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
