LATRINA WALDEN REVIEW, Questions and answers. 100% proven pass rate,

LATRINA WALDEN REVIEW, Questions and answers. 100% proven pass rate, Document Content and Description Below 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 (Poly merase 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 * Impetigo- honey crusted lesions Treatment: Topical mupirocin ( Bactrobam ) * 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 *Always we will do vision acuity FIRST!! *Diabetic retinopathy- Cotton wool spots, microanyurmisms, retinal hemorrhages * 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 ACBC * 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 BCAC. This is conduction hearing problem * Otitis media- caused by strep pneumo (most common). 1st line Treatment- Augmentin, amoxicillin* Ruptured tympanic membrane- blood and pus on pillow case (you know they have ear infection) watch it will heal on own * Otitis media with effusion (fluid on ear) - treat with decongestant, steroid nasal spray. Treat like allergy. Tympanic membrane looks bulging, shiny , fluid bubble * Another name for Otitis externa (swimmer ear) cause pseudomonas – tragus pain, red canal. Treatment: cortiscosporin drops (neomycin) * Xanthelasma- Fat pads around your pats eyes, check lipid panel (high cholesterol, hyperlipidemia) how long will take to resolve.. up to 10 years * Conjunctivitis: Viral: tearing, little exudate (normally unilateral) Bacterial: lots of exudate, crusty, drainage, eyelid sticking together (normally unilateral) Allergy: stringy, slight tearing, no exudate (starts bilaterally) * Mononucleosis- it is cause for Epstein virus. what diagnostic test is used: mono spot also known as heterophile antibody test. They Can go back to regular activity 4-6 weeks once the spleen goes back down. An ultrasound is normally ordered to check the spleen….3 month later come back the patient you treated, they probably caught something else not Mono. We do not give Amoxicillin, augmentin, ampicillin, Not “A” meds * Viral rhinitis- 1st line treatment: intranasal steroid, assessment blue tinged swollen nasal passage way Watery rhinorrhea, corza, mucosa a little red, fever, may or may not have sore throat…. What differential pop up to your head… Allergic Rhinitis … Blue pinch swollen nostril… Rhinitis first line treatment is intranasal Steroids *Afrin and visine is only used for 3 days- do not over use due to rebound stiffness (rhinitis medicamentosa) Cardia MR. ASS (Mitral Regurgitation, Aortic stenosis= Systolic S2 MS. ARD (Mitral Stenosis, Aortic regurgitation=diastolic S1) * MI on EKG: ST elevation, presents: N/V SOB, fatigue, weakness, arm/jaw/back pain, crushing pain in chest * Beta blocker given after MI to reduce cardiac load and slows down the heart to allow healing * Heart murmurs -Know Location and sound*Mitral regurgitation- loud, harsh blowing (5TH ICS midclavicular line). Radiates to the axillary * Stenosis- soft, rumbling either mitral or Aortic * Aortic stenosis (2nd ICS right sternal boarder) Radiates to the neck *Grade murmurs (1st time you hear a thrill is grade 4) S3 heard in CHF, Pregnant pt (fluid overload) S4 heard in elderly pt (Left Ventricular Hyperthrophy) * Isolated hypertension (wide blood pressure reading 170/60) Calcium channer blockers CCB-----NOT IN 1st & 2nd degree heart block * 1st degree heart block- prolonged PR interval * PAD- legs hurt at night, poor pulses, intermittent claudication, pain is relieved when elevated, shiny, hairless, cold. In office testing- (gold standard) ABI- Bad 0.9 ---1.3 calcifications * Thiazide- cause issues, most common or important hyperglycemia, hypertriglycerides, and hyperuricemia *Endocarditis- fever, chills, splinter hemorrhages, Janeway lesions (red spots on soles of feet or palms of hands), Osler’s nodes (red tender spots under the skin) * Before starting a stain check liver function (LFT) * Pulsus paradoxus- drop in blood pressure during inspiration, 10 pts or great drop. Mostly in Asthma patients * NSAIDS- why we don’t like to give cardiovascular pt NSAIDS can cause hypertension and CHF, reason * Diabetic and HTN- give ACE or ARB * BPH and HTN- alpha blocker hytrin (terazosin HCL) * Raynaud’s- common in cold weather, fingers are cold, lose sensation, different color finger tips ( red, blue, pale). Treatment: CCB * GERD- do NOT give Calciun Channel Blockers b/c cause GERD * Pregnant and HTN- DO NOT give ACE or ARB* CHF and HTN- do NOT give CCB * Metabolic syndrome – triad of symptoms obesity, HLD, HTN, do NOT give thiazide or beta blocker * Kidney stone and gout- do NOT give thiazide * COPD and Asthma – avoid beta blockers * Statin- Do not give/ avoid grapefruit juice * TB- seen in X ray upper lobes, Looks like black holes, “cavitations” Immunocompromised or immunosuppresed pt (HIV) 5mm Immigrants, “migrant farmers” or health care works- 10mm Culture and sputum is gold stand for DX *Pneumonia- in X ray seen in middle and Lower lobes * COPD- 1st line treatment anticholinergic, SABA second choice, LABA, inhaled corticosteroid, refer * Asthma- 1st line treatment SABA, low dose inhaled corticosteroid, LABA or Lama, increase inhaled corticosteroid to medium dose * Pertussis- whopping cough, treat with Azythromycin * Curve 65- used in a patient to determine readmission to hospital. Curve 65 stands for Confusion, urea (BUN), respiration, BP, Age (65). EXCEPT question *Community acquired pneumonia- Rust colored sputum, Treat Levaquin if 65 or older, if a child amoxicillin (high dose). The organism that causes is Strep Pneumo *AAA- presentation middle age man who smokes, white, male, tearing in the back * If you hear abdominal bruit? Could be Renal vascular stenosis or Renal Vascular hypertension- * Hyperthyroidism- weight loss, tachycardia, anxious, palpations. What is the disease process associated with? Graves disease, you treat with methimazole (Tapazole) and propylithiouracil. If you found a single nodule or multi nodule, what the most concern about? Single.. why? Most likely to be malignant. What do we do with multinodular? We used radioactive iodine therapy and synthroid for life.* Hypothyroidism- If you suspect they have it what king of symptoms you will see, weight gain, tired, dry skin, cold hands. The disease process associated is hassimoto’s, the lab test to confirm it is TPO (Thyroid peroxidase antibody) elevated, the TSH is normal * HGA1C- 9 or above started basil insulin What pancreas secret? Secrets insulin, amylase and also “Glucagon” * Fructosamine- name of a s