Np Test 1

Front 1

Define: Mean Corpuscular Volume (MCV)

Back 1

Size of erythrocyte

Front 2

Define: Mean corpuscular hemoglobine

Back 2

amount of hemo in each erythrocyte by weight

Front 3

Define: mean corpuscular hemoglobin concentration

Back 3

concentration of hemo in each erythrocyte

Front 4

Define: Hemoglobin electrophoresis

Back 4

% of different types of hemo in erythrocytes

Front 5

Obtain Serum ferritin determination to:

Back 5

ID depletion of iron in body

Front 6

Define transferring saturation and disease which it might be abnormal:

Back 6

% transferring saturated w Fe
acute hemorrhage, sideroblastic, anemia, IDA, thalassemia

Front 7

When may you find a abnormal neutrophil count ie >than 0

Back 7

myeloproliferative disorders, hematopoietic disorders, hemolysis, infection, immune deficient

Front 8

What is Total Iron binding capacity (TIBC) and when might you find it abnormal?

Back 8

amount of Fe in serum plus amount of transferring available in serum
IDA: TIBC: High due to low Fe we have high capacity low Fe
ACD: Low: less transferrin (more ferritin)

Front 9

When do expect to see a rise in lymphocyte

Back 9

infection lymphocytosis, mononucleosis, anemias, leukemia, hodgkins

Front 10

When would you see an abnormal plasma cell count

Back 10

mononucleosis, monocytic leukemia, plasma cell leukemia

Front 11

plasma cell count

Back 11

mononucleosis, monocytic leukemia, plasma cell leukemia

Front 12

Describe Erythropoietin patho

Back 12

secreted by kidney response to tissue hypoxia--> increase production of RBC

Front 13

Neutrophil should be the same as adults at what age

Back 13

same as adults by 2 wks

Front 14

when do eosinophil and monocytes reach the level of adults in the body?

Back 14

high first year same as adult by 1 yr

Front 15

What are characteristics of RBC: deficient B12 or folate

Back 15

macrocytic-normochromic anemaia (megoblastic)

Front 16

pernicious anemai most commonly due to

Back 16

B12 deficient: typcially chronic gastritis (DM1, thryroid, graves, myasthenai gravis, alcohol, h. pylori)

Front 17

Discuss folate
Macrocytic-normochromic

Back 17

Vit B for erythrocyte production, absorbedin upper intestin

Front 18

Sx of deficient folate
Macrocytic-normochromic

Back 18

scales, fissures in lips, corners of mouth , stomatitis, sores ulceration of buccal and tounge swelling

Front 19

Most common anemia and cause
also microcytic -hypochromic

Back 19

iron deficient: diet, ASA, NSAID, GI surgery, pica craving

Front 20

Sideroblastic anemia (SA) are rare: Symptoms include
microcytic-hypochromic

Back 20

Sx: iron overload erythropoietic hemochromatosis = splenomegly and hepatomegaly

Front 21

Aplasic anemia (AA) cell type

Back 21

normocytic-normochromic anemia

Front 22

Define Aplastic Anemia: normocytic-Normochromic and risk associated w/ disorder

Back 22

absence of all three blood cells, rapid progression high risk of death form infection, bleedin, ulceration fo mouth pharynx

Front 23

What are the 5 stages of Prochaska's change framework

Back 23

1. Precontemplation: not interested in change
2. contemplation: consider change & pos/neg aspects
3. Preparation: makes some change to behaviors or thoughts but feeling of no tools to proceed
4. action: ready to make change
5. maintenance/relaps: learns to continue the change and deal w/ backsliding

Front 24

Anemia of Chronic Disease (ACD) cell type?

Back 24

normoctyic -normochromic anemia

Front 25

ACD (anemia of chronic disease) may be caused by:

Back 25

AIDS, RA, SLE, malaria, Hepatitis, CHF: patho: decrease life span, suppressed erythropoietin, Fe metabloism

Front 26

ACD (anemia of chronic disease) Evaluation

Back 26

unable to repsond to Fe replacement, low TIBC, high serum ferritin

Front 27

Anemia Hemaglobin values

Back 27

<14 male, < 12 female, no sx till < 6 in healthy adult

Front 28

Anemia: sx

Back 28

fatigue, malaise, dyspnea decrease exercise tolerance

Front 29

Anemia: sx

Back 29

wide pulse pressure, midsystolic murmur, brittle nails, cheilitis, atrophy o ftongue, spoon shaped nails, pallor

Front 30

Anemia: Diagnostic

Back 30

CBC w/ platlet, RBC morphology, periphera smear, reticulocyte count (decrease production or increase loss)

Front 31

What does changes in reticulocyte mean for Anemia Diagnostic test results?

Back 31

>100 normal responding marrow to anemia
<75 impaired RBC production, low reticulocyte count
MCV most useful to ID reticulcytosis or decrease reticulocyte count

Front 32

Anemia: norms of Serum Fe males and females

Back 32

40-150 for males and 40-160 for females

Front 33

RBC size anemia: list disease with Microcytic (MCV <80)

Back 33

Fe deficiency, thalassemai, ACD, sideroblastic

Front 34

RBC size: list disease w/ Macrocytic (MCV >100)

Back 34

Megaloblastic andema (B12 and folate deficent)

Front 35

RBC size: list disease w/ normocytic (MCV 80-99)

Back 35

sicle cell, anemia, chronic disease, aplastic anemia, hemplytic anemias

Front 36

Discuss causes of Microcytic anemia

Back 36

most common, GI or menorrhagia blood loss, IDA , need 15mg/day Fe or 30mg/d if pregnant. Fe absorbed in duodenum

Front 37

Discuss microcytic anemia Sx/PE

Back 37

Fe store depletion, parestesia, sore tongue brittle nails (koilonychias) Pica, pallor of conjunctiva

Front 38

Microcytic anemia: diagnostic

Back 38

fall in feriting level --> Fe depletion, first change is decrease hemoglobin

Front 39

Microcytic anemia Tx

Back 39

oral Fe prep: 150-200mg/d, 4-6months until serum ferritin exceeds 50mcg then stop

Front 40

Fe patient education

Back 40

30 minutes before meals w/ ascorbic acid (OJ) to aid absorption

Front 41

Lifespan: When should you use Fe supplements. What is the best indicator of deficit

Back 41

Fe supplements during prego especially last two trimesters. Ferritin level best indicator of IDA

Front 42

Thalassemia patho and risk

Back 42

inherited, at risk: middle east, asisan, med, africa

Front 43

What are risk associated w/ chronic marijuana use

Back 43

COPD, driving impairment

Front 44

polycythmia vera: sx

Back 44

ruddy, red face, hands feet, ears, engorgement of retinal cerebral vessels

Front 45

How do you tx Polycythema vera

Back 45

ASA..50% die w/in 18 m of sx if no tx

Front 46

Define Leukopenia and when you might find it

Back 46

WBC <1000, > risk infection
Causes: radiation, shock, SLE, chemo

Front 47

Define Leukocytosis and when might you find it;

Back 47

>11K, infection, exercise, surery, prego, drugs also polycythema

Front 48

During an infection cycle, when will you see Granulocytosis or neutrophilia?

Back 48

in the early stages of infection

Front 49

define neutorpenia

Back 49

Decrease in circulating netraphils: low <2000, <500= agranulocytosis

Front 50

Acute leukemias (ALL, AML) patho

Back 50

AML: most common adult: decrease apoptosis --> splenomegaly and hepatomegaly

Front 51

Hodgkins lyphoma: cause

Back 51

no apoptosis of B cell nor immunoglobin gene: eBV

Front 52

Non-hodgkin lymphoma: cause

Back 52

too many abnormal WBC build up in spleen, bone marrow, liver resulting in cancers

Front 53

Hodgkin lymphoma: sx

Back 53

fever, night sweats, weakness, weight loss

Front 54

Non-hodgkin lymphoma: sx

Back 54

fever, night sweats, weakness, weight loss AND pleural effusion, abd pain, spleno and hepatomegaly

Front 55

hodgkins and non-hodgkins TX

Back 55

radiotherapy, surgery, chemo

Front 56

Thrombocytopenia definition

Back 56

platelet count <100,000: decrease platelet production increase consumption

Front 57

What leads to acquired thrombocytopenia:

Back 57

viral infection, drugs, nutritional deficiency, CRF, aplastic anemia

Front 58

Disseminated intravascular coagualtion (DIC)

Back 58

clotting and hemorrhage simultaineously occur

Front 59

DIC: Diagnostic and Tx

Back 59

D-Dimer test most reliable and specific. TX: underlying causes

Front 60

Cell description consistent w/ IDA

Back 60

low MCV, low MCH or microcytic, hypochromic

Front 61

Hematocrit at 23% tx w/ Fe what labs change should you see.

Back 61

reticulocytosis (fitzgerald)

Front 62

What happens when you take cipro and Fe together

Back 62

inactivate drug compound may be formed (fitzgerald)

Front 63

What supplement prevents neural tube defect in prego

Back 63

Folic acid

Front 64

chronic ingestion of over cooked food make you at risk for

Back 64

folate deficent anemia (fitzgerald)
what type of anemia is that?

Front 65

pernicious anemia caused by

Back 65

lack of intrinsic factor (fitzgerald)

Front 66

PE of pernicious anema

Back 66

stocking glove neuropathy (fitz)

Front 67

Asian: hbg: 9.1L, Hct 28%L, RBC 5, MCV 68L, RDW 13 = Dx

Back 67

thalessemia: asian and anemic also look at RDW:
Iron Deficiency Anemia: usually presents with high RDW with low MCV
Folate and vitamin B12 deficiency anemia: usually presents with high RDW and high MCV
Recent Hemmorrhage: typical presentation is high RDW with normal MCV

Front 68

57y/o female w/ RA Hgb=10.5, Hct 33%, MCV88 = Dx

Back 68

anemia of chronic disease (ACD): normal Hct: 36-46, Hem: 12-16, MCV: 80-100

Front 69

Unilateral throbbing HA w/ difficulty chewing and tender noncompressible temporal artery

Back 69

giant cell arteritis

Front 70

Tx of giant cell arteritis

Back 70

systemic corticoid therapy

Front 71

Most serious complication of giant cell arteritis

Back 71

blindness

Front 72

What is agnular chelitis

Back 72

fissuring and cracking at corners of mouth:
caused by fungal or deficient B12 or Fe

Front 73

Tx of angular chelitis

Back 73

nystating (fungal infection)

Front 74

What causes bilaterally itchy, red eyes, tearing throughout year, rope eye discharge (think basic)

Back 74

allergen

Front 75

suppurative conjunctivitis TX

Back 75

bacitracin- polymyxin B, cirprofloxacin or erythromycin (dont use a penicillin)

Front 76

Acute recurrent allergic conjunctivits

Back 76

cromoly opthalmic gtts, oral antihistamies

Front 77

Sx of angle-closure glaucoma

Back 77

sudden HA pain in left eye, blurred vision, pupil dilated, firm eyeball

Front 78

Sx: vision change w/ dull pain, photophobia, effected pupil is small irregular: What is the ocular disease.

Back 78

anterior uveitis

Front 79

what happens if you dont tx primary open angle glaucoma

Back 79

peripheral vision loss

Front 80

Who is at risk of developing primary open angle glaucoma (POAG)

Back 80

african, DM2 advanced age

Front 81

What is the tx for primary open angle glaucoma?

Back 81

beta adrenergic antagoinst, alpha agonist, prostaglandin: opthamology referral emergent

Front 82

Sx: pimple to eyelid, pustule, eye lid margin: what is the dx

Back 82

hordeolm

Front 83

sx: bump on eyelid, hard, nontender swelling lateral border: what is the dx

Back 83

chalazion

Front 84

Tx of hordeolum

Back 84

oral antimicrobial

Front 85

Prevention of meniere disease

Back 85

avoid ototoxic drug (ending in mycin), protect load noise, limit sodium

Front 86

define dizziness

Back 86

perception of altered equilibrium

Front 87

define vertigo

Back 87

perception of person or environment moving

Front 88

define nystagmus

Back 88

rhythmic oscillation of eyes

Front 89

define tinnits

Back 89

perception fo abnormal hearing or head noises

Front 90

Tx of otits external

Back 90

analgesic (T3), VolSol (acid), steroid w/ an antibiotic like neomycin or florquinolone

Front 91

PE of otits external

Back 91

tragus pain on palpation, possible conductive hearing loss, drainage

Front 92

PE of acute otitis media

Back 92

tympanic membrane immobility

Front 93

Tx of patient with acute otits media but allergic to PNC

Back 93

clarithromycin (macrolide)

Front 94

Tx of otits media not improved after 4 d of amoxicillin would be what antibiotic:

Back 94

Erythromycin (if PNC allegeric)
Augementin (beta-lactam)
Zithromax (macrolide)
cefuroxime (Second gen cephlasporin)

Front 95

M. catarrhalis results from

Back 95

high beta-lactamase production (PNC worthless)

Front 96

What is Centor Criteria for pharyngitis

Back 96

Hx of fever, tonsillar exudates, tender anterior cervical adenopathy, absence of cough

Front 97

Define Primary Prevention

Back 97

measures to prevent onset of targeted condition

Front 98

Example of Primary Prevention

Back 98

immunization, health education, seat belts...most cost effective form of healthcare

Front 99

Define Secondary Prevention

Back 99

identify and treat asymptomatic person who already have disease but not apparent; alter natural course of disease

Front 100

Example of Secondary Prevention

Back 100

screening test; colonoscopy, mammography

Front 101

Define Tertiary Prevention

Back 101

Care of established disease to restore highest function while minimize neg effect..primary prevention has been unsuccessful

Front 102

Define Specificity

Back 102

proportion of negative which are correctly identified

Front 103

Example of specificity

Back 103

% of HEALTHY people correctly identified as NOT having a certain condition: Ex: A sore throat that does not have strep has a negative rapid strep, that is specific.

Front 104

Define Sensitivity (statistical)

Back 104

proportion of actual positives which are correctly identified as having condition (sore throat w/ strep actually has positive rapid strep: that is sensitive)

Front 105

Example of sensitivity (statistical)

Back 105

% of SICK people who are correctly identified as HAVING the condition

Front 106

define p-value; statistical significance

Back 106

Represents PROBABILITY of error. Higher P value the less reliable P- 0.5 is borderline acceptable level of error

Front 107

define veracity

Back 107

health professionals honest and full disclosure. Obstain from deceit report lapses in standard of care...ie honesty (medical-dictionary.com)

Front 108

Define nonmalficence

Back 108

avoid harming others (medical-dictionary.com)

Front 109

Define beneficence

Back 109

the act of doing good, kindness (medical-dictionary.com)

Front 110

Define automony

Back 110

the act of being independent or self governed

Front 111

Define justice

Back 111

fairness, up holding what is just

Front 112

Define fidelity

Back 112

Faithfulness to obligations, duties, or observances.

Front 113

Power (analysis) statistics

Back 113

test ability to reject null hypothesis when actually false. Max is 1 min is 0. should be close to 0 to have high power. determines sample size estimation

Front 114

Define reliability (truthfulness)

Back 114

degree consistency which instrument measures variable. Reliable if measurements today are same tomorrow

Front 115

Define variables (stats)

Back 115

things measured, controlled or manipulated

Front 116

Define correlation as related to research.

Back 116

Do not influence variables only assess their relation

Front 117

Define experimental research

Back 117

manipulate some variable then measure the effects: casual relation between variables

Front 118

Define dependent ( stats)

Back 118

only measured or registered NOT manipulated

Front 119

Define independent variables (stats)

Back 119

those that are minipulated

Front 120

Define retrospective (historical cohort) and give example

Back 120

look back at events: ex: review health records to find trends.

Front 121

Define prospective (cohort) study

Back 121

follows group over time of similar individuals who differ on certain factors under study: ex: middle age truck drivers and smoking habits and lung cancer in 20 years

Front 122

Internal validity

Back 122

approximate truth about inferences regarding causes and effect or causal relation

Front 123

Define external validity

Back 123

generalizing, the approximate truth of conclusion: degree to which the conclusions in your study would hold for other persons in other places and at other times

Front 124

S. pyogenees pharyngits failure rate w/ tx with IM PNC

Back 124

20% similar to oral tx

Front 125

Expect onset when using nasal corticosteroid spray

Back 125

a few weeks

Front 126

What is a drug of choice for allergic rhinits

Back 126

claritin

Front 127

What receptors do antihistamines effect

Back 127

H1 receptors

Front 128

What are the action of decongestants

Back 128

vasoconstriction

Front 129

What medication is used for relief of acute nasal puritis

Back 129

oral antihistamine

Front 130

ARIA (Acute Rhinitis and Impact on Asthma) guidelines : best relief of acute nasal congestion

Back 130

decongestant spray

Front 131

ARIA: least control of rhinorrhea

Back 131

Cromoyln nasal spray

Front 132

What are the pathophysiological effects of Cromolyn (tx for asthma)

Back 132

mast cell stabilizer

Front 133

GLORIA (global resource in allergy): Tx of allergic conjunctivitis

Back 133

topical mast cell stabilizer (Cromolyn) w/ topical antihistamine

Front 134

One common method to control allergies especially at night

Back 134

dust mite control

Front 135

Acute bacterial rhinosinusitis Dx

Back 135

URI >7-10 or worsening in 5-7 days

Front 136

What sx do you find on acute bacterial rhinosinusitis (ABRS)

Back 136

maxillary tooth ache, colored nasal discharge, URI

Front 137

first line tx of acute bacterial rhinosinusitis

Back 137

amoxicillin

Front 138

Failure of treatment of acute bacterial rhinosinusitis after 72 hrs progress to:

Back 138

augmentin

Front 139

What is the next Tx of acute bacterial rhiniosinusitis if already tx with doxycycline and a (PNC allergy)

Back 139

levofloxacin (quinolone)

Front 140

acute bacterial rhinosinusits that appears moderaly ills

Back 140

tx with high dose augmentin

Front 141

blephritis: sx; tx

Back 141

ocular burning, eye lid margins red w/ scaling or crusting: + pain

Hint 141

warm compress, daily lid scrub, erythromycin or bacitracin ophthalmic

Front 142

cellulits orbital Sx and Treatment

Back 142

localized tenderness, erythema, edema, fever, proptosis; + pain

Hint 142

referral, IV antibiotics

Front 143

dacryosystitis

Back 143

chronic tearing, eyelash crusting, tenderness, circumscribed erytheema; + pain

Hint 143

warm compress, gentle massage, systemic antibiotics

Front 144

What are the sx of chalazion

Back 144

nontender chronic lesions, locaized erythema, edema of eyeids no pain

Hint 144

warm compress, daily lid scrubs, lid massage

Front 145

hordeolum

Back 145

tenderness, erythema, edema, internal lesion; +pain

Hint 145

warm compress, lid scrub for recurrence, topical antibiotic

Front 146

angle-closure glaucoma, sx, tx

Back 146

sever pain, n/v, halos around lights, photophobia, cornea cloudy w/ decrease vision, conjuctival.
emergent refereal to opthomologist, pilocarpine

Front 147

conjunctivits allergic, sx tx

Back 147

pruritus, conjnctival hyperemia, chemosis, watery or stringiy discharge; no pain

Hint 147

avoid allergens, cold compresses, topical and systemtic medications

Front 148

conjunctivitis bacterial, sx tx

Back 148

photophobial w/ blepharospasm, mucopurulent discharge w/ eyelash matting edema, hyperemia, preauricular adenopathy only w/ hyperacute disorder: may or may not have pain: topical antibiotic gtts, systemic antibiotics if gonococcal or chlamydial

Front 149

conjunctivitis viral sx,tx

Back 149

acute onset w/ systemic illness, photophobia or foreign body sensation, preauricular adenopathy, hyperemia, chemosis, water discharge classic dendritic corneal lesion w/ herpes:
Tx; supportive tx, cool compress, topical artifical tear, referral if herpatic

Front 150

What are sx associated w/ corneal foreign body, abrasion, or an ocular ulcer

Back 150

intense pain, photophobia, conjunctival hyperemia, decrease acuity, ulcers, prior hx f trauma w/ abrasion but not erosion

Hint 150

topical antibiotics systemic pain relief for abrasion and after foreign body

Front 151

What are sx of episcleritis or scleritis and how do you manage them.

Back 151

mild to sever pain, circumscribed erythema of affected sclera, vision unaffected

Hint 151

episcleritis self limiting, scleritis referral

Front 152

What are sx of iritis or uveitis?

Back 152

pain, photophobia, conjunctival hyperemia, pupil constriction, no discharge: urgent referral

Front 153

What are sx of keratitis

Back 153

pain photophobia corneal cloudiness w/ stromal involvement
urgent referral

Front 154

Disease that cause sudden eye sight loss

Back 154

acute angle-closure glaucoma, central retinal vessel occulsion , hyphema, irtitis, meningitis, migraine, optic neuritis

Front 155

disease cause gradual loss

Back 155

cataracts, corneal opacities, glaucoma, macular degeneration, pituitary tumore, retinal detachement

Front 156

Cataracts; SX, Tx

Back 156

blurry vision, film, dull red reflex, opaque pupil, Tx: glasses, light, stop night driving, surgical when need exceeds vision
Peds: tx immediate risk of amblyopia

Front 157

What is the tx for chalazion, hordeolum, blepharitis

Back 157

Tx: Warm compresses, bacitracin, erythromycin or Cipro if chronic
hordeolum: children
chalazion: adults

Front 158

cardiac: AAA: what increase risk of rupture

Back 158

>6.0 cm, rapid expansion, female, smoking, COPD, FHx, asymmetrical AAA

Front 159

AAA: PE

Back 159

75% asymptomatic..pulsating mass (knees flexed), back pain

Front 160

AAA: Dignostic

Back 160

Abd US (screenin an dconfirmation

Front 161

AAA: TX

Back 161

prevent rupture: size best predictor

Front 162

AAA: refer

Back 162

>4.0 cm to vascular surgon

Front 163

A-fib: PE

Back 163

palpitation (shorten diastole and vent filling), drop in BP, CO, light headed, dizziness, fatigue, SOB

Front 164

A-fib: PE sx

Back 164

if hyptensive and tachy immediate care

Front 165

A-fib Heart sounds

Back 165

possible systolic ejection murmur, if S3 then impending heart failure

Front 166

A-fib: diagnostic

Back 166

ECG, holter (24-48hr), provocative test (exercise ECG), ECHO for initial work up on all arrhythmias to determine left atrial and ventricular size

Front 167

what is the heart rate of PSVT

Back 167

140-240bpm

Front 168

Torsades de Pointes

Back 168

QRS morpholgical pattern, TX: magnesium

Front 169

A-fib tx:

Back 169

tx causes: rheumatic heart, mitral valve, HTN, CHD, hyperthyroid, acute alcohol, stimulant ect

Front 170

A-fib tx:

Back 170

uninterrupted anticoagulants for 4 wks prior and post conversion

Front 171

A-fib tx:

Back 171

anticoagulant: warfarin: INR between 2-3 if contraindicated then ASA and if <60y/o

Front 172

first degree AV block

Back 172

PR>20

Front 173

Second degree type I: mobitz type 1

Back 173

pregressive prolongation of PR interval until not conducted by ventricle

Front 174

What do you expect to see on the ECG w/ Second degree type II: mobitz II

Back 174

constant PRI interval (normal) until P wave is not conducted: more severe vs type I. Fails to conduct through the ventricles.

Front 175

Third degree AV block

Back 175

no relaiton between P and QRS, fatal

Front 176

What is included in a diagnostic work-up for A-fib?

Back 176

ECG, holter (24-48hr), provocative test (exercise ECG), ECHO for initial work up on all arrhythmias to determine left atrial and ventricular size

Front 177

PSVT: rate

Back 177

140-240bpm

Front 178

Describe the wave pattern of Torsades de Pointes and the tx?

Back 178

QRS morpholgical pattern, TX: magnesium

Front 179

A-fib tx:

Back 179

tx causes: rheumatic heart, mitral valve, HTN, CHD, hyperthyroid, acute alcohol, stimulant ect

Front 180

A-fib tx:

Back 180

uninterrupted anticoagulants for 4 wks prior and post conversin

Front 181

A-fib tx:

Back 181

anticoagulant: warfarin: INR between 2-3 if contraindicated then ASA and if <60y/o

Front 182

What finding on an ECG would help dx first degree AV block?

Back 182

PR>20

Front 183

Second degree type I: mobitz type 1

Back 183

pregressive prolongation of PR interval until not conducted by ventricle

Front 184

Second degree type II: mobitz II

Back 184

constant PRI nterval until P wave is not conducted: more severe vs type I

Front 185

what do you expect to see on the ECG w/ Third degree AV block

Back 185

no relation between P and QRS, fatal

Front 186

Blood pressure norms

Back 186

<140/90; <130/80 if heart failure or renal

Front 187

lipid norms

Back 187

LDL <100; reduced saturated fats < 7% calories
Triglycerides <150 mg

Front 188

How much physical activity is suggested

Back 188

30 min, 7 days week

Front 189

meds used for CAD; ASA if

Back 189

75-162mg PO QD; if contra then clopidogrel or warfarin. May be combined

Front 190

Meds used for CAD: Beta blocker if:

Back 190

If MI, ACS, left ventricular w/ or w/o HF

Front 191

meds for CAD: ACE-I if:

Back 191

Ventricular ejection fraction <40% and w/ HTN, DM or CKD

Front 192

meds for CAD: Influenza vaccine

Back 192

all CAD

Front 193

variant angian patho

Back 193

spasm most right coronary and left descending: focal and reproducible at same location

Front 194

PMI define

Back 194

point of maximum impulse

Front 195

Where do you expect to find PMI w/ cardiomegaly

Back 195

downward or laterally displaced

Front 196

define xanthomas or early arcus senilis

Back 196

elevated cholesterol seen around iris as hazy whiteness: assess peripheral circulation

Front 197

Ventricular gallop (S3) indicates possible

Back 197

heart failure

Front 198

What is present in tertiary syphilis

Back 198

Gumma (lesions found on liver, heart, brain, skin)

Front 199

atrial gallop (S4) indicated possible

Back 199

HTN, MI , resistance of ventricular filling

Front 200

systolic mitral regurgitation murmur indicates

Back 200

ischemic papillary muscle

Front 201

What is the pathophysiology of pericardial friction rub:

Back 201

inflammation around pericardial sac

Front 202

Name on diagnostic test for coronary artery disease (CAD)

Back 202

exercise tolerance test (stress test)

Front 203

In coronary artery disease w/ previous myocardial injury what changes to the ST segment on the ECG do you expect to find?
a. ST depression
b. ST elevation

Back 203

depression >1mm high likelihood of unstable angina

Front 204

Cardiac markers: CPK-MB norms

Back 204

rises 3-12, peak: 24hr, normal 48hr after injury

Front 205

Endocarditis: causes

Back 205

streptococcal (70% if not IV drug use),

Front 206

Endocarditis: diagnosis

Back 206

consider for all patients w/ murmur and fever of unknown origin

Front 207

Cardiac markers: myoglobin norms

Back 207

rises 1-3 hrs, peak 3-4 hrs, normal 24 hrs after injury

Front 208

Peripheral venous insufficiency: DVT: causes

Back 208

prolonged inactivity, estrogen, recent surgery, trauma

Front 209

cardiac markers: troponin, norms

Back 209

rises 3-12 hr, peak 3-4 hr, 14d

Front 210

What causes Endocartitis?

Back 210

streptococcal (70% if not IV drug use),

Front 211

Endocarditis: sx

Back 211

fever main sx (unless old, immuno), heart murmur, janeways lesion, osler nodes: palms of hands, soles due to septic embolization

Front 212

Endocarditis: tx:

Back 212

high dose bactericidal IV: PNC G r ceftriaxone and an aminoglycoside

Front 213

When would endocarditis be part of your differential diagnosis?

Back 213

Consider for all patients w/ murmur and fever of unknown origin

Front 214

Heart Failure: Sx

Back 214

S3 or s4 murmurs and lateral displacement of apical impulses, S4 due to over distention of ventricles

Front 215

Heart Failure: Diagnostic: lab

Back 215

BNP: brain natriuretic peptide: secreted due to elevation of end diastocli pressure: BNP >400= CHF Dx

Front 216

Heart failure: Diagnostic: rad

Back 216

Echocardiogram

Front 217

What are causes of Peripheral venous insufficiency: DVT

Back 217

prolonged inactivy, estrogen, recent surgery, trauma

Front 218

DVT sx:

Back 218

leg edema, calf tenderness, pain on dorsiflexion of foot (Homans sign), 50% no sx

Front 219

DVT diagnostic: Rad: none unless superficial phlebitis

Back 219

duplex ultrasound to ensure no DVT

Front 220

DVT diagnostic: Lab

Back 220

D-Dimer: marker for coagulation activiation and fibrinolysis

Front 221

DVT: common location

Back 221

femoral veins

Front 222

DVT: Tx

Back 222

superfical phlebitis: elevation of leg, compression w/ ace bandage, NSAIDS, antibiotics

Front 223

DVT: Tx

Back 223

heparin immediatley to prevent PE, hospitalization: 500u boluse then 800-1400u/hr--> PTT >2x normal for 2 days

Front 224

S1 heart sound become louder or quieter during pregnancy

Back 224

Louder

Front 225

DVT: Tx

Back 225

coumadin w/in 24 hrs, pt discharged when INR 2-3 and continued for 3-6m

Front 226

What type of murmur becomes evident during pregnancy

Back 226

physiologic systolic ejection

Front 227

Foods that decrease effectiveness of warfarin:

Back 227

high in vitamin K

Front 228

Chronic venous stasis: TX

Back 228

compression stocking, normal saline wet to dry topical antibiotics for ulcers

Front 229

chronic venous stasis: Tx

Back 229

stocking if eczema from sever stasis the 0.5% hydrocortisone

Front 230

What happens to the transvers thoracid diameter and diaphragmatic contraction

Back 230

it increases in size

Front 231

Varicose: causes

Back 231

pooling blood in large varicose veins

Front 232

varicose: sx

Back 232

heavy discomfort when standing increase bleed when older

Front 233

Varicose: Tx

Back 233

asymptomatic, refer if poorly tolerated

Front 234

Venous stasis ulcer sx include:

Back 234

most sever complication of post phlebitic syndrome: ulcer above medial malleousl, wound infected, pulses not palpable due to swelling

Front 235

venous stasis ulcer tx;

Back 235

bed res, wet-dry, ulcer debridment, oral antibiotics, compression w/ ACE

Front 236

Venous stasis: things to know

Back 236

occur around ankle, hx of phlebitis, sx of venous stasis, painful when infection, improved w/ elevation

Front 237

venous ischemia: things to know

Back 237

occur at tips of extremities/heel, Hx of cluadicating, very painful WORSE with elevation, absent pulse, secondary infection spread quick

Front 238

Where and when do you expect to find venous neuropathic (diabetic)

Back 238

occur at pressure points, painless but co-exist neuro pain, present after infection

Front 239

Murmurs: things to know

Back 239

timing is most improtant, mitral regurg best heard apex or 5th intercoostal, S1 loudest at apex and lower left sternal border

Front 240

Murmurs: things to know about S4 and atrial kick

Back 240

S4: atrial kick into noncompliant ventricle

Front 241

Aortic stenosis: location, PE, Tx

Back 241

right sternal border, CP< syncope, dyspnea, surgical

Front 242

mitral regurgitation: locatin, PE, tx

Back 242

apex, asymptomatic, then fatigue, dyspnea on exertion. if acute: Iv antibiotic, preventative for dental or surgical

Front 243

Mitral valve prolapse: where can you hear it, what are the sx and what is the tx?

Back 243

lower left sternal, PE: asymptomatic, then CP, palpiation,dyspnea, fatigue. Tx: none except echo q 3-5yr; antibiotic for dental

Front 244

Where do you listen to hear tricuspid regurg

Back 244

lower left sternal listening point
Also: ventricular septal defect

Front 245

aortic regurg

Back 245

lower left sternal, asymptomatic, then acute CHF, Tx; antibiotic prevent endocarditis, valve replace

Front 246

mitral stenosis

Back 246

apex left lateral, class 1: asymptomatic, Class 2: dyspnea w/ exertion. Tx: if A-fib then w/ anticoagulants

Front 247

HTN: BP ok

Back 247

<120-90

Front 248

Prehypertension

Back 248

120-139/80-89

Front 249

Stage 1 HTN

Back 249

140-159/90-99

Front 250

What are the parameters for Stage 2 HTN

Back 250

>160/>100

Front 251

Primary HTN: Patho: vascular

Back 251

hypertrophy<-- excess insulin, catecholmines, natriuretic hormone-->increase peripheral resistance

Front 252

Primary HTN: path: obesity

Back 252

central-->increased sympathetic nervous system output

Front 253

HTN: diet

Back 253

DASH: fruits, veg, low-fat dairy, Sodium: increase circulatory volume

Front 254

HTN prevention: How does alcohol increase BP?

Back 254

increase BP due to SNS, RAS decrease peripheral vascular tone

Front 255

Renal artery stenosos HTN: PE, screen

Back 255

<30->50, Hx arterhosclerosis, Screen: UA, creatinine

Front 256

HTN: pheochromocytoma: PE Screen

Back 256

5 H: HTN< HA, hyperhidrosis, hypermetabolic, DM
Screen: spot UA, 24hr UA

Front 257

renal artery stenosis HTN: Diagnostic, TX

Back 257

ateriogram: Tx: B-blocker, AVOID ACE-I, angioplasty, bypass

Front 258

HTN: pheochromocytoma: diagnostic, TX

Back 258

CT abdomen, Tx; A-blocker, then B-blocker, or both

Front 259

JNC7 f/u for initial BP w/o end organ if : normal <120/<80

Back 259

f/u in 2 yrs

Front 260

JNC7 f/u for initial BP: preHTN

Back 260

1yr

Front 261

JNC7 f/u for initial BP: stage 1 HTN

Back 261

confirm in 2 months

Front 262

JNC7 f/u for inistial BP: stage 2 HTN

Back 262

eval or refer for care w/in 1 m

Front 263

HTN PE:

Back 263

papilledema, buits, neuro deficit, skin thinning, loss of extremity hair, striae

Front 264

What diagnostic test should u obtain for a new HTN patient?

Back 264

UA, CBC, glucose, CMP, BUN< creatinine, uric acid, TSH, 24-hr urine cortisol if cushing syndrome suspect

Front 265

Osteoarthritis Sx

Back 265

pain, stiffness and limited ROM, metacarpal joints of thumbs and interphalangeal joints initial impact

Front 266

Osteoarthritis: Tx

Back 266

APa primary 1 g 4x dayily, Tramadol nonopiod pain may be used w/ NSAID, glucosamine w/ or w/o chondroitin for OA of knees

Front 267

Osteoarthritis: non-pharm Tx

Back 267

aerobic for cardio, weight reduction, PT and or OT, strength training to fix contractures

Front 268

Osteoarthritis: Diagnostic

Back 268

xray films normal early; later narrowed asymmetric joint space
none systemic disease so no serologic markers, labs to rule out other diseases

Front 269

Osteoarthritis: Injections limits

Back 269

3 injections per year and max of 12 per joint (may accelerate joint deterioration)

Front 270

What are the Sx of Acute Gout/Hyperuricemia

Back 270

rapid onset, at night wakes from sleep, warmth, red, swell, decrease ROM, monoarticular, First metatarsophalangeal big toe (podagra)

Front 271

What are sx of chronic Gout (tophaceous)

Back 271

typically>10yrs firm swelling, digits of hands and feet

Front 272

What increase risk of Gout flare up?

Back 272

trauma, overeating, alcohol, fasting.

Front 273

What is the non-pharm prevention and tx of Gout flare up

Back 273

diet is key: avoid diuretics weight gain, alcohol (lowers purine, protein), TX: cold compress

Front 274

How do you dx Gout

Back 274

joint aspiration: 6-13 minor or 1 major crystals in synovial fluid or tophus for Dx

Front 275

What is the pharm Tx of ACUTE Gout

Back 275

NSAID: (unless risk: >65yrs, creatinine <50ml/min, CHF, peptic ulcer, anticoagulant, hepatitis) High dose in first 24-48hrs.
-If ONLY 1-2 joints consider intra-articular injection
-if multiple joints or NSAIDS not tolerated use corticosteroid taper dose 7-14d
-colchicine 1mg then 0.5 q2h until absent sx or GI problems: only effective in first 12-24hrs..contra if GFR>10

Front 276

What is the pharm Tx of Chronic Gout

Back 276

Maintain serum Urate <6 (below normal), DO NOT start urate lowering during acute attack start 6-8wks after: (lengths attack)
-NSAIDS
-allopurinal 100mg until SU<6
Colchinicine 0.5-1mg to prevent rebound gout
-Febuxostat: 40mg/d
-probenecid (if contra allopurinal)

Front 277

Tennis Elbow Sx

Back 277

Medial epicondylitis (GOLFERS) pronators
Lateral epicondylitis (TENNIS) supinators
-Tinel's sign: tapping over ulnar groove reproduces pain/numb to 4-5th fingers

Front 278

What is the prevention of Tennis elbow

Back 278

overuse, proper techinques, lighter tools, less grip

Front 279

What is the diagnostic of Tennis elbow

Back 279

xray, AP, joint aspiration for crystals

Front 280

What is the managment of Tennis elbow

Back 280

NSAID, RICE 2 wks; consider steroid injections.

Front 281

Other elbow injuries: things to know

Back 281

Radial head fx: RICE, posterior splint elbow flexed at 90
-Ulnar neurtitis: rest affected hand, elbow pads, wrist-elbow splint, neutral position
-Olecranon bursisits: ray, aspirate bursa for dx, hosp if septic

Front 282

What are the modifiable risk factors of Osteoporosis

Back 282

low body weight <58kg,BMI<20, Ca or Vit D, inadequate physical activity, smoking, alcohol, corticosteroid, heparin

Front 283

What are the non-modifiable risk factors of Osteoporosis

Back 283

advaced age >65, female, caucasion, asian, FHx, traumatic fx

Front 284

Osteoporosis prevention

Back 284

Ca 1200mg and vit D 700 IU/d. Screen all women >65 or 60 w/ risk factors

Front 285

Osteoporosis diagnostic test

Back 285

Dexa of lumbar and Hip is GOLD standard for dx, T-score >-1 normal Osteopenia = T -1 to -2.5, osteoporosis T <-2.5

Front 286

What is the non-pharmacologic management of Osteoporosis?

Back 286

adequate Ca and Vit D, weight bearing exercise avoid smoking and excessive alcohol: 1000-1200 mg D Ca

Front 287

Osteoporosis managment pharm:

Back 287

T score <2.5, bisphosphanates and teriparatide. estrogen w/ or w/o progesterone raloxifene, risedronate. take on empty stomach w/ 6-8 water 30min before eating or lying down or w/ other meds. SQ PTH is anabolic bone agent

Front 288

Fibromyalgia diagnostic criteria

Back 288

3 or more months of MS apin above and below waist line bilaterally, w/ pain on palpation of tender points, profound fatigue, sleep disturbance rare after 55

Front 289

Fibromyalgia signs and sx

Back 289

>3m sx unexplained w/ other dx, fatigue, sleep disturbance, female 20-65, impared socail occupationa, depressive/anxiety, exclude statin causes

Front 290

Fibromyalgia Points of tenderness

Back 290

suboccipital muscle, middle upper trapezius, under lower stemomastoid near 2nd constochondral junction, origin of supraspinatus, 2 cm distal to lateral epicondyle, upper outer glueal, greater trochanter, medial fat pad of knee

Front 291

Fibromyalgia diagnostic test

Back 291

ESR, C-reactive protein, CK, TSH, CBC, renal Nd LFT

Front 292

Patient with medial knee pain and dx of arthritis would have pain..

Back 292

medially along the joint line

Front 293

The most common site of osteoarthirits is what part of the hip

Back 293

Anterior especially if it radiates into the groin

Front 294

What is the classic finding in de Quervain's tenosynovitis (extensor and flexor tendons of the thumb)

Back 294

Positive Finkelstein test.
pain may radiate up the forearm

Front 295

Findings of RA included

Back 295

Morning stiffness, postitive rheumatoid antigen, antinuclear antibodies

Front 296

What does the "get up and go" test in elderly test.

Back 296

Fall risk through musculoskeletal function

Front 297

Osteoarthritis pain first line of treatment

Back 297

exercise if this doesnt work then tylenol for pain: NSAID work better but have higher S/E risk an dshould no be used

Front 298

SPRAINS Grade
Stage I
Stage II
Stage III

Back 298

I- mild tenderness and edema able to bear weight.
II-moderat pain edema, tenderness, ecchymosis, weight barin painful but can walk
III: tear of ligament, joint instability, sever pain ,unable to weight bear. XRAY

Front 299

Ottawa ankle rules help determine

Back 299

whether x-ray is needed w/ suspected ankle injury

Front 300

Why is bronchospasm worse between 29-36 wks in preg?

Back 300

increase esophageal irritation from GERD: esophageal sphincter loosens due to increase pressure

Front 301

Anterior Drawers Test for what

Back 301

ACL injury laxity or movement

Front 302

Which of the rotator cuff is most susptible to injury

Back 302

Suproaspinatus (arm drop test)

Front 303

The mainstay for initial treatment of early OA

Back 303

Tylenol max of 4g/d unless on warfarin then 2500mg

Front 304

What is another pain medication that is a non-steroidal used for moderate pain in OA

Back 304

Tramadol (Ultram)

Front 305

What common GYN medication is used to decrease osteoporsis

Back 305

Estrogen w/ progesterone if they still have uterus

Front 306

What medication reduces the risk of methotrexate hepatotoxicity

Back 306

Folic acid

Front 307

Injuries to the ends of bone versus sprains is most common in what age

Back 307

children

Front 308

What is the best screening for Osteoporosis

Back 308

bone mass densitormetry usin DEXA

Front 309

What does the spurling Test test for in a MS examination

Back 309

cervical radiculopathy

Front 310

Who should initiate immunosuppressive therapy (mehtotrexat) for an RA Patient

Back 310

rheumatologis for diagnosis confirmation and initiation of DMARDS.

Front 311

What Gout medication is better for those with renal impairment

Back 311

Uloric and lower doses are needed to achieve resuls

Front 312

What diagnostic is used in suspected spinal stenosis

Back 312

MRI of the spine

Front 313

What is the heart sound of soft first heart sound, w/ pansystolic apical murmur that radiates to axilla

Back 313

mitral regurgitation

Front 314

Abdominal exam: high, midline abdominal pulsation of low amplitude that are directed forward indicates:

Back 314

a normal finding

Front 315

Generalized, non pururitic skin eruption intermittent exacerbation for years. erythematous plaque on gluteal fold scales and fissuring:

Back 315

psoriasis

Front 316

Drug most likely to increase lipoprotein levels

Back 316

hydrochlorothiazide: older beta blockers increase lipids

Front 317

Most common type of joint disease in US

Back 317

asteoarthtitis

Front 318

Sx of left ventricular heart failure

Back 318

third heart sound, cough , bibasilar rales

Front 319

Eval of rapid, alternating movements of hands assess

Back 319

cerebellar functioning (assess dysdiadochokinesa)

Front 320

Plantar fat pads on 2y/o child

Back 320

normal

Front 321

Test to determine clearance of digoxin.

Back 321

creatinine clearance estamate

Front 322

Beta blockers are not contraindicated in ......any more but calcium channel blockers are?

Back 322

heart failure

Front 323

Low back pain tx

Back 323

mild activity w/ motrin and rice

Front 324

In heart failure tx

Back 324

HCTZ (lasix light), aldactone (spironolactone): aldosterone, angiotension effects.

Front 325

Are plantar fat pads on 2y/o child?
a. abnormal
b. normal
c. sign of cancer
d. none of the above

Back 325

b. normal

Front 326

Do diuretics affect pre load or afterload

Back 326

Pre-load: by decreasing amount of fluid results in heart not working as hard to move blood.

Front 327

What are uses of aldasterone

Back 327

hyperoldosteronis

Front 328

Test to determine clearance of digoxin.

Back 328

creatinine clearance estamate

Front 329

Beta blockers are not contraindicated in ......any more but calcium channel blockers are

Back 329

heart failure

Front 330

what is the degree of sedation for antihistamines: atarax

Back 330

better itch relief and sedation (SE)

Front 331

Low back pain tx

Back 331

mild activity w/ motrin and rice

Front 332

Fe anemia before it is tx reticulocytes are (high or low), upon tx it will be (high or low)

Back 332

low, high (fast 1-2wks)

Front 333

In heart failure tx

Back 333

HCTZ (lasix light), aldactone (spironolactone): aldosterone, angiotension effects.

Front 334

Do diuretics affect pre load or afterload

Back 334

Pre-load: by decreasing amount of fluid results in heart not working as hard to move blood.

Front 335

bouchard nodes versus heberden nodes: define differences

Back 335

Heberdens are at DIP joint and Bouchards (less common) are at the MIP joint: both are bony "bumps". sign of osteoarthitis

Front 336

Glucocorticoid help with all itis

Back 336

cellulitis

Front 337

which situation would be associated w/ macrocytic anemia

Back 337

B12 and folic acid

Front 338

Qualitative research:

Back 338

does not mearsure only states lived experience

Front 339

Quantitative research

Back 339

uses numbers and statistics

Front 340

Independent variable

Back 340

First thing: it is not being influenced is being manipulated (type of diet)

Front 341

Dependent variable

Back 341

change measured in dependent variable: weight is dependent on diet (independent)

Front 342

Function of IRB (institutional research board)

Back 342

review research, be patient advocate, advised of risk and benifits.

Front 343

What vaccines are required at 4 months?

Back 343

DTaP
Hib
IPV
PCV
Rota

Front 344

Who can receive live attenuated flu vaccine (nasal spray)

Back 344

Healthy non pregnant: 2-49

Front 345

Which vaccine is contraindicated in pregnancy? Injectable Flu, Td, MMR, Hep B

Back 345

MMR

Front 346

What percent of acute Hep B will develop Chronic?

Back 346

5%

Front 347

What should be given if some has exposure to Heb B?

Back 347

HBV and shot of HBIG

Front 348

What has increase risk of suicide? rifampin, accutane, acyclovir, advair

Back 348

accutane

Front 349

Amniodarone has toxicity to what organ?

Back 349

lungs

Front 350

Which vaccine is effective after one dose? Hep A, Hep B, Gardisil, Herpes Zoster

Back 350

Herpes Zoster
Gardisil=3shots
Hep B= 2 shots

Front 351

What is primary Prevention and give an example?

Back 351

Prevent onset or acquisition of disease:
Ex: immunization, education, use to seatbelts

Front 352

What is secondary Prevention and give an example?

Back 352

identify and tx asymptomatic persons who have risk factors for given disease:
Ex: screening, Blood pressure, lipid profile

Front 353

What is tertiary Prevention and give an example?

Back 353

Goal of minimize disease complications and negative health from effects:
Ex: meds, lifestyle modification, tx

Front 354

What is the incubation period of influenza?

Back 354

1-4days

Front 355

How long are you infectious w/ influenza?

Back 355

Adults: 5days, Children 10days
immunodeficient shed virus of 3wks

Front 356

Who is at highest risk of death w/ influenza?

Back 356

<2 and >65y/o

Front 357

What ages can receive the trivalent influenza vaccine?

Back 357

6months and older and all pregnant women

Front 358

Who can receive the Live Attenuated Influenza vaccine?

Back 358

2years -49 y/o and healthy

Front 359

What medication can you consider when tx a HTN and DM:

Back 359

ACE-I: like fosinopril : nephroprotective features

Front 360

How many doses do <9y/o need for initial influenza vaccine?

Back 360

2 doses over 4 wks for TIV and 6wks for LAIV

Front 361

What are the four antiviral meds approved by the FDA for influenza?

Back 361

amantadine (Symmetrel), rimantadine (Flumadine), zanamivir (Relenza), oseltamivir (Tamiflu)

Front 362

What influenza medication are approved for influenza A?

Back 362

amantadine (Symmetrel), rimantadine (Flumadine)

Front 363

What influenza antivirals can be used for A and B strains?

Back 363

Zanamivir (Relenza), oseltamivir (Tamiflu)

Front 364

What amount of cholesterol does the ADA recommend

Back 364

300mg or less

Front 365

What are side effects of zanamivir (Relenza) and how is it administered?

Back 365

Used to tx the flu:
S/E: bronchospasm (w/ asthma or chronic lung)
Administered via inhalation

Front 366

What are the side effects of relenza (Tamiflu) and how is it administered?

Back 366

GI, n/v; PO take w/ food

Front 367

How far apart should MMR be given and how many doses are required?

Back 367

1m apart 2 doses (live attenuated virus)

Front 368

Can an MMR be given during pregnancy?

Back 368

NO

Front 369

What are sequelae illnes of Measles and mumps?

Back 369

Measles: encephalitis and pneumonia
Mumps: orchitis

Front 370

How many doses of Tdap should be administered and at what interval?

Back 370

5 doses: 1st two one month apart 3rd - 5th- 6m apart. Then q 10 yrs
starting at 6wks

Front 371

What age should Dtap be administered after entering school?

Back 371

11-12 y/o

Front 372

What is the max recommended age for receiving the HIib vaccination

Back 372

5 years old

Front 373

What immunization should be given at birth?

Back 373

Hep B

Front 374

List the immunization given at 6wks?

Back 374

Rotovirus, Dtap, Hib, Pneumococcal, polio

Front 375

List immunization started at 12months?

Back 375

MMR, varicella, Hep A

Front 376

When should the final dose of polio be given if not 6m after initial dose?

Back 376

On or after 4 yrs old

Front 377

When should the HPV vaccine be offered and how many doses?

Back 377

13-18 y/o: 3 doses

Front 378

What does pneumococcal vaccine protect you from?

Back 378

Invasive disease like meningitis, septicemia from S. pneumonia (leading cause of death from CAP)

Front 379

What medication should an HIV patient receive and how soon after diagnosis?

Back 379

antipneumococcal vaccine as soon as diagnosis is made

Front 380

How long after first pneumococcal should second pneumococcal be given?

Back 380

5 years

Front 381

Which of the following allergic rxn should not receive the Hep B vaccination? egg, bakers yeast, neomycin, streptomycin

Back 381

bakers yeast

Front 382

When should pregnant women be screen for HBsAg?

Back 382

At first prenatal visit regardless of HBV hx

Front 383

When should a booster dose of HBV be admistered and to whom?

Back 383

when anti-HB is <10mIU/ml and only for immunocompromised patients

Front 384

Drugs whose names end in "-pril" and reduce efferent arteriolar pressure are from what class:

Back 384

ACE-I:

Front 385

What vaccination should be given to someone exposed to Hep B?

Back 385

If previously vaccinated: single HBV booster
If no vaccination: HBV and HBIG w/in 24hrs of exposure

Front 386

What class of meds end in "sartan" and help preserve renal function in DM

Back 386

Angiotensin receptor blockers

Front 387

How is small pox spread?

Back 387

droplets: nasal, oral, pharyngeal

Front 388

What medications increase your risk of heat stoke?

Back 388

Med: tricyclic antidepressants (triptylines), beta blockers (lol), vasoconstrictors like decongestants.
Note: meds change the bodies ability to regulate core temp by negating increase CO and vasodilaiton

Front 389

When is small pox most contagious?

Back 389

onset of rash: may be w/ fever

Front 390

What lab should be gotten in a patinet w/ heat stroke

Back 390

CK to assess muscle damage --> release of electrolyte tissue damage, hyperkalemia

Front 391

What are sx of small pox?

Back 391

rash to tongue, open sores, rash to skin all over w/in 24hrs

Front 392

How long is smallpox contagious?

Back 392

until all crusts have fallen off

Front 393

What is the tx of small pox?

Back 393

supportive: vaccinate w/in 3 days of exposure lessens severity

Front 394

62y/o HTN, smoke, Trigly:280, HDL:38, LDL:135 what med is best (class)

Back 394

multi drug therapy is needed

Front 395

What age has the greatest mortality from varicella? 2-10, 30-50, 60-80

Back 395

30-50 years old (fitzgerald)

Front 396

46y/o HTN smoke, Trig: 110, HDL: 48, LDL: 192, on low-cholest diet what is next best step?

Back 396

HMG-CoA (coenzyme A reductase inhibitor) (lipitor, zocor, pravistatin) statins

Front 397

Where does the VZV lie dormant?

Back 397

sensory nerve ganglia (later causes shingles...dermatone)

Front 398

64y/o HTN DM2, Trig: 180, HDL 38, LDL: 135. Meds: sulfonylurea, TZD, biguanide, ACE-I, thiazide diuretic what next?

Back 398

lipid-lowering drug therapy initiated.

Front 399

What age is varicella vaccine started?

Back 399

after the 1st birthday and second between 4-6 y/o

Front 400

What lab should be check w/ taking HMG-CoA reductase inhibitor (Statin) ?

Back 400

aspartate aminotransferase (liver function), CK

Front 401

When should pregnant women recieve the first dose of varicella if no immunity?

Back 401

after delivery and before discharge

Front 402

What changes are expected when taking fibrates?

Back 402

increase in HDL: only medication that actually document increase in HDL

Front 403

What can be given if no immunization but contraindication for vaccination?

Back 403

VZIG post exposure

Front 404

What CD4 count in HIV should you withhold live virus?

Back 404

< 200 cell/uL

Front 405

How is diphtheria (gram-negative bacillu) transmitted?

Back 405

usually contaminated liquids ie milk

Front 406

When prescribing Zetia what should you expect to see?

Back 406

reduction in LDL

Front 407

What is the initial sx of diphtheria?

Back 407

pseudomembranous? pharyngitis

Front 408

What are risk factors for statin induced myostitis?

Back 408

advanced age, low body weight, high statin dose

Front 409

What should you give a patient exposed to tetanus but no immunization?

Back 409

Tetanus IG

Front 410

What is the average LDL reduction when only diet is modified in lowering cholesteral tx?

Back 410

5-10%

Front 411

How is Hep A transmitted?

Back 411

fecal oral route: self limiting rarely fatal

Front 412

When taking atorvastatin and cholestyramine advise the patient to take the medicaiton?

Back 412

separeate cholestyramine from other meds by 2hrs (affect absorption)

Front 413

What should clotting factor disorder patinets be immunized with?

Back 413

Hep A

Front 414

What medication is most effective against lipoprotein?

Back 414

niacin

Front 415

How is polio transmitted?

Back 415

fecal oral: OPV no longer used in US due to risk of paralytic poliomyelitis

Front 416

What are secondary causes of hypertriglyceridemia?

Back 416

hypothyroidism, poorly controlled DM or excessive alcohol

Front 417

Which would presents > risk for tetanus?
A. puncture while gardening
B: lac while cutting beef
C: human bite
D: abrasion from sidewalk

Back 417

Puncture wound while gardening

Front 418

HMG CoA reductase inhibitor (statin)? Effect, comments

Back 418

lower LDL by 18-55%
Increase: HDL by 5-15%
lower Trig by 7-20%
check AST prior to initiation, & periodically; check CK initiation. not needed further unless sx; A/E: rhabdo, myositis, increase when combined w/ fibrate, renal impairment

Front 419

Resin (cholestyramine, colestipol, colesevelam): benefits and adverse rxn

Back 419

low LDL:15-30%
increase HDL: 3-5%
nonsystemic w/ no hepatic monitoring required, minimal effect on Trig (may increase if trig >400)
A/E: GI, constipation, decrease of other meds absorption take >2hrs after

Front 420

18y/o w/ no primary tetanus should receive what tetanus immunzation?

Back 420

Tdap now then Td in 1 and 6 months

Front 421

Niacin (class: antihyperlipidemia): benifits, Use, adverse effects,

Back 421

increase HDL: 15-35%
decrease Trig: 20-50%
decrease LDL: 5-25%
Highly effective against atherogenic lipoprotein
A/E: flushing (take ASA 1hr prior to reduce), hyperlgycemia, hyperuricemia, GI, hepatotoxicity
Contra: active liver disease, gout, peptic ulcer

Front 422

50y/o who hasnt had tetanus vaccination in 10 years should receive what tetanus?

Back 422

Tdap

Front 423

Fibric acid derivatives: gemfibrozil (lopid), fenobribrate (tricor): what should you expect to see w/ tx and A/E

Back 423

increase HDL
decrease Trig: 20-50%
decrease LDL 5-20% (if normal Trig) May raise LDL w/ high Trig
A/E: dyspepsia, gallstones, myopathy if taken w/ statin
Contra: sever renal or hepatic disease

Front 424

What is the most common source of Hep A infection?

Back 424

contaminated drinking water

Front 425

What does Ezetimibe (Zetia) do and what are A/Rxn

Back 425

decrease LDL-C
increase HDL-C
-minimal effect on Trig, prescribe w/ another lipid lowering agent to enhance LDL
A/E: few due to no limited systemic absorption

Front 426

Which of the following should be tx for acute Hep A? A: interferon-alfa,
B: ribavirin
C: acyclovir
D: supportive care

Back 426

supportive care

Front 427

Sedondary hyperlipidemia:
What does inactivity result in

Back 427

decrase HDL

Front 428

Sedondary hyperlipidemia:
What does Alcohol abuse result in

Back 428

increase triglycerides, increase HDL increase LDL

Front 429

What age should women start having mammogram?

Back 429

40y/o. if high risk annually if low then yearly not recommended

Front 430

Sedondary hyperlipidemia:
What does DM result in

Back 430

increase Trig, decrease HDL, increase total cholesterol

Front 431

When should cervical screening be initiated?

Back 431

3yrs after intercourse
30y/o q 3yrs after 3 normal
Total hysterectomy: none

Front 432

Sedondary hyperlipidemia:
What does Hypothyroidism result in

Back 432

increase Trig increase Total TC

Front 433

When should endometrial cancer be discussed?

Back 433

at menopause: report any unexpected bleeding

Front 434

Secondary hyperlipidemia:
What does High dose thiazide diuretics result in

Back 434

increase TC, LDL, Trig

Front 435

What are the five A of tobacco counseling?

Back 435

Ask, Advise, Assess, Assist, Arrange

Front 436

Sedondary hyperlipidemia:
What does Chronic renal result in

Back 436

increase TC and Trig

Front 437

What medications are used in tobacco cessation?

Back 437

bupropion (Wellbutrin), varenicline (Chantix)

Front 438

Metabolic syndrome dx includes:

Back 438

abd obesity, trig levels higher than 150, HDL less than 40 in men and 50 in women

Front 439

What does ABRS stand for w/ ENT?

Back 439

Acute Bacterial Rhinosinusitis

Front 440

What is characteristic of Metabolic Syndrome related to insulin?

Back 440

Insulin resistance is present

Front 441

Things that point to bacterial versus viral sinusitis?

Back 441

Sx > 4 days, Purulent discharge, tooth or facial pain, maxillary sinus tenderness unilateral, sx worsen after improving.

Front 442

Describe plasminogen activator inhibitor:

Back 442

increased levels in atherosclerotic lesion
-inhibits fibrin degradation by plasmin
-enhances clot formation

Front 443

Purpose of giving decongestant w/ sinusitis is to..?

Back 443

Promote drainage

Front 444

Define metabolic syndrome:

Back 444

3 or more: obesity, blood pressure, dyslipidemia, glucose intolerance

Front 445

Patient 875mg amoxicillin for sinusitis but worsen after 5days what is the bug? What should you do

Back 445

it is probably a beta lactam and should use augmentin, tirid gen cephlasporin

Front 446

Amoxicillin for sinusitis develop hives what should you do?

Back 446

Stop amoxicillin. Start doxycycline or other none PNC/Ceph

Front 447

Metabolic syndrome Guidelines:

Back 447

abd men >40 inches, W >35
-Trig >150, HDL<40
BP: >130/85
Fasting glucose >110

Front 448

If a patient has anaphylactic on PNC what other antibiotic should not be given?

Back 448

cephlasporin

Front 449

Insulin resistance is inversely related to decrease urine clearanc of what

Back 449

Uric acid (gout)

Front 450

Adult w/ common cold takes fexoaphenadine (allegra) and fluticosone nasal spray for allergies...what should you do?

Back 450

keep her on allergy and add oral decongestant. Dont add guifenisin (it wets and fexoaphenadine is trying to dry up)

Front 451

What will oral decongestants exacerbate?

Back 451

(Psuedofed)...urge incontenance, blood pressure, mitral valve prolapse, BPH

Front 452

What are some disadvantages to apple shaped (central abd fat)

Back 452

metabolically active fat, high insulin levels, IR, free fatty acids and high insulin (increase hunger)

Front 453

What would contraindicated use of topical decongestant? ie affrin

Back 453

it is a vasoconstrictor: dont use in hypertensive patient

Front 454

IR contribute to prothromotic and proatherogenic state because

Back 454

Plasminogen activator inhibitor: inhibits fibrin degradation enhancing clot formation

Front 455

What is the modified CENTOR score to determine giving an antibiotic for pharyngitis?

Back 455

fever >100.4, no cough, anterior cervical nodes, tonsilar exudate swelling.
Also: ages 3-14 more likely
>45y/o subtract a number

Front 456

16y/o patient w/ acute pharyngitis and sinus sx but no sore throat only sinus sx but you get positive strep?

Back 456

PNC 10 days: prevent rheumatic fever

Front 457

Pt unable to swallow due to throat pain and in sniffing position w/ fever 103, and is spitting? what is the likely dx

Back 457

epiglotitis

Front 458

What is the tx of epiglotitis in a FP clinic?

Back 458

call 911

Front 459

Aerobic exercise can reduce IR by what percent

Back 459

40% and last 48hrs, reduces BP and improves lipids

Front 460

What the likely hood of having enlarged spleen w/ mono?

Back 460

50% have enlarged spleen palpate w/ flat part of hand not finger tips

Front 461

What medication improves insulin sensitivity and metablic parameters like lipids and BP

Back 461

TZD (pioglitazone, rosiglitazone)

Front 462

What are mono sx?

Back 462

FFFL: fatigue, fever, (f)pharyngitis, lymphadenopathy

Front 463

What does daily ASA do for BP, lipids

Back 463

counter act proinflammatory and prothrombotic effects of IR

Front 464

Sx suggestive of mono but mono spot is negative? what should you do?

Back 464

repeat mono spot in 5-7 days if cont sx. <2% w/ two negative test. Dont do epstein barr virus due to low sensitivity and high cost

Front 465

What does the WHO define as obesity ___kg/M2 or more

Back 465

30 Kg/M2

Front 466

What is kiesselbach plexus?

Back 466

Anterior nose likely to bleed 90% of nose bleed

Front 467

How do you treat epistaxis?

Back 467

topical vasocontrictor (phynlephrine spray), cotton saturated w/ vasocontrictor, insert in nasal opening

Front 468

What does orlistat do for weight loss

Back 468

reduc dietary fat absorption by 30%. Results in diarrhea if you eat fats

Front 469

What if you have epitaxis in rural clinic w/o other resources?

Back 469

silver nitrate: anesthesia first.

Front 470

What does Meridia due for weight loss

Back 470

acts on brain control for mood an dwell being and appetite

Front 471

Allergic Rhinitis: management

Back 471

first line: nasal steroid (fluticasone), then add antihistamine, then add decongestant, then add leukotriene blocker

Front 472

When can someone consider Bariatric surgical:

Back 472

100lbs or more over ideal or >40BMI

Front 473

What is the difference in first gen and send gen antihistamines?

Back 473

second gen is less drowsy and last 24hrs:
zyrtec is 2nd gen but does cause drowsines

Front 474

What are risk factors for pancreatitis:

Back 474

hyperlipidemia, abd trauma, thiazid diuretic use, alcoholism, gallbladder stones,

Front 475

Patient w/ insect sting and allergic sx of runny nose, erythema, puritis at sight what should you use to tx sx?

Back 475

systemic tx: diphehydramine liquid (absorbed faster than tablet)

Front 476

What lab is obtained to determine acute pancreatitis

Back 476

serum lipase level w/ amylase

Front 477

Patient dx w/ Otitis externa what is a classic sx?

Back 477

tragus pain, otic discharge, diminished hearing...should NOT have fever (not a systemic disease)

Front 478

What is the most reliable test for pancreatic cancer

Back 478

MRI is the most reliable diagnostic.

Front 479

What is care of pancreatitis

Back 479

parenteral hydration , analgesia, gut rest, tx underlying cause

Front 480

Cermumen impaction would produce what type of hearing lose?

Back 480

Conductive hearing loss (as does any obstruction)

Front 481

How does a pancreatic cancer present:

Back 481

abd pain , weight loss, anorexia, N/v, jaundices

Front 482

What is a sensorineural hearing loss?

Back 482

8th cranial nerve, effects inner ear, involves nerve

Front 483

Amylase in Acute Pancreatitis will appear ______ and return back to normal ______. What % are due to cholelithiasis vs % due to alcoholic pancreas

Back 483

* appears 2-12h after sx onset
* back to normal w/in 7d of pancreatitis resolution
* Amylase level >1000 U/L
*80%=Dx cholelithiasis
*6% = Dx alcoholic pancreatitis

Front 484

What is presbycusis?

Back 484

hearing loss from age...bilateral

Front 485

Amylase: What effects amylase levels
Nonpancreatic amylase:

Back 485

*salivary glands
* ovarian cysts
* ovarian tumors
* tubo-ovarian abscess
* ruptured ectopic preg
* lung cancer

Front 486

What does the Webber test detect?

Back 486

unilateral conductive and sensioneural hearing loss
Riene (mastoid bone then air)
Webber (top of head)

Front 487

What steps should be taken for eye complaints?

Back 487

Visual acquity, slit lamp, if only a light look at the side for smooth round globe, flouresceine stain for break in cornea

Front 488

Lipase in Acute Pancreatitis:
Lipase appear how soon after onset and peaks at what time frame

Back 488

* appears 4-8h after sx onset
* Peaks at 24h, decreases 8-14d of pancreatitis resolution

Front 489

What is associated w/ cataracts?

Back 489

decrease night vision, decrease vision, double vision, decrease color vision.

Front 490

What non pancreatic reasons would result in elevated Lipase?

Back 490

* renal failure
* perforated duodenal ulcer
* bowel obstruction
* bowel infarction

Front 491

Conjuctivits: why are meds given?

Back 491

only to get back to work or school earlier...they will clear on own

Front 492

Hyperthyroidism: signs and sx
Characteristics (patho)

Back 492

excessive energy release, rapid cell turnover

Front 493

What is a pinguecula?

Back 493

non-cancerous growth of the clear, thin tissue (conjunctiva) that lays over the white part of the eye (sclera)

Front 494

Corneal arcus is what?

Back 494

seen in older patients, may indicate elevated cholesterol

Front 495

Hyphema is what?

Back 495

bleeding in anterior chamber (emergency) caused by trauma

Front 496

What is a chalzion?

Back 496

hard nontender nodule on eyelid

Front 497

What is a stye or hordoleum?

Back 497

bump on eyelid that starts off tender

Front 498

RUQ abdominal pain is associated w/?

Back 498

Liver disease, choly, pneumonia

Front 499

What is the LES tone related to GERD?

Back 499

Lower esophageal sphincter, becomes relaxed which results in gastric juice back flow

Front 500

What is Barretts esophagitis?

Back 500

Pre malignant condition of the esophagus: a differential of GERD tx w/ PPI: age 50 get scoped, or not responsive to PPI, pain or bleeding get scoped too

Front 501

GERD tx?

Back 501

Remain upright 2-3hrs after they eat (clear stomach), pH should be elevated when reflux is expected

Front 502

What pharm tx is used in GERD?

Back 502

antacid (reduces pH) (short term 30min but reacts fast),
2nd: H2 blocker (histamine blocker) decrease acid production (dont change pH but work for 12-24hrs)
3rd: PPI the best aggressive tx: (not PRN drug) prescibed for 1 month

Front 503

H. pylori is gram negative: causes what?

Back 503

ulcers in stomach or esophagus,

Front 504

38y/o w/ suspect C-dif (gram neg) what is a classic description of stool?

Back 504

bloody and watery

Front 505

What infectious organism is common if under cooked poultry is consumed?

Back 505

salmonella ( also on pet turtles)

Front 506

IBS is dx by:

Back 506

Rome 3 criteria:
recurrent abd pain 3d/m in last 3m w/ 2 of the following:
relief w/ defecation
onset associated w/ frequency of stool
onset associated w/ form and appearance of stool

Front 507

54y/o states blood on tissue after BM: what should be done first?

Back 507

examine rectum, next send to GI

Front 508

C/o bloody nocturnal diarrhea w/ fever and cramping: what should you think of dx?

Back 508

ulcerative colitis (classic sx) inflammatory disease

Front 509

What age should you start asking about risk of colorectal cancer?

Back 509

30-40 if high risk then screen q 5 yrs

Front 510

Diverliculosis means you have some diverticula when they become inflamed you have diverticulitis: where is the pain?

Back 510

left lower quadrent

Front 511

What is the diagnostic test for diverticulitis?

Back 511

CT w/ contrast IV or oral

Front 512

Pt has inspiratory pain on palpation of RUQ: what is it and what is the dx?

Back 512

Murphys sign, cholycystitis

Front 513

In classic appendicitis the point of maximum tenderness is called?

Back 513

McBurneys point

Front 514

What exam should be performed in 26y/o female w/ RLQ pain?

Back 514

rectal and pelvic exam

Front 515

Liver function test include:

Back 515

ALT, AST, (just looking at the liver).
PT, albumin (how well liver is making things).

Front 516

What does ALT and AST mean if elevated?

Back 516

if alt is the higher of the two then they have hepatitis.
If ast is higher think (acetominophen, statins and tequila) both are elevated (things consumed

Front 517

Pt feels bad he has fever and malaise: AST is higher what is the likely cause

Back 517

acetominophen, statins or tequila (alcohol abuse)

Front 518

Pt lab values of ALT 290, AST 100 what is the probable dx?

Back 518

viral hepatitis

Front 519

75y/o w/ multiple myoloma (long bone pain elevated Ca) could exhibit what?

Back 519

2/3 found after fx: anemic, dump protein in urine (elevated alkaline phos) : liver enzyme elevated due to cancer of bone cancer of liver, bone disease (unless adolescent or pregnant then alkaline phos is elevated)

Front 520

5 causes of viral hepatitis are what?

Back 520

Hepatitis A&E transmitted from food, water
Hepatitis BCD transmitted from blood (can be chronic)

Front 521

Mechanism of transmission of A is?

Back 521

fecal oral

Front 522

Hepatitis marker: immunogobulin: IGM (minute you get infected you make it) IGg (after infection gone) (antibodies)

Back 522

learn this

Front 523

What does it mean if Igg is positive?

Back 523

it means they r immune

Front 524

What does it mean if IgM is positive?

Back 524

they have an infection (what ever your messuring ) right now

Front 525

What does it mean if IgM and IgG are both negative?

Back 525

no immunity no illness: if vaccine give it.

Front 526

Hepatitis B sx typically?

Back 526

asymptomatic: hepatocellular carcinoma (80% w/ hepatitis B)

Front 527

Who/what must develop protocols governing APN practice: Texas?

Back 527

Delegating physician and APN using 5 factors
1. texas law
2. experience
3. consulation availability
4. input of delegating physician
5. federal regulation

Front 528

Who must sign protocols?
How often are they reviewed

Back 528

delegating physician and APN
reviewed and signed annually

Front 529

Which of the below is a CHD risk equivalent:
a. HTN
b. Cigarette smoke
c. Male>45
d. DM

Back 529

DM: also symptomatic CAD, PD, AAA >risk of CHD

Front 530

Screened for hyperlipidemia via blood draw should be told to:
a. fast 12-14hrs
b. fast 6-8hrs
c. black coffee allowed
d. non-fasting not necessary

Back 530

a: fast 12-14hrs:
maximum effect of eating on tryclycertide leve at 3-4 hrs but peak during 12hr

Front 531

Class of Med will normalize lipid elevation?
a. niacin
b. fibric acid
c. statin
d. bile acid sequestrants

Back 531

c: Statin:

Front 532

Which test listed below may exclude secondary cause of hyperlipidemia?
a. cbc
b. urine C&S
c. TSH
d. fasting glucose

Back 532

C: TSH:
and diabetes, renal failure, hypothyroidism

Front 533

How often are statins taken to lower lipids?
a. twice daily
b. always w/ food
c. w/ ASA
d. in conjunction w/ diet and exercise

Back 533

D: in conjunction w/ diet and exercise:
(only once daily)

Front 534

Pt taking lovastatin for 3m for hyperlipidemia w/ muscle aches in thigh. What should be done?
a. stop lovastatin immediatly
b. check liver enzymes
c. order CPK
d. ask about night cramps

Back 534

c. order CPK: c/o myalgias consider rhabdomyolysis if elevated THEN stop lovastatin immediately

Front 535

HTN pt most likely to have adverse BP effect from excessive Na?
a. 21 asian
b. 35 menstruating female
c. 55 post menapausal
d. 70 african American male

Back 535

d: african American male:

Front 536

HT and MI 6yrs ago w/ mild SOB today. takes quinapril, ASA, metoprolol, statin: What sx is NOT indicative of CHF exacerbation?
a. fatigue
b. HA
c. Orthopenea
d. cough

Back 536

b: HA:

Front 537

CHF on ACE-I. W/ cough. What finding distinguish etiology of cough from CHF?
a. dry nonproductive
b. wet worse w/ recumbence
c. purulent and tachycardia
d. SOB after cough

Back 537

b. wet and worse: usually worse at night too

Front 538

SOB w/ CHF. What test would help determine this?
a. Echo
b. BNP
c. EKG
d. BUN

Back 538

b: BNP: >80% pg/l = 98% chance of CHF

Front 539

Class of med used to tx systolic dysfunction post-MI:
a. loop diuretic
b. beta blocker
c. ACE-I
d. thiazide diuretic

Back 539

c. ACE-I: prevent LV hypertrophy, dilation and dysfunction = prevent HF

Front 540

Ramipril initiated at low dose in patient w/ CHF. What is most important to monitor in about one wk:
a. HR
b. BP
c. EKG
d. K level

Back 540

d; potassium level:
ACE-I work on kidney and may impair renal excretion of K: monitor BUN, Cr one wk after starting

Front 541

What med could exacerbate CHF?
a. metoprolol
b. furosemide
c. metformin
d. acetaminophen

Back 541

a. metoprolol: cardioselective BB slow HR, inhibit pt w/ CHF to have increase HR to compensate decrease CO.

Front 542

75y/o HTN takes ACE-Ithiazide diuretic daily. BP 128/88, p: 98. Has dyspnea on exertion and peripheral edema:
a. need better BP manage
b. development of CHF
c. noncomplinace w/ medications
d. fluid or Na excess

Back 542

b: development CHF:

Front 543

Medication which produce exercise intolerance w/ HTN is:
a. HCTZ
b. amlodipine
c. metoprolol
d. fasinopril

Back 543

c. metoprolol: decrease HR = exercise intolerance HR cant increase for CO

Front 544

Pt w/ HTN has allergy to sulfa. Which med is contraindicated in pt?
a. ramipril
b. metoprolol
c. HCTZ
d. verapamil

Back 544

c: HCTZ: sulfa med also avoid loop diuretics

Front 545

Which is best choice of anti-HTN?
a. BB for 38y/o DM
b. ACE-I for pt on K sparing diurectic
c. BB in 46y/o w/ migraines
d. diurectic pt w/ gout

Back 545

c: BB in 46y/o migraines: Beta Blocker can be used on migraines

Front 546

Pt poorly controlled HTN for 10yrs. Indicate mostly likely position of his point of max impluse:
a. 5th incercostal mid-clavicular
b. 3rd ICS MCL
c. 5th ICS, left of MCL
d. 6th ICS, right MCL

Back 546

c. 5th ICS, left MCL: left vent hypertrophy may displace apical impulse

Front 547

Pt newly dx w/ HTN taking rampiril. What test would be important to monitor?
a. INR
b. Ca
c. K level
d. ALT/AST

Back 547

c: potassium level

Front 548

Pt w/ HTN takes 25mg HTCZ QD for 4wks. BP decrease from 155/95 to 145/90. What should you do next?
a. cont HCTZ
b. increase HCTZ
c. add another class to current HCTZ dose
d. stop HCTZ start different class

Back 548

c. add drug from another class to current med
: still need to decrease BP: combo effects decrease BP

Front 549

enlarged atrium or ventricle is important w/ audible murmur. Which study helps eval hypertrophy?
a. chest xray
b. ECG
c. Echo
d. doppler US

Back 549

c: ECHO

Front 550

Valve most commonly involved in chronic rhematic heart disease?
a. aortic
b. mitral
c. pulonic
d. tricuspid

Back 550

b: mitral most common, aortic 2nd most common, pulmonic 3rd most common

Front 551

Pt w/ audible diastolic murmur best heard in mitral listening point no click. Murmur is probably?
a. mitral valve prolapse
b. acute mitral regurg
c. chronic mitral regurg
d. mitral stenosis

Back 551

d. mitral stenosis:
audible click typical in MVP

Front 552

28y/o grade 3 mumrur. Which one needs referral?
a. fixed split
b. increase in splitting win inspiration
c. split S2 w/ inspiration
d. changes in intensity w/ position

Back 552

a. fixed split is ALWays abnormal

Front 553

25y/o w/ aortic stenosis. Etiology of AS is probably?
a. congenital
b. rheumatic
c. acquired calcific
d. unknonw

Back 553

a. congentialt: most likely w/ age
b. rheumatic: 2nd most common
c. acquired: >65y/o normal

Front 554

Most common arrhythmia resulting in valvular heart disease?
a. a fib
b. SVT
c. VF
d. heart block

Back 554

A: A-fib:

Front 555

Pt dx w/ tina pedis. Microscopic exam would reveal?
a. hyhae
b. yeast
c. spores
d. comboof hyphae and spores

Back 555

a. hyphae: also in corpus and cruris

Front 556

Test used to dx shingles if clinical is questionable?
a. Tzanck prep
b. viral load
c. rapid herpetic
d. CBc

Back 556

a: txanck prep: taken from blister: most blistering eruptions are herpatic until proven otherwise

Front 557

Most common skin cancer?
a. squamous cell carcinoma
b. basal cell carcinoma
c. malignant melanoma
d. cutaneous carcinoma

Back 557

b. basal cell carcinoma:

Front 558

Poison ivy x 3 d. She asks about spreading it to family. you state:
a. yes, after crusting occurs
b. yes, fludi in blister can be transmitted
c. no, transmission does not occur
d. no, you'b progressed beyond transmission

Back 558

c. no: exposure is from contact of plant

Front 559

Topical hydrocortisone cream most appropriate in pt dx w/
a. psoriasis
b. impetigo
c. atopic dermatitis
d. eczema

Back 559

d. eczema:
a. topical not strong enough to penetrate psoriasis
b. contraindicated in impetigo
c. emollient best for atopic

Front 560

Skin lesion fluoresces under Woods lamp. What microscopic findings is consistent w/ this?
a. clue cells
b. herpes simplex
c. spores
d. leukocytes

Back 560

c: spores = fungal infection

Front 561

17y/o w/ nodulocystic acne employed as cook. What is greatest positive impact in managing acne?
a. retin a plus minocycline
b. benzoyl peroxide plus erythromycin
c. isotretinonin
d. change occupation

Back 561

c. isotretinonin (accutane)

Front 562

Pt w/ atopic dermatitis will also have:
a. allergic rhinitis and anaphylaxis
b. asthma and allergic rhinitis
c. nasal polyps and asthma
d. allergic conjunctivitis and wheeze

Back 562

b. asthma and allergic rhinitis: atopic dermatitis = atopic triad

Front 563

Pt willl take oral Lamisil for fingernail fungus. NP knows:
a. will cure 95% of time
b. topical antifungal w/ work if nail matrix involved
c. Lamisil is potent inhibitor of CYP 3A4
d. toenail fungus resolves faster than fingernail fungus

Back 563

c: lamisil is potent inhibitor of CYP: caution w/ liver if >2.5 above normal stop

Front 564

Pt w/ tick one month ago w/ red circle and white center. Now c/o numbness, peripheral paresthesias, poor concentration. what lab test can dx Lyme disease?
a. CBC
b. lyme titer
c. ELISA
d. CSF for spirochete

Back 564

c. ELISA

Front 565

Herald patch is hallmark finding of what derm dx?
a. erythema infectiosum
b. pityriasis rosea
c. seborrheic keratosis
d. atopic derm

Back 565

b: pityriasis rosea

Front 566

Pt w/ silvery scales on extensor surface of elbows, knees, back: plaques are red: dx?
a. plaque psoriasis
b. guttate psoriasis
c. atopic dermatitis
d. staph cellulitis

Back 566

a. plaque psoriasis

Front 567

Cancer society: pneuomic ABCDE: B stands for?
a. bleed
b. black
c. border
d. benign

Back 567

c. border

Front 568

Skin lesion which is sold mass described as:
a. macule
b. papule
c. vesicle
d. bullae

Back 568

b: papule: 1.0cm

Front 569

Pt burned w/ hot water. Has several large fluid filled lesions. What r they called?
a. vesicles
b. bullae
c. erosions
d. dermal abrasions

Back 569

b. Bullae

Front 570

Lesion w/ folliculitis might be filled w/?
a. blood
b. pus
c. fluid
d. serum

Back 570

b. pus

Front 571

Impetigo is characterized by:
a. honey-colored crust
b. silvery scales
c. marlbe lesions
d. wheals

Back 571

a. honey colored crust

Front 572

Chancroid is a

Back 572

(soft chanker) STI: from bacteria H. Ducreyi

Front 573

Best means to observe for jaundice:
a. skin in diffuse light
b. scarp skin to ID KOH pos lesion
c. observe skin in direct sunlight
d. note the patients sclera

Back 573

d. note sclera: to see jaundice easily

Front 574

Treatement of Chancroid is:

Back 574

Azithromycin (macrolide)
ciprofloxacin (2nd gen fluorquinolone)
ceftriaxone (cephalosporin)

Front 575

Which following lesions never blanches when pressure applied?
a. spider angioma
b. spider vein
c. pupura
d. cherry angioma

Back 575

c. purpura; and petichia never blanch due to extravation of blood under skin

Front 576

What other disease do you expect to find when testing for chancroid (STD)

Back 576

herpes simplex

Front 577

60y/o w/ clubbing of fingers. What might this indicate?
a. CAD
b. Cirrhosis
c. lead tox
d. IDA: iron deficent anemia

Back 577

a. CAD: associated w. hypoxia

Front 578

What does Chancroid look like?

Back 578

vesicular pustular lesion painful, soft ulcer w/ necrotic base at point of inoculation.

Front 579

Pt w/ spoon shaped nails. What lab test should u obtain?
a. LFT
b. CBC
c. Hep B antigen
d. ABG

Back 579

B: CBC for IDA

Front 580

What is the causative organism in lymphogranuloma venereum

Back 580

C. trachomatis 1&3

Front 581

Which med will not increase photosensitivity?
a. amoxicillin
b. sulfa drugs
c. fluoroquinolones
d. doxycycline

Back 581

a. amoxicillin: all other will

Front 582

What are the physical findings w/ lymphogranuloma venereum

Back 582

lesions fuse and create multiple draining sinuses mainly in the groin

Front 583

Pt w/ psoriasis w/ topical hydrocortisone cream for years. Now states cream doesnt work? What has happened?
a. rebound
b. tachyphylaxis
c. tolerance
d. lichenification

Back 583

c. tolerance

Front 584

What is the tx for lymphogranuloma venereum

Back 584

tetracycline

Front 585

Chancroid: causative organism
presentation

Back 585

H. ducreyi
painful genital ulcer, mult lesion, inguinal lymphadenitis

Front 586

Pt w/ seborrheic dermatitis. What vehicle most appropriate in hairline?
a. ointment
b. cream
c. lotion
d. powder

Back 586

c. lotion: due to cooling, drying effect

Front 587

Chancroid Tx

Back 587

Azith 1g oral or
Ceftriaxone 250 IM or
Cirpo 500 BID x 3d

Front 588

What derm area has greatest percutaneous absorption?
a. sole of foot
b. scalp
c. forehead
d. genitalia

Back 588

d: genitalia

Front 589

Which of the following is inconsistent w/ otitis externa?
a. tragal pain
b. otic discharge
c. otic itching
d. fever

Back 589

d. fever (swimmers ear): pseudomonas; local infection

Front 590

Sx triad common w/ infectious mono?
a. fever, pharyngitis, lymphad
b. fatigue, pharygitis, fever
c. splenomegaly, fever, body aches
d. tonsillar exudates, lymphad, HA

Back 590

a. fever, pharyngitis, lymphad (Centor criteria)

Front 591

Med to avoid w/ mononucleosis:
a. azithromycin
b. ampicillin
c. acetaminophen
d. topical lidocaine

Back 591

b: ampicillin: beta lactam (PCN) causes rash

Front 592

Most common complication of influenza?
a. cough
b. bacterial pnumonia
c. viral pneumonia
d. bronchitis

Back 592

b. bacterial pneumonia: streptococcus pneumonia

Front 593

Older adult w/ cerumen: what type of hearing loss?
a. sensorineural
b. conductive
c. presbycusis
d. cholesteratoma

Back 593

b. conductive:

Sensorioneural = inner ear or 8th cranial, presbycusis = loss w/ aging >60y/o

Front 594

70y/o w/ hearing loss. which is typical of presbycusis?
a. inability to hear consonants
b. asymmetrical loss
c. inability to hear low pitched
d. pulsatile noise

Back 594

a. inability to hear consonants

Front 595

Which statement is correct about OM w/ effusion?
a. OME needs tx w/ antibioltic
b. OME precede or follow OM
c. OM is more common than OME
d. OM and OME have fever

Back 595

b. OME can precede or follow OM

Front 596

Which is dx w/ AOM?
a. decreased mobility of TM
b. visible bubbles behind TM
c. fluid an dbulging of TM
d. marked redness of TM

Back 596

c. fluid and bulging of TM

Front 597

Pt TM is chalky white mark w/ no complaints is probably?
a. normal TM
b. scarring of TM
c. chronic inflammation
d. pus

Back 597

b. scarring

Front 598

Which finding is an emergency?
a. fiery red epiglottis
b. sudden hoarseness
c. purulent drainage from ear
d. tragal tenderness

Back 598

a. fiery red epiglottis

Front 599

Pt w/ fever and phyryngitis has negative rapid strept test. TC is normal: The patient:
a. has strept and should be tx
b. has bacterial pathogen
c. has pharyngitis but undetermined etiology
d. tx'd w/ PNC due to sx

Back 599

C. pharyngitis

Front 600

45y/o spinning sensation for hrs before stopping w/ n/v and HA. Which is not sx of benign positional vertigo?
a. length of duration
b. N/v
c. Ha
d. sensation of spinning

Back 600

c. HA

Front 601

Pt dx w/ allergic rhinitis. Which sx is NOT associated w/ allergic rhinitis?
a. paroxysmal sneez
b. rhinorrhea
c. nasal congestion
d. facial pain

Back 601

d. facial pain: indicates infection

Front 602

Which is most typical w/ allergic rhinitis?
a. normal nasal turbinates
b. cough
c. post nasal drip
d. sx associated w/ expsure to cates

Back 602

d. sx exposure to cats: dx base on exposure.
a. typically pale boggy
b. common but not all
c. not all

Front 603

Nasal congestion upon exiting building. Occur in spring and summert. Dx?
a. seasonal allergic rhinitis
b.perennial allergic rhinitis
c. chronic non-allergic rhinitis
d. rhinitis medicamentosa

Back 603

c. chronic non-allergic: tx w/ topical azelastine
a: tree, grass mold
b. dust mite, animal dander

Front 604

Epistaxis most common occure:
a. in women
b. at kiesselbach plexus
c. posterior septum
d. pt on anticoagulant

Back 604

b. kiesselback plexus: 3 artery
a: more in men
c. 80% anterior
d. common but not most

Front 605

40y/o in good health w/ 0.5 white plaque on oral mucosa. no pain. What should you do next?
a. benign lesion: monitor
b. mechanical trauma: monitor
c. biopsy
d. referred to dentist

Back 605

c. biopsy: leukoplakia precancerous

Front 606

Pt dx w/ acute rhinosinusitis: etiology?
a. strept
b. staph
c. viral
d. mycoplasma

Back 606

c. viral: only 2% r bacterial

Front 607

Sx of bacterial sinusitis vs viral?
a. discolored nasal discharge
b. worsenign sx after improve
c. facial pressure
d. nasal conge

Back 607

b. worse after improvement:

Front 608

Pt w/ healthy eval. States woke this am cant hear out of left ear. Exam is normal: what next?
a. Rx antihistamine & nasal decongestant
b. send to audiologist
c. refer to eNT
d. initiate steroids and consider referral in 1 wk

Back 608

c. refer to ENT: need MRI: diff dx: acoustic neuromea

Front 609

Pt w/ ears stopped up, blew out forceful after pinching ears. Dx w/ TM rupture. What would indicate this?
a. bright red blood
b. pain
c. clear fluid
d. absence of hearign

Back 609

a. bright red blood
d: hearing muffled

Front 610

Pt w/ sensation of something in throat. normal exam. What dx?
a. factition sore throat
b. pseudo pharyngitis
c. globus
d. Gerd

Back 610

c. globus: most common cause is GERD

Front 611

Pt dx w/ strept throat tx w/ amoxicillin. No improvement in 48hrs. What next?
a. wait 24 more hrs
b. change to 1st gen cephalo
c. macrolide should be Rx
d. PNC or cephlo w/ beta lactamase should be considered

Back 611

d. PNC w/ beta lactam
c. macrolide has poor resistance to strept

Front 612

Pt given PNC V 3xd for 10 d sore throat. On day 9, feeling better but puritic full body rash? What is clinical finding?
a. rash will be fine and popular
b. hives
c. large, splotchy, non-pruritic
d. rash will not blanch

Back 612

b: hives: puritic, circumscribed, raised red w/ central wheel

Front 613

Pt w/ PNC allergy. Which would help determine whether to give cephalosporin?
a. ever taken cepholosporin
b. how long ago was rxn
c. what kind of rxn
d. what form of PNC

Back 613

c. kind of rxn: 2% w/ PNC rxn have cephlo rxn

Front 614

Pt hospitalized w/ CHF. Now c/o hearing loss. Which med caused it?
a. digoxin
b. furosemide
c. ramipril
d. metoprolol

Back 614

b. furosemide: also aminoglycosides, vanco, e-mycin, loop diurectics, antimalaria..

Front 615

29y/o return from camping. Hx of DM1 and migraines. 2d hx of n/v. Whichis least likely cause?
a. migrain Ha
b. DKA
c. AGI
d. Giardia infection

Back 615

d: giardia infection: causes dirrhea

Front 616

46y/o female low-grade fever and nausea pain at McBurneys pont. Nex action:
a. order a CBC
b. refer to ER
c. prescribe a laxative
d. obtain pregnancy test

Back 616

b. refer to er for CT scan

Front 617

Pt w/ inguinal hernia c/o colicky abdominal pain, n/v: it is likely:
a. hernia that is strangulated
b. gastroenteritis
c. chronic constipation
d. unrelated to his hernia

Back 617

a. hernia strangulated: emergency surg in 4-6hrs.

Front 618

Pt w/ supsected hernia examined:
a. lying down
b. standing
c. side-lying
d. while squatting

Back 618

b. standing

Front 619

Pt dx w/ Hep A. Most common risk factor:
a. drinking contaminate water
b. eating contaminated food
c. traveling internationally
d. IV drugs

Back 619

C: traveling international (most)
a & b: most unable to confirm
D: hep C

Front 620

Most pt w/ acute Hep A are:
a. males
b. acute ill
c. varied clinical presentation
d. develop subsequent cirrhosis

Back 620

c. varied clinical

Front 621

Pt w/ following laboratory value. Waht does this mean? Hepatitis A: (+) IgG:
a. has hep A
b. Has immunity to hep A
c. Has no immunity to hep A
d. more data needed

Back 621

B: has immunity (IgG is antibody

Front 622

Pt dx w/ Hep B. Most common risk factor?
a. drink water
b. eat food
c. travel international
d. sexual exposure

Back 622

d. sexual exposure

Front 623

Most pt w/ actue hep B:
a. females
b. acute ill
c. varied clincial presentations
d. develop subsequent cirrhosis

Back 623

c. varied presentation
a: = to males
b: fever, nausea, flu-like

Front 624

Pt w/ pos Hep B surface antibody: means:
a. acute hep B
b. chronic hep B
c. immune to hep B
d. needs immunization to hep B

Back 624

c. immune to hep B

Front 625

Pt w/ Hep C:
a. receive imminization for hep A
b. receive immun for hep b
c. receive immun for A&B
d. neither A or B

Back 625

c. receive immun for A&B

Front 626

83y/o dx w/ diverticulitis. Most common complaint:
a. rectal beed
b. bloating and crampiness
c. LLQ pain
d. frequent belching and flatulence

Back 626

c. LLQ pain

Front 627

GERD and physiologic reflux simalar except physiolgic reflux:
a. produce mucosal injury
b. nerver occures at night
c. occurs on ly postproandial
d. usually asymptomatic

Back 627

D: asymptomatic
A: is GERD

Front 628

Which drug/class most liley to produce rapid relief of heartburn?
a. antacid
b. H2 blocker
c. PPI
d. sucralfate

Back 628

a: antacid 20-30min
b and c: hrs to work
d: adheres to mucosal wall

Front 629

Most important risk factor in duodenal ulcer disease:
a. cigarette smoking
b. spicy food
c. coffee consumption
d. inffection w/ H. pylori

Back 629

d. infection w/ H. pylori: peptic ulcer disease gastric adenocarcinoma and lymphoma

Front 630

Pt w/ gall bladder disease has classic sx. Which sx below is NOT classic of gallbladder?
a. intense, dull pressure mid abd
b. pain radiates into chest, back or right shoulder blade
c. pain worsen after fatty meal
d. pain occurs w/ fasting

Back 630

d. pain occurs w/ fasting:

Front 631

Which would be unusual in pt w/ uncomplicated gallbladder disease?
a. fever
b. guarding
c. Postive murphys
d. nausea

Back 631

a. fever: not typical

Front 632

42y/o dx w/ ulcerative colitis years ago. Last colonscopy 5yrs. What screenign is neded for colon cancer?
a. at age 50 w/ colonoscopy
b. now w/ fecal occult
c. now w/ colonoscopy
d. at age 45 w/ colonoscopy

Back 632

c. now w/ colonoscopy: 45 then every 1-2 yrs

Front 633

Relation betweel colon polyps and colon cancer:
a. polyps all become malignant
b. polyps slow progression to cancer
c. polyps rapid progression to cancer
d. no relationship

Back 633

b. slow progression

Front 634

Single stool specimen during rectal exam is:
a. adequate fro screening cancer
b. detect presence of polyps
c. inadequate to screen cancer
d. adequate for low risk patient to screen cancer

Back 634

c. inadequate for cancer: need 3

Front 635

Hemorrhoids is unusual if?
a. bleed or itch
b. 45-65 y/o
c. 20-30y/o
d. more common in pregnant

Back 635

c. 20=30y/o not very common

Front 636

Later or tertiary: presentation, slide 3 tx

Back 636

Gumma (granulomatous lesions involveing skin, mucous membranes, bone) aortic insufficiency, aortic aneurysm, Argly Roberttson pupil seizures
PNC G 2.4 M IM weekly x 3 wk or if allergic like secondary:
doxy 100mg BID x 2 wks

Front 637

70y/o bright red blood on toilet this am after BM. Most likely?
a. hemorrhoids
b. diverticulosis
c. colon cancer
d. colon polyp

Back 637

a. hemorrhoids

Front 638

50y/o hx of 3-4 alcoholic drinks daily w/ weekend binge has elevated liver enzymes. which is most likely?
a. AST=200, ALT=75
b. AST=100, ALT=90
c. AST=100, ALT=200
d. AST=30, ALT = 300

Back 638

a: Remember: elevated
AST = actaminophen, statin, toxic,
ALT = liver --> Hepatitis

Front 639

37y/o routine blood work during exam shows Elevated liver enzymes. Physical Exam reveals large tender liver: what next?
a. repeat liver enzymes today
b. order hep panel
c. RTC in 1 wk for recheck
d. order CBC

Back 639

b. hepatitis panel

Front 640

Pt had acute RUQ pain lasted 3days. Low grade fever. What should be suspected if serum amylase elevated?
a. cholecystitis
b. peoptic ulcer disease
c. diverticulitis
d. pancreatitis

Back 640

d. pancreatitis: days of pain = enzyme increase 6-12hr after injury

Front 641

What 2 states are most common w/ pancreatitis?
a. gallstones and alcoholism
b. hypertriglyceridemia and cholecystitis
c. appendicitis and renal stones
d. diabetes and cholecystitis

Back 641

a. gallstones and alcoholism

Front 642

Joints most commonly involved in OA:
a. fingers
b. wrist
c. hips
d. knees

Back 642

a. fingers

Front 643

X-ray of right nee w/ joint space narrowing. What does this mean?
a. patient aging
b. gout
c. normal
d. cartilage is breaking down

Back 643

d. cartilage is breaking down: risk: advance age, obes, jioint injuries

Front 644

Which test if po is part of criteia for SLE?
a. ANA
b. Rheumatoid factor
c. RPR
d. ESR

Back 644

ANA: also: butterfly face rash, disoid rash, sun-related rash, painless oral ulcerations, joint pain two or more, heart or lung inflammation

Front 645

60y/o former college football c/o medial knee pain. Has arthritis in knee. What would pain be located?
a. medially, radiating into upper thigh
b. medially, alnong joint
c. inch above medial knee joint
d. inch below medial knee joint

Back 645

b: medially along joint line: classic arthritis pain. tears in medial collateral and meniscal.

Front 646

Pt undiagnosed w/ RA. Which finding should cause suspect RA?
a. morning stiffness, pos RA antigen and antinuclear antibody
b. fever, symmetrical jiont involvement, normal sed rate
c. asymmetrical joint, male pain
d. nodular lesion on elbow, neg sed, pos, antinuclear

Back 646

a. morning stiffness >1hr, rhematoid nodules, bone erosion on xray, pos sed rate

Front 647

The "get up and go: test in elderly used to eval:
a. risk for falls
b. lower extremity strenght
c. mental acuity
d. driving safety

Back 647

a. risk of falls

Front 648

81y/o active w/ OA in R knee. c/o pain. What is 1st line tx. per American colleg of rhematology?
a. exercise
b. acetaminophen
c. ibuprofen
d. propoxyphene

Back 648

a. exercise

Front 649

84y/o femal w. OA to right hip. C/o daily pain. What med is first line tx?
a. naproxen
b. acetaminophen
c. Ibuprofen
d. propxyphene

Back 649

b. acetaminophen up to 1000mg 4xd

Front 650

Adolescent athlete injured his ankle playing basketball. Right ankle pain,ecchymosis, significant edema, unable to bear weight at time of exam: least likely:
a. avulsion fracture
b. grade 1 sprain
c. grade 2 sprain
d. grade 3 sprain

Back 650

b. grade 1 sprain

Front 651

Ottawa ankle rules determine when:
a. inversion ankle injury occured
b. anterior talofibular fx has occurred
c. xray are needed w/ susptected andle fx
d. referral to ortho

Back 651

c. xray needed: ankle or mid foot pain and bone tenderness. bone tenderness at base of 5th metatarsal or unable to bear weight for four steps when examined

Front 652

When should functional rehab occur after ankle or knee sprain?
a. day of injury
b. 5 days post injury
c. 2-3 wks after injury
d. when pain level allows

Back 652

a: early function rehabe day fo injury speeds time of recovery and resumption fo activities. : range of motion initially

Front 653

Initial managment of sprain:
a. xray
b. rest, ice, compression ,elevation
c. anti-inflammatory med
d. activity as toleration

Back 653

b. RICE

Front 654

Anterior drawer test assess:
al injury to lateral menisucs
b. stability of ACL
c. instability of PCL
D. stability fo knee

Back 654

b. stability of ACL (anterior cruciate ligament): pain not immediate

Front 655

36y/o w/ asthma and HTN what med should you avoid when tx his HTN

Back 655

beta blocker (propanolol)

Front 656

Long distance runner dx w/ tibial stress fracture. What should NP recommend initially to speed recovery?
a. casting,
b. crutches
c. cross-training
d. Ca supplement

Back 656

c. cross training

Front 657

75y/o w/ OA and pain. Which increases GI related ulceration?
a. celecoxib
b. warfarin
c. Thiazide diuretic
d. pravastatin

Back 657

a. celecoxib

Front 658

16y/o play trumpet daily practice for 1 wk. c/o pain to 3-4th toe of left foot. not swollen or red. What is etiology?
a. strain
b. bursitis
c. stress fx
d. tendonititis

Back 658

c. stress fx due to over use

Front 659

Pt w/ right shoulder pain 7/10, after acute shoulder injury yesterday. fell against brick wall. pain radiates into upper arm. what rad study should be conducted initially?
a. x-ray
b. CT
c. MRI
D. US

Back 659

a. xray

Front 660

50y/o reports acute pain to lower back 2wks after yard work. radiates down left leg. self tx nsaids. When should you using imaging?
a. now.
b. at 4 wks
c. at 8 wks
d. never

Back 660

b. 4 wks: unlss hx of cancer, >50y/o neuro deficits, pain inconsistent w/ hx

Front 661

55y/o sever pain at base of left first toe. Limping but not trauma. which sx is other than gout?
a. pain
b. edema
c. erythema
d. fever

Back 661

d. fever: signals infection

Front 662

80y/o very active but presents today w/ posterior hip pain for past wk. Which is least likely part fo differential dx.
a. OA
b. sacroiliac joint disease
c. lumbar radiculopathy
d. herpes zoster

Back 662

d. herpes zoster

Front 663

75y/o knits w/ positive finkelstein test. Dx?
a. gamekeepers thumb
b. De Quervains tenosynovitis
c. OA of thumg
d. trigger thumb

Back 663

b. De Quervain tenosynovitis: inflammatoin of extensor and flexor tendon. radiate up forearm

Front 664

Extrinsic shoulder pain is LEAST likely produced by:
a. CV system
b. abdomen
c. infectious organism
d. urologic system

Back 664

d: urologic system

Front 665

Drop arm test used to assess patient w/ suspsected:
a. cervical injury
b. torn rotator cuff
c. impingement syndrome
d. malingering

Back 665

b. torn rotator

Front 666

Which is not true regardign cervical whiplash injury?
a. occurs after traumatic event
b. may accompany severe pain, spasm
c. Identifiable on MRI or CT but not xray
d. Occipital pain and HA

Back 666

c. It is not identifiable on MRI or xray

Front 667

NP are certified by:
a. state
b. ANA
c. state boards
d. ANCC or AANP

Back 667

d: ANCC or AANP:
state boards license NP

Front 668

Which does not influence scope of practice?
a. code of ethics
b. state federal laws gov practice
c. reimbursement rate for visits
d. nurse practice acte

Back 668

c.: scope of practice is established legally, ethically, and by boards of nursing and professional organizations.

Front 669

Standards of practice establised to:
a. regulate and control nurse practitioner practice
b. limit liability of NP
c. protect NP from frivolous law
d. promote autonomous practice

Back 669

a. regulate and control NP practice: provide accountability for professionals and help protect the public

Front 670

Licensure:
a. another term for certification
b. contingent on certification
c. used to establish minimal competence
d. necessary for reimbursement

Back 670

c. used to estab minimal comp

Front 671

Certification:
a. required by all 50 states
b. validates competence
c. recognized by all 50 states
d. required for reimbursement

Back 671

b. validate competence: in an area of specialty

Front 672

NP has a managed clinic for hosp employee, employed by hosp. This NP is described as:
a. intrapreneur
b. entrepreneur
c. risk taker
d. nurse specialist

Back 672

A: intrapreneur: carved out specialty w/in existing organization. Entrepreneur assumes financial and personal risk of owning

Front 673

NP who owns their own clinic?
a. entrepreneur
b. intrapreneur
c. independent NP
d. networker

Back 673

a. entrepreneur:

Front 674

Legal authority to practice as an NP is determined by:
a. state boards of nursing
b. state legislature
c. fed guidelines
d. certification boards

Back 674

b: state legist
state boards --> scope of practice
Certification board --> met mim requirements

Front 675

Name given to subjects in research study who do not have disease or condition?
a. placebos
b. controls
c. case series
d. cross secional

Back 675

b. controls: commonly employed

Front 676

NP decided to study grp of pt trying to quit smoking. All take the same med for 60d and RTC q 1xwk for 60d. What study design?
a. non-research
b. cohort study
c. case control study
d. controlled trial

Back 676

b. cohort: observational study that is prospective in nature. Cohort ask "what will happen".
Case control: looks back (retrospective)

Front 677

NP has HIV. Employed in private clinic: NP:
a. obligated to inform employer
b. obligate to inform pt
c. no obligations
d. under obligation if performing invasive procedure

Back 677

c. non obligation

Front 678

NP works minor care. Pt w/o insurance w/ puncture wound. Dirty needle suspected. the NP:
a. admin Tetanus
b. prescribe med for HIV exposure despite no insurance
c. no mention possibility of HIV
d. offer to buy HIV med at employee discount

Back 678

b. prescribe med

Front 679

Elderly dementia in w/ daughter and has bruises on arm and posterior. What should NP do?
a. don not report abuse until certain
b. r/o elder abuse
c. report to authorities
d. ask daughter if she is abusing

Back 679

c. report to authorities

Front 680

Pt attacked by cat. 4cm lac to forearm. NP sutured lac which became infected requiring hospitalization. This is?
a. negligence
b. unfortunate situation
c. malpractice
d. poor judgement and malpractice

Back 680

a. negligence: one fails to exercise care that reasonable person would.

Front 681

NP states he keeps meds and takes them occasionaly? what is your first professoinal responsibility?
a. report to police and owner
b. report to state board
c. report to state board of pharmacy
d. no professional responsibilty

Back 681

b. to state board

Front 682

Liability policy which pays claims only during period that policy is active?
a. claims made policy
b. tail coverage
c. liability protection
d. bobtail coverage

Back 682

a. claims made policy

Front 683

What is the most common place for indirect hernia?
a. Hesselbach triangle
b. internal inguinal ring
c. outer inguinal ring
d. abdominal ring

Back 683

b. Internal inguinal ring

Front 684

Which immunizations should a child receive if they have sickle cell?
a. all at a rapid rate
b. all at a normal rate
c. all at a decelerate rate
d. limit the immunization given

Back 684

b. all at a normal rate/interval

Front 685

What immunization may be given during the first trimester?
a. vaicella and MMR
b. Td only
c. Pneumococcus
d. Hep A&B

Back 685

B. Td only: live virus should never be given, pneumococcus given in 2nd or 3rd trimester

Front 686

40y/o w/ lab values of: HBsAg(-), HBsAb (+), HBcAb (-). Interpret them?
a. had hepatitis
b. has hepatitis
c. should immunize
d. has been immunized

Back 686

d. has been immunized:
1. Neg Hep B antigen (HBAg) = no Hep B
2. He has + Hep B surface antiody (HBsAb)= immune
3. neg Hep B core antibody (HBcAb)=never had Hep B

Front 687

What is typical sx of GERD?
a. chest pain
b. SOB
c. pyrosis
d. hoarseness

Back 687

c. pyrosis (heartburn)

Front 688

70y/o aa male c/o pain to back and trunk. CAD ruled out. Ha normocytic normochromic anemia w/ hypercalcemia: dx?
a. multiple myeloma
b. lymphoma
c. leukemia
d. prostate cancer

Back 688

a. multiple myeloma: neoplastic proliferation in bone marrow

Front 689

What is a contraindication to giving MMR:
a. FHx of adverse event after dose
b. fever 104 w/in 72hrs
c. seizures w/in 7days
d. encephalopathy w/in 7 days after immunization

Back 689

d. encephalopathy is always a contraindication.
Fever of 105 w/in 48hr would be too

Front 690

An elderly adult w/ appendicitis is unlikely to exhibit:
a. generalized abdominal pain
b. Initial WBC elevation
c. UTI sx
d. low grade fever

Back 690

b. initial WBC elevation: kids and elderly do not get an initial rise in WBC

Front 691

What is recommendation of administering MMR and varicella?
a. not given on same day
b. given on same day
c. cannot be given w/ flu
d. can only be given w/ live virus

Back 691

b. should be given on same day: increases their titers when given together. if not together the seperate by 30 days

Front 692

Pt w/ diarrhea has WBC in stool sample:
a. a misdiagnosis
b. a malignancy
c. food indiscretion
d. bacterial infection

Back 692

d. bacterial infection: Crohns disease or ulcerative colitis also

Front 693

Overweight 76y/o recent DM, long term HTN and hyperlipidemia: Now has A-fib. What other risk do u consider?
a. S3 gallop
b. CHF
c. SOB
d. hypothyroidism

Back 693

b: HTN and hyperlipidemia increase risk of CHF --> Afib, S3 and SOB r consequences not risk

Front 694

Pt w/ tinea pedis. What is the microscopic finding?
a. hyphae
b. yeast
c. spores
d. combination of hyphae, spores

Back 694

a. hyphae: long, thin= dermatophyic infections

Front 695

What medication will exacerbate GERD?
a. verapamil
b. metformin
c. ferrous sulfate
d. ceftriaxone

Back 695

a. verapamil: CCB: Calcium needed for muscle contraction: lower esophageal sphicter

Front 696

Fundoscopic reveals AV nicking on a HTN pt:
a. incidental finding
b. indicative of long standing HTN
c. Pt should be screened for diabetes
d. refer to ophthalmology

Back 696

b. indicative of longstanding HTN: when arteries cross veins in eye: Cotton wool exudate = diabetes

Front 697

Who is most common risk factor for developing Hep B:
a. homo
b. drug injection
c. hetero
d. body piercing

Back 697

c. hetero: any are applicable: but hertero has highest likelihood of disease transmission, most common

Front 698

Benazepril (ACE-I) should be discontinued immediately:
a. dry cough develops
b. pregnancy occurs
c. K levels decrease
d. gout develop

Back 698

b. pregnancy occur: ACE-I: teratogenic effects to renal system

Front 699

Following medications does not warrant monitoring K?
a. fosinopril
b. candesartan
c. HCTZ
d. amlodipine

Back 699

d: Amoldipine CCB no need to monitor K:
ACE and ARB cause hyper K
HCTZ: cause Hypo K

Front 700

HCP was stuck w/ neeedle from patient who may have HIV. Rapid HIV was found positive. ?
a. HP is infected w/ HIV
b. Pt is infected w/ HIV
c. further testing of pt required
d. further testing of HP required

Back 700

c. further testing pt requried: + ELISA always requires f/u test with Wester Blot: HP would be test to estabish HIV at time of stick.

Front 701

Topical 5-fluorouracil (5-FU) used to tx:
a. atopic dermatitis
b. hepatitis
c. thalassemia
d. basal cell carcinoma

Back 701

d. basal cell carcinoma: only on superficial 5% BID x 3-6wks

Front 702

Pt w/ peptic ulcer disease: sx occure few hours after eating:
a. gastric ulcer
b. duodenal ulcer
c. gastric or duodenal
d. H. pylori

Back 702

b. duodenal: 2-5hr after eating. Relief by eating/antacid. contrast w/ gastric w/ sx minutes of eating: less relief from antacids

Front 703

74y/o pt w/ laceration. Last tetanus >10yrs. Completed primary series. What vaccine?
a. tetanus toxoid only
b. tetanus and diptheria only
c. none primary will protect
d. Tetanus, diphtheria, acellular pertussis

Back 703

b. tetanus and diphtheria: Dtap is for adolescents not elderly.

Front 704

Pt taking metronidazole for C. Difficile: What should be avoided?
a. excess fluids
b. Vit B12
c. grapefruit
d. alcohol

Back 704

d. alcohol: produced disulfiram rxn w/ metronidazole wait 72hrs after last dose

Front 705

P tw/ diarrhea tested for C. diff. How soon should enzyme yeild results (EIA)?
a. 20min
b. 24hrs
c. 3d
d. <1wk

Back 705

b. 24hrs detect C. Diff toxin no organism.

Front 706

Difference between cellulitis and erysipelas:
a. organism
b. length of time that infection lasts.
c. tx
d. area involved

Back 706

d. location: erysipelas upper dermis superficial lymphatic: cellulitis: deep dermis

Front 707

Lower leg wound appears infected. Red, warm edematous. Acute onset of pain, sx low grade fever. What is it?

Back 707

b. Erysipelas: not always upper. Erysipelas has acute onset, cellulitis is slow onset

Front 708

Asymptomatic carotid arteries auscultate for bruits:
a. bruits indicative of impending stroke
b. bruit indicative of significant carotid stenosis
c. generalized atherosclerosis
d. reflective stroke risk

Back 708

c. generalized atherosclerosis: symptomatic bruit need immediate attention.

Front 709

Sudden onset of red eye: sensitivity to light and sensation fo foreign body: no contacts:
a. refer to ophthomolgy
b. tx for viral conjunctivitis
c. tx bacterial
d. observe for 24hrs if visual acuity is normal

Back 709

a. refer to ophthomolgy for red eye: photophobic sensation fo foreign body.

Front 710

Male taking HCTZ for HTN: sever pain to great toe: dx w/ gout: Which med would be contraindicated at this time?
a. allopurinaol
b. prednisone
c. colchicine
d. indomethacin

Back 710

a. allopurinol: not for acute gout: only reduces uric acid but cont during attack

Front 711

High purine diet exacerbate gout: Which foods are high purine?
a. coffee
b. eggs.
c. beef
d. bread

Back 711

c. meat/fish: coffee lower risk, Tea increase gout

Front 712

60y/o c/o lower back apin for 5-6wks: 4/10, no relief w/ change of position: dx:
a. sciatica
b. ankylosing spondylitis
c. disc disease
d. systemic illness

Back 712

d. systemic illness, like cancer or infection: key is no relief when lying down. old, female >4wks pain.

Front 713

NP agreed to participate in medicare healht insurance: Medicare only pays 80% how do you collect the other 20%?
a. bill remainder
b. cannot bill remainder
c. collect 100# if billed incident o MD
d. NP resubmit bill for additional payment

Back 713

a. bill remainder:

Front 714

Pt w/ Medicare part A only. What does this mean?
a. your visit will be reimbursed by the fed gov
b. reimbursed only if you bill incident to a physician
c. only hospital visits are covered
d. he desires a cost-effective med.

Back 714

c. only hospital visits are covered: also covers skilled nursing facilities

Front 715

ACE-I specifically indicated in patients who have:
a. HTn DM w/ proteinuria, HF
B, DM, HTN, HLD
C. asthma, HTN DM
d. renal nephropathy, HF, HLD

Back 715

A: HTN, DM w/ proteinuria, HF: worsen renal insufficiency

Front 716

How would u create a therapeutic relationship w/ patient?
a. Tell patient he can trust you
b. at end of visit, tell patient you enjoyed taking care of him
c. ask open-ended questions
d. touch pt during the interview

Back 716

c. therapeutic relationship w/ pt can be established in many different ways. Ask open ended questions.

Front 717

Pt who frquently has episodes of gout should avoid which sets of food?
a. beans, rice, tea
b. scrambled eggs, milk, toast
c. roast beef and rice w/ gravy
d. fish and steamed veggies

Back 717

C: roast beef and rice w/ gravy
High purine: beef, pork bacon, lamb, seafood, beer, bread:
Low: fruits and fruit juices, green veggies, nuts, dairy, chocolate

Front 718

Pt w/ primary case scabies was probably infected:
a. 1-3d ago
b. 1 wk ago
c. 2wks ago
d. 3-4 wks ago

Back 718

d: incubation period for scabies is about 3-4 wks after primary infeciton. worse at night

Front 719

AV nicking is ID in pat w/ what disease?
a. glaucoma
b. cataracts
c. diabetes
d. HTN

Back 719

D: Hypertension: retinal microvascular changes: early changes, flame hemorrhages or cotton wool indicate severe damage

Front 720

40y/o w/ multiple, painful reddened nodules on anterior surface of both legs. Concerned. Associated w/ hx of:
a. DVT
b. phlebitis
c. ulcerative colitis
d. alcoholism

Back 720

c. ulcerative colitis: erythema nodosum: in pretibial locations due to infectious agents, drugs systemic inflammatory disease

Front 721

Pt has 2 palpable, tender, left pre-auricular nodes that are 0.5 cm in diameter. What might be found in this pt?
a. sore throat
b. ulceration on tongue
c. conjunctivitis
d. ear infection

Back 721

c. eye drained partly by pre-auricular lymph nodes

Front 722

Elderly HTN Pt has osteoporosis. Which anti HTN agen thave secondary effect of improving her osteoporosis?
a. thiazide diuretic
b. CCB
c. ACE-I
d. Beat blocker

Back 722

a. thiazide diuretics incrase serum Ca by decreasing fluid.

Front 723

One wk old infant w/ mucopurulent eye discharge bilaterally. What is the etiology?
a. mother has STD
b. Plugged tear duct
c. bacterial conjunctivitis
d. viral conjunctivitis

Back 723

a. mother has STD: chlamydia sx will appear 1-2wks post delivery. Gonorrhea sx in 2-4days

Front 724

Which pt below should be screened for ostoeporosis?
a. 60 y/o male RA
b. 50 y/o caucasion female
c. 65y/o male otherwise healthy
d. 65y/o post menapausal

Back 724

a. 60y/o w/ RA: only screen males w/ risk factors, women start at 65y/o

Front 725

Pt w/ c/o sudden decreased visual acuity w/ pupil 4mm fixed. Affected eye is red. What is etiology?
a. stroke
b. brain tumor
c. glaucoma
d. cataract

Back 725

c. glaucoma: urgent referral to ophthalmology:acute angle glaucoma: also may have n/v

Front 726

What can be a complication of Lyme disease:

Back 726

bells palsy (need to obtain a titer to verify)

Front 727

4y/o child w/ OM w/ effusion:
a. needs antibiotic
b. has viral infection
c. just had acute OM
d. cloudy fluid in middle ear

Back 727

c. just had acute OM; OME precedes or follows AOM. dont tx w/ antibiotic but f/u for later OM

Front 728

40y/o w/ lab values of:
HBsAg (-), HBsAb (+), HBcAb (+)

a. had hepatitis
b. never had hepatitis
c. consider immunization
d. Pt has been immunized?

Back 728

a. had hepatitis:
1. Negative hep B surface antigen (HBsAg)= no hep
2. + hep B surface antibody (HBs Ab)=immune
3. + core antibody (HBcAb)= he has had Hep b

Front 729

Pt w/ medicare part B. What does that mean?
a. fed gov will pay
b. only covers outpatient services
c. will have co-pay today
d. prescriptions will be partly covered

Back 729

b. medicate benefit covers out patient services: Prt B pays the examiner: xrya, DME, lab, home health. Charged a monthly fee based on income. There is an initial co-pay

Front 730

Which med have unfavorable effect on HTN BP?
a. lovastatin
b. ibuprofen
c. fluticasone
d. amoxicillin

Back 730

b. ibuprofen: Na retention: increase BP, lower extremity edema, increase workload of heart, inhibition of prostaglandin

Front 731

Agent commonly used to tx pt w/ scabies is permethrin. How often?
a. once
b. one QD x 3d
c. BID for 3d
d. QD x 1 wk

Back 731

a. once: single whole body from neck down for 8-12hrs

Front 732

Proper technique for removing a tick?
a. tweezers
b. petroleum jelly
c. alcohol
d. hot match

Back 732

a. tweezers

Front 733

Which mitral disorder from redundancy of mitral valve's leaflets?
a. acute mitral regurg
b. chronic mitral regurg
c. mitral valve prolapse
d. mitral stenosis

Back 733

c. mitral valve prolapse: and subsequent degeneration of mitral tissue.

Front 734

Pt was dx today w/ preg. Last preg 3yrs ago. Had protective rubella titer. What should be done about rubella titer today?
a. no need to get one
b. Eval to make sure its protective
c. vaccinate now
d. no need to vaccinate was protective 3 yrs ago.

Back 734

d. do not need protective 3y ago: protective titer is 1:10 or greater.

Front 735

What has the most rapid analgesic onset?
naproxen, liquid ibuprofen, diclofenac, celecoxib (all nsaids)

Back 735

liquid ibuprofen

Front 736

Common, early findings in pt w/ chronic aortic regur (AR) is:
a. LVH
b. A-fib
c. pulmonary congestion
d. low systolic BP

Back 736

a. LVH: enlarges blood regurg from aorta: A-fib is not typcial or usual in AR: pulmonary congestion is seen later. AR b/p is elevated systolic and decrease dystolic

Front 737

Test of choice to confirm and assess developmental dysplasia of hip (DHH) in 3m old:
a. frog leg x ray
b. plain hip xray
c. US of hip
d. CT of hip

Back 737

c. US of hip:

Front 738

Most common place for basal cell carcinoma:
a. scalp
b. face
c. anterior shin
d. upper posterior back

Back 738

b: face

Front 739

74y/o dx w/ shingles. NP would prescribe?
a. oral antiviral
b. oral antiviral + oral steroid
c. oral antiviral and topical steroid
d. topical steroid

Back 739

oral antiviral: w/in 72hrs of sx onset. steroids limited benifit vs risk

Front 740

Pt w/ mono: which lab is usually abnormal?
a. lymphcytosis and atypical lymphocytes
b. elevated monocytes
c. decrease WBC
d. elevated liver enzymes

Back 740

a: lymphocytosis and atypcial lymphocytes: monocytes elevation also occur though not as often as are LFT, WBC

Front 741

65y/o dx w/ gout: likely that:
a. have elevated uric acid
b. consume too much meat
c. joint like hip or shoulder involved
d. sever inflammation of single jioint

Back 741

d. single joint: typically great toe: not always have elevated uric: especially w/ acute attack

Front 742

63y/o male former smoker on simvastatin, rampril, ASA daily. B/P lipids controlled. C/o fatigue and not feeling well. VS normal. What next?
a. CBC and wait a few days
b. ID feeling of depression/hopelessness
c. CBC, metabolic, TSH, UA
d. B12, TSH, CBC, chest xray

Back 742

c: CBC, metabolic panel, TSH, UA:

Front 743

Common misconception that pt should avoid MMR if:
a. allergic to eggs
b. allergic to neomycin
c. FHx allergic to MMR
d. taking oral antibiotics

Back 743

a. allergic to eggs

Front 744

Lipid particle w/ greatest atherogenic effect?
a. TC
b. HDL
c. LDL
d. Trig

Back 744

c: LDL: low HDL and high trig accelerate atherogenesis

Front 745

Pharm tx for children w/ HTN should be initiated:
a. those obese
b. Stage I HTN
c. diabetic w/ HTN
d. asymptomatic stage i or ii HTN

Back 745

c: diabetic w/ HTN:

Front 746

Which statement is true for NSAIDS for LBP?
a. equally efficacious as APAP for pain
b. more s/E than APAP
c. provide superior relief of sx 1wk
d. should not be used to tx acute LBP

Back 746

B: s/e are renal impairmetn, ARF, gastritis

Front 747

Most common cause fo diarrhea in adults:
a. E. coli
b. salmonella
c. difficle
d. viral GE

Back 747

D: viral gastroenteritis:

Front 748

Most common cause fo diarrhea in adults:
a. E. coli
b. salmonella
c. difficle
d. viral GE

Back 748

D: viral gastroenteritis:

Front 749

3 most common causes fo bacterial diarrha in US are salmonella, campylobacter and:
a. e. coli
b. enterovirus
c. yersinia
d. shigella

Back 749

d. shigella:

Front 750

Pt w/ allergic rhinitis has sinus infection. Takes fexofenadine daily.What should be part of med regimen w/ an antibiotic?
a. stop fexofenadine and add decongestant
b. add decongestant and nasal steroid
c. cont fexo and antbiotic only
d. cont fexo and add a decongestant

Back 750

d. cont his fexofenading: adding decongestant promotes drainage, speed resolution of sinus. nasal can be added but only if poor control of allergies

Front 751

18y/o female pt w/ Fe IDA. Anemia has occurred in past 3-4m. what might be expected?
a. incrased RDW
b. decreased rDW
c. elevated serum ferritin
d. decreased TIBC (total iron binding capacity)

Back 751

a. increased RDW: RDW is RBC distribution width. Recent onset iron deficiency anemia. Variation in size of RBC demonstrated by increased RDW. Serum ferritin measure of iron store. TIBC is always increased in pt w/ IDA.

Front 752

Study listed below is considered experimental study?
a. case series
b. cross-sectional study
c. cohort study
d. meta-analysis

Back 752

d. meta-analysis: observation studies are studies where subj r observed. no intervention takes place.

Front 753

80 y/o w/ BP of 176/80. tx?
a. thiazide diuretic
b. ACE-I
c. CCB
d. ARB

Back 753

Pt w/ isolated systolic hypertension (ISH). increase cardiac and cerebral events. Tx w/ long acting CCB (amlodipine, felodipine)

Front 754

Pt w/ diabetes right lwoer leg edematous, erythematous tender to touch over anterior shin. no evidence of pus leg is warm: dx?
a. DVT
b. buergers disease
c. cellulitis
d. venous disease

Back 754

c. cellulitis:
Buergers = inflammation of med size arteries and no shin pain
DVT: rare anterior pain

Front 755

Swimmers ear is dx in pt w/ tragal tenderness. what other sx present?
a. OM
b. Hearing loss
c. otic itching
d. fever

Back 755

c. otic itching: tx w/ topical agent and keep dry

Front 756

Pt w/ heavy menses. What lab value reflects IDA?
a. elevated TIBC
b. decreased TIBC
c. norm serum iron
d. decrased RDW

Back 756

a. elevated TIBC: reduced RBC count and decreased H&H. RDW would increase.

Front 757

Which is pt w/ acute cholecystitis?
a. pt rolls from side to side on exam table
b. pt is ill appearing and febrile
c. elderly pt is more likely to exhibit murphys sign
d. most are asymptomatic until stone blocks bile duct

Back 757

b: pt ill appearing and febrile: pt w/ acute cholecystitis usually complains of abd pain in URQ:

Front 758

Describe Kernig sx

Back 758

pt lying supine - hip flexed 90 degree; knee extension = resistance or pain to lower back or posterior thigh

Front 759

Pt w/ leukocytosis:
a. has bacterial infeciton
b. has viral infection
c. infection unknown origin
d. does not have infection

Back 759

c: infection unknown origin:
Leukocytosis has predominance of WBC in blood. May elevate to viral or bacterial.

Front 760

Most common sx associated w/ gastroesophageal reflux disease are heartburn and :
a. cough
b. reguritation and dysphagia
c. cough and hoarseness
d. belching and sore throat

Back 760

3 most common associated sx of GERD are heartburn, post prandial, regurgitation and dysphagia

Front 761

Niacin is known to:
a. increase fasting glucose
b. produce HTN
c. decrease trig
d. decrease HDL

Back 761

a: decrease glucose tolerance: use w/ caution in pt w/ Impaired fasting glucose. Used to increase HDL

Front 762

Pt dx w/ mononucleosis. Which statement is correct?
a. Likely adolescent male
b. spelnomegaly more likely than not
c. cannot be co-infected w/ strep
d. cervical lymphadenopathy prominent

Back 762

d. lymphadenopathy, fever, fatigue, pharngitis (FFFL): mono is common in adolescents and college: it is possible to co-infect: Avoid tx w/ PNC due to rash.

Front 763

Vit B-12?
a. is easily absorbed through GI
b. deficiencies are seen in elderly pt only
c. low level can result in elevated lipids
d. inadequate amounts can produce cognitive changes

Back 763

d: B12 is absorbed through GI tract from foods, BUT when supplements taken they are NOT absorbed well in GI. Usually life long once deficiency noted.

Front 764

Pt w. hyperlipidemia:
a. a statin daily
b. TSH levels
c. second measurement to confirm dx
stress test

Back 764

b: TSH: elevated TSH may causes eleveated lipids: dont tx lipids until TSH confirmed and decreased to at least 10; then tx lipids

Front 765

What does absence of venous pulsation during eye exam indicated?

Back 765

increased ICP

Front 766

What is the first sign that a male child is reaching sexual maturation?
a. increase testicle size
b. enlargement of scotum
c. increase length of penis
d. scrotal and penile changes

Back 766

a. increase testicular size

Front 767

Pt w/ suspected plantar fasciitis. What is best way to examine?
a. great toe dorsiflexed
b. foot in neutral position
c. patient stands
d. ankel at 90 degreee

Back 767

a. when great toe is dorsiflexed: plantar fascia is easy to palpate due to tightening.

Front 768

Young athlete w/ depression of longitudinal arch of both feet. C/o heel pain bilaterally. Normal foot exam and cont activities. What is recomendation for foot pain?
a. xray foot first
b. heel support in shoes
c. NSAIDs initially
d. rigid orthotics

Back 768

b. heel support: consider flat foot, tx w/ well support heel counter. NSAIDs wont correct underlying, orthotics may increase pain.

Front 769

40y/o has aortic stenosis wants to know what sx indicate worsening?
a. palpitations and weakness
b. ventricular arrhythmias
c. shortness of breath and syncope
d. fatigue and exercise intolerance

Back 769

c. shortness of breath and syncope:
3 most common sx of AS is angina, syncope, and CHF (dyspnea)

Front 770

Pt w/ mono has pharyngitis, fever and lymphaadenopathy. Sx started 3 d ago:
a. he will have pos mono
b. he normal CBC
c. could have neg Mono
d. could have pos mono and normal CBC

Back 770

c. cough have neg mono:
Monospot detects presence fo heterophile antibodies in mon. If mono spot is too early it will be neg. If pt sx persist repeat mono. Lymphocytosis is normal in mono so pt will not have a normal CBC

Front 771

Head circumference shed until a should be measured until what age:
a. 12m
b. 18m
c. 24m
d. 36m

Back 771

d. 36m: above the ears

Front 772

Niacin can:
a. decrease TC and TRig
b. decrease Glucose and LDL
c. cause flushing and HTN
d. increase liver enzymes

Back 772

d: increase liver enzymes:
it increases glucose
does not cause HTN, hypotension is common

Front 773

Which pt is most likely to have mitral valve prolapse?
a. adolescent male w/ no cardiac hx
b. 25y/o male w/ exercise intolerance
c. 30y/o female w/ no cardiac hx
d. 65y/o male w/ SOB

Back 773

c: 30y/o female w/ no cardiac hx: most common in women 14-30: common sx: arrhythmias, and chest pain. most are asymptomatic

Front 774

New born w/ hyperbilirubinemia: When would bilirubin be expected to peak?
a. 1-2d
b. 3-4d
c. 5-7d
d. 7-10d

Back 774

b: 3-4d: premi: 5-7d

Front 775

Grp A strept pharyngitis:
a. single sx
b. also has abdominal pain
c. no exudative sx
d. has inflammed uvula

Back 775

b. can be accompained by abd pain:abrupt onset: sore throat, fever, GI: n/v: w/o tx resolves in 3-5d

Front 776

45y/o w/ following:
HBsAg (+), HBsAb (-), HBcAb (-)
a. has hepatitis
b. had hepatitis
c. consider immunization
d. results indeterminate

Back 776

A: has hep:
+ hep B surface antigen (HBsAg) = has Hep
2. early in desease due to no core (HBcAb)
3. HBsAb should be neg due to HBsAg being positive (+ after immunization)

Front 777

table for determination fo max BP values fro children are based on:
a. height %, BMI, gender
b. gender age
c. height %, gender age
d. BMI and gender

Back 777

c. height %, gender age:

Front 778

63y/o former smoker, takes simvastatin, ramipril and ASA: BP and lipids controlled, c/o fatigue and not feeling well: VS normal, hep panel neg: What is most likely cause for his elevated liver enzymes?
a. generic version of simvastatin
b. alcoholic in denial
c. daily grapefruit for 10 days
d. rare liver toxicity from usual dose of simvastatin

Back 778

c. daily grapefruit: inhibits cytochrom P450. Statins and CCB react w/ grapefruit

Front 779

Female pt present w/ tenderness at Mcburney point. Appendicitis is considered. What lab test woud LEAST helpful to Exclude appendicitis?
a. CBC w/ elevated WBC
b. UA w/ leukocytes
c. Pos serum preg
d. Pos pelvic culture

Back 779

a: CBC w/ elevated WBC: simply indicates and infection
2. UA to r/o UTI
3. Serum preg for ectopic
4. pelvic culture for PID

Front 780

Pt w/ hep B probably has a predominace of :
a. leukocytes
b. lymphocytes
c. neutrophils
d. eosinophils

Back 780

b. lymphocytes: increase w/ viral infections but total WBC will be decreased.

Front 781

Pt w/ monoucleosis most likely:
a. lymphcytosis
b. eosinophilia
c. leukocytosis
d. monocytosis

Back 781

a. lymphocytosis: viral
eosinophil = parasitic or allergic
leukocytosis no specific for mono
monocytes rise but not specific for mono

Front 782

Atopic dermatitis exacerbation are tx w/:
a. emollients
b. topicla steroids
c. antihistamines
d. antibiotics

Back 782

b. topical steroids: eczema: keep well lubricated w/ emollients but for exacerbation --> topical steroids (lowest potency)

Front 783

Pt presents w/ severe toothache. Sensitivity to hot and cold w/ visible pus around painful areas:
a. pulpitis
b. caries
c. gingivitis
d. perodontitis

Back 783

a. Pulpitis:
Caries and gingivitis have no pus.

Front 784

20y/o B-ball player lands has possible sprain yesterday. c/o ankle and foot pain but limps: management
a. RICE
b. non-weight bearing until fx ruled out
c. short leg splint
d. NSAIDs rest partial non-weight bearing

Back 784

b. non-weight bearing till fx r/o

Front 785

What are risk factors for TIA

Back 785

Afib, CAD, oral contraceptive

Front 786

Private NP clinci, presents w/ trichomonas. State law requires reporting of STD Pt request not o report due to husband working at health dept: what do you do?
a. dont report
b. tell pt you wont but do it
c. report it
d. report but w/ little details

Back 786

C: report it: names or ID are not part of reporting.

Front 787

15y/o female never menstruated. What is most important for NP to assess?
a. stature
b. tanner stage
c. anemia
d. FH of amenrrhea

Back 787

b. tanner stage: breast and pubic hair signify pubertal changes of maturation.

Front 788

Primary therapeutic intervention for hives:
a. steroids
b. anti-histamines
c. CCB
d. topical steroid cream

Back 788

antihistamine

Front 789

Pt dx w/ mild chronic CHF. Which drug manages sx and improve outcome?
a. verapamil
b. digoxin
c. furosemide
d. monopril

Back 789

d. monpril: ACE-I: reduce mortality and morbidity in CHF:
CCB are contraindicated
Lasix and dig improve sx but not long term outcomes

Front 790

Ankle inversion is common complaint from pt w/:
a. medial ankle sprain
b. lateral ankle sprain
c. severely torn ligament
d. fx of medial malleolous

Back 790

b. lateral ankle sprain:

Front 791

Pt w/ small vesicles on lateral edges of fingers and intense itching. Exam reveals small vesicles on palmar surface of hand. What is this called?
a. seborrheic dermatitis
b. dyshidrotic dermatitis
c. herpes zoster
d. varicella zoster

Back 791

b. dyshidrotic dermatitis: is a condition in which small, usually itchy blisters develop on the hands and feet. Symptoms: Small fluid-filled blisters called vesicles appear on the fingers, hands, and feet.

Front 792

NP not increase dosage of antihypertensive even though pt BP is still 140/90. Might be described as:
a. clinical inertia
b. malpractice
c. resistant HTN
d. lackadaisical attitude

Back 792

a. clinical inertia: providers who fail to intensify therapy despite pat not reaching goal

Front 793

NP fundoscopic exam. ID small dull yellowish-whit coloration in retina?
a. cotton wool spots
b. microaneurysm
c. hemorrhages
d. exudates

Back 793

a. cotton wool spots: impaired blood flow to retina, diabetes and HTN.

Front 794

How soon can you determine anti-proteinuric effect of ACE-I

Back 794

6-8wks

Front 795

What is the next lab if a pos albumin screen?

Back 795

spot albumin w/ creatinine ratio

Front 796

what is the definition of renal neropathy?

Back 796

>300mg/d of albuminauria on 2 occasion seperated by 3-6m

Front 797

What are the target lipids for DM according to ADA

Back 797

HDL >50
LDL <100
Trig <150

Front 798

Inguinal hernia is hernation of what

Back 798

bowel or omentum into scrotum

Front 799

How does an inguinal hernia present?

Back 799

scrotal pain and a scrotal mass or scrotal swell (abd pain) bowel sounds in scrotum (w/ a stethascope??)

Front 800

What is Hesselbach triangle?

Back 800

inguinal ligament, rectus muscle and epigastric vessel: Inguinal hernia

Front 801

Why is ASA used as an antiplatelet therapy?

Back 801

ASA inhibits enzyme cyclooxygenase adn reduces thromboxane A2 production

Front 802

Define Secondary prevention?

Back 802

intervention to help prevent second occurrence of deleterious event. ex: ASA after a stroke

Front 803

How long after a rubella should a pt avoid pregnancy

Back 803

1 month (though no documented injury of offspring) safe when breastfeeding

Front 804

What immunizations can be given in 1st trimester?

Back 804

influenza, tetanus, diptheria

Front 805

When should varicella be given in pregnancy?

Back 805

Never, no live viruses should be given during pregnancy

Front 806

What is the primary reservoir for HIV?

Back 806

lymphatic tissue

Front 807

If someone has persistent generalized lymphadenopathy what should be tested?

Back 807

HIV

Front 808

A pt w/ a long hx of HTN dx w/ chronic renal insufficiency: What would dx test reveal?

Back 808

clear urine & elevated creatinine: clear because kidney cant filter content.

Front 809

What organ is responsible for erythropoietin production:

Back 809

kidney

Front 810

What is murphys sign

Back 810

inspiratory arrest w/ deep palpation of upper right quadrant (cholecystitis)

Front 811

What is the wording used when an APRN directs another nurse to a specific task? Delegating or assigning

Back 811

APRN are only allowed to delegate assitive personnel they may assign another nurse

Front 812

What is the process of receivign prescriptive authority for controlled substance?

Back 812

TBON authority, TDPS registration, DEA registration number.

Front 813

What level of controlled substance may an APRN provide?

Back 813

schedule III, IV, V

Front 814

What is the maximum period that a controlled substance may be prescribed for by an APRN?

Back 814

30 days

Front 815

Can an APRN refill a prescription?

Back 815

Yes but only after consultation and documentation w/ a delegating physician. (TBON)

Front 816

What is the minimum age a controlled substance may be prescribed by an APRN?

Back 816

2y/o if younger then consultation is required w/ documentation

Front 817

What do expect to find when giving a fibrate?

Back 817

increase HDL

Front 818

What do you expect to find when giving niacin for lipids?

Back 818

increase HDL

Front 819

What do you expect to find when giving Zetia for lipids?

Back 819

reduction in LDL

Front 820

With Zetia (ezetimibe) what should routinely be monitored?

Back 820

No need to monitor labs...little impact on liver or kidney

Front 821

Which of the following man not causes statin-induced myositis?
advanced age, use of statin w/ resin, low body weight, high statin dose

Back 821

Us of statin w/ resin is not a risk for myositis

Front 822

Which of the following is most effective against lipidprotein?
1. HMG-CoA reductase inhibitors
2. Niacin
3. bile acid
4. fibrates

Back 822

2. Niacin

Front 823

What can untx hypothyroid lead to in lipid profile?

Back 823

increased LDL, TC, and Trig

Front 824

What should rigorous physical exercise do to lipid values?

Back 824

increase HDL, Lower VLDL, Lower Triglycerides

Front 825

What should you expect to see when giving fish oil?

Back 825

decrease triglycerides

Front 826

What should you expect to see when giving Plant stanol and sterold on lipid profile?

Back 826

decrease LDL

Front 827

What happens to RBC in alcoholics and why?

Back 827

become macrocytic due to reduction in folate