2024 NR 571 MID TERM STUDY
SET EXAM WITH CORRECT
ANSWERS
What is high sensitivity troponin and when to use? - CORRECT-ANSWERSfirst
line test for cardiac cell damage
used for initial injury
What is CKMB - CORRECT-ANSWERSCK isoenzyme specific to cardiac muscle
tissue (MI)
When should CKMB be used? - CORRECT-ANSWERSfor suspicion of secondary
ischemia after an initial infarct
LRINEC score is for what? - CORRECT-ANSWERSdifferentiation of severe
cellulitis or abscess from NF
What is evaluated in the LRINEC score? - CORRECT-ANSWERSCRP, WBC, Hgb,
Na, Cr, and Glucose
High risk for NF - CORRECT-ANSWERSLRINEC score above 6
Which of the following patients is at the highest risk for necrotizing fasciitis?
a. A 60 year-old male with a past medical history of traumatic leg fracture 2
years ago.
b. A 46 year-old male with a past medical history of HIV presenting with
acute low back pain.
c. A 39 year-old female treated for cellulitis from a spider bite who clinically
improves within the 1st 24 hours of antibiotic administration.
d. A 65 year-old obese female with a past medical history of obesity,
diabetes, and hypertension who underwent an open cholecystectomy 2 days
ago. - CORRECT-ANSWERSd. A 65 year-old obese female with a past medical
history of obesity, diabetes, and hypertension who underwent an open
cholecystectomy 2 days ago.
What is the most distinguishing feature of necrotizing fasciitis?
a. Increased drainage and odor from the wound
b. Pain disproportionate to the clinical presentation
c. Erythema and edema
,d. Fever - CORRECT-ANSWERSb. Pain disproportionate to the clinical
presentation
All of the following are true statements regarding necrotizing fasciitis,
except:
a. Infection may be due to a monomicrobial or polymicrobial pathogen
b. The infection has a slow progression (weeks to months)
c. Visible, necrotizing skin, may not be apparent
d. Diabetes and chronic kidney disease are risk factors - CORRECT-
ANSWERSb. The infection has a slow progression (weeks to months)
Differential for osteomyelitis - CORRECT-ANSWERSCellulitis
Diabetic ulcer
TB bone infection
Metastatic cancer
Diagnostic testing for osteomyelitis - CORRECT-ANSWERSBld Cx
CBC
ESR
MRI
Bone CT/PET Scan
Bone biopsy
____ changes slowly while ____ changes more rapidly in osteomyelitis -
CORRECT-ANSWERSESR , CRP
Most accurate imaging for osteomyelitis - CORRECT-ANSWERSMRI
Which of the following patients is at highest risk of osteomyelitis? (Select all
that apply)
A. 45-year-old schoolteacher with history renal transplant.
B. 22-year-old with Crohn's disease.
C. 32-year-old IV drug user who is homeless
D. 72-year-old with laboratory confirmed influenza. - CORRECT-ANSWERSA.
45-year-old schoolteacher with history renal transplant
C. 32-year-old IV drug user who is homeless
Risk factors for osteomyelitis - CORRECT-ANSWERSAdvanced age
Children
IV Drug abuse
CVL
recent surgery
Trauma/open fax
Vascular insufficiency
DM
paraplegia
,Initial testing for osteomyelitis - CORRECT-ANSWERSPlain X-ray - rules out fx
CT use in osteomyelitis - CORRECT-ANSWERSAble to detect soft tissue
infection and small foreign body
Less sensitive than MRI
US use in osteomyelitis - CORRECT-ANSWERSCan be used when MRI not
possible due to hardware
Used to differentiate between neuropathic and arthropathy
alkaline phosphate and osteomyelitis - CORRECT-ANSWERSDoes not usually
rise with osteomyelitis
Alkaline phosphatase usually rises in... - CORRECT-ANSWERSBone disease:
Pagets, metastatic cancer, and infiltrative liver dx
Pressure ulcer screening tool - CORRECT-ANSWERSTissue
Infection
Moisture
Edge of wound
pressure ulcer screening tools - CORRECT-ANSWERSBraden Scale
Norton
Waterlow
Deep tissue injury - CORRECT-ANSWERSPurple or maroon localized area of
discolored intact skin or blood-filled blister due to damage of underlying soft
tissue from pressure and/or shear.
Stage I Pressure Injury - CORRECT-ANSWERSSkin intact; Erythema; Does NOT
blanch
Stage II pressure ulcer - CORRECT-ANSWERSpartial thickness skin loss
involving epidermis, dermis, or both
Stage III Pressure Injury - CORRECT-ANSWERSfull thickness tissue loss with
visible fat
Stage IV pressure injury - CORRECT-ANSWERSFull thickness skin loss;
Muscle, bone, tendon
unstageable pressure ulcer - CORRECT-ANSWERSA full-thickness wound in
which the amount of necrotic tissue, or eschar, in the wound bed makes it
impossible to assess the depth of the wound or the involvement of
underlying structures
, Heparin-induced thrombocytopenia (HIT) - CORRECT-ANSWERS>50%
reduction in platelet count within 7-10 days of exposure of heparin
-Severe form results in global thromboembolism due to immune reaction
with platelet factor 4
Identification of HIT - CORRECT-ANSWERS>50% drop in plt count
positive PF4 -heparin antibody
medication management of PE - CORRECT-ANSWERSDOAC or VKA (stable
pts)
Thrombolytic therapy (unstable) - catheter directed tpa or heparin
when to use ICV filters for thromboembolic dx - CORRECT-ANSWERSwhen
thrombolytic or AC therapy in contraindicated
normal level for Troponin I - CORRECT-ANSWERS<0.04
normal level for CKMB - CORRECT-ANSWERS3-5% of total CK
What is BNP - CORRECT-ANSWERSB-type natriuretic peptide
Normal BNP levels - CORRECT-ANSWERS<100 pg/mL
Differential for chest pain - CORRECT-ANSWERSConsider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion,
pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - CORRECT-ANSWERS90
Initial diagnostics for chest pain - CORRECT-ANSWERS12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
SET EXAM WITH CORRECT
ANSWERS
What is high sensitivity troponin and when to use? - CORRECT-ANSWERSfirst
line test for cardiac cell damage
used for initial injury
What is CKMB - CORRECT-ANSWERSCK isoenzyme specific to cardiac muscle
tissue (MI)
When should CKMB be used? - CORRECT-ANSWERSfor suspicion of secondary
ischemia after an initial infarct
LRINEC score is for what? - CORRECT-ANSWERSdifferentiation of severe
cellulitis or abscess from NF
What is evaluated in the LRINEC score? - CORRECT-ANSWERSCRP, WBC, Hgb,
Na, Cr, and Glucose
High risk for NF - CORRECT-ANSWERSLRINEC score above 6
Which of the following patients is at the highest risk for necrotizing fasciitis?
a. A 60 year-old male with a past medical history of traumatic leg fracture 2
years ago.
b. A 46 year-old male with a past medical history of HIV presenting with
acute low back pain.
c. A 39 year-old female treated for cellulitis from a spider bite who clinically
improves within the 1st 24 hours of antibiotic administration.
d. A 65 year-old obese female with a past medical history of obesity,
diabetes, and hypertension who underwent an open cholecystectomy 2 days
ago. - CORRECT-ANSWERSd. A 65 year-old obese female with a past medical
history of obesity, diabetes, and hypertension who underwent an open
cholecystectomy 2 days ago.
What is the most distinguishing feature of necrotizing fasciitis?
a. Increased drainage and odor from the wound
b. Pain disproportionate to the clinical presentation
c. Erythema and edema
,d. Fever - CORRECT-ANSWERSb. Pain disproportionate to the clinical
presentation
All of the following are true statements regarding necrotizing fasciitis,
except:
a. Infection may be due to a monomicrobial or polymicrobial pathogen
b. The infection has a slow progression (weeks to months)
c. Visible, necrotizing skin, may not be apparent
d. Diabetes and chronic kidney disease are risk factors - CORRECT-
ANSWERSb. The infection has a slow progression (weeks to months)
Differential for osteomyelitis - CORRECT-ANSWERSCellulitis
Diabetic ulcer
TB bone infection
Metastatic cancer
Diagnostic testing for osteomyelitis - CORRECT-ANSWERSBld Cx
CBC
ESR
MRI
Bone CT/PET Scan
Bone biopsy
____ changes slowly while ____ changes more rapidly in osteomyelitis -
CORRECT-ANSWERSESR , CRP
Most accurate imaging for osteomyelitis - CORRECT-ANSWERSMRI
Which of the following patients is at highest risk of osteomyelitis? (Select all
that apply)
A. 45-year-old schoolteacher with history renal transplant.
B. 22-year-old with Crohn's disease.
C. 32-year-old IV drug user who is homeless
D. 72-year-old with laboratory confirmed influenza. - CORRECT-ANSWERSA.
45-year-old schoolteacher with history renal transplant
C. 32-year-old IV drug user who is homeless
Risk factors for osteomyelitis - CORRECT-ANSWERSAdvanced age
Children
IV Drug abuse
CVL
recent surgery
Trauma/open fax
Vascular insufficiency
DM
paraplegia
,Initial testing for osteomyelitis - CORRECT-ANSWERSPlain X-ray - rules out fx
CT use in osteomyelitis - CORRECT-ANSWERSAble to detect soft tissue
infection and small foreign body
Less sensitive than MRI
US use in osteomyelitis - CORRECT-ANSWERSCan be used when MRI not
possible due to hardware
Used to differentiate between neuropathic and arthropathy
alkaline phosphate and osteomyelitis - CORRECT-ANSWERSDoes not usually
rise with osteomyelitis
Alkaline phosphatase usually rises in... - CORRECT-ANSWERSBone disease:
Pagets, metastatic cancer, and infiltrative liver dx
Pressure ulcer screening tool - CORRECT-ANSWERSTissue
Infection
Moisture
Edge of wound
pressure ulcer screening tools - CORRECT-ANSWERSBraden Scale
Norton
Waterlow
Deep tissue injury - CORRECT-ANSWERSPurple or maroon localized area of
discolored intact skin or blood-filled blister due to damage of underlying soft
tissue from pressure and/or shear.
Stage I Pressure Injury - CORRECT-ANSWERSSkin intact; Erythema; Does NOT
blanch
Stage II pressure ulcer - CORRECT-ANSWERSpartial thickness skin loss
involving epidermis, dermis, or both
Stage III Pressure Injury - CORRECT-ANSWERSfull thickness tissue loss with
visible fat
Stage IV pressure injury - CORRECT-ANSWERSFull thickness skin loss;
Muscle, bone, tendon
unstageable pressure ulcer - CORRECT-ANSWERSA full-thickness wound in
which the amount of necrotic tissue, or eschar, in the wound bed makes it
impossible to assess the depth of the wound or the involvement of
underlying structures
, Heparin-induced thrombocytopenia (HIT) - CORRECT-ANSWERS>50%
reduction in platelet count within 7-10 days of exposure of heparin
-Severe form results in global thromboembolism due to immune reaction
with platelet factor 4
Identification of HIT - CORRECT-ANSWERS>50% drop in plt count
positive PF4 -heparin antibody
medication management of PE - CORRECT-ANSWERSDOAC or VKA (stable
pts)
Thrombolytic therapy (unstable) - catheter directed tpa or heparin
when to use ICV filters for thromboembolic dx - CORRECT-ANSWERSwhen
thrombolytic or AC therapy in contraindicated
normal level for Troponin I - CORRECT-ANSWERS<0.04
normal level for CKMB - CORRECT-ANSWERS3-5% of total CK
What is BNP - CORRECT-ANSWERSB-type natriuretic peptide
Normal BNP levels - CORRECT-ANSWERS<100 pg/mL
Differential for chest pain - CORRECT-ANSWERSConsider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural effusion,
pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic, gastritis
Psych: anxiety attacks
Revascularization in under ____ minutes - CORRECT-ANSWERS90
Initial diagnostics for chest pain - CORRECT-ANSWERS12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
