SARAH MICHELLE LIVE REVIEW STUDY GUIDE LATEST UPDATE

SARAH MICHELLE LIVE REVIEW STUDY GUIDE 2024- 2025 LATEST UPDATE A new graduate nurse practitioner has a patient presents with a hearing complaint. The patient states that they have had decreased hearing on the right side for the last month that is continuing to get worse. The NP completes both the Rinne and Weber tests. If the patient has Ménière's disease, what would be the expected finding on the Weber test? 1. AC is 2 times longer than BC 2. BC is 2 times longer than AC 3. The tuning fork lateralizes to the right ear 4. The tuning fork lateralizes to the left ear - CORRECT ANSWER 4. The tuning fork lateralizes to the left ear What are common signs and symptoms of Meniere's Disease? - CORRECT ANSWER Vertigo, tinnitus, ear pressure, nystagmus What is our biggest worry for a Meniere's Disease patient? - CORRECT ANSWER There is a possibility for a potential, permanent hearing loss. What is rhinitis meidcamentosa? - CORRECT ANSWER Drug-induced rebound nasal congestion, this can happen after use of nasal decongestants like Afrin. These nasal decongestants should ideally not be used for greater than 3-5 days because of this risk. What is herpes keratitis? - CORRECT ANSWER This is an infection of the cornea due to herpes simplex virus How is herpes keratitis diagnosed? - CORRECT ANSWER By examining the eye under a black lamp and visualized the cornea, in herpes keratitis, fern like lines will be seen on the cornea A child that has a history of mononucleosis is at increased risk for development for what cancer later in life? And why? - CORRECT ANSWER Hodgkin's Lymphoma and Burkitt's Lymphoma, this is due to the exposure of the Epstein-Barr virus What types of patients will be at a higher risk of pneumonia? - CORRECT ANSWER Patient with chronic lung diseases: asthma, COPD, cystic fibrosis. Why are cough suppressants not helpful in pneumonia patients? - CORRECT ANSWER Because we WANT them to get that gunk out, we do not want them to hold it in their lungs, an expectorant would be a better option for these patients. When should a follow up chest X-Ray be completed after treatment of pneumonia? - CORRECT ANSWER Around 8 week mark SARAH MICHELLE LIVE REVIEW STUDY GUIDE 2024- 2025 LATEST UPDATE 2 | P a g e What is COPD? - CORRECT ANSWER Chronic Obstructive Pulmonary Disease. This is a chronic condition that is made up of chronic bronchitis and emphysema. It is a progressive inflammatory lung disease that makes it hard for the patients to breathe, because the chronic bronchitis leads to mucous build up and the emphysema portion destroys areas of the lungs. What signs and symptoms are common in COPD patients? - CORRECT ANSWER Chronic cough Sputum production Dyspnea- difficulty breathing What signs and symptoms are specific to B12 deficiency anemia? - CORRECT ANSWER Neurological symptoms, paresthesia (numbness and tingling in hands and feet), unsteady gait, memory issues Beefy red tongue What diet can result in B12 deficiency? - CORRECT ANSWER Vegan- oral supplements can be used for treatment What surgery can result in B12 deficiency? - CORRECT ANSWER Gastric surgery- patient will lose intrinsic factor that is required to absorb B12- these patients will require life long IM B12 injections What patient population is lupus commonly seen? - CORRECT ANSWER Women of childbearing age- ages 15-45, African Americans are going to be at higher risk What is the diagnostic criteria for Lupus? - CORRECT ANSWER Must have 4/11 diagnostic criteria: Malar rash Discoid rash Photosensitivity Oral/nasal ulcers Non-erosive arthritis Cardio-pulmonary complaints Renal complaints Neurological concerns Immunological disorders + ANA test Hematologic disorders What is Sjogren's Syndrome and what is the treatment? - CORRECT ANSWER Dry eyes and dry mouth- treatment revolves around symptom management- artificial tears, hard candies, etc. SARAH MICHELLE LIVE REVIEW STUDY GUIDE 2024- 2025 LATEST UPDATE 3 | P a g e Common in lupus patients What is a major concern for lupus patients? How do we monitor this? - CORRECT ANSWER Impact on the kidneys- Lupus nephritis Be on the look out for glomerularnephritis as well as proteinuria These patients will require routine UA for assessment of their kidneys and protect them What is the function of the thyroid? - CORRECT ANSWER Viral hormone gland Metabolism regulation- impacts every SINGLE cell within the body Proper growth and development across the entire lifespan What produces TSH? - CORRECT ANSWER Pituitary gland What is the function of TSH? - CORRECT ANSWER Tells your thyroid when to produce and release those critical thyroid hormones- T3 and T4. What disorders include hypothyroidism? - CORRECT ANSWER Iodine deficiency, Hashimoto's, or thyroiditis A presence of thyroid peroxidase antibodies indicates that? - CORRECT ANSWER Hypothyroidism is caused by an autoimmune process of some sort What are some signs and symptoms of hypothyroidism? - CORRECT ANSWER Weight gain, constipation, dry skin, cold intolerance, fatigue, course hair, facial puffiness, thick tongue, and maybe some cardiac side effects What patient education must be included regarding Synthroid administration? - CORRECT ANSWER Must be taken on an empty stomach before other medications What are signs and symptoms of a myxedema coma? - CORRECT ANSWER Low body temperature, edema, confusion, lethargy, tongue thickening, difficulty breathing What medications can precipitate myxedema coma? - CORRECT ANSWER Lithium or amiodarone Your patient who is on 75 mcg Synthroid PO daily comes in for a 6 week follow up to check their TSH level. When you get the results, their TSH is 0.1. What should you do next as the NP? - CORRECT ANSWER Assess how the patient is taking their Synthroid