary retention. What med could be causing this?

Anticholinergics (Atrovent)

What murmur radiates to theneck

Aortic stenosis

Pt Education for IBS

Avoid gas producing foods (beans, cabbage, onions) Increase fiber (constipation) stress reduction and excercise If IBS with diarrhea (loperamide)

Hispanic

BIG on family units, non-compliant (eg. SICK MAN TELL HIM TO TALK TO HIS FAMILY / pregnant pt to keep prenatal visits)

Where are Herberdens & Bouchard's Node located

BOuchard's = knuckle/ more proximal Herberdens - near nail distal

How to calculate ankle brachial index

BP cuff measures resting systolic BP of ankle compared with the systolic BP of upper arm (brachial artery) score <9 abnormal

what drugs increase INR

Bactrim and Rifampin

First line treatment for Foliculitis

Bactroban (Mupirocin)

1st line treatment for Impetigo

Bactroban (Mupirocin) look for honey colored crusts

What BP med should be started on a patient post MI

Beta Blocker

Incident to Billing

Bill 100% as long as a physician is in the building

What BP class should be avoided in a patient with CHF

CCB

What BP class should be avoided in a patient with GERD

CCB

What BP med given for patient with isolated systolic BP

CCB

S3 associated finding in what population

CHF, pregnancy normal, young children

Multiple people with the same disease or phenomena

Case series

Blurry vision, increased sensitivity to glare, poor night vision,

Cataract

What is a complication of a patient with history of chronic otitis media

Cholesteatoma (growth in ear) REFER to Otolaryngolist requires surgical removal

A group of DM nurses following patients in a longitudinal study is what?

Cohort

Collaborate vs Consultant

Collaborate = formal process of sharing responsibility Consultant= informal process eg. new NP asks a colleague about medical advice a mentor

Medicare C covers

Combination of A/B must be enrolled in both supplemental insurance cover glasses, dentures

Computer Decision Support

Computer program that helps make diagnosis; Guides practice (e.g. drug-drug reaction software at work)

Reliability

Consistency of results

Neurovasculization & flame shaped hemorrhages

DM retinopathy

Secondary Prevention

Detecting pre-clinical disease AKA looking for trouble

What diagnostic test is used for osteoporosis

Dexa scan may repeat every 2 years

DMARDs definition

Disease-modifying anti rheumatic drugs e.g. methotrexate, plaquinil

Knee instability test

Drawer (anterior drawer/posterior drawer)

Medicare D covers

Drugs

Chronic venous insufficiency relief

Elevate to decrease swelling

what medication reacts with tegretol

Erythromycin

what meds to avoid in pregnancy

Estrogen Bactrim - causes hyperbillirubinemia in 3rd trimester and newborns No quinolines - <18 including pregnancy No Doxi

When using interpreter should you make eye contact, or look at interpreter

Eye contact for observance of non-verbal cues e.g.. pain

What are risk factors for breast cancer

Family history, nulliparous female, mexican, older

Herbal remedy for Migraines

Feverfew

7th day of adventist

Follow a health diet (no caffeine, most are vegans) Saturday is holy day

Pregnant pt is 32 weeks. You have a choice to give Doxi, Lefoflaxcin, Batrim and Erythomycin. Which drug do you give and which do you avoid and why

Give Erythomycin - macrolide Avoid: Doxi -category D stains teeth No Quinlones <18 or in fetus due to affect neural development No Sulfa drugs in 3rd trimester

Optic disc cupping

Glaucoma

1st line treatment for GERD

H2 blocker (Ranatidine, Zantac)

When to add insulin and whats name of one

HGBA1c 9 (Lantus)

Cotton wool spots are seen in?

HTN & DM retinopathy

Papilledema & Optic disc swelling

HTN retinopathy

Pityriasis Rosea

Herald patch, christmas tree pattern

roseola

High fever, 2 to three days break out in rash

Evaluation Management 3 parts

History, Examination, & medical decision making (complexity)

Prevalence

How common the problem is # of existing cases eg. Maliaria in Asia

what drugs react with coumadin

INR

What patients should avoid receiving Varicella & MMR

Immunocompromised (HIV, Chemo, pregnancy, No spleen) Sickle Cell Ok

What happens to the HGB/HCT in a pt leaving in the mountains with a high altitude

Increases (air is thinner so become more hypoxic and will go up)

Dependent Variable vs Independent variable

Independent variable - the characteristic of the variable being observed or measured is used to influence an event (can manipulate eg. amount of exercise) Dependent variable - the OUTCOME that is caused by the influence of the independent variable (e.g.. weight loss)

When pt consent is not required for HIPPA

Insurance billing Collection agency unpaid bill Report abuse or domestic violence Reportable diseases - to state Consulting another provider Teen

Herbal remedy for Anxiety & Insomnia

Kava Kava

Fidelity

Keep your promise (loyalty & trust) Obligation to maintain trust in a relationship e.g. the NP should try his or her best to develop a trusting relationship with pt

S4 associated finding in what population

LV Hypertrophy, MI

Sensitive test for ACL

Lachman

What is a situational leader

Leader and a follower all at the same time

What study is using data resources

MA

First line treatment of PNA without comorbidities

Macrolides (azithromycin, clarithromycin) ABCDE

Relative Risk Reduction

Measure of how much risk is reduced in the experimental group compared with the control group (Eg. probablity of a disease developing those who smoke and those who don't.)

Who funds Medicare vs Medicaid

Medicare - federally funded Medicaid - state funded and funding varies by state to state

Name research pyramid

Meta Analysis (combines data from multiple studies or SR) Systematic Review _____ Randomized Control Trail (only experimental study) Experiment Cohort Study Case Reports _______ Expert Group Editorials Opinions

What would describe a database research or systematic review

Meta analysis or systematic review rate 1

What medication can help regulate menstrual cycle in pt with PCOS

Metformin

what stage is a pt with night time awakenings 3- 4 times a month

Mild persistent

Emancipated Minor

Military & married

Night time awakening >1 week but not nightly

Moderate Persistant Asthma

what stage is a pt with FEV1 <80

Moderate persistent

Adolescent relationship with smoking

More likely not to smoke if they don't smoke at a young age

What population May have to modify physical exam due to clothing

Muslim

How much does Medicare pay NP

NP 85% doctors 100%

Public opinion on NP as primary provider-

NP should find ways to overcome barrier

1st line treatment for Gout and following treatments

NSAIDs (indomethacine) first goal is pain relief then can add Colchicine during acute phase (shortens episode)

Jehovah Witness

No Blood transfusions (may need court order in child for emergency)

Highest risk of suicide

Older white male

What murmur has a click sound

On test: mitral valve regurgitation

Condition with Herberdens & Bouchard's Node

Osteoarthritis

osteoporosis vs Osteopenia t-score

Osteoporosis = T-score -2.5 or less Osteopenia = 1.5 - 2.0

What are 2 vaccines the elderly should receive

PNA & Influenza

Failed first line treatment in GERD next steps

PPI omeprazole

HTECH

Passed in 2009 health information technology big push for meaningful use of electronic records by facilities

nonmaleficence

Preventing or avoiding harm e.g. not given a middle aged woman with osteoporosis a biophosphate with history of GI bleeding and PUD

Preventative treatment for Gout

Probenecid (increases uric acid secretion in the urine) Maintenance drug = allopurinol; don't initiate in an acute phase

Root cause ANALYSIS

Process in health care to get to the bottom of factors that resulted in an error

Confidentiality

Protect patients identity (e.g..identifiable health records, demographic info

Standards of care

Protects the public (ethics)

What is a split S2

Pulmonic on inspiration and normal if goes away

What study is "mixed studies together"

RCT

Experimental study

RCT (fancy study) one control group and one intervention or treatment group

treatment of severe acne vulgaris

Refer can't prescribe accutane

What relieves Chronic venous insufficiency

Relieved with elevation LE (very swollen)

Treatment for PNA with comorbidities

Respiratory fluoroquinolone Moxifloxacin & levoflaxcin

Malpractice

Results in inury

Symptoms of Hypocalcemia

Reverse: Hypocalcemia = muscles are hyperactive (twitches spasms) Hyperactive = muscle flaccid or weak

Coundition with Bouchard's Nodes

Rheumatoid Arthritis (Swan-neck deformity/boutonniere deformity)

What 2 meds increase INR in coumadin

Rifampin & Bactrim

State board of nursing

SBON has legal authority to license monitor, or discipline nurses who practice in their state

Jews religious observance

Sabbath starts friday night and ends saturday night NO Labor, (don't drive or use cellphones). MAY AVOID COMING TO THE CLINIC UNTIL MONDAY if GOT SICK ON SATURDAY

Herbal remedy for BPH

Saw Palmetto

what stage is a pt with FEV1 <60

Severe

Peripheral Artery Disease appearance

Shiny & pale skin (no discoloration), no hair, ulcer normally present, may have gangrene

Fifth disease

Slapped cheek (five fingers on hand)

In the case of abuse do you contact law enforcement or social searches

Social services (CPS, APS

where do NPs get right to practice

State legislature who enacts the state nurse practice act

what meds to avoid with BPH

TCA

what meds should be avoided in BPH pts

TCA (Doxepin, amytriptylline,

14 year old with boy with red scrotum and rugae and no penile development what should you do?

Tanner stage 2 normal

Veracity

Tell the truth ( present information honest & truthful)

12 step program for alcoholic

Tertiary (they already etoh dependent)

Smoking session education is what type of prevention

Tertiary (they already smoke)

what chronic disease are PCOS patents at greater risk to develop

They are overweight = insulin resistance in PCOS= DM2

What BP medication would you give a women with osteoporosis

Thiazide Diuretic

Oral candidasis

Treat with an "azole"

What antidepressants should be avoided in patient with BPH and why

Tricyclic antidepressants (eg.Doxepin, Amytriptylline) causes urinary retention

Evaluation Management

Used to bill patients and are part of the CPT code. Not billable if document missing E&M code; intervention is all based on the documentation. Can't bill if documentation doesn't back up

Bleph-10

Used to treat Occular eye infections (look for red eye)

What test for MCL & LCL

Vagus (gum together)/ Varus

What immunizations are given at 12 months

Varicella & MMR (live viruses)

Veins or Arteries larger in the eye

Veins

What is the name of the prayers that 7th Day of Adventist

Vespers

When should child be potty trained when moving

Wait there should be no interruptions its a stressful process

How do you treat Pre-HTN

Weight loss and Exercise

How can PCOS patents regulate their menses

Weight loss and exercise

African Americans

Will of God (EG. ESRD pt and didn't think he should prolong life) ask him what do you want to do

Asians

Ying & Yang / hot / cold treatment NO eye contact

Incidence

a measure of number of NEW cases e.g. malaria in U.S.

When do you interview a patient with suspected domestic abuse

alone

What patients should receive a PNA vaccine

anyone with respiratory disease (e.g.. 14 year old with asthma)

Mumur that radiates to the neck

aortic stenosis

what culture is less likely to have eye contact with the provider

asians and native americans

Standards of practice

authoritative statement by which the quality of practice, service, or education can be judged

Licencse

authority to practice in state (permission)

Describe normal development of 6 month infant

babbles, rolls over in both directions (front/back & back/front) imitates sounds can stand and support weight if hands held up passes objects from one hand to other sits without support

Fixed Split S2

bad if stays

Most common skin cancer

basal cell cancer (waxy, pearly appearance)

Central vs Peripheral cyanosis

bluish discoloration, especially of the skin and mucous membranes central (around the core, lips, and tongue) and peripheral (only the extremities or fingers).

Negligence

breech of duty no injury

Report with one person

case reports

What smoking cessation meds can you still smoke

chantix and wellbutrin

Presentation of Down syndrome

chromosome 21 round face that appears flat slanting eyes and low set ears; enlarged tongue shorter neck transverse palmar crease

Pt with sudden headache increase IOP and sudden loss of peripheral vision

closed angle glaucoma

meta analysis

combines data from multiple studies (systematic review) resulting in higher statistical power and a single conclusion

Quality Assurance

concerned about the outcomes of the patient; provide best quality of care eg. pt satisfaction

case report

detailed report of one patient with a disease or unusual condition

ICD-10

diagnosis code

Chronic venous Insufficiency appearance

discolored (brawny to brown color) Very edeamoutous

what if pregnant patient rubella titer is negative

don't give during pregnancy give immediately after delivery

What is the difference between electronic medical record and electronic health record

electronic medical record = digital version of 1 patients chart at one provider electronic health record = summary of all patients records with other providers consulted. (TRANSFERS from state to state)

propanol used to treat what tremor

essential

what describes RCT

experimental studies with placebo; research that says trail this (has control group and treatment group)

Family systems theory

family is one system each member of the family has a role and changes in members role will affect other family members

Hep A route of transmission

fecal oral

what completes the purity for males and femals

females menarchy males growth spurt

Pityriasis rosceea

fine scales, Christmas tress pattern, herald patch

Phimosis

forsekin cannot by pushed back from glans of penis

What drug can be used to treat osteoporosis

fosfamax

PPI increases the risk for developing what

fractures reduce absorption (B12), C-diff, CAD, and more

Loss of peripheral vision

glaucoma

What is COQ10 for

heart health

8 year patient with asthma and you need to measure the PFT. Only have height and gender which one will you use to measure

height only thing measured you can observe gender

St Johns Wart

herb used for depression

Ginkgo

herb used for memory

Black Cohosh

herbal medicine used to treat post menopausal hot flashes

side effect of thiazide diuretics

hyperglycemia increased LDL/Triglyceride Hyperuricemia (gout) Hypokalemia & hyponatremia avoid in pts with sulfa allergy

What to do if a pregnant pt Hep B titer is negative

immunize

HA1c 8.5 still on 500 mg metformin BID what should you do add lantus add another drug increase metformin to 1,00 Bid order micro albumin

increase metformin 1,000 mg BID and order micro albumin

Periorbital cellulitis & Treatment

infection of the eyelid or skin around the eye (swelling, redness) REFER

Medicare A covers

inpatient & skilled nursing facility

PAD characteristics for diagnosis

intermittent claudication walking hurts; rest better dangling extremity feels better PAD ankle brachial index <0.9

Justice

lack of bias pt has right to fair and equitable treatment e.g.. homeless alcoholic man without health insurance presents to ED

Weber abnormal in conductive loss

laterlize to bad ear

what leg pick needs to go to vascular doctor

leg with veins that look like spider bad varicose veins

Who qualifies for Medicaid

low income government aid

benefits of breastfeeding

lower risk of asthma/allergies help immune system fewer ear infections, URI & diarrhea reduce risk of sids higher IG

Loss of central vision

macular degeneration

what is a complication of acute otitis media

mastoiditisv- infection of the mastoid bone

+Anti-HCV

may have Hep C order HCV RNA (by PCR) if positive pt has Hep C

what knee injury causes a click sound

meniscus

treatment of Acne Rosacae

metronidazole gel

Patient more prone to cluster headache

middle age male

Cluster headache

middle age men, unilateral behind eye, runny nose

Risk Management

minimize the risk (patient safety e.g. falls)

What murmur radiates to the axillary area

mitral regurgitation

mumur with click

mitrial valve regurgitation on the test

what stage is a pt with daily use of albuterol inhaler

moderate persistent

why don't we give insulin to homeless patients

no access to food

what treatment for otitis externa

only ear drops? cortisporin

Rule of shingles

only given in individuals age 65 only and won'

what is another term for telehealth

open access to care

tele-health

open-access to care (rural patient with vision impairment great candidate)

What complication of too much syndthroid doubling the dose

osteoporosis

Depoprovera side effect & what patient population to avoid use

osteoporosis & bulmia/anorexic because bones already brittle

Utilitarianism

outcome of the action is what matters "use resource to the benefit of most" eg. wic program not for elderly men or other adults it would cost society more if women and children are harmed by inadequate food intake

Meicare B covers

outpatient visits, DME, ER visits

treatment for cluster headache

oxygen

cohort study

perspective study; research subjects are observed for a long period

why don't asians respond well to pain meds

poor metablizors of CYP2D6

Privacy

preserving a patients dignity (eg. gowns so back not visible, foley not visible to visitors)

Gout-prevents long term deformity

probenecin)

HIPPA

protects privacy and confidentiality

Systematic review

pulling articles together e.g. pub med, cochrane

IBS presentation

recurrent episodes of crampy lower abdominal pain with bloating, flatulence accompanied by either constipation and or diarrhea. PAIN RELIEVED WITH DEFECATION trigger recent emotional stress Stool may have mucous BUT NO BLOOD

what does the eye look like that is treated with Bleph-10

red eye with drainage

15 year old boy with no testicular enlargement what should you do or is this normal?

refer

Gangloin Cyst

round, small, painless lump on the tendon or joints of the wrists or hands that resolve on their own

Scarlet fever

sandpaper rash

Fetal alcohol syndrome presentation

small head shortened palpebral fissures with epicentral folds and a flat nasal bridge; thin lip underdeveloped ears

Xanthelasma

soft yellow flat plaques on upper/lower lids by inner canthus (cholesterol plaques)

Scope of Practice

state what can and can't do

Kwaski disesese & treatment

strawberry tongue, fever last longer than 5 days, rash, treat with high dose aspirin

Drugs that interact with Warfarin

sulfa drugs (Bactrim) Macrolides (erythomycin & Biaxin (clarithromycin) NSAIDS

how does oral contraceptives work

suppress ovulation

Certification

tells public have the minimal knowledge

which one will you treat with a topical antibiotic pics with skin

the baby one because babies can't have oral antibiotics

Beneficence

the obligation to help the pt; doing good; "do no harm" acting in pt best interest e.g. educating pt on new prescription, calling surgeon to get stronger prescription for pain med

Baby with 20/400 vision what should you do

this is normal hold them at 8 feet

External validity

threat to external validity is when you can't generalize to a population (eg. study with 20 african Americans can't apply to hispanic population)

what is the treatment for acne vulgaris

topical benzol

Treatment of Mild Acne Vulgaris

topical benzoyl peroxide

treatment of moderate acne vulgaris

topical benzoyl peroxide + oral antibiotic (tetracycline or minocycline)

Lipid profile

total cholesterol <200 LDL <100 HDL >40 Trigs <150 (treat first if 500)

Cryptorchidism

undescended testicle linked to #1 risk for testiular cancer

CPT

used to bill for outpatient office procedures and services

What do you do with a 8 month with a hydrocele

watch and wait don't refer until 12 months

Leukoplakia

white colored thick patch on the tongue. REFER to rule out CA

When'd o you interview minors

with parents and alone to screen for risky behaviors

when do you give high intensity statin

younger than 75 with hx MI, CAD, angina, PAD, coronary revasculization surgery, CVA TIA no risk factors but LDL >190

Justice

"No matter who it is you will treat them" Being fair and acting without bias (e.g.homeless)

Acne Rosacae

"rosy cheeks" chronic symmetric redness