NR 509 APEA 3 Study FNP Leik System
Review Questions With Complete
Solutions
Sensitivity correct answer: (SNOUT) Negative results rules out the disease.
Specificity correct answer: (SPIN) Positive results rules in the disease.
Primary Prevention correct answer: Prevent the disease in its entirety. Examples include healthy diet, exercise, safety (helmets/seatbelts), immunizations, and job safety
Secondary Prevention correct answer: Early detection of a disease. Examples include screening tests
Tertiary Prevention correct answer: Rehabilitation of a disease. Examples include support groups, education for pts with pre-
existing disease, drug side effect safety, medical equipment safety, any type of rehab like PT or OT
Breast Cancer Screening Guidelines (USPSTF) correct answer: Onset = 50yo. Biannual. Stop at age 74yo. No SBE.
Breast Cancer Screening Guidelines (ACA) correct answer: Onset = 40yo. Annual. No stop age. Cervical cancer screening guidelines correct answer: Onset=21yo (immunocompromised individuals start at onset of sexual activity). Every 3 years Pap w/ no HPV test until 30yo. Pap and HPV test after 30 yo and can begin screening every 5 years. Stop at age 65yo. Complete hysterectomy means no Pap unless pt has history of cervical cancer or high grade lesion.
Colorectal cancer correct answer: Onset 50yo. 1) colonoscopy q
10 years if wnl, 2) sigmoidoscopy q 5 years if wnl, 3) annual FOBT with 3 stool samples. Stop age 75 yo.
Prostate cancer correct answer: USPSTF does not recommend screening with PSA but it based on individual pt.
Lipid screening correct answer: Onset 18-35/45yo screen if at increased risk of heart disease. Males >35yo and Females >45yo
Flu vaccine correct answer: LAIV - Live virus can only be given to healthy non-pregnant 2 -49 yo w/o recent hx of asthma (Peds). Cautioned or C/I in pts with egg, gentamicin or gelatin allergy and kids receiving aspirin therapy (Reye's syndrome). TIV (trivalent inactivated vaccine) is approved for >6months.
Tetanus vaccine correct answer: Q 10 years. Booster for dirty wounds if last TDAP/Td is > 5 years old. >7yo receive Td/TDAP. Avoid in egg allergy and Gullian Barre. 5 doses of DTAP aka Pediarix (2,4,6,15 months and 5 yo) First TDAP is at age 11-12yo. Td is the booster every 10 years or if someone has never had TDAP (came out in 2005) then they should have a one
time dose of TDAP and then continue with Td boosters. Pneumococcal vaccine correct answer: PCV 23 given one time at age 65 yo in healthy adults and for persons who are 2 years and older and at high risk for pneumococcal disease (e.g., those with sickle cell disease, HIV infection, or other immunocompromising conditions). PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma. One time booster given 5 years after first dose (So non-healthy pts will receive 2 doses of PSV23 over their lifetime). PCV 13 is for <5 yo. When both PCV13 and PPSV23 are indicated, PCV13 should be administered first; PCV13 and PPSV23 should not be administered during the same visit. When indicated, PCV13 and PPSV23 should be administered to adults whose pneumococcal vaccination history is incomplete or unknown.
Varicella Vaccine correct answer: 60 yo. May be given to pts who have previously had shingles. May be given earlier at age 50yo. Live virus so c/I include pregnancy and immunocompromised.
Herpes Keratitis correct answer: Inflammation of the cornea. C/O abrupt severe eye pain, photophobia and blurred vision. Diagnose with fluorescein dye and black lamp. Look for fernlike
lines (corneal abrasions appear more linear). Infection permanently damages corneal epithelium which may result in blindness.
Acute angle closure correct answer: Glaucoma (Increased ICP r/t blocked drainage duct). Elderly pt c/o abrupt onset of severe eye pain, HA, N/V, halos around eyes, and decreased vision. Exam reveals mid-dilated pupil that is oval shaped, cloudy cornea, and fundoscopic exam shows cupping of the optic nerve.
Tx = keep pt supine, trx to ED for acetazolamide, B blockers, and topical steroids. Sx may be required
Cholesteatoma correct answer: Cauliflower like growth in the middle ear. Pt c/o foul smelling discharge and hearing loss. On exam, no TM or ossicles visible. PMhx of chronic OM. The mass is not cancerous but it can erode in to the bones of the face and damage CN7. Tx = ENT referral for sx, abx. Mass is usually
made of epithelium and cholesterol. AKA pearl tumor.
Battle's sign correct answer: Bruise behind the ear over the mastoid process. Hx of trauma, and indicates a fracture of the basilar skull. Golden serous discharge from ear or nose. Refer to
ED for abx and imaging (CSF will be + for glucose. Mucous will be - for glucose).
Cavernous sinus thrombosis correct answer: Blood clot in w/I cavernous sinus. This cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema, photophobia, proptosis and inability to move eye appropriately.
Peritonsillar abcess correct answer: Pt c/o severe sore throat, difficult and painful swallowing (odonophagia) and LOCKJAW (trimus), and a hot potato voice. Unilateral swelling peritonsillar
area and soft palate with displaced uvula. Tx = I&D in ED or needle aspiration
Review Questions With Complete
Solutions
Sensitivity correct answer: (SNOUT) Negative results rules out the disease.
Specificity correct answer: (SPIN) Positive results rules in the disease.
Primary Prevention correct answer: Prevent the disease in its entirety. Examples include healthy diet, exercise, safety (helmets/seatbelts), immunizations, and job safety
Secondary Prevention correct answer: Early detection of a disease. Examples include screening tests
Tertiary Prevention correct answer: Rehabilitation of a disease. Examples include support groups, education for pts with pre-
existing disease, drug side effect safety, medical equipment safety, any type of rehab like PT or OT
Breast Cancer Screening Guidelines (USPSTF) correct answer: Onset = 50yo. Biannual. Stop at age 74yo. No SBE.
Breast Cancer Screening Guidelines (ACA) correct answer: Onset = 40yo. Annual. No stop age. Cervical cancer screening guidelines correct answer: Onset=21yo (immunocompromised individuals start at onset of sexual activity). Every 3 years Pap w/ no HPV test until 30yo. Pap and HPV test after 30 yo and can begin screening every 5 years. Stop at age 65yo. Complete hysterectomy means no Pap unless pt has history of cervical cancer or high grade lesion.
Colorectal cancer correct answer: Onset 50yo. 1) colonoscopy q
10 years if wnl, 2) sigmoidoscopy q 5 years if wnl, 3) annual FOBT with 3 stool samples. Stop age 75 yo.
Prostate cancer correct answer: USPSTF does not recommend screening with PSA but it based on individual pt.
Lipid screening correct answer: Onset 18-35/45yo screen if at increased risk of heart disease. Males >35yo and Females >45yo
Flu vaccine correct answer: LAIV - Live virus can only be given to healthy non-pregnant 2 -49 yo w/o recent hx of asthma (Peds). Cautioned or C/I in pts with egg, gentamicin or gelatin allergy and kids receiving aspirin therapy (Reye's syndrome). TIV (trivalent inactivated vaccine) is approved for >6months.
Tetanus vaccine correct answer: Q 10 years. Booster for dirty wounds if last TDAP/Td is > 5 years old. >7yo receive Td/TDAP. Avoid in egg allergy and Gullian Barre. 5 doses of DTAP aka Pediarix (2,4,6,15 months and 5 yo) First TDAP is at age 11-12yo. Td is the booster every 10 years or if someone has never had TDAP (came out in 2005) then they should have a one
time dose of TDAP and then continue with Td boosters. Pneumococcal vaccine correct answer: PCV 23 given one time at age 65 yo in healthy adults and for persons who are 2 years and older and at high risk for pneumococcal disease (e.g., those with sickle cell disease, HIV infection, or other immunocompromising conditions). PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma. One time booster given 5 years after first dose (So non-healthy pts will receive 2 doses of PSV23 over their lifetime). PCV 13 is for <5 yo. When both PCV13 and PPSV23 are indicated, PCV13 should be administered first; PCV13 and PPSV23 should not be administered during the same visit. When indicated, PCV13 and PPSV23 should be administered to adults whose pneumococcal vaccination history is incomplete or unknown.
Varicella Vaccine correct answer: 60 yo. May be given to pts who have previously had shingles. May be given earlier at age 50yo. Live virus so c/I include pregnancy and immunocompromised.
Herpes Keratitis correct answer: Inflammation of the cornea. C/O abrupt severe eye pain, photophobia and blurred vision. Diagnose with fluorescein dye and black lamp. Look for fernlike
lines (corneal abrasions appear more linear). Infection permanently damages corneal epithelium which may result in blindness.
Acute angle closure correct answer: Glaucoma (Increased ICP r/t blocked drainage duct). Elderly pt c/o abrupt onset of severe eye pain, HA, N/V, halos around eyes, and decreased vision. Exam reveals mid-dilated pupil that is oval shaped, cloudy cornea, and fundoscopic exam shows cupping of the optic nerve.
Tx = keep pt supine, trx to ED for acetazolamide, B blockers, and topical steroids. Sx may be required
Cholesteatoma correct answer: Cauliflower like growth in the middle ear. Pt c/o foul smelling discharge and hearing loss. On exam, no TM or ossicles visible. PMhx of chronic OM. The mass is not cancerous but it can erode in to the bones of the face and damage CN7. Tx = ENT referral for sx, abx. Mass is usually
made of epithelium and cholesterol. AKA pearl tumor.
Battle's sign correct answer: Bruise behind the ear over the mastoid process. Hx of trauma, and indicates a fracture of the basilar skull. Golden serous discharge from ear or nose. Refer to
ED for abx and imaging (CSF will be + for glucose. Mucous will be - for glucose).
Cavernous sinus thrombosis correct answer: Blood clot in w/I cavernous sinus. This cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema, photophobia, proptosis and inability to move eye appropriately.
Peritonsillar abcess correct answer: Pt c/o severe sore throat, difficult and painful swallowing (odonophagia) and LOCKJAW (trimus), and a hot potato voice. Unilateral swelling peritonsillar
area and soft palate with displaced uvula. Tx = I&D in ED or needle aspiration
