LATRINA WALDEN REVIEW
* Fever with rash of the palm and soles of the feet after camping or hiking in the mountain?
Rocky mountain spotted fever treat with Doxycycline, lab test to diagnose PCR (Polymerase
chain reaction), the organism that cause is by R. rickettsii
* Lyme disease- rash and tick...
fever with rash of the palm and soles of the feet after camping or hiking in the mountain
skin is red but it is itchy fine white silver scales
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FNP LATRINA WALDEN REVIEW
LATRINA WALDEN REVIEW
* Fever with rash of the palm and soles of the feet after camping or hiking in the mountain?
Rocky mountain spotted fever treat with Doxycycline, lab test to diagnose PCR (Polymerase
chain reaction), the organism that cause is by R. rickettsii
* Lyme disease- rash and tick, the other name is erythema migraine, treated with doxycycline,
the organism that causes the disease is Borrelia burgdorferi, Elisa is the confirmatory test and
confirm with western test same as HIV
* Skin is red but it is itchy fine white silver scales “psoriasis”. Treated with topical steroids
What if she fell and she was injured. This injured area developed a scab with silver
plaque this is called Koebner phenomenon. Let’s say this scaly area was removed and
the patient developed pinpoint bleeding this is called Auspitz’s sign
* atopic dermatitis- another name Eczema, allergy and asthma. Treated with topical steroids, you
instructed to avoid the hot water, emollient cream base and moisturized your body!!
* Tinea Corporis- Child with ring like itchy rash that slowly enlarge and has central clearance.
Treated with antifungal cream. mom took son to barber and he developed an Itchy rash that is in
the shape of a circle and is getting bigger. It has central clearing
* Actinic Keratosis- dry round pink to red lesion, they do not heals!! You usually see it in face
and sun exposed areas, forehead, ears, nose, face, neck. We treated for small areas with
Cryotherapy, big area use 5-fluorouracil. Punch Biopsy gold standard!!
* Seborrheic Keratosis- Black or tan spots (pasted on someone) benign
* 5 years old complaining of itching at night assessment fingers and toes with burrowing
“scabies”, you used permethrin cream and wash everything in hot water
* If you have a patient who is diabetes and has cellulitis, what will be your most concern?
Osteomyelitis. Let’s supposed you Treated one leg over and over the patient for cellulitis and it is
not clearing up and when the Doppler you don’t hear anything.. you have to rule out DVT.
Absent pulses of one leg rule out DVT!!
* If skin infection Keflex or penicillin
* MRSA you give Bactrim, clindamycin or doxycycline.
* You have a patient with mastitis you give penicillin or Keflex for any skin infection. What are
the instructions you will give is to continue breastfeed.
,* If some is allergy to penicillin you will give a macrolide (azithromycin)
* Asymetrical, has irregular border, with different color, dark brown, light brown “Melanoma”,
Punch Biopsy is the gold standard. Know the presentation
* Moluscum contangious- papules with indurate center, sometimes describe as belly bottom,
Dome shaped, white encapsulated rash, itchy you should never see it in the private areas of the
children
* Erysipelas it cause by Group A Strep- clear marked lines on the checks (face cellulitis).
Treatment with penicillin or Dicloxacillin
* Pearly, waxy, may or may have an ulcerated center… Basal cell carcinoma!
* Acne- treatment is a topical retinoids, returned and said it’s not working, next give ABX (oral
tetracycline ), still not working refer to dermatology. Treatment is working but is causing the
face to turn red, DO NOT STOP the medication have them use the topical every other day
* Pityriasis rosea- herald patch (Christmas tree) found on chest/ abdomen
Two possible drug test questions
* Cocaine use- nose bleeding with a deviated septum. She is an IV drug user what cdc
recommend you test for? Hepatitis C
* Marijuana – EXCEPT: does not cause low sperm count
* Corneal abrasion- round and irregular
* Macular degeneration- central vision loss 1st
* Glaucoma, what would you see when you do a funduscopic exam? You will see coping of the
optic disc CUP-to DISK
* Acute angle closure glaucoma- sudden, painful, halo, corneal cloudy. Send to ER (won’t lose
their sight on my watch, close that door send to ER)
* Open angle glaucoma- non-painful, slow onset, peripheral vision lost 1st. can’t drive
* Retinal detachment- halo, flashes of light, closing Curtin
, * Cholesteatoma(cauliflower ear)- malformation of the ear, foul smelling. Treatment- send to
ENT
* Stomatitis- ulcerations of the mouth (may see questions like: mom brings baby into the office
and won’t eat, assessment ulcers in mouth without any other ulcers on the body). If they
mentions ulcer in the mouth, hand and foot, then it is Hand -foot mouth disease
* Papilledema- Optic disc swelling with blurred edges (caused by ICP) most common cause
HTN. This is Why we should also ask when their last eye exam
* Hypertension retinopathy- Retinal hemorrhage, AV nicking (artery crosses vein that causes
kinking), Copper wiring arterial
* AV nicking- Arteriovenous nicking, also known as AV nicking, is the phenomenon where, on
examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which
results in the compression of the vein with bulging on either side of the crossing. Patient with AV
nicking suffer from HTN
* Koplik spots- rubeola (measles)- presents with fever and 3 C- cough, conjunctivitis, coryza
(congestion
* Conductive hearing loss is a blockage , wax build up, foreign body, even if you have an
accident and tilt your head and had a bone or something, that is considered conductive hearing
loss as well. The sound s can’t get through the tympanic membrane. BC >AC
* Sensorial hearing loss- middle and inner hear problem, it is a disease process. Otoxicity, As we
get older we naturally lose our hearing “presbycusis”. As we get older we naturally lose our
hearing “presbycusis”. Rhinne test AC>BC
* Meniere disease what kind of symptoms are? vertigo, ringing in the ear, “nystagmus”. The
maneuver you can do if you suspect someone has Meniere disease is Epley’s maneuver. Shin to
shoulder and tilt their head in your hand…they may vomit on you. You give antihistamine
* Weber test- lateralize to the bad affected ear, and Rhine test BC>AC. This is conduction
hearing problem
* Otitis media- caused by strep pneumo (most common). 1st line Treatment- Augmentin,
amoxicillin
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