AANP FNP certification Complete Review

AANP FNP certification Complete Review "3 months of synthroid, TSH increased, T4 normal, what do you do? - Correct answer Increase Medication" "3 ways to assess cognitive function in patient with signs/symptoms of memory loss - Correct answer Mini mental exam" "4 month old with strabismus, mom is worried...... - Correct answer tell her it is normal." "4 month old wont keep anything down, what is the main thing you look at? - Correct answer Growth chart" "6 month old closed anterior fontanel. - Correct answer XRAY" "Abnormal cells on PAP, what do you do next? - Correct answer Refer for Colposcopy" "CAGE ACRONYM - Correct answer Cut down Annoyed by criticism Guilty about drinking Eye opener drink" "Causes of tachycardia - Correct answer Fever Anemia Hypotension" "Cranial nerves responsible for extraocular eye movements - Correct answer CN 3,4,6" All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM - Correct answer III first time audible, IV first time thrill" "Fundal height 12 weeks - Correct answer Fundal Height 12 weeks above symphysis pubis. EXAM Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US" "3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - Correct answer Iron, TIBC" "Definition of metabolic syndrome - Correct answer cluster of conditions that increase risk of heart disease, stroke, diabetes." "diagnose trichomoniasis - Correct answer wet prep" "Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - Correct answer Pelvic US" "Man with HTN, CAD, present femoral pulses but absent pedal - Correct answer Arterial Insufficiency" "McMurray's Sign (+) palpable or audible click while extending with varus stress - Correct answer Meniscus tears" "Lachman's Test - Correct answer pivot shift test (ACL tear)" "Newborn with foot turned in, what do you do? - Correct answer refer to orthopedist" "Osgood-Schlatter disease - Correct answer Knee pain. inflammation or irritation of the tibia at its point of attachment with the patellar tendon" "Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? - Correct answer Alzheimer's" "Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - Correct answer Refer to oncologist" "Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - Correct answer Tinea Corporis" "Pt presents with "bag of worms:, indicates? - Correct answer Varicocele" "Pt with atopic dermatitis, look for what other diseases? - Correct answer Asthma" "Pt with bleeding after menopause - Correct answer endometrial biopsy, need to screen for cancer" "Pt with hx of PID, increased rick for? - Correct answer Infertility" "Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? - Correct answer This is good. Want higher than 350" "Pt with hx of htn and stroke, now having memory loss. What does this indicate? - Correct answer Vascular dementia" "Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - Correct answer slap cheek, PVB19, rash hands / feet Fetal death and birth defects" "Quick assessment of patients fall risk? Timed Get up and Go - Correct answer Timed Get up and Go" "Red beefy tongue? - Correct answer pernicious anemia" "Rotator cuff injury presentation - Correct answer disturbs sleep, arm weakness, dull ache" "Shingles near eye - Correct answer immediate referral to ophthalmology" "Signs and symptoms of Roseola (6ths disease) ? - Correct answer Viral infection Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage -Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash -Seizures may occur during this period. -On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs. -High fever, pink flat or raised rash" "Treatment for chronic alcoholism: - Correct answer 12 step program" "Treatment for Gonorrhea? - Correct answer Rocephin 250mg IMx1 plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department" "Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - Correct answer IUD" "Basal cell cancer - Correct answer Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare" "Actinic Keratosis - Correct answer Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin" "Actinic Keratosis - Correct answer Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area -a pre squamous cell carcinoma occurs on sun-damaged skin biopsy cryo or 5fu cream" "subungual hematoma tx - Correct answer Make a hole and drain the blood" "Moderate acne treatment - Correct answer Without inflammation: Topical retinoid Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered) Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone" "heart murmur with holosystolic or pan systolic Heart mumur with mid systolic - Correct answer MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH" "Coarctation of Aorta - Correct answer COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs. -congenital cardiac condition characterized by a narrowing of the aorta -" "Murmur Grade III - VI - Correct answer Loud murmur easily heard" "JVD caused by - Correct answer -tension pneumothorax, -Rt. sided heart failure, -cardiac tamponade, -traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale" "Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - Correct answer Anterior septum" "Definitive diagnosis of acute bacterial prostatitis - Correct answer urinalysis and culture" "GERD treatment - Correct answer H2 is first line, give hs" "Grade 3 cells on Pap, treatment? - Correct answer LEEP excision" "Fingernail hematoma treatment? - Correct answer drill hole and drain blood?" "Increased risk of ectopic pregnancy - Correct answer Salpingitis, or history of abortion, PID," "Koplick spots - Correct answer Measles (rubeola). Grains of salt lesions inside mouth in Measles" "Koplick spots - Correct answer Measles (rubeola). Grains of salt lesions inside mouth in Measles" "Legg-Calve-Perthes Disease - Correct answer Avascular necrosis of the proximal femoral head" "Lipid level of 1500, increased risk for? - Correct answer Pancreatitis" "Low HGB, Low HCT, High MCV indicates what? - Correct answer Macrocytic anemia, B12 Def" "Man with BPH, prostate feels on digital exam? - Correct answer Enlarged, symmetrical, smooth" "pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - Correct answer endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles." "Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - Correct answer PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up," "Chronic Bronchitis Treatment - Correct answer Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen" "TB... PPD is positive if area of induration is: - Correct answer >5 mm in an immunocompromised patient or close contact >10 mm in immigrant, health care workers, drug user >15 mm in a patient who lives in an area where TB is very rare." "what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - Correct answer Croup/Epiglottitis" "AV nicking (Arterioles pressing on vein of the eye) - Correct answer HTN retinopathy" "intraocular pressure (IOP) - Correct answer Fluid pressure inside the eye; measured with tonometry" "Rovsing sign - Correct answer pain in the RLQ when the LLQ is palpated (indicative of appendicitis)" "Pencil-like stools occur in an obstruction of what - Correct answer Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy" "headache after trauma - Correct answer SDH" "migraine headache - Correct answer -paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate" "Vitamin B12 - Correct answer Folate shares a close relationship with this other B Vitamin." "Vitamin B12 - Correct answer Cognitive deficits, glossitis, pernicious anemia, Folate shares a close relationship with this other B Vitamin." "88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. - Correct answer be changed to NSAID, SED rate is a sign of inflammation" "Which medication causes low sperm count for a patient - Correct answer SSRI" "grandiosity - Correct answer Exaggerated belief in or claims about one's importance or identity. Bipolor" "ADHD - Correct answer A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity." "pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? - Correct answer HPV test if not done. Refer for colposcopy" "Chlamydia trachomatis - Correct answer Doxycycline (+ ceftriaxone for gonorrhea coinfection)" "Genital warts treatment - Correct answer Cryotherapy OR Podophyllotoxin cream - OR Imiquimod (Aldara cream)" "HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - Correct answer tell the pt. that he is qualified to be diagnosed with AIDS according to CDC" "Most common cause of death in children - Correct answer motor vehicle" "Tanner 2 - Correct answer Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker" "Tanner 4 - Correct answer Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum" "pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. - Correct answer vascular dementia" "presbycusis - Correct answer a gradual loss of sensorineural hearing that occurs as the body ages" "Which among the list can cause increase in respiration - Correct answer hypercapnia" "Osteoporosis Risk Factors (ACCESS) - Correct answer A-lcohol Use C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS" "to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - Correct answer VITAMIN D 600-800, CALCIUM . OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH" "Carotid bruit - Correct answer abnormal flow of blood through the carotid artery" "Carotid bruit - Correct answer abnormal flow of blood through the carotid artery due to atherosclerotic disease" "Common causes of GERD - Correct answer risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil" "Common causes of GERD - Correct answer risk factors- alcohol, anticholinergic, CCB, BB chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline" "Zeprexa. What lab and intervention to put in place - Correct answer CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose" "Weber test - Correct answer Sensorineural loss Weber test(top of head) no laterization, normal finding, does not lateralize to either ear, bilateral hearing loss, if hear better in left ear, right sensorineural loss" "Weber test - Correct answer Sensorineural loss Weber test (top of head) no laterization- normal, does not lateralize to either ear- bilateral hearing loss, if hear better in left ear, right sensorineural loss. SUN- sensorial lateralize unaffected ear CAFFE- Conductive lateralize to affected ear" "Assessment on patient with ascites - Correct answer Dullness" "Assessment on patient with ascites - Correct answer Dullness to percussion" "Varus Stress Test - Correct answer application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL" "Varus Stress Test - Correct answer TEST LCL (lateral-vaRus) McMurrays- Meniscus CLICK application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL" "German Measles (Rubella) - Correct answer Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots." "patient with IOP of 32mmHg, what do you expect during fundoscopic exam - Correct answer " "patient with IOP of 32mmHg, what do you expect during fundoscopic exam - Correct answer increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry" "BPH and urge incontinence - Correct answer anticholinergics/oxybutynin, impamine/tricyclic/antidepressant Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH" "BPH and urge incontinence - Correct answer TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant" "seasonal affective disorder (SAD) - Correct answer a mood disorder caused by the body's reaction to low levels of sunlight in the winter months" "intussusception - Correct answer telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS" "intussusception - Correct answer telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL" "IBS (irritable bowel syndrome) - Correct answer An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO" "IBS (irritable bowel syndrome) - Correct answer SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress" "Osteoporosis treatment - Correct answer TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth Statins increase bone mineral density" "Osteoporosis treatment - Correct answer TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID, Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY >2.5" "Retinoblastoma - Correct answer white reflection in child's pupil" "a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - Correct answer Ultrasound" "Romberg test - Correct answer cerebellar -ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds" "Direct Coombs test - Correct answer r/o bilirubin" "preeclampsia treatment - Correct answer bed rest, laying on her side" "Molluscum contagiosum treatment - Correct answer Currettage, liquid nitrogen" "pyloric stenosis - Correct answer non bilious vomiting, olive like firm mass palpated on right upper quadrant" "horizontal nystagmus that stops when eye is close to midline in a college student - Correct answer Ménière's disease ?" "Nystagmus test - Correct answer the involuntary jerking of the eyes as a person gazes to the side" "eating, painful lump noted on the jaw that comes and go. - Correct answer sialolithiasis)." "Etopic Pregnancy: Risk Factors - Correct answer Previous ectopic pregnancy Prior fallopian tube surgery Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Pelvic inflammatory disease Endometriosis cigarette smoking age older than 35 years history of infertility use of assisted reproductive technology, such as in vitro fertilization (IVF)" "Which among the list can cause increase in respiration - Correct answer Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)?" "for staph aureus infection (skin) with pus - Correct answer MRSA- TX Bactrim or tetracyclines?" "hyperparathyroidism - Correct answer high calcium" "Hyperthyroidism treatment - Correct answer methimazole, PTU-propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers" "Mammography Screening - Correct answer -Age 45 - 54 yearly mammogram -55 and older every 2 years" "Fifth's Disease (Erythema Infectiosum) - Correct answer B19: lytic infection, respiratory transmission Sx: flushed rash/fever in kids Px: fever, get better in a week" "pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - Correct answer TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin." "chlamydia in pregnancy - Correct answer Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM" "papilledema - Correct answer optic disc swollen w/ blurred edges due to increased ICP EXAM" "actinic keratoses - Correct answer Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM" "Allergic Conjunctivitis - Correct answer "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner." "COPD - Correct answer COPD- Gold 1-2- SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN" "CN IX Glossopharyngeal - Correct answer - Shoulder shrug/ ROMBERG test EXAM" "CN V Trigeminal - Correct answer Herpes. CORNEAL ABRASION. EXAM" "CN VIII Vestibulocochlear - Correct answer ears 8 EXAM" "CN VII Facial - Correct answer BELLS EXAM" "ACEI contraindicated - Correct answer pregnancy" "Safe to give varicella/MMR - Correct answer Do not give <12 mo. EXAM QUESTION" "Acne Vulgaris - Correct answer common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide." "Acne Rosacea - Correct answer - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM" "Cataracts - Correct answer is on EXAM in elderly night vision issues. Opaque" "Kawasaki disease - Correct answer - acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM" "Erythema migrans - Correct answer Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM" "Serotonin syndrome - Correct answer Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM" "Fundal Height - Correct answer Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US." "Psoriasis - Correct answer Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds. (Koebner phenomenon- new psoriatic plaques form over skin trauma) (Auspitz sign- pinpoint bleeding when plaques are removed). TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic. D" "Dacrocystitis - Correct answer Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents." "Acne Rosacea - Correct answer Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM" "Parathyroid hormone - Correct answer PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM" "Diabetic Retinopathy - Correct answer Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED" "HTN Retinopathy - Correct answer Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM" "Wilms Tumor - Correct answer Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM" "Primary Amenorrhea - Correct answer Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics." "Aphthous stomatitis - Correct answer Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash." "Temporal arteritis - Correct answer Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids." "Atopic Dermatitis (eczema) - Correct answer Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy lesions" they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM" "Tinea Corporis - Correct answer ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending" "Cellulitis - Correct answer Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS." "Erysipelas - Correct answer Group A strep, painful, Upper dermis, clear demarcated, cheeks, shins. TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d. MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim." "Varicella Zoster - Correct answer "contagious 48 h. before, until all lesions crusted over" low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. "initially on trunk, then scalp and face" TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM" "Impetigo - Correct answer Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM" "Scarlet fever- scarlantina - Correct answer "sandpaper textured-pink rash with sore throat" strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM" "Lichen planus - Correct answer LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM" "Spider bite - Correct answer fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam" "Pityoris rosea - Correct answer Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM" "Corneal abrasion - Correct answer Corneal Abrasions- Round/Irregular. Was on EXAM." "Acute Angle Closure Glaucoma - Correct answer acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM" "Conductive - Correct answer Conductive: Lateralization to bad ear. Rinne- BC > AC. Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM" "Koplik spots - Correct answer Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM" "Sensorineural - Correct answer Sensorineural: Lateralization to good ear. Rinne- AC > BC." "OME - Correct answer Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM" "Presbycusis - Correct answer sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM" "OE - Correct answer Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM" "Sinusitis - Correct answer TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE" "Meiniers disease - Correct answer VERTIGO TINNITUS, HEARING LOSS. nystagmas" "Rocky Mountain Spotted Fever - Correct answer Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. EXAM" "Addison's - Correct answer Addison's- deficient in cortisol (think low sodium, blood sugar, but Increase K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM" "rheumatoid arthritis - Correct answer Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM" "Osteoarthritis - Correct answer Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM" "Osteoporosis - Correct answer OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM" "Fibromyalgia polymyalgia - Correct answer Fibro- 11/18 points. Widespread pain for at least three months. EXAM. polymyalgia Tx prednisone 12 months. Must taper off. RISK for Temporal arteritis, DX BX, elevated ESR" "Mono - Correct answer test heterophile antibody test. ON EXAM" "MR. ASS - Correct answer (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam." "Mitral Regurg - Correct answer (Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL. Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb." "All diastolic murmurs are pathological. Grades Murmurs - Correct answer I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM" "MVP - Correct answer MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC." "S3- HF, S4-LVH stiffening, - Correct answer S3- HF, Kentucky, early diastole. Abn >35. Bell EXAM S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM" "Isolated Systolic HTN - Correct answer CCB" "PAD/ PVD - Correct answer PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM" "CVI - Correct answer CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM" "blood pressure - Correct answer BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM." "Thiazide diuretics - Correct answer no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM" "Statin - Correct answer Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM" "Pulses paradoxus - Correct answer Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM" "Emphysema - Correct answer Emphysema Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM" "Acute Bacterial Pneumonia- CXR - Correct answer middle lobe. ON EXAM" "OSA - Correct answer does not include Microglossia which is an absent tongue congenital. EXAM" "TB - Correct answer fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes." "TPO - Correct answer TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM" "hyperthyroid - Correct answer Hyperthyroid- Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then." "A1C > 9 - Correct answer If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM" "Parathyroid - Correct answer For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM" "cushings - Correct answer Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must draw cortisol levels in the morning." "Fructosamine test - Correct answer checks sugar for past 2-4 weeks." "triglycerides - Correct answer causes pancreatitis >500. If >500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM" "Pancreatitis - Correct answer diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring" epigastric pain. Fever, n/v. EXAM TOPICS" "Metformin - Correct answer Metformin - monitor BUN, Creatinine. contraindicated renal and liver disease ARF creatinine up and GFR down. affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea flatulence CT: hold 24 hr before and 48hr after" "Polycythemia vera - Correct answer slow growing blood cancer. blood too thick, clots. bone marrow to many RBC. risk bleed , anemia, CBC" "CCB - Correct answer BLE edema- walk around" "Kava Kava - Correct answer anxiety and insomnia, don't mix w sedating benzos." "Bipolar med - Correct answer lithium- monitor TSH, toxicity bind to TH cause hypothyroidism." "Depression med acute Anxiety/ panic med GAD med - Correct answer depression SSRI panic benzo, Xanax, ativan GAD SSRI SNRI- Buspar, Effexor, Cymbalta- Taper OFF" "SNRI/ Benzo Discontinuation - Correct answer Buspar, Effexor, Cymbalta and Benzo Taper OFF" "Thiazide GLUT- - Correct answer Glyceridemia Lipidemia Uricacidemia Triglyceridemia HYPO-Kalemia" "Mono, return to play and Dx - Correct answer 4-6 weeks when spleenolmegaly resolves Mono spot/ Heterophile" "Viral stomatitis - Correct answer ulcer on cheek (Aphthous)- viral canker sore" "cholesteatoma - Correct answer chronic sinusitis or OM. cauliflower, foul-smell, hearing loss. erodes bones in face affects facial CN 7. Benign- risk hearing loss refer SURGERY" "Acute Closed Angle Glaucoma Vs Open Angle - Correct answer Acute: Sudden pain, halos, cupping, dilated, cloudy , IOP, HA, refer ED Open (primary) : CN 2, gradual loss peripheral vision first" "Papilledema - Correct answer Swollen, optic disc, increase cup to disc ratio, HA, ICP, HTN," "Acyclovir (cheapest) - Correct answer 200mg 5 x day" "Pt on PPI, has osteoporosis has a cough, - Correct answer refer for EGD r/o Barrett's." "allergic rhinitis - Correct answer blue pale turbinate clear drainage. Tx inhaled corticosteroids" "hordeolum Vs chalazion blepharitis - Correct answer hordeolum: painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin. chalazion does not hurt Blepharitis always unilateral, Tx baby shampoo warm compress" "Sialolithiaisis - Correct answer painful lump, calculi or salivary stones. sub mandibular gland whartons; duct." "Roseola infantum- Sixth disease - Correct answer viral, young children, high Fever 3-4 days followed by maculopapular rash" "Herpetic keratitis - Correct answer ocular herpes - blurr vision, inflammation of eye; gritty feeling, conjunctivitis, sharp pain, and photophobia "ACE/ARB contraindications - Correct answer pregnancy Renal failure Renal Stenosis" "METABOLIC SYNDROME - Correct answer METABOLIC SYNDROME NO THIAZIDES,CCB (HF) NO TZD ACTOS (Pioglitazone) GIVE Metformin, ACE or ARB- kidney protective, BB- causes hypoglycemia," "Triglyceride < 300 what do we do first? Triglyceride in 300 plus risk for ___ what do we do? - Correct answer Lifestyle modification Pancreatitis, Niacin then add, fenofibrates" "Serotonin syndrome ss - Correct answer hyper rigidity, fever, myoclonus, dilated pupils, AMS, hyper reflexes, from SSRI or mix w MAOI and TCA" "NSAID contraindicated in - Correct answer HF and ARF increase BP impair renal prostaglandin and sodium retention" "strabismus - Correct answer misalignment of eyes, abnormal after 6 months" "macular degeneration - Correct answer loss of central vision" "retinal detachment - Correct answer floaters, curtain, flashes" "Xanthelasmas - Correct answer sharply demarcated yellowish deposit of cholesterol underneath the eye" "Red reflex absent - Correct answer retinoblastoma (leukorrhea) , cataracts, glaucoma. Will have white reflex"