SARAH MICHELLE LIVE REVIEW STUDY
GUIDE
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 ANS: 4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? ANS: Vertigo, tinnitus, ear pressure,
nystagmus
What is our biggest worry for a Meniere's Disease patient? ANS: There is a possibility for a potential,
permanent hearing loss.
What is rhinitis meidcamentosa? ANS: 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? ANS: This is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? ANS: 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? ANS: 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? ANS: Patient with chronic lung diseases:
asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? ANS: 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? ANS: Around 8
week mark
What is COPD? ANS: 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? ANS: Chronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? ANS: Neurological symptoms,
paresthesia (numbness and tingling in hands and feet), unsteady gait, memory issues
Beefy red tongue
What diet can result in B12 deficiency? ANS: Vegan- oral supplements can be used for treatment
,What surgery can result in B12 deficiency? ANS: 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? ANS: Women of childbearing age- ages 15-45,
African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? ANS: 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? ANS: Dry eyes and dry mouth- treatment
revolves around symptom management- artificial tears, hard candies, etc.
Common in lupus patients
What is a major concern for lupus patients? How do we monitor this? ANS: 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? ANS: Viral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? ANS: Pituitary gland
What is the function of TSH? ANS: Tells your thyroid when to produce and release those critical thyroid
hormones- T3 and T4.
What disorders include hypothyroidism? ANS: Iodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? ANS: Hypothyroidism is caused by an
autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? ANS: 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? ANS: Must be taken on
an empty stomach before other medications
What are signs and symptoms of a myxedema coma? ANS: Low body temperature, edema, confusion,
lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? ANS: Lithium or amiodarone
GUIDE
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 ANS: 4. The tuning fork lateralizes to the left ear
What are common signs and symptoms of Meniere's Disease? ANS: Vertigo, tinnitus, ear pressure,
nystagmus
What is our biggest worry for a Meniere's Disease patient? ANS: There is a possibility for a potential,
permanent hearing loss.
What is rhinitis meidcamentosa? ANS: 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? ANS: This is an infection of the cornea due to herpes simplex virus
How is herpes keratitis diagnosed? ANS: 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? ANS: 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? ANS: Patient with chronic lung diseases:
asthma, COPD, cystic fibrosis.
Why are cough suppressants not helpful in pneumonia patients? ANS: 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? ANS: Around 8
week mark
What is COPD? ANS: 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? ANS: Chronic cough
Sputum production
Dyspnea- difficulty breathing
What signs and symptoms are specific to B12 deficiency anemia? ANS: Neurological symptoms,
paresthesia (numbness and tingling in hands and feet), unsteady gait, memory issues
Beefy red tongue
What diet can result in B12 deficiency? ANS: Vegan- oral supplements can be used for treatment
,What surgery can result in B12 deficiency? ANS: 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? ANS: Women of childbearing age- ages 15-45,
African Americans are going to be at higher risk
What is the diagnostic criteria for Lupus? ANS: 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? ANS: Dry eyes and dry mouth- treatment
revolves around symptom management- artificial tears, hard candies, etc.
Common in lupus patients
What is a major concern for lupus patients? How do we monitor this? ANS: 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? ANS: Viral hormone gland
Metabolism regulation- impacts every SINGLE cell within the body
Proper growth and development across the entire lifespan
What produces TSH? ANS: Pituitary gland
What is the function of TSH? ANS: Tells your thyroid when to produce and release those critical thyroid
hormones- T3 and T4.
What disorders include hypothyroidism? ANS: Iodine deficiency, Hashimoto's, or thyroiditis
A presence of thyroid peroxidase antibodies indicates that? ANS: Hypothyroidism is caused by an
autoimmune process of some sort
What are some signs and symptoms of hypothyroidism? ANS: 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? ANS: Must be taken on
an empty stomach before other medications
What are signs and symptoms of a myxedema coma? ANS: Low body temperature, edema, confusion,
lethargy, tongue thickening, difficulty breathing
What medications can precipitate myxedema coma? ANS: Lithium or amiodarone
