AANP FNP Certification Exam with complete solution

AANP FNP Certification Exam with complete solution All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM - correcy answer-III first time audible, IV first time thrill Fundal height 12 weeks - correcy answer-Fundal Height 12 weeks above symphysis pubis. EXAM Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - correcy answer-Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - correcy answer-Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - correcy answer-Mini mental exam 4 month old with strabismus, mom is worried...... - correcy answer-tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - correcy answer-Growth chart 6 month old closed anterior fontanel. - correcy answer-XRAY Abnormal cells on PAP, what do you do next? - correcy answer-Refer for Colposcopy CAGE ACRONYM - correcy answer-Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - correcy answer-Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - correcy answer-CN 3,4,6 Definition of metabolic syndrome - correcy answer-cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - correcy answer-wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - correcy answer-Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - correcy answer-Anterior septum Definitive diagnosis of acute bacterial prostatitis - correcy answer-urinalysis and culture GERD treatment - correcy answer-H2 is first line, give hs Grade 3 cells on Pap, treatment? - correcy answer-LEEP excision Fingernail hematoma treatment? - correcy answer-drill hole and drain blood? Increased risk of ectopic pregnancy - correcy answer-Salpingitis, or history of abortion, PID, Koplick spots - correcy answer-Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - correcy answer-Measles (rubeola). Grains of salt lesions inside mouth in Measles Legg-Calve-Perthes Disease - correcy answer-Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - correcy answer-Pancreatitis Low HGB, Low HCT, High MCV indicates what? - correcy answer- Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - correcy answer-Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - correcy answer-Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - correcy answer-Meniscus tears Lachman's Test - correct answer-pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - correct answer-refer to orthopedist Osgood-Schlatter disease - correct answer-Knee pain. inflammation or irritation of the tibia at its point of attachment with the patellar tendon Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? - correct answer-Alzheimer's Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - correct answer-Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - correct answer-Tinea Corporis Pt presents with "bag of worms:, indicates? - correct answer-Varicocele Pt with atopic dermatitis, look for what other diseases? - correct answer- Asthma Pt with bleeding after menopause - correct answer-endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? - correct answer-Infertility Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? - correct answer-This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? - correcy answer-Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - correcy answer-slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go - correcy answer-Timed Get up and Go Red beefy tongue? - correcy answer-pernicious anemia Rotator cuff injury presentation - correcy answer-disturbs sleep, arm weakness, dull ache Shingles near eye - correcy answer-immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease) ? - correcy answer-Viral infection Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage -Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash -Seizures may occur during this period. -On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs. -High fever, pink flat or raised rash Treatment for chronic alcoholism: - correcy answer-12 step program Treatment for Gonorrhea? - correcy answer-Rocephin 250mg IMx1 plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - correcy answer-IUD Basal cell cancer - correcy answer-Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - correcy answer-Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - correcy answer-Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area -a pre squamous cell carcinoma occurs on sun-damaged skin biopsy cryo or 5fu cream subungual hematoma tx - correcy answer-Make a hole and drain the blood Moderate acne treatment - correcy answer-Without inflammation: Topical retinoid Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered) PLUS ADD Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone heart murmur with holosystolic or pan systolic Heart mumur with mid systolic - correcy answer-MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta - correcy answer-COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs. -congenital cardiac condition characterized by a narrowing of the aorta - Murmur Grade III - VI - correcy answer-Loud murmur easily heard JVD caused by - correcy answer--tension pneumothorax, -Rt. sided heart failure, -cardiac tamponade, -traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - correcy answer-endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles. Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - correcy answer-PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - correcy answer-Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - correcy answer->5 mm in an immunocompromised patient or close contact >10 mm in immigrant, health care workers, drug user >15 mm in a patient who lives in an area where TB is very rare. what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - correcy answer-Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - correcy answer-HTN retinopathy intraocular pressure (IOP) - correcy answer-Fluid pressure inside the eye; measured with tonometry Rovsing sign - correcy answer-pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - correcy answer-Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - correcy answer-SDH migraine headache - correcy answer--paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate Vitamin B12 - correcy answer-Folate shares a close relationship with this other B Vitamin. Vitamin B12 - correcy answer-Cognitive deficits, glossitis, pernicious anemia, Folate shares a close relationship with this other B Vitamin. 88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. - correcy answer-be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient - correcy answer- SSRI grandiosity - correcy answer-Exaggerated belief in or claims about one's importance or identity. Bipolor ADHD - correcy answer-A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity. pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? - correcy answer-HPV test if not done. Refer for colposcopy Chlamydia trachomatis - correcy answer-Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment - correcy answer-Cryotherapy OR Podophyllotoxin cream - OR Imiquimod (Aldara cream) HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - correcy answer-tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children - correcy answer-motor vehicle Tanner 2 - correcy answer-Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - correcy answer-Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. - correcy answer-vascular dementia presbycusis - correcy answer-a gradual loss of sensorineural hearing that occurs as the body ages a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - correcy answer- Ultrasound Romberg test - correcy answer-cerebellar -ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds Direct Coombs test - correcy answer-r/o bilirubin preeclampsia treatment - correcy answer-bed rest, laying on her side Molluscum contagiosum treatment - correcy answer-Currettage, liquid nitrogen pyloric stenosis - correcy answer-non bilious vomiting, olive like firm mass palpated on right upper quadrant horizontal nystagmus that stops when eye is close to midline in a college student - correcy answer-Ménière's disease ? Nystagmus test - correcy answer-the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. - correcy answer- sialolithiasis). Etopic Pregnancy: Risk Factors - correcy answer-Previous ectopic pregnancy Prior fallopian tube surgery Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Pelvic inflammatory disease Endometriosis cigarette smoking age older than 35 years history of infertility use of assisted reproductive technology, such as in vitro fertilization (IVF) Which among the list can cause increase in respiration - correcy answer- Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - correcy answer- hypercapnia Osteoporosis Risk Factors (ACCESS) - correcy answer-A-lcohol Use C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - correcy answer-VITAMIN D 600-800, CALCIUM . OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH Carotid bruit - correcy answer-abnormal flow of blood through the carotid artery Carotid bruit - correcy answer-abnormal flow of blood through the carotid artery due to atherosclerotic disease Common causes of GERD - correcy answer-risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil Common causes of GERD - correcy answer-risk factors- alcohol, anticholinergic, CCB, BB chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline Zeprexa. What lab and intervention to put in place - correcy answer- CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose Weber test - correcy answer-Sensorineural loss Weber test(top of head) no laterization, normal finding, does not lateralize to either ear, bilateral hearing loss, if hear better in left ear, right sensorineural loss Weber test - correcy answer-Sensorineural loss Weber test (top of head) no laterization- normal, does not lateralize to either ear- bilateral hearing loss, if hear better in left ear, right sensorineural loss. SUN- sensorial lateralize unaffected ear CAFFE- Conductive lateralize to affected ear Assessment on patient with ascites - correcy answer-Dullness Assessment on patient with ascites - correcy answer-Dullness to percussion Varus Stress Test - correcy answer-application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL Varus Stress Test - correcy answer-TEST LCL (lateral-vaRus) McMurrays- Meniscus CLICK application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL German Measles (Rubella) - correcy answer-Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots. patient with IOP of 32mmHg, what do you expect during fundoscopic exam - correcy answer- patient with IOP of 32mmHg, what do you expect during fundoscopic exam - correcy answer-increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - correcy answer-anticholinergics/oxybutynin, impamine/tricyclic/antidepressant Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH BPH and urge incontinence - correcy answer-TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - correcy answer-a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - correcy answer-telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS intussusception - correcy answer-telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL IBS (irritable bowel syndrome) - correcy answer-An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) - correcy answer-SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress Osteoporosis treatment - correcy answer-TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth Statins increase bone mineral density Osteoporosis treatment - correcy answer-TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID, Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY >2.5 Retinoblastoma - correcy answer-white reflection in child's pupil for staph aureus infection (skin) with pus - correcy answer-MRSA- TX Bactrim or tetracyclines? hyperparathyroidism - correcy answer-high calcium Hyperthyroidism treatment - correcy answer-methimazole, PTU- propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers Mammography Screening - correcy answer--Age 45 - 54 yearly mammogram -55 and older every 2 years Fifth's Disease (Erythema Infectiosum) - correcy answer-B19: lytic infection, respiratory transmission Sx: flushed rash/fever in kids Px: fever, get better in a week pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - correcy answer-TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy - correcy answer-Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema - correcy answer-optic disc swollen w/ blurred edges due to increased ICP EXAM actinic keratoses - correcy answer-Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM Allergic Conjunctivitis - correcy answer-"stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - correcy answer-COPD- Gold 1-2- SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN CN IX Glossopharyngeal - correcy answer-- Shoulder shrug/ ROMBERG test EXAM CN V Trigeminal - correcy answer-Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - correcy answer-ears 8 EXAM CN VII Facial - correcy answer-BELLS EXAM ACEI contraindicated - correcy answer-pregnancy Safe to give varicella/MMR - correcy answer-Do not give <12 mo. EXAM QUESTION Acne Vulgaris - correcy answer-common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide. Acne Rosacea - correcy answer-- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts - correcy answer-is on EXAM in elderly night vision issues. Opaque Kawasaki disease - correcy answer-- acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM Erythema migrans - correcy answer-Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM Rocky Mountain Spotted Fever - correcy answer-Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. EXAM Addison's - correcy answer-Addison's- deficient in cortisol (think low sodium, blood sugar, but Increase K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM rheumatoid arthritis - correcy answer-Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM Osteoarthritis - correcy answer-Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM Osteoporosis - correcy answer-OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM Fibromyalgia polymyalgia - correcy answer-Fibro- 11/18 points. Widespread pain for at least three months. EXAM. polymyalgia Tx prednisone 12 months. Must taper off. RISK for Temporal arteritis, DX BX, elevated ESR Serotonin syndrome - correcy answer-Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM Fundal Height - correcy answer-Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US. Psoriasis - correcy answer-Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds. (Koebner phenomenon- new psoriatic plaques form over skin trauma) (Auspitz sign- pinpoint bleeding when plaques are removed). TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic. D Dacrocystitis - correcy answer-Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents. Acne Rosacea - correcy answer-Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM Parathyroid hormone - correcy answer-PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM Diabetic Retinopathy - correcy answer-Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED HTN Retinopathy - correcy answer-Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM Wilms Tumor - correcy answer-Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM Primary Amenorrhea - correcy answer-Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics. Aphthous stomatitis - correcy answer-Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash. Temporal arteritis - correcy answer-Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids. Atopic Dermatitis (eczema) - correcy answer-Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy lesions" they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM Tinea Corporis - correcy answer-ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending Cellulitis - correcy answer-Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS. Erysipelas - correcy answer-Group A strep, painful, Upper dermis, clear demarcated, cheeks, shins. TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d. MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim. Varicella Zoster - correcy answer-"contagious 48 h. before, until all lesions crusted over" low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. "initially on trunk, then scalp and face" TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM Impetigo - correcy answer-Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM Scarlet fever- scarlantina - correcy answer-"sandpaper textured-pink rash with sore throat" strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM Lichen planus - correcy answer-LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM Spider bite - correcy answer-fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam Pityoris rosea - correcy answer-Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM Corneal abrasion - correcy answer-Corneal Abrasions- Round/Irregular. Was on EXAM. Acute Angle Closure Glaucoma - correcy answer-acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM Conductive - correcy answer-Conductive: Lateralization to bad ear. Rinne- BC > AC. Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM Koplik spots - correcy answer-Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM Sensorineural - correcy answer-Sensorineural: Lateralization to good ear. Rinne- AC > BC. OME - correcy answer-Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM Presbycusis - correcy answer-sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM OE - correcy answer-Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM Sinusitis - correcy answer-TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE Meiniers disease - correcy answer-VERTIGO TINNITUS, HEARING LOSS. nystagmas Mono - correcy answer-test heterophile antibody test. ON EXAM MR. ASS - correcy answer-(Systolic Murmur) Only systolic murmurs will radiate to a location on the exam. Mitral Regurg - correcy answer-(Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL. Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb. All diastolic murmurs are pathological. Grades Murmurs - correcy answer-I- barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM MVP - correcy answer-MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC. S3- HF, S4-LVH stiffening, - correcy answer-S3- HF, Kentucky, early diastole. Abn >35. Bell EXAM S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM Isolated Systolic HTN - correcy answer-CCB PAD/ PVD - correcy answer-PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM CVI - correcy answer-CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM blood pressure - correcy answer-BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM. Thiazide diuretics - correcy answer-no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM Statin - correcy answer-Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM Pulses paradoxus - correcy answer-Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM Emphysema - correcy answer-Emphysema Lungs- Percussion- HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM Acute Bacterial Pneumonia- CXR - correcy answer-middle lobe. ON EXAM OSA - correcy answer-does not include Microglossia which is an absent tongue congenital. EXAM TB - correcy answer-fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes. TPO - correcy answer-TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM hyperthyroid - correcy answer-Hyperthyroid- Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then. A1C > 9 - correcy answer-If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM Parathyroid - correcy answer-For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM cushings - correcy answer-Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must draw cortisol levels in the morning. Fructosamine test - correcy answer-checks sugar for past 2-4 weeks. triglycerides - correcy answer-causes pancreatitis >500. If >500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM Pancreatitis - correcy answer-diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring" epigastric pain. Fever, n/v. EXAM TOPICS Metformin - correcy answer-Metformin - monitor BUN, Creatinine. contraindicated renal and liver disease ARF creatinine up and GFR down. affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea flatulence CT: hold 24 hr before and 48hr after Polycythemia vera - correcy answer-slow growing blood cancer. blood too thick, clots. bone marrow to many RBC. risk bleed , anemia, CBC CCB - correcy answer-BLE edema- walk around Kava Kava - correcy answer-anxiety and insomnia, don't mix w sedating benzos. Bipolar med - correcy answer-lithium- monitor TSH, toxicity bind to TH cause hypothyroidism. Depression med acute Anxiety/ panic med GAD med - correcy answer-depression SSRI panic benzo, Xanax, ativan GAD SSRI SNRI- Buspar, Effexor, Cymbalta- Taper OFF SNRI/ Benzo Discontinuation - correcy answer-Buspar, Effexor, Cymbalta and Benzo Taper OFF Thiazide GLUT- - correcy answer-Glyceridemia Lipidemia Uricacidemia Triglyceridemia HYPO-Kalemia ACE/ARB contraindications - correcy answer-pregnancy Renal failure Renal Stenosis METABOLIC SYNDROME - correcy answer-METABOLIC SYNDROME NO THIAZIDES,CCB (HF) NO TZD ACTOS (Pioglitazone) GIVE Metformin, ACE or ARB- kidney protective, BB- causes hypoglycemia, Triglyceride < 300 what do we do first? Triglyceride in 300 plus risk for what do we do? - correcy answer- Lifestyle modification Pancreatitis, Niacin then add, fenofibrates Serotonin syndrome ss - correcy answer-hyper rigidity, fever, myoclonus, dilated pupils, AMS, hyper reflexes, from SSRI or mix w MAOI and TCA NSAID contraindicated in - correcy answer-HF and ARF increase BP impair renal prostaglandin and sodium retention strabismus - correcy answer-misalignment of eyes, abnormal after 6 months macular degeneration - correcy answer-loss of central vision retinal detachment - correcy answer-floaters, curtain, flashes Xanthelasmas - correcy answer-sharply demarcated yellowish deposit of cholesterol underneath the eye Red reflex absent - correcy answer-retinoblastoma (leukorrhea) , cataracts, glaucoma. Will have white reflex Mono, return to play and Dx - correcy answer-4-6 weeks when spleenolmegaly resolves Mono spot/ Heterophile Viral stomatitis - correcy answer-ulcer on cheek (Aphthous)- viral canker sore cholesteatoma - correcy answer-chronic sinusitis or OM. cauliflower, foul- smell, hearing loss. erodes bones in face affects facial CN 7. Benign- risk hearing loss refer SURGERY Acute Closed Angle Glaucoma Vs Open Angle - correcy answer-Acute: Sudden pain, halos, cupping, dilated, cloudy , IOP, HA, refer ED Open (primary) : CN 2, gradual loss peripheral vision first Papilledema - correcy answer-Swollen, optic disc, increase cup to disc ratio, HA, ICP, HTN, Acyclovir (cheapest) - correcy answer-200mg 5 x day Pt on PPI, has osteoporosis has a cough, - correcy answer-refer for EGD r/o Barrett's. allergic rhinitis - correcy answer-blue pale turbinate clear drainage. Tx inhaled corticosteroids hordeolum Vs chalazion blepharitis - correcy answer-hordeolum: painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin. chalazion does not hurt Blepharitis always unilateral, Tx baby shampoo warm compress Sialolithiaisis - correcy answer-painful lump, calculi or salivary stones. sub mandibular gland whartons; duct. Roseola infantum- Sixth disease - correcy answer-viral, young children, high Fever 3-4 days followed by maculopapular rash Herpetic keratitis - correcy answer-ocular herpes - blurr vision, inflammation of eye; gritty feeling, conjunctivitis, sharp pain, and photophobia- AVOID SUN REFER OPTHO Tx acyclovir