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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
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LATEST UPDATED | GET A+!!! 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 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, Definition of metabolic syndrome - correct answer cluster of conditions that increase risk of heart disease, stroke, diabetes.
LATEST UPDATED | GET A+!!! diagnose trichomoniasis - correct answer wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next?
LATEST UPDATED | GET A+!!! 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
LATEST UPDATED | GET A+!!! 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.
Murmur Grade III - VI - correct answer Loud murmur easily heard JVD caused by - correct answer - tension pneumothorax,
LATEST UPDATED | GET A+!!! 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 a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - correct answer Ultrasound
LATEST UPDATED | GET A+!!! Romberg test - correct answer cerebellar
LATEST UPDATED | GET A+!!! 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
LATEST UPDATED | GET A+!!! 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
LATEST UPDATED | GET A+!!! 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
LATEST UPDATED | GET A+!!! 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 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 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
LATEST UPDATED | GET A+!!! 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.
LATEST UPDATED | GET A+!!! 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 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,
LATEST UPDATED | GET A+!!! 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.
LATEST UPDATED | GET A+!!! 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 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