Nurse 623 Exam 2023-24 with a correct answers

Nurse 623 Exam 2023-24 What are the Stages of Lyme Disease? - correct answer Early localized Early disseminated Late Lyme Early Localized Lyme Disease - correct answer -occurs days to months after exposure -Symptoms nonspecific: malaise, fever, cervical stiffness, myalgias, arthralgias -Can have a " bulls eye rash aka "erythema migrans"which is > 5cm Early diseminated Lyme Disease - correct answer -occurs days to 10 months after infection -Systemic manifestations ie: meningitis, cranial nerve palsies (esp. VII) and radiculoneuritis Swelling of joints, numbness in extremities, palpatations adn difficulty concentrating. -NO RASH Late Lyme Disease - correct answer -occurs months to years after exposure -May have intermittent arthritis -May also experience neurological manifestations ie: encephalopathy, peripheral neuropathy or neurocognitive impairment. S/S of HIV - correct answer -Majority of acute HIV asymptomatics -Flu like symptoms the firststages 6 days to 6 weeks -Fever, sore throat myalgias, headache, cervival lymphadenopathy and nightsweats Risk Factors for HIV - correct answer Sexual history, sexually transmitted disease, substance abuse, transfusion history, infection history and occupation history Hypersensitivity Reactions - correct answer Type 1 Hypersensitivity RX - correct answer Type II Hypersensitivity Rx - correct answer Type III Hypersensitivity RX - correct answer Type IV Hypersensitivity Rx - correct answer MCV - correct answer the size of the RBC MCH - correct answer Volume of RBC MCHC - correct answer the concentration % Normocytic anemia - correct answer MCV 82-92 (normal size) MCH 25-30 (normal color) MCHC 32-36 EX: anemia of chronic disease, sepsis, hemorrhagic, aplastic anemia and heriditary spherocytosis Microcytic Anemia - correct answer " Small light incompetant" MCV<80 (small ) MCH 20-25 (pale) MCHC 27 EX: iron deficiency anemia , Thalassemia Macrocytic Anemia - correct answer " Big Dark Dumb" MCV>96 (large) MCH 30-50 (dark) MCHC 32-36 EX: Pernicious anemia, Vitamin B12 deficiency, folic acid deficiency, Antimetabolite drugs ( methotrexate) Normal H&H Male versus Female - correct answer Male Hgb:13.5-17.5 HCT: 40-54% Female Hgb: 12-15.5 HCT: 36-48% Lupus - correct answer Malaise fevers, unexplained WL, ABD pain, depression, sleeplessness, swelling of the joints Rheumatoid Arthritis - correct answer Early stages: (bilateral )diffuse arthritis, WL, anorexia, and low grade fevers. May also have pain in extremities painful eyes and CP upon inspiration.... ****Joint pain and swelling present on awakening but improves as the day progresses*** Ankylosing Spondylitis - correct answer Pain in the ankeles, eyesm hips, joints, lower back neck or shoulders. Pain during excercise or rest Eyes can be inflammed or red. Visual disturbances or light sensitivity Fatigue, malaise, inflammed tendons, IBD sleep d/o or physical deformities Osteoarthritis - correct answer Eczema S/S - correct answer Early: symmetrical lesions which ooze, crust , and become excoriated occurs in the folds Later: rash become crusted, scaley thickened and lichenified Psoriasis - correct answer Eczema treatment - correct answer Goal: to control S/S because there is no cure ase pruritis nt secondary infection te the patient so they can control the disease themselves hydration er restoring theraphies 6. eliminate triggers Sjogrens Syndrome - correct answer Very challanging to diagnose because symptoms overlap with many other diseases such as MS., Lupus, chronic fatigue and fibromyalgia S/S: dry gritty burning eyes, dry oral cavities/ tongue, increased dental decay, change in taste or smell digestive problems and debilitating fatigue Allergic Dermatitis Acute: - correct answer Acute: weeping lesions with numerous tiny vessicles on a erythematous base that is itchy... may burn or sting. Treatment Goal: Symptom relief calamine lotion, topical steroids and oatmeal baths (Aveeno) **if weeping: moist compresses, simple srying agents and calamien lotion several times per day** Allergic dermatitis severe - correct answer steroid creams possibly po steroids10-14 days taper Patient education Allergic Dermatitis - correct answer -do not stop steroids abruptly if given for > 5 days -identify the cause, avoid exposure, wear gloves and protective clothing, contact provider for exacerbations Cellulitis defination and treatment - correct answer usually staph or strep red, warm, and temder to palpate Cellulitis Treatment: 1.Uncomplicated no bite: dicloxaxillin or cephalexin (Keflex 10-14 days) PCN allergy: Erythromycin 3.Humanand dog bites : Augmentin Abcess definition and treatment - correct answer Folliculitis - correct answer superficial to deep skin infection of the hair follicle with staph or strep Goal: Make skin inhospitable to pathogens Treatment; 1.Wash skin BID with antibacterial soap skin softens open large pustules and trim necrotic tissue 3. Bactroban for secondaryinfected skin lesions ****systemic ABX not advantageous to topical**** Pustule - correct answer elevated lesion semilar to a vessicle but filled with purulent fluid ie: acne, impetigo Macule - correct answer flat circumcised area that is a change in the skin color less than 1 cm. ie: freckle, flat mole petichea Patch - correct answer flat, nonpalpable irregular shaped macule >1cm ie: vitallago, port wine stains, mongolian spots Keloid - correct answer irreg shaped, enlarging scar form excessive collagen formation Papule - correct answer elevated firm circumcised area less <1cm ie: wart, elevated mole, insect bite Eccymoisis - correct answer small hemmoraghic spot round irreg blue or purple patch Hematoma - correct answer localized collection of blood , usually clotted in an organ or space or tissue due to a break in the wall of a blood vessell Acute viral syndrome - correct answer general viral syndrome that has no clear cause S/S: fever, chills, runny nose, cough, sor throat, HA, SOB, wheezing, N./V, decreased appetite. Treatment Antipyuretics: fever Antihistamines: rash, itching trouble breathing Decongestant: stuffy nose antitussives: cough Relapsing fever - correct answer Sudden fever within 2 weeks of infection transmitted via louse or tick (borellia species) characterized by repeated episodes of fever s/s: Rocky mountain spotted fever - correct answer caused by bacterium Rickettsia can cause potential fatal illness amercian dog tick, ricky nountain wood tick and brown dog tick s/s: starts 2-14 days of tick N/v/fevern ABd pain, rash on wrist FA and ankles 2-5 days afer onset of feversometimes on trunk and palms of hands low platelet count, low NA and elevated LFT's treatment: doxy 100 mg BID x7 days, 10-14 days more serious cases TRBF - correct answer Tick: ornithodorous tick Africa, spain saudi arabia, asia and regions of the US and Canada each fever may alst up to 3 days. may have a fever 2 weeks leave and return Diagnosis: Blood smear test Treatment: Tetracycling 500 mg q6, doxy 100 BID or if tera contraindicated erythromycin every 6 hours 7-10 days LBRF - correct answer Louse: body lice Asia, Africa, Central and south amercia fever 3-6 days often followed by single milder episode Diagnosis: blood smear test Treatment :single dose of tetracycline 500mg, doxy 200 or if tetra contraindicated use erythromycin 500 mg Tinea corporis - correct answer ringworm of the body Tinea versicolor - correct answer development of discolored patches of the skin, Thes patches may be lighter or darker than the surrounding skin tinea capitus - correct answer ringworm of the scalp Tinea pedis - correct answer tinea of the feet " atheletes feet" tinea manumus - correct answer tinea of the hands Tinea treatment - correct answer Most cases respond well to 2-4 weeks of treatment with " azole" . If systemic fungus use oral antifungal... Labs should be obtained due to risk of hepatoxicity inlcuding LFT's and CBC. Repat labs 4 weeks after treatment . Griseoulvin is chosen course of treatment but can cause granuocytopenia and leukopenia. Herpes Zoster - correct answer AKA" shingles" Most affected: elderly, immunocompromised history of pox can be triggered by stress Treatment: Acyclovir, Nsaids Complications: Post Herpetic Neuralgia---> treat with Gabapentin herpes simplex - correct answer impetigo - correct answer " golden crust" Mono - correct answer results from the Eppstien Barr virus and less likely CMV Transission via saliva " Kissing disease" Diagnositics: CBC, heterophile antbody test (Monospot), rapid plasam reagin Monospot can take up tp 3 weeks to be positive Mono treatment - correct answer Supportive Measures (rest and recovery) Hydration, NSAIDS, salt water gargles adn throat lozenges. If worried aout airway use prednisone 40 mg po followed by taper. Steroids decrease viral shedding but does not affect symptom duration Leukemia acute versus Chronic - correct answer CLL - correct answer ALL - correct answer CML - correct answer AML - correct answer SIckle Cell Disease - correct answer sickle shaped RBC's block the blood vessels blood and ocxygen cant get to the tissues which cauess pain and organ failures S/s: Pain, nausea,anorexia, anxiety, heart palpattaions and SOB Sickle Cell Treatment - correct answer Folic ACid suppliment 1 mg po daily Diet rich in complex vitamin B and C Rehydration---> Key in reversal Hydroxurea: check Cr and LFT's at baseline and periodically during treatment. Opiods for pain Oxygen to prevent acidosis HIV viral load versus CD4 count - correct answer Viral load: the amount of HIV on your blood s the more HIV in your blood the faster your CD4 count will fall which increases your risk of illness due to HIV Diagnostic cutt off for determination of AIDS - correct answer <200 CD4 or an oppurtunistic infection or other AIDS defining illness. AT this time HIV drug resistance testinng is performed. Bulluis Pemphigoid - correct answer skin d/o characterized by large blistres found on arms, legs or mid torso i areas that flex immune systems attacks the thin layer f skin Common in older people > 60 years( risk increases with age) S/S - Lg blisters can be clear fluid or blood. -surrounding skin can be reddened , normal or darker than normal -Can be very itchy Treatment for Bullous Pemphigoid) - correct answer Wide spread disease:systemic corticosteroids which should be initiated after biopsies and blood draws are completed response time : 1-2 weeks if ABX such as tetra is added steroid can be tapers. Localized disease can be managed with high potency topicla streoids with or w/o occluison Xerostomia - correct answer dry mouth caused by cessation of slaivary secretions Sjogrens - correct answer Fetid breasth secondary to dental caries mucosal pale with small fissures.. also beefy red tongue, dry/gritty eyes Sjogrens diagnostics - correct answer ased tear production al damage ased saliva l gland biopsy red salicary gland funtion ntibodies SSA and or SSB Lupus - correct answer BILmacular rash " butterfly" Biggest complaint: Fatigue Tx: symptom control check Vit D Calcum supplement Plaquinil corticosteroids dehydroepiandrostone Complications; ;Osteoporosis due to lack f sun exposure and Vit D deficiency RA - correct answer key findings: symettrical polysrthritis and morning stiffness which last > 1 hour Goal: start conservative get agressive(reduace pain and inflammation) Tx: early managment, PT/OT, heat and cold, excercise rest assistive devices and weightloss polymalgia rheumatica - correct answer affects middle age adults, women >men BL pain in shoulder, hips and thighs worse in the am Polymyalgia rheumatica diagnosis - correct answer elevated sed rate incraesed CRP normocytic anemia Polymyalgia rheumatica treatment - correct answer Corticosteroids Fibromyalgia - correct answer most common cause of MS pain in women age 22-55 S/S post excercise fatigue, HA, joint pain, impaired memory, sore throat, Fibormyalgia diagnosis - correct answer wide spread MS pain which has been present for at least 3 months and must be present in 11 of the 18 triger points on digital palpation Fibromyalgia Treatment - correct answer Drugs dont seem to help Low impact aerobic excercise, vognitive behavioral theraphy, low dose Tricyclics and SSRI's Hemolytic anemia - correct answer RBCs are destryed from the bloodtsream befr etheir lifespaln is overDisc shapped " doughnuts no center" what labs are used to diagnose hemolytic anemia - correct answer CBC: increased RDW Peripheral blood smear: Serum lactate dehysronase (LDH): hemolysis serum haptoglobin_ low+ mod to sev hemolysis Indirect bilirubin: >3 is indicative of hemolysis Microcytic Anemia - correct answer size <80 Causes: Iron deficiency anemia, anemia of chronic disease, Thalassemia, Sideroblastic Anemia S/s Tachycardia, palp, fatigue, SOB, DOE, dizziness Management: iron def: TRansfuse if HCT ,27, supplemental iron ACD: transfuse or growth factors Thallasemia: transfuse/folate, oral iron chelation SIderoblastic: transfusion vit B6 Normocytic Anemia - correct answer normal labs cause : Acute blood loss, hemoysis, volume overload(prenancy or overhydration) TX: symptomatic correct anemia and stabalize underlying cause Macrocytic Anemia - correct answer size >100 cause:Perc anemia (Vit B12 deficiency) Folate deficiency antimetabolite drugs (Methotrexate), Chronic ETOH Liver Disease Relapsing Polychondritis - correct answer Treatment of Polychondritis - correct answer Anaphylactic Reaction (med and steps) - correct answer Drug: EPI Step 1: give epi 1:1000 dilution 0.3-0.5 IM in upper lateral thigh in supine position with head below level of heartif possible Step 2: repeat EPI every 5-15 minutes. If hypotensive position supine with feet elevated Step 3L: support bronchodilation if w/i larygeaspam with albuterol 3ml neb Step 4: Hopsital support IVF's benadryl,, intubation ect...... Treatment of Lyme diseaese - correct answer Doxycycline 100 mg po BID x 14 days when targeting Borrelia Abcess treatment - correct answer bactrim or doxy: covers staph. Must add a beta lactem if strep a possibility or single regimine clindamycin( less effective but greater coverage Seborrheic Dermatitis - correct answer identified by skin flakes/ dandruff on scalp, eyebrows, hair beard or mustache. Can also be found as grasy skin flakes from ears chest armps or parts of the body Treatment for seborrheic dermatitis - correct answer OTC dandruff shampoo that has selenium sulfide shampoo, nizoral Keratolytic or oil based lotions to soften the heavy crust Hydrocortizone 0.5-0.1% for face (OTC) or betamethasone 0.1% for scalp exudative lesions may need compresses of burrows solution