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827 Cards in this Set
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Define: Mean Corpuscular Volume (MCV)
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Size of erythrocyte
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Define: Mean corpuscular hemoglobine
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amount of hemo in each erythrocyte by weight
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Define: mean corpuscular hemoglobin concentration
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concentration of hemo in each erythrocyte
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Define: Hemoglobin electrophoresis
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% of different types of hemo in erythrocytes
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Obtain Serum ferritin determination to:
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ID depletion of iron in body
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Define transferring saturation and disease which it might be abnormal:
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% transferring saturated w Fe
acute hemorrhage, sideroblastic, anemia, IDA, thalassemia |
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When may you find a abnormal neutrophil count ie >than 0
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myeloproliferative disorders, hematopoietic disorders, hemolysis, infection, immune deficient
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What is Total Iron binding capacity (TIBC) and when might you find it abnormal?
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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) |
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When do expect to see a rise in lymphocyte
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infection lymphocytosis, mononucleosis, anemias, leukemia, hodgkins
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When would you see an abnormal plasma cell count
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mononucleosis, monocytic leukemia, plasma cell leukemia
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plasma cell count
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mononucleosis, monocytic leukemia, plasma cell leukemia
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Describe Erythropoietin patho
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secreted by kidney response to tissue hypoxia--> increase production of RBC
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Neutrophil should be the same as adults at what age
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same as adults by 2 wks
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when do eosinophil and monocytes reach the level of adults in the body?
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high first year same as adult by 1 yr
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What are characteristics of RBC: deficient B12 or folate
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macrocytic-normochromic anemaia (megoblastic)
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pernicious anemai most commonly due to
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B12 deficient: typcially chronic gastritis (DM1, thryroid, graves, myasthenai gravis, alcohol, h. pylori)
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Discuss folate
Macrocytic-normochromic |
Vit B for erythrocyte production, absorbedin upper intestin
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Sx of deficient folate
Macrocytic-normochromic |
scales, fissures in lips, corners of mouth , stomatitis, sores ulceration of buccal and tounge swelling
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Most common anemia and cause
also microcytic -hypochromic |
iron deficient: diet, ASA, NSAID, GI surgery, pica craving
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Sideroblastic anemia (SA) are rare: Symptoms include
microcytic-hypochromic |
Sx: iron overload erythropoietic hemochromatosis = splenomegly and hepatomegaly
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Aplasic anemia (AA) cell type
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normocytic-normochromic anemia
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Define Aplastic Anemia: normocytic-Normochromic and risk associated w/ disorder
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absence of all three blood cells, rapid progression high risk of death form infection, bleedin, ulceration fo mouth pharynx
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What are the 5 stages of Prochaska's change framework
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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 |
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Anemia of Chronic Disease (ACD) cell type?
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normoctyic -normochromic anemia
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ACD (anemia of chronic disease) may be caused by:
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AIDS, RA, SLE, malaria, Hepatitis, CHF: patho: decrease life span, suppressed erythropoietin, Fe metabloism
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ACD (anemia of chronic disease) Evaluation
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unable to repsond to Fe replacement, low TIBC, high serum ferritin
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Anemia Hemaglobin values
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<14 male, < 12 female, no sx till < 6 in healthy adult
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Anemia: sx
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fatigue, malaise, dyspnea decrease exercise tolerance
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Anemia: sx
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wide pulse pressure, midsystolic murmur, brittle nails, cheilitis, atrophy o ftongue, spoon shaped nails, pallor
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Anemia: Diagnostic
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CBC w/ platlet, RBC morphology, periphera smear, reticulocyte count (decrease production or increase loss)
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What does changes in reticulocyte mean for Anemia Diagnostic test results?
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>100 normal responding marrow to anemia
<75 impaired RBC production, low reticulocyte count MCV most useful to ID reticulcytosis or decrease reticulocyte count |
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Anemia: norms of Serum Fe males and females
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40-150 for males and 40-160 for females
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RBC size anemia: list disease with Microcytic (MCV <80)
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Fe deficiency, thalassemai, ACD, sideroblastic
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RBC size: list disease w/ Macrocytic (MCV >100)
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Megaloblastic andema (B12 and folate deficent)
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RBC size: list disease w/ normocytic (MCV 80-99)
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sicle cell, anemia, chronic disease, aplastic anemia, hemplytic anemias
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Discuss causes of Microcytic anemia
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most common, GI or menorrhagia blood loss, IDA , need 15mg/day Fe or 30mg/d if pregnant. Fe absorbed in duodenum
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Discuss microcytic anemia Sx/PE
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Fe store depletion, parestesia, sore tongue brittle nails (koilonychias) Pica, pallor of conjunctiva
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Microcytic anemia: diagnostic
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fall in feriting level --> Fe depletion, first change is decrease hemoglobin
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Microcytic anemia Tx
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oral Fe prep: 150-200mg/d, 4-6months until serum ferritin exceeds 50mcg then stop
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Fe patient education
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30 minutes before meals w/ ascorbic acid (OJ) to aid absorption
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Lifespan: When should you use Fe supplements. What is the best indicator of deficit
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Fe supplements during prego especially last two trimesters. Ferritin level best indicator of IDA
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Thalassemia patho and risk
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inherited, at risk: middle east, asisan, med, africa
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What are risk associated w/ chronic marijuana use
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COPD, driving impairment
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polycythmia vera: sx
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ruddy, red face, hands feet, ears, engorgement of retinal cerebral vessels
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How do you tx Polycythema vera
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ASA..50% die w/in 18 m of sx if no tx
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Define Leukopenia and when you might find it
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WBC <1000, > risk infection
Causes: radiation, shock, SLE, chemo |
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Define Leukocytosis and when might you find it;
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>11K, infection, exercise, surery, prego, drugs also polycythema
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During an infection cycle, when will you see Granulocytosis or neutrophilia?
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in the early stages of infection
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define neutorpenia
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Decrease in circulating netraphils: low <2000, <500= agranulocytosis
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Acute leukemias (ALL, AML) patho
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AML: most common adult: decrease apoptosis --> splenomegaly and hepatomegaly
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Hodgkins lyphoma: cause
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no apoptosis of B cell nor immunoglobin gene: eBV
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Non-hodgkin lymphoma: cause
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too many abnormal WBC build up in spleen, bone marrow, liver resulting in cancers
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Hodgkin lymphoma: sx
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fever, night sweats, weakness, weight loss
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Non-hodgkin lymphoma: sx
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fever, night sweats, weakness, weight loss AND pleural effusion, abd pain, spleno and hepatomegaly
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hodgkins and non-hodgkins TX
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radiotherapy, surgery, chemo
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Thrombocytopenia definition
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platelet count <100,000: decrease platelet production increase consumption
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What leads to acquired thrombocytopenia:
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viral infection, drugs, nutritional deficiency, CRF, aplastic anemia
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Disseminated intravascular coagualtion (DIC)
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clotting and hemorrhage simultaineously occur
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DIC: Diagnostic and Tx
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D-Dimer test most reliable and specific. TX: underlying causes
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Cell description consistent w/ IDA
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low MCV, low MCH or microcytic, hypochromic
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Hematocrit at 23% tx w/ Fe what labs change should you see.
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reticulocytosis (fitzgerald)
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What happens when you take cipro and Fe together
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inactivate drug compound may be formed (fitzgerald)
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What supplement prevents neural tube defect in prego
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Folic acid
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chronic ingestion of over cooked food make you at risk for
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folate deficent anemia (fitzgerald)
what type of anemia is that? |
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pernicious anemia caused by
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lack of intrinsic factor (fitzgerald)
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PE of pernicious anema
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stocking glove neuropathy (fitz)
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Asian: hbg: 9.1L, Hct 28%L, RBC 5, MCV 68L, RDW 13 = Dx
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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 |
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57y/o female w/ RA Hgb=10.5, Hct 33%, MCV88 = Dx
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anemia of chronic disease (ACD): normal Hct: 36-46, Hem: 12-16, MCV: 80-100
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Unilateral throbbing HA w/ difficulty chewing and tender noncompressible temporal artery
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giant cell arteritis
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Tx of giant cell arteritis
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systemic corticoid therapy
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Most serious complication of giant cell arteritis
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blindness
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What is agnular chelitis
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fissuring and cracking at corners of mouth:
caused by fungal or deficient B12 or Fe |
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Tx of angular chelitis
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nystating (fungal infection)
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What causes bilaterally itchy, red eyes, tearing throughout year, rope eye discharge (think basic)
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allergen
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suppurative conjunctivitis TX
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bacitracin- polymyxin B, cirprofloxacin or erythromycin (dont use a penicillin)
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Acute recurrent allergic conjunctivits
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cromoly opthalmic gtts, oral antihistamies
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Sx of angle-closure glaucoma
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sudden HA pain in left eye, blurred vision, pupil dilated, firm eyeball
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Sx: vision change w/ dull pain, photophobia, effected pupil is small irregular: What is the ocular disease.
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anterior uveitis
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what happens if you dont tx primary open angle glaucoma
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peripheral vision loss
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Who is at risk of developing primary open angle glaucoma (POAG)
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african, DM2 advanced age
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What is the tx for primary open angle glaucoma?
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beta adrenergic antagoinst, alpha agonist, prostaglandin: opthamology referral emergent
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Sx: pimple to eyelid, pustule, eye lid margin: what is the dx
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hordeolm
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sx: bump on eyelid, hard, nontender swelling lateral border: what is the dx
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chalazion
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Tx of hordeolum
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oral antimicrobial
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Prevention of meniere disease
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avoid ototoxic drug (ending in mycin), protect load noise, limit sodium
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define dizziness
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perception of altered equilibrium
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define vertigo
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perception of person or environment moving
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define nystagmus
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rhythmic oscillation of eyes
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define tinnits
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perception fo abnormal hearing or head noises
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Tx of otits external
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analgesic (T3), VolSol (acid), steroid w/ an antibiotic like neomycin or florquinolone
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PE of otits external
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tragus pain on palpation, possible conductive hearing loss, drainage
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PE of acute otitis media
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tympanic membrane immobility
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Tx of patient with acute otits media but allergic to PNC
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clarithromycin (macrolide)
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Tx of otits media not improved after 4 d of amoxicillin would be what antibiotic:
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Erythromycin (if PNC allegeric)
Augementin (beta-lactam) Zithromax (macrolide) cefuroxime (Second gen cephlasporin) |
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M. catarrhalis results from
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high beta-lactamase production (PNC worthless)
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What is Centor Criteria for pharyngitis
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Hx of fever, tonsillar exudates, tender anterior cervical adenopathy, absence of cough
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Define Primary Prevention
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measures to prevent onset of targeted condition
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Example of Primary Prevention
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immunization, health education, seat belts...most cost effective form of healthcare
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Define Secondary Prevention
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identify and treat asymptomatic person who already have disease but not apparent; alter natural course of disease
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Example of Secondary Prevention
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screening test; colonoscopy, mammography
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Define Tertiary Prevention
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Care of established disease to restore highest function while minimize neg effect..primary prevention has been unsuccessful
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Define Specificity
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proportion of negative which are correctly identified
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Example of specificity
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% 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.
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Define Sensitivity (statistical)
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proportion of actual positives which are correctly identified as having condition (sore throat w/ strep actually has positive rapid strep: that is sensitive)
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Example of sensitivity (statistical)
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% of SICK people who are correctly identified as HAVING the condition
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define p-value; statistical significance
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Represents PROBABILITY of error. Higher P value the less reliable P- 0.5 is borderline acceptable level of error
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define veracity
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health professionals honest and full disclosure. Obstain from deceit report lapses in standard of care...ie honesty (medical-dictionary.com)
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Define nonmalficence
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avoid harming others (medical-dictionary.com)
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Define beneficence
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the act of doing good, kindness (medical-dictionary.com)
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Define automony
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the act of being independent or self governed
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Define justice
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fairness, up holding what is just
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Define fidelity
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Faithfulness to obligations, duties, or observances.
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Power (analysis) statistics
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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
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Define reliability (truthfulness)
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degree consistency which instrument measures variable. Reliable if measurements today are same tomorrow
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Define variables (stats)
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things measured, controlled or manipulated
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Define correlation as related to research.
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Do not influence variables only assess their relation
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Define experimental research
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manipulate some variable then measure the effects: casual relation between variables
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Define dependent ( stats)
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only measured or registered NOT manipulated
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Define independent variables (stats)
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those that are minipulated
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Define retrospective (historical cohort) and give example
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look back at events: ex: review health records to find trends.
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Define prospective (cohort) study
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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
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Internal validity
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approximate truth about inferences regarding causes and effect or causal relation
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Define external validity
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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
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S. pyogenees pharyngits failure rate w/ tx with IM PNC
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20% similar to oral tx
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Expect onset when using nasal corticosteroid spray
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a few weeks
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What is a drug of choice for allergic rhinits
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claritin
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What receptors do antihistamines effect
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H1 receptors
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What are the action of decongestants
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vasoconstriction
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What medication is used for relief of acute nasal puritis
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oral antihistamine
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ARIA (Acute Rhinitis and Impact on Asthma) guidelines : best relief of acute nasal congestion
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decongestant spray
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ARIA: least control of rhinorrhea
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Cromoyln nasal spray
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What are the pathophysiological effects of Cromolyn (tx for asthma)
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mast cell stabilizer
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GLORIA (global resource in allergy): Tx of allergic conjunctivitis
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topical mast cell stabilizer (Cromolyn) w/ topical antihistamine
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One common method to control allergies especially at night
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dust mite control
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Acute bacterial rhinosinusitis Dx
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URI >7-10 or worsening in 5-7 days
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What sx do you find on acute bacterial rhinosinusitis (ABRS)
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maxillary tooth ache, colored nasal discharge, URI
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first line tx of acute bacterial rhinosinusitis
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amoxicillin
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Failure of treatment of acute bacterial rhinosinusitis after 72 hrs progress to:
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augmentin
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What is the next Tx of acute bacterial rhiniosinusitis if already tx with doxycycline and a (PNC allergy)
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levofloxacin (quinolone)
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acute bacterial rhinosinusits that appears moderaly ills
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tx with high dose augmentin
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blephritis: sx; tx
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ocular burning, eye lid margins red w/ scaling or crusting: + pain
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warm compress, daily lid scrub, erythromycin or bacitracin ophthalmic
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cellulits orbital Sx and Treatment
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localized tenderness, erythema, edema, fever, proptosis; + pain
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referral, IV antibiotics
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dacryosystitis
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chronic tearing, eyelash crusting, tenderness, circumscribed erytheema; + pain
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warm compress, gentle massage, systemic antibiotics
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What are the sx of chalazion
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nontender chronic lesions, locaized erythema, edema of eyeids no pain
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warm compress, daily lid scrubs, lid massage
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hordeolum
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tenderness, erythema, edema, internal lesion; +pain
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warm compress, lid scrub for recurrence, topical antibiotic
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angle-closure glaucoma, sx, tx
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sever pain, n/v, halos around lights, photophobia, cornea cloudy w/ decrease vision, conjuctival.
emergent refereal to opthomologist, pilocarpine |
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conjunctivits allergic, sx tx
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pruritus, conjnctival hyperemia, chemosis, watery or stringiy discharge; no pain
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avoid allergens, cold compresses, topical and systemtic medications
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conjunctivitis bacterial, sx tx
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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
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conjunctivitis viral sx,tx
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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 |
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What are sx associated w/ corneal foreign body, abrasion, or an ocular ulcer
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intense pain, photophobia, conjunctival hyperemia, decrease acuity, ulcers, prior hx f trauma w/ abrasion but not erosion
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topical antibiotics systemic pain relief for abrasion and after foreign body
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What are sx of episcleritis or scleritis and how do you manage them.
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mild to sever pain, circumscribed erythema of affected sclera, vision unaffected
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episcleritis self limiting, scleritis referral
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What are sx of iritis or uveitis?
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pain, photophobia, conjunctival hyperemia, pupil constriction, no discharge: urgent referral
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What are sx of keratitis
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pain photophobia corneal cloudiness w/ stromal involvement
urgent referral |
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Disease that cause sudden eye sight loss
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acute angle-closure glaucoma, central retinal vessel occulsion , hyphema, irtitis, meningitis, migraine, optic neuritis
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disease cause gradual loss
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cataracts, corneal opacities, glaucoma, macular degeneration, pituitary tumore, retinal detachement
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Cataracts; SX, Tx
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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 |
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What is the tx for chalazion, hordeolum, blepharitis
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Tx: Warm compresses, bacitracin, erythromycin or Cipro if chronic
hordeolum: children chalazion: adults |
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cardiac: AAA: what increase risk of rupture
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>6.0 cm, rapid expansion, female, smoking, COPD, FHx, asymmetrical AAA
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AAA: PE
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75% asymptomatic..pulsating mass (knees flexed), back pain
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AAA: Dignostic
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Abd US (screenin an dconfirmation
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AAA: TX
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prevent rupture: size best predictor
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AAA: refer
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>4.0 cm to vascular surgon
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A-fib: PE
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palpitation (shorten diastole and vent filling), drop in BP, CO, light headed, dizziness, fatigue, SOB
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A-fib: PE sx
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if hyptensive and tachy immediate care
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A-fib Heart sounds
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possible systolic ejection murmur, if S3 then impending heart failure
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A-fib: diagnostic
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ECG, holter (24-48hr), provocative test (exercise ECG), ECHO for initial work up on all arrhythmias to determine left atrial and ventricular size
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what is the heart rate of PSVT
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140-240bpm
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Torsades de Pointes
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QRS morpholgical pattern, TX: magnesium
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A-fib tx:
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tx causes: rheumatic heart, mitral valve, HTN, CHD, hyperthyroid, acute alcohol, stimulant ect
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A-fib tx:
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uninterrupted anticoagulants for 4 wks prior and post conversion
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A-fib tx:
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anticoagulant: warfarin: INR between 2-3 if contraindicated then ASA and if <60y/o
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first degree AV block
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PR>20
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Second degree type I: mobitz type 1
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pregressive prolongation of PR interval until not conducted by ventricle
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What do you expect to see on the ECG w/ Second degree type II: mobitz II
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constant PRI interval (normal) until P wave is not conducted: more severe vs type I. Fails to conduct through the ventricles.
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Third degree AV block
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no relaiton between P and QRS, fatal
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What is included in a diagnostic work-up for A-fib?
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ECG, holter (24-48hr), provocative test (exercise ECG), ECHO for initial work up on all arrhythmias to determine left atrial and ventricular size
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PSVT: rate
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140-240bpm
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Describe the wave pattern of Torsades de Pointes and the tx?
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QRS morpholgical pattern, TX: magnesium
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A-fib tx:
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tx causes: rheumatic heart, mitral valve, HTN, CHD, hyperthyroid, acute alcohol, stimulant ect
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A-fib tx:
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uninterrupted anticoagulants for 4 wks prior and post conversin
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A-fib tx:
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anticoagulant: warfarin: INR between 2-3 if contraindicated then ASA and if <60y/o
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What finding on an ECG would help dx first degree AV block?
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PR>20
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Second degree type I: mobitz type 1
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pregressive prolongation of PR interval until not conducted by ventricle
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Second degree type II: mobitz II
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constant PRI nterval until P wave is not conducted: more severe vs type I
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what do you expect to see on the ECG w/ Third degree AV block
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no relation between P and QRS, fatal
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Blood pressure norms
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<140/90; <130/80 if heart failure or renal
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lipid norms
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LDL <100; reduced saturated fats < 7% calories
Triglycerides <150 mg |
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How much physical activity is suggested
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30 min, 7 days week
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meds used for CAD; ASA if
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75-162mg PO QD; if contra then clopidogrel or warfarin. May be combined
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Meds used for CAD: Beta blocker if:
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If MI, ACS, left ventricular w/ or w/o HF
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meds for CAD: ACE-I if:
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Ventricular ejection fraction <40% and w/ HTN, DM or CKD
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meds for CAD: Influenza vaccine
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all CAD
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variant angian patho
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spasm most right coronary and left descending: focal and reproducible at same location
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PMI define
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point of maximum impulse
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|
|
Where do you expect to find PMI w/ cardiomegaly
|
downward or laterally displaced
|
|
|
define xanthomas or early arcus senilis
|
elevated cholesterol seen around iris as hazy whiteness: assess peripheral circulation
|
|
|
Ventricular gallop (S3) indicates possible
|
heart failure
|
|
|
What is present in tertiary syphilis
|
Gumma (lesions found on liver, heart, brain, skin)
|
|
|
atrial gallop (S4) indicated possible
|
HTN, MI , resistance of ventricular filling
|
|
|
systolic mitral regurgitation murmur indicates
|
ischemic papillary muscle
|
|
|
What is the pathophysiology of pericardial friction rub:
|
inflammation around pericardial sac
|
|
|
Name on diagnostic test for coronary artery disease (CAD)
|
exercise tolerance test (stress test)
|
|
|
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 |
depression >1mm high likelihood of unstable angina
|
|
|
Cardiac markers: CPK-MB norms
|
rises 3-12, peak: 24hr, normal 48hr after injury
|
|
|
Endocarditis: causes
|
streptococcal (70% if not IV drug use),
|
|
|
Endocarditis: diagnosis
|
consider for all patients w/ murmur and fever of unknown origin
|
|
|
Cardiac markers: myoglobin norms
|
rises 1-3 hrs, peak 3-4 hrs, normal 24 hrs after injury
|
|
|
Peripheral venous insufficiency: DVT: causes
|
prolonged inactivity, estrogen, recent surgery, trauma
|
|
|
cardiac markers: troponin, norms
|
rises 3-12 hr, peak 3-4 hr, 14d
|
|
|
What causes Endocartitis?
|
streptococcal (70% if not IV drug use),
|
|
|
Endocarditis: sx
|
fever main sx (unless old, immuno), heart murmur, janeways lesion, osler nodes: palms of hands, soles due to septic embolization
|
|
|
Endocarditis: tx:
|
high dose bactericidal IV: PNC G r ceftriaxone and an aminoglycoside
|
|
|
When would endocarditis be part of your differential diagnosis?
|
Consider for all patients w/ murmur and fever of unknown origin
|
|
|
Heart Failure: Sx
|
S3 or s4 murmurs and lateral displacement of apical impulses, S4 due to over distention of ventricles
|
|
|
Heart Failure: Diagnostic: lab
|
BNP: brain natriuretic peptide: secreted due to elevation of end diastocli pressure: BNP >400= CHF Dx
|
|
|
Heart failure: Diagnostic: rad
|
Echocardiogram
|
|
|
What are causes of Peripheral venous insufficiency: DVT
|
prolonged inactivy, estrogen, recent surgery, trauma
|
|
|
DVT sx:
|
leg edema, calf tenderness, pain on dorsiflexion of foot (Homans sign), 50% no sx
|
|
|
DVT diagnostic: Rad: none unless superficial phlebitis
|
duplex ultrasound to ensure no DVT
|
|
|
DVT diagnostic: Lab
|
D-Dimer: marker for coagulation activiation and fibrinolysis
|
|
|
DVT: common location
|
femoral veins
|
|
|
DVT: Tx
|
superfical phlebitis: elevation of leg, compression w/ ace bandage, NSAIDS, antibiotics
|
|
|
DVT: Tx
|
heparin immediatley to prevent PE, hospitalization: 500u boluse then 800-1400u/hr--> PTT >2x normal for 2 days
|
|
|
S1 heart sound become louder or quieter during pregnancy
|
Louder
|
|
|
DVT: Tx
|
coumadin w/in 24 hrs, pt discharged when INR 2-3 and continued for 3-6m
|
|
|
What type of murmur becomes evident during pregnancy
|
physiologic systolic ejection
|
|
|
Foods that decrease effectiveness of warfarin:
|
high in vitamin K
|
|
|
Chronic venous stasis: TX
|
compression stocking, normal saline wet to dry topical antibiotics for ulcers
|
|
|
chronic venous stasis: Tx
|
stocking if eczema from sever stasis the 0.5% hydrocortisone
|
|
|
What happens to the transvers thoracid diameter and diaphragmatic contraction
|
it increases in size
|
|
|
Varicose: causes
|
pooling blood in large varicose veins
|
|
|
varicose: sx
|
heavy discomfort when standing increase bleed when older
|
|
|
Varicose: Tx
|
asymptomatic, refer if poorly tolerated
|
|
|
Venous stasis ulcer sx include:
|
most sever complication of post phlebitic syndrome: ulcer above medial malleousl, wound infected, pulses not palpable due to swelling
|
|
|
venous stasis ulcer tx;
|
bed res, wet-dry, ulcer debridment, oral antibiotics, compression w/ ACE
|
|
|
Venous stasis: things to know
|
occur around ankle, hx of phlebitis, sx of venous stasis, painful when infection, improved w/ elevation
|
|
|
venous ischemia: things to know
|
occur at tips of extremities/heel, Hx of cluadicating, very painful WORSE with elevation, absent pulse, secondary infection spread quick
|
|
|
Where and when do you expect to find venous neuropathic (diabetic)
|
occur at pressure points, painless but co-exist neuro pain, present after infection
|
|
|
Murmurs: things to know
|
timing is most improtant, mitral regurg best heard apex or 5th intercoostal, S1 loudest at apex and lower left sternal border
|
|
|
Murmurs: things to know about S4 and atrial kick
|
S4: atrial kick into noncompliant ventricle
|
|
|
Aortic stenosis: location, PE, Tx
|
right sternal border, CP< syncope, dyspnea, surgical
|
|
|
mitral regurgitation: locatin, PE, tx
|
apex, asymptomatic, then fatigue, dyspnea on exertion. if acute: Iv antibiotic, preventative for dental or surgical
|
|
|
Mitral valve prolapse: where can you hear it, what are the sx and what is the tx?
|
lower left sternal, PE: asymptomatic, then CP, palpiation,dyspnea, fatigue. Tx: none except echo q 3-5yr; antibiotic for dental
|
|
|
Where do you listen to hear tricuspid regurg
|
lower left sternal listening point
Also: ventricular septal defect |
|
|
aortic regurg
|
lower left sternal, asymptomatic, then acute CHF, Tx; antibiotic prevent endocarditis, valve replace
|
|
|
mitral stenosis
|
apex left lateral, class 1: asymptomatic, Class 2: dyspnea w/ exertion. Tx: if A-fib then w/ anticoagulants
|
|
|
HTN: BP ok
|
<120-90
|
|
|
Prehypertension
|
120-139/80-89
|
|
|
Stage 1 HTN
|
140-159/90-99
|
|
|
What are the parameters for Stage 2 HTN
|
>160/>100
|
|
|
Primary HTN: Patho: vascular
|
hypertrophy<-- excess insulin, catecholmines, natriuretic hormone-->increase peripheral resistance
|
|
|
Primary HTN: path: obesity
|
central-->increased sympathetic nervous system output
|
|
|
HTN: diet
|
DASH: fruits, veg, low-fat dairy, Sodium: increase circulatory volume
|
|
|
HTN prevention: How does alcohol increase BP?
|
increase BP due to SNS, RAS decrease peripheral vascular tone
|
|
|
Renal artery stenosos HTN: PE, screen
|
<30->50, Hx arterhosclerosis, Screen: UA, creatinine
|
|
|
HTN: pheochromocytoma: PE Screen
|
5 H: HTN< HA, hyperhidrosis, hypermetabolic, DM
Screen: spot UA, 24hr UA |
|
|
renal artery stenosis HTN: Diagnostic, TX
|
ateriogram: Tx: B-blocker, AVOID ACE-I, angioplasty, bypass
|
|
|
HTN: pheochromocytoma: diagnostic, TX
|
CT abdomen, Tx; A-blocker, then B-blocker, or both
|
|
|
JNC7 f/u for initial BP w/o end organ if : normal <120/<80
|
f/u in 2 yrs
|
|
|
JNC7 f/u for initial BP: preHTN
|
1yr
|
|
|
JNC7 f/u for initial BP: stage 1 HTN
|
confirm in 2 months
|
|
|
JNC7 f/u for inistial BP: stage 2 HTN
|
eval or refer for care w/in 1 m
|
|
|
HTN PE:
|
papilledema, buits, neuro deficit, skin thinning, loss of extremity hair, striae
|
|
|
What diagnostic test should u obtain for a new HTN patient?
|
UA, CBC, glucose, CMP, BUN< creatinine, uric acid, TSH, 24-hr urine cortisol if cushing syndrome suspect
|
|
|
Osteoarthritis Sx
|
pain, stiffness and limited ROM, metacarpal joints of thumbs and interphalangeal joints initial impact
|
|
|
Osteoarthritis: Tx
|
APa primary 1 g 4x dayily, Tramadol nonopiod pain may be used w/ NSAID, glucosamine w/ or w/o chondroitin for OA of knees
|
|
|
Osteoarthritis: non-pharm Tx
|
aerobic for cardio, weight reduction, PT and or OT, strength training to fix contractures
|
|
|
Osteoarthritis: Diagnostic
|
xray films normal early; later narrowed asymmetric joint space
none systemic disease so no serologic markers, labs to rule out other diseases |
|
|
Osteoarthritis: Injections limits
|
3 injections per year and max of 12 per joint (may accelerate joint deterioration)
|
|
|
What are the Sx of Acute Gout/Hyperuricemia
|
rapid onset, at night wakes from sleep, warmth, red, swell, decrease ROM, monoarticular, First metatarsophalangeal big toe (podagra)
|
|
|
What are sx of chronic Gout (tophaceous)
|
typically>10yrs firm swelling, digits of hands and feet
|
|
|
What increase risk of Gout flare up?
|
trauma, overeating, alcohol, fasting.
|
|
|
What is the non-pharm prevention and tx of Gout flare up
|
diet is key: avoid diuretics weight gain, alcohol (lowers purine, protein), TX: cold compress
|
|
|
How do you dx Gout
|
joint aspiration: 6-13 minor or 1 major crystals in synovial fluid or tophus for Dx
|
|
|
What is the pharm Tx of ACUTE Gout
|
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 |
|
|
What is the pharm Tx of Chronic Gout
|
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) |
|
|
Tennis Elbow Sx
|
Medial epicondylitis (GOLFERS) pronators
Lateral epicondylitis (TENNIS) supinators -Tinel's sign: tapping over ulnar groove reproduces pain/numb to 4-5th fingers |
|
|
What is the prevention of Tennis elbow
|
overuse, proper techinques, lighter tools, less grip
|
|
|
What is the diagnostic of Tennis elbow
|
xray, AP, joint aspiration for crystals
|
|
|
What is the managment of Tennis elbow
|
NSAID, RICE 2 wks; consider steroid injections.
|
|
|
Other elbow injuries: things to know
|
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 |
|
|
What are the modifiable risk factors of Osteoporosis
|
low body weight <58kg,BMI<20, Ca or Vit D, inadequate physical activity, smoking, alcohol, corticosteroid, heparin
|
|
|
What are the non-modifiable risk factors of Osteoporosis
|
advaced age >65, female, caucasion, asian, FHx, traumatic fx
|
|
|
Osteoporosis prevention
|
Ca 1200mg and vit D 700 IU/d. Screen all women >65 or 60 w/ risk factors
|
|
|
Osteoporosis diagnostic test
|
Dexa of lumbar and Hip is GOLD standard for dx, T-score >-1 normal Osteopenia = T -1 to -2.5, osteoporosis T <-2.5
|
|
|
What is the non-pharmacologic management of Osteoporosis?
|
adequate Ca and Vit D, weight bearing exercise avoid smoking and excessive alcohol: 1000-1200 mg D Ca
|
|
|
Osteoporosis managment pharm:
|
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
|
|
|
Fibromyalgia diagnostic criteria
|
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
|
|
|
Fibromyalgia signs and sx
|
>3m sx unexplained w/ other dx, fatigue, sleep disturbance, female 20-65, impared socail occupationa, depressive/anxiety, exclude statin causes
|
|
|
Fibromyalgia Points of tenderness
|
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
|
|
|
Fibromyalgia diagnostic test
|
ESR, C-reactive protein, CK, TSH, CBC, renal Nd LFT
|
|
|
Patient with medial knee pain and dx of arthritis would have pain..
|
medially along the joint line
|
|
|
The most common site of osteoarthirits is what part of the hip
|
Anterior especially if it radiates into the groin
|
|
|
What is the classic finding in de Quervain's tenosynovitis (extensor and flexor tendons of the thumb)
|
Positive Finkelstein test.
pain may radiate up the forearm |
|
|
Findings of RA included
|
Morning stiffness, postitive rheumatoid antigen, antinuclear antibodies
|
|
|
What does the "get up and go" test in elderly test.
|
Fall risk through musculoskeletal function
|
|
|
Osteoarthritis pain first line of treatment
|
exercise if this doesnt work then tylenol for pain: NSAID work better but have higher S/E risk an dshould no be used
|
|
|
SPRAINS Grade
Stage I Stage II Stage III |
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 |
|
|
Ottawa ankle rules help determine
|
whether x-ray is needed w/ suspected ankle injury
|
|
|
Why is bronchospasm worse between 29-36 wks in preg?
|
increase esophageal irritation from GERD: esophageal sphincter loosens due to increase pressure
|
|
|
Anterior Drawers Test for what
|
ACL injury laxity or movement
|
|
|
Which of the rotator cuff is most susptible to injury
|
Suproaspinatus (arm drop test)
|
|
|
The mainstay for initial treatment of early OA
|
Tylenol max of 4g/d unless on warfarin then 2500mg
|
|
|
What is another pain medication that is a non-steroidal used for moderate pain in OA
|
Tramadol (Ultram)
|
|
|
What common GYN medication is used to decrease osteoporsis
|
Estrogen w/ progesterone if they still have uterus
|
|
|
What medication reduces the risk of methotrexate hepatotoxicity
|
Folic acid
|
|
|
Injuries to the ends of bone versus sprains is most common in what age
|
children
|
|
|
What is the best screening for Osteoporosis
|
bone mass densitormetry usin DEXA
|
|
|
What does the spurling Test test for in a MS examination
|
cervical radiculopathy
|
|
|
Who should initiate immunosuppressive therapy (mehtotrexat) for an RA Patient
|
rheumatologis for diagnosis confirmation and initiation of DMARDS.
|
|
|
What Gout medication is better for those with renal impairment
|
Uloric and lower doses are needed to achieve resuls
|
|
|
What diagnostic is used in suspected spinal stenosis
|
MRI of the spine
|
|
|
What is the heart sound of soft first heart sound, w/ pansystolic apical murmur that radiates to axilla
|
mitral regurgitation
|
|
|
Abdominal exam: high, midline abdominal pulsation of low amplitude that are directed forward indicates:
|
a normal finding
|
|
|
Generalized, non pururitic skin eruption intermittent exacerbation for years. erythematous plaque on gluteal fold scales and fissuring:
|
psoriasis
|
|
|
Drug most likely to increase lipoprotein levels
|
hydrochlorothiazide: older beta blockers increase lipids
|
|
|
Most common type of joint disease in US
|
asteoarthtitis
|
|
|
Sx of left ventricular heart failure
|
third heart sound, cough , bibasilar rales
|
|
|
Eval of rapid, alternating movements of hands assess
|
cerebellar functioning (assess dysdiadochokinesa)
|
|
|
Plantar fat pads on 2y/o child
|
normal
|
|
|
Test to determine clearance of digoxin.
|
creatinine clearance estamate
|
|
|
Beta blockers are not contraindicated in ......any more but calcium channel blockers are?
|
heart failure
|
|
|
Low back pain tx
|
mild activity w/ motrin and rice
|
|
|
In heart failure tx
|
HCTZ (lasix light), aldactone (spironolactone): aldosterone, angiotension effects.
|
|
|
Are plantar fat pads on 2y/o child?
a. abnormal b. normal c. sign of cancer d. none of the above |
b. normal
|
|
|
Do diuretics affect pre load or afterload
|
Pre-load: by decreasing amount of fluid results in heart not working as hard to move blood.
|
|
|
What are uses of aldasterone
|
hyperoldosteronis
|
|
|
Test to determine clearance of digoxin.
|
creatinine clearance estamate
|
|
|
Beta blockers are not contraindicated in ......any more but calcium channel blockers are
|
heart failure
|
|
|
what is the degree of sedation for antihistamines: atarax
|
better itch relief and sedation (SE)
|
|
|
Low back pain tx
|
mild activity w/ motrin and rice
|
|
|
Fe anemia before it is tx reticulocytes are (high or low), upon tx it will be (high or low)
|
low, high (fast 1-2wks)
|
|
|
In heart failure tx
|
HCTZ (lasix light), aldactone (spironolactone): aldosterone, angiotension effects.
|
|
|
Do diuretics affect pre load or afterload
|
Pre-load: by decreasing amount of fluid results in heart not working as hard to move blood.
|
|
|
bouchard nodes versus heberden nodes: define differences
|
Heberdens are at DIP joint and Bouchards (less common) are at the MIP joint: both are bony "bumps". sign of osteoarthitis
|
|
|
Glucocorticoid help with all itis
|
cellulitis
|
|
|
which situation would be associated w/ macrocytic anemia
|
B12 and folic acid
|
|
|
Qualitative research:
|
does not mearsure only states lived experience
|
|
|
Quantitative research
|
uses numbers and statistics
|
|
|
Independent variable
|
First thing: it is not being influenced is being manipulated (type of diet)
|
|
|
Dependent variable
|
change measured in dependent variable: weight is dependent on diet (independent)
|
|
|
Function of IRB (institutional research board)
|
review research, be patient advocate, advised of risk and benifits.
|
|
|
What vaccines are required at 4 months?
|
DTaP
Hib IPV PCV Rota |
|
|
Who can receive live attenuated flu vaccine (nasal spray)
|
Healthy non pregnant: 2-49
|
|
|
Which vaccine is contraindicated in pregnancy? Injectable Flu, Td, MMR, Hep B
|
MMR
|
|
|
What percent of acute Hep B will develop Chronic?
|
5%
|
|
|
What should be given if some has exposure to Heb B?
|
HBV and shot of HBIG
|
|
|
What has increase risk of suicide? rifampin, accutane, acyclovir, advair
|
accutane
|
|
|
Amniodarone has toxicity to what organ?
|
lungs
|
|
|
Which vaccine is effective after one dose? Hep A, Hep B, Gardisil, Herpes Zoster
|
Herpes Zoster
Gardisil=3shots Hep B= 2 shots |
|
|
What is primary Prevention and give an example?
|
Prevent onset or acquisition of disease:
Ex: immunization, education, use to seatbelts |
|
|
What is secondary Prevention and give an example?
|
identify and tx asymptomatic persons who have risk factors for given disease:
Ex: screening, Blood pressure, lipid profile |
|
|
What is tertiary Prevention and give an example?
|
Goal of minimize disease complications and negative health from effects:
Ex: meds, lifestyle modification, tx |
|
|
What is the incubation period of influenza?
|
1-4days
|
|
|
How long are you infectious w/ influenza?
|
Adults: 5days, Children 10days
immunodeficient shed virus of 3wks |
|
|
Who is at highest risk of death w/ influenza?
|
<2 and >65y/o
|
|
|
What ages can receive the trivalent influenza vaccine?
|
6months and older and all pregnant women
|
|
|
Who can receive the Live Attenuated Influenza vaccine?
|
2years -49 y/o and healthy
|
|
|
What medication can you consider when tx a HTN and DM:
|
ACE-I: like fosinopril : nephroprotective features
|
|
|
How many doses do <9y/o need for initial influenza vaccine?
|
2 doses over 4 wks for TIV and 6wks for LAIV
|
|
|
What are the four antiviral meds approved by the FDA for influenza?
|
amantadine (Symmetrel), rimantadine (Flumadine), zanamivir (Relenza), oseltamivir (Tamiflu)
|
|
|
What influenza medication are approved for influenza A?
|
amantadine (Symmetrel), rimantadine (Flumadine)
|
|
|
What influenza antivirals can be used for A and B strains?
|
Zanamivir (Relenza), oseltamivir (Tamiflu)
|
|
|
What amount of cholesterol does the ADA recommend
|
300mg or less
|
|
|
What are side effects of zanamivir (Relenza) and how is it administered?
|
Used to tx the flu:
S/E: bronchospasm (w/ asthma or chronic lung) Administered via inhalation |
|
|
What are the side effects of relenza (Tamiflu) and how is it administered?
|
GI, n/v; PO take w/ food
|
|
|
How far apart should MMR be given and how many doses are required?
|
1m apart 2 doses (live attenuated virus)
|
|
|
Can an MMR be given during pregnancy?
|
NO
|
|
|
What are sequelae illnes of Measles and mumps?
|
Measles: encephalitis and pneumonia
Mumps: orchitis |
|
|
How many doses of Tdap should be administered and at what interval?
|
5 doses: 1st two one month apart 3rd - 5th- 6m apart. Then q 10 yrs
starting at 6wks |
|
|
What age should Dtap be administered after entering school?
|
11-12 y/o
|
|
|
What is the max recommended age for receiving the HIib vaccination
|
5 years old
|
|
|
What immunization should be given at birth?
|
Hep B
|
|
|
List the immunization given at 6wks?
|
Rotovirus, Dtap, Hib, Pneumococcal, polio
|
|
|
List immunization started at 12months?
|
MMR, varicella, Hep A
|
|
|
When should the final dose of polio be given if not 6m after initial dose?
|
On or after 4 yrs old
|
|
|
When should the HPV vaccine be offered and how many doses?
|
13-18 y/o: 3 doses
|
|
|
What does pneumococcal vaccine protect you from?
|
Invasive disease like meningitis, septicemia from S. pneumonia (leading cause of death from CAP)
|
|
|
What medication should an HIV patient receive and how soon after diagnosis?
|
antipneumococcal vaccine as soon as diagnosis is made
|
|
|
How long after first pneumococcal should second pneumococcal be given?
|
5 years
|
|
|
Which of the following allergic rxn should not receive the Hep B vaccination? egg, bakers yeast, neomycin, streptomycin
|
bakers yeast
|
|
|
When should pregnant women be screen for HBsAg?
|
At first prenatal visit regardless of HBV hx
|
|
|
When should a booster dose of HBV be admistered and to whom?
|
when anti-HB is <10mIU/ml and only for immunocompromised patients
|
|
|
Drugs whose names end in "-pril" and reduce efferent arteriolar pressure are from what class:
|
ACE-I:
|
|
|
What vaccination should be given to someone exposed to Hep B?
|
If previously vaccinated: single HBV booster
If no vaccination: HBV and HBIG w/in 24hrs of exposure |
|
|
What class of meds end in "sartan" and help preserve renal function in DM
|
Angiotensin receptor blockers
|
|
|
How is small pox spread?
|
droplets: nasal, oral, pharyngeal
|
|
|
What medications increase your risk of heat stoke?
|
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 |
|
|
When is small pox most contagious?
|
onset of rash: may be w/ fever
|
|
|
What lab should be gotten in a patinet w/ heat stroke
|
CK to assess muscle damage --> release of electrolyte tissue damage, hyperkalemia
|
|
|
What are sx of small pox?
|
rash to tongue, open sores, rash to skin all over w/in 24hrs
|
|
|
How long is smallpox contagious?
|
until all crusts have fallen off
|
|
|
What is the tx of small pox?
|
supportive: vaccinate w/in 3 days of exposure lessens severity
|
|
|
62y/o HTN, smoke, Trigly:280, HDL:38, LDL:135 what med is best (class)
|
multi drug therapy is needed
|
|
|
What age has the greatest mortality from varicella? 2-10, 30-50, 60-80
|
30-50 years old (fitzgerald)
|
|
|
46y/o HTN smoke, Trig: 110, HDL: 48, LDL: 192, on low-cholest diet what is next best step?
|
HMG-CoA (coenzyme A reductase inhibitor) (lipitor, zocor, pravistatin) statins
|
|
|
Where does the VZV lie dormant?
|
sensory nerve ganglia (later causes shingles...dermatone)
|
|
|
64y/o HTN DM2, Trig: 180, HDL 38, LDL: 135. Meds: sulfonylurea, TZD, biguanide, ACE-I, thiazide diuretic what next?
|
lipid-lowering drug therapy initiated.
|
|
|
What age is varicella vaccine started?
|
after the 1st birthday and second between 4-6 y/o
|
|
|
What lab should be check w/ taking HMG-CoA reductase inhibitor (Statin) ?
|
aspartate aminotransferase (liver function), CK
|
|
|
When should pregnant women recieve the first dose of varicella if no immunity?
|
after delivery and before discharge
|
|
|
What changes are expected when taking fibrates?
|
increase in HDL: only medication that actually document increase in HDL
|
|
|
What can be given if no immunization but contraindication for vaccination?
|
VZIG post exposure
|
|
|
What CD4 count in HIV should you withhold live virus?
|
< 200 cell/uL
|
|
|
How is diphtheria (gram-negative bacillu) transmitted?
|
usually contaminated liquids ie milk
|
|
|
When prescribing Zetia what should you expect to see?
|
reduction in LDL
|
|
|
What is the initial sx of diphtheria?
|
pseudomembranous? pharyngitis
|
|
|
What are risk factors for statin induced myostitis?
|
advanced age, low body weight, high statin dose
|
|
|
What should you give a patient exposed to tetanus but no immunization?
|
Tetanus IG
|
|
|
What is the average LDL reduction when only diet is modified in lowering cholesteral tx?
|
5-10%
|
|
|
How is Hep A transmitted?
|
fecal oral route: self limiting rarely fatal
|
|
|
When taking atorvastatin and cholestyramine advise the patient to take the medicaiton?
|
separeate cholestyramine from other meds by 2hrs (affect absorption)
|
|
|
What should clotting factor disorder patinets be immunized with?
|
Hep A
|
|
|
What medication is most effective against lipoprotein?
|
niacin
|
|
|
How is polio transmitted?
|
fecal oral: OPV no longer used in US due to risk of paralytic poliomyelitis
|
|
|
What are secondary causes of hypertriglyceridemia?
|
hypothyroidism, poorly controlled DM or excessive alcohol
|
|
|
Which would presents > risk for tetanus?
A. puncture while gardening B: lac while cutting beef C: human bite D: abrasion from sidewalk |
Puncture wound while gardening
|
|
|
HMG CoA reductase inhibitor (statin)? Effect, comments
|
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 |
|
|
Resin (cholestyramine, colestipol, colesevelam): benefits and adverse rxn
|
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 |
|
|
18y/o w/ no primary tetanus should receive what tetanus immunzation?
|
Tdap now then Td in 1 and 6 months
|
|
|
Niacin (class: antihyperlipidemia): benifits, Use, adverse effects,
|
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 |
|
|
50y/o who hasnt had tetanus vaccination in 10 years should receive what tetanus?
|
Tdap
|
|
|
Fibric acid derivatives: gemfibrozil (lopid), fenobribrate (tricor): what should you expect to see w/ tx and A/E
|
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 |
|
|
What is the most common source of Hep A infection?
|
contaminated drinking water
|
|
|
What does Ezetimibe (Zetia) do and what are A/Rxn
|
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 |
|
|
Which of the following should be tx for acute Hep A? A: interferon-alfa,
B: ribavirin C: acyclovir D: supportive care |
supportive care
|
|
|
Sedondary hyperlipidemia:
What does inactivity result in |
decrase HDL
|
|
|
Sedondary hyperlipidemia:
What does Alcohol abuse result in |
increase triglycerides, increase HDL increase LDL
|
|
|
What age should women start having mammogram?
|
40y/o. if high risk annually if low then yearly not recommended
|
|
|
Sedondary hyperlipidemia:
What does DM result in |
increase Trig, decrease HDL, increase total cholesterol
|
|
|
When should cervical screening be initiated?
|
3yrs after intercourse
30y/o q 3yrs after 3 normal Total hysterectomy: none |
|
|
Sedondary hyperlipidemia:
What does Hypothyroidism result in |
increase Trig increase Total TC
|
|
|
When should endometrial cancer be discussed?
|
at menopause: report any unexpected bleeding
|
|
|
Secondary hyperlipidemia:
What does High dose thiazide diuretics result in |
increase TC, LDL, Trig
|
|
|
What are the five A of tobacco counseling?
|
Ask, Advise, Assess, Assist, Arrange
|
|
|
Sedondary hyperlipidemia:
What does Chronic renal result in |
increase TC and Trig
|
|
|
What medications are used in tobacco cessation?
|
bupropion (Wellbutrin), varenicline (Chantix)
|
|
|
Metabolic syndrome dx includes:
|
abd obesity, trig levels higher than 150, HDL less than 40 in men and 50 in women
|
|
|
What does ABRS stand for w/ ENT?
|
Acute Bacterial Rhinosinusitis
|
|
|
What is characteristic of Metabolic Syndrome related to insulin?
|
Insulin resistance is present
|
|
|
Things that point to bacterial versus viral sinusitis?
|
Sx > 4 days, Purulent discharge, tooth or facial pain, maxillary sinus tenderness unilateral, sx worsen after improving.
|
|
|
Describe plasminogen activator inhibitor:
|
increased levels in atherosclerotic lesion
-inhibits fibrin degradation by plasmin -enhances clot formation |
|
|
Purpose of giving decongestant w/ sinusitis is to..?
|
Promote drainage
|
|
|
Define metabolic syndrome:
|
3 or more: obesity, blood pressure, dyslipidemia, glucose intolerance
|
|
|
Patient 875mg amoxicillin for sinusitis but worsen after 5days what is the bug? What should you do
|
it is probably a beta lactam and should use augmentin, tirid gen cephlasporin
|
|
|
Amoxicillin for sinusitis develop hives what should you do?
|
Stop amoxicillin. Start doxycycline or other none PNC/Ceph
|
|
|
Metabolic syndrome Guidelines:
|
abd men >40 inches, W >35
-Trig >150, HDL<40 BP: >130/85 Fasting glucose >110 |
|
|
If a patient has anaphylactic on PNC what other antibiotic should not be given?
|
cephlasporin
|
|
|
Insulin resistance is inversely related to decrease urine clearanc of what
|
Uric acid (gout)
|
|
|
Adult w/ common cold takes fexoaphenadine (allegra) and fluticosone nasal spray for allergies...what should you do?
|
keep her on allergy and add oral decongestant. Dont add guifenisin (it wets and fexoaphenadine is trying to dry up)
|
|
|
What will oral decongestants exacerbate?
|
(Psuedofed)...urge incontenance, blood pressure, mitral valve prolapse, BPH
|
|
|
What are some disadvantages to apple shaped (central abd fat)
|
metabolically active fat, high insulin levels, IR, free fatty acids and high insulin (increase hunger)
|
|
|
What would contraindicated use of topical decongestant? ie affrin
|
it is a vasoconstrictor: dont use in hypertensive patient
|
|
|
IR contribute to prothromotic and proatherogenic state because
|
Plasminogen activator inhibitor: inhibits fibrin degradation enhancing clot formation
|
|
|
What is the modified CENTOR score to determine giving an antibiotic for pharyngitis?
|
fever >100.4, no cough, anterior cervical nodes, tonsilar exudate swelling.
Also: ages 3-14 more likely >45y/o subtract a number |
|
|
16y/o patient w/ acute pharyngitis and sinus sx but no sore throat only sinus sx but you get positive strep?
|
PNC 10 days: prevent rheumatic fever
|
|
|
Pt unable to swallow due to throat pain and in sniffing position w/ fever 103, and is spitting? what is the likely dx
|
epiglotitis
|
|
|
What is the tx of epiglotitis in a FP clinic?
|
call 911
|
|
|
Aerobic exercise can reduce IR by what percent
|
40% and last 48hrs, reduces BP and improves lipids
|
|
|
What the likely hood of having enlarged spleen w/ mono?
|
50% have enlarged spleen palpate w/ flat part of hand not finger tips
|
|
|
What medication improves insulin sensitivity and metablic parameters like lipids and BP
|
TZD (pioglitazone, rosiglitazone)
|
|
|
What are mono sx?
|
FFFL: fatigue, fever, (f)pharyngitis, lymphadenopathy
|
|
|
What does daily ASA do for BP, lipids
|
counter act proinflammatory and prothrombotic effects of IR
|
|
|
Sx suggestive of mono but mono spot is negative? what should you do?
|
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
|
|
|
What does the WHO define as obesity ___kg/M2 or more
|
30 Kg/M2
|
|
|
What is kiesselbach plexus?
|
Anterior nose likely to bleed 90% of nose bleed
|
|
|
How do you treat epistaxis?
|
topical vasocontrictor (phynlephrine spray), cotton saturated w/ vasocontrictor, insert in nasal opening
|
|
|
What does orlistat do for weight loss
|
reduc dietary fat absorption by 30%. Results in diarrhea if you eat fats
|
|
|
What if you have epitaxis in rural clinic w/o other resources?
|
silver nitrate: anesthesia first.
|
|
|
What does Meridia due for weight loss
|
acts on brain control for mood an dwell being and appetite
|
|
|
Allergic Rhinitis: management
|
first line: nasal steroid (fluticasone), then add antihistamine, then add decongestant, then add leukotriene blocker
|
|
|
When can someone consider Bariatric surgical:
|
100lbs or more over ideal or >40BMI
|
|
|
What is the difference in first gen and send gen antihistamines?
|
second gen is less drowsy and last 24hrs:
zyrtec is 2nd gen but does cause drowsines |
|
|
What are risk factors for pancreatitis:
|
hyperlipidemia, abd trauma, thiazid diuretic use, alcoholism, gallbladder stones,
|
|
|
Patient w/ insect sting and allergic sx of runny nose, erythema, puritis at sight what should you use to tx sx?
|
systemic tx: diphehydramine liquid (absorbed faster than tablet)
|
|
|
What lab is obtained to determine acute pancreatitis
|
serum lipase level w/ amylase
|
|
|
Patient dx w/ Otitis externa what is a classic sx?
|
tragus pain, otic discharge, diminished hearing...should NOT have fever (not a systemic disease)
|
|
|
What is the most reliable test for pancreatic cancer
|
MRI is the most reliable diagnostic.
|
|
|
What is care of pancreatitis
|
parenteral hydration , analgesia, gut rest, tx underlying cause
|
|
|
Cermumen impaction would produce what type of hearing lose?
|
Conductive hearing loss (as does any obstruction)
|
|
|
How does a pancreatic cancer present:
|
abd pain , weight loss, anorexia, N/v, jaundices
|
|
|
What is a sensorineural hearing loss?
|
8th cranial nerve, effects inner ear, involves nerve
|
|
|
Amylase in Acute Pancreatitis will appear ______ and return back to normal ______. What % are due to cholelithiasis vs % due to alcoholic pancreas
|
* 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 |
|
|
What is presbycusis?
|
hearing loss from age...bilateral
|
|
|
Amylase: What effects amylase levels
Nonpancreatic amylase: |
*salivary glands
* ovarian cysts * ovarian tumors * tubo-ovarian abscess * ruptured ectopic preg * lung cancer |
|
|
What does the Webber test detect?
|
unilateral conductive and sensioneural hearing loss
Riene (mastoid bone then air) Webber (top of head) |
|
|
What steps should be taken for eye complaints?
|
Visual acquity, slit lamp, if only a light look at the side for smooth round globe, flouresceine stain for break in cornea
|
|
|
Lipase in Acute Pancreatitis:
Lipase appear how soon after onset and peaks at what time frame |
* appears 4-8h after sx onset
* Peaks at 24h, decreases 8-14d of pancreatitis resolution |
|
|
What is associated w/ cataracts?
|
decrease night vision, decrease vision, double vision, decrease color vision.
|
|
|
What non pancreatic reasons would result in elevated Lipase?
|
* renal failure
* perforated duodenal ulcer * bowel obstruction * bowel infarction |
|
|
Conjuctivits: why are meds given?
|
only to get back to work or school earlier...they will clear on own
|
|
|
Hyperthyroidism: signs and sx
Characteristics (patho) |
excessive energy release, rapid cell turnover
|
|
|
What is a pinguecula?
|
non-cancerous growth of the clear, thin tissue (conjunctiva) that lays over the white part of the eye (sclera)
|
|
|
Corneal arcus is what?
|
seen in older patients, may indicate elevated cholesterol
|
|
|
Hyphema is what?
|
bleeding in anterior chamber (emergency) caused by trauma
|
|
|
What is a chalzion?
|
hard nontender nodule on eyelid
|
|
|
What is a stye or hordoleum?
|
bump on eyelid that starts off tender
|
|
|
RUQ abdominal pain is associated w/?
|
Liver disease, choly, pneumonia
|
|
|
What is the LES tone related to GERD?
|
Lower esophageal sphincter, becomes relaxed which results in gastric juice back flow
|
|
|
What is Barretts esophagitis?
|
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
|
|
|
GERD tx?
|
Remain upright 2-3hrs after they eat (clear stomach), pH should be elevated when reflux is expected
|
|
|
What pharm tx is used in GERD?
|
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 |
|
|
H. pylori is gram negative: causes what?
|
ulcers in stomach or esophagus,
|
|
|
38y/o w/ suspect C-dif (gram neg) what is a classic description of stool?
|
bloody and watery
|
|
|
What infectious organism is common if under cooked poultry is consumed?
|
salmonella ( also on pet turtles)
|
|
|
IBS is dx by:
|
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 |
|
|
54y/o states blood on tissue after BM: what should be done first?
|
examine rectum, next send to GI
|
|
|
C/o bloody nocturnal diarrhea w/ fever and cramping: what should you think of dx?
|
ulcerative colitis (classic sx) inflammatory disease
|
|
|
What age should you start asking about risk of colorectal cancer?
|
30-40 if high risk then screen q 5 yrs
|
|
|
Diverliculosis means you have some diverticula when they become inflamed you have diverticulitis: where is the pain?
|
left lower quadrent
|
|
|
What is the diagnostic test for diverticulitis?
|
CT w/ contrast IV or oral
|
|
|
Pt has inspiratory pain on palpation of RUQ: what is it and what is the dx?
|
Murphys sign, cholycystitis
|
|
|
In classic appendicitis the point of maximum tenderness is called?
|
McBurneys point
|
|
|
What exam should be performed in 26y/o female w/ RLQ pain?
|
rectal and pelvic exam
|
|
|
Liver function test include:
|
ALT, AST, (just looking at the liver).
PT, albumin (how well liver is making things). |
|
|
What does ALT and AST mean if elevated?
|
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 |
|
|
Pt feels bad he has fever and malaise: AST is higher what is the likely cause
|
acetominophen, statins or tequila (alcohol abuse)
|
|
|
Pt lab values of ALT 290, AST 100 what is the probable dx?
|
viral hepatitis
|
|
|
75y/o w/ multiple myoloma (long bone pain elevated Ca) could exhibit what?
|
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)
|
|
|
5 causes of viral hepatitis are what?
|
Hepatitis A&E transmitted from food, water
Hepatitis BCD transmitted from blood (can be chronic) |
|
|
Mechanism of transmission of A is?
|
fecal oral
|
|
|
Hepatitis marker: immunogobulin: IGM (minute you get infected you make it) IGg (after infection gone) (antibodies)
|
learn this
|
|
|
What does it mean if Igg is positive?
|
it means they r immune
|
|
|
What does it mean if IgM is positive?
|
they have an infection (what ever your messuring ) right now
|
|
|
What does it mean if IgM and IgG are both negative?
|
no immunity no illness: if vaccine give it.
|
|
|
Hepatitis B sx typically?
|
asymptomatic: hepatocellular carcinoma (80% w/ hepatitis B)
|
|
|
Who/what must develop protocols governing APN practice: Texas?
|
Delegating physician and APN using 5 factors
1. texas law 2. experience 3. consulation availability 4. input of delegating physician 5. federal regulation |
|
|
Who must sign protocols?
How often are they reviewed |
delegating physician and APN
reviewed and signed annually |
|
|
Which of the below is a CHD risk equivalent:
a. HTN b. Cigarette smoke c. Male>45 d. DM |
DM: also symptomatic CAD, PD, AAA >risk of CHD
|
|
|
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 |
a: fast 12-14hrs:
maximum effect of eating on tryclycertide leve at 3-4 hrs but peak during 12hr |
|
|
Class of Med will normalize lipid elevation?
a. niacin b. fibric acid c. statin d. bile acid sequestrants |
c: Statin:
|
|
|
Which test listed below may exclude secondary cause of hyperlipidemia?
a. cbc b. urine C&S c. TSH d. fasting glucose |
C: TSH:
and diabetes, renal failure, hypothyroidism |
|
|
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 |
D: in conjunction w/ diet and exercise:
(only once daily) |
|
|
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 |
c. order CPK: c/o myalgias consider rhabdomyolysis if elevated THEN stop lovastatin immediately
|
|
|
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 |
d: african American male:
|
|
|
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 |
b: HA:
|
|
|
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 |
b. wet and worse: usually worse at night too
|
|
|
SOB w/ CHF. What test would help determine this?
a. Echo b. BNP c. EKG d. BUN |
b: BNP: >80% pg/l = 98% chance of CHF
|
|
|
Class of med used to tx systolic dysfunction post-MI:
a. loop diuretic b. beta blocker c. ACE-I d. thiazide diuretic |
c. ACE-I: prevent LV hypertrophy, dilation and dysfunction = prevent HF
|
|
|
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 |
d; potassium level:
ACE-I work on kidney and may impair renal excretion of K: monitor BUN, Cr one wk after starting |
|
|
What med could exacerbate CHF?
a. metoprolol b. furosemide c. metformin d. acetaminophen |
a. metoprolol: cardioselective BB slow HR, inhibit pt w/ CHF to have increase HR to compensate decrease CO.
|
|
|
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 |
b: development CHF:
|
|
|
Medication which produce exercise intolerance w/ HTN is:
a. HCTZ b. amlodipine c. metoprolol d. fasinopril |
c. metoprolol: decrease HR = exercise intolerance HR cant increase for CO
|
|
|
Pt w/ HTN has allergy to sulfa. Which med is contraindicated in pt?
a. ramipril b. metoprolol c. HCTZ d. verapamil |
c: HCTZ: sulfa med also avoid loop diuretics
|
|
|
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 |
c: BB in 46y/o migraines: Beta Blocker can be used on migraines
|
|
|
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 |
c. 5th ICS, left MCL: left vent hypertrophy may displace apical impulse
|
|
|
Pt newly dx w/ HTN taking rampiril. What test would be important to monitor?
a. INR b. Ca c. K level d. ALT/AST |
c: potassium level
|
|
|
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 |
c. add drug from another class to current med
: still need to decrease BP: combo effects decrease BP |
|
|
enlarged atrium or ventricle is important w/ audible murmur. Which study helps eval hypertrophy?
a. chest xray b. ECG c. Echo d. doppler US |
c: ECHO
|
|
|
Valve most commonly involved in chronic rhematic heart disease?
a. aortic b. mitral c. pulonic d. tricuspid |
b: mitral most common, aortic 2nd most common, pulmonic 3rd most common
|
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|
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 |
d. mitral stenosis:
audible click typical in MVP |
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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 |
a. fixed split is ALWays abnormal
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25y/o w/ aortic stenosis. Etiology of AS is probably?
a. congenital b. rheumatic c. acquired calcific d. unknonw |
a. congentialt: most likely w/ age
b. rheumatic: 2nd most common c. acquired: >65y/o normal |
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Most common arrhythmia resulting in valvular heart disease?
a. a fib b. SVT c. VF d. heart block |
A: A-fib:
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Pt dx w/ tina pedis. Microscopic exam would reveal?
a. hyhae b. yeast c. spores d. comboof hyphae and spores |
a. hyphae: also in corpus and cruris
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Test used to dx shingles if clinical is questionable?
a. Tzanck prep b. viral load c. rapid herpetic d. CBc |
a: txanck prep: taken from blister: most blistering eruptions are herpatic until proven otherwise
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Most common skin cancer?
a. squamous cell carcinoma b. basal cell carcinoma c. malignant melanoma d. cutaneous carcinoma |
b. basal cell carcinoma:
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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 |
c. no: exposure is from contact of plant
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Topical hydrocortisone cream most appropriate in pt dx w/
a. psoriasis b. impetigo c. atopic dermatitis d. eczema |
d. eczema:
a. topical not strong enough to penetrate psoriasis b. contraindicated in impetigo c. emollient best for atopic |
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Skin lesion fluoresces under Woods lamp. What microscopic findings is consistent w/ this?
a. clue cells b. herpes simplex c. spores d. leukocytes |
c: spores = fungal infection
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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 |
c. isotretinonin (accutane)
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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 |
b. asthma and allergic rhinitis: atopic dermatitis = atopic triad
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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 |
c: lamisil is potent inhibitor of CYP: caution w/ liver if >2.5 above normal stop
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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 |
c. ELISA
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Herald patch is hallmark finding of what derm dx?
a. erythema infectiosum b. pityriasis rosea c. seborrheic keratosis d. atopic derm |
b: pityriasis rosea
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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 |
a. plaque psoriasis
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Cancer society: pneuomic ABCDE: B stands for?
a. bleed b. black c. border d. benign |
c. border
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Skin lesion which is sold mass described as:
a. macule b. papule c. vesicle d. bullae |
b: papule: 1.0cm
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Pt burned w/ hot water. Has several large fluid filled lesions. What r they called?
a. vesicles b. bullae c. erosions d. dermal abrasions |
b. Bullae
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Lesion w/ folliculitis might be filled w/?
a. blood b. pus c. fluid d. serum |
b. pus
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Impetigo is characterized by:
a. honey-colored crust b. silvery scales c. marlbe lesions d. wheals |
a. honey colored crust
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Chancroid is a
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(soft chanker) STI: from bacteria H. Ducreyi
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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 |
d. note sclera: to see jaundice easily
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Treatement of Chancroid is:
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Azithromycin (macrolide)
ciprofloxacin (2nd gen fluorquinolone) ceftriaxone (cephalosporin) |
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Which following lesions never blanches when pressure applied?
a. spider angioma b. spider vein c. pupura d. cherry angioma |
c. purpura; and petichia never blanch due to extravation of blood under skin
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What other disease do you expect to find when testing for chancroid (STD)
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herpes simplex
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60y/o w/ clubbing of fingers. What might this indicate?
a. CAD b. Cirrhosis c. lead tox d. IDA: iron deficent anemia |
a. CAD: associated w. hypoxia
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What does Chancroid look like?
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vesicular pustular lesion painful, soft ulcer w/ necrotic base at point of inoculation.
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Pt w/ spoon shaped nails. What lab test should u obtain?
a. LFT b. CBC c. Hep B antigen d. ABG |
B: CBC for IDA
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What is the causative organism in lymphogranuloma venereum
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C. trachomatis 1&3
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Which med will not increase photosensitivity?
a. amoxicillin b. sulfa drugs c. fluoroquinolones d. doxycycline |
a. amoxicillin: all other will
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What are the physical findings w/ lymphogranuloma venereum
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lesions fuse and create multiple draining sinuses mainly in the groin
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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 |
c. tolerance
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What is the tx for lymphogranuloma venereum
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tetracycline
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Chancroid: causative organism
presentation |
H. ducreyi
painful genital ulcer, mult lesion, inguinal lymphadenitis |
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Pt w/ seborrheic dermatitis. What vehicle most appropriate in hairline?
a. ointment b. cream c. lotion d. powder |
c. lotion: due to cooling, drying effect
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Chancroid Tx
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Azith 1g oral or
Ceftriaxone 250 IM or Cirpo 500 BID x 3d |
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What derm area has greatest percutaneous absorption?
a. sole of foot b. scalp c. forehead d. genitalia |
d: genitalia
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Which of the following is inconsistent w/ otitis externa?
a. tragal pain b. otic discharge c. otic itching d. fever |
d. fever (swimmers ear): pseudomonas; local infection
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Sx triad common w/ infectious mono?
a. fever, pharyngitis, lymphad b. fatigue, pharygitis, fever c. splenomegaly, fever, body aches d. tonsillar exudates, lymphad, HA |
a. fever, pharyngitis, lymphad (Centor criteria)
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Med to avoid w/ mononucleosis:
a. azithromycin b. ampicillin c. acetaminophen d. topical lidocaine |
b: ampicillin: beta lactam (PCN) causes rash
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Most common complication of influenza?
a. cough b. bacterial pnumonia c. viral pneumonia d. bronchitis |
b. bacterial pneumonia: streptococcus pneumonia
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Older adult w/ cerumen: what type of hearing loss?
a. sensorineural b. conductive c. presbycusis d. cholesteratoma |
b. conductive:
Sensorioneural = inner ear or 8th cranial, presbycusis = loss w/ aging >60y/o |
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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 |
a. inability to hear consonants
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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 |
b. OME can precede or follow OM
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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 |
c. fluid and bulging of TM
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Pt TM is chalky white mark w/ no complaints is probably?
a. normal TM b. scarring of TM c. chronic inflammation d. pus |
b. scarring
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Which finding is an emergency?
a. fiery red epiglottis b. sudden hoarseness c. purulent drainage from ear d. tragal tenderness |
a. fiery red epiglottis
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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 |
C. pharyngitis
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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 |
c. HA
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Pt dx w/ allergic rhinitis. Which sx is NOT associated w/ allergic rhinitis?
a. paroxysmal sneez b. rhinorrhea c. nasal congestion d. facial pain |
d. facial pain: indicates infection
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Which is most typical w/ allergic rhinitis?
a. normal nasal turbinates b. cough c. post nasal drip d. sx associated w/ expsure to cates |
d. sx exposure to cats: dx base on exposure.
a. typically pale boggy b. common but not all c. not all |
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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 |
c. chronic non-allergic: tx w/ topical azelastine
a: tree, grass mold b. dust mite, animal dander |
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Epistaxis most common occure:
a. in women b. at kiesselbach plexus c. posterior septum d. pt on anticoagulant |
b. kiesselback plexus: 3 artery
a: more in men c. 80% anterior d. common but not most |
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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 |
c. biopsy: leukoplakia precancerous
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Pt dx w/ acute rhinosinusitis: etiology?
a. strept b. staph c. viral d. mycoplasma |
c. viral: only 2% r bacterial
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Sx of bacterial sinusitis vs viral?
a. discolored nasal discharge b. worsenign sx after improve c. facial pressure d. nasal conge |
b. worse after improvement:
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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 |
c. refer to ENT: need MRI: diff dx: acoustic neuromea
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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 |
a. bright red blood
d: hearing muffled |
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Pt w/ sensation of something in throat. normal exam. What dx?
a. factition sore throat b. pseudo pharyngitis c. globus d. Gerd |
c. globus: most common cause is GERD
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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 |
d. PNC w/ beta lactam
c. macrolide has poor resistance to strept |
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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 |
b: hives: puritic, circumscribed, raised red w/ central wheel
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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 |
c. kind of rxn: 2% w/ PNC rxn have cephlo rxn
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Pt hospitalized w/ CHF. Now c/o hearing loss. Which med caused it?
a. digoxin b. furosemide c. ramipril d. metoprolol |
b. furosemide: also aminoglycosides, vanco, e-mycin, loop diurectics, antimalaria..
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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 |
d: giardia infection: causes dirrhea
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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 |
b. refer to er for CT scan
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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 |
a. hernia strangulated: emergency surg in 4-6hrs.
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Pt w/ supsected hernia examined:
a. lying down b. standing c. side-lying d. while squatting |
b. standing
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Pt dx w/ Hep A. Most common risk factor:
a. drinking contaminate water b. eating contaminated food c. traveling internationally d. IV drugs |
C: traveling international (most)
a & b: most unable to confirm D: hep C |
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Most pt w/ acute Hep A are:
a. males b. acute ill c. varied clinical presentation d. develop subsequent cirrhosis |
c. varied clinical
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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 |
B: has immunity (IgG is antibody
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Pt dx w/ Hep B. Most common risk factor?
a. drink water b. eat food c. travel international d. sexual exposure |
d. sexual exposure
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Most pt w/ actue hep B:
a. females b. acute ill c. varied clincial presentations d. develop subsequent cirrhosis |
c. varied presentation
a: = to males b: fever, nausea, flu-like |
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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 |
c. immune to hep B
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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 |
c. receive immun for A&B
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83y/o dx w/ diverticulitis. Most common complaint:
a. rectal beed b. bloating and crampiness c. LLQ pain d. frequent belching and flatulence |
c. LLQ pain
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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 |
D: asymptomatic
A: is GERD |
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Which drug/class most liley to produce rapid relief of heartburn?
a. antacid b. H2 blocker c. PPI d. sucralfate |
a: antacid 20-30min
b and c: hrs to work d: adheres to mucosal wall |
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Most important risk factor in duodenal ulcer disease:
a. cigarette smoking b. spicy food c. coffee consumption d. inffection w/ H. pylori |
d. infection w/ H. pylori: peptic ulcer disease gastric adenocarcinoma and lymphoma
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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 |
d. pain occurs w/ fasting:
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Which would be unusual in pt w/ uncomplicated gallbladder disease?
a. fever b. guarding c. Postive murphys d. nausea |
a. fever: not typical
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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 |
c. now w/ colonoscopy: 45 then every 1-2 yrs
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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 |
b. slow progression
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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 |
c. inadequate for cancer: need 3
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Hemorrhoids is unusual if?
a. bleed or itch b. 45-65 y/o c. 20-30y/o d. more common in pregnant |
c. 20=30y/o not very common
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Later or tertiary: presentation, slide 3 tx
|
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 |
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70y/o bright red blood on toilet this am after BM. Most likely?
a. hemorrhoids b. diverticulosis c. colon cancer d. colon polyp |
a. hemorrhoids
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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 |
a: Remember: elevated
AST = actaminophen, statin, toxic, ALT = liver --> Hepatitis |
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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 |
b. hepatitis panel
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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 |
d. pancreatitis: days of pain = enzyme increase 6-12hr after injury
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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 |
a. gallstones and alcoholism
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Joints most commonly involved in OA:
a. fingers b. wrist c. hips d. knees |
a. fingers
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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 |
d. cartilage is breaking down: risk: advance age, obes, jioint injuries
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Which test if po is part of criteia for SLE?
a. ANA b. Rheumatoid factor c. RPR d. ESR |
ANA: also: butterfly face rash, disoid rash, sun-related rash, painless oral ulcerations, joint pain two or more, heart or lung inflammation
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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 |
b: medially along joint line: classic arthritis pain. tears in medial collateral and meniscal.
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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 |
a. morning stiffness >1hr, rhematoid nodules, bone erosion on xray, pos sed rate
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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 |
a. risk of falls
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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 |
a. exercise
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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 |
b. acetaminophen up to 1000mg 4xd
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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 |
b. grade 1 sprain
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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 |
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
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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 |
a: early function rehabe day fo injury speeds time of recovery and resumption fo activities. : range of motion initially
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Initial managment of sprain:
a. xray b. rest, ice, compression ,elevation c. anti-inflammatory med d. activity as toleration |
b. RICE
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Anterior drawer test assess:
al injury to lateral menisucs b. stability of ACL c. instability of PCL D. stability fo knee |
b. stability of ACL (anterior cruciate ligament): pain not immediate
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36y/o w/ asthma and HTN what med should you avoid when tx his HTN
|
beta blocker (propanolol)
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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 |
c. cross training
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75y/o w/ OA and pain. Which increases GI related ulceration?
a. celecoxib b. warfarin c. Thiazide diuretic d. pravastatin |
a. celecoxib
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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 |
c. stress fx due to over use
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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 |
a. xray
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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 |
b. 4 wks: unlss hx of cancer, >50y/o neuro deficits, pain inconsistent w/ hx
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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 |
d. fever: signals infection
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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 |
d. herpes zoster
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75y/o knits w/ positive finkelstein test. Dx?
a. gamekeepers thumb b. De Quervains tenosynovitis c. OA of thumg d. trigger thumb |
b. De Quervain tenosynovitis: inflammatoin of extensor and flexor tendon. radiate up forearm
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Extrinsic shoulder pain is LEAST likely produced by:
a. CV system b. abdomen c. infectious organism d. urologic system |
d: urologic system
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Drop arm test used to assess patient w/ suspsected:
a. cervical injury b. torn rotator cuff c. impingement syndrome d. malingering |
b. torn rotator
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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 |
c. It is not identifiable on MRI or xray
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NP are certified by:
a. state b. ANA c. state boards d. ANCC or AANP |
d: ANCC or AANP:
state boards license NP |
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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 |
c.: scope of practice is established legally, ethically, and by boards of nursing and professional organizations.
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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 |
a. regulate and control NP practice: provide accountability for professionals and help protect the public
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Licensure:
a. another term for certification b. contingent on certification c. used to establish minimal competence d. necessary for reimbursement |
c. used to estab minimal comp
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Certification:
a. required by all 50 states b. validates competence c. recognized by all 50 states d. required for reimbursement |
b. validate competence: in an area of specialty
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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 |
A: intrapreneur: carved out specialty w/in existing organization. Entrepreneur assumes financial and personal risk of owning
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NP who owns their own clinic?
a. entrepreneur b. intrapreneur c. independent NP d. networker |
a. entrepreneur:
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Legal authority to practice as an NP is determined by:
a. state boards of nursing b. state legislature c. fed guidelines d. certification boards |
b: state legist
state boards --> scope of practice Certification board --> met mim requirements |
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Name given to subjects in research study who do not have disease or condition?
a. placebos b. controls c. case series d. cross secional |
b. controls: commonly employed
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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 |
b. cohort: observational study that is prospective in nature. Cohort ask "what will happen".
Case control: looks back (retrospective) |
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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 |
c. non obligation
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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 |
b. prescribe med
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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 |
c. report to authorities
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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 |
a. negligence: one fails to exercise care that reasonable person would.
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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 |
b. to state board
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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 |
a. claims made policy
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What is the most common place for indirect hernia?
a. Hesselbach triangle b. internal inguinal ring c. outer inguinal ring d. abdominal ring |
b. Internal inguinal ring
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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 |
b. all at a normal rate/interval
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What immunization may be given during the first trimester?
a. vaicella and MMR b. Td only c. Pneumococcus d. Hep A&B |
B. Td only: live virus should never be given, pneumococcus given in 2nd or 3rd trimester
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40y/o w/ lab values of: HBsAg(-), HBsAb (+), HBcAb (-). Interpret them?
a. had hepatitis b. has hepatitis c. should immunize d. has been immunized |
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 |
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What is typical sx of GERD?
a. chest pain b. SOB c. pyrosis d. hoarseness |
c. pyrosis (heartburn)
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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 |
a. multiple myeloma: neoplastic proliferation in bone marrow
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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 |
d. encephalopathy is always a contraindication.
Fever of 105 w/in 48hr would be too |
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An elderly adult w/ appendicitis is unlikely to exhibit:
a. generalized abdominal pain b. Initial WBC elevation c. UTI sx d. low grade fever |
b. initial WBC elevation: kids and elderly do not get an initial rise in WBC
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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 |
b. should be given on same day: increases their titers when given together. if not together the seperate by 30 days
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Pt w/ diarrhea has WBC in stool sample:
a. a misdiagnosis b. a malignancy c. food indiscretion d. bacterial infection |
d. bacterial infection: Crohns disease or ulcerative colitis also
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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 |
b: HTN and hyperlipidemia increase risk of CHF --> Afib, S3 and SOB r consequences not risk
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Pt w/ tinea pedis. What is the microscopic finding?
a. hyphae b. yeast c. spores d. combination of hyphae, spores |
a. hyphae: long, thin= dermatophyic infections
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What medication will exacerbate GERD?
a. verapamil b. metformin c. ferrous sulfate d. ceftriaxone |
a. verapamil: CCB: Calcium needed for muscle contraction: lower esophageal sphicter
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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 |
b. indicative of longstanding HTN: when arteries cross veins in eye: Cotton wool exudate = diabetes
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Who is most common risk factor for developing Hep B:
a. homo b. drug injection c. hetero d. body piercing |
c. hetero: any are applicable: but hertero has highest likelihood of disease transmission, most common
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Benazepril (ACE-I) should be discontinued immediately:
a. dry cough develops b. pregnancy occurs c. K levels decrease d. gout develop |
b. pregnancy occur: ACE-I: teratogenic effects to renal system
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Following medications does not warrant monitoring K?
a. fosinopril b. candesartan c. HCTZ d. amlodipine |
d: Amoldipine CCB no need to monitor K:
ACE and ARB cause hyper K HCTZ: cause Hypo K |
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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 |
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.
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Topical 5-fluorouracil (5-FU) used to tx:
a. atopic dermatitis b. hepatitis c. thalassemia d. basal cell carcinoma |
d. basal cell carcinoma: only on superficial 5% BID x 3-6wks
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Pt w/ peptic ulcer disease: sx occure few hours after eating:
a. gastric ulcer b. duodenal ulcer c. gastric or duodenal d. H. pylori |
b. duodenal: 2-5hr after eating. Relief by eating/antacid. contrast w/ gastric w/ sx minutes of eating: less relief from antacids
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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 |
b. tetanus and diphtheria: Dtap is for adolescents not elderly.
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Pt taking metronidazole for C. Difficile: What should be avoided?
a. excess fluids b. Vit B12 c. grapefruit d. alcohol |
d. alcohol: produced disulfiram rxn w/ metronidazole wait 72hrs after last dose
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P tw/ diarrhea tested for C. diff. How soon should enzyme yeild results (EIA)?
a. 20min b. 24hrs c. 3d d. <1wk |
b. 24hrs detect C. Diff toxin no organism.
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Difference between cellulitis and erysipelas:
a. organism b. length of time that infection lasts. c. tx d. area involved |
d. location: erysipelas upper dermis superficial lymphatic: cellulitis: deep dermis
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Lower leg wound appears infected. Red, warm edematous. Acute onset of pain, sx low grade fever. What is it?
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b. Erysipelas: not always upper. Erysipelas has acute onset, cellulitis is slow onset
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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 |
c. generalized atherosclerosis: symptomatic bruit need immediate attention.
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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 |
a. refer to ophthomolgy for red eye: photophobic sensation fo foreign body.
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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 |
a. allopurinol: not for acute gout: only reduces uric acid but cont during attack
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High purine diet exacerbate gout: Which foods are high purine?
a. coffee b. eggs. c. beef d. bread |
c. meat/fish: coffee lower risk, Tea increase gout
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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 |
d. systemic illness, like cancer or infection: key is no relief when lying down. old, female >4wks pain.
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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 |
a. bill remainder:
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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. |
c. only hospital visits are covered: also covers skilled nursing facilities
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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 |
A: HTN, DM w/ proteinuria, HF: worsen renal insufficiency
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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 |
c. therapeutic relationship w/ pt can be established in many different ways. Ask open ended questions.
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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 |
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 |
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Pt w/ primary case scabies was probably infected:
a. 1-3d ago b. 1 wk ago c. 2wks ago d. 3-4 wks ago |
d: incubation period for scabies is about 3-4 wks after primary infeciton. worse at night
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AV nicking is ID in pat w/ what disease?
a. glaucoma b. cataracts c. diabetes d. HTN |
D: Hypertension: retinal microvascular changes: early changes, flame hemorrhages or cotton wool indicate severe damage
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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 |
c. ulcerative colitis: erythema nodosum: in pretibial locations due to infectious agents, drugs systemic inflammatory disease
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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 |
c. eye drained partly by pre-auricular lymph nodes
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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 |
a. thiazide diuretics incrase serum Ca by decreasing fluid.
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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 |
a. mother has STD: chlamydia sx will appear 1-2wks post delivery. Gonorrhea sx in 2-4days
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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 |
a. 60y/o w/ RA: only screen males w/ risk factors, women start at 65y/o
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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 |
c. glaucoma: urgent referral to ophthalmology:acute angle glaucoma: also may have n/v
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What can be a complication of Lyme disease:
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bells palsy (need to obtain a titer to verify)
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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 |
c. just had acute OM; OME precedes or follows AOM. dont tx w/ antibiotic but f/u for later OM
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40y/o w/ lab values of:
HBsAg (-), HBsAb (+), HBcAb (+) a. had hepatitis b. never had hepatitis c. consider immunization d. Pt has been immunized? |
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 |
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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 |
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
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Which med have unfavorable effect on HTN BP?
a. lovastatin b. ibuprofen c. fluticasone d. amoxicillin |
b. ibuprofen: Na retention: increase BP, lower extremity edema, increase workload of heart, inhibition of prostaglandin
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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 |
a. once: single whole body from neck down for 8-12hrs
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Proper technique for removing a tick?
a. tweezers b. petroleum jelly c. alcohol d. hot match |
a. tweezers
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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 |
c. mitral valve prolapse: and subsequent degeneration of mitral tissue.
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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. |
d. do not need protective 3y ago: protective titer is 1:10 or greater.
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What has the most rapid analgesic onset?
naproxen, liquid ibuprofen, diclofenac, celecoxib (all nsaids) |
liquid ibuprofen
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Common, early findings in pt w/ chronic aortic regur (AR) is:
a. LVH b. A-fib c. pulmonary congestion d. low systolic BP |
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
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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 |
c. US of hip:
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Most common place for basal cell carcinoma:
a. scalp b. face c. anterior shin d. upper posterior back |
b: face
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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 |
oral antiviral: w/in 72hrs of sx onset. steroids limited benifit vs risk
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Pt w/ mono: which lab is usually abnormal?
a. lymphcytosis and atypical lymphocytes b. elevated monocytes c. decrease WBC d. elevated liver enzymes |
a: lymphocytosis and atypcial lymphocytes: monocytes elevation also occur though not as often as are LFT, WBC
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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 |
d. single joint: typically great toe: not always have elevated uric: especially w/ acute attack
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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 |
c: CBC, metabolic panel, TSH, UA:
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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 |
a. allergic to eggs
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Lipid particle w/ greatest atherogenic effect?
a. TC b. HDL c. LDL d. Trig |
c: LDL: low HDL and high trig accelerate atherogenesis
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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 |
c: diabetic w/ HTN:
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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 |
B: s/e are renal impairmetn, ARF, gastritis
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Most common cause fo diarrhea in adults:
a. E. coli b. salmonella c. difficle d. viral GE |
D: viral gastroenteritis:
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Most common cause fo diarrhea in adults:
a. E. coli b. salmonella c. difficle d. viral GE |
D: viral gastroenteritis:
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3 most common causes fo bacterial diarrha in US are salmonella, campylobacter and:
a. e. coli b. enterovirus c. yersinia d. shigella |
d. shigella:
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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 |
d. cont his fexofenading: adding decongestant promotes drainage, speed resolution of sinus. nasal can be added but only if poor control of allergies
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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) |
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.
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Study listed below is considered experimental study?
a. case series b. cross-sectional study c. cohort study d. meta-analysis |
d. meta-analysis: observation studies are studies where subj r observed. no intervention takes place.
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80 y/o w/ BP of 176/80. tx?
a. thiazide diuretic b. ACE-I c. CCB d. ARB |
Pt w/ isolated systolic hypertension (ISH). increase cardiac and cerebral events. Tx w/ long acting CCB (amlodipine, felodipine)
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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 |
c. cellulitis:
Buergers = inflammation of med size arteries and no shin pain DVT: rare anterior pain |
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Swimmers ear is dx in pt w/ tragal tenderness. what other sx present?
a. OM b. Hearing loss c. otic itching d. fever |
c. otic itching: tx w/ topical agent and keep dry
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Pt w/ heavy menses. What lab value reflects IDA?
a. elevated TIBC b. decreased TIBC c. norm serum iron d. decrased RDW |
a. elevated TIBC: reduced RBC count and decreased H&H. RDW would increase.
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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 |
b: pt ill appearing and febrile: pt w/ acute cholecystitis usually complains of abd pain in URQ:
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Describe Kernig sx
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pt lying supine - hip flexed 90 degree; knee extension = resistance or pain to lower back or posterior thigh
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Pt w/ leukocytosis:
a. has bacterial infeciton b. has viral infection c. infection unknown origin d. does not have infection |
c: infection unknown origin:
Leukocytosis has predominance of WBC in blood. May elevate to viral or bacterial. |
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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 |
3 most common associated sx of GERD are heartburn, post prandial, regurgitation and dysphagia
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Niacin is known to:
a. increase fasting glucose b. produce HTN c. decrease trig d. decrease HDL |
a: decrease glucose tolerance: use w/ caution in pt w/ Impaired fasting glucose. Used to increase HDL
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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 |
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.
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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 |
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.
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Pt w. hyperlipidemia:
a. a statin daily b. TSH levels c. second measurement to confirm dx stress test |
b: TSH: elevated TSH may causes eleveated lipids: dont tx lipids until TSH confirmed and decreased to at least 10; then tx lipids
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What does absence of venous pulsation during eye exam indicated?
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increased ICP
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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 |
a. increase testicular size
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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 |
a. when great toe is dorsiflexed: plantar fascia is easy to palpate due to tightening.
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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 |
b. heel support: consider flat foot, tx w/ well support heel counter. NSAIDs wont correct underlying, orthotics may increase pain.
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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 |
c. shortness of breath and syncope:
3 most common sx of AS is angina, syncope, and CHF (dyspnea) |
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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 |
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 |
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Head circumference shed until a should be measured until what age:
a. 12m b. 18m c. 24m d. 36m |
d. 36m: above the ears
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Niacin can:
a. decrease TC and TRig b. decrease Glucose and LDL c. cause flushing and HTN d. increase liver enzymes |
d: increase liver enzymes:
it increases glucose does not cause HTN, hypotension is common |
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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 |
c: 30y/o female w/ no cardiac hx: most common in women 14-30: common sx: arrhythmias, and chest pain. most are asymptomatic
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New born w/ hyperbilirubinemia: When would bilirubin be expected to peak?
a. 1-2d b. 3-4d c. 5-7d d. 7-10d |
b: 3-4d: premi: 5-7d
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Grp A strept pharyngitis:
a. single sx b. also has abdominal pain c. no exudative sx d. has inflammed uvula |
b. can be accompained by abd pain:abrupt onset: sore throat, fever, GI: n/v: w/o tx resolves in 3-5d
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45y/o w/ following:
HBsAg (+), HBsAb (-), HBcAb (-) a. has hepatitis b. had hepatitis c. consider immunization d. results indeterminate |
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) |
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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 |
c. height %, gender age:
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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 |
c. daily grapefruit: inhibits cytochrom P450. Statins and CCB react w/ grapefruit
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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 |
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 |
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Pt w/ hep B probably has a predominace of :
a. leukocytes b. lymphocytes c. neutrophils d. eosinophils |
b. lymphocytes: increase w/ viral infections but total WBC will be decreased.
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Pt w/ monoucleosis most likely:
a. lymphcytosis b. eosinophilia c. leukocytosis d. monocytosis |
a. lymphocytosis: viral
eosinophil = parasitic or allergic leukocytosis no specific for mono monocytes rise but not specific for mono |
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Atopic dermatitis exacerbation are tx w/:
a. emollients b. topicla steroids c. antihistamines d. antibiotics |
b. topical steroids: eczema: keep well lubricated w/ emollients but for exacerbation --> topical steroids (lowest potency)
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Pt presents w/ severe toothache. Sensitivity to hot and cold w/ visible pus around painful areas:
a. pulpitis b. caries c. gingivitis d. perodontitis |
a. Pulpitis:
Caries and gingivitis have no pus. |
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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 |
b. non-weight bearing till fx r/o
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What are risk factors for TIA
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Afib, CAD, oral contraceptive
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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 |
C: report it: names or ID are not part of reporting.
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15y/o female never menstruated. What is most important for NP to assess?
a. stature b. tanner stage c. anemia d. FH of amenrrhea |
b. tanner stage: breast and pubic hair signify pubertal changes of maturation.
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Primary therapeutic intervention for hives:
a. steroids b. anti-histamines c. CCB d. topical steroid cream |
antihistamine
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Pt dx w/ mild chronic CHF. Which drug manages sx and improve outcome?
a. verapamil b. digoxin c. furosemide d. monopril |
d. monpril: ACE-I: reduce mortality and morbidity in CHF:
CCB are contraindicated Lasix and dig improve sx but not long term outcomes |
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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 |
b. lateral ankle sprain:
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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 |
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.
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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 |
a. clinical inertia: providers who fail to intensify therapy despite pat not reaching goal
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NP fundoscopic exam. ID small dull yellowish-whit coloration in retina?
a. cotton wool spots b. microaneurysm c. hemorrhages d. exudates |
a. cotton wool spots: impaired blood flow to retina, diabetes and HTN.
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How soon can you determine anti-proteinuric effect of ACE-I
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6-8wks
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What is the next lab if a pos albumin screen?
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spot albumin w/ creatinine ratio
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what is the definition of renal neropathy?
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>300mg/d of albuminauria on 2 occasion seperated by 3-6m
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What are the target lipids for DM according to ADA
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HDL >50
LDL <100 Trig <150 |
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Inguinal hernia is hernation of what
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bowel or omentum into scrotum
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How does an inguinal hernia present?
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scrotal pain and a scrotal mass or scrotal swell (abd pain) bowel sounds in scrotum (w/ a stethascope??)
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What is Hesselbach triangle?
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inguinal ligament, rectus muscle and epigastric vessel: Inguinal hernia
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Why is ASA used as an antiplatelet therapy?
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ASA inhibits enzyme cyclooxygenase adn reduces thromboxane A2 production
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Define Secondary prevention?
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intervention to help prevent second occurrence of deleterious event. ex: ASA after a stroke
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How long after a rubella should a pt avoid pregnancy
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1 month (though no documented injury of offspring) safe when breastfeeding
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What immunizations can be given in 1st trimester?
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influenza, tetanus, diptheria
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When should varicella be given in pregnancy?
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Never, no live viruses should be given during pregnancy
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What is the primary reservoir for HIV?
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lymphatic tissue
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If someone has persistent generalized lymphadenopathy what should be tested?
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HIV
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A pt w/ a long hx of HTN dx w/ chronic renal insufficiency: What would dx test reveal?
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clear urine & elevated creatinine: clear because kidney cant filter content.
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What organ is responsible for erythropoietin production:
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kidney
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What is murphys sign
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inspiratory arrest w/ deep palpation of upper right quadrant (cholecystitis)
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What is the wording used when an APRN directs another nurse to a specific task? Delegating or assigning
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APRN are only allowed to delegate assitive personnel they may assign another nurse
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What is the process of receivign prescriptive authority for controlled substance?
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TBON authority, TDPS registration, DEA registration number.
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What level of controlled substance may an APRN provide?
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schedule III, IV, V
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What is the maximum period that a controlled substance may be prescribed for by an APRN?
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30 days
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Can an APRN refill a prescription?
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Yes but only after consultation and documentation w/ a delegating physician. (TBON)
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What is the minimum age a controlled substance may be prescribed by an APRN?
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2y/o if younger then consultation is required w/ documentation
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What do expect to find when giving a fibrate?
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increase HDL
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What do you expect to find when giving niacin for lipids?
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increase HDL
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What do you expect to find when giving Zetia for lipids?
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reduction in LDL
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With Zetia (ezetimibe) what should routinely be monitored?
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No need to monitor labs...little impact on liver or kidney
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Which of the following man not causes statin-induced myositis?
advanced age, use of statin w/ resin, low body weight, high statin dose |
Us of statin w/ resin is not a risk for myositis
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Which of the following is most effective against lipidprotein?
1. HMG-CoA reductase inhibitors 2. Niacin 3. bile acid 4. fibrates |
2. Niacin
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What can untx hypothyroid lead to in lipid profile?
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increased LDL, TC, and Trig
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What should rigorous physical exercise do to lipid values?
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increase HDL, Lower VLDL, Lower Triglycerides
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What should you expect to see when giving fish oil?
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decrease triglycerides
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What should you expect to see when giving Plant stanol and sterold on lipid profile?
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decrease LDL
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What happens to RBC in alcoholics and why?
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become macrocytic due to reduction in folate
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