NSG 6420 FINAL EXAM

Otitis externa – administration of topical agents Topical antibiotics are indicated for uncomplicated conditions x 7 days. Choose medications that are effective against both P. aeruginosa and S. aureus, such as Fluoroquinolone antibiotics. OTITIS EXTERNA WITH SWOLLEN OR OCCLUDED EAR CANAL. WHAT IS INTERVENTION? I CHOSE THE ONE WITH EAR WICKING IN THE ANSWER EENT – differentials, assessment SEVERAL QUESTIONS ON BRONCHITIS… Acute bronchitis tx- symptom management, no abx There was one about what was the diff dx for hypothyroidism, devated nasal septum, chronic sinusitis and one more thing…I answered mumps. I don’t know if it’s right but for some reason my gut told me to answer that so I didn’t 2nd guess myself lol Bacterial conjunctivitis – education, counseling Counsel and educate patients that symptoms are self-limited and abx not always necessary. Controversial re: initially starting abx or not. Initial choices for a topical antibiotic include trimethoprim–polymyxin B or fluoroquinolone drops QID x 1 week. Patient should avoid touching eyes, throw away eye makeup and purchase new after infection resolves, if not could re-infect eyes. 3 types of bacterial conjunctivitis require systemic tx: H. influenzae- tx with augmentin, Gonococcal- tx with ceftriaxone 1g IM or cipro 500mg PO x1, if PCN allergy, and azithromycin 1gm PO x1; requires same day ophthalmologist referral Chlamydial- azithromycin 1gm po x1 or doxycycline 100mg BID x 7days. INTERVENTION THAT IS NOT APPROPRIATE- CLEAN ALL LINENS Group A Strep Group A β-hemolytic Streptococcus (GAS) - most important to identify b/c responsible for acute rheumatic fever (ARF) and poststreptococcal glomerulonephritis. Peak incidence late winter- early spring but seen all yr long. Spread by respiratory secretions or lg droplets, incubation 2-5 days. THERE IS A QUESTION ABOUT THIS… I ANSWERED 24-72 HOURS S/S: erythema of the throat and tonsils; patchy, discrete, white or yellowish exudate; pharyngeal petechiae; and tender anterior cervical adenopathy. Fever above 38.3 or 101 previous exposure- may exhibit the typical diffuse exanthem of scarlet fever, a sandpaper-type rash, and erythematous (strawberry) tongue. Pressure on the tonsillar pillars may produce purulent drainage. The uvula may also be edematous. Diagnostic studies: throat culture, a rapid antigen detection test (RADT), and sometimes an antistreptolysin O (ASO) titer (not used initially as takes longer and may not be positive with initial infx). Treatment: PCN V, 500 mg BID -TID x10 days, or Amoxicillin 250mg TID-QID or 500mg BID x10 days. If PNC allergy, clarithromycin 250mg BID x 10 days. Influenza/Bronchitis – risk factors- environmental risk-living in substandard housing esp. greater risk for kids, exposure to sick individuals, diabetes pt have increased risk, those in nursing homes higher risk of getting viruses treatment- symptomatic management-antipyretics, bedrest, increased fluids, cough meds, etc Macrolides are first line treatment. Azithromycin 500mg day 1, then 250mg d 2-5, erythromycin 500mg QID x 14 days, clarithromycin 500mg BID x 7d. Second line therapy: Bactrim 160-800mg (DS) BID x 14 days. THIS QUESTION WAS ABOUT WHICH PATIENT WAS NOT AT GREATER RISK FOR COMPLICATIONS…choices were young kids, pregnant, ppl with chronic dx and one other. I answered kids because it seemed the least wrong. National Asthma Education and Prevention Program – Stepwise Treatment WHAT is step 1 tx for persistent asthma? I answered low dose ICS + LABA COPD – assessment, education, treatment Question about what is dx? Increased AP diameter, exp wheezes, and chronic bronchitis or something? Answer was clearly COPD There was 1 more question about COPD, I can’t remember it though Most common complaint- dyspnea on exertion How is COPD diagnosed: spirometry COPD stages & GOLD tx: Stage I-Mild, FEV1/FVC<70%, FEV<80%, chronic cough and sputum production/ tx: SABA Stage II- Moderate: FEV1/FVC<70, FEV1 50-80%, SOB with exertion, cough/sputum production / tx: SABA + LABA Stage III- severe, FEV1/FVC <70, FEV1 30-50%, Greater SOB, reduced exercise capacity, fatigue, exacerbations more frequent with decrease QOL. / tx: SABA + LABA + INHALED GLUCORTICOIDS Stage IV: VERY severe, FEV1/FVC<70, FEV1>30, respiratory failure, cor pulmonale (increase jvp, edema), QOL Impaired How does FEV1 decrease: inflammation, narrowing of peripheral airway, airway collapse in severe emphysema Education for COPD: Smoking cessation is the MOST important intervention to stop the rapid decline in lung function. Education on medication, oxygen therapy, smoking cessation, nutrition, exercise, breathing techniques to minimize dyspnea, and health promotion should be stressed. JNC 8 – Treatment recommendations (Buttaro p. 575) - HTN o Goal- bp <140/90 for everyone o Over 60 without CKD 150/90 - Medications HTN o Black- thiazide and CCBs avoid ace/arbs o Non-black- thiazide- ace/arbs, CCBs o CKD- ace/arb - NOTE- AVOID THIAZIDES IF ALLERGIC TO SULA (contains sulfa) What would prescribe if patient failed to reach 6 week BP goal with just HCTZ? I answered ACE-I/ARB Aortic stenosis – assessment, treatment - Mid-systolic murmur - Radiates to the neck - Harsh and noisy murmur Classic symptoms: Chest pain, syncope, exercise intolerance, and dyspnea are assoc w/ severe AS Management: Asymptomatic AS- periodic monitoring for symptom development and dx prog. Symptomatic management is surgical: 2 options: surgical replacement and transcatheter aortic valve replacement (TARV) Question about testing and which one would NOT be recommended or something like that…I answered cardiac stress test, others were about consult with cardiologists, and lifestyle modifications A fib – assessment, treatment Treatment: initial tx should be to convert back to SR either by cardioversion or antiarrhythmic drugs (amiodarone). Long term goals: rate control and prevention of thromboembolism. Amiodarone is the most effective antiarrhythmic drug, has long half-life, can build up in liver and cornea. Beta-blockers or nondihydropyridine CCBs (verapamil or diltiazem) are best for rate control alone. Diverticular disease – assessment, treatment -Diverticulosis-sac like herniations in the colon; increasing dietary fiber will reduce incidence of diverticular dx. Treatment is increased fiber intake WHO recommends 27-40g/day; can find dietary fiber in whole grains and cereals, fruits, vegetables and legumes -Most patients are asymptomatic; if c/o symptoms- irregular defecation, intermittent abdominal pain, bloating, or excessive flatulence, associated complaints include urinary dysfunction, anorexia, nausea, vomiting, and heartburn, and older individuals often relate recurrent bouts of steady or crampy pain Diverticulitis: -Most common complication is acute diverticulitis; Most patients with infection or localized inflammation have mild to moderate, colicky to steady, aching abdominal pain usually present in the LLQ, accompanied by fever, and leukocytosis, N/V, constipation or diarrhea. CT of A/P is standard to eval diverticulitis. -Treatment: treatment consists of taking clear liquids for 2 or 3 days, limiting physical activity, and taking oral antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS, 160 mg/800 mg twice daily) plus metronidazole (500 mg three times daily), amoxicillin–clavulanate potassium (Augmentin, 875 mg/125 mg), or ciprofloxacin (500 mg twice daily) plus metronidazole (500 mg three times daily) for 7-14 days What is non-pharmacological tx for diverticular dx? Increase dietary fiber IBS – -assessment- abd pain must be present for dx, may have constipation or diarrhea or alternating pattern of constipation/diarrhea. -treatment- focus of IBS treatment is symptomatic and includes dietary modifications, medications, supportive and behavioral therapy, education, and reassurance. -successful management of IBS appears to be the establishment of a therapeutic patient/provider relationship; physiologic and psychosocial factors play a role in the severity of symptoms, expression of illness and should be in development of a management plan -Meds used: antispasmodics, antidiarrheals, anti-constipation, psychotropic (antidepressants) and alternative therapies such as probiotics or peppermint oil Question about why are psychosocial interventions important in tx of IBS? There are 2 answers that could be right, I picked the one that said something along the lines of psychosocial plays a role in the dx but not the one with diagnosis in the answer. I can’t remember how the question and answer are worded specifically C-dif – Risk Factors- Increasing age (excluding infancy) Severe underlying disease Non-surgical gastrointestinal procedures Presence of a nasogastric tube Receiving anti-ulcer medications Stay on intensive care unit Long duration of hospital stays Long duration of antibiotic course Receiving multiple antibiotics Which is not a risk factor for c diff? I picked gender -clindamycin, cephalosporins, and PCNs as the classes of antibiotics most associated with C difficile associated diarrhea I feel like there was a question about these meds and cdiff on there, but I can’t remember it exactly Anemia – assessment, risk factors, treatment Assessment: fatigue, malaise, headache, dyspnea, irritability, and a mild decrease in exercise tolerance, reduced exercise capacity, resting tachycardia, and dyspnea requiring supplemental oxygen. Other nonspecific findings that can accompany long-term, moderate to severe anemia include wide pulse pressure, mid-systolic or pansystolic murmur, confusion, lethargy, brittle nails, glossitis, angular cheilitis, and spoon-shaped nails. Pallor of the mucous membranes, lips, conjunctivae, nail beds, and palmar creases. Diagnostics: CBC with platelet count, white cell differential, RBC morphology, reticulocyte count, and a peripheral blood smear; serum ferritin, TIBC, and Iron saturation Treatment: depends on type of anemia; usually involves supplementation of the deficiency, such as iron, vit b12 or folate. Anemia question including lab results most of which weren’t helpful, put I picked that it was Iron def anemia, based on the info it gave me Pernicious anemia – risk factors, diagnosis, treatment Pernicious anemia- (macrocytic-normochromic) most prevalent cause of vitamin B12 deficiency. Onset usually occurs after the age of 50 years. Atrophy of the parietal cells of the stomach leads to a complete loss of intrinsic factor (IF). IF is necessary for the body to be able to absorb dietary sources of vitamin B12. Risk factors: Autoimmune and linked to heredity. Also, chronic use of PPIs & H2 blockers can also possibly contribute. Chronic gastritis can damage parietal cells, and partial or complete gastric resection results in loss of parietal cells and therefore loss of IF. Often coexists with other autoimmune disorders, GI disorders, type 1 diabetes, and thyroid (Hashimoto, Graves, or Addison’s dx) Diagnosis- Schilling test (used for dx but not monitoring). -there is a question that asks what is the diagnostic test for pernicious anemia? Treatment: Tx underlying problem which is usually malabsorption; tx = replacement of vit b12. Dosage forms available in oral, IM, and intranasal spray. Oral B12 usually not used for Pernicious anemia since there is malabsorption issue, usually given IM. Dose of Vit 12 1000mcg daily x1 week then monthly, must be continued for life. Questions about pernicious anemia and tx? Vitamin b 12 GIB – assessment What drug can cause GIB? The answer is ASA ED – treatment Goal of tx is to identify and treat cause -First line tx- Oral phosphodiesterase type 5 (PDE5) inhibitors are a class of medications that facilitate erection by enhancing the effects of nitric oxide and blocking the degradation of cGMP; -Med names: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra); meds differ in onset of action and duration -Second-line therapies for the treatment of ED include intraurethral suppositories, intra- cavernous injections, and vacuum pump devices. -Alprostadil (prostaglandin E1) is indicated for the treatment of ED related to angiogenic, neurogenic, psychogenic, or mixed causes. Alprostadil is a urethral suppository (Muse) or as a solution for intracavernosal injection (Caverject, Edex). The patient with ED who is at increased risk (or something like this)? I answered the one with the unstable angina, I picked that one because I figured that would be the one who would use Nitro-which those shouldn’t be taken together Prostatitis – assessment The question about this asks about the NIH scale for prostatitis and which one is the asymptomatic classification? According to the following it should be Category IV Prostatitis describes a combination of infectious diseases (acute and chronic bacterial prostatitis), CPPS or asymptomatic prostatitis. The NIH classification of prostatitis syndromes12 includes: • Category I: Acute bacterial prostatitis (ABP) which is associated with severe prostatitis symptoms, systemic infection and acute bacterial UTI. • Category II: Chronic bacterial prostatitis (CBP) which is caused by chronic bacterial infection of the prostate with or without prostatitis symptoms and usually with recurrent UTIs caused by the same bacterial strain. • Category III: Chronic prostatitis/chronic pelvic pain syndrome which is characterized by chronic pelvic pain symptoms and possibly voiding symptoms in the absence of UTI. • Category IV: Asymptomatic inflammatory prostatitis (AIP) which is characterized by prostate inflammation in the absence of genitourinary tract symptoms. Prostatitis staging and treatment- Four basic types of prostatitis: acute bacterial, chronic bacterial, nonbacterial, and prostatodynia Usually gram-negative organisms for both acute and chronic prostatitis S/S: Fever, chills, malaise, myalgias, and arthralgias are common with acute bacterial prostatitis. Genitourinary symptoms include hesitancy, frequency, urgency, nocturia, dysuria, and a sensation of incomplete bladder emptying. Acute prostatitis- Bactrim DS and fluoroquinolones first line tx; tx for at least 3 weeks, if not 6 weeks to prevent from becoming chronic prostatitis Chronic prostatitis-treatment is more complex because of the difficulty in attaining therapeutic intraprostatic antibiotic levels in a noninflamed prostate. Tx: highest effectiveness for penetration into prostatic tissue include fluoroquinolones, sulfonamides, tetracyclines, and macrolides; may need tx for 4 months. Testicular torsion – assessment, treatment -involves twisting of the spermatic cord & results in occlusion of blood flow sudden in onset with extreme pain; may awaken the patient from sleep or be trauma induced. -Assoc s/s-patient may experience abdominal pain, nausea, and vomiting; 25% of patients have a fever. -2 clinical signs that are suggestive of testicular torsion are: a testicle that rides high in the scrotum and an absent cremasteric reflex on examination. -Diagnostics: testicular US Tx: Treatment is prompt surgical consultation with surgical exploration with the intent to prevent ischemia and restore blood flow Non-traumatic testicular torsion- what is the intervention? I answered surgery. The only other answer I remember is detorsion, which I wasn’t sure was a thing, and I don’t ever remember learning anything other than immediate surgery is needed. Genital herpes – assessment, treatment -visible, painful genital or anal lesions or grouped vesicles at the site of inoculation and regional lymphadenopathy; recurrent outbreaks. -spread by direct contact with lesions, mucosal membranes, or genital or oral secretions; transmission can occur when no outbreak present -tx acyclovir or valacyclovir Question about tx for herpes, it’s the only answer with acyclovir in it. Scabies – assessment, treatment -Assessment: Red, raised burrows with intense itching at night -Tx: topical application of 5% permethrin cream (Elimite), applied from the neck down, giving attention to the interdigital webs, axillae, umbilicus, gluteal cleft, genitals, areas under the nails, and soles of the feet. The medication should be left on for 8 to 12 hours and then washed off. The treatment should be repeated in 1 to 2 weeks. -Oral ivermectin is used off label to treat crusted scabies or if topical treatments are not effective. The dose of ivermectin is 200 µg/kg, taken once only, but the dose may be repeated in 14 days There are 2 questions about scabies. One with permethrin cream and the other with ivermectin as the answers Contact dermatitis/seasonal allergies – assessment, treatment 2 types irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD); both produce rash and 80% of time it is noted on hands ICD-use products of low irritation and allergy potential, such as petrolatum. Domeboro solution is soothing for acutely inflamed and crusting lesions. ACD-mainstay of tx is topical medium to high dose corticosteroids, may also benefit from antihistamines as is type 4 hypersensitivity rx Contact dermatitis tx. It’s the only answer antihistamines in the answer, the others don’t make sense. Melanoma – risk factors, assessment Risk factors- Personal or family history of previous melanoma ≥50 common moles Atypical or large moles, especially if dysplastic Red or light hair Solar lentigines (acquired brown macules on sun-exposed areas) Freckles (inherited brown macules) Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths Light eye or skin color, especially skin that freckles or burns easily Severe blistering sunburns in childhood Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy Personal history of nonmelanoma skin cancer Which person is statistically less likely to get melanoma? I picked the African American Assessment- by the ABCDE tool A-Asymmetry B- Border irregularity C-color variations D-diameter > 6mm E- elevation/evolving (or changing) Question about staging of melanoma, and which one is NOT correct? I picked color, because the others were the Tumor, Node, Metastasis answers. It was the one that made the most sense Orthopedic pain – assessment, treatment Couple questions about low back pain. One asks about what is tx and other is listing diff dx for what reported symptoms (kidney infection/stone, lumbar sprain/strain, etc). The one for tx- I answered cyclobenzaprine and the other one is low back pain There is one about carpal tunnel and tx. I picked no pharmacological tx for carpal tunnel. There is one about knee pain and tx as surgery isn’t indicated. I picked the ones with pain meds in the answer. There is also a question about a McMurray test, and what does it assess? I picked knee, which if google is right then that’s correct lol Spurling test medical maneuver used to assess nerve root pain (also known as radicular pain). The examiner turns the patient's head to the affected side while extending and applying downward pressure to the top of the patient's head. Dix-Hallpike test Asks about which test would assess vertigo/dizziness Positional Nystagmus Testing (Hallpike-Dix Maneuver) 1. Check the patient for spontaneous nystagmus while he or she is seated on the examining table. 2. Bring the patient quickly back to the recumbent or supine position with the head extended back 30 to 45 degrees over the end of the bed or table and the head tilted 30 to 45 degrees to one side (i.e., one ear down toward the floor). 3. Repeat the previous step two times, once with the head tilted to the left, and then again with the head tilted to the right. 4. Observe the patient for latency, duration, direction, and fatigability of nystagmus, both while positioned down and as helped to upright position. Trendelenburg test Tests for hip dysfunction- Is assessed from behind as patient shifts weight from one leg to the other. Negative (normal) – the pelvis that remains level when weight is shifted from one foot to the other Positive (abnormal) the pelvis tilts toward the unaffected hip during weight-bearing on the affected side Vertigo – assessment General medical review, including meds Neuro exam with cognitive screen, cranial nerves, motor exam, sensory exam for vision and hearing, gait and balance and Romberg test. Cardiac exam- heart rate and rhythm, heart sounds, carotid bruits, BP including orthostatic vitals Dix-Hallpike test (assessment for vertigo) See above. Seizures – International Classification of Epileptic Seizures I. Partial seizures. Epileptic focus is in one hemisphere of the brain. Also called focal or local seizures. A. Simple partial seizures. Usually the aura of a complex seizure. Patient has no loss of consciousness. 1. Motor: tonic or clonic activity of one arm or leg 2. Sensory: such as an auditory, olfactory, visual hallucination 3. Autonomic: such as the epigastric rising sensation 4. Psychic: déjà vu, fear, indescribable feeling B. Complex partial seizure. Consciousness is altered. Patient may exhibit complex behaviors. 1. Can begin with a simple partial onset 2. Can begin with immediate alteration of consciousness C. Partial seizure evolving to generalized. Patient starts with a simple or complex partial seizure that evolves into a generalized tonic-clonic seizure. II. Generalized. Epileptic focus is not lateralized to one hemisphere. Begins in both hemispheres of the brain simultaneously. A. Nonconvulsive. 1. Absence (petit mal) 2. Atonic: loss of muscle tone (drop attacks) B. Convulsive. Involves motor activity. 1. Myoclonic: abrupt muscle twitches or jerks 2. Tonic-clonic (grand mal): tonic, then clonic activity 3. Tonic: involving increased muscle tone, rigidity 4. Clonic: muscle contraction and relaxation movements Treatment- goal of management in epilepsy is to control seizures with minimum adverse effects; control with a single drug should be goal. Generalized seizures- -first line therapy- levetiracetam (Keppra)- can be used for gen or focal seizures -Valproate (Depakote)- addt’l first line drug for generalized forms of epilepsy -Other options include Lamotrigine (Lamictal)-favored for women r/t low risk of birth defects, For focal epilepsy and complex partial seizures -carbamazepine (Tegretol)- most effective drug & low cost Phenytoin (Dilantin)- effective but has worse SE profile esp for women Topiramate (Topamax)- not first line d/t cognitive SE: dysphagia and somnolence; effective for migraine prophylaxis Gabapentin (Neurontin)- not very useful for seizure activity, can exacerbate seizures primary generalized epilepsies; useful as pain management drug There is a question about seizures. I’m trying to remember it. Neuro – assessment Thalassemia vs deficiency anemia Thalassemia- remember genetic disorder Thalassemia-rare group of inherited blood disorders, ranging from mild to severe, which is caused by a variant or missing gene which affects production of Hgb. 2 types alpha and beta. Diagnosis made within first few years of life. Management includes 2 things: regular transfusions to keep Hgb adequate for normal growth and development and iron chelating therapy to prevent iron overload. Deficiency anemia (Vit b12 and folate def)-primary cause of macrocytic anemia. Both nutrients required for DNA synthesis, and BM is highly sensitive to def. B12 found in meats and meat products, folate found in most foods, esp green leafy foods. Vit b12 def when severe has neuro s/s as well as anemia s/s. CBC with low Hgb and MCV greater than 100. Management includes determining if it is b12 def or folate def, or both, treating the cause-either supplementation with vit b12 or folic acid. DM2 – assessment, diagnosis, treatment What test would help the provider assess DM?? CMP -assessment: Full physical assessment with attention to end-organ function/damage (eyes, brain, kidneys); important key assessments: VS, eyes, neck (thyroid), cardiac, lungs, skin, feet -diagnosis: symptomatic patients- random plasma glucose reading over 200. - asymptomatic patients- 2 random plasma glucose readings over 200 -per expert panel- HgA1c over 6.5% or higher, fasting glucose of 126 or higher, 2-hour plasma glucose level of 200 or higher during oral glucose tolerance test -treatment: -Metformin is first line therapy, mechanism of action= suppression of hepatic glucose production, which results in lower fasting glucose levels. -Sulfonylureas-(glyburide, glipizide, glimepiride) reduce blood glucose by stimulating insulin secretion; can reduce HgA1c by 1.5% -α-Glucosidase inhibitors- (Acarbose, miglitol)-act in small intestine by delaying digestion of polysaccharides; inhibition of starch and sucrose enzyme reduces post prandial glucose levels; must be taken before 1st bite of meal with carbohydrates -thiazolidinediones (TZDs)- (pioglitazone (Actos) and rosiglitazone (Avandia)-improve the sensitivity of liver, fat, and muscle to both endogenous and exogenous insulin, works to decrease insulin resistance, thereby improving insulin sensitivity and decreasing insulin levels, reduces hepatic glucose output. -glucagon-like peptide 1 (GLP-1) agonists- (Exenatide (Byetta) given BID, Liraglutide (Victoza)-given QD, exenatide (Bydureon), dulaglutide (Trulicity), and albiglutide (Tanzeum)- given q week)- non-insulin injectable, stimulates insulin secretion, suppresses glucagon secretion, & slows gastric emptying -dipeptidyl peptidase 4 (DPP-4) inhibitors- work to release insulin, and decrease glucagon levels by inactivation of incretin hormones -sodium-glucose cotransporter-2 (SGLT2) inhibitors-canagliflozin (Invokana), empagliflozin (Jardiance), and dapagliflozin (Farxiga)-given QD-increase excretion of glucose in the urine and reduce plasma glucose concentration, may assist in weight loss There were a few questions on DM, but answers were silly in that only 1 made sense and none of the other meds listed even tx DM Hypothyroidism – assessment, treatment -Common s/s-most common presenting symptom- fatigue, increased sensitivity to cold, weight gain, hoarseness, puffiness of the face and hands, heavy and irregular menstrual periods, dry skin, dry and brittle hair, depression, paresthesias, muscle aches, and constipation. Goiter may or may not be present. -assessment-TSH first line diagnostic test, if TSH is elevated T4 should be checked. Treatment-levothyroxine until TSH level return to normal; recheck levels every 4-6 weeks until euthyroid level is obtained, then checked every 6-12 months Graves disease – assessment, risk factors, treatment -Autoimmune thyroid disorder-most common cause of hyperthyroidism Common s/s- dry blurry eyes, diffuse goiter, thyroid bruit, SOB, palpitations, tachycardia, angina, weight gain, proximal muscle weakness, heat intolerance, tremor, pruritus, hyperhidrosis, onycholysis, osteoporosis, anxiety, irritability, nervousness, sleeplessness. Lists these s/s and asks what is most likely dx? Hyperthryoidism Risk factors-family history of graves dx, women (7xtimes more likely than men), age >40, other autoimmune diseases, emotional or physical stress, pregnancy and smoking Also question about risk factors for Graves/hyperthyroidism (I think) Treatment-beta-blockers, thioamide therapy with methimazole, or propylthiouracil- inhibits thyroid hormone synthesis by blocking organificaiton, radioiodine therapy or thyroidectomy; referral to endocrinologist Metabolic syndrome – assessment Risk factors- genetic, high BMI/obesity, age (increase with age), meds (corticosteroids, antidepressants, and anticonvulsants) It is characterized by: -insulin resistance with hyperinsulinemia; -hypertension; -abdominal (central or visceral) obesity; and -dyslipidemia consisting of hypertriglyceridemia, low HDL and increased LDL Lists these and asks what is dx? Metabolic syndrome Characteristics that have been added more recently include elevated C-reactive protein (CRP) levels, increased plasminogen activator inhibitor 1 (PAI-1) levels, and microalbuminuria. -velvety skin on neck and axilla The definitive test (gold standard) for determination of insulin resistance is the euglycemic insulin clamp technique. However, very expensive, more practical way is by measuring fasting plasma insulin concentration. High plasma insulin values with normal glucose levels suggest insulin resistance. -diagnosis of metabolic syndrome is based on clinical presentation, so it is important to rule out hypertension, dyslipidemia, or obesity without manifestations of insulin resistance. Parkinson’s What med is prescribed for it? Carbidopa/Levodopa Other Pt is at risk for vitamin def when on which medications? Anticonvulsants Patient with seizures, what would cause you to order immediate imaging? -First seizure, first seizure over age of 40, recovered post seizure, plus one more option. I answered first seizure over 40 but debated btw that and first seizure. There were questions about which med treats which disease. Most of these were easy since we know meds. Example: Levothyroxine for Hypothyroidism, etc.