DO NOT DELETE!

Acute *Bacterial* rhinosinusitis

*Most acute sinusitis caused by viruses* S/S: *> 10 days*, maxillary toothache, "double sickening" PE: Non-specific Pathogens: S. pneumoniae, H. influenzae, M. catarrhalis Tx: reserve abx for S > 10days, amoxicillin, azithromycin, doxy Complications: orbitial cellulitis/abcess, brain abscess, osteomyelitis, cavernous sinus thrombosis

Community Acquired Pneumonia (CAP)

*Outside hospital* or within 48hr of admission In most cases causative agent is not identifies, bacteria most common *Streptococcus pneumoniae most common* gram + diplococci

AOM tx:

-1/2 no bacterial and resolve w/o intervention -may consider watchful waiting x 48hrs -If no antibx in last month: amoxicillin high dose or cefdinir x 10 days -if antibx in last month: augmention x 10 days -failure after 3 days: drug resistance IM rocephin/clinda

First line treatment of GABHS pharyngitis:

-10 day course of pcn or amoxicillin.

When is a tonsillectomy recommended?

-6-7 throat infections in one year; 5+ per year in last two years; 3+ per year in last three years -difficult to treat medically d/t medication allergies

Cataracts:

-90% age related -can be congenital -exposure to sun

lesions:

-95% on lower lip -carcinoma of tongue/floor of mouth metastasize and poor prognosis

Relaibility

-Ability of test to consistently yield same result over time//diff observers (inter/intra observer variability) EG: UCSD/Scripps and Mon/Fri

pulpitis tx:

-Afebrile: pain relief; referral -Swelling/fever: Pen V or clindamycin w/analgesics; refer with 12-24hrs to dentist -Temp >101 with edema and facial asymmetry: immediate referal; may need inpt antibx

Medicare

-Age over 65, multiple parts (hospital, outpatient care; optional: managed care and prescription coverage) -Not "free" to seniors: premiums, deductibles, co-insurance, and prescription coverage

Uninsured in the US

-All groups are decreasing --Even with ACA: we have 36 million people that don't have access to health care **Greatest reason is cost (working poor, medically indigent)

What is the treatment for recurrent GABHS pharyngitis if treated with PCN?

-Amoxicillin/clavulanate -clindamycin -IM PCN G

Screening assumption

-Assumes there is a treatment that improves outcome when the disease is found earlier

Nutrient Intake Patterns

-Cal, protein, vit, minerals, intake - swallowing difficulties -GI disturbance -unusual food habits -misuse of supplements -restricted/therapeutic diet

Health reform and cost

-Changes to medicare premiums -Changes to make medicare meds more affordable -Provide medicare payments to hospital w lowest medicare spending -Allow accountable care orgs who meet quality thresholds to share in medicare savings -Reduce payments

CHIP

-Children's health insurance program (fed and state) --Low income children not covered by medicaid -There isn't a safety net that covers all children in US **health insurance for children under 18 whose parents earn too much to qualify for Medicaid, but not enough to afford private insurance.

Menderes Disease

-Chronic Condition of inner ear -spinning vertigo, low frequency sensorineural hearing loss, tinnitus, fullness in affected ear -excessive fluid and pressure on labyrinth -need ENT referral

Strabismus in adults:

-DM -Graves -injury -shellfish poisoning -stroke -TBI -vision loss

Concerns about quality

-Disparities (eg: lack of access to care = 25% higher mortality) -Patient safety and medical errors (eg: hospital acquired infections)

Future tobacco research

-E-cigs/vaping products -Hookah -Marijuana -Disparities

eiplottitis tx:

-ED referral -empiric coverage for group A streptococcus pneumoniae, staphylococcus pyogens, or h. influenzae (3rd gen cephalosporin or augmentin) -airway monitor, ICU

hyphema:

-EMERGENCY -hemorrhage into anterior chamber of eye from iris or ciliary body rupture; may be spontaneous but usually trauma

Health insurance options

-Employment-based (decreased over time, costly, people opt out) -Government program -Self-insured (small %)

Family Smoking Prevention and Tobacco Control Act

-FDA regulation of cigarettes --Companies have to submit ingredient list, and how the ingredients are processed

herpes simplex labialis:

-HSV-1, perioral -reactivation

Major priorities of health care reform

-Increasing access, expansion -Innovations and assessments in cost containment and quality -Improving affordability -Improving the patients bill of rights -Investment in a stronger primary care foundation

Access options to care

-Insurance -Self pay on a fee for service basis (uncommon = really expensive)

Anterior epistaxis:

-Kiesselbach's plexus 90% of bleeds

Surgeon General's Report

-Linked smoking to poor health, including cancer

Medicaid

-Low income and disabled -Each state sets eligibility requirements --CA: Medical: covers disabled and certain low income adults and children only

Types of screening

-MASS: large, pop scale (eg: blood pressure measurements) -SELECTIVE: targeted at subsets who are at high risk based on factors such as age, fam history, exposure (eg: breast exams for women over 40, prostate for men over 50

Secondary Prevention

-Measures provided to inds to identify ASYMPTOMATIC persons who have RISK FACTORS or pre-clinical disease but in whom the cond has not become clinically apparent ***Identify ppl who don't yet have symptoms that have some sort of risk factor -GOAL: Improve outcome w early detection/treatment -EG: breast/prostate cancer screening

Tertiary prevention

-Measures provided to inds to treat persons who already developed the disease to prevent further progression or complications -GOAL: try to limit disability and stop/delay progression -EG: Rehab program for stroke/anti-clotting meds for heart attack

What symptomatic therapy should be used with GABHS pharyngitis?

-NSAIDS -Medicated lozenges

Otitis externa differential:

-OM -FB -mastoiditis -cerumen -malignant otitis externa

OM signs:

-OME: *injected/edematous mucous membranes of nasal and oral cavities *eardum dull but not bulging, mobility decreased -AOM: *TM amber or yellow-orange, may be injected and pinkish gray to fiery red *TM full or bulging with absent or obscured bony landmarks and cone light reflex

Self-Funded Insurance Programs

-One that pays the health care costs of its employees with the premiums collected from the employees and the contributions made by the employer -Need a sizable group of employees over which to spread the risk

Hemoglobin

-Oxygen carrying pigment in RBC -low level could mean anemia

TMD other mgmt:

-PT -oral surgeon -behavioral therapy -NSAIDS, muscle relaxer at bedtime

Screening tests importance

-Pain/discomfort -Complications -Wrong answers -False negatives

Minorities smoking data

-Racial/ethnic minorities are more likely to be light and intermittent smokers than Non-Hispanic Whites **Have not found evidence suggesting that racial/ethnic minorities have more success quitting smoking

Screening vs diagnostic tests

-Screening: identifies early signs of disease w no sign/symptoms of disease -Diagnostic: persons whom disease is suspected due to symptoms, physical/lab findings

Bacterial Conjunctivitis mgmt:

-Sulfacetamide -Tobramycin -Ciprofloxacin -Ofloxacin -Moxifloxacin (severe cases)

OME presentation:

-TM amber w/fluid bubbles, non mobile, fluid level may be present

US health care system

-Task: assuring that the right patient receives the right service at the right time and in the right place and by the right caregiver --EG: patient w appendicitis --> ER and surgery --Costly, spends more than any other country

Why are health care costs increasing?

-Technological advances -Pharmaceutical costs -More older Americans (50% of health care costs are because of 5% of pop; older am --> chronic diseases)

AA/Hispanic/Latinos data

-Those who smoked menthols were more likely to consider quitting smoking/think they would successful quit **Smoking menthols was negatively associated w being quit for at least 6 months across all racial/ethnic groups

Purpose of screening

-To detect disease before we would if we didn't screen (before symptoms occur) --So we can treat earlier/improve survival/outcome **NOT intended to be diagnostic (diagnosis --> confirms disease, it's after screening)

Allergic Conjunctivitis mgmt:

-Topical decongestant/antihistamine combos (OTC) such as naphcon A -mast cell stabilizers such as patalol

strengths

2 and 4

Depression is diagnosed on clinical presentation. What time frame is important for distinguishing between depressed mood and clinical depression?

2 weeks Screening tests for depression include questions about depressed mood or other symptoms that have lasted at least two weeks. This is an important time frame. Typical screening questions ask: "in the past 2 weeks, have you felt little interest or pleasure in doing things" or "in the past 2 weeks, have you felt down, depressed, or hopeless"?

Screening

-Trying to determine whether or not people who don't have a disease, might have it --Sorts out apparently well persons who probably have a disease from those who prob don't (EG: blood pressure, cholesterol testing, TB skin testing) **SECONDARY PREVENTION: trying to detect something (primary = trying to prevent it before it happens)

Cigarette companies target

-Women -African Americans -Kids -LGBT -Went into developing countries

blood disorders

-Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets. -Blood disorders affect one or more parts of the blood and prevent your blood from doing its job. They can be acute or chronic. Many blood disorders are inherited. Other causes include other diseases, side effects of medicines, and a lack of certain nutrients in your diet. -Types of blood disorders include *Platelet disorders* Von Willebrand Disease *excessive clotting* *bleeding problems, which affect how your blood clots* hemophilia -Anemia, which happens when your blood does not carry enough oxygen to the rest of your body Cancers of the blood, such as leukemia and myeloma -aplastic anemia -Eosinophilic disorders, which are problems with one type of white blood cell. *http://www.nlm.nih.gov/medlineplus/blooddisorders.html*

Acute sinusitis:

-abrupt onset and post-therapeutic resolution; lasts <4 weeks

Dry eye:

-acquired or congenital -Sjogren's syndrome -local infection -trauma (facial nerve damage)

Pericoronitis (third molar/wisdom tooth pain):

-acute inflammatino around tissue of partially erupted tooth. usually young adults. -pain to ear throat -foul taste -trouble swallowing -ginginval tissue red and swollen -can cause peritonsillar abscess, ludwig angina, cellulitis

Gingivitis:

-acute pain onset; short duration -subacute: less severe chronic: slow onset lon gduration; usually painless unless acute exaceration

Bacterial conjunctivitis

-acute purulent drainage, hyperemia, edema -highly contagious, spread by contact/droplet -staph aureus, H flu -tx topical erythro or drops

Hordeolum (stye):

-acutely presenting, erythematous tender lump within eyelid

viruses causing conjunctivitis:

-adenoviruses -coxsackie virus -varicella -herpes simplex and zoster

Acute necrotizing ulcerative gingivitis ( ANUG or trench mouth)

-affects hard palate -adolescents to young adults -punched out crater -covered by grad slough -submandibular lymphadenopathy -slight temp -severe: high fever, tachy, leukocytosis, loss of appetitie, malaise -caused by normal flora

Strongest independent predictors of GABHS pharyngitis are:

-age 5-15 years -absence of cough -tender anterior cervical adenopathy -tonsillar exudates -fever

wet macular degernation:

-age related; new blood vessels develop under retina in macula causing sudden distortion or loss of central vision. -immediate referral

ototoxic drugs:

-aminoglycosides -tobramycin -gentamycin -erythromycin -vanc -saliciylates, loop diuretics (reversible)

What are first line antibx for rhinosinusitis?

-amoxicillin w/wo clavulanate

Symptomatic treatment for rhinosinusitis:

-analgesics -intranasal corticosteroids -saline nasal irrigation

glaucoma tx:

-angle closure: Acetazolamide during attack to lower IOP, IV mannitol -Laser therapy -Bedrest

sialadenitis tx:

-antistaph antibx (dicloxacillin, 1st gen cephalosporin, clindamycin preferred) -warm compress -IV if septic -vanc if MRSA especially in NH elderly -hydration, sialagogues (lemon juice) -warm compress -massage, good hygiene -acetaminophen -liquid diet 2-3 days -drain abscess -excision if chronic

Leukoplakia:

-astympatic; may be premalignant -white gray flat irrgular plaque -usually in buccal mucosa -underlying inflammation irritant

Dry eye treatment level 3:

-autologous serum, special lenses,

allergic rhinitis tx:

-avoidence of allergens -2nd gen oral antihistamines -intranasal corticosteroids (must use daily and takes 1-2 weeks) -Leukotriene receptor antagonists -Alpha-adrenergic drugs can cause rebound engorgement

ceruminolytic agents:

-baby oil -mineral oil -tap water -colace

Blepharitis pharm mgmt:

-bacitracin, erythromycin, quinolone ointment -oral antibx for resistant infections (doxycycline or tetracycline)

sialadenitis etiology:

-bacterial (very painful) -viral -obstruction (hurts when eating) -autoimmune (usually painless and most often women -consider malignancy if chronic

Sialadenitis:

-bacterial infection of salivary gland from stone or gland hyposecretion -pain, swelling, redness tenderness -major glands are: parotid, submandibular, and sublingual. -most common is parotid

Allergic rhinitis dx:

-based on history -seasonal history with inhaled allergen -may improve with change in environment

FB:

-becomes lodged in corneal or conjunctival tissues

hyphema findings:

-blood in anterior chamber -fluid line in pupil

Orbital/periorbital cellulitis mgmt:

-broad spectrum antibx: cephalosporin, ampicillin-clavulanic acid -f/u in 12-24hrs -refer to optho or inpt if no response to tx

Addisons Disease

-calcification of cartilage/painless nodules

what causes stomatitis and glossitis:

-candidiasis -canker sores -herpes -allergic stomatitis -denture related -systemic disease

squamous cell carcinoma risk factors:

-cause uknown -more often in tobacco and ETOH -heavy smokers -viral -diet, marijuana use -genetic -oral cancer carries 20% increased risk for secondary primary cancer

Otitis Externa

-caused by excessive wetness or dryness -peaks in children 5-14 -s/s pain esp when touching ears, itching, conductive hearing loss, edema of ear canal, thick clump otorrhea, white cheesy cerumen -tx: ciprodex

Erythroplakia differentials:

-chemical burn -candidiasis -lupus -lichen planus

Blepharitis contributing factors:

-chemical/environmental exposure -eye make up -contact lenses

blepharitis seborrheic findings:

-chronic inflammation of eyelid -erythema -greasing scaling -loss of lashes -seborrheic dermatitis of eyebrows/scalp

Medications

-chronic use -poly-pharmacy -drug-nutrient interaction

recurrent OM:

-clearance of middle ear effusions between acute inflammation episodes

Dentures:

-common problem is loose or uncomfortable -yearly consult for fit -not fitted forlife -must remove at night -bony erosion, mucosal ulceration, and oral candidiasis

Hearing loss:

-conductive: disorders of external/middle ear interfer with mechanical transmission -often a mechanical cause -obstruction of canal -cerumen (most common) -debris, FB -otitis externa -tumor

Conjunctivitis findings:

-conjunctival erythema -burning -profuse exudate -itching -FB sensation -ocular exudate with matting -preauricular adenopathy -tearing

strabismus testing:

-corneal light reflex -cover/uncover -red reflex -visual acuity -CT/MRI if tumor suspected -pupillary response/accomodation -extraocular muscle exam -fundoscopic exam

Erythroplakia tx:

-dc irritants -14 day observe for healing -referral

dental caries:

-decalcification of teeth tissue; demineralization of inorganic portion -most common disease in humans -poor hygiene, high sugar -fluoride in water reduces susceptibility -people with dementia have higher rates and institutionalized elders

Pingueculum & Pterygium:

-degenerative lesions of conjunctiva -result from epithelial hyperplasia (sun exposure/irritants)

AOM differentials:

-dental disorders, TMJ -otitis externa -serous otitis -mastoiditis -tonsillitis -FBO -trauma

gingivitis tx:

-dental visits to remove -plaque control -power toothbrush -flossing -topical antimicrobial mouthwash -chlorhexidine

Acute necrotizing ulcerative gingivitis ( ANUG or trench mouth) complications:

-destruction of gingiva and supporting tissues, tooth loss -severe sequela: gangrene, pneumonia, bacteremia, brain abscess, meningitis

Impact of Nutritional Assessment

-detect risk factors early on -early detection.intervention can significantly impact outcome -intervention/prevention reduces cost of managing developmental disabilities and chronic disease

Chalazion

-develop in meibomian glads of conjunctival side of lid -localized lesions, nontenter, minimal erythema -usually away from the lid border -small no tx, large compress

posterior epistaxis:

-difficult to control -sphenopalatine artery -idiopathic or with vascular disease

Red flags in conjunctivitis:

-diminished acuity -photophobia -severe FB sensation preventing patient to keep eye open -corneal opacity -fixed pupil -severe HA w/nausea

Epistaxis treatment:

-direct pressure x 15 minutes with ice -lean forward -if still bleeding, afrin -lidocaine then silver nitrate if you can see bleeding area -nasal packing for anterior bleed -refer to ENT or ED if still bleeding -CBC and clotting times if no obvious reason -saline for dried nasal tissue

FB in nose:

-do NOT attempt to remove batteries -usually unilateral -may completely occlude nasal passage

strabismus findings:

-doube vision -eye crossing -loss of depth perception -vision loss -significant difference in visual acuity between eyes -displaced corneal light reflex -cannot focus w/o tilting head/squinting -abnormal cover/uncover -nystagmus

Four signs with high likelihood for acute bacterial sinusitis:

-double sickening -purulent rhinorrhea -ESR >10mm/hr -purulent secretion in nasal cavity

What antibx should be used in rhinosinusitis for patients with pcn allergy or as a second-line?

-doxycycline -levofloxacin -clindamycin + third generation cephalosporin

Angular cheilosis:

-dry and burning sensation at corner of mouth -epithelium looks wrinkled and macerated -wrinkles deepen with fissures appear ulcerated but do not bleed -causes: candida albicans; staph, strep -riboflavin deficiency -referral -petrolatum ointment

Blepharitis risk factors:

-dry eyes -frequent chalazia or hordeola -facial/scalp seborrhea -immunocompromised -acne -DM -isotretinoin

Conductive Hearing Loss

-dysfunction in the mechanical conduction of external sound -can be caused by cerumen, infection, tumors, TM perforation, AOM -otoclerosis: fusion of stapes over oval window

Sensorineural Hearing Loss

-dysfunction in the sensorineural structs and pathways to the brain -disorder of cochlea and retocochlear region -noise trama is principal cause -high frequencies affected first -presbycussis: gradual degeneration

OME patho:

-dysfunction of eustachian tube preventing drainage -preceding cold, allergies, sinus congestion -smokers higher risk -may develop after AOM and last for weeks/months

most common ENT complains:

-ear pain (otalgia) -impaired hearing -tinnitus -mouth sores -hoarseness -sore throat

Dry eye treatment levels: level 1

-education and dietary modifications -eliminate meds -artificial tears -possible eyelid therapy

Pingueculum:

-elevated yellowish growth in nasal aspect of palpebral conjunctiva

tinnitus mgmt:

-eliminate offending meds -learn to cope -avoid risk factors -possible Vitamin A,C, cyanocobalamin, nicotinic acid -earplugs -oral antidepressants may be effective

Vasomotor or idiopathic rhinitis:

-environmental triggers -good response to oral decongestants and intranasal steroids -does not respond to oral antihistamines

Cholesteatoma

-epidermal inclusion cyst of the middle ear or mastoid -made up of desquamated debris from keratinizing squamous epithelial inning of middle ear -needs tx to prevent permanent damage

Dactyostenosis findings:

-epiphora (overflow of tears on lower lid) -mild crusting -red eye -mucus reflux through puncture when pressure applied -distention/inflammation of lacrimal sac

Chronic sinusitis:

-episodes of prolonged inflammation with repeated or inadequate treated infection >12 weeks.

herpes simplex labialis tx:

-episodic oral antivirals: sx reducation in 1-2 days -topical antivirals -recurrent episodes: valcyclovir or famciclovir for suppressive therapy

Otitis externa patho:

-exposure to moisture, aggressive cleaning -allergies/skin condition bacterial: *Staph. epidermidis *pseudomonas sp. *staph aureus *Candida and aspergillus in chronic.

Physical Conditions

-extremes in age -pregnancy -fat/ muscle wasting -organ disfunction -aids -cancer -other med condiitons

squamous cell carcinoma differentials and assessment:

-fails to heal in 2 weeks and bleeds easy -persistent white/red patch in mouth -lump in mouth, throat or tongue -difficulty chewing, swalloing, jaw, tongue problems -numb tongue -jaw swelling

Strabismus risk factors:

-family history -prematur retinopathy -low birth weight -smoking during pregnancy

AOM presentation:

-fever -drainage -other URI sx -full, pink, red scarlet TM, possibly perforated -lymph enlargement

eiplottitis findings:

-fever -toxic looking -narrow glottic opening -resp distress, drooling, anxiety -hot potato voice -NO EXAM WITH DEPRESSOR -have airway equipment at bedside

sialadenitis s/s:

-fever, chills, unilateral swelling -firm and diffusely tender gland with erythema and ededma -pus can be expressed from duct and should culture. -abscess if focal enlargement

What antibx may be used in GABHS pharyngitis if there is a pcn allergy?

-first-generation cephalosporins -clindamycin -macrolides

dental caries prevention:

-fluroide water -hygiene -topical flourides

Rhinitis medicamentosa mgmt:

-focus on withdrawal of meds -wean gradually -first week is most dificult -usually self resolving -avoid in future -prevention is key -may need ENT if refractory

Otitis externa tx:

-fungal: fluconazole -Malignant: *ENT referral *presents with severe pain and swelling, no fever, elevated ESR -Pseudomonas (95%) -treat IV cipro.

periodontal disease (pyorrhea)

-gingival and bony structures destroyed -causes: smoking tobacco DM osteoporosis *presence increases risk of CVD and stroke

Sinusitis sx:

-gradual onset -recurrent or chronic dull, constant pain -increases and throbs -maxillary: pain over cheeks and upper teeth. may worsen with standing. -frontal: pain over eyebrows. may worsen when recumbent. ethmoid: pain over/behind eyes with retro-orbital pain.

chalazion:

-granulomatous infection of meibomian gland with painless swelling of eyelid -initially tender and erythematous before becoming contender lump -usually associated with blepharitis

What are symptoms of epidemic keratoconjunctivitis?

-gritty feeling in eyes -watery discharge -photophobia -redness -corneal involvement

Nonpharm conjunctivitis mgmt:

-hand hygiene -clean wash cloth -change pillowcase daily -warm compress -cool compress for allergic -no contacts -discard eye makeup

Cerumen Impaction

-hard cerumen partially or completely occlude the ear canal -use mineral/baby oil then a spoon or water pix -ss: decreased hearing, pressure in ear canal -can cause TM perforation

Chronic arthritis

-hard nodules

herpes simplex labialis presentation:

-have several episodes yearly -prodome tingling -moderate to severe pain 24hrs -vesicles within 48 hrs replaced by ulcer crusts -resolves in 7-9 days. lesions may last 2 weeks

Goals of Nutrition Assessment

-health promotion - disease prevention/ treatment -periodic nutrition screening/ assessment needed throughout life, not just during illness -involves interpretation of data from nutritional screening

Chronic OM sx:

-hx of repeated AOM with otorrhea > 3 months -hearing loss is primary concern

When is a 10 day course treatment of antibiotics in GABHS pharyngitis recommended?

-if risk of rheumatic fever is high

Tympanovstomy tubes

-if three episodes of AOM in last 6 months -4 episodes in last year with one in last 6 months

Sialdenitis etiology:

-in 50-60yrs -chronically ill with xerostomia -Sjogren syndrome -radiation or iodine therapy -adolescents with anorexia

Macular degeneration:

-in less than 20/20 and improves with pinhole is uncorrected refractive error -fundo exam is normal w/refractive errors -yellow round spots (druse); early degeneration -clums or pigment irregularly with depigmented areas of atrophy in macula is late phase.

glaucoma risk factors:

-increased pressure and age -family history -open angle: DM, african american, -angle-closure: hyperopia small cornea

Otitis externa:

-infection of external auditory canal -causes: swimming fluids for cleaning digging or irritating canal -pushing wax/trauma -may be bacterial or fungal

Acute Otitis Media

-infection of middle ear -abrupt onset of s/s ear pain, irritability, otorrhea, fever -middle ear effusion by bulging TM, limited or decreased mobility -ear inflammation: red TM, otalgia, interfering with sleep/activity -tx: amoxicillin 1st then agumention

Hordeolum

-infection of oil glands that surrounds an eyelash follicle -cased by staph aureus -s/s: swelling, tenderness, erythema spreading away from site of infection, sensation of something in eye -tx. warm compresses, cleanses with neutral soap, antibiotic if s/s persist

Pharyngitis:

-infection/irritation of pharynx and tonsils -noninfectious-allergies, trauma, burn, CA infectious: viral( most common), bacterial, fungus

nonallergic rhinitis:

-infectious -irritant related -vasomotor -hormone related -associated with med use/overuse -atrophic in geriatric patients

common causes of conjunctivitis:

-infectious agents: bacterial, fungal, viral -toxicity -allergy

conjunctivitis:

-inflammation of conjunctiva covering front of eye

Blepharitis

-inflammation of eyelid margins caused by staph -tends to be chronic -s/s scaling of eyelid margins, itching, crusting, erythema, sensation of foreign body, burning, hx of recurrent chalazia or hordeola -tx: source of irritation

Rhinitis:

-inflammation of mucous membranes of nose from allergen -sneezing, rhinorrhea, itching

stomatitis:

-inflammation of oral mucus membranes

gingivitis sx:

-inflammation; increased secretions and bleeding -bright red -acute: edematous -chronic: firbrous with pits -caused by plaque formation; gram + rods -plaque becomes gray-yellow and forms tartar. -if untreated= periodontitis

Allergic Conjunctivitis

-intense itchyness, rubbing, tearing, edema -bilateral presentation -common in kids with allergic disease

tinnitus:

-intermittent, continuous, pulsatile -Risk factors: hearing loss, labyrinthitis, Menieres, OM -hyper/hypo tension, head trauma, anemia, hypo/hyperthyroidism, allergies -meds: salicylates, quinine, alcohol, indomethacin (reversible) -kanamycin, streptomycin, gentamicin, vancomycin (irreversible)

Allergic rhinitis med tx:

-intranasal antihistamines have rapid onset and effective -intranasal atrovent (anticholingergic) good for rhinorrhea and sneezing but not congestion -combon steroid + antihistamine -use oral steroids only when severe and unresponsive. use 5-7 days max.

Ulcerative blepharitis:

-involves lash follicle and meibomian glands of eyelid -may have pustules that crust and bleed -lashes become thin and break easily

corneal erosion:

-involves underlying stomal layer in addition to epithelial defect

Allergic rhinitis:

-itching -epiphoria (stringy, watery discharge) -sneezing, coughing, sore/burning throat

Blepharitis ulcerative findings:

-itching -tearing -chalazia -recurrent styes -photophobia -small ulceration at eyelid margin -broken/absent eyelashes

pulpitis (toothache)

-large lesion -large restoration filling -early is inflammation in pulp (central portion of tooth) -vital soft tissue

Rhinitis medicamentosa epidemiology:

-lead to chronic sinusitis, atrophic rhinitis, permanent turbinate hyperplasia -withdrawal sx

squamous cell carcinoma plan:

-lesion 6-18 months before presentation -dental surgeon for bx -lip tumors have highest success rate -surgery radiation chemo

Complete oral exam includes:

-lips -cheek (buccal mucosa) -palate -salivary ducts -tonsillar area -tongue -floor of mouth -gingiva -teeth-

Local alveolar osteitis (dry socket) sx:

-localized pain 2-3 days after extraction -irritation of sensory nerves in dry bony socket -foul odor -no suppuration

Edentulousness:

-loss of 21 natural teeth -trouble chewing, undesirable diets, trouble enunciating -poor esthetics -lower self esteem -may have dentures that can cause lesions

Periodontitis etiology:

-loss of bony support -90% of elders have it -red and bleeding gums -unpleasant taste -pain free unless infection

Amblyopia

-loss of vision -secondary vision loss -usually unilateral deficit -tx: patching, atropine eyedrops

Psychological/Social Factors

-low literacy -language barriers -depression/ mental health -limited resources -low income -substance abuse

Hair

-luster, color, alopecia, scalp -PCM, lack of protein, EFAs, Zinc, Copper

Viral rhinitis presentation:

-malaise -HA -sore throat -occ fever

GAS (strep throat) findings:

-marked erythema of throat/tonsils -exudate -tender anterior cervical adenopathy -look ill -usually NO cough -

dactyostenosis mgmt:

-massaging BID of lacrimal duct -gtts if infected -referral

Parotid abscess:

-may be caused by oral cavity infection spread -may spread from parotid lymph draining infected area

chronic sinusitis:

-may need imaging -immunological abnormalities -ENT referall -antibiotic resistance?

Auditory Brainstem Response (ABR)

-measures the initiation of sound-induced electoral signals in cochlea -measures functioning of the peripheral auditory system and neurologic pathways

What can cause decreased tear production?

-meds: anticholinergics, beta-adrenergic, antihistamines -aging -diminished blink rate

Otitis Media with Effusion

-middle ear effusion lacking infection -fluid in middle ear -no fever, otalgia -tx. watchful waiting

OME chief complaint:

-mild pain, popping, cracking, watery ears, ringing, vertigo -hx of cough, rhinitis, allergies, flying, diving -may not be able to pop ears

glaucoma prevention:

-monitor IOP regular eye exams -avoid OTC vasoconstrictive ocular agents and anticholinergic meds

squamous cell carcinoma:

-more common in men -4th decade of life -seen -90% of malignant oral cavity tumors -blacks more than whites

Recurrent aphthous stomatitis (canker sores)

-more in females -familiar tendencies -winter and springs -superficial ulceration -prodromal burning 1-48hrs before -2-5mm -rupture in 2 days and form saucer like ulcer -red/gray central portion -single or multiple -heal w/in 7-10 days.

Local alveolar osteitis (dry socket):

-most common complication of tooth extraction -caused by loss of blood clot at site of extraction

Epistaxis:

-most common is from disruption of nasal mucosa from trauma/inflammation -may be from HTN liver disease, clotting disorder

Red Light Reflex

-must be symmetrical -start in neonates & do at all visits

cerumen impaction:

-must have documentation of hearing loss before cerumen removal can by paid for by medicare

Diabetic retinopathy:

-need yearly exam -3 stages *background -preproliferative -proliferative

Burning mouth syndrome

-no eitology -nutritional deficiencies -anxiety, depression -DM II -salivary flow changes -allergic reaction -candidiasis -dentures -

macular degeneration mgmt:

-no prevention -no treatments in early stage -intermediate stage: high dose antioxidant vitamins and zinc may help -laster for wet but limited value for central lesions

tinnitus differentials:

-noise exposure -meds -presbycusis -otitis -vascular disorders

dental caries s/s:

-non painful white, brown black spite -bacterial plaque forms: streptococcus mutans or lactobacillus acidophilus metabilize fructose

Vasomotor rhinitis:

-noninfectious without eosinophilia -watery rhinorrhea, nasal congestion, "nasal" speech, mouth breathing -onset is rapid, may switch sides with attack -chronic year round -obstructive sx; NO itching -nasal mucosa erythematous

Audiogram

-normal hearing is 0-20dB -at 40dB difficulty hearing fain or distant speech -55dB understand normal speech at 3 to 5 feet -90dB hear a sound voice at one foot from ear

Dactyostenosis:

-obstruction of nasolacrimal duct -most common cause of epiphora and ocular discharge in newborn -can be congenital or by infection (staph or strep)

Canker sore classification:

-occasional -acute: persists for weeks; may have GI disorder -chronic: for years

dry eye treatment level 2:

-ocular lubricants, anti inflammatories -cyclosporine emulsion (RESTASIS)

Burning mouth syndrome:

-often in post menopause -burning to tongue; infrequent other soft tissue with normal mucosal findings -topical analgesic rinse -chronic pain protocol -tailored mgmt

Cataract findings:

-opacification of lends -diminished light reflex -leukocoria -blurred vision -glare -light halos -diminished night vision, visual acuity

glaucoma tx:

-open angle: BB and prostaglandins -laser therapy

glaucoma types:

-open-angle -angle-closure (closed angle, narrow angle) -primary/secondary -congenital

sinusitis meds:

-oral analgesics -Afrin <3-4 days -expectorants to liquify sinus secretions and facilitate drainage -anti-inflammatory topical steroids in nasal spray -empirical antibx therapy 7-10 days Augment *avoid macrolides and bactrim d/t resistance

Imidazoline nasal decongestant:

-oxymetazoline clonidine -cause vasoconstriction through alpha2-adrenoreceptors but may decrease endogenous norepinephrine through negative feedback.

TMD sx:

-pain -HA -muscle spasm -jaw noise -limited movement -ear sx

Corneal/FB presentation:

-pain -redness -tearing -photophobia -FB sensation

Local alveolar osteitis (dry socket) tx:

-pain control -tylenol; codeine -dental consult for irrigation and placement of dressing -dental follow up every 1-2 days for 10 days until re-epitheliazation

Temporomandibular disorders (TMD):

-pain in muscle of mastication, preauricular area, and/or TM joint -chewing, bruxism, aggravate pain

What can distinguish hand-foot-mouth disease from GABHS pharyngitis ?

-painful oral lesions with exanthem on hands and feet

Tophi

-painless uric acid crystal deposits -seen in gout patients

Xerostomia:

-partial/complete lack of saliva -cracking lips, difficulty swallowing, changes in tongue texture -usually increase liquid consumption -secondary complication of salivary gland disease (sjogren)

What is double sickening?

-pattern of initial improvement followed by worsening of symptoms in 5-10 days; consistent with acute bacterial rhinosinusitis.

GAS (strep throat)

-peaks in late winter/early spring -children, young adults -sudden sore throat, painful swallowing, fever, chills, HA, abd pain -responsible for acute rheumatic fever and post-strep glomerulonephritis

Chronic OM:

-perforated draining TM and possible invasive granulation tissue -foul smelling otorrhea (anaerobic bacterial infection) -chronic grayish yellow suppuration

Chronic OM:

-persists more than 3 months, usually from rupture with intermittent or persistent otic discharge

Meds that cause gingival overgrowth:

-phenytoin -cyclosporin -CCB

Otoacoustic Emissions (OAE)

-physiologic test -measures response of inner ear to brief clicks or tones -done at any age -can detect unilateral & mild hearing loss -dose not quantify loss

Periodontitis risk factors:

-poor hygiene -plaque

Hematoma

-presents as a blue doughy mass if not drained can result in deformity -caulifower ear

Periodontitis tx:

-preserve teeth goal -restore function -prevent recurrence -two phase tx: *deep scaling remove irritant institute place control -topical and systemic antibx -stop smoking -phase two is surgical

Corneal abrasion mgmt:

-prevention -minor can be managed by PCP (tobramycin ointment, cipro gtts) -if not healed in 1-2 days, refer -superficial FB can be removed by PCP; do not apply patch

diabetic retinopathy mgmt:

-prevention -only med to slow progression is lisinopril -laster therapy with proliferative or significant macular edema

cataract mgmt:

-prevention -routine exams -protective eyewear -reduct ETOH, smoking

Sympathomimetic nasal decongestant:

-pseudophedrine, amphetamine, phenylephine -activate sympathetic nerves through presynaptic release of endogenous norepinephrine. binds to alpha-receptors and causes vasoconstriction. Rebound may be through weak affinity toward beta-adrenoreceptors

Hearing Screenings

-pure tone audiometry at ages 3-5, 10, 12, 15, & 18 years

Subacute sinusitis:

-purulent nasal discharge persists despite thearpy 4-12 weeks.

sinusitis findings:

-purulent nasal secretion -total opacifications -red swollen nasal mucosa -pale mucosa with watery is allergic sinusitis or rhinitis -negative transillumination -tenderness with palpation -ethoid may cuase eyelid edema, extraocular palsy, conjunctival injection

acute herpatic gingivostomatitis:

-rare but in older adults if debilitated -red shiny gingiva adjacent to mucosa -gray vesicle initially then ulcers -regional lymphadenopathy with high fever -heals in a week -differentiated by diffuse gingival involvement

Edentulousness tx:

-rebasing or relining -make new dentures -implants

TMD mgmt:

-reduce/eliminate pain and restore function -diet adjustment, education, no gum chewing, sticky candy -ice if acute or moist heat if chronic

Obstructive sialadenitis:

-referral -stone is managed same as bacterial -surgical removal of stone -surgical excision of gland often necessary

Primary angle Glaucoma

-relative pupillary block -more in asian descent -ss unilateral HA, visual blurring, nausea, photophobia -PE: non reactive pupils that are semi-dilated -OPTHO EMERGENCY

Otitis externa tx:

-remove debris carefully -ear gtts: mild-cortisporin suspension mod to severe-cipro gtts -use few days after sx gone -DO NOT USE NEOMYCIN IF TM PUNCTURED -oral antibx if diabetic or immunocompromised: *Cipro, augmentin, or cephalosporin -assume OM as well and treat -ETOH after swimming to prevent

dental caries tx:

-restorative -protect pulp -heat can cause inflammation from dental instruments -may need root canal -debridement and prep of nerve canal space -obturation (filling) with biologically inert material

Auricular Infections

-result of piercing -tx with topical alcohol and antibiotic ointment

Tympanic Pembrane Perforation

-resulting from external compression such as slap, object inserted into ear -spontaneous healing usually occurs within 3 days if not refer to ENT

Rhinitis medicamentosa:

-rhinitis or chemical rhinitis -nasal congestion w/o rhinorrhea or sneezing. triggered by topical vasoconstrictive meds for >4-6 days

most common virus in acute viral rhinosinusitis:

-rhinovirus -adenovirus -influenza -parainfluenza

Tinnitus

-ringing in one or both ears -constant or intermittent -worsens with age

organism in bacterial pharyngitis:

-s. pyogens-GABHS -group C (college students) group G (community, food borne) -gonococcal

Labyrinthitis

-s/s vertigo, n/v, aggravated by head movement, tinnitus, hearing loss -most subside within 2-3 days -most caused by virus -management: bed rest, meclizine

Xerostomi risk factors/patho:

-saliva flow does not decline with age -medical condtion/radiation -meds: anticholinergic, decongestant, antihistamine -loss of saliva increases infections and tooth decay -treat sx -referral -salive substitute such as biotene

cerumen impcation:

-scoop -water irrigation -10% sodium bicarb gtts usually easy to remove in office

eiplottitis:

-serious and potentially fatal -acute inflammation of epiglottis and surrounding structures -usually bacterial -mean age is 44yrs but rare in adults -immediate hospitalization

Peritonsillar abscess (PTA)

-serious complication of exudative pharyngitis -pus in peritonsillar tissue -f. necrophorum or PCN resistance -fever, acutely ill, pain, drooling, hoarse -surgical drainage w/IV antibx -referral

Otitis externia chief complaint:

-severe pain -discharge from ear -foul smell pressure

Pulpitis sx:

-severe pain to hot/cold -lasts after stimulus removed -may radiate to ear or suborbital area -sensitivity lost with total pulp necrosis -pressure released via root apex -sensitivity to percussion or crown of tooth -can cause cellulitis or abscess if not treated

Acute necrotizing ulcerative gingivitis ( ANUG or trench mouth) treatment:

-severe: admit, IV antibx, supportive care less severe: immediate referral amoxil + metronidazole augmentin clinda doxy avoid tobacco and ETOH rinses marked improvement in 5 days

Sinusitis f/u:

-should have symptomatic improvement in 72hrs if on antibx -return visit in 10-14 days

Dry Macular Degeneration:

-slow progressive atrophy and degernation of retina

orbital/periorbital Cellulitis is caused by:

-staph aureus -group A streptococcus -steptococcus pneumoneae -h. influenzae -fungus

Bacterial organism in conjunctivitis:

-staph aureus -streptococci -h. influenza -neisseria gonorrheae

most common organism in sialadenitis:

-staph. aureus

Sinusitis patho:

-strep pneumonia, h. influenzae, M. Catarrhalis, GAS, anaerobes, virus, staph aureus -usually involves maxillary and anterior ethmoid sinuses

Most common organism in community-acquired bacterial rhinosinusitis:

-streptococcus pneumoniae -h. influenzae -Moraxella catarrhalis

AOM patho:

-streptococcus pneumoniae in ADULTS (40-50%) -h. influenzae (10-30%) -reflux or aspiration ->50% are viral (adenovirus, influenza, RSV)

OME treatment:

-supportive -can be chronic -decongestants, intranasal steroids, antihistamines-will enable eustachian tube to open

AOM sx:

-suppurative OM or purulent -"deep" ear pain and fever -unilateral hearing loss -otic discharge -recent URI -dizziness, vertigo, tinnitus, NV

Rhinitis medicamentosa H&P:

-sx confined to nose and with chronic nasal congestion w/o rhinorrhea or sneezing -beefy red nasal mucous membranes with punctate bleeding, granular or boggy -increased tissue friability and stringy mucoid discharge -good history

sinusitis mgmt:

-symptomatic -if >10 days or with unilateral facial pain, purulence, cough, fever, then antibx or decongestants -ask recent antibx use -avoid unnecessary antibx -saline nasal spray -sinus irrigation 2+ times day -cool mist humidifier -avoid smoke -increase fluids -heated mist

aphthous stomatitis tx:

-symptomatic -mouthwash -lydocaine viscous -topical corticosteroids -traimcinolone and oragel -non-irritating foods -amino acid L-lysine with each meal during prodrome and when lesions present; can be used as preventative -tetracycline decreases pain and duration x 7 days

dry eye treatment level 4

-systemic anti-inflammatories -surgical interventions; correct abnormalities, graft mucous membranes, transplant salivary gland duct

glaucoma testing:

-tanometry -corneal inspection -optic nerve inspection -visual field testing

What is the treatment for recurrent GABHS pharyngitis if treated with first generation cephalosporin (cephalexin)?

-third generation cephalosporin (cefdinir)

GAS (strep throat) diagnostics:

-throat culture is gold standard -RADT ; less sensitive -CBC-leukocytosis -centor scoring

tinnitus diagnostics:

-tinnitus questionnaire -audiology -CBC -ESR -Fasting glucose -TSH -possible imaging

Otitis externia presentation:

-tons of exudate -painful movement -yellow, green, white discharge -canal or TM may not be visible.

Centor scoring:

-tonsillar exudate -tender cervical nodes -fever >100.5 -no cough -if 3 met, predictive value is 40-60%.

Pingueculum and pterygium mgmt:

-topic lubricants -anti-inflammatorys -topical steroids

Chlamydial and gonococcal conjunctivitis mgmt:

-topical and systemic: PCN and doxycycline Ocular: optho mgmt gentamicin ofloxacin

Prealbumin/Transthyretin

-transport protein -correlates with short term changes in status

Otitis media with effusion:

-transudation of plasma from middle ear blood vessels, leading to chronic effusion in absence of s/s of acute infection

hyphema risk factors:

-trauma -hemophilia -DM -anticoags

Periodontitis:

-untreated gingivitis -gums pull away from teeth and form infected pockets -if not treated teeth may become less or be removed -destroys alveolar bone

acute herpatic gingivostomatitis tx:

-usually self limiting -may disseminate -systemic analgesia -mouth rinses (benadryl/kaopectate) -NO CORTICOSTEROIDS -antiviral

Pterygium:

-vascularized lesion that extends from conjunctiva of nasal palpebral fissure onto nasal cornea

Erythroplakia:

-velvety red lesions -<2cm w/ or w/o hyperkeratotic component -floor of mouth, soft palate, ventrolateral border of tongue -may be precuros to squamous cell cancer

GAS (strep throat) tx:

-viral: rest, fluids, voice rest, saline gargles, tylenol, chloraseptic spray -GAS: Pen VK BID or Bicillin LA x 1 *Do not use flouroquinolone, Bactrim, doxy, or tetra d/t high resistance

Rhinitis mgmt:

-viral: treat sx fever: tylenol rhinorrhea: oral decongestants topicals Atroven nasal spray dextromethorphan for cough

Abnormal Lab Values

-visceral proteins -lipid profile -blood glucose

strabismus prevention;

-vision correction -monitor with family history -referral

Strabismus mgmt:

-vision correction -patching of strong eye -therapy -surgical intervetion -atropine gtts

conjunctivitis testing:

-visual acuity first -dilated exam (proptosis, nerve dysfunction, etc) -fluorescein staining (r/o corneal involvement) -blue penlight illumination (corneal scratches, dendrites)

Diabetic Retinopathy findings:

-visual changes -Fundoscopic exam: *microaneurysms *intraretinal hemorrhage *macular edema *lipid deposits *cotton wool spots *venous beading and dilation *edema

chalazion mgmt:

-warm compress -intralesional steroid injection -lid massage -lid scrub

blepharitis management:

-warm compress -lid scrub with baby shampoo -lid massage to empty meibomian glands -remove contacts and disinfect

Bacterial rhinosinusitis treatment:

-watchful waiting and antibx

Viral Conjunctivitis

-watery discharge, small follicular changes in paplepbrial conjunctive, mild erythema -highly contagious, spread by contact -adenovirus most common cause -will go away on own

strabismus in children:

-weakness or paralysis of extra ocular muscles or cranial nerves -disruption in normal ocular tissue development, visual cortex or visual fusion centers *CP *TBI -congenital *Congenital rubella cataracts -Genetic syndromes *Downs, edwards, Prader-willi -Severe farsightedness (hypermetropia) -Tumors

Thrush:

-white curd plaques on erythematous mucosa -loosely attached and can scrape off -tongue red and burns -may be chronic with poor hygiene and nutrition -illness, antibx use, impaired immunity, steroids -tx: good hygiene, nystatin, usually resolve after 1-2 weeks of treatment

When do symptoms of epidemic keratoconjunctivitis appear?

-within 14 days after exposure

Perennial allergic rhinitis:

-year round indoor allergens -loss of taste of smell, decreased hearing, popping in ears -lower sneezing threshold -exercise reverses temporarily

dosing

0.5 mg for 3 days , then 0.5 mg bid for 4 days then 1 mg bid

5ths disease slapped cheeks

3 stage of rash Fifth disease has three stages: Prodromal stage: Begins with symptoms of an upper respiratory infection, such as low-grade fever, headache, chills, and malaise. Second stage: A red rash appears on the cheeks, known as the "slapped cheek" rash. Usually resolves in 2-3 days. Third stage: The rash moves to the arms and legs and becomes a "lacy"-appearing rash that is flat/purple in appearance. May last for a few weeks.

During pregnancy, folic-acid requirements increase twofold to fourfold. A. True B. False

A

In evaluating mitral valve incompetency, you expect to find the following murmur: A. systolic with radiation to the axilla B. diastolic with little radiation C. diastolic with radiation to the axilla D. localized systolic

A

Who is most likely to exhibit depression related to his illness?

A patient with Parkinson's disease.

Clindamycin is most effective against which of the following organisms? A. S. pneumoniae B. H. influenzae C. M. catarrhalis D. Adenovirus

A. S. pneumoniae

An 18-year-old woman has a chief complaint of a "sore throat and swollen glands" for the past 3 days. Her physical examination includes a temperature of 101F (38.3C), exudative pharyngitis, and tender anterior cervical lymphadenopathy. Right and left upper quadrant abdominal tenderness is absent. The most likely diagnosis is: A. Streptococcus pyogenes pharyngitis B. infectious mononucleosis C. viral pharyngitis D. Vincent angina

A. Streptococcus pyogenes pharyngitis

A 22-year-old woman presents with a "bump" on her right eyelid. Examination reveals a 2-mm hard, non-tender swelling on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion B. a hordeolum C. blepharitis D. cellulitis

A. a chalazion

Which of the following is a first-line therapy for the treatment of ABRS in an adult with no recent antimicrobial use? A. amoxicillin B. trimethoprim-sulfamethoxazole C. clarithromycin D. levofloxacin

A. amoxicillin

A reasonable treatment option for AOM that is not improved after 3-day therapy with an appropriate dosage of amoxicillin therapy is: A. cefuroxime B. erythromycin C. cephalexin D. sulfamethoxazole

A. cefuroxime

Likely causative organisms in AOM include: A. certain gram-positive and gram-negative bacteria B. gram-negative bacteria and pathogenic viruses C. rhinovirus and S. aureus D. predominantly beta-lactamase-producing organisms

A. certain gram-positive and gram-negative bacteria

Allergy immunotherapy is most successful in controlling allergies caused by: A. dust mites B. molds C. animal dander D. air pollution

A. dust mites

Which of the following is most likely to be found on the fundoscopic examination in a patient with untreated POAG? A. excessive cupping of the optic disk B. arteriovenous nicking C. papilledema D. flame-shaped hemorrhages

A. excessive cupping of the optic disk

What are signs and symptoms of strep pharyngitis (Group A)?

Acute illness with a predominant sore throat and a temperature higher than 38.5°C (101.3°F). Constitutional symptoms include fever, chills, myalgias, headaches, and nausea. If cough not true GABHS.

Which of the following would be an appropriate therapy for a Mild COPD patient? Albuterol Fluticasone Prolastin Salmeterol

Albuterol

Proair HFA Proventil HFA Ventolin HFA

Albuterol Beta Agonist 2 puff every 4-6 hrs

A, B,C,D

Albuterol Bronchodilator Corticosteroid Everything

Asthma differs from COPD in that: COPD is a restrictive disease while Asthma is Obstructive Asthma is a restrictive disease while COPD is obstructive COPD is a reversible disease while Asthma is not fully reversible Asthma is a reversible disease while COPD is not fully reversible

Asthma is a reversible disease while COPD is not fully reversible

How to prevent recurrence of strep ?

Asymptomatic carrier in the family (a pet) Changing toothbrushes and rinsing removable orthodontic appliances thoroughly may help to prevent recurrent infections Patients with streptococcal pharyngitis are considered contagious until they have been taking an antibiotic for 24 hours. Children should not go back to their day-care center or school until their temperature returns to normal and they have had at least 24 hours of antibiotic therapy.

Mitral regurgitate best heard at

At Apex at s1 Following a normal S1 and briefly quiet systole, the valve suddenly prolapses, resulting in a midsystolic click. The click is so characteristic of MVP that even without a subsequent murmur, its presence alone is enough for the diagnosis. Immediately after the click, a brief crescendo-decrescendo murmur is heard, usually best at the apex.

Azelaic acid

Azelaic acid is available in 15% and 20% cream. It is sold under the brand names Finacea and Azelex. Azelaic acid is an acne preparation in the form of a cream, not a topical gel. Approximately six weeks of therapy should be allowed before expecting improvement. This medication is less potent, but less irritating than tretinoin preparations.

Triamcinolone

Azmacort 100 mcg/spray

A 40-year-old woman with pyelonephritis is taking two mediations: ciprofloxacin and ferrous sulfate (for iron-deficiency anemia). She asks about taking both medications. You advise that: A. she should take the medications with a large glass of water. B. an inactive drug compound is potentially formed if the two medications are taken together. C. she can take the medications together to enhance adherence to therapy. D. the ferrous sulfate potentially slows gastrointestinal motility and results in enhanced ciprofloxacin absorption.

B

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb = 7.6 g Hct = 20.5% RBC = 2.1 million mm3 MCV = 76 fL MCHC= 28 g/dL RDW = 18.4% Reticulocytes = 1.8% The most likely cause of these finding is: A. poor nutrition. B. occult blood loss. C. malabsorption. D. chronic inflammation.

B

An abnormally elevated D-dimer test is highly sensitive and specific for the diagnosis of thromboembolic disease A. True B. False

B

Aortic stenosis in a 15-year-old male is most likely: A. a sequela of rheumatic fever. B. a result of a congenital defect. C. calcific in nature. D. found with atrial septal defect.

B

Cilostazol (Pletal) should be used with great caution in the presence of which of the following diagnoses? A. diabetes mellitus B. heart failure C. hypertension D. dyslipidemia

B

Common physical examination findings in patients with pernicious anemia include: A. hypoactive bowel sounds. B. stocking-glove neuropathy. C. thin, spoon-shaped nails. D. retinal hemorrhages.

B

Intervention in anemia of chronic disease most often includes: A. oral vitamin B12. B. treatment of the underlying cause. C. transfusion. D. parenteral iron.

B

Match stable angina with its pathophysiologic characteristic A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms B. predictable onset of chest pain or discomfort, usually with physical exertion C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material

B

Most of the body's iron is obtained from: A. animal-based food sources. B. recycled iron content from aged red blood cells (RBCs). C. endoplasmic reticulum production. D. vegetable-based food sources.

B

One month into therapy for pernicious anemia, you wish to check the efficacy of the intervention. The best laboratory test to order at this point is a: A. Schilling test. B. hemoglobin measurement. C. reticulocyte count. D. serum cobalamin.

B

Pernicious anemia is usually caused by: A. dietary deficiency of vitamin B12. B. lack of production of intrinsic factor by the gastric mucosa. C. RBC enzyme deficiency. D. a combination of micronutrient deficiencies caused by malabsorption.

B

Risk factors for folate-deficiency anemia include: A. menorrhagia. B. chronic ingestion of overcooked foods. C. use of nonsteroidal antiinflammatory drugs. D. gastric atrophy.

B

The use of a systemic corticosteroid in the treatment of anaphylaxis is primarily helpful for: A. treatment of the most acute symptoms. B. minimization of a protracted allergic response. C. prevention of future episodes. D. reducing the risk of fatality associated with the event.

B

When counseling a patient about the neurological alterations often associated with vitamin B12 deficiency, the NP advises that: A. these usually resolve within days with appropriate therapy. B. if present for longer than 6 months, these changes are occasionally permanent. C. the use of parenteral vitamin B12 therapy is needed to ensure symptom resolution. D. cognitive changes associated with vitamin B12 deficiency are seldom reversible even with appropriate therapy.

B

When prescribing erythropoietin supplementation, the NP considers that: A. the adrenal glands are its endogenous source. B. the addition of micronutrient supplementation needed for erythropoiesis is advisable. C. its use is as an adjunct in treating thrombocytopenia. D. with its use, the RBC life span is prolonged.

B

Which of the following conditions is unlikely to result in anemia of chronic disease? A. rheumatoid arthritis B. peripheral vascular disease C. chronic renal insufficiency D. osteomyelitis

B

Which of the following is most consistent with iron-deficiency anemia? A. low mean corpuscular volume (MCV), normal mean corpuscular hemoglobin (MCH) B. low MCV, low MCH C. low MCV, elevated MCH D. normal MCV, normal MCH

B

You examine a 47-year-old man who presents with difficulty initiating and maintaining sleep and chronic pharyngeal erythema with the following results on hemogram: Hemoglobin (Hgb) = 15 g Hct = 45% RBC = 4.2 million mm3 MCV = 108 fL MCHC=33.2 g/dL These values are most consistent with: A. pernicious anemia. B. alcohol abuse. C. thalassemia minor. D. Fanconi disease.

B

You examine a 57-year-old woman with rheumatoid arthritis who is on disease-modifying antirheumatic disease but continues to have poor disease control and find the following results on hemogram: Hgb = 10.5 g Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC=32.8 g/dL RDW= 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with: A. pernicious anemia. B. anemia of chronic disease. C. beta-thalassemia minor. D. folate-deficiency anemia.

B

You see a 54-year-old man who reports acute angina episodes with significant exertion. He is currently taking a beta blocker and clopidogrel. You consider the use of which of the following at the start of anginal symptoms? A. an oral dose of a calcium channel blocker B. a dose of nitroglycerin via oral spray C. an extra dose of the beta blocker D. a sustained-effect nitroglycerin patch

B

Your priority in caring for Tom, the aforementioned patient, is to: A. administer a rapidly acting oral antihistamine. B. administer parenteral epinephrine. C. initiate vasopressor therapy. D. administer a parenteral systemic corticosteroid.

B

The most appropriate pharmacologic intervention for treating ABRS in a 45-year-old person who is moderately ill with the condition is: A. erythromycin B. high-dose amoxicillin with clavulunate C. cephalexin D. ciprofloxacin

B. high-dose amoxicillin with clavulunate

Physical examination findings in otitis externa include: A. tympanic membrane immobility B. increased ear pain with tragus palpation C. tympanic membrane erythema D. tympanic membrane bullae

B. increased ear pain with tragus palpation

A 34-year-old man with penicillin allergy presents with ABRS. Three weeks ago, he was treated with doxycycline for "bronchitis". You now prescribe: A. clarithromycin B. levofloxacin C. cephalexin D. amoxicillin

B. levofloxacin

Which of the following is a characteristic of S. pneumoniae? A. mechanism of antimicrobial resistance primarily due to the production of beta-lactamase B. mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell C. organisms most commonly isolated from mucoid middle ear effusion D. gram-negative organisms

B. mechanism of antimicrobial resistance usually via altered protein-binding sites held within the microbe's cell

Whooping cough

B. pertussis -50% before 2yrs, *adults are reservoir* S/S: 6weeks, Catarrhal stage (0-2wks): sneezing, rhinitis, malaise, anorexia, hacking night cough Proxysmal stage (2-4wks): burst of rapid, consecutive coughts follow by "whoop" Convalescent stage (4-6wks) decreasing frequency/severity Lymphocyte count hight, *prevention is key* (Tdap) Tx: erythromycin, azithromycin

Which of the following best describes hearing loss associated with presbycusis? A. rapidly progressive, often asymmetric, and in all frequencies B. slowly progressive, usually symmetric, and predominantly high frequency C. variable in progression, usually unilateral, and in the midrange frequencies D. primarily conductive and bilateral with slow progress

B. slowly progressive, usually symmetric, and predominantly high frequency

When advising a patient with scarlet fever, the NP considers that: A. there is increased risk for poststreptococcal glomerulonephritis B. the rash often peels during recovery C. an injectable cephalosporin is the preferred treatment option D. throat culture is usually negative for group A streptococci

B. the rash often peels during recovery

Treatment options for streptococcal pharyngitis for a patient with penicillin allergy include all of the following except: A. azithromycin B. trimethoprim-sulfamethoxazole C. clarithromycin D. erythromycin

B. trimethoprim-sulfamethoxazole

Expected findings in AOM include: A. prominent bony landmarks B. tympanic membrane immobility C. itchiness and crackling in the affected ear D. submental lymphadenopathy

B. tympanic membrane immobility

Lobar/Focal pneumonia

Bacterial infection

Fluid Requirements

Based on AI: -women 2.7L -men 3.7L Based on cal requirement: -1mL/1cal Based on Body surface area: -1ml/m^2

Why is it unclear if early detection of prostate cancer is actually beneficial

Because of the high prevalence of clinically non-significant disease and the potential harms of Bx (bleeding, infection, urinary obstruction), and of treatment (high rate of impotence from surgery/radiation)

If the patient has a 1st degree relative <60 years old with finding OR if 2 or more first-degree relatives are any age - have the findings

Begin screening colonoscopy at age 40 or 10 years before the youngest case in the immediate family-whichever comes first. The screening colonoscopy is performed at 5-year intervals

If the first degree relative age >60 OR if they have 2 or more second-degree relatives at any age

Begin screening colonoscopy at age 40, screening colonoscopy interval same as average-risk individual

What characterizes bulimia nervosa?

Binge eating

Which of the following characterizes bulimia nervosa?

Binge eating Recurrent episodes of binge eating characterize bulimia. Loss of control is always present, especially when eating. This results in eating quantities of food far beyond what would normally be consumed. Binge eating is always followed by a compensatory activity. This may take the feature of purging or nonpurging. Nonpurging involves excessive exercise or post-binge fasting. Binges and the compensatory activity occur a minimum of twice weekly for at least 3 months for diagnosis of bulimia nervosa.

Which type of bipolar disorder is characterized by one or more manic episodes or mixed episodes (symptoms of both mania and depression occurring nearly every day for at least 1 week) ?

Bipolar 1 - May also have one or more major depressive episodes.

What is the most severe form of the illness marked by extreme manic episodes?

Bipolar I disorder

Which type of biploar disorder is characterized by at least one hypomanic episode & one depressive episode?

Bipolar II disorder

distinguished from depressive disorders by the occurrence of manic, or hypomanic episodes, in addition to depressive episodes

Bipolar disorder

A male patient has a family history of bipolar disorder in two first degree relatives. How does bipolar disorder affect family?

Bipolar disorder often affects multiple family members.

Can a person have thoughts of suicide during depression or mania?

Both

Difference in free and bound T4?

Bound is bound to protein and cannot be effective whereas Free is not bound and is metabolically active

Parkinson's disease is characterized by 4 features

Bradykinesia Muscular Rigidity Resting Tremor Postural Instability

Addisons

Addison's disease is also known as primary adrenal insufficiency. The most common cause of damage to the adrenal cortex (the outer layer of the gland) is autoimmune destruction. The adrenal cortex produces glucocorticoids (cortisol) and mineralocorticoids (aldosterone). Aldosterone regulates sodium retention and potassium excretion through the kidneys (affects blood pressure). Electrolyte abnormalities are high potassium and low sodium. In primary disease (Addison's), serum cortisol is low, ACTH is high, and serum aldosterone is low. If the patient is not treated, severe stress (illness, accident) may cause an adrenal crisis ("Addisonian" crisis), which can be fatal.

Symbicort HFA

Budesonide/ Formoterol 2 puffs twice daily

A 48-year-old woman developed iron-deficiency anemia after excessive perimenopausal bleeding, successfully treated by endometrial ablation. Her hematocrit (Hct) level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include: A. a correction of mean cell volume. B. an 8% increase in Hct level. C. reticulocytosis. D. a correction in ferritin level.

C

A healthy 34-year-old man asks whether he should take an iron supplement. You respond that: A. this is a prudent measure to ensure health. B. iron-deficiency anemia is a common problem in men of his age. C. use of an iron supplement in the absence of a documented deficiency can lead to iatrogenic iron overload. D. excess iron is easily excreted.

C

A woman who is planning a pregnancy should increase her intake of which of the following to minimize the risk of neural tube defect in the fetus? A. iron B. niacin C. folic acid D. vitamin C

C

An abnormality of which of the following is the most sensitive marker for myocardial damage? A. aspartate aminotransferase B. creatine phosphokinase (CPK) C. troponin I (cTnI) D. lactate dehydrogenase

C

An increase in the normal variation of RBC size is known as: A. poikilocytosis. B. granulation. C. anisocytosis. D. basophilic stippling.

C

In health, the ratio of hemoglobin to hematocrit is usually: A. 1:1. B. 1:2. C. 1:3. D. 1:4.

C

In the first weeks of anemia therapy with parenteral vitamin B12 in a 68-year-old woman with hypertension who is taking a thiazide diuretic, the patient should be carefully monitored for: A. hypernatremia. B. dehydration. C. hypokalemia. D. acidemia.

C

Of the following medications, which is least likely to be implicated as a trigger for anaphylaxis? A. ibuprofen B. amoxicillin C. acetaminophen D. aspirin

C

Poikilocytosis refers to alterations in a red blood cells: A. thickness. B. color. C. shape. D. size.

C

Results of hemogram in a person with anemia of chronic disease include: A. microcytosis. B. anisocytosis. C. reticulocytopenia. D. macrocytosis.

C

The most common clinical manifestation of systemic anaphylaxis typically is: A. dizziness. B. airway obstruction. C. urticaria. D. gastrointestinal upset.

C

Tom is a 19-year-old man who presents with sudden onset of edema of the lips and face and a sensation of "throat tightness and shortness of breath" after a bee sting. Physical examination reveals inspiratory and expiratory wheezing. Blood pressure is 78/44 mm Hg, heart rate is 102 bpm, and respiratory rate is 24/min. His clinical presentation is most consistent with the diagnosis of: A. urticaria. B. angioedema. C. anaphylaxis. D. reactive airway disease.

C

When the cause of a macrocytic anemia is uncertain, the most commonly recommended additional testing includes which of the following? A. haptoglobin and reticulocyte count. B. Schilling test and gastric biopsy. C. methylmalonic acid and homocysteine. D. transferrin and prealbumin.

C

Which of the following changes on the 12-lead ECG would you expect to find in a patient with myocardial ischemia? A. 2-mm ST segment elevation B. S wave larger than 10 mm C. T wave inversion D. deep Q waves

C

Which of the following is most consistent with a person presenting with unstable angina? A. a 5-minute episode of chest tightness brought on by stair climbing and relieved by rest B. a severe, searing pain that penetrates the chest and lasts about 30 seconds C. chest pressure lasting 20 minutes that occurs at rest D. "heartburn" relieved by position change

C

Which of the following is not consistent with anemia of chronic disease (ACD)? A. NL RDW B. NL MCHC C. Hct less than 24% D. NL to slightly elevated serum ferritin

C

Which of the following is the best advice on taking ferrous sulfate to enhance iron absorption? A. "Take with other medications." B. "Take on a full stomach." C. "Take on an empty stomach." D. "Do not take with vitamin C."

C

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g (normal 12 to 14 g) Hct = 28% (normal 36% to 42%) RBC = 5 million mm3 (normal 3.2 to 4.3 million mm3) MCV = 68 fL (normal 80 to 96 fL) MCHC=33.2 g/dL (normal 32-36 d/dL) RBC distribution width (RDW) = 13% (normal ≤15%). Reticulocytes = 1.5% This is most consistent with the laboratory assessment of: A. iron-deficiency anemia. B. Cooley anemia. C. alpha-thalassemia minor. D. hemoglobin Barts.

C

What is a major advantage of CAGE questionnaire?

Brevity of questions

Individual Assessment

Broad base info about: - body comp - nutrition status -food habits ANALYSIS CARE PLANNING IMPLEMENTATION EVALUATION + RECORDING

Community Acquired Pneumonia (CAP) *PE*

Bronchial breath sounds *inspiratory crackles* Egophony A-E changes Increased tactile fremits Dullness to percussion

What are the causes of pharyngitis?

Causes: coxsakievirus(hand,mouth, foot dx), enteric cytopathic human orphan (ECHO) viruses (GI), and Epstein-Barr virus(mono). Bacteria-Group A beta-hemolytic streptococcus (strep throat, scarlet fever, impetigo), Neisseria gonorrhea, and Corynebacterium diphtheriae Fungal source-Candida Noninfectious-allergy rhinitis, postnasal drip, mouth breathing, and trauma, chemical injury, Gastroesophageal Reflux Disease (GERD), smoking

Third most gynecological cancer in the US

Cervical cancer

84 year old with advanced dementia symptoms. What is NOT in the differential? Tumor Cerebral Hemorrhage Cerebral Infarct Normal aging process

Changes in cognition are NOT associated with the aging process although 50% of patients over 90 have some form of dementia. All patients should have some type of imaging done to rule out tumor infection hemorrhage infarct, ect. Experts are unable to agree on which studies are the most valuable.

Cheilosis

Cheilosis is a skin disorder in which fissures and maceration occur in the corner of the mouth.

The incubation period for M. pneumoniae is usually: A. less than 1 week B. 1 week C. 2 weeks D. 3 weeks

D. 3 weeks

A 45-year-old man presents with otitis externa. Likely causative pathogens include all of the following except: A. fungal agents B. P. auruginosa C. S. aureus D. M. catarrhalis

D. M. catarrhalis

Common causative organisms of acute suppurative conjunctivitis include all of the following except: A. Staphylococcus aureus B. Haemophilus influenzae C. Streptococcus pneumoniae D. Pseudomonas aeruginosa

D. Pseudomonas aeruginosa

A 48-year-old man presents with a new-onset right eye vision change accompanied by dull pain, tearing, and photophobia. The right pupil is small, irregular, and poorly reactive. Vision testing obtained by using the Snellen chart is 20/30 OS and 20/80 OD. The most likely diagnosis is: A. unilateral herpetic conjunctivitis B. open-angle glaucoma C. angle-closure glaucoma D. anterior uveitis

D. anterior uveitis

Risk factors for POAG include all of the following except: A. African ancestry B. type 2 diabetes mellitus C. advanced age D. blue eye color

D. blue eye color

Treatment options in acute and recurrent allergic conjunctivitis include all of the following except: A. cromolyn ophthalmic drops B. oral antihistamines C. ophthalmological antihistamines D. corticosteroid ophthalmic drops

D. corticosteroid ophthalmic drops

According to the ARIA treatment guidelines, which of the following medications affords the LEAST control of rhinorrhea associated with allergic rhinitis? A. anticholinergic nasal spray B. antihistamine nasal spray C. corticosteroid nasal spray D. cromolyn nasal spray

D. cromolyn nasal spray

All of the following are consistent with normal age-related vision changes EXCEPT: A. need for increased illumination B. increasing sensitivity to glare C. washing out of colors D. gradual loss of peripheral vision

D. gradual loss of peripheral vision

Which of the following represents a therapeutic option for ABRS in a patient with no recent antimicrobial care with treatment failure after 72 hours of appropriate-dose antimicrobial therapy? A. clindamycin B. clarithromycin C. ofloxacin D. high-dose amoxicillin with clavulunate

D. high-dose amoxicillin with clavulunate

Which of the following medications is most appropriate for allergic rhinitis therapy in an acutely symptomatic 24-year-old machine operator? A. nasal cromolyn B. diphenhydramine C. flunisolide nasal spray D. loratadine

D. loratadine

Which of the following is consistent with the visual problems associated with macular degeneration? A. peripheral vision loss B. blurring of near vision C. difficulty with distant vision D. loss of the central vision field

D. loss of the central vision field

Treatment options for POAG include all of the following topical agents except: A. beta-adrenergic antagonists B. alpha2-agonists C. prostaglandin analogues D. mast cell stabilizers

D. mast cell stabilizers

Which of the following medications affords the best relief of acute nasal itch? A. anticholinergic nasal spray B. oral decongestant C. corticosteroid nasal spray D. oral antihistamine

D. oral antihistamine

Treatment options for uncomplicated hordeolum include all of the following except: A. erythromycin ophthalmic ointment B. warm compresses to the affected area C. incision and drainage D. oral antimicrobial therapy

D. oral antimicrobial therapy

A firm, painless, relatively fixed submandibular node would most likely be seen in the diagnosis of: A. herpes simplex B. acute otitis media (AOM) C. bacterial pharyngitis D. oral cancer

D. oral cancer

Treatment options in suppurative conjunctivits include all of the following ophthalmic preparations except: A. bacitracin-polymyxin B B. ciprofloxacin C. erythromycin D. penicillin

D. penicillin

A 78-year-old woman has early bilateral senile cataracts. Which of the following situations would likely pose the greatest difficulty? A. reading the newspaper B. distinguishing between the primary colors C. following extraocular movements D. reading road signs while driving

D. reading road signs while driving

Prevention and prophylaxis in Meniere's disease include all of the following except: A. avoiding ototoxic drugs B. protecting the ears from loud noise C. limiting sodium intake D. restricting fluid intake

D. restricting fluid intake

2 screening methods used for detecting prostate cancer

DRE and PSA levels

Which statement about attention deficit disorder (ADD) is correct?

DSM V is used to diagnose a child with ADD ADD and ADD with hyperactivity are two separate diagnoses. This disorder is more common in boys (5:1) and symptoms must be present by age 7 for at least 6 months before diagnosis can be made. DSM V should be used to diagnose children. Parents and/or teachers should establish specific elements. Examples include fidgeting, difficulty remaining in seat, excessive talking, impatient when asked to wait their turn, blurting out answers before time, and interrupting conversation. These must be established in more than one environment.

4 year old immunization

DTap and IPV would be due for this 4-year-old child.

Roflumilast

Daliresp

Lab results seen in Primary hyperthyroidism?

Decreased TSH, Elevated T4 and normal T3

What will happen to the sleep pattern during a manic episode?

Decreased need to sleep - accompanied by increased energy and hyperactivity.

Rickets, Osteoporosis, Bone Pain

Deficiency of calcium, D, P

A 69 year old female reports anhedonia last month. What should be part of the assessment?

Depression

A 69 year-old female patient reports feelings of anhedonia for the last month. What should be part of the nurse practitioner's assessment?

Depression Anhedonia is the loss of pleasure or interest in things that have always brought pleasure or interest. If this is the case, this patient should be screened for depression. Anhedonia is a red flag for depression.

Subjective perception of altered equilibrium

Dizziness

Quality of care

Doing the right thing, at the right time, in the right way, for the right people, and having the best results *US = most expensive care system but we rank lowest for equity

Frequency of colorectal cancer screening after first screen

Done every 10 years if no abnormal findings are detected

Secondary and tertiary care ex

EG: Baby with a rash -First contact: Pediatrician, common rash = (primary care) -Specialized/unusual rash --> dermatologist (less common) (secondary) -Even more specialized/unusual rash --> limited clinic (tertiary)

Blood Levels

Evaluate: -absorptive capacity -organ function -disease management -nutritional status -risk for chronic diseases (cholesterol/lipoprotein ratio, CRP, glycosylated Hgb (long term blood sugar))

Tertiary care

Even more highly specialized and technologically sophisticated medical and surgical care than seconadry care for those w unusual complex conds

Physical examination of strep pharyngitis?

Examine ENT Auscultate heart and lungs Percuss abdomen especially the spleen area (mono) Palpate the lymph nodes-anterior and posterior cervical chains Check for CVA tenderness (glumerolonephritis) Neurologic exam-check for nuchal rigidity and meningeal irritation. (meningitis)

Physical examination of strep pharyngitis?

Examine for pastia's lines -this is seen in Group A strep Erythema marginatum ,caused by Group A streptococcus, is an evanescent, nonpuritic pink rash mainly on the trunk and extremities.

Name the mood. inappropriate lack of restraint in expressing one's feeling and overvaluing one's own important (delusions of grandeur) i.e. king of france

Expansive Mood

Gold 3 (severe)

FEV1 30% to <50%

Gold 2 (Moderate)

FEV1 50% to <80%

Gold 4 ( very severe)

FEV1 <30%

Gold 1 (Mild)

FEV1 > 80% predicted

complicated exacerbations antimicrobial therapy

FEV1 between 50-35% age 65 or older and >4 exacerbations/year Augmentin

antimicrobial therapy uncomplicated exacerbation?

FEV1 is > 50% predicted value

compicated exacerbations with risk of P. aeroginosa

FEV1 less than 35% Levaquin

spirometry

FEV1:FVC ratio less than 70% indicates airway obstruction FEV1 less than 80% or improvement less than 12% indicates irreversible airway obstruction

Complications of CAP

Failure o respond to Abx 72hrs Recurrent PNA: refer Lung abscess Empyema High risk pt for influenza complications -Age < 2 or > 65 -Chronic medical conditions - BMI > 40 - Native American/Alaskan Natives - Residents of care facilities

Pneumonia Pathophysiology

Failure of pulmonary defense -immune systme -Mucociliary clearnace (smoker) -aspiration Route of entry -droplet -aspiration: stroke, drug/meds, Etoh -Hematogenous: IVDU=staphococcus

Screening methods for colorectal cancer

Fecal Occult blood test Immunochemical-based test double-contrast barium enema Endoscopy DNA mutation markers Flexible Sigmoidoscopy Colonoscopy

What gender is most at risk for thyroid disease?

Female

Streptococcal Score Validated in Adults and Children

Fever (subjective or measured in office) →1 Absence of cough →1 Tender anterior cervical adenopathy →1 Tonsillar swelling or exudates →1 Age Younger than 15 years →+1 15 to 45 years →0 Older than 45 years →-1 Scoring: 0 or -1 points: streptococcal infection ruled out 1 to 3 points: order rapid test and treat accordingly 4 to 5 points: probable streptococcal infection, treat

Fits hug Curtis syndrome

Fitz-Hugh-Curtis Syndrome (Perihepatitis) Chlamydial and/or gonococcal infection of the liver capsule (not the liver itself) resulting in extensive scarring between the liver capsule and abdominal contents (e.g., colon). Scars look like "violin strings" (seen on laparoscopy). A complication of disseminated GC and/or PID. Classic Case Sexually active female with symptoms of PID complains of RUQ (right upper quadrant) abdominal pain and tenderness on palpation. The liver function tests are normal. Treated as a complicated gonorrheal/chlamydial infection (14-day treatment).

Fluticasone

Flovent 44,110,220

Breo Ellipta

Fluticasone/ Vilanterol 1 inhalation once daily ***

advair diskus/HFA

Fluticasone/Salmeterol 1 puff twice daily (diskus) 2 puffs twice daily (HFA)

Cushings

For endogenous Cushing's syndrome, the primary treatment of choice is surgery. For endogenous Cushing's syndrome, surgical resection is the primary treatment of choice to remove a tumor of the adrenal gland overproducing cortisol, or to remove a tumor of the pituitary gland or other sites that are overproducing adrenocorticotropic hormone. For those with Cushing's disease, first-line treatment is transsphenoidal surgery, which results in an approximately 80% cure rate. Often surgery is curative though radiation therapy may be needed in conjunction with surgery. Certain medications to control the body's production of cortisol have been approved for use in patients with endogenous Cushing's syndrome who have failed surgery or cannot have surgery. For patients taking long-term treatment of corticosteroids, tapering the dose as soon as possible is recommended. For endogenous Cushing's syndrome, surgical resection is the primary treatment of choice.

improve risk reduction for cancer screens

For most cancer screens, there is a 3-35% risk reduction that have been reported when intervening successfully earlier than you otherwise would have without screen.

Foradil/ Perforomist

Formoterol inhale one capsule once daily inhal 20 mcg twice dail via nebulizer

Fragile x

Fragile X syndrome is the most common form of inherited intellectual disability. The disorder is associated with a higher incidence of autism (especially boys). Males are affected more severely than females. The facial features can vary. The classic facie is a long, narrow face with a prominent forehead and chin and large ears. Other features include hyperlaxity of the joints, flat feet, high arched palate, and others. Definitive diagnosis is by genetic

Most common cause of Cushing's Syndrome?

From long term high dose steroid replacement therapy.

What is the incidence of Group A Beta Hemolytic Streptococcus?

GABHS accounts for: 15-30% of pharyngitis cases in children 5-15% of cases in adults *Incidence is more common in children.

Cachexia

General malnutrition, protein wasting (skeleton/muscles)

GOLD

Global initiative for chronic Obstructive Lung DIsease

What are some complications of Group A Beta Hemolytic Strep?

Glomerulonephritis Scarlet fever Peritonsillar abscess Reactive arthritis Rheumatic fever Sydenham's chorea (movement disorder from RF) and other autoimmune movement disorders Bacteremia Cervical lymphadenitis Endocarditis Fasciitis/myositis Mastoiditis Meningitis Otitis media Perianal dermatitis in children Pneumonia Sinusitis Toxic shock

Mononucleosis

Common symptoms of mononucleosis include positive EBV titers, elevated liver enzymes, and elevated creatinine and BUN.

Anthropometric

Comparative measurements of the body. Adults: Height, weight, BMI, waist-to-hip ratio, and percentage of body fat.

CURB-65

Confusion Urea >7mmol/L (19mg/dl) RR > 30 BP: S < 90 or D < 60 Age >65yrs *Max 5 points* 0-1: safe as outpatient 2-3: consider short stay or close monitoring 4-5: Admit, ICU

What are the dangers of not treating Cushing's Syndrome?

Continued over excretion leads to osteoporotic changes, T2DM and cormormidities that accompany that

Uncomplicated pyleo

Correct answer: Levofloxacin 750 mg daily times five days Levofloxacin 750 mg is approved for use for five days. In cases of acute uncomplicated pyelonephritis suitable for outpatient therapy, primary treatment may include the following: ciprofloxacin 500 mg twice daily for seven days ciprofloxacin ER 1,000 mg daily for seven days levofloxacin 750 mg daily for five days moxifloxacin 400 mg daily for seven days Amoxicillin with clavulanate, cephalosporin, or TMP-SMX-DS can be used all for 14 days. Beta-lactams are not as effective as fluoroquino

Mvp

Correct answer: The condition is present in approximately 40% of the general population Mitral valve prolapse (MVP) is likely the most common valvular heart problem; the condition is present in perhaps 10% of the general population. MVP is often found in people with minor thoracic deformities such as scoliosis. Maintaining a high level of fluid intake should be encouraged in patients with MVP because the mitral valve prolapses more, which increases the murmur when circulating volume is low. The potentially biggest threat in patients with MVP is the rupture of chordae, which is usually seen only in individuals with connective tissue diseases, especially Marfan syndrome.

Heart failure

Correct answer: Thinning of the interlobular septa Thickening, rather than thinning of the interlobular septa, is typically seen on the chest X-ray of a patient with heart failure. This is known as Kerley B lines. Other findings on the chest X-ray in heart failure include cardiomegaly and alveolar edema with pleural effusions and bilateral infiltrates in a butterfly pattern, sharp definition of pulmonary vasculature, and haziness of hilar shadow

Community Acquired Pneumonia (CAP) *S/S*

Cough +/- sputum Hyperthermia or hypothermia Dyspnea/tachypnea Chest discomfort with deep breathing (pleuritic) Sweats/Rigor Tachycardia Hypoxia Fatigue Anoxeria

What cranial nerve is responsible for hearing?

Cranial nerve 8

Aids diagnosis criteria

Criteria used to diagnose AIDS include hairly leukoplakia of the tongue, Kaposi's sarcoma, and thrush.

Pharyngitis Due to Group A Beta Hemolytic Streptococcus

Crowding increases transmission, and outbreaks of streptococcal pharyngitis are common in institutional settings, the military, schools and families. Outbreaks resulting from human contamination of food during preparation have also been reported.

______ ________ is characterized by chronic fluctuating moods involving periods of hypomania and depression, lasting at least 2 years.

Cyclothymic disorder

CF

Cystic fibrosis (CF) is an inherited disease of the mucus and sweat glands. It affects mostly your lungs, pancreas, liver, intestines, sinuses and sex organs. CF causes your mucus to be thick and sticky. The mucus clogs the lungs, causing breathing problems and making it easy for bacteria to grow. This can lead to problems such as repeated lung infections and lung damage. The symptoms and severity of CF vary widely. Some people have serious problems from birth. Others have a milder version of the disease that doesn't show up until they are teens or young adults. Although there is no cure for CF, treatments have improved greatly in recent years. Until the 1980s, most deaths from CF occurred in children and teenagers. Today, with improved treatments, some people who have CF are living into their forties, fifties, or older.

A person with latex allergy also often has a cross-allergy to all of the following except: A. banana. B. avocado. C. kiwi. D. romaine lettuce.

D

Clinical presentation of advanced lower-extremity vascular disease includes all of the following except: A. resting pain. B. absent posterior tibialis pulse. C. blanching of the foot with elevation. D. spider varicosities

D

Erythropoietin is a glycoprotein that influences a stem cell to become a: A. lymphocyte. B. platelet. C. neutrophil. D. red blood cell.

D

Folate-deficiency anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

D

In children younger than age 6 years, accidental overdose of iron-containing products is: A. easily treated. B. a source of significant GI upset. C. worrisome but rarely causes significant harm. D. a leading cause of fatal poisoning in the age group.

D

In evaluating the person with aortic stenosis, the NP anticipates finding 12-lead ECG changes consistent with: A. right bundle branch block. B. extreme axis deviation. C. right atrial enlargement. D. left ventricular hypertrophy.

D

In performing a cardiac examination in a person with MVP, you expect to find: A. an early- to mid-systolic, crescendo−decrescendo murmur. B. a pansystolic murmur. C. a low-pitched, diastolic rumble. D. a mid- to late-systolic murmur.

D

Increased risks for fatal reactions from anaphylaxis include all of the following except: A. personal history of asthma. B. delay in administering epinephrine C. age in the teen years. D. delay in administering antihistamines.

D

Pernicious anemia causes which of the following changes in the RBC indices? A. microcytic, normochromic B. normocytic, normochromic C. microcytic, hypochromic D. macrocytic, normochromic

D

The condition of a sudden shortness of breath that usually occurs after 2-3 of hours of sleep that leads to sudden awakening followed by a feeling of severe anxiety and breathlessness is known as: A. dyspnea. B. orthopnea. C. resting dyspnea. D. paroxysmal nocturnal dyspnea.

D

Which of the following food-based allergies is likely to be found in adults and children? A. milk B. egg C. soy D. peanut

D

Which of the following is associated with the highest risk of ischemic heart disease? A. presence of microalbuminuria plus heavy alcohol intake B. absence of microalbuminuria plus use of a thiazolidinedione C. absence of microalbuminuria plus chronic physical inactivity D. presence of microalbuminuria plus cigarette smoking

D

Which of the following is least likely to be found in patients with pulmonary embolus (PE)? A. pleuritic chest pain B. tachypnea C. DVT signs and symptoms D. hemoptysis

D

Which of the following is most consistent with a patient presenting with acute MI? A. a 5-minute episode of chest tightness brought on by stair climbing B. a severe, localized pain that penetrates the chest and lasts about 3 hours C. chest pressure lasting 20 minutes that occurs at rest D. retrosternal diffuse pain for 30 minutes accompanied by diaphoresis

D

Which of the following is true regarding anaphylaxis? A. Adults usually do not develop new anaphylaxis triggers such as food allergies. B. Peanuts are the primary food that can cause a severe allergic reaction. C. Future anaphylactic reactions will become increasingly more severe. D. Trace amounts of an allergen in a food can cause a severe anaphylactic reaction.

D

Worldwide, which of the following is the most common type of anemia? A. pernicious anemia B. folate-deficiency anemia C. anemia of chronic disease D. iron-deficiency anemia

D

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g Hct = 32% RBC = 2.9 million mm 3 MCV = 72 fL MCHC=28.2 g/dL RDW = 18.9% Physical examination is likely to include: A. conjunctiva pallor. B. hemic murmur. C. tachycardia. D. no specific anemia-related findings.

D

Community Acquired Pneumonia (CAP) *Inpatient testing*

Hospitalized patients Higher probability of infectious causes & sicker pts Allows for narrwoing of Abx coverage Sputum gram stain: broadening initial Abx Urine antigen: S. pnemonia & legionella: narrow Abx Rapid of Influenza A/B Blood cx: prior to Abx CBC, Chem7, ABG

Sensitivity

How likely a test is to detect presence of disease in someone with that disease **Accurately detect a positive **A/A+C

Specificity

How likely a test is to detect the absence of a disease in someone w/o the disease --Accurately detect a negative **D/(B+D)

A patient presents to the nurse practitioner's clinic and states that she feels sad and thinks she's depressed. What information is important to elicit in order to diagnose her with depression?

How long have you felt like this? In order to diagnose a patient with depression, certain criteria must be met. DSM V has established specific criteria that must be present for a diagnosis of depression to be made. One essential criterion is the presence of depressed mood for at least 2 weeks. If the depressed mood has lasted less than this, a diagnosis is premature. Information about family history supports a diagnosis but is not a criterion. The last two questions assess for risk of suicide.

huntington's disease

Huntington's disease (HD) is an inherited disease that causes certain nerve cells in the brain to waste away. People are born with the defective gene, but symptoms usually don't appear until middle age. Early symptoms of HD may include uncontrolled movements, clumsiness, and balance problems. Later, HD can take away the ability to walk, talk, and swallow. Some people stop recognizing family members. Others are aware of their environment and are able to express emotions. If one of your parents has Huntington's disease, you have a 50 percent chance of getting it. A blood test can tell you if have the HD gene and will develop the disease. Genetic counseling can help you weigh the risks and benefits of taking the test. There is no cure. Medicines can help manage some of the symptoms, but cannot slow down or stop the disease.

________ may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity.

Hypomania

Podagra

Gout (also known as podagra when it involves the big toe) is characterized by recurrent attacks of acute inflammatory arthritis—red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (approximately 50% of cases).

Which of the following diseases is the result of a bacterial infection of peripheral nerves? Hansen's disease botulism tetanus acute bacterial meningitis rabies

Hansen's disease

Most common form od hypothyroidism in the U.S.

Hashimoto thyroiditis

moderate risk patient risk

Have 15-20% lifetime risk

Djd Heberden's Nodes (DIP) Bony nodules on the distal interphalangeal joints (DIP). Bouchard's Nodes (PIP) Bony nodules on the proximal interphalangeal joints (PIP) Rheumatoid arthritis Uveitis: refer to ophthalmologist for treatment (high dose steroids). Drug class question: Plaquenil is an antimalarial. Labs Sedimentation rate: elevated CBC: mild microcytic or normocytic anemia common Rheumatoid Factor: positive in 75 to 80% of patients Radiographs: bony erosions, joint space narrowing, subluxations (or dislocation)

Heberden's and/or Bouchard's nodes have appeared many times on the exam. Memorize the location of each. The following may help: Heberden's: the "den" ending on the word is the letter "D" for DIP joint. By the process of elimination, Bouchard's is on the PIP joint. Types of treatment methods used for DJD: NSAIDs, analgesics, steroid injection on inflamed joints (NO systemic/oral steroids compared to RA), surgery (e.g.,joint replacement). Do not confuse DJD treatment with treatment for RA. Treatment for RA includes all of DJD treatment methods plus systemic steroids, antimalarials (Plaquenil), and antimetabolites (methotrexate).

After the acute phase of bipolar disorder, why should the patient write a journal and how can it benefit them?

Help client to keep a chart of daily mood symptoms, treatments, sleep patterns, and life events -may help people with bipolar disorder and their families to better understand the illness.

What is the role of cortisol?

Helps the body respond to stress

Lava migrans- raised serpigniois Shaped rash

Hookworm ova in dog or cat feces develop into infective larvae when left in warm moist ground or sand; transmission occurs when skin directly contacts contaminated soil or sand Topical thiabendazole 15% liquid or cream (compounded) bid to tid for 5 days is extremely effective. Oral thiabendazole is not well tolerated and not usually used.

Tia

If symptoms of a transient ischemic attack persist beyond 24 hours, the diagnosis of a stroke should be considered. A transient ischemic attack (TIA) is an acute neurological event in which all signs and symptoms, including numbness, weakness, and flaccidity, visual changes, ataxia, or dysarthria, resolve usually within minutes, but certainly by 24 hours after onset. If changes persist beyond 24 hours, the diagnosis of stroke should be considered.

What can happen to a depressed or manic person who has not slept for several days?

If they stay up for long enough they can get psychotic (hearing things, seeing things, perceiving things inaccurately)

All of these play a role in COPD Pathology EXCEPT: Airway Inflammation IgE binding leading to Mast cell activation Goblet Cell Mucous Production AAT deficiency related elastin damage

IgE binding leading to Mast cell activation

Pneumonia

Imflammatory condition of the lung in which alveoli become filled with fluid and blood, infection Clinically: New infiltrate (imaging) + evidence of infection (new fever, purulent sputum, leukocytosis, hypoxemia) -Imflammation causing leakage

Skin Testing

Immune Marker -PPD (purified protein derivative of tuberculin) - mumps -anergy (no response can be sign of PCM)

Lymphocyte Count

Immune Marker (Normal >2700) - decrease PCM - affected by many conditions, infection, meds, chemo, XRT, steroids)

Which criterion below is a criterion for Alzheimer's Disease?

Impairment of executive function The diagnostic criteria for Alzheimer's disease (AD) was established by DSM V and other organizations. The criteria are similar. Criteria include a gradual onset of cognitive decline. A rapid onset usually indicates another etiology, perhaps, delirium. Other criteria include impairment of recent memory, difficulty with language or finding words, the inability to execute skilled motor activities, disturbances of visual processing or disturbances in executive function that includes abstract reasoning and concentration. Focal neurologic signs are consistent with a vascular dementia. Radiologic evidence is not a criterion for diagnosis, though it may support the diagnosis of AD. There is no laboratory evidence of AD.

What are S/S of Cushing's syndrome?

Increased deposition of sub-q fat on the face, upper body and trunk, facial erythema, atrophy and thinning of the skin, easy bruising, purple abd striae, slow healing, muscle weakness, osteoporotic changes, thinning extremities, HTN, glucose intolerance, absent menses or male infertility/ erectile dysfunction

Arcapta

Indacaterol inhale contents of one capsule once daily

3rd party payment system

Indicates that bills will be paid by the insurer and not the patient or the health care provider

Meniscus tear

Individuals who experience a meniscus tear usually experience pain and swelling as their primary symptoms. Another common complaint is joint locking, or the inability to completely straighten the joint. This is due to a piece of the torn cartilage physically impinging the joint mechanism of the knee.

What is pharyngitis?

Infection or irritation of the pharynx and/or tonsils

Viral

Influenza (A/B): adults RSV: pedi Adenovirus: pharyngitis, conjunctivitis Parainfluenza: pedi, URI and LRI, *Croup*

immunizations

Influenza vaccine - annualy pneumococcal vaccine - two lifetime doses spaced 5 years apart

How does tetanospasmin act? -It blocks the release of inhibitory neurotransmitters in the CNS. -It is a pyrogenic toxin. -It triggers the endocytosis of skeletal muscle cells. -It induces nervous system proteins to fold into abnormal shapes. -It blocks the secretion of acetylcholine into the synaptic cleft.

It blocks the release of inhibitory neurotransmitters in the CNS

Budesonide

Pulmicort 200 mcg/spray

Cost containment quality access triangle

QUALITY, ACCESS, COST -Increase access --> increase cost, decrease quality -Increase cost: decrease quality, decrease access -Increase quality: increase cost, decrease access

Common drugs that interfere with absorption of levothyroxine?

Question , Ferrous sulfate, carafate, calcium, antacids

Beclomethasone

Qvar 42 ,84 Mcg/spray

How often do we re-screen if 3-10 adendomas OR 1 adenoma >1cm OR an adenoma with villous features OR Adenoma with high grade dysplasia

Receives a colonoscopy 3 years after initial polypectomy

Preeclampsia

Recommended care for women diagnosed with preeclampsia includes bed rest with bathroom privileges, weight and BP monitoring, and closely following urine protein and serum protein, creatinine, and platelet counts. Oral medications are not used as first-line treatment.

USPTF recommendations on prostate cancer screening

Recommends against screening because there is moderate or high certainty that the service did not show reduced mortality

How is Cushing's Syndrome treated?

Referral to endocrinologist is warranted. Patient would need surgery if it is a tumor or medications to suppress extra cortisol excretion. May also need treatment for T2DM that may be associated with Cushing's

Viral rashes

Review of Viral Rashes Measles: Koplik's spots Rubella: fetal birth defects, but mild illness to child (also known as 3-day measles). Erythema Infectiosum (fifth disease): slapped cheek appearance. Roseola: high fever up to 106°. Despite very high fever, child appears well. Pityriasis rosea: "Christmas-tree pattern" or Herald patch.

Individual Considerations

Rheumatic fever follows 0.5% and 3% of ineffectively treated cases of Group A strep upper respiratory infections. 20% of children 5 to 15 years of age who are diagnosed with rheumatic fever had pharyngitis in the preceding 3 months.

familial dysautonomia

Riley-Day syndrome is an inherited disorder that affects nerves throughout the body. Causes Riley-Day syndrome is passed down through families (inherited). A person must inherit a copy of the defective gene from each parent to develop the condition. This condition is seen most often in people of Eastern European Jewish ancestry (Ashkenazi Jews). The disease is caused by a change (mutation) of the IKBKAP gene on chromosome 9. It is rare in the general population. Symptoms Breath holding spells (can lose consciousness) Constipation Decrease in sense of taste Diarrhea Dry eyes Feeding problems Inability to feel pain and changes in temperature (can lead to injuries) Lack of tears when crying Long periods of vomiting Poor coordination and unsteady walk Poor growth Repeated fevers Repeated pneumonia Seizures Skin blotching Sweating while eating Unusually smooth, pale tongue surface Symptoms are present at birth and grow worse over time. Exams and Tests The health care provider will do a physical exam to look for: Absent or decreased deep tendon reflexes Lack of a response after receiving a histamine injection (normally redness and swelling would occur) Lack of tears with crying Low muscle tone (hypotonia), especially in babies Repeated episodes of high blood pressure Severe scoliosis Tiny pupils after receiving certain eye drops Blood tests are available to check for the IKBKAP gene. Treatment Treatment may include: Anticonvulsant therapy for seizures Feeding in an upright position and giving textured formula to prevent gastroesophageal reflux Measures to prevent low blood pressure when standing (postural hypotension), such as increasing intake of fluid, salt and caffeine, and wearing elastic stockings Medicines to control vomiting Medicines to prevent dry eyes Physical therapy of the chest Protecting against injury Providing enough nutrition and fluids Surgery or spinal fusion Treating aspiration pneumonia Outlook (Prognosis) Advances in diagnosis and treatment are increasing the survival rate. A newborn baby with Riley-Day has a 1 in 2 chance of living to age 30.

What are the risk factors for developing bipolar disorder?

Risk Factors - family history/ prior mood episodes, stressful life events, substance use, lack of social support

Temporal arteritis

Risk factors for giant cell or temporal arteritis include female, not male gender, and Northern European descent, particularly people of Scandinavian origin. Giant cell or temporal arteritis is an autoimmune vasculitis most common in patients 50 to 85 years old; average age at onset is 70 years. A systemic disease affecting medium-sized and large-sized vessels, giant cell arteritis also causes inflammation of the temporal artery, producing a severe unilateral headache. As soon as the diagnosis is made, high-dose systemic corticosteroid therapy should be initiated until the disease appears to be under control, followed by a careful reduction until the lowest dose that can maintain clinical response can be determined. This dose is continued for six months to two years. When symptoms have been stable, the corticosteroid is slowly discontinued with close monitoring.

Prostate ca risk factors

Risk factors for prostate cancer include: older age African-American ancestry a family history of prostate cancer obesity

Rods - night vision Cones-color

Rods and cones are photoreceptor cells of the retina. The cones of the eyes are responsible for color vision. Cones are very sensitive to colors (red, blue, or green) and work better in brighter light. Rods are good for night vision and for vision in low-light conditions because they are sensitive to light and dark. To remember them, note that both cone and color start with the letter "C."

Roseola- fever then rash appears the rash is not itchy and usually starts at the trunk

Roseola infantum is a common viral rash that is caused by the human herpes virus; the most common ages of onset are between 6 months and 2 years. The rashes are maculopapular (small round pink-colored) rashes that first appear on the trunk and then spread to the extremities.

A 60 year-old patient is noted to have rounding of the distal phalanx of the fingers. What might have caused this

Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often associated with chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease

exacerbation most common agent

S. pneumonia

Pharyngitis/Tonsillitis

S/S: Centor criteria= T>38, tender anterior cervical adenopathy, tonsillar exudate, *lack of cough* GABHS PE: lymphadenopathy, rash, erythemaous, edematous pharynx/tonsils with exudate. Hapatosplenomegaly in EBV Pathogens: GABHS, N. gonorrhoeae, diptheriae, EBV rhino, adeno Tx: 0-1 Centor: No abx 2-3 Centor: treat with +throat cx +4 Centor: Abx, PenVK, Cefuroxime, azytho, arythro Complications: glomerulonephritis, sclarlet fever, rheumatic myocarditis, peritonsillar abscess

Acute Bronchitis

S/S: Cough, non-productive, last 3-4+ weeks, fever, malaise PE: +/- rhonchi, rales ausculation Pathogens: viruses, M. pneumoniae, C. pneumoniae, B. pertussis Dx: CRX, sputum cx, nasopharyngeal swab-influenza or pertussis Tx: Abx not indicated unless + cx, albuterol if wheezing

Laryngitis

S/S: hoarseness persisting after URI Pathogen: viruses-90%, M. catarrhalis, H. influenzae Tx: supporative care, voice rest, abx and steroids if severe inflammation Complications: vocal fold hemorrhage, polyps

Common Cold: Viral Rhinosinusitis

S/S: rhinorrhea, nasal congestion, malaise, cough, low-grade fever PE: erythematous, edematous mucosa, clear lungs, nasal discharge Pathogens: rhinovirus, coronavrius, adenovirus Tx: Supporative care; decongestatnsm NSAID's Complications: secondary *bacterial* infections, exacerbations

S1,s2 hear sound motivated apples

S1 motivated - mitral, tricuspid , av S2 apples - aortic , pulmonic , semilunar

S2

S2 best heard at the pulmonic area is physiologically split in about 90% of people. The second heart sound is produced by the closure of the aortic and pulmonic valves. The sound produced by the closure of the aortic valve is termed A2, and the sound produced by the closure of the pulmonic valve is termed P2. The A2 sound is normally much louder than the P2 due to higher pressures in the left side of the heart; thus, A2 radiates to all cardiac listening posts (loudest at the right upper sternal border) and P2 is usually only heard at the left upper sternal border.

Bronchodilators

SABA SAA LABA LAA combos Methylxanthines

The preferred medication class to treat patients with an initial episode of depression is:

SSRIs The major classes of antidepressants used to treat depression are listed in this question. Multiple studies have concluded that there is no clear choice on selection of one class over another for efficacy. However, SSRIs are usually the first choice because they are associated with fewer side effects and there is less danger of suicide with an overdose. Monoamine oxidase inhibitors are involved with a number of drug-drug and drug-food interactions and so these are seldom chosen initially.

Name symptoms of depression.

Sadness Excessive crying Loss of pleasure Sleeping too much or too little Low energy Restlessness Difficulty concentrating Irritability Loss of appetite or overeating Feelings of worthlessness and hopelessness Ongoing physical problems that are not caused by physical illness or injury (e.g., headaches, digestive problems, pain) Can develop psychosis Thoughts of death or suicide

Why would Selective Serotonin Reuptake Inhibitors (SSRI's) be chosen as a common medication for depression treatment?

Safer than other meds for depression

Scarlet fever

Scarlet fever is a bacterial infection caused by the group A Streptococcus infection. The patient will exhibit sore throat, high fever, and a fine sandpaper rash, which is characteristic of scarlet fever.

What are the recommendations for screening older patients for depression?

Screen at each visit. Depression is very common in all adults, especially older adults. Screening can be accomplished easily and quickly in a primary care setting. Untreated depression leads to higher rates of mortality when other co-morbid conditions exist, especially heart disease.

If patient has a relative that has colorectal cancer, when should we start screening. what else could we start thinking about.

Screen the patient starting 10 years-of age before their relative was found to have the cancer, or start at age 40 and no later. And could start genetic counseling

breast cancer Screening ages 50-75

Screening in age 50-74: Standardly recommended

When can we stop lung cancer screening

Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Length Bias

Screening tests find slow-developing cases, which have long pre-symptomatic phases. Fast growing (more aggressive, worse prognosis) tumors could be missed by screening. Therefore the survival may appear better for screened individuals without there necessarily being a real difference between individuals of a screened and unscreened population.

What if we see a sessile adenoma

Sessile adenoma is removed piecemeal: A colonoscopy is performed 2-6 months to verify the complete removal.

Advair would be first used in which stage on COPD? Mild Moderate Severe Very Severe

Severe

Lead toxicity can be associated with

Sideroblastic anemia occurs when iron is unable to be incorporated into the hemoglobin molecule despite there being adequate amounts of iron available. An iron deficiency anemia results. This can be due to an inherited enzyme deficiency, it can be acquired (as in the case of lead toxicity), or of it can be of idiopathic origin. Lead can produce a sideroblastic anemia because it prevents iron from being incorporated into the heme portion of the hemoglobin molecule. Sideroblasts may be visible on blood smear. They represent an accumulation of iron in the cell's mitochondria.

Which of the following is the leading cause of meningitis in newborns? Streptococcus agalactiae Neisseria meningitidis Haemophilus influenzae Streptococcus pneumoniae Listeria monocytogenes

Streptococcus agalactiae

The leading cause of meningitis in adults is Streptococcus pneumoniae. Streptococcus agalactiae. coxsackie A virus. Haemophilus influenzae. West Nile virus.

Streptococcus pneumoniae

What can stress do for a bipolar person? What can they do to help prevent this?

Stress can bring an exacerbation of symptoms on. They should learn good coping skills

A 70 year old patient is concerned and comes into the clinic complaining of Headache slurred speech and onset of symptoms within the last 60 minutes. When the patient is examined, her complaints are confirmed by the examiner. What is the likely etiology of the event?

Stroke

In patients with longstanding IDB, what should our guidelines be for colonoscopy

Surveillance colonoscopy, looking for dysplasia as a marked for colorectal cancer risk, should be considered along with the extent and duration of the disease as a guide to when/if colectomy should be considered.

Murmur

Systolic murmurs use the MR TRAS mnemonic Diastolic murmurs use the MS. PRAR mnemonic

Is T3 or T4 more active?

T3 is 5 times more active than T4

Cavitary lesions

TB Necrotizing bacterial infection

What lab test is performed in order to determine if thyroid medication should be raised or lowered?

TSH

. microcytic, hypochromic red cells

Thalassemia minor can be recognized by: a. microcytic, normochromic red cells b. normocytic, normochromic red cells c. microcytic, hypochromic red cells d. normocytic, hyperchromic red cells

downfall of Virtual Colonoscopy (CT colonoscopy)

This is good, but you cannot biopsy and if you find anything you will still have to go in and do colonoscopy

What is secondary adrenal insufficiency?

This is inadequate production of adrenal hormones due to pituitary disease. (Not enough ACTH from pituitary)

Medically indigent

Those lacking the financial ability to pay for their own medical care

Access to care

Timely use of personal health services to achieve the best health outcomes, it requires 3 distinct steps 1. Gaining entry into health care system 2. Accessing a health care location 3. Finding a health care provider with whom the patient can communicate and trust *insurance doesn't necessarily mean access to care

Perception of abnormal hearing or head noises

Tinnitus

What is the key reason to treat strep throat?

To reduce the incidence of rheumatic fever

What are the symptoms of toxic lithium side effects?

Toxicity (can begin at>1.5 mEq/L) Vomiting Severe diarrhea Course hand tremor Twitching Ataxia/lack of coordination Lethargy Dysarthria (difficulty speaking/slurred speech) Hyperactive deep tendon reflexes Vertigo/confusion Muscle weakness ECG changes Coma/Death

"MR TRAS" (use for all systolic murmurs) Systole or S1 murmurs are also described as holosystolic, pansystolic, early systolic, mid-systolic, or late systolic murmurs.

MR- mitral regurgitate pansystolic (or holosystolic) murmur heard best at the apex or the apical area radiates to axilla loud-blowing and high-pitched murmur (use the diaphragm of the stethoscope) Tricuspid Regurgitation not on the test at present Aortic Stenosis a mid-systolic ejection murmur best heard at the second ICS at the right side of the sternum radiates to the neck a harsh and noisy murmur (use the diaphragm of the stethoscope) Patients with aortic stenosis should avoid physical overexertion. These patients are at risk for sudden death. Monitored by serial cardiac sonograms with Doppler flow studies. Surgical valve replacement if moderately

"MS. PRAR" Diastole or S2 is also decribed as early diastole, late diastole, or mid-diastole. Diastolic murmurs are always indicative of heart disease

MS (Mitral Stenosis) A low-pitched diastolic rumbling murmur heard best at the apex of the heart or the apical area also called an "opening snap" (use bell of the stethoscope) PR (Pulmonic Regurgitation) not on the test at present AR (Aortic Regurgitation) A high-pitched diastolic murmur best heard at the second ICS at the right side of the sternum high-pitched blowing murmur (use diaphragm of the stethoscope)

What suggests that a patient may be abusing alcohol?

Macrocytosis, tremulousness, hypertension

Which findings suggest that a patient may be abusing alcohol?

Macrocytosis, tremulousness, hypertension Findings that should trigger an examiner to suspect alcohol abuse in a patient are tremors, hypertension, rhinophyma, peripheral neuropathy, telangiectasias, and hepatosplenomegaly. A patient does not usually exhibit all of these characteristics. In fact, he may not exhibit any of these symptoms and still abuse alcohol. The symptoms listed in the other choices are not specifically associated with alcoholism. Macrocytosis is common in alcoholics because there is a high rate of B12 deficiency and folate deficiency; both produce macrocytic anemias.

What is the mean age of onset for bipolar disorder?

Mean age of onset 21-30 years.

How is Cushing's syndrome diagnosed?

Measure the cortisol in a 24-hour urine (>100= Cushings), Midnight cortisol swab (normally cortisol would be low so a high number is indicative of Cushings), Dexmethasone suppression testing

Biochemical

Measurement of biochemical functions (e.g., concentrations of nutrient by-products or enzyme activities in the blood or urine) related to a nutrient's function.

What Headache is most likely to be triggered by food?

Migraines chocolate, aged cheese, nuts nitrates and caffeine.

Duration of Abx

Min 5 days, 5-7 for typical -longer for pseudomonas Afebrile 48-72hrs, at baseline O2 Only 1: HR > 100 RR > 24 SBP < 90

Uncomplicated peptic ulcer disease negative h pylori

Misoprostol is recommended for short-term, uncomplicated PUD; it acts by decreasing gastric acid production and enhancing mucosal resistance to injury.

Mitral valve prolapse

Mitral Valve Prolapse (MVP) Normal sinus rhythm associated with an S2 "click" followed by a systolic murmur. More common in tall and thin adult females. Higher risk of thromboemboli and infective endocarditis. Diagnosed by cardiac ultrasound. IE prophylaxis is no longer recommended by the AHA for MVP. Classic Case Female adult patient may complain of fatigue, palpitations, lightheadedness.

Mitral location Aortic location

Mitral area fifth ICS on the left side of sternum medial to the midclavicular line apical murmur or the apex of the heart Pulmonic area second ICS on the left side of the sternum left side of the upper sternum at the base of the heart Aortic area second ICS to the right side of the sternum right side of the upper sternum at the base of the heart

Dulera HFA

Mometasone/ Formoterol 2 puffs twice daily

What is a common side effect of trazodone (antidepressant TCA)? When should trazodone be taken?

Trazodone cause profound drowsiness, and should be taken at bedtime.

A young man is experiencing fever and severe headaches, and is having difficulty staying awake. He reports having spent time in Africa on a missionary trip several months ago. Recently he spent time in a park where he went swimming in the lake and was bitten by a bat he attempted to catch. His cerebrospinal fluid is nearly clear, and contains long, slender, mobile cells. This description indicates infection with rabies virus. Neisseria meningitidis. Acanthamoeba. Trypanosoma brucei. an enterovirus.

Trypanosoma brucei

What other tests to be considered in pharyngitis?

Monospot test CBC with differential Gonorrhea culture Blood culture if sepsis is suspected Radiograph of neck if possible trauma

Albumin

Most abundant and often measured protein -made in the liver, maintains oncotic pressure

Risk factor for cervical cancer

Most significant is HPV. In a larger international trial, the provenance of oncogenic HPB in cervical cancers was 99%

d. stop the warfarin today and repeat the INR tomorrow

Mrs. Smith is a 72 y/o pt who takes warfarin for chronic atrial fibrillation. Today his INR is 4.0 His CBC is normal and there is no evidence of bleeding. the NP should: a. stop the warfarin for the next four days and repeat the INR on day 5 b. admit to the hospital immediately c. administer Vitamin K and repeat INR in two hrs d. stop the warfarin today and repeat the INR tomorrow

Hansen's disease is caused by Streptococcus agalactiae. prions. Neisseria meningitidis. Mycobacterium leprae. coxsackie A virus.

Mycobacterium leprae

Interstitial/Reticular pneumonia

Mycoplasma pneumniae PJP

Multiple myeloma

Myeloma is a cancer of the plasma cells (or mature B-cells/lymphocytes), which affects the bone marrow. Plasma cells produce antibodies and reside mainly in the bone marrow. Signs/symptoms are bone pain, fractures, hypercalcemia, depressed immunity, and anemia. The bone marrow produces WBCs (neutrophils, lymphocytes, eosinophils, basophils), RBCs, and platelets. The typical patient is an older adult who is aged 60 years or older.

Myxedema

Myxedema is a rare, and sometimes fatal, disease in which the thyroid is severely underactive and causes life-threatening symptoms. These symptoms include low blood pressure, decreased breathing, decreased body temperature, unresponsiveness, and even coma. Graves' disease, thyroid storm, and eye disorder are seen with an overactive thyroid disease known as hyperthyroidism.

A 4 year-old is being examined today in the NP clinic. He appears shy and does not make eye contact with the examiner. The mother does not make eye contact with the examiner either. The patient lacks animation and does not smile. What likely possibility must be considered?

Neglect is possible The possibility of neglect should always be given when a young patient and caregiver make poor eye contact with the examiner. Other clues to neglect are a lack of animation and no social smile. Additionally, the child should be observed for nutritional status, behavior, attitude, and physical appearance. Sexual abuse should also be considered, but there is nothing in the stem of the question to suggest this or a lack of medical insurance.

Striverdi Respimat

Olodaterol Inhale one inhalation once daily

When CRX

One abnormal vital sign: -Temp >100 -RR >20 -HR >100 Or 2 of the following: -Decreased breath sounds -Crackles -Absence of asthma *Inflitrate on chest imaging is required for Dx of pneumonia*

CAP Tx Inpatient

Non ICU -Respiratory Fluoroquinolone (Moxi, Gemi, Levo) -Macrolide (aithro or doxy) + beta-lactam (Amox, amox-clav, cefpodoxime, cefuroxime) ICU -Azithro or respiratory fluoroquinlones plus antioneumococcal beta lactam (cefotaxime, ceftriaxone, ampicillin-sulbactam) -PCN allergy: resp fluoroquinlones plus aztreonam -Pseudomonas: Antipseudomonal beta-lactams (pip-taz) plus cipro or levo OR aminoglycoside (gent, tobra) plus azithro -MRSA (vanco, linezolid)

A patient with anorexia nervosa (AN) had symptoms that began about 6 months ago. She presents today and is diagnosed with AN. She has a laboratory evaluation. What might be expected?

Normal lab values Most lab values remain normal until late stages of the illness in patients who are anorectic. The initial lab assessment should include a CBC, glucose, electrolytes, BUN, Cr, and a pregnancy test in females who are amenorrheic.

Mass screening is not indicated for what two kinds of cancers in women

Ovarian cancer Endometrial Cancer

severe causative agent exacerbation

P. aeroginosa

Ascites

PCM, protein def, other disorders (GI)

Diarrhea

PCM, thiamin, malabsorption, IBD, infection, other disorders, meds, antibiotics (GI)

Appetite

PCM, thiamin, niacin, meds, other problems (cancer, renal failure) (GI)

Hiv

PCP prophylaxis when CD4 <200. Bactrim DS used first, if allergic to sulfa, use pentamidine. Screening test is the ELISA test (tests for antibodies only). Confirmatory test is Western Blot. Example of a diagnostic test is PCR (viral RNA), viral load, etc. HIV-infected pregnant women: start AZT in the 2nd trimester. Hairy leukoplakia of tongue: rule out

A 29 year-old postpartum female reports that she is having difficulty with concentration, sleep, and has feelings of guilt. She states that she feels sad most of the time. These symptoms have been present since the birth of her baby about one month ago. She can be diagnosed with:

PPD This patient is correctly diagnosed with postpartum depression. Postpartum depression is diagnosed when depression begins within the first month after delivery. There are 9 symptoms that characterize depression (in non-pregnant patients) and these are used in postpartum patients as well. When a patient exhibits fewer than 5 symptoms, but at least 2 of these symptoms every day for most of the day for at least 2 weeks, s/he may be diagnosed with minor depressive disorder. Depressed mood must be one of these symptoms. If s/he exhibits 5 or more, s/he may be diagnosed with major depressive disorder. In dysthymia, similar symptoms are evaluated, and they must be present at least 2 years. Hypothyroidism can account for feelings of low energy, but hypothyroidism does not produce feelings of guilt or other symptoms associated with depression.

A 62 year old female patient presents to the clinic with very recent onset of intermittent but severe facial pain over the right cheek. She is diagnosed with Trigeminal Neuralgia. What assessment finding is typical of this?

Pain may be triggered by light touch

method for cervical cancer screening

Papanicolaou smear

Many physicians follow USPSTF guidelines what are they for breast cancer screening

USPSTF in 2009: 40-49 requires discussion of individualized risk versus benefit. 50- 74 requires biennial mammography w/ insufficient evidence of benefit >74 --- useful b/c spells out evidence levels.

Screening methods that could be useful in detecting endometrial cancer

Ultrasound, endometrial scraping

a. the pt has HCV

a 48 y/o pt has the following lab values. How should they be interpreted? HCV IgG(+), RIBA (radio immuno blot assay) (+) a. the pt has HCV b. the pt does not have HCV c. the pt should consider immunization d. the results are indeterminate

d. osteoarthritis

a 65 y/o male is being txed with oral medications for HTN, hyperlipidemia, diabetes and osteoarthritis. The most likely reason for his iron deficiency anemia is oral tx for: a. hypertension b. hyperlipidemia c. diabetes d. osteoarthritis

a. multiple myeloma

a 66 y/o African American male c/o pain in his trunk, especially his ribs. Cardiovascular disease is ruled out. He has a normocytic, normochromic anemia with hypercalcemia. The differential dx should include: a. multiple myeloma b. lymphoma c. leukemia d. parathyroid disease

c. alcohol abuse

a 70 y/o male has an elevated MCV with an anemia. His triglycerides are 420. What should be suspected? a. pernicious anemia b. folate deficiency c. alcohol abuse d. hypertriglyceridemia

b. lymphoma

a 70 y/o male has lymph nodes in his axillary and inguinal areas that are palpable but non-tender. He states that he feels well today. What should be included in a differential dx for this pt? a. leukemia b. lymphoma c. asymtomatic lymphadenitis d. cat-scratch disease

c. acetaminophen

a 70 y/o presents to the NPs office for a well exam today. What medication probable has no affect on screening for occult blood in the stool? a. aspirin b. clopidogrel c. acetaminophen d. ibuprofen

b. folic acid and pernicious

a 75 y/o pt who has multiple chronic diseases has been in very poor healthy for a decade. What type of anemias is he most likely to exhibit? a. iron deficiency and folic acid b. folic acid and pernicious c. iron deficiency and anemia of chronic disease d. thalassemia and vitamin B12

b. pernicious anemia

a B12 deficiency can produce: a. microcytic anemia b. pernicious anemia c. sideroblastic anemia d. insomnia

valvuloplasty

a balloon-tipped catheter inserted through peripheral vessel into heart. balloon is inflated increase diameter, and balloon removed

b. iron deficiency anemia

a child and father live in an old house. they both are found to be lead toxic. What type anemia is typically observed in pts who are lead toxic? a. pernicious anemia b. iron deficiency anemia c. lead anemia d. anemia of chronic disease

Mycoplasma pneumoniae is:

a disease with extrapulmonary manifestations. Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to diagnose because symptoms can be varied and involve multiple body systems (extrapulmonary manifestations). Infection with Mycoplasma may present with a normal white blood cell count, maculopapular rash, GI symptoms, tender joints and aches, and though rare, cardiac rhythm disturbances. Respiratory symptoms may not be pronounced. On chest x-ray there are some unique findings (peribronchial pattern) with Mycoplasma. These include thickened bronchial shadow, streaks of interstitial infiltration, and atelectasis. These are more likely to occur in the lower lobes.

a. avoid aspirin and sulfa drugs

a female pt has been dx with Glucose-6-phosphate dehydrogenase deficiency (G6PD). What should be done to prevent lysis of red cells in this pt? a. avoid aspirin and sulfa drugs b. minimize iron consumption in her diet c. receive immunizations timely d. consume adequate amts of water daily

a. dark green leafy vegetables and dried peas and beans

a female vegetarian presents to your clinic with iron deficiency anemia. What can the nP suggest she eat to help with resolution of iron deficiency anemia? a. dark green leafy vegetables and dried peas and beans b. mushrooms, oatmeal, and whole grain breads c. beets, broccoli, and beef d. baked potatoes, beets, and broccoli

When is a person infectious with epidemic keratoconjunctivitis?

a few days before developing symptoms to 14 days after symptom onset

Neisseria meningitidis is characterized as -a Gram-positive coccobacillus. -a Gram-negative diplococcus. -having a polysaccharide capsule and fimbriae. -a Gram-negative diplococcus with a polysaccharide capsule and fimbriae. -being rapidly motile.

a gram-negative diplococcus with a polysaccharide capsule and fimbriae

c. the HIV status of the pt further testing

a healthcare provider was stuck with a needle from a pt suspected to be infected with HIV. a rapid HIV test was performed and was found to be positive. this means that the: a. healthcare provider has been infected with HIV b. the pts is infected with HIV c. the HIV status of the pt further testing d. the HIV status of the health provider requires further testing

a. RDW

a measure of the degree of variation in red cell size in indicated by: a. RDW b. MCHC c. MCV d. MCH

a. no tx is needed

a pt calls your office. He states that he just came in from the woods and discovered a tick on his upper arm. He states that he has removed the ticka nd the area is slightly red. What should he be advised? a. no tx is needed b. he should be prescribed doxycycline c. he needs a topical scrub to prevent Lyme disease d. he should come to the office for a ceftriaxone injection

c. he has an infection of unknown origin

a pt demonstrates leukocytosis. This means: a. he has a bacterial infection b. he has a viral infection c. he has an infection of unknown origin d. he does not have an infection

b. order a CBC

a pt exhibits petechiae on both lower legs but has no other complaints. How should the NP proceeds? a. refer to hematology b. order a CBC c. order blood cultures d. stop aspirin and re-assess in one week

b. more susceptible to bacterial infection

a pt had a splenectomy after an automobile accident 3 months ago. Pts who are asplenic are: a. at an increased risk of hepatomegaly b. more susceptible to bacterial infection c. at risk for bleeding disorders d. more likely to exhibit anemia

b. iron deficiency anemia

a pt has CBC results that indicate a microcytic, hypochromic anemia. The NP should suspect: a. pernicious anemia b. iron deficiency anemia c. vitamin B12 deficiency d. sickle cell anemia

b. lymphocytes

a pt has HBV. he probably has a predominance of: a. leukocytes b. lymphocytes c. neutrophils d. eosinophils

c. cephalosporins

a pt has a penicillin allergy. He describes an anaphylactic reaction. Which medication class should be specifically avoided in him? a. quinolones b. macrolides c. cephalosporins d. tetracyclines

c. he is immune to hepatitis B

a pt has a positive hepatitis B surface antibody. His core antibody is negative. This indicates: a. he has acute hepatitis B and needs immunization b. he has chronic hepatitis B c. he is immune to hepatitis B d. he needs immunization to hepatitis B

d. cervical lymphadenopathy may be prominent

a pt has been dxed with mononucleosis. Which statement is correct? a. he is likely an adolescent male b. splenomegaly is more likely than not c. he cannot be co-infected with Strept d. cervical lymphadenopathy may be prominent

d. influenza

a pt has had an anaphylactic rx to eggs. She should avoid immunization with: a. varicella b. hepatitis B c. IPV d. influenza

a. increased TIBC

a pt has heavy menses. which lab value below reflects an iron deficiency anemia? a. increased TIBC b. decreased TIBC c. normal serum iron d. decreased RDS

c. he has no immunity to hepatitis A

a pt has the following lab values. What does this mean? Hepatitis A: (-) IgM (-)IgG a. he has Hepatitis A b. he has immunity to hepatitis A c. he has no immunity to hepatitis A d. more data is needed

b. on an empty stomach

a pt is being txed for iron deficiency anemia. Iron is better absorbed: a. with food b. on an empty stomach c. with a food rich in vitamin C d. in the evening

b. hypochronic

a pt is found to have an anemia. The pt's MCH is decreased. The pt's anemia can be described as: a. macrocytic b. hypochronic c. macrochromic d. normochromic

a. hyperchromic

a pt is found to have an anemia. The pt's MCH is increased. The pt's anemia can be described as: a. hyperchromic b. hypochronic c. macrochromic d. normochromic

d. normochromic

a pt is found to have an anemia. The pt's MCH is normal. The pt's anemia can be described as: a. macrocytic b. normocytic c. macrochromic d. normochromic

c. microcytic

a pt is found to have an anemia. The pt's MCV is decreased. The pt's anemia can be described as: a. macrocytic b. normocytic c. microcytic d. normochromic

a. macrocytic

a pt is found to have an anemia. The pt's MCV is increased. The pt's anemia can be described as: a. macrocytic b. normocytic c. macrochromic d. normochromic

b. normocytic

a pt is found to have an anemia. The pt's MCV is normal. The pt's anemia can be described as: a. macrocytic b. normocytic c. macrochromic d. normochromic

c. eosinophils

a pt is having an allergic rx to seafood. Which white cell will probably be increased? a. neutrophil b. lymphocytes c. eosinophils d. basophils

a. receive doxycycline for Lyme disease

a pt with a positive hx of a tick bite about two weeks ago and erythema migrans has a positive ELISA for borrelia. The Western blot is positive. How should he be managed? a. receive doxycycline for Lyme disease b. receive penicillin for rocky Mountain spotted fever c. he does not have Lyme disease or rocky Mountain spotted fever d. he needs additional testing to confirm Lyme disease

a. an antacid

a pt with iron deficiency anemia takes an iron supplementation daily. What should he be advised to avoid within a couple of hrs of taking iron? a. an antacid b. heavy exercise c. potassium supplements d. grapefruit juice

c. he could have a negative monospot

a pt with mononucleosis has pharyngitis, fever, and lymphadenopathy. His sxs started 3 days ago a. he will have a positive monospot b. he will have a normal CBC c. he could have a negative monospot d. he could have a positive monospot and normal CBC

a. lymphocytosis

a pt with mononucleosis wuld most likely have: a. lymphocytosis b. eosinophilia c. leukocytosis d. monocytosis

c. glossitis

a pt with pernicious anemia may be observed to have: a darkening of the skin b. joint aches c. glossitis d. thrombocytopenia

b. demonstrates the amt of iron in storage

a serum ferritin level: a. could indicate thalassemia in a pt b. demonstrates the amt of iron in storage c. indicates when a pt has iron deficiency anemia d. confirms a low hgb and hct

The single most effective maintenance therapy for allergic rhinitis is:

a topical nasal steroid Many studies have shown that topical nasal steroids like budesonide, fluticasone, and mometasone provide superior relief of nasal stuffiness, nasal discharge, sneezing, and postnasal drip than antihistamines. Decongestants treat symptoms associated with nasal stuffiness. Currently, topical nasal steroids are the treatment of choice for relief of symptoms associated with allergic rhinitis (AR). Antihistamines and decongestants can be added to the regimen of a patient with AR

b. memory issue and glossitis

a vitamin b-12 deficiency might be suspected in an older pt with what complaints? a. fatigue and restless legs b. memory issue and glossitis c. painful legs with exercise d. insomnia and anorexia

Which of the following statements concerning rabies is FALSE? -Treatment includes vaccination. -All mammals can serve as a reservoir for the disease. -Bats are the source of most cases of rabies in humans. -It is caused by an ssRNA virus. -Transmission is usually via a bite from a rabid animal.

all mammals can serve as a reservoir for the disease

methylxanthines

aminophylline theophylline

Deductible

amount of expenses that the beneficiary (insured) must pay out of pocket before the insurance company begins to pay for covered services --the higher the deductible of a policy, the lower the premiums

a. increased RDW

an 18 y/o female pt has iron deficiency anemia. If this anemia has occurred in the past 3-4 months, what might be expected? a. increased RDW b. decreased RDW c. elevated serum ferritin d. decreased total iron binding capacity

3 principles in screening

consider burden on society should have tests available for proper screening with controlled spec, sens, and PPV and NPV must have interventions for positive screens that are avialable and that reduce true morbidity and mortality and inc QOL.

Variant Creutzfeldt-Jakob disease can be prevented by avoiding consumption of undercooked meat. consumption of contaminated meat. contact with mosquitoes. contact with bird droppings. contaminated waterways.

consumption of contaminated meat

What is epidemic keratoconjunctivitis transmitted?

contact with infected eye secretions

Poliovirus is most often transmitted via household pets. contaminated water. endospores. droplets. mosquitoes.

contaminated water

around the lens

cortical cataracts present

Which cranial nerve is assessed by administering the Snellen Test?

cranial nerve 2

Which of the following causes of viral meningitis is transmitted by the fecal-oral route? echovirus rabies equine encephalitis virus California encephalitis virus West Nile virus

echovirus

C

first line : ICS + LABA or LAMA second line : LAMA + LABA or LAMA + PDEi4 or LABA+ PDE4i

B

first line : LAMA or LABA second line : LAMA + LABA

COPD pharmacotherapy stage A

first line : SABAprn or SAMA prn second line : LAMA or LABA or SABA+SAMA

D

first line: ICS + LABA and/or LAMA second line: ICS + LABA and LAMA or ICS + LABA and PDE4i or LAMA+ LABA or LAMA + PDE4i

A person with 20/60 vision: has better vision than someone with 20/80

first number represents distance (usually 20 feet) The second number represents distance the average eye can see the letters on a specific line of the chart. In other words the examinee can see at 20 feet what the average eye (20/20) can see at 80 feet. 20/80 is a measure of distance vision, not near vision. The big E represents 20/200 vision. 20/200 is considered legally blind by most standards.

myotinic dystrophy

frontal balding associated with

A typical aura Migrane can involve a

fully reversible speech disturbance.

cortical/subscapular

glare common in

bevespi aerosphere

glycopyrrolate and formoterol long acting two inhalations twice daily

A common presentation of an inguinal hernia is:

groin or abdominal pain with a scrotal mass. An inguinal hernia is characterized by herniation of bowel or omentum into the scrotum. It typically presents with scrotal pain and a scrotal mass or scrotal swelling. Abdominal or groin pain with a scrotal mass is a common presentation. Bowel sounds may be audible in the scrotum.

Drawbacks of screening

harm caused by screening test Harm caused by futher investigation Harm caused by treatment Psychosocial impact of diagnosis

relative death reduction in flexible sigmoidoscopy usage

has a 59-79% death reduction

An elderly patient with organic brain syndrome is at increased risk for elder abuse because:

has declining cognitive function

Primary prevention

has the potential to prevent an event prior to its occurrence.

dosing

heavy - 4 mg light 2mg weeks 1-6 : 1 piece every 1-2 hrs weeks 7-9: 1 piece every 2-4 hrs weeks 10-12: 1 piece every 4-8 hrs

Dosing

heavy smokers ( >10 day) : start with 21 mg for 4-6 weeks , then 14 mg for 2 weeks , then 7 for 2 weeks Light smokers (< 10) : start with 14 mg for 6 weeks, then 7 mg for 2 weeks

Why is MRI breast cancer screening helpful

helpful in detecting >90% of cancer in contralateral breast

What is the black box warning for Valproate/Divalproex Solution (Depakote®) ?

hepatoxicity, teratogenicity, pancreatitis

What is epidemic keratoconjunctivitis (EKC)?

highly contagious severe form of conjunctivitis

ocular biometry

how to determine type of lens implanted

YAG laser capsulotomy

how to treat pco

The following describes which state of a bipolar person? Inflated self-esteem/grandiosity Decreased need for sleep (e.g. feels rested after only 3 hrs. of sleep) More talkative than usual Mildly racing thoughts/flight of ideas Easily distracted Increase in goal-directed behavior/ productivity/creativity Risky behaviors

hypomania

During which state are are bipolar patients very productive and extremely creative?

hypomanic

Tricyclic antidepressants may be safely used in older patients who have:

hypothyroidism Tricyclic antidepressants (TCA) are particularly UNSAFE in patients with conduction defects. Use of TCAs can induce bradyarrhythmias and thus can be deleterious for any patient, but especially in older adults who may be prone to this because of conduction defects and underlying myocardial ischemia. Patients with glaucoma and benign prostatic hyperplasia should avoid TCAs as well because of the anticholinergic effects. Selective serotonin reuptake inhibitors (SSRI) should be considered first line for most older patients with depression.

A patient with a past history of treatment for hyperthyroidism is most likely to exhibit:

hypothyroidism Hypothyroidism is the most likely result when a patient has been treated for hyperthyroidism because treatment typically destroys the gland's ability to produce thyroid hormone (T3 and T4), in the future. Radioactive iodine or drugs can be used to inhibit synthesis of thyroid hormone.

How could Bipolar II disorder be misdiagnosed as depression? What can happen if they are given antidepressants?

if we don't notice the signs of hypomania. -If they are accidently given antidepressants then they can have a manic episode.

red reflex

immature cataracts still have

a. lymphocytosis and atypical lymphocytes b. elevated monocytes

in a pt with mononucleosis, which lab abnormality is most common? a. lymphocytosis and atypical lymphocytes b. elevated monocytes c. a decreased total white count d. elevated liver enzymes

Tetanus vaccine contains -antibodies against Clostridium tetani. -antibodies against Clostridium tetani endospores. -fragments of Clostridium tetani cell walls. -inactivated Clostridium tetani endospores. -inactivated tetanospasmin.

inactivated tetanospasmin

patient exhibits at least two of the following for antimicrobial therapy

increased dyspnea increased sputum volume *increased sputum purulence*

utibron neohaler

indacaterol and glycopyrrolate long acting inhale contents of one capsule once daily

Which population is most likely to develop bacterial meningitis? healthy carriers infants and young children senior citizens All of the above.

infants and young children

Infective endocarditis

infection of heart chambers or valves vegetative growth

external hordeolum:

inflammation of hair follicle of eyelash

internal hordeolum:

inflammation of meibomian glands

Define Endocarditis

inflammation of the endocardium (inner lining of the heart) from a pathogen and damaged endocardial tissue

glossitis:

inflammation of tongue; often present with stomatitis

combivent

ipratropium/ albuterol short acting one inhalation four times daily

combivent respimat

ipratropium/ albuterol inhaler

duoneb

ipratropium/ albuterol nebulizer solution

An elderly patient has an audible carotid bruit. He has a history of hypertension Hyperlipidemia and and MI 5 years ago. The finding of a bruit indicates that the patient:

is more likely to die from cardiovascular disease than cerebrovascular disease

Which of the following is true of foodborne botulism? -Large amounts of bacteria must be consumed to produce disease. -It is an intoxication disorder. -It is not a life-threatening infection even when left untreated. -Normal food preparation methods can prevent it. -An effective vaccine is available.

it is an intoxication disorder

The nervous system is described as "axenic" which means it is full of axons. it is an oxygen-free environment. there are no axons in it. it is normally free of microbes. it contains extensive lymphoid tissue.

it is normally free of microbes

Redness, fissuring in corners of eyes

lack of riboflavin, pyridoxine (eyes)

Bloating, Distention

lactose intolerance (other intolerance), other disorder, meds, end stage liver disease (GI)

What time of the year is GABHS pharyngitis more common?

late winter and early spring

PDE-4 inhibitors used when?

later stages of COPD

Ankle inversion is a common complaint from a patient with a:

lateral ankle sprain An ankle inversion causes the sole of the foot to roll into the body. This produces stretching of the lateral malleolar ligaments of the ankle and a lateral ankle sprain. Injury to the medial ligaments is a more serious injury and can produce a medial ankle sprain or an avulsion fracture. No information in the stem of the question suggests a fracture or tear of the ligament, though all sprains produce varying degrees of ligament tears.

c. sideroblastic anemia

lead toxicity can be associated with: a. folic acid deficiency anemia b. anemia of chronic disease c. sideroblastic anemia d. vitamin B12 deficiency

A male patient has a family history of bipolar disorder in two first degree relatives. Bipolar disorder:

often affects multiple family members. There is strong familial component to bipolar disorder. Patients with bipolar disorder have shortened life expectancies. Up to 50% of patients with this disorder will attempt suicide at least once. Approximately 15% will be successful. Risk factors for suicidal behavior in patients with bipolar disorder include family history of suicide attempts, substance abuse, presence of impulsivity or aggression, and frequent depressive episodes.

Pre-existing cond

med cond that had been diagnosed/treated within 6 months before the health insurance policy went into effect

myotonic dystrophy atopic dermatitis diabetes

metabolic causes of cataracts

3mm

mm of incision in PCE

posterior subscapular

most common type in young people

nucleur

nearsightedness common in

Copayment

negotiated set amount that a patient pays for certain services

Which of the following would be found in a synaptic cleft? cell bodies neurotransmitters axons ganglia neurons

neurotransmitters

Is radiography recommended in uncomplicated acute rhinosinusitis?

no

Which of the following characteristics are shared by the causative agents of bacterial meningitis? They're all Gram-negative. They are all diplococci. They are all prevented through the Hib vaccine. None of the above is correct.

none of the above is correct

Blepharitis:

nonuclerative form -occasionally seen with trisomy 21 -can be seen with psoriasis, seborrhea, eczema, allergies, lice

Prevention

Vaccine

A 34 year-old bipolar patient has been placed on a fluoxetine and valproate for manic depressive symptoms. He has had great improvement in his symptoms and has returned to work. The psychiatrist has released him to your care. What must be monitored in this patient?

Valproate levels, platelet count, liver function studies Valproate has been associated with liver toxicity and failure, and thrombocytopenia. Liver function studies and platelet counts should be monitored prior to therapy and then regularly as indicated by the drug manufacturer. Valproate levels should be measured to insure target blood level between 50-125 micrograms/mL. Common side effects of valproate are nausea, vomiting, easy bruising, and tremors.

A 34 year old bipolar patient is on fluoxetine and valproate for manic depressive symptoms. What must be monitored in this patient?

Valproate levels, platelet count, liver function studies.

Which two Anticonvulsant medications also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes?

Valproate/Divalproex Solution (Depakote®) Carbamazepine (Tegretol®)

Rodents are the natural hosts for the virus which causes Venezuelan equine encephalitis. St. Louis encephalitis. West Nile encephalitis. Eastern equine encephalitis. Western equine encephalitis.

Vanezuelan equine encephalitis

Perception that the person or the environment is moving

Vertigo

cancer types we screen for

We currently only recommend screening for 4 kinds of cancers (1) colorectal, (2) breast, (3) Lung (4) Cervical

bias between cancer and DM

We have a biased with cancer versus diabetes (we are okay with controlling our blood sugars among diabetes), but if we have "controlled" cancer, we just want it to be gone. Our criteria for "success" is different with cancer versus other diseases.

An adolescent female patient with anorexia nervosa must exhibit 4 criteria for diagnosis. Which criterion listed below is NOT part of the diagnostic criteria?

Weight below 90% of ideal body weight Weight below 85% of ideal body weight is the correct criterion. This involves refusal to gain or maintain weight within normal range. Occasionally weight below ideal body range does not involve losing weight, but instead involves refusal to gain weight during a growth spurt. This is commonly observed during pubertal growth spurts and is more common in adolescent females than males. The other three criteria are correct as listed.

Common S/S of hypothyroid

Weight gain, fatigue, cold intolerance, dry skin, constipation, increased cholesterol, depression

Common S/S of hyperthyroid

Weight loss, heat intolerance, irritability, bulging eyes, muscle weakness, hyperreflexia, tachycardia, ridging of the nails, frequent BMs

Bupropion SR

Wellbutrin SR, Zyban

When is surgery the TOC in hyperthyroid?

When a cancer is suspected

What is primary adrenal insufficiency and what causes it?

When the adrenal gland is damaged and does not produce adequate hormones. Can be caused by autoimmune, infection, blood loss or tumor

What is Cushing's Syndrome?

When the body is exposed to high levels of cortisol for a long period of time.

When should you avoid logical arguments with a person who has bipolar disorder?

When they are in a state of mania

Fluorosis

White areas of teeth, excess fluoride, dental caries, lack of fluoride, excess sugar

Prolapsed hemorrhoid

With chronically protruding or prolapsing hemorrhoids, the patient often reports itch, mucus leaking, and staining of the undergarments with streaks of stool. Manual reduction of a protruding hemorrhoid after evacuation can be helpful. The most common patient report in anal fissures is one of severe anal pain during a bowel movement, rather than itch, and mucus leaking and stool streaking on the undergarments is not typical. Grade I internal hemorrhoids do not prolapse. Contrary to common thought, hemorrhoids do not represent varicosities.

Screening table

X: cond (diseased and not diseased) Y: Screening result (pos and neg) **Sensitivity = diseased (TP/TP+FN) **Specificity = not diseased (TN/TN+FP)

Zoledronic acid

Zoledronic acid is administered as an IV infusion once a year to treat osteoporosis or every two years to prevent osteoporosis. Zoledronic acid is a biophosphonate, not a RANKL inhibitor. It is administered as an IV infusion, not given subcutaneously or orally.

c. hgb= 9.6mg/dL

a 15 y/o is about 10% below her ideal body weight. She c/o dizziness when she stands. Lab studies were performed. Besides malnutrition, what else could account for her dizziness? a. BUN is mildly elevated b. glucose=80mg/dL c. hgb= 9.6mg/dL d. potassium is 3.5meq/L

a. doxycyline

a 16 y/o has been dxed with Lym disease. Which drug should be used to tx him? a. doxycyline b. amoxicillin-clavulanate c. trimethoprim-sulfamethoxazole d. cephalexin

d. multi-vitamin with iron

a 26 y/o female has thalassemia minor. What should be limited in her diet to avoid hepatotoxicity? a. vitamin C b. vitamin B12 c. folic acid d. multi-vitamin with iron

c. the pt should consider hepatitis B immunization

a 35 y.o pt has the following lab values. How should they be interpreted? HBsAg(-), HBsAB(-), HBcAb(-) a. the pt had hepatitis B b. the pt has hepatitis B c. the pt should consider hepatitis B immunization d. the pt has had hepatitis B immunization

d. the pt has been immunized

a 40 y/o pt has the following lab values. How should they be interpreted? HBsAg(-), HBsAb(+), HBcAb(-) a. the pt has hepatitis b. the pt had hepatitis c. the pt should consider immunization d. the pt has been immunized

b. the pt does not have HCV

a 43 y/o pt who has been dx with hepatitis B has the following lab values. How should they be interpreted based on these values? HCV IgG(-), RIBA (radio immuno blot assay) (-) a. the pt has HBV and HCV b. the pt does not have HCV c. the pt could have HCV d. the results are indeterminate

a. the pt has hepatitis

a 45 y/o pt has the following lab values. How should they be interpreted? HBsAg(+), HBsAb(-), HBcAb(+) a. the pt has hepatitis b. the pt had hepatitis c. the pt should consider immunization d. the results are indeterminate

primary risk factor in COPD

smoking deficiency of serine protease inhibitor alpha 1 antitrypsin (AAT)

patient education

smoking cessation - 5 A's adherence avoid air toxins stay healthy

Why does viral URI tend to lead to rhinosinusitis?

stagnate secretes promote bacterial growth

A patient reports a history of a TIA 6 months ago. His daily medications are lisinopril pravastatin and metformin. After advising him to quit smoking, what intervention is most important in helping him to prevent stroke in him? -auscultation of carotids at each visit -taking baby aspirin daily* -assesing AIC every 3-6 months -encouranging smoking cessation with each visit

start a daily aspirin

annuloplasty

sternotomy incision is made to remove stenotic tissue at the valve a ring is placed at valve leaflets to prevent regurgitation

Functions of the meninges include -protection from external shock. -support for the brain and spinal cord. -support for the brain and spinal cord and protection from external shock. -production of neurotransmitters. -transmission of signals from the peripheral nervous system.

support for the brain and spinal cord and protection from external shock

acute otitis media:

suppurative OM purulent OM

chordoplasty

surgical repair made to shape chordae tendineae to prevent regurgitation

A characteristic of rheumatoid arthritis not typical in osteoarthritis is:

symmetrical involvement of of joints Rheumatoid arthritis is characterized by pain, symmetrical involvement of multiple joints, morning stiffness lasting longer than one hour. Patients with osteoarthritis have morning stiffness lasting less than one hour, usually less than 30 minutes. Weight loss is not typical in either of these diseases. Bouchard's nodes are typical in osteoarthritis and represent enlargement of the proximal interphalangeal joint.

Viral rhinosinusitus treatment:

symptom relief and avoid unnecessary antibx

blurred vision halos glare- difficulty seeing around bright lights difficult seeing at nighttime occasionally diplopoa amblyopia in children faded colours

symptoms of cataracts

A common side effect of trazodone may be alleviated by:

taking this medication at bedtime Trazodone is a tricyclic antidepressant that can produce profound drowsiness. It is often taken at bedtime to induce sleep. This medication should always be taken at bedtime. Trazodone is often given to treat insomnia related to depression or to alleviate the jitteriness and restlessness sometimes associated with SSRI and SNRI use.

Delirium differs from dementia because delirium:

often develops acutely Delirium is a change in consciousness or cognition. It may be accompanied by a physical diagnosis like urinary tract infection; or it may be due to consumption of a medication. Regardless, a change in cognition or consciousness needs immediate evaluation. The evaluation should include a medication review, physical exam and laboratory evaluation, and mental status exam.

Endocytosis of Streptococcus pneumoniae by various body cells is triggered by fimbriae. a polysaccharide capsule. pneumolysin. phosphorylcholine. secretory IgA protease.

phosphorylcholine

emphysema characteristics

pink puffers 55-75 severe dyspnea less prominent cough occasional sputum thin build no hypoxia

Slow deterioration of muscle function occurring over many years occurs in African sleeping sickness. leprosy. minor polio. postpolio syndrome. West Nile encephalitis.

postpolio syndrome

What strategy is used to minimize the incidence of side effects when giving an elderly patient an SSRi?

prescribe a low dose initially

A common strategy used to minimize the incidence of side effects when giving an elderly patient a selective serotonin reuptake inhibitor (SSRI) is:

prescribe a low dose initially. A principle that is employed when prescribing medications for elderly patients is to "start low and go slow". This should be employed when prescribing SSRIs too. The lowest dose should be a starting point; or a prescriber may order an even lower dose initially. The dose may be slowly increased until therapeutic effects are observed.

patho COPD

respiratory infflammation leading to destructive chronic airflow limitation neutrophils, macrophages , TD8+ lymphocytes

oxygen indicated for patients

resting PaO2 less than 55 mmHg

The disease known as cryptococcal meningitis -is transmitted in respiratory aerosols. -begins as a lung infection. -results from exposure to bird droppings. -results from exposure to bird droppings and begins as a lung infection. -is caused by a Gram-negative coccus.

results from exposure to bird droppings and begins as a lung infection

age alocohol diabetes smoking uv light htn corticosteroids

risk factors for cataracts

Serevent

salmeterol use up to two inhalations twice daily

Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. What are people wrongly diagnosed of with these symptoms sometimes?

schizophrenia

COPD assessment test

score of 10 indicates COPD

A 82 year old is brought into clinic. His wife states that he was working in his garden today and became disoriented and had slurred speech. She helped him back to the house and gave him cool fluids and within 15 minutes his symptoms resolved. He appears in his usual state of health when he is examined. He states although he was scared he feels fine now. How should the NP proceed?

send to the ER. Likely TIA needs imaging and lab work possible MRI

The optic nerves are an example of which of the following? synaptic nerves sensory nerves spinal nerves motor nerves mixed nerves

sensory nerves

What is the black box warning for Lamotrigine (Lamictal®) ?

serious rashes requiring treatment and discontinuation of treatment; the incidence of these rash have included Steven Johnson's syndrome

A patient with cluster head aches:

should eliminate triggers like nicotine and alcohol

key points

sleep disturbance, may remove patch at bedtime

Abuse during pregnancy:

tends to occur throughout the pregnancy. Unfortunately, pregnant women are more likely to be abused than non-pregnant ones. When women are abused prior to becoming pregnant, abuse generally escalates during pregnancy. Abuse is not specific to a certain trimester. Abuse during pregnancy tends to occur throughout pregnancy. Because of this, it is important to keep vigilant and re-assess at each prenatal visit.

A baby arrives at an emergency room suffering from violent muscles spasms and difficulty breathing. The baby's body is so rigid a proper exam is difficult, but the staff note the baby is only a few weeks old and the umbilicus has not healed properly. The signs are consistent with which of the following diseases? infant botulism acute bacterial meningitis tetanus listeriosis rabies

tetanus

Encephalitis is an infection of neurons of the peripheral nervous system. the meninges. the cauda equina. the brain. the eye.

the brain

In trachoma, which of the following becomes scarred and filled with blood vessels, resulting in blindness? the cornea the fibrous tunic the retina the sclera the conjunctiva

the cornea

c. high viral load periods

the greatest risk of transmitting HIV is during: a. the acute phase b. the time that detectable antibody is present c. high viral load periods d. late infection phase

a. splenomegaly

the lab identifies metamyelocytes in a 50 y/o pt who had a CBC performed. What might be an expected finding in this pt? a. splenomegaly b. elevated liver function studies c. decreased urine acid level d. decreased platelet count

b. leukocytosis

the major lab abnormality noted inpts with pneumonia is: a. eosinophils b. leukocytosis c. Gram stain positive d. leukopenia

b. macrocytosis

what hallmark finding is associated with both B12 and folate deficiencies? a. glossitis b. macrocytosis c. memory loss d. an MCV<80fL

opacification of the lens of the eye

what is a cataract

d. case control

what would be the study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state? a. randomized clinical trial b. cohort study c. case series d. case control

When should antibx therapy be considered with rhinosinusitis?

when symptoms fail to improve in 7-10 days or if they worsen at any time

When is CT of sinuses recommended in sinusitis?

when there is no response to treatment

b. hct=35.2

which adult female pt has an anemia? a. hgb=14.4 b. hct=35.2 c. hgb=13.5 d. hct=40.1

a. folic acid deficiency anemia

which anemia is described as a macrocytic anemia? a. folic acid deficiency anemia b. Thalassemia c. iron deficiency anemia d. sickle cell anemia

c. iron deficiency anemia and thalassemia

which anemias are described as microcytic, hypochromic anemias? a. vitamin B12 and iron deficiency anemia b. folic acid and iron deficiency anemia c. iron deficiency anemia and thalassemia d. sickle cell anemia and anemia of chronic disease

a. mononucleosis

which disease listed below can be associated with lymphocytosis? a. mononucleosis b. strept throat c. iron deficiency anemia d. hemolytic anemia

b. sulfamethoxazole

which medication should be avoided in a pt with a sulfa allergy? a. sulfonylurea b. sulfamethoxazole c. naproxen d. cefazolin

a. vitamin B12

which of the following CANNOT be a microcytic anemia? a. vitamin B12 b. anemia of chronic disease c. iron deficiency anemia d. thalassemia

a. there are few conditions that cause depletion of CD4 cells other than HIV

which of the following statements regarding HIV is correct? a. there are few conditions that cause depletion of CD4 cells other than HIV b. CD4 cell counts vary very little in individuals infected with HIV c. a normal CD4 counts is <200/mm3 d. CD4 counts are the first abnormality seen in pts with HIV

d. inadequate amts can produce cognitive changes

which statement is true about vitamin B12? a. it is easily absorbed throught the GI tract b. deficiencies are seen in elderly pts only c. low levels can result in elevated lipid levels d. inadequate amts can produce cognitive changes

a. neutrophils

which white cell should be present in the greatest number in a pt who is healthy today? a. neutrophils b. basophils c. eosinophils d. lymphocytes

Which beverage below does not increase the risk of gout in a male who is prone to this condition?

wine Alcohol is known to be a contributing factor in development of gouty arthritis. Males are more prone to gout than females, and alcohol consumption increases the likelihood of gout development. Of all alcohols, wine contributes least to the development of gout. Consumption of meat and fish increase the concentration of uric acid and thus, the risk of developing gout.

A 28 year-old has a Grade 3 murmur. Which characteristic indicates a need for referral?

~A fixed split A split is created because of closure of valves. For example, an S2 is created by closure of the aortic and pulmonic valves. Normally these split with inspiration and almost never with expiration. Splits should never be fixed. This indicates some pathology like an atrial septal defect, pulmonic stenosis, or possibly mitral regurgitation. In any event, this patient needs initial evaluation with an echocardiogram because fixed splits are always considered abnormal.

In collection of a specimen for a PAP smear, how is the endocervical specimen collected?

~After the ectocervical specimen with a brush Ectocervical specimens are collected first to minimize any bleeding that can occur from endocervix when it is sampled. The brush is considered a superior tool for collection of endocervical specimens because it produces the highest yield of endocervical cells, and thus, is a good reflection of the health of the cervix. Alternatively, a cervical broom can be used to collect cells. It collects endocervical cells and ectocervical cells simultaneously. It is rotated for 5 turns before the samples are placed on the slide. This may be used in pregnant women.

Pericoronitis tx:

febrile: Pen V or clinda; analgesics; dental referral

How long days epidemic keratoconjunctivitis clinically last?

7-21 days; usually self limited

Mini mental status exam helps identify patients who have symptoms of

cognitive impairment

Second leading cause of cancer death in the US

colorectal

nicotine lozenge

commit

vitrectomy

commonest eye surgery that causes cataracts

30cal/kg

"ball-park" range -active men -very active women

25-28cal/kg

"ball-park" range -adults >55years -active women -sedentary man -most hospitalized non-stressed patients

14-20cal/kg

"ball-park" range -obese -inactive -chronic diabetes

35-45cal/kg

"ball-park" range -underweight -very active men -malnourished -catabolic

What type of thinking to need to point out when in therapy with a patient who is bipolar?

"effective thinking"

Validity

"everything relative to __ is good or bad" Assumes something that is absolutely true about a certain test -EG: correctly identifying those who are depressed (sensitivity) and not depressed (specificity)

CAP Tx Outpatient

#1 Healthy, no Abx 3mos -Macrolide (Clarithro, Azithro) or Doxy #2 Comoribd or Abx in last 3mos, >65yrs -Fluorquinolones (Moxi, Gemifloxacin, Levo) -Macrolide pluse beta-lactam (Amox-claulanate, Cefpodoxime, Cefuroxime) #3 Area with high macrolide resistant Strep pneumoniae -Fluoroquinolone

Methods of breast cancer screening:

(1) Breast self-exam (2) clinical breast exam (3) Mammography (4) MRI

Methods of Assessment

(A) Anthropometric (B) Biochemical Assessment (C) Clinical Assessment (D) Dietary Assessment

Fecal Occult blood test in cancer screening usefulness

(could be made false positive by blood detection from too much iron in blood or hemorrhoids, not often used anymore). Used if person refuses colonoscopy to try to convince them w/ + test.

Validity curve order

(well) True negatives --> false negatives --> false positives --> true positives (sick)

What is the therapeutic range of Lithium Carbonate?

******* Therapeutic Range - 0.6-1.4 mEQ/L. *****

Master Settlement Agreement

*Agreement b/w state attorney general and 4 largest tobacco companies to settle healthcare costs -(lost ind lawsuits) **Banned ads to kids/billboards/allowed "light" cigarettes

thalassemia

*Cooley's Anemia* *effects* Thalassemia is a blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia. *onset* -The most severe form of alpha thalassemia major causes stillbirth (death of the unborn baby during birth or the late stages of pregnancy). -Children born with thalessemia major (Cooley's anemia) are normal at birth, but develop severe anemia during the first year of life. -Other symptoms can include: --Bone deformities in the face --Fatigue --Growth failure --Shortness of breath --Yellow skin (jaundice) -Persons with the minor form of alpha and beta thalassemia have small red blood cells (which are identified by looking at their red blood cells under a microscope), but no symptoms. *prognosis* -Severe thalassemia can cause early death due to heart failure, usually between ages 20 and 30. Getting regular blood transfusions and therapy to remove iron from the body helps improve the outcome. -Less severe forms of thalassemia usually do not shorten lifespan. -Genetic counseling and prenatal screening may help people with a family history of this condition who are planning to have children. *http://www.nlm.nih.gov/medlineplus/ency/article/000587.htm*

trisomy 13

*Patau syndrome* *effects* -Trisomy 13 occurs when extra DNA from chromosome 13 appears in some or all of the body's cells. -Trisomy 13 -- the presence of an extra (third) chromosome 13 in all of the cells. -Trisomy 13 mosaicism -- the presence of an extra chromosome 13 in some of the cells. -Partial trisomy -- the presence of a part of an extra chromosome 13 in the cells. -The extra material interferes with normal development. -Trisomy 13 occurs in about 1 out of every 10,000 newborns. Most cases are not passed down through families (inherited). Instead, the events that lead to trisomy 13 occur in either the sperm or the egg that forms the fetus. *onset* Cleft lip or palate Clenched hands (with outer fingers on top of the inner fingers) Close-set eyes -- eyes may actually fuse together into one Decreased muscle tone Extra fingers or toes (polydactyly) Hernias: umbilical hernia, inguinal hernia Hole, split, or cleft in the iris (coloboma) Low-set ears Intellectual disability, severe Scalp defects (missing skin) Seizures Single palmar crease Skeletal (limb) abnormalities Small eyes Small head (microcephaly) Small lower jaw (micrognathia) Undescended testicle (cryptorchidism) *prognosis* More than 80% of children with trisomy 13 die in the first year. *http://www.nlm.nih.gov/medlineplus/ency/article/001660.htm*

Primary prevention

*Taking action before causes of diseases/injury before they happen -GOAL: Prevention of onset of disease/illness -EG: Immunization, seatbelts, sanitation

trisomy 21

*down syndrome* *effects* -In most cases, Down syndrome occurs when there is an extra copy of chromosome 21. This form of Down syndrome is called Trisomy 21. The extra chromosome causes problems with the way the body and brain develop. -Down syndrome is one of the most common causes of human birth defects. *onset* -Down syndrome symptoms vary from person to person and can range from mild to severe. No matter the severity of the condition, persons with Down syndrome have a widely-recognized appearance. -The head may be smaller than normal and abnormally shaped. For example, the head may be round with a flat area on the back. The inner corner of the eyes may be rounded instead of pointed. -Common physical signs include: Decreased muscle tone at birth Excess skin at the nape of the neck Flattened nose Separated joints between the bones of the skull (sutures) Single crease in the palm of the hand Small ears Small mouth Upward slanting eyes Wide, short hands with short fingers White spots on the colored part of the eye (Brushfield spots) -Physical development is often slower than normal. Most children with Down syndrome never reach their average adult height. -Children may also have delayed mental and social development. Common problems may include: Impulsive behavior Poor judgment Short attention span Slow learning As children with Down syndrome grow and become aware of their limitations, they may also feel frustration and anger. -Many different medical conditions are seen in people with Down syndrome, including: -Birth defects involving the heart, such as an atrial septal defect or ventricular septal defect Dementia may be seen Eye problems, such as cataracts (most children with Down syndrome need glasses) Early and massive vomiting, which may be a sign of a gastrointestinal blockage, such as esophageal atresia and duodenal atresia Hearing problems, probably caused by regular ear infections Hip problems and risk of dislocation Long-term (chronic) constipation problems Sleep apnea (because the mouth, throat, and airway are narrowed in children with Down syndrome) Teeth that appear later than normal and in a location that may cause problems with chewing Underactive thyroid (hypothyroidism) *prognosis* -Although many Down syndrome children have physical and mental limitations, they can live independent and productive lives well into adulthood. -About half of children with Down syndrome are born with heart problems, including atrial septal defect, ventricular septal defect, and endocardial cushion defects. Severe heart problems may lead to early death. -Persons with Down syndrome have an increased risk of certain types of leukemia, which can also cause early death. -The level of intellectual disability varies, but is usually moderate. Adults with Down syndrome have an increased risk of dementia. *http://www.nlm.nih.gov/medlineplus/ency/article/000997.htm*

muscular dystrophy

*effect* Muscular dystrophy (MD) is a group of more than 30 inherited diseases. They all cause muscle weakness and muscle loss. *onset* Some forms of MD appear in infancy or childhood. Others may not appear until middle age or later. The different types can vary in whom they affect, which muscles they affect, and what the symptoms are. All forms of MD grow worse as the person's muscles get weaker. Most people with MD eventually lose the ability to walk. *prognosis* There is no cure for muscular dystrophy. Treatments can help with the symptoms and prevent complications. They include physical and speech therapy, orthopedic devices, surgery, and medications. Some people with MD have mild cases that worsen slowly. Others cases are disabling and severe. *http://www.nlm.nih.gov/medlineplus/musculardystrophy.html*

trisomy

*effects* -Most of our cells have 23 pairs of chromosomes, with one set from our mother and the other from our father. An abnormal number of chromosomes can arise during meiosis, the type of cell division that creates eggs and sperm, or germ cells. For example, when the chromosome 21 pair fails to separate, an egg cell may end up with two copies. After the egg is fertilized by a sperm, the resulting embryo has three copies of chromosome 21-and will have Down syndrome. People with this condition have serious medical problems, including heart defects, intellectual disabilities, premature aging and certain forms of leukemia -Because Down syndrome is caused by the presence of three chromosome copies, it's called a trisomy. In addition to Down syndrome, other trisomies that can be screened for in early pregnancy include trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome)

sickle cell trait

*effects* -People who inherit one sickle cell gene and one normal gene have sickle cell trait (SCT). People with SCT usually do not have any of the symptoms of sickle cell disease (SCD), but they can pass the trait on to their children. How Sickle Cell Trait is Inherited If both parents have SCT, there is a 50% (or 1 in 2) chance that any child of theirs also will have SCT, if the child inherits the sickle cell gene from one of the parents. Such children will not have symptoms of SCD, but they can pass SCT on to their children. -If both parents have SCT, there is a 25% (or 1 in 4) chance that any child of t heirs will have SCD. There is the same 25% (or 1 in 4) chance that the child will not have SCD or SCT. -If one parent has SCT, there is a 50% (or 1 in 2) chance that any child of this parent will have SCT and an equal 50% chance that the child will not have SCT. *onset* -Most people with SCT do not have any symptoms of SCD, although—in rare cases—people with SCT might experience complications of SCD, such as pain crises. In their extreme form, and in rare cases, the following conditions could be harmful for people with SCT: Increased pressure in the atmosphere (which can be experienced, for example, while scuba diving). -Low oxygen levels in the air (which can be experienced, for example, when mountain climbing, exercising extremely hard in military boot camp, or training for an athletic competition). -Dehydration (for example, when one has too little water in the body). -High altitudes (which can be experienced, for example, when flying, mountain climbing, or visiting a city at a high altitude). -More research is needed to find out why some people with SCT have complications and others do not. *http://www.cdc.gov/ncbddd/sicklecell/traits.html*

When to worry

-0 to 4 months: should startle to loud sounds, quiet to moms voice -5-6 months: localized to a sound, imitate sounds -13-15 months: point toward sound when asked -16-18 months: follow simple directions -19-24: should point to body part

Early Hearing Detection & Intervention Program

-1-3-6 guidelinds -emphasizes screening by 1 month of age -diagnosis of hearing loss by 3 months -early intervention services by 6 months

sickle cell disease

*effects* -Sickle cell anemia is a disease in which your body produces abnormally shaped red blood cells. The cells are shaped like a crescent or sickle. They don't last as long as normal, round red blood cells. This leads to anemia. The sickle cells also get stuck in blood vessels, blocking blood flow. This can cause pain and organ damage. -A genetic problem causes sickle cell anemia. People with the disease are born with two sickle cell genes, one from each parent. If you only have one sickle cell gene, it's called sickle cell trait. About 1 in 12 African Americans has sickle cell trait. *onset* -The most common symptoms are pain and problems from anemia. Anemia can make you feel tired or weak. In addition, you might have shortness of breath, dizziness, headaches, or coldness in the hands and feet. *prognosis* -Sickle cell anemia has no widely available cure. Treatments can help relieve symptoms and lessen complications. Researchers are investigating new treatments such as blood and marrow stem cell transplants, gene therapy, and new medicines. *http://www.nlm.nih.gov/medlineplus/sicklecellanemia.html*

tay-sachs

*effects* -Tay-Sachs disease is a rare, inherited disorder. It causes too much of a fatty substance to build up in the brain. This buildup destroys nerve cells, causing mental and physical problems. -The cause is a gene mutation which is most common in Eastern European Ashkenazi Jews. To get the disease, both parents must have the gene. If they do, there is a 25% chance of the child having the disease. A blood test and prenatal tests can check for the gene or the disease. *onset* -Infants with Tay-Sachs disease appear to develop normally for the first few months of life. Then mental and physical abilities decline. The child becomes blind, deaf, and unable to swallow. Muscles begin to waste away and paralysis sets in. Even with the best of care, children with Tay-Sachs disease usually die by age 4. *prognosis* -There is no cure. Medicines and good nutrition can help some symptoms. Some children need feeding tubes. *http://www.nlm.nih.gov/medlineplus/taysachsdisease.html*

trisomy 18

*effects* -Trisomy 18 is a somewhat common syndrome. It is three times more common in girls than boys. -The syndrome occurs when there is extra material from chromosome 18. The extra material affects normal development. *onset* Clenched hands Crossed legs Feet with a rounded bottom (rocker-bottom feet) Low birth weight Low-set ears Mental delay Poorly developed fingernails Small head (microcephaly) Small jaw (micrognathia) Undescended testicle Unusual shaped chest (pectus carinatum) *prognosis* Half of infants with this condition do not survive beyond the first week of life. Some children have survived to the teenage years, but with serious medical and developmental problems. *http://www.nlm.nih.gov/medlineplus/ency/article/001661.htm*

anencephaly

*effects* Anencephaly is a condition that prevents the normal development of the brain and the bones of the skull. This condition results when a structure called the neural tube fails to close during the first few weeks of embryonic development. The neural tube is a layer of cells that ultimately develops into the brain and spinal cord. Because anencephaly is caused by abnormalities of the neural tube, it is classified as a neural tube defect (NTD). If the neural tube fails to close properly, the developing brain and spinal cord are exposed to the amniotic fluid that surrounds the fetus. This exposure causes the nervous system tissue to break down (degenerate). As a result, people with anencephaly are missing large parts of the brain called the cerebrum and cerebellum. These brain regions are necessary for thinking, hearing, vision, emotion, and coordinating movement. The bones of the skull are also missing or incompletely formed. *onset* -Anencephaly is a complex condition that is likely caused by the interaction of multiple genetic and environmental factors. Some of these factors have been identified, but many remain unknown. -Anencephaly is one of the most common types of neural tube defect, affecting about 1 in 1,000 pregnancies. However, most of these pregnancies end in miscarriage, so the prevalence of this condition in newborns is much lower. An estimated 1 in 10,000 infants in the United States is born with anencephaly. -Most cases of anencephaly are sporadic, which means they occur in people with no history of the disorder in their family. A small percentage of cases have been reported to run in families; however, the condition does not have a clear pattern of inheritance. For parents who have had a child with anencephaly, the risk of having another affected child is increased compared to the risk in the general population. *prognosis* -Almost all babies with anencephaly die before birth or within a few hours or days after birth. *http://ghr.nlm.nih.gov/condition/anencephaly*

meningomyelocele

*effects* a type of spina bifida 1. protrusion of the meninges, CSF, nerve roots, and a portion of the spinal cord occurs 2. the sac (defect) is covered by a thin membrane that is prone to leakage or rupture 3. neurological deficits are evident *onset* 1. depends on the spinal cord involvement 2. visible spinal defect 3. flaccid paralysis of the legs 4. altered bladder and bowel function 5. hip and joint deformities 6. hydrocephalus NCLEX 367 *prognosis* -the early prognosis for the child with myelomeningocele depends on the neurologic deficits present at birth, including motor ability, bladder and bowel innervation, and the presence of associated cerebral anomalies -improved surgical techniques do not alter the major physical disability and deformity, not the chronic urinary tract and pulmonary infections and constipation that affect the quality of life for these children FON 1048

A patient has 2 palpable, tender, left pre-auricular nodes that are about 0.5 cm in diameter. What might also be found in this patient?

- conjunctivitis The eyes are drained partly by the pre-auricular lymph nodes. They are palpated near the ear and can swell in response to eye infections, allergies, or foreign bodies in the eye.

What are the special challenges with medications and pregnancy and mental illness?

- effects of mood stabilizing medications and the risks of not managing illness

Hematocrit

-% of RBCs in blood (to total volume) -low level could mean anemia or blood loss

Menthol cigarettes

--70% of AA smokers choose mentholated cigarettes **smoking menthols makes it more hard to quit smoking

Sensitivity and specificity

--Both depend on cut point --Cut point lowered = more positives = INCREASED sensitivity, DECREASED specificity (well people = pos); increased TP, increased FP --Cut point increased: more negatives, decreases false positives = INCREASED specificity, DECREASED sensitivity; decreased TP, increased FN

8 scenarios that would suggest BRCA mutations in the family gene pool

--Two first degree relatives with breast cancer, one of whom was diagnosed age 50 or younger ---Combination of three or more first or second-degree relatives with breast cancer, regardless of age at Dx --- Combination of broth breast and ovarian cancer among first and second-degree relatives --- A first degree relative with bilateral breast cancer --- Two or more first or second degree relatives with obarian cancer --- First or second degree relative with both breast and ovarian cancer at any age --- History of breast cancer in a male relative ---- If Ashkenazi Jewish descent and have any first degree-relative with breast or ovarian

dosing

1st cig less than 30 min after waking : 4 mg first cig after 30 min after waking : 2 mg weeks 1-6: 1 lozenge every 1-2 hrs weeks 7-9: 1 lozenge every 2-4 hrs weeks 10-12: 1 lozenge every 4-8

At what stage after getting left-sided Ulcerative colitis should we worry about increasing cancer risk

12-15 years after left-sided colitis significantly increases risk for malignancy. These people must be looked at VERY CAREFULLY.

Govt insurance pops

1. Elderly --> Medicare 2. Disabled/low income --> Medicaid 3. Children --> CHIP

Span of adult liver

15-18cm midclavic line

dosing

150 mg qd for 3 days then 1 po bid

Subacute infective endocarditis

1. Occurs from already defective valve, usually from: streptococci or E.coli 2. fungus infections (Candida or aspergillus) 3. Vegetations form (break off )become thromboemboli 4. Infection may erode through endocardium into underlying structures causing; 1. tears 2. deformities of leaflets 3. dehiscence of prosthetic valves 4. deformity of chordae tendineae 5. mural abscesses (weeks to months)

Assessment

1. toxic effect of the infection 2. Destruction of the heart valves 3. embolization of fragments of vegetative growths

Anterior epistaxis is usually caused by: A. hypertension B. bleeding disorders C. localized nasal mucosa trauma D. a foreign body

C. localized nasal mucosa trauma

Infection may erode through the endocardium into underlying structures ?

1. causing tears (around valves)- cause prosthetic valves to become loose 2. deformities of valve leaflets 3. dehiscence of prosthetic valves 4. deformity to chordae tendineae 5. mural abscesses - in heart wall

Signs and Symptoms of infective endocarditis

1. classic primary symptoms of endocarditis are fever and new heart murmur 2. flu-like symptoms; fevers, chills, myalgia, anorexia, weight loss

Risk Factors Infective Endocarditis (7)

1. frequent introduction of pathogens or a compromised immune system 2. history of valvular heart disease with valve replacement 3. IV drug abuse 4. Indwelling IV catheters (especially when the IV tip lies within the heart 5. Immunosuppression from disease 6. immunosuppression from malnutrition function (cancer treatments) 7. history of previous endocarditis

Labs/diagnostics Endocarditis

1. inflammatory process 2. elevated WBC and ESR (erythrocyte sedimentation rate) 3. definitive finding is positive blood culture (not always there) 4. echocardiogram can identify diseased valves, vegetations, and hypertrophy with HF 5. if kidney damage: anemia with low hemoglobin

Endocarditis Interventions

1. long term IV antibiotics - may need long-term IV catheter (central line picc) 2. labs to monitor therapeutic antibiotic levels and effectiveness of the medication 3. discharge referral and teaching esp. if going home with IV therapy 4. monitor for worsening of condition or embolization 5. teaching about anticoagulants

S&S endocarditis: Peripheral manifestations

1. petechiae: small, pinpoint hemorrhages in the skin 2. splinter hemorrhages of nails - black lines or red streaks 3. Roth Spots- white spots seen on retina that are round or oval 4. Janeway Lesions (painless, hemorrhagic lesions on palms, soles, nose, ear) 5. Osler's Nodes- tender, red lesions with white centers on finger and toes

Endocarditis surgical invterventions

1. surgical debridement, repair, or replacement of . defective valves 2. valvuloplasty 3. annuloplasty 4. chordoplasty 5. valve replacement

Migraine Headache without aura 5 criteria must be met

1.) Headache lasting 4-72 hours 2.) has 2 of the following characteristics- unilateral location pulsating, moderate to severe intensity aggravated by routine activity. 3.) during the HA at least one of the following occurs; nausea and or vomiting photophobia phonophobia 4.) at least 5 of these attacks must occur 5.) no underlying disease

How is levothyroxine dosed?

1.6 mcg/kg and needs to be calculated using ideal body weight. Start lower and titrate as needed. Start around 25 mcg daily in patients >60.

what is normal intraocular pressure?

10-23 mmHg

When should blood levels of anticonvulsant medications be obtained?

12 hours after the last dose

Cromolyn's mechanism of action is as a/an: A. anti-immunoglobulin E antibody B. vasoconstrictor C. mast cell stabilizer D. leukotriene modifier

C. mast cell stabilizer

tiotropium duration

24 hours

When can someone diagnosed with GABHS pharyngitis return to work or school?

24 hours after starting antibiotics and when afebrile

What is the incubation period for GABHS pharyngitis?

24-72 hours

Which depressed patient below has characteristics that are risk factors for suicide?

78 year old male recently widowed Demographic risk factors for suicide are male gender, older age, having been recently widowed, and living alone. Dentists and other health care workers are at risk for successful suicide because of their knowledge of and access to medications that could be used to commit suicide.

What depressed patient has risk factors for suicide?

78 year old widowed male

Which elderly patient is at highest risk of suicide?

86 year-old male with chronic pain and depression Elderly patients are more successful than younger patients when they attempt suicide. Those at highest risk are white males 85 years or older with depression. Symptoms in the elderly which should be of particular concern to healthcare providers are hopelessness, insomnia, unremitting pain, alcohol abuse, restlessness, and impaired concentration.

Which patient is at highest risk of suicide?

86 yr-old male with chronic pain Elderly patients and males are more successful when they attempt suicide. Those at highest risk are white males 85 years or older. Symptoms in the elderly that should be of particular concern to healthcare providers, because they are associated with increased risk of suicide, are hopelessness, insomnia, unremitting pain, alcohol abuse, restlessness, and impaired concentration.

A depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response?

8-12 weeks Most learned authorities agree that if there is no response by 8-12 weeks at a maximal therapeutic dose, a different antidepressant should be tried. The 8-12 week period is an appropriate time frame because it will take this long to increase the dose and attempt to reach maximal dose for therapeutic response. 4-6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach and evaluate therapeutic effect.

A 76 year-old depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response?

8-12 weeks Most learned authorities agree that if there is no response by 8-12 weeks at a maximal therapeutic dose, a different antidepressant should be tried. The 8-12 week period is the correct time frame because it will take this long to increase the dose and attempt to reach maximal dose for therapeutic response. 4-6 weeks is nearing the appropriate time frame, but this may be too short a period of time to reach and evaluate therapeutic dose.

Which of the following criteria is attributed to migraine headaches with out aura? pain lasting

4-72 hours

This patient is at highest risk of suicide?

86 year old male with chronic pain

T3 can also be bound or free... is the majority bound or free?

About 99% is bound

Strengths

7 , 14, 21

Follow up CXR

7-12 weeks after CAP treatment for ->50 yrs, smokers - Non-resolving S/S

What is the recommended duration of therapy for uncomplicated acute bacterial rhinosinusitis?

5-10 days in adults

When does a child's vision approximate 20/20

5-6 A child's vision should be screened beginning at age 3 years if he is cooperative. The vision of a 3 year-old should be about 20/50. A 4 year-old's vision is usually 20/40. By 5 years of age, vision is usually 20/30. By 6 years of age, a child's vision should be approximately normal, 20/20.

Death rate in breast cancer over age 65

56%

choroidal haemmorhage vitreous loss retinal detachment endopthalmitis fibrosis posterior capsular opacification- late

6 complications of cataract surgery

traumatic nuclear cortical posterior subscapular secondary metabolic

6 types of cataracts

A family member of a newly diagnosed Alzheimer's disease patient asks how long the patient will have to take Donepezil, and acetylcholinesterase inhibitor, before learning weather it is beneficial or not. You reply:

6-12 months The evaluation should include caregiver feedback, repeat mental status assessments ability to perform ado healthcare provider assessment side effects and cost. If stopped it can be restarted at a later date.

When should you reevaluate thyroid level after initiating or adjusting levothyroxine treatment?

6-8 weeks

Anemia in children is potentially associated with poorer school performance. A. True B. False

A

Approximately 90% of the body's erythropoietin is produced by the kidney. A. True B. False

A

Wilms tumor

A Wilm's tumor is a congential tumor of the kidney that should never be palpated, once diagnosed, to avoid spread of the tumor cells. Microscopic or gross hematuria may be present.

average risk to patients for getting BC

<15%

What length of symptoms constitutes acute rhinosinusitis?

<4 weeks

A 44 year-old female patient is diagnosed with a urinary tract infection (UTI). Which bacteria count collected via "midstream, clean catch" supports a diagnosis of UTI?

> 100,000 bacteria Urine should be devoid of bacteria unless there is an infection or when asymptomatic bacteriuria is present. When bacteria are present in a urine specimen, consideration must be given to how the specimen was collected. When the specimen is collected via midstream, clean catch, the tolerance for organisms is less than 100,000. It is expected that the urine collected in this way will include bacteria from external genitalia as urine exits the body. If the number of bacteria are greater than 100,000, a urinary tract infection is correctly diagnosed.

What length of symptoms constitutes chronic rhinosinusitis?

>12 weeks

Age Group Screened for cervical Cancer

>21 years to age 65 typically; continue every 1-3 years. If normal screens, then stop age 65. If abnormal before 65, continue 3 more screens after age 65 and if they are normal, then you can stop.

80% of colorectal cancers detected at what age

>55 we want to find it early, so we start at 50

According to the recommendations of the American Association of Clinical Endocrinologists, the recommended low-density lipoprotein goal for a 64-year-old man with diabetes mellitus who with a history of ACS 2 years ago should be less than: A. 70 mg/dL (<1.8 mmol/L). B. 100 mg/dL (< 2.6 mmol/L). C. 130 mg/dL (< 3.4 mmol/L). D. 160 mg/dL (< 4.1 mmol/L).

A

Match unstable angina with its pathophysiologic characteristic A. new onset of chest pain and discomfort at rest or worsening of symptoms with activities that previously did not provoke symptoms B. predictable onset of chest pain or discomfort, usually with physical exertion C. results from full thickness (transmural) necrosis of the myocardium and total occlusion of coronary artery D. results from severe coronary artery narrowing, transient occlusion, or microembolization of thrombus and/or atheromatous material

A

One of the earliest laboratory markers in evolving macrocytic or microcytic anemia is: A. an increase in RBC distribution width (RDW). B. a reduction in measurable hemoglobin. C. a low MCH level. D. an increased platelet count.

A

Second-line drug intervention in the presence of anaphylaxis should be: A. oral diphenhydramine. B. nebulized albuterol. C. nebulized epinephrine. D. oral prednisone.

A

The body's normative response to anemia is reticulocytopenia. A. True B. False

A

The red blood cell content is approximately 90% hemoglobin. A. True B. False

A

The time to highest blood concentration (Cmax) of epinephrine is shorter when the medication is given: A. intramuscularly in the vastus lateralis. B. subcutaneously in the abdominal wall. C. intramuscularly in the deltoid. D. intramuscularly into the gluteus.

A

Which of the following plays an essential role in type 1 hypersensitivity? A. Immunoglobulin E B. immunoglobulin A C. immunoglobulin G D. immunoglobulin F

A

You are examining an 85-year-old woman and find a grade 3/6 crescendo−decrescendo systolic murmur with radiation to the neck. This is most likely caused by: A. aortic stenosis B. aortic regurgitation. C. anemia. D. mitral stenosis.

A

4 stages

A - low risk, less symptoms B- Low risk, more symptoms C- High risk, low symptoms D- High risk, more symptoms

Mitral valve proplapse who is most likely to be diagnosed

A 30 year-old female with no cardiac history Mitral valve prolapse (MVP) is most commonly diagnosed in women aged 14-30 years of age. However, it can be found in children (though not usually) or in older adults. The symptoms most commonly associated with MVP are arrhythmias, both atrial and ventricular, and chest pain. However, most patients with MVP are asymptomatic.

How would you determine if a patient's secondary hypothyroidism is hypothalamic or pituitary in nature?

A TRH test can be used. If the TSH level rises about 30 minutes after administration then the hypothalamus is the malfunction. If it does not then the pituitary is the problem.

What are pastias lines?

A clinical sign in which pink or red lines formed of confluent petechiae are found in skin creases, particularly the crease in the antecubital fossa. It occurs in patients with scarlet fever prior to the appearance of the rash and persists as pigmented lines after desquamation.

Cobblestone mucosal

A cobblestone mucosal pattern is often identified on endoscopy or contrast radiography in Crohn's disease. Endoscopy is contraindicated in acute diverticulitis. A cobblestone mucosal pattern is identified in Crohn's disease rather than in ulcerative colitis. Endoscopy is not used to diagnose irritable bowel syndrome (IBS). Diagnosis of IBS is usually made via careful history and clinical presentation, with a focus on excluding other conditions as there are no clear diagnostic markers.

If a patient has a normal TSH but show clinical S/S of thyroid what would you order?

A free T4

A hot thyroid nodule on a scan indicates what?

A hyperfunctioning nodule. These are rarely malignant

A cold thyroid nodule on a scan indicates what?

A hypofunctioning nodule. These require biopsy and are cancer until proven otherwise

What is Addison's disease?

A lack of sufficient hormones produced by the adrenal glands (cortisol, aldosterone and androgens)

Lower vs Upper Respiratory

Above larynx: Upper -Common cold, Sinusitis, Pharyngitis/tonsillitis, Epiglottitis, Laryngitis Below larynx: Lower -Tracheitis, Acute bronchitis, Bronchiolitis, Pneumonia

Combivent is an inhaler used in COPD that contains: A long acting beta agonist & short acting beta agonist A short acting beta agonist & long acting anticholinergic A long acting anticholinergic& long acting beta agonist A short acting beta agonist & short acting anticholinergic

A short acting beta agonist & short acting anticholinergic

What is erythema marginatum?

A type of erythema involving pink rings on the torso and inner surfaces of the limbs which come and go for as long as several months.It is found primarily on extensor surfaces.

An 88-year-old, community-dwelling man who lives alone has limited mobility because of osteoarthritis. Since his last office visit 2 months ago, he has lost 5% of his body weight and has developed angular chelitis. You expect to find the following on examination: A. fissuring and cracking at the corners of the mouth B. marked erythema of the hard and soft palates C. white plaques on the lateral borders of the buccal mucosa D. raised, painless lesions on the gingiva

A. fissuring and cracking at the corners of the mouth

A 74 year-old woman with well-controlled hypertension who is taking hydrochlorothiazide presents with a 3-day history of unilateral throbbing headache with difficulty chewing because of the pain. On physical examination, you find a tender, noncompressible temporal artery. Blood pressure (BP) is 160/88 mm Hg, apical pulse is 98 bpm, and respiratory rate is 22/min; the patient is visibly uncomfortable. The most likely diagnosis is: A. giant cell arteritis B. impending transient ischemic attack C. complicated migraine D. temporal mandibular joint dysfunction

A. giant cell arteritis

Characteristics of M. catarrhalis include: A. high rate of beta-lactamase production B. antimicrobial resistance resulting from altered protein-binding sites C. often being found in middle ear exudate in recurrent otitis media D. gram-positive organisms

A. high rate of beta-lactamase production

All of the following are common causes of penicillin treatment failure in streptococcal pharyngitis except: A. infection with a beta-lactamase producing Streptococcus strain B. failure to initiate or complete the antimicrobial course C. concomitant infection or carriage with a beta-lactamase-producing organism D. inadequate penicillin dosage

A. infection with a beta-lactamase producing Streptococcus strain

Which of the following is inconsistent with the clinical presentation of ABRS? A. nasal congestion responsive to decongestant use B. maxillary toothache C. colored nasal discharge D. antecedent event such as acute upper respiratory tract infection or allergic rhinitis

A. nasal congestion responsive to decongestant use

Which of the following is a common vision problem in the person with untreated primary open-angle glaucoma (POAG)? A. peripheral vision loss B. blurring of near vision C. difficulty with distant vision D. need for increased illumination

A. peripheral vision loss

Concomitant disease seen with giant cell arteritis includes: A. polymyalgia rheumatica B. acute pancreatitis C. psoriatic arthritis D. Reiter syndrome

A. polymyalgia rheumatica

In caring for the patient in Question 14 (angle-closure glaucoma), the most appropriate next action is: A. prompt referral to an ophthalmologist B. to provide analgesia and repeat the evaluation when the patient is more comfortable C. to instill a corticosteroid ophthalmic solution D. to patch the eye and arrange for follow-up in 24 hours

A. prompt referral to an ophthalmologist

A 19-year-old man presents with a chief complaint of a red, irritated right eye for the past 48 hours with eyelids that were "stuck together" this morning when he awoke. Examination reveals injected palpebral and bulbar conjunctiva; reactive pupils; vision screen with the Snellen chart of 20/30 in the right eye (OD), left eye (OS), and both eyes (OU); and purulent eye discharge on the right. This presentation is most consistent with: A. suppurative conjunctivitis B. viral conjunctivitis C. allergic conjunctivitis D. mecahnical injury

A. suppurative conjunctivitis

Treatment of otitis media with effusion usually includes: A. symptomatic treatment B. antimicrobial therapy C. an antihistamine D. a mucolytic

A. symptomatic treatment

Therapeutic interventions for the patient in Question 1 (giant cell arteritis), should include: A. systemic corticosteroid therapy for many months B. addition of an angiotensin-converting enzyme inhibitor (ACEI) to her antihypertensive regimen C. warfarin therapy D. initiation of topirimate (Topamax)

A. systemic corticosteroid therapy for many months

A risk factor for malignant external otitis includes: A. the presence of an immunocompromised condition B. age younger than 21 years C. a history of a recent upper respiratory tract infection D. a complicated course of otitis media with effusion

A. the presence of an immunocompromised condition

According to the Global Resources in Allergy (GLORIA) guidelines, which of the following is recommended for intervention in persistent allergic conjunctivitis? A. topical mast cell stabilizer with a topical antihistamine B. ocular decongestant C. topical nonsteroidal anti-inflammatory drug D. topical corticosteroid

A. topical mast cell stabilizer with a topical antihistamine

Which of the following findings is most consistent with the diagnosis of acute bacterial rhinosinusitis (ABRS)? A. upper respiratory tract infections persisting beyond 7 to 10 days or worsening after 5 to 7 days B. mild midfacial fullness and tenderness C. preauricular lymphadenopathy D. marked eyelid edema

A. upper respiratory tract infections persisting beyond 7 to 10 days or worsening after 5 to 7 days

Decongestants work primarily through: A. vasoconstriction B. action on the H1 receptor sites C. inflammatory mediation D. peripheral vasodilation

A. vasoconstriction

Mechanism

AAT inhibits neutrophil elastase

Three major ageNcies that offered different recommendations for breast cancer (and other cancer) screening

ACP (2007) ACS (2003) USPSTF (2009)

Prevention endocarditis

AHA guidelines for high-risk patient populations to receive prophylactic antibiotics before invasive procedures such as invasive dental , GI, GU procedures strict aseptic technique proper handwashing

Actinic keratosis

Actinic keratosis: precursor of squamous cell cancer. Memory tip: the letter "C" in ACTINIC is a reminder for CANCER. Do not confuse this with seborrheic keratosis, which is benign (common mistake).

Endocarditis Related RN Diagnosis

Activity intolerance Cardiac output, decreased tissue perfusion, decreased knowledge deficit

Which antipsychotic has been aproved as a monotherapy to treat Bipolar DO and Also used as PRNs for psychosis?

Abilify

Clinical presentation of peritonsillar abscess includes: A. occipital lymphadenopathy B. congested cough C. muffled "hot potato" voice D. abdominal pain

C. muffled "hot potato" voice

Cap

ATS Guidelines recommend macrolides for persons 65 years or less who have no comorbitiy. For those older than 65 years or who have a comorbid condition (i.e., heart disease, COPD, diabetes), β-lactum and a macrolide or the new quinolones with gram positive activity (i.e., levaquinolone) are preferred.

Tsetse flies transmit trachoma. Venezuelan equine encephalitis. St. Louis encephalitis. new variant Creutzfeldt-Jakob disease. African sleeping sickness.

African sleeping sickness

the most important risk factor for developing prostate cancer

Age

Risks for prostate cancer (3)

Age (most important), African Americans, FH (if prostate cancer age ages below 65)

Average risk patient starts screening

Age 50

risk factors for breast cancer

Age, FH, Nulliparity (never having completed pregnancy >20 weeks), First pregnancy after age 30, early menarche or late menopause, dense breasts, personal Hx of ovarian/endometrial cancer

Even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. What is this called?

Agnosognosia

A 70 year-old male patient has an elevated MCV with an anemia. His triglycerides are 420. What should be suspected?

Alcohol abuse This patient has an elevated mean corpuscular volume. This indicates a macrocytic anemia. Common macrocytic anemias are B12 deficiency and folate deficiency. These are common in older patients, especially if they consume large quantities of alcohol. This patient also has elevated triglycerides. Triglycerides are commonly elevated when patients are exposed to alcohol and carbohydrates. This patient's history indicates two elements that indicate alcohol abuse. He should be questioned regarding alcohol abuse.

How would the NP treat hyperthyroidism?

Always refer. If tachycardia you can give a low dose beta blocker until seen by endocrinologist. If thyroid storm send to ER

Mrs. Smith is worried about her eldest child who recently lost his job. She is unable to sleep at night because "she is just so worried she can't sleep." Which medication listed below should NOT be used to treat anxiety in an older adult?

Ambien Zolpidem is a sleep aid, not an anti-anxiety medication. If a benzodiazepine is prescribed, it should be short or intermediate duration. Since benzodiazepines are often abused and can produce cognitive impairment, they should be carefully prescribed. Additionally, they should be prescribed for short-term use only, preferably not more than 60-90 days.

A 19 year old with anorexia has bradycardia, and orthostatic hypotension. What might accompany today's findings?

Amenorrhea

A 19 year-old college student is at least 15% below her ideal body weight. She reports doing well in classes but drinks alcohol nightly, and several cups of coffee throughout the day. She is bradycardic and gets dizzy when she stands. What may also be observed in this patient?

Amenorrhea This patient has anorexia nervosa. She is far below ideal body weight and exhibits evidence of poor nutrition and health. More than 90% of patients with anorexia are amenorrheic. These patients have low levels of leuteinizing hormone and follicle stimulating hormone. Because of prolonged hypoestrogenic states, they are highly susceptible to osteopenia and osteoporosis. It is not known why, but, many patients with anorexia also exhibit mitral valve prolapse, not mitral regurgitation. Because she is bradycardic, an EKG should be performed. QT prolongation is common in these patients, especially when bradycardia is present. Hypotension is more common than hypertension in anorexic patients.

A 19 year-old college student with anorexia is being treated as an outpatient. Today she is bradycardic and occasionally has orthostatic hypotension. What might accompany today's findings?

Amenorrhea This patient has anorexia nervosa. She is far below ideal body weight and exhibits evidence of poor nutrition and health. More than 90% of patients with anorexia are amenorrheic. These patients have low levels of luteinizing hormone and follicle stimulating hormone. Because of prolonged hypoestrogenic states, they are highly susceptible to osteopenia and osteoporosis. It is not known why, but many patients with anorexia also exhibit mitral valve prolapse, not mitral regurgitation. Because she is bradycardic, an EKG should be performed. QT prolongation is common in these patients, especially when bradycardia is present. Hypotension is more common than hypertension in anorexic patients.

Premiums

Amount you pay monthly, quarterly, semiannually or annually to purchase different types of insurance.

short acting beta agonist long acting beta agonist should never be used without inhaled steroid to treat a patient with asthma!

An example of a short-acting beta agonist is albuterol, levalbuterol, pirbuterol, or bitolterol. These provide rapid dilation of the bronchioles and can give immediate relief; hence the term for this class of medications: rescue medications. Salmeterol is a long-acting beta agonist. These should never be used without an inhaled steroid to treat a patient with asthma. Mometasone and beclomethasone are steroids commonly used to treat patients with asthma.

A 74 year-old is diagnosed with shingles. The NP is deciding how to best manage her care. What should be prescribed?

An oral antiviral agent- not a steroid!

Pale

Anemia (can cause this sign)

Pale Conjunctiva

Anemia can cause this (eyes)

Macrocyclic normochromic anemia- b12 , folate (pernicious)

Anemias resulting from Vitamin B12 or folate deficiency are sometimes referred to as "macrocytic" or "megaloblastic" anemia because red blood cells are larger than normal. A diagnosis of pernicious anemia first requires demonstration of megaloblastic anemia with a complete blood count (CBC) with differential that evaluates the mean corpuscular volume (MCV), as well the mean corpuscular hemoglobin concentration (MCHC). Pernicious anemia is identified with a high MCV (macrocytic) and a normal MCHC (normochromic) anemia.

average risk patient screening

Annual biennial mammography in ages 40-74+

Where is TSH produced?

Anterior Pituitary

Ulcerative colitis

Antibiotic use in ulcerative colitis is discouraged because of the increased risk of C. difficile infection. In Crohn's disease, metronidazole and ciprofloxacin are used when perineal disease or an inflammatory mass is noted. Medication therapy in inflammatory bowel disease is usually initiated at the time of a flare, often the most common point of disease diagnosis. In Crohn's disease and ulcerative colitis, oral aminosalicylates, including sulfasalazine and mesalamine, are usually first-line therapy and are equally effective. In ulcerative colitis, when the disease is limited to the distal colon, mesalamine and corticosteroids can be administered rectally.

When medicating a bipolar patient what has to be given along with antidepressants?

Antidepressants must be used in combination with mood stabilizers

The most common co-morbidity associated with depression is:

Anxiety Anxiety is the most common co-morbidity associated with depression; especially panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. All of the other choices listed are co-morbidities associated with depression, but do not occur with the same frequency. When these co-morbidities occur in conjunction with depression and are not treated, they worsen the prognosis.

What other disorder could a patient with an eating disorder concomitantly have?

Anxiety disorders

A patient with an eating disorder may concomitantly exhibit:

Anxiety disorders Affective disorders, anxiety disorders, and substance abuse issues are common in patients who have eating disorders. Obsessive-compulsive disorder is also commonly observed. Patients with eating disorders are more likely to have a first or second degree relative with an eating disorder, affective disorder, or alcohol abuse. There is no evidence that patients with eating disorders exhibit a higher incidence of sleep disorders or liver disease. Thyroid disease should always be assessed in patients with eating disorders, but this does not represent the reason for weight loss when eating disorder is present.

A patient with an eating disorder might exhibit evidence of:

Anxiety disorders In patients with eating disorders, it is common to identify affective disorders, anxiety disorders, or substance abuse issues. Obsessive-compulsive disorder is also commonly observed. Patients with eating disorders are more likely to have a first or second degree relative with an eating disorder, affective disorder, or alcohol abuse. There is no evidence that patients with eating disorders exhibit a higher incidence of sleep disorders, or have been sexually abused. Thyroid disease should always be assessed in patients with eating disorders, but this does not represent the reason for weight loss when eating disorder is present.

Apt. M

Aortic 2 ics right; pulmonic 2 ics left ; tricuspid 4 left sternal border ics; mitral 5 at mcl

Clinical descriptions of mucus do not really help in clinical decision-making regarding pneumonia, but certain clinical characteristics are associated with specific types of pneumonia. Strept pneumonia, also known as pneumococcal pneumonia, is associated with rust colored sputum. Scant or watery sputum is associated with atypical pathogens like Mycoplasma and Chlamydophila pneumonia. Thick, discolored sputum may be associated with bacterial pneumonia.

Aortic regurgitation is a grade 1-3/4 high-pitched blowing diastolic murmur heard best at the third left intercostal space. It may be enhanced by forced expiration or by leaning forward. It is more common in men and is usually caused by rheumatic heart disease, but occasionally is due to latent syphilis. Mitral stenosis is a low-pitched, late diastolic murmur best heard at the apex. Mitral regurgitation is a systolic murmur; it is high-pitched and best heard at the lower border of the right scapula. Aortic stenosis is a harsh systolic murmur, heard best at the second right intercostal space or apex.

First-line therapy for angular chelitis therapy includes the use of: A. metronidazole gel B. hydrocortisone cream C. topical nystatin D. oral ketoconazole

C. topical nystatin

BRCA 1 and BRCA2 Genes:

Are specific mutations associated with Breast cancer. FH would present with patterns suggestive of BRCA mutations

Brovana

Arformoterol inhale 15 mcg twice a day via nebulizer

What do elderly patients taking tricyclic antidepresants often exhibit?

Arrhythmias

Elderly patients who are treated for depression with tricyclic antidepressants (TCAs) often exhibit:

Arrhythmias The TCAs have pronounced anticholinergic activity and thus, produce bothersome side effects like dry mouth, constipation, urinary retention, confusion, and even delirium. The TCAs block H1 receptors that may be responsible for sleepiness and weight gain. Hypotension may also result, especially in the elderly. This may be due to an alpha-1 receptor blockade. These medications must be used very cautiously in the elderly because they can produce bradycardia and prolongation of the QT interval. Therefore, a resting EKG is necessary prior to starting any TCA.

5 A's smoking cessation

Ask Advise Assess Assist Arange

Anaerobic Pneumonia

Aspiration with decreased LOC, Etoh, swizure, CNS disease, NG tubes Poor dental hygien and malnutrition Body positios correlated to lung zone that develops pna Bacteria: Peptostreptococcus, Bacteroides, often Polymicrobial Presentation: insidious onset, fatigure, wight loss, malaise, cough with foul smelling sputum, poor dentition Labs: bronchoscopy, transthoracic aspiration or thoracentesis if effusion Imaging: abscess, necrotizing pneumonia, empyema, pleural loculations

Mycoplasma pneumoniae

Atypical "Walking pneumonia" Younger persons (teens) S/S: insidious onset, non-productive cough, fever, headache, malaise Imaging: unilateral or bilateral patchy opacities, small pleural effusion 25% OM, bullous myringitis, SJS Tx: (Macrolide) Azithro, Erytho, Doxy

Legionella pneumophila

Atypical Inhaled from aquatic source Produces necrotizing multifocal pneumonia with intracellular bacteria (no gram stain or sputum) S/S: myalaig, HA, fever, cough, CP, *V/D* Associated lab: Hyponatremia, trasaminitis, elevated creatin kinase Tx: erythromycin, azithro

Chlamydia pneumoniae

Atypical less severe pneumonia S/S: phyaryngitis, sinusitis or laryngits 1-3wks before bronchits or pneumonia, Cough 3wks Dx: not tested for Tx: Azythro/Erythro, Doxy

complicated COPD antimicrobial treatment

Augmentin

Screening methods that could be useful in detecting ovarian cancer

CA 125 and trans-vaginal ultrasound

According to the Allergic Rhinitis and Its Effects on Asthma (ARIA) treatment guidelines, which of the following medications affords the best relief of acute nasal congestion? A. anticholinergic nasal spray B. decongestant nasal spray C. corticosteroid nasal spray D. oral antihistamine

B. decongestant nasal spray

Patients with strep throat can be cleared to return to work or school after __ hours of antimicrobial therapy. A. 12 B. 24 C. 36 D. 48

B. 24

The incubation period for S. pyogenes is usually: A. 1 to 3 days B. 3 to 5 days C. 6 to 9 days D. 10 to 13 days

B. 3 to 5 days

The most common causative bacterial pathogen in ABRS is: A. M. pneumoniae B. S. pneumoniae C. M. catarrhalis D. H. influenzae

B. S. pneumoniae

You are seeing a 25-year-old man with S. pyogenes pharyngitis. He asks if he can get a "shot of penicillin" for therapy. You consider the following when counseling about the use of intramuscular penicillin: A. There is nearly a 100% cure rate in streptococcal pharyngitis when it is used B. Treatment failure rates approach 20% C. It is the preferred agent in treating group G streptococcal infection D. Injectable penicillin has a superior spectrum of antimicrobial coverage compared with the oral version of the drug

B. Treatment failure rates approach 20%

A 22-year-old woman presents with a "pimple" on her right eyelid. Examination reveals a 2-mm pustule on the lateral border of the right eyelid margin. This is most consistent with: A. a chalazion B. a hordeolum C. blepharitis D. cellulitis

B. a hordeolum

Antihistamines work primarily through: A. vasoconstriction B. action on the histamine-1 (H1) receptor sites C. inflammatory mediation D. peripheral vasodilation

B. action on the histamine-1 (H1) receptor sites

In the treatment of allergic rhinitis, leukotriene modifiers should be used as: A. an agent to relieve nasal itch B. an inflammatory inhibitor C. a rescue drug D. an intervention in acute inflammation

B. an inflammatory inhibitor

With regard to pharyngitis caused by group C streptococci, the NP considers that: A. potential complications include glomerulonephritis B. appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms C. infection with these organisms carries a significant risk of subsequent rheumatic fever D. acute infectious hepatitis can occur if not treated with an appropriate antimicrobial

B. appropriate antimicrobial therapy helps to facilitate more rapid resolution of symptoms

Which of the following is consistent with the visual problems associated with macular degeneration? A. peripheral vision loss B. blurring of near vision C. difficulty with distant vision D. loss of the central vision field

B. blurring of near vision

A 25-year-old woman has a 3-day-history of left ear pain that began after 1 week of URI symptoms. On physical examination, you find that she has AOM. She is allergic to penicillin (use results in a hive-form reaction). The most appropriate antimicrobial option for this patient is: A. ciprofloxacin B. clarithromycin C. amoxicillin D. cephalexin

B. clarithromycin (Biaxin)

Which finding below is typical in a patient with Bells Palsy? Unilateral Numbness of the cheek

Bells Palsy is weakness or temporary paralysis of CN 7. It is usually idiopathic and unilateral. It is unusual to have pain. Numbness on the effected side, sagging eyebrow and possibly and inability to blink on the affected side. If unable to blink, the eye should be lubricated. Bells palsy may take weeks before it completely resolves.

A patient complains of severe facial pain on the right side of her face. She sates that her symptoms have gotten worse over the last 48 hours. Which diagnosis is NOT part of the differential diagnosis? -Bells palsy -Trigeminal neuralgia -Tooth abscess -Shingles

Bells palsy Bells palsy does NOT produce pain.

A patient with acute anxiety will experience the fastest relief of symptoms when he is treated with:

Benzodiazepine The most rapid relief of anxiety symptoms will occur with a benzodiazepine. The relief occurs with each dose and tapers as the dose is metabolized. The other agents listed will take multiple doses, or days to weeks before relief is experienced. With daily and continued use of benzodiazepines, the anti-anxiety effect may become diminished.

What is the usual age of onset of symptoms for patients with bipolar disorder?

Between 15 and 30 years

What is the usual age of onset of symptoms for patients with bipolar disorder?

Between 15 and 30 years The usual age of onset of symptoms is between 15 and 30 years. Onset of symptoms almost never occurs in patients older than age 65 years or younger than 15 years.

What two tests are useful in confirming acute bacterial maxillary sinusitis?

C-reactive protein ESR

A 25-year-old woman who has seasonal allergic rhinitis likes to spend time outdoors. She asks you when the pollen count is likely to be the lowest. You respond: A. "Early in the morning" B. "During breezy times of the day" C. "After a rain shower" D. "When the sky is overcast"

C. "After a rain shower"

Which of the following is true concerning Meniere disease? A. Neuroimaging helps locate the offending cochlear lesion B. Associated high-frequency hearing loss is common C. It is largely a diagnosis of exclusion D. Tinnitus is rarely reported

C. It is largely a diagnosis of exclusion

Appropriate oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis suitable for outpatient therapy includes a course of a: A. macrolide B. cephalosporin C. fluoroquinolone D. penicillin

C. fluoroquinolone

Which of the following is a characteristic of H. influenzae? A. Newer macrolides are ineffective against the organism B. Its antimicrobial resistance results from altered protein-binding sites within the wall of the bacteria C. Some isolates exhibit antimicrobial resistance via production of beta-lactamase D. This is a gram-positive organism

C. Some isolates exhibit antimicrobial resistance via production of beta-lactamase

You prescribe nasal corticosteroid spray for a patient with allergic rhinitis. What is the anticipated onset of symptom relief with its use? A. immediately with the first spray B. 1 to 2 days C. a few days to a week D. 2 or more weeks

C. a few days to a week

A 19-year-old woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a ropelike eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n): A. bacterium B. virus C. allergen D. injury

C. allergen

You inspect the oral cavity of a 69-year-old man who has a 100-pack year cigarettes smoking history. You find a lesion suspicious for malignancy and describe it as: A. raised, red, and painful B. a denuded patch with a removable white coating C. an ulcerated lesion with indurated margins D. a vesicular-form lesion with macerated margins

C. an ulcerated lesion with indurated margins

A 58-year-old woman presents with a sudden left-sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyeball is firm. Vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is: A. unilateral herpetic conjunctivitis B. open-angle glaucoma C. angle-closure glaucoma D. anterior uveitis

C. angle-closure glaucoma

One of the most serious complications of giant cell arteritis is: A. hemiparesis B. arthritis C. blindness D. uveitis

C. blindness

Oral decongestant use should be discouraged in patients with: A. allergic rhinitis B. migraine headache C. cardiovascular disease D. chronic bronchitis

C. cardiovascular disease

Which of the following is absent in otitis media with effusion? A. fluid in the middle ear B. otalgia C. fever D. itch

C. fever

First-line intervention for anterior epistaxis includes: A. nasal packing B. application of topical thrombin C. firm pressure to the area superior to the nasal alar cartilage D. chemical

C. firm pressure to the area superior to the nasal alar cartilage

Which screen for alcohol abuse has been validated in the elderly?

CAGE CAGE is a screen for alcohol abuse that is validated in adults and older adults. The C stands for "have you ever felt you should CUT down" your alcohol consumption. The A stands for " does other's criticism of your drinking ANNOY you". G stands for "have you ever felt GUILTY about drinking". The E stands for "have you ever had an EYE opener to steady your nerves or get rid of a hangover". A positive response on any question constitutes a positive screen.

Before a diagnosis of depression is made for a pregnant teenager, what labs should be obtained?

CBC, TSH, renal and liver function tests, urine toxicology screen.

Patient has Anosomia, Which cranial nerve should be evaluated?

CN 1 (one)

What are the diagnostics done to diagnose Addison's Disease?

CT scan (small non-calcified adrenal glands are indicative), Morning cortisol and ACTH levels (High ACTH and low cortisol are consistent), Confirmation with cosyntropin test (exogenous ACTH given and in Addisons there is no simultaneous rise in cortisol)

When can rapid cycling occur?

Can occur in both bipolar I and II

Dry, dull conjunctiva, night blindness

Caused by a deficiency of vit A

canavan's disease

Canavan disease is a gene-linked neurological disorder in which the brain degenerates into spongy tissue riddled with microscopic fluid-filled spaces. Canavan disease has been classified as one of a group of genetic disorders known as the leukodystrophies. Recent research has indicated that the cells in the brain responsible for making myelin sheaths, known as oligodendrocytes, cannot properly complete this critical developmental task. Myelin sheaths are the fatty covering that act as insulators around nerve fibers in the brain, as well as providing nutritional support for nerve cells. In Canavan disease, many oligodendrocytes do not mature and instead die, leaving nerve cell projections known as axons vulnerable and unable to properly function. Canavan disease is caused by mutation in the gene for an enzyme called aspartoacylase, which acts to break down the concentrated brain chemical known as N-acetyl-aspartate. Symptoms of Canavan disease usually appear in the first 3 to 6 months of life and progress rapidly. Symptoms include lack of motor development, feeding difficulties, abnormal muscle tone (weakness or stiffness), and an abnormally large, poorly controlled head. Paralysis, blindness, or hearing loss may also occur. Children are characteristically quiet and apathetic. Although Canavan disease may occur in any ethnic group, it is more frequent among Ashkenazi Jews from eastern Poland, Lithuania, and western Russia, and among Saudi Arabians. Canavan disease can be identified by a simple prenatal blood test that screens for the missing enzyme or for mutations in the gene that controls aspartoacylase. Both parents must be carriers of the defective gene in order to have an affected child. When both parents are found to carry the Canavan gene mutation, there is a one in four (25 percent) chance with each pregnancy that the child will be affected with Canavan disease. Is there any treatment? Canavan disease causes progressive brain atrophy. There is no cure, nor is there a standard course of treatment. Treatment is symptomatic and supportive. What is the prognosis? The prognosis for Canavan disease is poor. Death usually occurs before age 10, although some children may survive into their teens and twenties.

1-5 Bi-RADS criteria findings of mammography

Category 1 - Negative • Category 2 - benign finding • Category 3 - probably a benign finding • Category 4 - suspicious abnormality and biopsy is suggested • Category 5 - highly suggestive of a malignancy

Bronchiolitis

Children & immunocompromised Respiratory syncytial vrius #1, peak at 6mos age S/S: wheezing, cough, dyspnea, hypoxia, cyanosis, malaise Dx: CXR-atelectasis or hyperinflation Tx: support, hydration, Ribavirin in severe cases, Palivizumab for prevention

How many a child with strep pharyngitis present?

Children may present with abdominal pain or emesis.

myotonic dystrophy

Christmas tree appearance of cataract

types of inflammatory bowel disease

Chrones Disease Ulcerative Cholitis

All of the following are characteristics of Chronic Bronchitis EXCEPT:

Chronic Cough on most days at least 3 months of the year Copious amounts of mucus production Airway obstruction due to bronchial inflammation Destruction of the pulmonary Acini

A patient may derive benefit from a tricyclic antidepressant (TCA) if he experiences depression and:

Chronic pain Amitriptyline and nortriptyline are commonly used in patients who exhibit depression and chronic pain syndromes. TCAs are known to produce mild peripheral vasodilator effects and subsequent relief of pain by an unknown mechanism.

Medical/Legal Pitfalls

Chronic pharyngitis -look for malignancy Be aware of the signs of immunosuppression Carefully document follow-up instructions, signs and symptoms of recurrence and all complications

Predisposing factors of pharyngitis ?

Cigarette smoking Allergies URIs Oral sex Drugs-antibiotics and immunosuppresants Debilitating illnesses such as cancer that can cause Candida albicans

Anaerobic Pneumonia Tx

Clindamycine or Augmentin or PNC + metronidazole -continued until resolution >1mos Surgical drainage for empyema Still cover CAP

A patient has suspected serotonin syndrome. How can this be diagnosed?

Clinical exam and index of suspicion Serotonin syndrome is a clinical diagnosis characterized by too much serotonergic activity in the central nervous system. There is no way to measure serotonin levels at this time. Therefore, no clinical laboratory or imaging study can identify this syndrome. However, these studies may rule out other conditions.

Primary care

Clinical preventive services, first-contact treatment services, and ongoing care for commonly encountered medical conds

Which of the following produces the most deadly toxins known? Clostridium botulinum Mycobacterium leprae Listeria monocytogenes Chlamydia trachomatis Clostridium tetani

Clostridium botulinum

Serotonin syndrome may result from taking an SSRI and:

Dextromethorphan Serotonin syndrome is a potentially life-threatening condition. The syndrome occurs when there is too much serotonergic activity in the central nervous system. It can occur with an interaction between two medications, like an SSRI and dextromethorphan, an SSRI and a triptan, an intentional overdose, or with high doses of an SSRI in a particularly sensitive patient. Symptoms of serotonin syndrome include hyperreflexia, clonus, rigidity in the lower extremities, tachycardia, hyperthermia, hypertension, vomiting, disorientation, agitated delirium, or tremor. None of the other medications listed can precipitate serotonin syndrome.

A 38 year old bipolar male has taken lithium for many months, with stabilized mood. He reports frequent urination, while on lithium. What could be the underlying cause of his frequent urination?

Diabetes insipidus

A 38 year-old patient diagnosed with bipolar disease has taken lithium for many months. His mood has stabilized. He was told to report frequent urination while taking lithium. What might be the underlying cause of his frequent urination?

Diabetes insipidus The most common side effect of lithium therapy is nephrogenic diabetes insipidus (NDI). Polyuria and polydipsia secondary to NDI occur in about 20% of patients who take lithium. Lithium accumulates in the collecting tubule cells and causes damage. This leads to changes in antidiuretic hormone (ADH) production, sodium levels, and hypercalcemia. Other changes can occur in the renal system such as mild renal insufficiency. Patients on lithium therapy should be monitored closely for side effects and to ensure that lithium levels are maintained within therapeutic range because lithium has a narrow therapeutic index.

A patient has been diagnosed with anxiety. What sleep disturbance might she have?

Difficulty falling asleep Patients with anxiety complain of difficulty falling asleep. Patients with depression complain of early morning awakening and difficulty remaining asleep. A manic patient may state that he never feels tired enough to sleep.

A 45 year-old patient started taking paroxetine one week ago for depression. She calls to report intermittent headache and nausea. What is a likely etiology?

Drug side effect Paroxetine is a selective serotonin reuptake inhibitor (SSRI). Nausea, headache, diarrhea are not unusual symptoms observed in patients who take SSRIs. The symptoms are more common with initiation of therapy and with dose increases. The symptoms tend to subside after a week or so.

Influenza Tx

Early <48hrs S/S Reduces likelihood of LRI Reduce Abx use Anfluenza A, B, HINI -Oseltamivir (tamiflu) -Zanamivir

Which symptom listed below is typical of depression?

Early morning wakening Sleep difficulty is a common complaint among patients with depression. Patients with difficulty falling asleep are often anxious. Frequent waking and early morning wakening are often complaints by patients with depression. There is no agreed on physiologic explanation, but, this is a common symptom.

Problem with endometrial cancer. Possible reason we dont screen

Early treatments not greatly effective in improving outcome

You suspect a patient abuses ethanol. What lab values would support this suspicion?

Elevated ALT, AST, GGT.

A nurse practitioner suspects that a patient is abusing ethanol. What laboratory values would support this suspicion?

Elevated ALT, AST, and GGT Liver enzymes rise in response to acute injury to the liver. ALT and AST are frequently elevated when alcohol abuse occurs. Specifically, the AST is usually the higher of the two enzymes and can signify alcohol abuse when it is more than 2 times greater than the ALT. In patients who abuse alcohol daily, the ALT and AST may be normal. GGT, gamma-glutamyl transferase, is often elevated even when ALT and AST are normal. It can help identify damage to the liver as a result of alcohol abuse.

Lab results seen in Primary Hypothyroidism?

Elevated TSH, Low T4, normal T3

Lab results seen in subclinical hypothyroidism?

Elevated TSH, normal T4 and T3

Emphysema

Emphysema is characterized by having a barrel-shaped chest, pursed-lip breathing, and dyspnea when at rest. Infiltrates on an x-ray indicate bacterial infection, such as pneumonia.

Community Acquired Pneumonia (CAP) *Outpatient testing*

Empiric Abx Consider diagnositc testing with travel and public health concers -Flu -TB

exaggerated feeling of well-being or elation during which the person may describe feeling "high" "ecstatic" or "on top of the world"

Euphoria

A patient with bipolar disease has purchased a $10,000 baby grand piano. He does not play the piano. Consistent with a manic episode in bipolar disease, this is an example of:

Grandiosity 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.

Most common form of hyperthyroidism in the U.S.

Grave's Disease

When is RAI the TOC in hyperthyroid?

Grave's that relapses, severe cardiac disease or risks, multi nodular goiter. Women who have this done need to postpone conception for 6 months.

What infection causes 15-30% sore throats in children and 5-15% in adults?

Group A beta-hemolytic streptococcal infection (GABHS)

Atopic dermatitis

Ha a liniar distribution

The condition known as "pinkeye" may be the result of infection with Trypanosoma brucei. Clostridium botulinum. Chlamydia trachomatis. Acanthamoeba. Haemophilus influenzae.

Haemophilus influenzae

Which of the following causative agents of meningitis requires heme and NAD+ for its growth? Listeria monocytogenes Streptococcus agalactiae Streptococcus pneumoniae Haemophilus influenzae Neisseria meningitidis

Haemophilus influenzae

Which statement about bulimia nervosa is accurate?

High dose SSRIs are used to treat this The medications of choice to treat bulimia nervosa are the SSRIs. Generally, high doses are required. Wellbutrin is not an SSRI and should not be given to patients with eating disorders because of great fluctuations in drug levels related to purging. Generally, this is more common in women than men. Loss of control IS a characteristic of this illness.

What is the nursing management for the person with lithium toxicity?

Hold lithium Check Vital signs Obtain Li blood level STAT and Electrolytes Hydrate 5-6 liters/ day - address electrolytes Ascertain reasons for Li toxicity

Medications considered first line to treat attention deficit disorder and attention deficit hyperactivity disorder are Schedule:

II Schedule II medications are those described as having a high abuse risk. These can cause severe psychological or physical dependence. Stimulants are used to treat patients with ADD/ADHD because they are thought to affect the dopaminergic and noradrenergic systems that cause the release of catecholamines in the synapses in the central nervous system. Stimulants are considered first line pharmacologic therapy. Specific medication types are methylphenidate, dextroamphetamine, and mixed amphetamine salts. They all have abuse potential and should be prescribed very cautiously.

If found to have HPV?

If HPV(+) Colposcopy If HPV(-) Annual Pap smear

Selection Bias

If individuals in the screened population differ from unscreened invididuals, the survival differences may not be due to screening. Ex: the volunteers may be low/high risk people compared to the population at whole

Screening breast cancer >74

If life expectancy is >5 years, then screen • Because we usually don't know outcome from treatment of disease. Don't want to cause unnecessary pain/disability

Diagnostic examination for group a strep pharyngitis?

If rapid strep is negative: perform a throat culture and sensitivity which is the gold standard. Don't have to wait for results to treat, TREAT!

Factors for COPD diagnosis include all of the following EXCEPT: Diagnosed AAT deficiency Decline in activity ability around cigarette smoke Improvement of 12% or better on spirometry following albuterol administration Chronic productive cough

Improvement of 12% or better on spirometry following albuterol administration

Describe the mood changes in rapid cycling in its most severe form.

In its most severe form includes continuous cycling between sub-threshold mania and depression or hypomania and depression

Name symptoms of manic episode.

Inappropriate sense of euphoria (excitement) Reckless, impulsive behavior/poor judgment Little sleep needed Excessive energy Racing thoughts; Flight of ideas Talking too much or too fast (pressured speech) Out of control spending Extreme difficulty concentrating Irritability Abnormally increased activity, including sexual activity Abuse of drugs, particularly cocaine, alcohol, & sleeping medications Provocative, intrusive, or aggressive behavior Denial that anything is wrong Can develop psychosis

A 6 year-old is brought to your clinic because of behavior problems at school. DSM V criteria are used to diagnose attention deficit disorder (ADD). Which finding must be present for this diagnosis?

Inattention There are three categories of symptoms: hyperactivity, inattention, and impulsivity. The diagnostic criteria have been defined by the American Psychiatric Association and can be found in the DSM V.

Major health care goal

Increase knowledge of the major issues faced by the US health care system, including access to care, quality of care and cost

Capitation

Insurers and health care providers agree upon covered health care services for a set price

A adolescent female with anorexia nervosa must exhibit 4 criteria for diagnosis. What are they?

Intense fear of weight gain, severe body image disturbance, absence of menstrual cycle, weight below 85% of ideal body weight.

What are the nursing interventions and points of focus for inpatient treatment for bipolar disorder?

Interventions: Assess for suicidal ideation/plan Create action plan to deal with suicidal ideation Assess for hypomanic, manic/ depressive episodes - triggers Monitor coping strategies Focus on: Nutrition Sleep Adherence to tx plan/ medications Thought processes & content Communication Appropriate social interaction Self concept ADL's Participation in work, school, family Knowledge of Bipolar D/O and its Tx. Quality of life.

A patient with a complicated acute COPD exacerbation with increased risk of p.aeroginosa infection should be treated with which of the following agents? Penicillin Levaquin Clarithromycin Augmentin

Levaquin

What are the nursing interventions and points of focus for inpatient treatment for bipolar disorder?

Interventions: Prevent pt. from harming self/others Ensure basic needs met Monitor medication effects Plan for long-term management Focus on: Nutrition Sleep Adherence to Tx plan/ meds- partnership ADL's - verbalize expectation Thought processes & content Communication Appropriate social interaction Self concept Quality of life (meds plus therapy=highest quality) Knowledge of Bipolar D/O & its Tx.

Atrovent

Ipratropium anticholinergic 2-4 puffs three to four times per day

SAA

Ipratropium (atrovent)

Cup-like Depressions in Nails

Iron deficiency

Name the mood. easily annoyed and provoked to anger. (when someones voice is going up then lower yours let them know they have a choice to change behavior)

Irritable Mood

Screening in breast cancer age 40-59

Is controversial and requires evaluation of a patients individual risk, and a discussion about the potential benefits and harms of screening via mammography

S&S from infarctions to organs from emboli and ischemia Kidneys brain spleen/bowel heart S&S of ?

Kidneys: hematuria, oliguria, failure, anemia (failure to produce erythropoietin) brain: change in LOC, change in vision, TIAs (transient ischemic attacks), CVAs (stroke) spleen/bowel: abdomen tenderness, nausea, vomitting, cramping heart: CP or MI Signs and symptoms of heart failure

Name the mood alternates between euphoria and irritability (very big mood swing)

Lability of Mood

Bleeding Gums

Lack of C, K, (Mouth)

Scaling around nostrils

Lack of Riboflavin

Bruising

Lack of Vitamin C, K can cause this

Temor

Lack of electrolytes)

Mucosal Atrophy

Lack of niacin (mouth)

Scaly dermatitis

Lack of niacin, A, Zinc, EFA

Swollen/Moon Face

Lack of protein

Angular cheilosis

Lack of riboflavin (mouth)- swollen lips, buccal mucosa extends to lips

Magenta Tongue

Lack of riboflavin (tongue)

Hpv lesions

Lesions of HPV infection will turn white with application of acetic acid.

The nurse practitioner (NP) is treating a 22 year-old for depression with high dose fluoxetine. After several months of dosage changes, she is finally doing well and comes today for a follow up visit. She is happy and states that she might be pregnant. A urine test indicates pregnancy. The NP has referred the patient to an obstetrician who will see the patient in 4 weeks. How should the fluoxetine be handled today?

Let the obstetrician and patient make a decision about continuing fluoxetine Fluoxetine is one of the best studied selective serotonin reuptake inhibitors in pregnancy and lactation. There has been no reported evidence of teratogenicity. While the healthcare provider would rather this patient not take a medication while she is pregnant, consideration must be given to the severity of her depression and her response to treatment. The discussion the NP and obstetrician will have with the patient should include risks and benefits of treatment, and potential risks of stopping fluoxetine. The risk of exposure to medication must always be weighed against the risk of not treating this patient. All psychotropic medications cross the placenta and so developing fetuses are exposed to these medications. Fluoxetine is a category C medication.

A 22 year old is doing well on a high dose fluoxetine after several months. Her urine test indicates pregnancy. The provider referred her to an obstetrician who will see her in 4 weeks. How should the fluoxetine be handled today?

Let the obstetrician and patient make a decision about continuing fluoxetine.

Xopenex HFA

Levalbuterol Beta agonist 2 puffs every 4-6

Levodopa

Levodopa continues to be used to minimize the symptoms of Parkinson disease, but it tends to be less effective with more adverse effects as the disease progresses. Most patients who take levodopa for more than 5 to 10 years develop dyskinesia. Selegiline is a monoamine oxidase-B inhibitor which helps to increase levodopa's half-life by reducing its metabolism. Amantadine is an antiviral drug with some antiparkinsonian benefits, but its effects are time-limited. It can be used in the later stages of the disease to help reduce dyskinesias. Benztropine is an anticholinergic, used in Parkinson disease to help with tremor and dyskinesia. Side effects include dry mouth, urinary retention, and altered mentation.

What are triggers for the pain of trigeminal neuralgia?

Light touch to the affected area chewing cool breeze on the cheek smiling grimacing more common in elderly adults.

Which of the following causative agents of bacterial meningitis is transmitted by contaminated food? Streptococcus pneumoniae Streptococcus agalactiae Neisseria meningitidis Listeria monocytogenes Haemophilus influenzae

Listeria monocytogenes

Which of the following is the least common cause of bacterial meningitis? Listeria monocytogenes Haemophilus influenzae Streptococcus agalactiae Streptococcus pneumoniae Neisseria meningitidis

Listeria monocytogenes

a water soluble salt - the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.

Lithium Carbonate

A patient reports that she takes kava kava regularly for anxiety with good results. What should the NP evaluate?

Liver function studies Kava kava is an herb from the South Pacific that is used to treat anxiety, fibromyalgia, and hyperactivity, attention deficit disorder. Hepatotoxicity has been reported with kava kava use, especially when consumed as tea. Liver toxicity should be reviewed in this patient. If she is not willing to use another agent for treatment of her anxiety, liver function studies should be monitored periodically.

When is drug therapy the treatment of choice for hyperthyroid?

Long term only in Graves. TOC in young patients with small goiter or active eye problems

What are the S/S of addisonian crisis?

Low BP, low blood sugar, and high K

What criteria is mammography based upon

Mammography is based on Bi-RADS criteria

sensitivity ans specificity of breast cancer screening

Mamography has a sensitivity of 70-90% and a specificity of 90-95%

A patient with bipolar disease has purchased a $10,000 baby grand piano. He does not play the piano. This behavior is typical during:

Mania 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.

Confusion

May be attributed to deficiency of thiamin, niacin, dehydration -drug use, intoxication, low glucose, stroke

Weakness/Fatigue

May be attributed to: PCM, lack of B12, E, biotin, niacin, anemia, thiamin, riboflavin, pantothenic acid, K+, Mg, P (overall deficiency)

Dementia

May be due to lack of B12, thiamin

Neuropathy

May be due to lack of thiamin, chromium, pyrodoxine

What are the potential risks from antidepressants, especially if bipolar disorder is misdiagnosed & only treated for depressed mood?

May induce mania or hypomania Can cause rapid cycling

The type of bacterial meningitis that becomes epidemic among adults is caused by Streptococcus agalactiae. Listeria monocytogenes. Haemophilus influenzae. Neisseria meningitidis. Streptococcus pneumoniae.

Neisseria meningitdis

neural tube defects

Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely. There is usually nerve damage that causes at least some paralysis of the legs. In anencephaly, most of the brain and skull do not develop. Babies with anencephaly are either stillborn or die shortly after birth. Another type of defect, Chiari malformation, causes the brain tissue to extend into the spinal canal. *http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=neural+tube+defects&x=21&y=7*

An 80 year old adult has begun to use over the counter diphenhydramine to help him fall asleep. What common side effect can occur in older adults with use of this medication?

Next day sleepiness Diphenhydramine should be avoided in older adults. Diphenhydramine exhibits potent anti-cholinergic effects in patients who take this, but especially in older adults. Urinary retention is common (not incontinence) in older men with benign prostatic hyperplasia, but retention occurs in women too. Diphenhydramine is contraindicated in patients with glaucoma. The most serious side effect is cognitive impairment, like daytime sleepiness. Visual disturbances can occur as well as annoying side effects like dry mouth and constipation.

Nicotine Patch names

Nicoderm CQ , Habitrol

nicotine gum name

Nicorette

Does a person with Bipolar II go into periods of mania?

No

Does bipolar affect intellect?

No

A patient is diagnosed with carpal tunnel syndrome. Which finger is NOT affected by carpal tunnel?

No 5th finger involvement Carpal tunnel is entrapment of the Median nerve at the wrist due to inflammation of the wrist tendons traverse carpal ligaments and or surrounding tissue. Compression of the Median nerve products paresthesias in the Thumb index finger middle finger and the radial side of the ring finger. The Fifth Finger is not effected.

Rhythmic oscillations of the eyes

Nystagmus

Community Assessment

Objectives: -general goals +objectives determined -involve staff and agency decisions -what actions are necessary -projected timeline Program plan: -plan of action developed -plan carried out as projected -considers staffing needs -determines documentation required -sources of funding -budget planning Evaluation: -assessment ongoing -evaluate results -revisions may be necessary for study purposes or conversion to regulation, ongoing program status

Which patient is most likely to exhibit depression related to his illness? A patient with:

Parkinson's disease Diseases associated with the central nervous system are associated with high rates of depression. These include stroke, Parkinson's disease, multiple sclerosis, and dementia. Other illnesses associated with high rates of depression are cancer and cardiovascular illnesses like myocardial infarction. Depression worsens the outcome of any physical illness.

A 70 year old patient exhibits pill rolling tremor. This likely indicates:

Parkinsons disease

How often do we re-screen if Small rectal hyperplastic polyps

Patient is screened the same as an average risk individual

What is Addisonian Crisis

Patient will present with low BP, low glucose and high K levels. Will need IV steroids, saline, dextrose and electrolyte management. This is an emergency that needs immediate referral

How often do we re-screen if

Patients receive colonoscopy <3 years after the initial polypectomy and consider a genetic syndrome

How often do we re-screen if >10 adenomas on a single examination:

Patients receive colonoscopy <3 years after the initial polypectomy and consider a genetic syndrome

What is the treatment of pharyngitis?

Patients with history of rheumatic fever and those with household member with a documented Group A strep infection need immediate treatment without prior testing. Pen-Vee-K (penicillin) Children: Amoxicillin 250mg BID to TID for 10days Amoxicillin 50mg/kg/day for 10 days; max of 1,000mg If allergic to PCN- Cephalexin, Cefadroxil Clindamycin (adverse effect: pseduomembranous colitis) Azithromycin.

Pen vk

Pen VK is safe to use for strep throat during pregnancy. Pen VK is a category B medication for pregnancy and lactation.

Down's syndrome

People with Down syndrome (trisomy 21) develop a syndrome of dementia that has the same characteristics of Alzheimer's disease that occurs in individuals without Down syndrome. The only difference is that Alzheimer's disease occurs much earlier in people with Down syndrome; patients with Down syndrome begin to have symptoms in their late 40s or early 50s. In the United States, atlantoaxial instability (AAI) with or without subluxation has been reported in as many as 10%-30% of individuals with Down syndrome. Children with Down syndrome are at a much higher risk for congenital heart disease. Types of defects include atrioventricular septal defects (most common), ventricular septal defects, atrial septal defects, patent ductus arteriosus, and tetralogy of Fallot.

What are some physical findings in strep pharyngitis?

Petechiae of the palate Pharyngeal and tonsillar erythema Exudates Anterior cervical adenopathy. However, many patients do not fit the textbook picture.

A patient presents to your clinic numerous times with vague complaints. She seems to respond poorly to medical treatment that is given to her. What should be considered when obtaining a history from her?

Physical abuse or depression Violence is very common in the United States. While men and women are both victims, women are more commonly victims. Patients who have been victims of violence are more likely to utilize healthcare and to have poor response to treatment. If the patient is suspected to have been a victim of violence, they should also be screened for anxiety, depression, and post-traumatic stress disorder.

A 70 year-old male has a yellowish, triangular nodule on the side of the iris. This is probably

Pinguecula are common as patients age. They usually appear on the nasal side first and then on the temporal side. This is a completely benign finding. A stye is also called a hordeolum. It is a tender, painful infection of a gland at the eyelid margin. These are self-limiting. A chalazion is a non-tender enlargement of a meibomian gland. A subconjunctival hemorrhage is a blood red looking area on the sclera that does not affect vision. It occurs and resolves spontaneously

A 26 year old patient with a long history of chronic sinusitis presents today with temperature of 103.2F, headache and stiff neck. Which finding below should make the NP suspect meningitis?

Positive Kerning and Brudinski fever nucal rigidity headaches and altered mental status characterize acute bacterial meningitis.

Positive signs of pregnancy

Positive Signs Palpation of fetus by health provider Ultrasound and visualization of fetus Fetal heart tones (FHT)

A 29 year old post-partum females reports difficulty with concentration, sleep, and guilt. She feels sad most of the time. She reports that these symptoms have been ongoing since her baby's birth about one month ago. What is her diagnosis?

Postpartum Depression

What is the diagnostic criteria for diagnosing bipolar disorder?

Presence of one or more manic episodes or mixed episodes, including one or more major depressive episodes

An elderly patient is at increased risk of stroke and takes an Aspirin daily. Aspirin in this patient is an example of

Primary prevention

What is the primary nursing priority for a patient during a manic episode? Which needs have to be addressed?'

Priority care is protection of the patient Biologic needs: food- rest - hydration

This therapy is a consideration only for COPD patients with a deficiency of AAT Lung Volume Reduction Surgery Ipratropium/Albuterol Prolastin Flovent

Prolastin

Alpha Antitrypsin Replacement

Prolastin, Aralast, Zemaira very expensive

The most common cause of cancer in men following skin cancer

Prostate cancer

The second leading cause of cancer death among men

Prostate cancer

Ppi

Protracted proton pump inhibitor (PPI) use is associated with reduced, rather than increased, absorption of iron, copper, vitamin B12, and other micronutrients in the elderly. An increase in fracture risk of the hip, spine, wrist, and forearm has been noted with long-term PPI use. Individuals with multiple health problems, when hospitalized or in long-term care, who are online chronic PPI therapy have an increased risk of contracting pneumonia and of developing C. difficile colitis.

Dx testing Influenza

Rapid 48-72hrs high viral shedding Treat with high clinical suspicion Treat ealry <48hrs S/S PRC Viral cx

What is the treatment for Addison's disease?

Replacement of hormones. Need to refer to endocrinology for long term management

Which of the following would increase Theophylline Clearance? Older Age Smoking Azithromycin Therapy Bacterial Pneumonia

Smoking

Common complaints of pharyngitis?

Sore throat Scratchy throat Fever Headache Malaise Oral vesicles Exudate on throat, lymphadenopathy, fatigue, dysphagia, abdominal pain, vomiting

Secondary care

Specialized attention and ongoing management for common and less frequently encountered medical conds, including support services for people with special challenges due to chronic or long-term conds

A 52 year-old patient presents with an acute drooping right eye and drooping right upper lip. The right side of her face is numb. She is otherwise healthy. Based on the most likely etiology, how should she be managed? Bells palsy

Steroids plus an antiviral agent

Substance abuse is very comorbid with bipolar disease. What do they usually take when they high? Low?

Stimulants when low Sleeping meds when really high (Zanex, valuim)

Etiologic Agents: Bacterial

Strep pneumoniae: *most common* Gram+ diplococci Mycoplasma pneumoniae: "walking" atypical H. influenzae: epiglottis/COPD Gram - Chlamydia pneumoniae Staph aureas: IVDU, Hospital N. meningitis: dorms, Gram- diplocci M. catarrhallis: COPD K. pneumoniae: ETOH aspiration, DM Legionella: water supply MRSA: Lung abcess PJP: HIV/Aids

Test of Waste Products

Testing of: -urine -feces -sweat -wounds, drains

Test of Tissues

Testing: -hair -cells -nails -evaluate trace minerals

Bph

Tamsulosin is an alpha blocker specifically indicated for benign prostatic hyperplasia (BPH). It has minimal effect on blood pressure. Finasteride and dutasteride are 5-alpha-reductase inhibitors that block the conversion of testosterone to dihydrotestosterone; they help to reduce the size of the prostate and ameliorate symptoms. Tadalafil is a phosphodiesterase inhibitor. It is approved for the treatment of BPH, however, this agent cannot be used in combination with alpha blockers or with patients taking nitrates.

two drugs used to treat hyperthyroid in U.S.? Which is preferred?

Tapazole and PTU. Tapazole preferred because it can be taken once daily. PTU is preferred in pregnancy

A 79 year-old female lost her husband of 55 years four days ago. She presents today with her daughter because she believes that she is "going crazy". She reports that she often hears his voice though she realizes that he has died. She has not slept well since his death and hasn't eaten very much. She has taken her usual medications for hypertension, osteoporosis, osteoarthritis, and hypothyroidism. She has no history of psychiatric illness. How should the nurse practitioner manage this?

Tell her that this is a normal response and that it will resolve. This imagined hearing or seeing of a deceased person is referred to as "searching behavior" and is not indicative of psychiatric illness. It is a common response after the death of a loved one, especially after 55 years of marriage. This patient and her daughter should be educated regarding the stages of grief and the variable length of each of the stages. Usually by 6 months, grief has begun to resolve, but this is a variable process. She should be encouraged to maintain her usual sleep, nutrition, and activity patterns as much as possible.

A 79 year old female lost her husband of 55 years 4 days ago. She reports hearing her husband's voice, even though she knows he has passed. She has not slept well or eaten very much since his death, and has no history of psychiatric illness. How should you manage this?

Tell her that this is a normal response, and it will resolve.

How should the nurse practitioner approach a patient who consumes excessive amounts of alcohol but denies that he has a problem?

Tell him that you are concerned about his health. The first step in being able to receive help for a problem is to be able to acknowledge that a problem exists. Since this patient is not willing to acknowledge a problem, but he needs help, one tack is to let him know that you are concerned about his health. If LFTs are ordered, they may not demonstrate elevation; especially if he consumes alcohol every day. Ordering a blood alcohol content, even if positive will be little or no help in having this patient realize that he consumes excessive amounts of alcohol. The provider could tell him to find another health care provider, but, this will do little to get this patient help.

A 72 year old patient with relatively benign medical history complains of a new onset headache associated with abrupt onset of visual disturbances. There sedimentation rate is elevated. Her neuro exam is otherwise normal. What is the most likely reason for her symptoms?

Temporal Arteritis

SLE

The ANA is usually positive in lupus patients. Other types of autoantibody testing recommended for these patients, in addition to antinuclear antibody (ANA) tests, are antiphospholipid antibodies, antibodies to double-stranded DNA, and anti-Smith (Sm) antibodies. Patient with suspected lupus should be referred to a rheumatologist. The sedimentation rate and the C-reactive protein are nonspecific findings of inflammation and are present in autoimmune diseases, infections, and others.

Bacille calmette guirren Vaccine BCG VACCINE- for TB

The BCG vaccine is given routinely in some countries where tuberculosis is endemic (or epidemic). One of the few exceptions for the BCG vaccine in the United States is for health care workers who see a high percentage of patients who are infected with M. tuberculosis strains resistant to both isoniazid and rifampin. BCG is considered a biohazardous material (U.S. Black Box Warning) and proper handling and disposal must be followed.

Td vaccine --- no fever

The Td vaccine is adult tetanus and diphtheria. A mild fever may occur as a side effect of the vaccine; it occurs in up to about 1 in 15.

S3

The best place to listen for the S3 heart sound is the pulmonic area.

why is cancer screening important

The cancer screening process is important for saving lives and preventing disabilities and is involved in detecting disease early in ASYMPTOMATIC (symptomatic patients would be tested with diagnostic tests) patients with the goal of reducing morbidity and mortality

Preeclampsia

The classic triad of symptoms of preeclampsia includes hypertension, edema (weight gain), and proteinuria.

Lead time bias

The lead-time is the period between early detection of the disease and the time of its usual clinical presentation. This lead-time must be subtracted from the overall survival time of the screened patients to avoid lead time bias when calculating how much lifespan is prolonged. Otherwise, this early detection solely increases the duration of the patient's awareness of their disease without reducing mortality.

Ottis external

The most common bacterium is Pseudomonas. The second most common bacterium is Staphylococcus aureas. Polymyxin and neomycin combination ear drops (Cortisporin) are the first-line treatment for otitis externa. Other ear drops that are also effective are the quinolone ear drops (ofloxacin, ciprofloxacin topical drops).

Ulcerative colitis

The most important clue for ulcerative colitis is bloody stools that are covered with mucus and pus, along with the systemic symptoms (fatigue, low-grade fever).

Spleen

The normal spleen weighs approximately 7 ounces, not 9 ounces. The size of the normal spleen can be recalled by the "rule of odds": it is 1 x 3 x 5 inches in size, weighs about 7 ounces, and is located between ribs 9 and 11. More than 50% of patients with infectious mononucleosis develop splenomegaly; the risk of splenic rupture is greatest in the second and third weeks of illness.

Secondary prevention

The nurse practitioner is evaluating the teenager for major depression. Since the teenager already has the disease (depression), this is a screening test. All screening tests/labs (mammography, Pap smears, etc.) are secondary prevention activities.

What is Cushing's Disease?

This is a subset of Cushing's syndrome that is caused by a benign tumor on the pituitary secreting ACTH or on the adrenal cortex secreting cortisol.

Appi

The pain of acute appendicitis is often aggravated, not relieved by walking or coughing. Nausea and vomiting are late symptoms that invariably occur a number of hours after the onset of pain; this late onset helps to differentiate appendicitis from gastroenteritis, in which vomiting usually precedes abdominal cramping. A total white blood cell (WBC) count and differential are obtained as part of the evaluation of patients with suspected appendicitis. The following are typically noted in the "left shift" seen in the presence of severe bacterial infection, such as acute appendicitis: Leukocytosis: An elevation in the total WBCs Neutrophilia: An elevation in the number of neutrophils in circulation Bandemia: An elevation in the number of bands or young neutrophils in circulatio

most powerful force in women getting a breast mammography

The physicians recommendations have been shown to be the most powerful factor influencing a woman's decision to obtain a mammogram -The most common reason women give for not having a mammogram is that their doctor never told them to get one

Blumbergs sign

The presence of rebound tenderness, used to help with the diagnosis of acute appendicitis, is also known as a positive Blumberg's sign. Rebound tenderness, which is abdominal pain that worsens with the release of deep palpation, indicates the likelihood of peritoneal irritation and helps with the diagnosis of acute appendicitis. The presence of rebound tenderness is also known as a positive Blumberg's sign. The psoas test checks for tenderness of the psoas muscle by passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip. The obturator sign is done through flexion and internal rotation of the hip. Homans sign was used as a sign for deep vein thrombosis, not for appendicitis.

At what stage after getting pan-colitis should we worry especially about getting colorectal cancer?

The risk increases after 8 years of pan colitis. These people must be looked at VERY CAREFULLY.

Warfarin

The use of rifampin with warfarin decreases the anticoagulant effects of warfarin. The use of quinidine, tamoxifen, and cimetidine increase, rather than decrease the anticoagulant effect of warfarin.

Breath sounds

There are two normal breath sounds. Breath sounds heard over the tracheobronchial tree are called bronchial breathing and breath sounds heard over the lower lobes of lung tissue are called vesicular breathing.

Risk Factors for Lung cancer

There is increased risk in smokers, exposure to asbestos, with FH, or based on personal history w/ cancer

A patient is taking a generic version of a selective serotonin reuptake inhibitor (SSRI). She reports intermittent nausea and mild headache daily since she started this medication 5 days ago. How should the nurse practitioner respond?

These are typical complaints of patients who take SSRIs. Typical symptoms of SSRIs include mild headache, nausea, insomnia, restlessness, and agitation. The emergence of these symptoms is typically dose related and will resolve within 2 weeks. The patient should be encouraged to eat small bites when she feels like she is becoming nauseated and may take acetaminophen or a similar product if the headaches are bothersome. Changing drug classes is also a possibility if the symptoms become too distracting or bothersome.

A patient reports intermittent nausea and daily mild headache since starting SSRI 5 days ago. How would you respond?

These are typical side effects of SSRI's.

How often do we re-screen if 1-2 small tubular adenomas with low-grade dysplasia:

These patients receive colonoscopy 5-10 years after the initial polyectoma

How often are they usually going to check the levels of anticonvulsants until the patient is stable? What about after that?

They are usually going to check the levels once a week until they stable and then every 6 months once stable

What statement describes depression in older adults?

They can be managed with some of the same medications as younger adults. Depression in older adults is difficult to diagnose because they may present with symptoms such as decreased energy, may associate depressive symptoms with "just getting older" and not mention them to healthcare providers, or they may present with somatic complaints. This last symptom is common in younger adults. Laboratory evaluation should include a CBC, TSH, B-12 level, electrolytes, urinalysis, and others as indicated by history. Many medications used to treat depression in younger patients are used in older patients. The dosages are usually decreased.

An elderly hypertensive patient has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis?

Thiazide diuretics have the secondary effect of increasing serum calcium by decreasing fluid. This makes more calcium available for absorption. This would not be used to treat a patient with osteoporosis, but, this mechanism of action could be helpful as an adjunct for patients who are receiving other forms of treatment for osteoporosis. The other agents listed would have no effect on osteoporosis. Calcium channel blockers impede movement of calcium into cells. This has no effect on available serum calcium.

Cough Differential Dx

Think...... HEENT Cardiovascular Pulmonary GI Rheumatologic *Medications*

Which statement about serous otitis media is correct?

This can be diagnosed with pneumatic otoscopy Serous otitis media (SOM) is also called otitis media with effusion (OME) or "glue ear". OME occurs when there is fluid (non-infectious) in the middle ear. This prevents normal mobility of the tympanic membrane and creates a conductive hearing loss. Pneumatic otoscopy is the primary non-invasive diagnostic method because it has a high sensitivity and specificity. It may be present before otitis media develops, or it may follow resolution of otitis media. OME is far more common than otitis media and is not associated with systemic symptoms like fever. Acute otitis media (AOM) describes infected fluid in the middle ear.

Which chronic skin disorder primarily affects hairy areas of the body? a. Seborrheic dermatitis b. Atopic dermatitis c. Contact dermatitis d. Hydradenitis suppurativa

a. Seborrheic dermatitis Rationale: Seborrheic dermatitis causes flaking of the skin, usually the scalp. In adolescents and adults, when it affects the scalp, it is termed dandruff. When this occurs in young children or infants, it is termed cradle cap. The exact cause is unknown, however it has a propensity for hairy areas of the body such as the scalp, face, chest, and legs. It appears greasy and flaky. This may be seen in patients with Parkinson's disease.

Which medication listed below could potentially exacerbate heart failure in a susceptible individual? a. Metoprolol b. Furosemide c. Metformin d. Acetaminophen

a. Metoprolol Rationale: Metoprolol is a cardioselective beta blocker that decreases heart rate. A patient with heart failure wil compensate for heart failure by increasing heart rate to maintain cardiac output (CO). Metoprolol impairs the patient's ability to increase heart rate when needed to maintain cardiac output (CO=stroke volume x heart rate). Consequently, the use of beta blockers in patients with heart failure should be monitored carefully. Furosemide may actually improve shortness of breath in a patient with heart failure. Metformin and acetaminophen have no direct effect on cardiac output on a patient with heart failure.

A 28-year-old has a Grade 3 murmur. Which characteristic indicates a need for a referral? a. a fixed split b. an increase with splitting with inspiration c. a split S2 with inspiration d. changes in intensity with position change

a. a fixed split Rationale: A split is created because of closure of valves. For example, an S2 is created by closure of the aortic and pulmonic valves. Normally these split with inspiration and almost never with expiration. Splits should never be fixed. This indicates some pathology like an atrial septal defect, pulmonic stenosis, or possibly mitral regurgitation. In any event, this patient needs an initial evaluation with an endocardiogram because fixed splits are always considered abnormal.

The most common arrhythmia resulting from valvular heart disease is a. atrial fibrillation b. paroxysmal superventricular tachycardia c. ventricular fibrillation d. heart block

a. atrial fibrillation Rationale: The most common arrhythmia seen in all forms of valvular disease is atrial fibrillation. It is usually seen in patients with organic heart disease. Paroxysmal supraventricular tachycardia is one of the most common arrhythmias but often occurs in patients with no underlying heart disease. It is usually caused by reentry in the AV node and not by valvular heart disease. Ventricular fibrillation and heart block are more likely to represent disease in the conduction system of the myocardium.

A 25-year-old patient has aortic stenosis (AS). The etiology of his AS is probably a. congenital b. rheumatic c. acquired calcific d. unknown

a. congenital Rationale: In someone younger than 65 years of age, the most likely cause is congenital. The aortic valve usually consists of three cusps, but some individuals are born with a bicuspid aortic valve. Rheumatic heart disease is the second most common cause of aortic stenosis in this age group, but the incidence has decreased drastically in the last many decades because of the use of antibiotics to treat Streptococcal infections. In more than 90% of patients older than 65 years, acquired calcifications appear on a normal tricuspid valve and produce aortic stenosis.

Impetigo is characterized by a. honey-colored crusts b. silvery scales c. marble-like lesions d. wheals with pus

a. honey-colored crusts Rationale: Impetigo is a superficial bacterial infection of the skin characterized by honey-colored crust. Another form of impetigo is characterized by the presence of bullae. These infections are treated with topical antibiotics, good hygiene, and frequent hand-washing. It is usually caused by Staphylococcus or Group A Streptococcus.

A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate a. hyphae b. yeast c. rods or cocci d. a combination of hyphae and spores

a. hyphae Rationale: Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic infections. Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis. Yeasts are usually seen in candidal infections. Cocci and rods are specific to bacterial infections.

Patients with atopic dermatitis are likely to exhibit a. itching b. asthma and allergic bronchitis c. nasal polyps and asthma d. allergic conjunctivitis and wheezing

a. itching Rationale: Atopic dermatitis is diagnosed on clinical presentation and includes evidence of prutitic skin. It is recurrent and often begins in childhood. For decades the "atopic triad" has been used to refer to patients with atopic dermatitis, asthma, and allergic rhinitis. This has recently been called in to question. A similar triad, known as Samter's triad, consists of asthma, aspirin sensitivity, and nasal polyps. Samter's triad is not the same as the atopic triad.

A patient represents with plaques on the exterior surface of the elbows, knees, and back. The plaques are erythematous and there are thick, silvery scales. This is likely a. plaque psoriasis b. guttate psoriasis c. atopic dermatitis d. Staph cellulitis

a. plaque psoriasis Rationale: Plaque psoriasis is seen initially in young adults and is characterized as described above. The thick, silvery scale is pathognomonic and is usually asymptomatic, though, some patients will complain of pruritis. A clinical finding that will help establish a diagnosis is pitting of fingernails. This is found in about 50% of patients with psoriasis. The plaques are commonly distributed on the scalp, extensor surface of the elbows, knees, and back. This is a chronic skin disorder.

A patient will be screened for hyperlipidemia via a serum specimen. He should be told: a. to fast for 12 to 14 hours b. to fast for 6 to 8 hours c. that black coffee is allowed d. a non-fasting state will not affect the results

a. to fast for 12 to 14 hours Rationale: Serum total and HDL cholesterol can be measured in fasting or non-fasting individuals. There are very small and clinically insignificant differences in these values when fasting or not. The primary effect of eating on a patient's lipid values is on the triglyceride levels. The maximum effect of eating on triglyceride levels occurs at 3 to 4 hours after eating, but there may be several peaks during a 12-hour period. Therefore, the most accurate triglyceride levels will be obtained following a 12-hour fast.

emphysema

abnormal permanent enlargement of alveoli accompanied with wall destruction caused by decreased lung elasticity

What describes a manic episode?

abnormally and persistently elevated, expansive, or irritable mood for at least one week

tudorza

aclidinium use two inhalation twice daily

Tertiary prevention

action designed to prevent additional deleterious events from happening.

Most important risk for breast cancer

age

Migraine risk decreases with There is no headache with

age bells palsy

How often do we re-screen breast cancer

age 50-74: Typically re-screen every 1-2 years

What is COPD

airflow limitation not fully reversible airflow limitation is usually progressive and associated with abnormal inflammatory response of the lungs

d. about 65 yrs old

an African American male c/o of pain in his back and trunk. He is dx with muliple myeoloma. He is probably: a. about 21 y/o b. about mid 30s c. younger than 50 yrs d. about 65 yrs old

A good first choice of antidepressants in an older adult is:

an SSRI An SSRI is a good choice of an antidepressant in an older adult because of the decreased side effects seen when compared with the other agents listed, but especially a TCA. These can produce conduction defects in older adults, sedation, and potent anticholinergic side effects.

One summer, bird watchers and zookeepers in a major city notice that more birds than usual are dying. At the same time reports of human encephalitis cases increase sharply. The cerebrospinal fluid of human patients is clear. Similar enveloped RNA virus particles are detected in samples from both birds and humans. Which of the following might be responsible for this outbreak? coxsackie A virus Neisseria meningitidis Cryptococcus neoformans an arbovirus rabies virus

an arbovirus

d. may have a GI bleed

an elderly male dx with a microcytic, hypochromic anemia: a. should be worked up for a malignancy b. might be consuming excessive amts of alcohol c. will have a decreased RBC count d. may have a GI bleed

Bipolar disorder is characterized by which type of mood?

an elevated expansive or irritable mood

b. pernicious anemia

an example of a macrocytic anemia is: a. iron deficiency anemia b. pernicious anemia c. anemia of chronic disease d. sideroblastic anemia

Secondary prevention

an intervention demonstrated to help prevent a secondary occurrence of a deleterious event; or may refer to an intervention designed for early detection.

b. associated with chronic disease

an obese 78 y/o male with poorly controlled HTN and diabetes has a normocytic, normochromic anemia. This anemia is likely: a. iron deficiency b. associated with chronic disease c. pernicious anemia d. folic acid deficiency anemia

a. increased MCV

an older adult has suspected B12 deficiency. Which of the following lab indices is most indicative of a B12 deficiency? a. increased MCV b. increased MCH c. decreased hematocrit d. thrombocytosis

b. macrocytosis

an older pt has suspected B12 deficiency. Which of the following lab indices is more indicative of a B12 deficiency? a. microcytosis b. macrocytosis c. leukocytosis d. thrombocytosis

How often do we screen smokers for lung cancer

annually

What type of medications are the following? Lamotrigine (Lamictal®) Gabapentin (Neurontin®) Topiramate (Topamax®).

anticonvulsants

What is the most common co-morbidity associated with depression?

anxiety

The most common mental disorder in older adults is:

anxiety Anxiety is very common in older adults. Depression is very common too, and may accompany anxiety in older adults. The prevalence of anxiety may be due in part to other physical illnesses or serious diseases or disorders, like cancer, Parkinson's disease. New onset anxiety should prompt the examiner to consider withdrawal of medication or side effects of medication being taken at therapeutic levels.

A patient with bulimia nervosa probably has concurrent:

anxiety It is very common that other co-morbidities are present with eating disorders. Anorexia is commonly accompanied by anxiety, especially at mealtimes. Neurotransmitters are thought to play some role in the pathogenesis of anorexia nervosa. This is common in the United States in women especially between the ages of 15 and 30 years. It is relatively uncommon in males.

What are the two most common types of co morbid conditions that occur with bipolar disease?

anxiety disorders and substance abuse

white specks

appearance of cortical

white line centrally with green/brown discolouration

appearance of nuclear

most self-exam lumps on breast exam

are benign

In patients who exhibit depression, selective serotonin reuptake inhibitors (SSRIs) are commonly chosen as a medication for treatment. SSRIs are often chosen because they

are safer than other medications for depression SSRIs are commonly chosen over tricyclic antidepressants (TCAs) and other medication classes for depression because they have fewer side effects and are thus better tolerated by patients; and because they are safer if overdose occurs. The SSRIs have never been shown to be more efficacious than the TCAs, though publication bias may demonstrate this. Generally, levels of antidepressant medications are not monitored and so laboratory testing is not an issue.

acute infective endocarditis

arises from new infection staphylococci Onset and resulting destruction is RAPID, days to weeks

Once the patient is on lithium what do you need to be sure to assess that goes along with the therapeutic range?

assess level of hydration

If you give meds to a person who is experiencing psychotic break, what should you always do first?

assess the person for a baseline. BP, Mood, etc.

special considerations

associated with an increased risk of depression, mood alterations, suicidal ideation

which is more prevalent asthma or COPD

asthma, but COPD more deadly

How long does there have to be symptoms of flucuating moods to diagnose cyclothymic disorder?

at least two years

Risks associated with too much levothyroxine?

atrial fibrillation, accelerated bone loss

uncompicated COPD antimicrobial treatment

azithromycin

A patient with shortness of breath has suspected heart failure. What diagnostic test would best help determine this? a. Echocardiogram b. B type natriuretic peptide (BNP) c. EKG d. Chest x-ray

b. B type natriuretic peptide (BNP) Rationale: BNP is a hormone involved in regulation of blood pressure and fluid volume. When the BNP level is 80 pg/mL or greater, the sensitivity and specificity is 98% and 92%, favoring a diagnosis of heart failure. Alternatively, BNP level less than 80 pg/mL strongly suggest that heart failure is not present (some U.S. institutions use 100 pg/mL). Other conditions may cause elevated BNP levels: thoracic and abdominal surgery, renal failure, and subarachnoid hemorrhage. Consequently, careful assessment of the patient is prudent. Echocardiograms mechanically evaluate the heart and establish an ejection fraction. If <35-40%, then CHF can usually be diagnosed. Ejection fractions do not always correlate with patient symptoms. EKG evaluates the electrical activity of the heart. Chest x-ray can indicate heart failure, but a BNP is a more sensitive measure.

A patient was burned with hot water. He has several large fluid-filled lesions. What are these termed? a. Vesicles b. Bullae c. Cysts d. Wheals

b. Bullae Rationale: Bullae are fluid-filled lesions that are greater than 6 mm in diameter. These are common in patients who have a superficial partial thickness burn. Vesicles are also fluid filled, but they are smaller than 5 mm in diameter. A cyst is enclosed in a sac that can contain fluid or gelatinous material. Wheals are erythematous, irregular raised areas on the skin. All of these are termed primary lesions.

A patient is found to have koilonychia. What laboratory test would be prudent to perform? a. Liver function test b. Complete blood count c. Hepatitis B surface antigens d. Arterial blood gases

b. Complete blood count Rationale: Koilonychia is a term that describes spoon-shaped nails. Spoon-shaped nails may be present in patients with long-standing iron deficiency anemia. A CBC should be performed to assess for anemia. The most common symptoms of iron deficiency anemia are weakness, headache, irritability, fatigue, and exercise intolerance.

A 60-year-old patient is noted to have rounding of the distal phalanx of the fingers. What might have caused this? a. Coronary artery disease b. Hepatic cirrhosis c. Lead toxicity d. Iron deficiency anemia

b. Hepatic cirrhosis Rationale: Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often associated with chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease.

A patient with newly diagnosed heart failure has started fosinapril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure? a. It is dry and non-productive. b. It is wet and worse with recumbence. c. It is purulent and tachycardia accompanies it. d. Shortness of breath always results after coughing.

b. It is wet and worse with recumbence. Rationale: The cough associated with fosinapril (an ACE inhibitor), is dry, non-productive and may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as "worse at night". A cough that is purulent and when tachycardia accompanies it is often associated with fever and probably reflects an infectious process like pneumonia.

A "herald patch" is a hallmark finding in which condition? a. Erythema infectiosum b. Pityriasis rosea c. Seborrheic keratosis d. Atopic dermatitis

b. Pityriasis rosea Rationale: Pityriasis rosea (PR) is a self-limiting exanthematous skin disorder characterized by several unique findings. It is more common in young adults. A characteristic finding is the "herald" or "mother" patch found on trunk. This looks like a ringworm and precedes the generalized "Christmas tree" pattern rash. The lesions associated with the rash are salmon-colored and oval in shape. Most cases clear in 4 to 6 weeks, but the plagues may last for several months.

Which test listed below may be used to exclude a secondary cause of hyperlipidemia in a patient with elevated lipids? a. CBC b. TSH c. Urine culture and sensitivity d. Sedimentation rate

b. TSH Rationale: Patients who have dyslipidemia should be screened for diabetes, renal disease, and hypothyroidism. Nephrotic syndrome can produce remarkably elevated cholesterol levels. Therefore, measurements of glucose, creatinine, and thyroid stimulating hormone should be performed when elevating dyslipidemia. Sedimentation rate is a measurement of non-specific inflammation and so it is not helpful in this situation. Specifically, hypothyroidism can produce marked lipid abnormalities.

A patient has used a high potency topical steroid cream for years to treat psoriasis exacerbations when they occur. She presents today and states that this cream "just doesn't work anymore." What word describes this? a. Rebound effect b. Tachyphylaxis c. Tolerance d. Lichenification

b. Tachyphylaxis Rationale: Tachyphylaxis is the word used to describe a gradual and progressively poorer clinical response to a treatment or medication. This is particularly true of topical glucocorticoids, broncodilators, nitroglycerin, and antihistamines when they are overused. The rebound effect describes a condition where initial clinical improvement occurred, but worsening now has occurred. lichenification refers to the thickening of the skin. Drug free intervals are important to prevent tachyphylaxis.

The most common form of skin cancer is a. squamous cell carcinoma b. basal cell carcinoma c. malignant melanoma d. cutaneous carcinoma

b. basal cell carcinoma Rationale: Skin cancers are divided into two major groups: non-melanoma and melanoma skin cancer. Basal cell carcinoma is considered non-melanoma skin cancer and is the most common form of skin cancer in the United States. It is most common in 40-60 year-olds, but can be found in any age if the skin is regularly exposed to sunlight or ultraviolet radiation. Basal cell carcinoma grows slowly and if not treated can spread to surrounding areas of tissue or bone.

A 75-year-old patient with longstanding hypertension takes a combination ACE inhibitor/thiazide diuretic and amlodipine daily. Today his diastolic blood pressure and heart rate are elevated. He has developed dyspnea on exertion and peripheral edema over the past several days. These symptoms demonstrate: a. primary renal dysfunction b. development of heart failure c. failure of HCTZ d. dietary indiscretions

b. development of heart failure Rationale: The symptoms of increased heart rate in the presence of dyspnea on exertion and peripheral edema are symptoms of heart failure. Longstanding hypertension is a major risk factor for development of heart failure. Dietary indiscretion, like sodium/fluid excess may produce peripheral edema, but should not produce dyspnea and peripheral edema in the absence of heart failure.

A patient with poorly controlled hypertension and history of myocardial infarction 6-years-ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom in NOT indicative of a heart failure exacerbation? a. fatigue b. headache c. orthopnea d. cough

b. headache Rationale: Fatigue is a common symptom in cardiac patients that can represent a worsening of many cardiac diseases such as coronary artery disease, heart failure, and valvular dysfunction. Orthopnea and cough, especially nocturnal, are classic symptoms of heart failure.

The valve most commonly involved in chronic rheumatic heart disease is the a. aortic b. mitral c. pulmonic d. tricuspid

b. mitral Rationale: The mitral valve has a propensity for disorders secondary to rheumatic heart disease. Rarely is the pulmonic valve involved, but the aortic and tricuspid valves follow in descending order of involvement. Following an episode of rheumatic fever, which occurs infrequently in the US today but is common in developing countries, the valves can become stenotic or regurgitant. This is a major cause of valvular disease in the US seen primarily in immigrants.

A skin lesion which is a solid mass is described as a a. macule b. papule c. vesicle d. bullae

b. papule Rationale: A papule is an elevated solid mass up to 1.0 cm. in diameter. A macule is flat and small; like a fickle. A vesicle is filled with a serous fluid and less than 1.0 cm. in diameter. A bullae is fluid-filled and larger than 1.0 cm. in diameter.

The lesions seen in a patient with folliculitis might be filled with a. blood b. pus c. fluid d. serous fluid

b. pus Rationale: Folliculitis is a superficial inflammation of the hair follicle usually caused by bacteria. As a superficial infection, it involves only the epidermis. When this occurs, there are usually numerous pustular lesions. The composition of pus is dead white cells and other cellular debris.

The best way to evaluate jaundice associated with liver disease is to observe a. blanching of the hands, feet, and nails b. the sclera, skin, and lips c. the lips, oral mucosa, and tongue d. tympanic membrane and skin only

b. the sclera, skin, and lips Rationale: Looking at the sclera allows the examiner to see jaundice more easily and reliably. Jaundice may also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin. Jaundice in adults is a result of liver disease usually, but can be due to excessive hemolysis of red blood cells. In infants the usual cause is hemolysis of red blood cells as is seen in physiologic jaundice.

A child is brought to the hospital with a high fever, nausea, and vomiting, and complaining of headache. The cerebrospinal fluid collected by spinal tap is cloudy and contains spherical cells which stain Gram-positive. These signs and symptoms are consistent with -cryptococcal meningitis due to infection with Cryptococcus neoformans. -bacterial meningitis probably due to Streptococcus. -tetanus resulting from infection with Clostridium botulinum. -primary amebic encephalitis caused by Naegleria. -aseptic meningitis from infection with Neisseria meningitidis.

bacterial meningitis probably due to Streptococcus

physical findings

barrel chest cyanosis of mucosal membranes increased resting respiratory rate shallow breathing pursed lips during respiration

chronic bronchitis characteristics

blue bloaters 46-65 mild dyspnea prominent cough prominent sputum obese hypoxia

second most common cause of cancer death in women

breast cancer

The major advantage of the CAGE questionnaire is:

brevity of questions The CAGE questionnaire is a screen for alcohol abuse. It consists of 4 questions that can be quickly and easily incorporated when eliciting a patient's history. The "C" is to remind the questioner to ask the patient whether he's ever felt the need to "C"ut down on drinking; "A"nnoyed by criticism about his drinking; "G"uilty about his drinking; in need of an "E"ye opener. These 4 questions are very easy to ask and can be answered with a simple yes/no response. The majority of patients with alcoholism respond yes to at least 2 of these questions. Patients without alcohol problems virtually never respond "yes" to 2 or more. The questionnaire is known to have high sensitivity and specificity, but is less sensitive for early or heavy drinking.

mechanism of action

bronchodilation through variety of mechanism

surgical options

bullectomy, lung volume reduction , lung transplantation

The nurse practitioner examines a patient who has had poison ivy for 3 days. The patient asks if she can spread it to her family members. The nurse practitioner replies: a. "yes, but only before crusting has occurred" b. "yes, the fluid in the blister can transmit it" c. "no, transmission does not occur from the blister's contents" d. "no, you are no longer contagious"

c. "no, transmission does not occur from the blister's contents" Rationale: The skin reaction seen after exposure to poison ivy (or any other skin irritant), takes place because of contact with the offending substance. In the case of poison ivy, the harmful exposure occurs from contact with oil from the plant. The eruptions seen are NOT able to transmit the reaction to other people unless oil from the plant remains on the skin and someone touches the oil. The fluid found in the blisters is NOT able to transmit poison ivy to anyone, only the oil from the plant can do that. After the oil has touched the skin, some time must pass for the reaction to occur. Therefore, reaction times vary depending on skin thickness and quantity of oil contacting the skin.

A patient has poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI): a. 5th Intercostal space (ICS) mid-clavicular line (MCL) b. 8th ICS MCL c. 5th ICS, left of MCL d. 6th ICS, right of MCL

c. 5th ICS, left of MCL Rationale: The PMI or apical impulse is produced when the left ventricle moves anteriorly and touches the chest wall during contraction. This is normally found at the 5th intercostal space, mid-clavicular line. Certain conditions and diseases like heart failure, cardiomyopathy may account for this, or left ventricular hypertrophy from prolonged hypertension can displace the apical impulse. The displacement usually occurs left and laterally from its usual location. Thus, 5th ICS, left of mid-clavicular line. Conditions like pregnancy may displays apical impulse upward and to the left.

In what people is rapid cycling most common?

children

Which class of medication id frequently used to improve long-term outcomes in patients with systolic dysfunction? a. Loop diuretics b. Calcium channel blockers c. ACE inhibitors d. Thiazide diuretics

c. ACE inhibitors Rationale: ACE inhibitors are commonly used in patients with systolic dysfunction because they reduce morbidity and mortality, i.e. these medications alter prognosis. They also improve symptoms of fatigue, shortness of breath, and exercise intolerance. Loop and thiazide diuretics improve symptoms, but do not alter long-term prognosis with heart failure. Beta blockers should be used in conjunction with ACE inhibitors and diuretics, but not as solo agents. Beta blockers can potentially worsen heart failure, so their use in patients with heart failure should be monitored carefully.

A patient with hypertension has taken hydrochlorothiazide 25 mg daily for the past 4-weeks. His B/P has decreased from 155/95 to 145/90. How should the nurse practitioner proceed? a. Wait 4-weeks before making a dosage change b. Increase the hydrochlorothiazide to 50 mg daily c. Add a drug from another class to the daily 25 mg of hydrochlorothiazide d. Stop the hydrochlorothiazide and start a drug from a different class

c. Add a drug from another class to the daily 25 mg of hydrochlorothiazide Rationale: Although we do not know this patient's age, race, or target blood pressure, it still exceeds the minimum threshold of 140/90 mm Hg. It is not acceptable to continue the current dose. Increasing the hydrochlorothiazide to 50 mg daily will not result in a decrease in blood pressure, only an increase in potassium loss. Adding a drug from a different medication class is a good choice because the combined effects of antihypertensive medications nearly always produce a decrease in blood pressure and both drugs can be maintained in low doses to minimize side effects.

What patient category needs a backup throat culture if RADT is negative?

children; they are at higher risk for other complications; not needed if a optical immunoassays used and it is more accurate

Which item below represents the best choice of anti-hypertensive agents for the indicated patient? a. Beta blocker for a 38-year-old diabetic patient b. ACE inhibitor for a patient on a K⁺ sparing diuretic c. Beta blocker for a 46-year-old patient with migraines d. Diuretic for a patient with a history of gout

c. Beta blocker for a 46-year-old patient with migraines Rationale: Beta blockers may be used is prophylactic agents in patients with migraine headaches, thus, serving to treat hypertension and as prophylaxis for migraine headaches in this patient. Beta blockers may mask the signs and symptoms of hypoglycemia in patients with diabetes. They should be used with caution, but use when indicated. ACE inhibitors decrease potassium loss and should not be routinely used in patients who are on potassium sparing diuretics because hypercalcemia may result. Diuretics can produce hyperuricemic states due to fluid loss. Therefore, they should be avoided in patients with gout.

The American Cancer Society uses and ABCDE pneumonic to help patients develop awareness of suspicious skin lesions. What does the "B" represent? a. Bleeding b. Black c. Border d. Benign

c. Border Rationale: The pneumonic is helpful when looking at skin lesions, but is primarily used for patient education. The "A" represents asymmetry (asymmetrical lesions are worrisome), "B" is border (irregular borders), "C" is color (colored lesions have more melanin imparted to them and may be associated with malignant melanomas), "D" is diameter (larger than a pencil eraser is concerning), and "E" represents enlarging or elevated (lesions which are actively enlarging are growing; elevated lesions are concerning).

A patient reports that he found a tick on himself about a month ago. He reports that there is a red circle and a white center near where he remembers the tick bite. He did not seek treatment at the time. Today he complains of myalgias and arthralgias. What laboratory test can be used to help diagnose Lyme Disease? a. CBC b. Lyme titer c. ELISA d. skin scraping

c. ELISA Rationale: A detailed history should always precede testing for Lyme Disease. The red circle with the white center is likely arrhythmia migrans (EM). EM is the characteristic skin lesion of Lyme disease (and other illnesses) and usually occurs within one month following the tick bite. Many learned authorities including the Infectious Disease Society of America conclude the individuals should not be screened or tested for Lyme disease unless they have a high probability of having Lyme disease. In this case, historical features coupled with physical exam support the diagnosis, and the screening. The most common initial serologic testing for screening is an ELISA. If it is positive, it should be confirmed with a Western blot. Unfortunately, there are a large number of false positives and so a confirmation should be performed.

Which study would be most helpful in evaluating the degree of hypertrophy of the atrium or ventricle? a. Chest x-ray b. Electrocardiogram c. Echocardiogram d. Doppler ultrasound

c. Echocardiogram Rationale: Echocardiography is of greatest value when evaluating values, chamber size, cardiac output, and overall function of The myocardium. It is non-invasive and allow specific measurement of chamber size and thickness of the myocardium. The chest film is important in identification of chamber enlargement, but its primary importance is in assessment of the pulmonary vasculature. Electrocardiography (ECG) provides information about the hearts conduction system and identifies cardiac rhythm, though ventricular enlargement can be identified on ECG. Doppler ultrasound identifies intracardiac flow velocities and can assist in quantifying the severity of regurgitation or stenosis.

Types of COPD

chronic bronchitis emphysema combo

chronic bronchitis

chronic excessive mucus secretions airway obstruction due to edema and bronchial inflammation cough present most days for at least 3 months for 2 years

Which of the following antibiotics may increase the likelihood of photosensitivity? a. Amoxicillin b. Cephalosporins c. Fluoroquinolones d. Macrolides

c. Fluoroquinolones Rationale: Many medications can produce a phototoxic reaction when a patient is exposed to sunlight. Antibiotics are especially notable for this. Common antibiotics associated with photosensitivity are tetracyclines, sulfa drugs, and fluoroquinolones. Other common medications that increase photosensitivity are hydrochlorothiazide, diltiazem, selective serotonin reuptake inhibitors, antihistamines, ibuprofen, and naproxen.

A 65-year-old male patient has the following lipid levels: Total cholesterol = 240 mg/dL LDL = 140 mg/dL HDL = 35 mg/dL Triglycerides = 129 mg/dL What class of medications is preferred to normalize his lipid levels and reduce his risk of a cardiac event? a. Niacin b. Fibric acids c. HMG Co-A reductase inhibitors d. Bile acid sequestrants

c. HMG Co-A reductase inhibitors Rationale: The only medication class that reduces elevated lipid levels and has proven efficacy in reducing risk of cardiac events, even for primary prevention, is a HMG Co-A reductase inhibitor, a statin. Statin therapy has been shown to reduce overall mortality due to cardiovascular deaths. The statin should significantly reduce his total cholesterol and LDL levels.

A patient with hypertension describes a previous allergy to a sulfa antibiotic as "sloughing of skin" and hospitalization. Which medication is contraindicated in this patient? a. Ramipril b. Metoprolol c. Hydrochlorothiazide d. Verapamil

c. Hydrochlorothiazide Rationale: This patient's allergy to "sulfa" sounds like Stevens-Johnson Syndrome, a potentially life-threatening allergic reaction. Hydrochlorothiazide has a sulfonamide ring in its chemical structure, generally referred to as "sulfa". This sulfonamide ring can initiate an allergic reaction in patients with sulfa allergy. Since the patient's allergic reaction to sulfa was so serious, other sulfonamide medications should be completely avoided until consultation with an allergist. The other medications can be used without concern in the presence of a patient with sulfa allergy because there is no sulfonamide component.

Which laboratory abnormality may be observed in a patient who takes lisinopril? a. Decreased INR b. Decreased calcium level c. Increased potassium level d. Increased ALT/AST

c. Increased potassium level Rationale: Lisinopril is an ACE inhibitor. This medication causes retention of potassium. A potassium level should be measured about one month after initiating therapy and after each dose change. The other laboratory values are not specific to changes that can take place when a patient takes an ACE inhibitor.

A 40-year-old African American patient has a B/P readings of 175/100 and 170/102. What is the reasonable plan of care for this patient today? a. Start low dose thiazide diuretic b. Start an ACE inhibitor twice daily c. Initiate low dose HCTZ and candesartan d. Initiate amlodipine, beta blocker, or ACE inhibitor

c. Initiate low dose HCTZ and candesartan Rationale: This patient has Stage 2 hypertension based on JNC VII's classification of hypertension. Stage 2 hypertension should be treated initially with two medications and lifestyle modifications. Based on this, choice c is the best response. A single medication is unlikely to decrease his blood pressure to a normal range.

A 16-year-old male has nodulocystic acne. What might have the greatest positive impact in managing his acne? a. Retin-A plus minocycline b. Benzoyl peroxide plus erythromycin c. Isotretinoin (Accutane) d. Oral antibiotics

c. Isotretinoin (Accutane) Rationale: Nodulocystic acne is the most severe form of acne vulgaris. Nodules and cysts characterize this disease. They can be palpated and usually seen on the skin, although, they actually are under the skin's surface. They develop when the follicle wall ruptures and leaks pus and cell contents in the dermis. The contaminated material infects adjoining follicles and the nodule develops. Isotretinoin is the only known effective treatment.

A patient is taking atorvastatin for newly diagnosed dyslipidemia complains of muscle aches in his upper and lower legs for the past 3-weeks. It has not improved with rest. How should this be evaluated? a. Stop the atorvastatin immediately. b. Check liver enzymes first. c. Order a CPK level d. Ask about nighttime muscle cramps.

c. Order a CPK level Rationale: This patient has a complaint of myalgias that could be associated with statin use. This patient should be assessed for rhabdomyolysis. This is done by measuring a CPK level. If this level is elevated, atorvastatin should be stopped immediately. Liver enzymes would not assess for the etiology of myalgias. They assess tolerance of statins in the liver. Nighttime muscle cramps are not associated with statin use.

Which of the following lesions never blanches when pressure is applied? a. Spider angioma b. Spider vein c. Purpura or petechiae d. Cherry angioma

c. Purpura or petechiae Rationale: Blanching with pressure over spider angiomas always occurs. Spider veins and cherry angiomas usually blanch with pressure. Purpura and petechiae never blanch with pressure. Purpura and petechiae present an extravasation of blood under the skin. This will not blanch. This is usually observed in patients with thrombocytopenia or trauma.

A skin lesion fluoresces under a Wood's lamp. What microscopic finding is consistent with this? a. clue cells b. herpes simplex c. hyphae d. leukocytes

c. hyphae Rationale: A Wood's lamp emits ultraviolet light when turned on. If an area fluoresces under Wood's lamp illumination, a fungal (and sometimes bacterial) infection should be suspected. The test is most effectively performed in a darkened room so the fluorescence can be more easily identified. Deodorant, soap, and makeup may also fluoresce. About one-third of hyphae fluoresce.

A medication which may produce exercise intolerance in a patient with hypertension is a. hydrochlorothiazide b. amlodipine c. metoprolol d. fosinopril

c. metoprolol Rationale: Metoprolol is a cardioselective beta blocker. It will produce bradycardia that is responsible for exercise intolerance. As a patient exercises, concomitant increase in heart rate allows for an increase in cardiac output. If the heart rate is not able to increase because of beta blocker influence, neither can the cardiac output. The patient will necessarily slow down his physical activity. Choices a and d have no direct effect on heart rate. Amlodipine is a calcium channel blocker that does not decrease heart rate.

A patient will be taking oral terbinafine for fingernail fungus. The nurse practitioner knows that a. this will cure her infection 95% of the time b. a topical anti-fungal will work just as well when the nail matrix is involved c. terbinafine is a potential inhibitor of the CYP 3A4 enzymes d. toenail fungus resolves faster than fingernail fungus after treatment

c. terbinafine is a potential inhibitor of the CYP 3A4 enzymes Rationale: Most oral antifungal agents inhibit the 3A4 enzymes in the cytochrome P450 system. This is why they must be used with extreme caution (or not used) in patients who consume medications that need 3A4 enzymes for metabolism. And, liver enzymes must be monitored in patients who take oral antifungal medications and discontinued if elevations are >2.5 times the upper limits of normal. There is no oral agent that has a 95% cure rate for fingernail fungus (tinea unguium). This can be a difficult infection to clear even if oral antifungal agents are utilized. A topical antifungal agent typically will not clear the infection if the nail matrix is involved. There is anecdotal evidence that menthol ointments or bleach may cause resolution when used topically. Generally, resolution of fingernail fungus occurs more rapidly than toenail fungus because toenails grow at lower rates than fingernails.

Why is double contrast barium enema not great?

can miss smaller lesions. Problem is that most colon cancers are on the left side, but some on right. Used to be combined with flexible sigmoidoscopy, but not just get colonoscopy.

trauma aging radiation congenital eye surgery

causes of cataracts

Ludwig angina:

cellulitis in floor of mouth

Which of the following would be an effective treatment for bacterial meningitis? Hib vaccine PCV MCV4 cephalosporins All of the above are correct.

cephalosporins

Nervous system control of voluntary muscles, perception, and thought is localized in the brain stem. cerebrum. meninges. cerebellum. spinal cord.

cerebrum

varenicline

chantix

Lung Cancer screening is recommended for?

current smokers or those who have quit within the past 15 years, AND have <30 pack years histories of smoking AND are age 55-74 (ACS recoendation) or 55-80 (USPSTF recommendatio

Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption? a. 21-year-old Asian American male b. 35-year-old menstruating female c. 55-year-old post menopausal female d. 70-year-old African American male

d. 70-year-old African American male Rationale: Two groups of patients typically experience adverse blood pressure effects from consumption of sodium greater than 2,000 mg daily. Those patients considered to be most sodium sensitive are elderly patients and African American patients.

Which test is NOT suitable to diagnose shingles if the clinical presentation is questionable? a. Tzanck preparation b. Polymerase chain reaction (PCR) c. Direct fluorescent antibody (DFA) d. Complete blood count (CBC)

d. Complete blood count (CBC) Rationale: Herpes viruses are the causative agents in shingles, chickenpox, genital herpes, and oral fever blisters. Diagnosis is usually made on clinical presentation. However, in questionable cases, lab tests may be employed. A Tzanck preparation is a rapid test used to diagnose infections due to herpes viruses. Cells taken from a blister's fluid are smeared on a slide and stained with a Wright's stain or the fluid can be used for other methods of testing. DFA is the most common test employed for shingles diagnosis because it can be rapidly performed and offers results in about 90 minutes. PCR may be performed on skin scrapings, serum or blood for herpetic diagnosis. CBC may indicate a patient with a viral infection, but is non-specific for herpetic infections.

According to the National Heart, Lung and Blood Institute, which characteristic listed below is a coronary heart disease (CHD) risk equivalent; that is, which risk factor places the patient at similar risk for CHD as a history of CHD? a. Hypertension b. Cigarette smoking c. Male age > 45 years d. Diabetes mellitus

d. Diabetes mellitus Rationale: In determining whether a patient should be treated for hyperlipidemia, a patient's risk factors must be determined. After assessing fasting lipids, specifically LDLs, CHD equivalents must be identified. These are diabetes, symptomatic carotid artery disease, peripheral artery disease, abnormal aortic aneurysm, and multiple risk factors that confer a 10 year risk of CHD > 20%. Major CHD risk factors are elevated LDL cholesterol, cigarette smoking, hypertension, low HDL cholesterol, family history of premature CHD [in male first degree relatives (FDR) < 55years; female FDR, 65 years] , and age (men ≥ 45 years, women ≥ 55 years). Patients with 2 or more risk factors should have a 10 risk assessment performed and treated accordingly.

A patient has seborrheic dermatitis. Which vehicle would be most appropriate to use in the hairline area to treat this? a. Solution b. Cream c. Powder d. Foam

d. Foam Rationale: Seborrheic dermatitis affects the hairy areas of the body. In hairy areas of the body, foams are specifically used because they spread easily and are transparent. Lotions can be used in hairy areas because they provide a cooling, drying effect and are transparent. Lotions are the weakest of all vehicles. Creams and powders could be used, but patients prefer other vehicles and so compliance is less with these.

Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about one week? a. Heart rate b. Blood pressure c. EKG d. Potassium level

d. Potassium level Rationale: ACE inhibitors work in the kidney in the renin angiotensin aldosterone system and can impair renal excretion of potassium in patients with normal kidney function. In patients with impaired renal blood flow and/or function, the risk of hyperkalemia is increased. Common practice is to monitor potassium, BUN, and Cr at about one week after initiation of an ACE inhibitor and with each increase in dosage.

Risk factors for endometrial cancer development

early menarch; late menopause; infertility; obsetity; FH of DM, breast or ovarian cancer or pelvic radtiotion therapy

Risk factors for Ovarian cancer development

early menarche; late first pregnancy; late menopause; FH of ovarian, breast, or colorectal cancer; Hersonal history of colorectal cancer; obestity

A low potency topical hydrocortisone cream would be most appropriate in a patient who has been diagnosed with a. psoriasis b. impetigo c. cellulitis d. atopic dermatitis

d. atopic dermatitis Rationale: Low potency steroid creams are almost never potent enough to treat psoriasis. These require higher potency steroid preparations or systemic agents. Impetigo is a superficial bacterial infection and a steroid cream would be contraindicated. Cellulitis is an infection of the subcutaneous layer of the skin and requires an oral or systemic antibiotic. Atopic dermatitis is a chronic inflammatory disorder of the skin that involves a genetic defect in the proteins supporting the epidermal layer. A patient with atopic dermatitis would be the most appropriate (of those listed above) to use a low potency topical steroid cream.

Which of the following areas of the body has the greatest percutaneous absorption? a. sole of the feet b. scalp c. forehead d. genitalia

d. genitalia Rationale: Genitalia have the highest percutaneous absorption across the entire body. This is important because low potency creams will act with greater potency in this area. Always start with low potency creams in the genitalia. The sole of the foot has the lowest percutaneous absorption followed by the scalp, forehead, and genitalia. Therefore, the sole of the foot will require more potent vehicles to enhance absorption.

In order to reduce lipid levels, statins are most beneficial when taken: a. once daily in the AM b. always with food c. with an aspirin in the evening d. in conjunction with diet and exercise

d. in conjunction with diet and exercise Rationale: Statins are used to reduce elevated level of lipids in conjunction with modifications in diet and exercise. The timing of statin dosing and and indication with food (or not) is different for each statin. Most patients who take statins are also candidates for aspirin therapy as primary or secondary prevention, but aspirin does not improve statin tolerance. Statins are correctly taken once daily.

Carbamazepine is used in patients with bipolar disorder for mood stabilization. Prescribers who have patients taking carbamazepine should be alert to:

drug-drug interactions Carbamazepine is an enzyme inducer in the cytochrome P450 system. Consequently, there are a number of drug-drug interactions that can take place as a result. Any time a new medication is prescribed, pharmacist oversight or a drug interaction checker should be employed. Additionally, any time new symptoms develop, medication use and compliance should be assessed.

Carbamazepine is for bipolar disorder for mood stabilization. What should you be alert for in patients taking carbamazepine?

drug-drug interactions. Carbamazepine is an enzyme inducer in the cytochrome P450 system.

A patient has an audible diastolic murmur best heard in the mitral listening point. There is no audible click. His status has been monitored for the past 2 years. This murmur is probably a. mitral valve prolapse b. acute mitral regurgitation c. chronic mitral regurgitation d. mitral stenosis

d. mitral stenosis Rationale: Mitral valve prolapse (MVP) is an unlikely etiology since MVP is a systolic murmur. Additionally, the question states there is no audible click, and a mid to late systolic click is characteristic of MVP. Acute mitral regurgitation (MR) develops usually after rupture of the chordae tendineae, ruptured papillary muscle after myocardial infarction, or secondary to bacterial endocarditis. Symptoms of failure appear with abrupt clinical deterioration in the patient. There would not be a two-year course for this patient. Dilation of the left atrium and ventricle is typical in chronic MR since both chambers are affected from the regurgitant blood flow across the diseased valve, but, MR is a systolic murmur, not diastolic. This is mitral stenosis (MS) because MS produces the only diastolic murmur listed in the question.

valve replacement

damaged valve replaced with prosthetic or biological valve (bovine, porcine, cadaver)

Dry, poor tugor

dehydration can cause this

MMSE helps to identify patients with symptoms of:

dementia The mini mental status exam (MMSE) is a very common and easily administered cognitive evaluation for dementia. It tests orientation, recall, attention, calculation, language manipulation, and constructional praxis. It is not sensitive for mild dementia and may be influenced by educational level and age. Even with these limitations, the MMSE is the most widely used cognitive test for dementia in the US.

Serotonin is thought to play a role in the etiology of:

depression Serotonin (5-HT) is a neurotransmitter released in the brain. It is part of the monoamine oxidase system. These neurotransmitters are responsible for many emotional and behavioral disorders. Agents that cause more serotonin to be available in the brain have an ameliorating effect on symptoms of depression, anxiety, and obsessive-compulsive behavior.

Temoral Arteritis

diagnosed by temporal artery biopsy. Temporal arteritis is a chronic vasculitis of the medium and large vessels. A biopsy can be performed on the same day it is suspected. Generally patients have complaints of new onset headaches, abrupt onset visual disturbances jaw claudication, unexplained fever or anemia and an elevated sedimentation rate. The average age of diagnosis is 72 years. She should be referred to neurology for evaluation today.

One first-degree relative with breast cancer....

doubles the risk

A patient who abuses alcohol will probably exhibit:

elevated ALT, AST, and GGT Liver enzymes rise in response to acute injury to the liver. ALT and AST are frequently elevated when alcohol abuse occurs. Specifically, the AST is usually the higher of the two enzymes and can signify alcohol abuse when it is more than 2 times greater than the ALT. In patients who abuse alcohol daily, the ALT and AST may be normal. GGT, gamma-glutamyl transferase, is often elevated even when ALT and AST are normal. It can help identify damage to the liver as a result of alcohol abuse.

Evaluation of Care

endocarditis can be prevented so ultimate evaluation of treatment would be that patient does not develop disease if patient does contract endocarditis, curing the infection with no residual damages would be the goal to evaluate

HIPAA

ensured that people will not have to wait for health insurance to go into effect when changing jobs

Clinical Assessment

evaluation of nutritional status based upon direct observation of the patient/signs and symptoms

How often do 21-65 year olds continue cervical cancer screening

every 1-3 years

Cranial nerves 3,4,6 do

extraocular movement

hypotropia:

eye drifts downward

esotropia:

eye drifts inward

exotropia:

eye drifts outward

hypertropia:

eye drifts upward

Strabismus

eyes do not line up in same direction or look at same object at same time

A patient who is 73 years old was diagnosed with diabetes several years ago. His A1C has remained elevated on oral agents and a decision to use insulin has been made. What is the goal post prandial glucose for him

less then 180 for older adults In older adults, strong consideration must be given to the risk associated with hypoglycemic states. Falls, accidents, and stroke are more likely; and these are more deleterious in older adults than younger adults who have episodes of hypoglycemia. A1C levels should be < 7% for most older adults; > 7% for frail adults. Good clinical judgment must be exercised in setting a goal A1C for this patient due to age.

d. sickle shaped cells

leukemia may have varied clinical presentations. Which characteristic would be unusual to find in a pt with leukemia? a. thrombocytopenia b. hepatosplenomegaly c. severe anemia d. sickle shaped cells

Risk of P. aeroginosa antimicrobial treatment

levaquin

Listeria monocytogenes pathogenesis is directly related to its ability to produce a powerful toxin. form endospores. produce a polysaccharide capsule. resist most antimicrobial agents. live and reproduce inside its host's cells.

live and reproduce inside its host's cells

Chronic Azithromycin benefits

longer time to exacerbation decreased rates exacerbation improved quality of life

How do we screen for lung cancer

low dose CT

What are the different levels on the spectrum of mood disorders?

mania hypomania normal mood mild to moderate depression severe depression

Women greater risk for depression and rapid cycling than are male patients. Where as males at greater risk for _______ ________.

manic episodes

Fixed indemnity

max amount an insurer will pay for a certain service

Psychomotor Changes

may be due to Kwashiorkor

Gold recommendations for azithromycin

only for exacerbations

what can distinguish herpangina from GABHS pharyngitis?

oral lesions in posterior oral cavity

A 26 year-old female with low-grade fever and nausea has pain at McBurney's point. The most appropriate action by the NP is to:

order a CBC and pregnancy test -Patients with appendicitis usually have pain at McBurney's point, the painful area in the lower right quadrant of the abdomen. However, because this patient is of child bearing age, pregnancy is part of the differential and must be ruled out. Once pregnancy status is determined, patient disposition can be managed. If pregnancy is ruled out, then workup for appendicitis can proceed. CT scan of abdomen has very high sensitivity and specificity for appendicitis (95 and 94% respectively) and so it is the gold standard for diagnosis of appendicitis

additional causes

oxidative stress imbalance of proteases and antiproteases

non pharm therapy

oxygen mechanical ventilation smoking cessation pulmonary rehabiltation

treating exacerbation

oxygen therapy short acting bronchodilators corticosteroids antibiotics

The least common type of polio is paralytic polio. nonparalytic polio. postpolio syndrome. an asymptomatic infection. minor polio.

paralytic polio

Corneal abrasion:

partial or complete defect in epithethial layer of cells after trauma or overexposure to sun light

role of therapy

patients unable to use inhaled bronchodilators

A 68 year old smoker with a history of well controlled hypertension, describes a syncopal episode which occurred yesterday while mowing his lawn. Today he has no complaints. Initially the NP should:

perform a complete neurological and cardiac exam with auscultation of carotid arteries. a referral to speciality care is indicated after workup by nP. Syncope is a significant finding especially in a smoker with HTN

glaucoma

progressive damage to optic nerve causing atrophy and blindness; usually has elevated pressures

additional acute complications

pulmonary hypertension acute respiratory failure polycythemia

Two or more first-degree relatives with breast cancer...

quadruples the risk

Which of the following nervous system diseases is treated with both passive and active immunization? primary amebic meningoencephalopathy arboviral encephalitis rabies West Nile encephalitis botulism

rabies

Most patients with migraine headache symptoms do not need imaging for diagnosis. Which finding in a patient with migraine HA symptoms would compel the NP to order an imaging study?

rapidly increasing frequency of headache

Where should you refer a patient for psychological help after they are not in a state of mania anymore?

refer them for CBT

The most common symptoms associated with gastroesophageal reflux disease (GERD) are heartburn and:

regurg and dysphagia The three most commonly associated symptoms of GERD are heartburn, especially post-prandial, regurgitation, and dysphagia, especially after long-standing heartburn. Other common symptoms are chest pain, nausea, and odynophagia (painful swallowing).

What is the baseline function tests that needs to be performed before giving lithium?

renal function and thyroid

The clinical difference between minor depression and major depression is:

the number of symptoms present. Major depression is diagnosed when at least 5 symptoms out of nine symptoms (that characterize depression) are identified by the examiner. Minor depression is characterized by the presence of 2-4 of the nine symptoms. Symptoms must be present for at least 2 weeks and must be present most of the day nearly every day. One symptom that must be present is depressed mood. The 9 criteria are identified by the DSM V manual.

Co-insurance

the portion of the insurance company's approved amounts for covered services that a beneficiary is responsible for paying

b. anti-histamines

the primary therapeutic intervention for pts who present with hives is: a. steroids b. anti-histamines c. calcium channel blockers d. topical steroid cream

a. when other STDs are present

the risk of HIV transmission is increased: a. when other STDs are present b. in females c. when pts are aware of the HIV status d. in pts with diabetes

During which section of the biological, psychological, and social domain do you implement WRAP?

the social domain

b. hepatitis B surface antigen and IgM

the two tests which can indicate with certainty that a pt has hepatitis B at present are: a. hepatitis B surface antigen and antibody b. hepatitis B surface antigen and IgM c. hepatitis B surface antibody and core antibody d. positive IgG and positive core antibody

What is the main concern with tricyclic antidepressants?

they are more toxic in smaller overdoses. They are cardiotoxic but they are also not a good med of choice for anyone who is suicidal

c. purpura

thrombocytopenia may present as: a. fatigue b. fever c. purpura d. a butterfly rash

In a person in a manic state, what labs should you be looking at? What will you be assessing for with sexual behavior?

thyroid labs; Hypersexuality, risky behaviors

spiriva

tiotropium inhale contents of one capsule once daily

stiolto respimat

tiotropium/ olodaterol long acting two inhalation once daily

Viral meningitis is also called "aseptic meningitis" -since it is treatable with antiviral medications. -to indicate no bacteria are involved. -because it is frequently a nosocomial infection. -to distinguish it from encephalitis. -because it is vaccine-preventable.

to indicate no bacteria are involved

All of the following diseases can be fatal if untreated EXCEPT tetanus. rabies. trachoma. cryptococcal meningitis. primary amebic meningoencephalopathy.

trachoma

inflammation releases these chemical mediators

tumor necrosis factor alpha interleukin 8 (IL-8) leukotriene B4 (LTB4)

ECCE phaecoemulsification with intraocular lens replacement

two surgeries are

incruse ellipta

umeclidinium use one inhalation once daily

anoro ellipta

umeclidinium/ vilanterol long acting one inhalation once daily

A newly diagnosed pregnant teenager has suspected depression. Before a diagnosis is made, she should have a CBC, TSH, renal and liver function tests and:

urine toxicology screen There is a high correlation between psychiatric disorders and drug/alcohol use. This should be ascertained as soon as possible since these can have serious implications on the fetus/mother's health. None of the other tests listed have an impact on diagnosis of depression in a pregnant patient. CBC, TSH, and renal/hepatic function tests are used to screen depression "look a likes" (anemia, hypothyroidism, renal or hepatic dysfunction). Hemoglobin A1C is a good idea but is not as urgent as the urine toxicology screen unless there are diabetes risk factors present.

role in therapy

used for frequent or persistant symptoms stage 2 (moderate)

Which of the following is classified as a spongiform encephalopathy? botulism variant Creutzfeldt-Jakob disease African sleeping sickness Hansen's disease arboviral encephalitis

variant Creutzfeldt-Jakob disease

What are most cases of acute rhinosinusitis caused by?

viral URI

What is rapid, pressured speech characterized by?

volume or rate of speech is increased

What do current guidelines suggest for acute rhinosinusitis when symptoms first appear?

watchful waiting within the first 7-10 days

Within 6 months of treatment, what do patients (using SSRI's) often exhibit?

weight gain

special considerations

weight gain

Within 6 months of treatment, patients who are treated for depression with selective serotonin reuptake inhibitors often exhibit:

weight gain Weight gain is common among men and women who take SSRIs and tricyclic antidepressants (TCAs) because they stimulate appetite. Decreased libido may occur several weeks after starting SSRIs, but this can also be a symptom of depression. The tricyclic and heterocyclic compounds are often associated with blood sugar elevations. Elevations almost never occur within 6 months of starting use. Jitteriness and restlessness are commonly associated with SSRI use. These side effects generally subside after a month or less of therapy.

S/S of Addison's disease

weight loss, recurrent infections, darkening of skin, low blood pressure, low blood sugar, fatigue, diziness

a. fatigue and lymphadenopathy

what are the most common s/s associated with mononucleosis? a. fatigue and lymphadenopathy b. cough and pharyngitis c. splenomegaly and fevel d. rash and pharyngitis

d. gynecologic losses and bleeding in the GI tract

what choice below can be attributed to the two most common causes of iron deficiency anemia in adults? a. bleeding n the GI tract and through loss of bone mass b. aging and menses c. poor diet and lack of adequate iron intake d. gynecologic losses and bleeding in the GI tract

macular degeneration

what does 30% of cataracts coexist with

Acute otitis media can be diagnosed by identifying which otic characteristic(s)?

~Middle ear effusion and erythema of the TM The diagnosis of acute otitis media (AOM) requires the finding of a middle ear effusion (MEE) AND a sign of acute inflammation, such as distinct fullness or bulging of the tympanic membrane (TM), ear pain, or marked redness of the TM. MEE is characterized by the presence of middle ear fluid (bubbles or an air fluid interface) or finding of TM abnormalities (opacity, impaired mobility, or color change). The other finding that constitutes a diagnosis of AOM is the finding of acute, purulent otorrhea that is not due to otitis externa. This characterizes a ruptured TM from otitis media.

High risk patients include

• Known BRCA carrier or untested but 1st degree relative of BRCA+, or Chest wall radiation ages 10-30, or >20% lifetime risk

High risk BC patients require ...

• Requires annual mammography + MRI beginning at ate 30

Moderate risk patients require

• Requires annual mammography and discussion of optional MRI

When would MRI be recommended as an adjunct to mammography

• Women age 30+ who have a known BRCA mutation • First-degree relative with known BRCA mutation • Those with chest irradiation between 10-30 • Those with greater than 20% lifetime risk of breast cancer as determined by a CLINICAL RISK PREDICTION MODEL