APEA 3P EXAM|| ACTUAL EXAM ALL QUESTIONS AND 100% CORRECT ANSWERS ALREADY GRADED A+, Exams of Nursing

Download APEA 3P EXAM|| ACTUAL EXAM ALL QUESTIONS AND 100% CORRECT ANSWERS ALREADY GRADED A+ and more Exams Nursing in PDF only on Docsity! 1 | P a g e APEA 3P EXAM|| ACTUAL EXAM ALL QUESTIONS AND 100% CORRECT ANSWERS ALREADY GRADED A+|| LATEST AND COMPLETE VERSION 2024 WITH VERIFIED SOLUTIONS|| ASSURED PASS!! 1. Most common type of skin cancer in USA: Skin cancer 2. Most common type of skin cancer: basal cell carcinoma 3. basal cell carcinoma symptoms: Appearance varies; smooth, shiny bump, pink to pearly white 4. Basal cell carcinoma common locations: cheeks, nose, face, neck, arms, back 5. basal cell carcinoma diagnosis gold standard: biopsy. if not an option, refer to derm 6. Actinic keratosis: Precursor to squamous cell carcinoma numerous dry, round and pink to red lesions w/ rough and scaly texture --> does not heal, slow growing in sun exposed areas 7. Actinic keratosis diagnosis gold standard: Biopsy. if not an option, refer to derm 8. Actinic keratosis treatment gold standard: small- cryotherapy large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, crust, scab and be red **5-flouracil/ efudex-wear sunscreen!!** 9. squamous cell cancer: chronic red scaly rough textured lesion w/ irregular borders crusting or bleeding may be present 2 | P a g e 10. Squamous cell carcinoma common locations: rims of ears, lips, nose, face and top of hands 11. precursor lesion to squamous cell cancer: actinic keratosis 12. squamous cell carcinoma diagnosis by?: biopsy gold standard. if biopsy is not an option, refer to dermatology . 13. Risk factors for skin cancer(melanoma and both non-melanoma): Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer 14. Melanoma symptoms (ABCDE): asymmetry (shape/uneven texture) border (irregular/notched/blurred) color (variegated colors from black, blue, dark to light brown) diameter (size >6mm size of pencil eraser or larger) evolving (changes in color/size/shape) may be itchy 15. Acral lengtiginous melanoma: Most common type of melanoma in dark skinned individuals (blacks & asians) --> look for longitudinal brown to black bands under the nailbed. a changing spot or mole in the palms, or the soles of the feet 16. seborrheic keratosis: soft, round, wart-like growth that is light tan to black and looks pasted on asymptomatic &benign 17. Bacterial Meningitis Bacteria: Streptococcus pneumoniae- most common strain Haemophilus influenzae Neisseria meningitidis Escherichia coli *others 18. Bacterial meningitis symptoms (Classic Triad): High fever Nuchal rigidity rapid change in mental status w/ headache Triad=neck up 5 | P a g e Will have increased ESR 33. Erythema Migrans (early Lyme disease): TX: Doxycycline is always first line for all ages 100 mg BID x 10-21 days Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap and water. Dispose of the tick by flushing it into the toilet 34. Tick repellant skin use: DEET 35. Tick repellant clothing use: Permethrin 36. Brown Recluse Spider Bite: SX: • Fever, chills • Nausea and Vomiting • Located in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender, or can be painless • Blisters appear within 24-48 hours • Necrotic in center, which kills the tissue **can be painless 37. Brown Recluse Spider Bite treatment: Treatment: • Ice packs to wound as the cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and watch 38. Skin lesions: primary skin lesions Macule Vesicle Papule MVP Size: <1 CM 39. Macule: Flat, nonpalpable, but visually distinct areas on the skin surface with color different from the person's normal skin; less than 1 cm FRECKLE 40. Vesicle: elevated, raised lesion filled with serous fluid (herpetic lesions) 41. Papule: palpable solid lesion (acne, moles) 42. primary skin lesions >1cm in size: Nodule Plaque Bullae (Blister) Pustule 6 | P a g e Wheal 43. Nodule: raised solid lesion (BCC) 44. Plaque: solid raised lesion with flat top (psoriasis) 45. Bulla/Bullae: elevated superficial blister filled with serous fluid (2nd degree burn, impetigo) 46. Pustule: circumscribed elevated lesion containing pus (acne pustules) 47. Secondary Skin Lesions-Lichenification: thickening of the epidermis with exaggeration of normal skin due to chronic skin itching (eczema) 48. Secondary skin lesions- Scale: flaking skin (psoriasis) 49. Secondary skin condition-crust: dried exudate (impetigo) 50. Secondary skin condition-ulceration: eroding of epidermis and dermis (if deep can involve subcutaneous tissue) 51. Secondary skin condition-scar: permanent fibrotic change following damage to dermis (surgical scars) 52. Secondary skin condition-keloids/hypertrophic scars: overgrowth of scar tissue (more common in Black and Asian descent) 53. Rule of 9's: Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each Front trunk = 18% Back trunk = 18% 54. Rule of 9's =-child leg: Chlid one leg=13.5% One leg adult =18% 55. Rule of 9's =child head: Child head- 18% (half of adult %) 56. First degree (superficial):: Red to bright red skin and tenderness/pain 57. second-degree (partial-thickness) burns: Painful red skin, bullae (blisters), reddened/weepy skin --> BLISTERS START AT SECOND DEGREE 7 | P a g e 58. third-degree (full-thickness) burns: Pain sensation absent. Pale/white color, charred skin, leather-like texture 59. Criteria for Burn Center Referral:: Face, hands, feet, genitals, major joints Electrical burns, lightning burns Partial thickness burns >10% of total body surface area Third degree burns in any age group 60. If pt. has a Sulfa allergy and can't use Silvadene what is the alternative?: - Bacitracin, Polysporin/Triple antibiotic cream or ointment 61. Cellulitis: Bacteria (Gram Positive): Streptococcus (beta hemolytic strep), Staph aureus (MRSA) 62. Cellulitis Symptoms:: Diffused pink to red colored skin, warm to touch, and may become abscessed If red streaks radiating from infection it has spread to lymph nodes (lymphangitis) Usually within the deep dermis and is poorly demarcated (poor boundaries) Most common location is the lower legs -->If pt. has DM and develops cellulitis watch for osteomyelitis 63. Cellulitis treatment: First line: Abscess/cellulitis is I&D (if <5 cm no PO antibiotic needed) • Check for tetanus vaccine status Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5-10 days Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If you suspect osteomyelitis order an MRI If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) 64. Erysipelas:: Bacteria: Group A Streptococcus Located: • Involves upper dermis and superficial lymphatics • Found on the cheeks and shins 10 | P a g e After washing face wait 30 minutes before applying medication to help minimize irritation 80. Acne medications to avoid in pregnancy (category X &C): Category X: Topical tazarotene (Tazorac), Accutane Category C: Topical retinoids (tretinoin, adapalene) 81. Acne Rosacea: Symptoms: • Chronic small acne like papules/pustules, and telangiectasias around nose, mouth, and chin symmetrically Treatment: First line: o (Avoid triggers of flushing (EtOH, excessive sun, spicy foods) Metro gel or Azelex gel QD-BID Low dose Tetracycline 250 mg QID or doxycycline 100 mg QD if gel not effective or the patient has pustular/ocular rosacea 82. Psoriasis: Symptoms: • Inherited condition (atopy) Pruritic erythematous plaques Fine silvery-white scales with pitted fingernails Occurs on scalp, elbows, knees, sacrum, and intergluteal folds (extensor surfaces) Migratory arthritis 83. Psoriasis treatment: Treatment: • Topical steroids o Seven classes of steroids 10 o Avoid class I-III on children, and sensitive skin (face, groin, etc.) o Class I- super potent o Class VII least potent • Tar preps (mild cases) • Anti-TNF (severe cases) or immunologics o Methotrexate, cyclosporine, etanercept, adalimumab 84. Koebner phenomenon:: New psoriatic plaques form over skin trauma 85. Auspitz sign:: Pinpoint bleeding when plaques are removed 86. Atopic Dermatitis (Eczema):: Inherited condition (atopy) Extremely itchy On neck, and hands as well as other flexural folds An IgE condition Small vesicles (MVP- macule, vesicle, papule all are <1 CM all others e1 CM) that rupture leaving painful, bright-red, weepy lesions 11 | P a g e Will become lichenified from itching 87. Atopic dermatitis (eczema) treatment: First Line: o Topical steroids and emol- lients Avoid hot water/soaps Can take oral antihistamines to help with itching Avoid wool clothes 88. Contact Dermatitis: An inflammation of the skin caused by having contact with certain chemicals or substances; many of these substances are used in cosmetol- ogy. It is very pruritic, and usually there is no lichenification. Lesions evolve into vesicular bullae that easily rupture leaving bright-red moist areas that are painful 89. Contact dermatitis Treatment:: • First Line: o Stop exposure to substance • Topical steroids QD to BID x 1-2 weeks • Consider referral to allergist for patch testing 90. Scabies: Pruritic rash located in the interdigital webs of the hands, axillae, breasts, buttock folds, waist, scrotum, and penis • Severe generalized itching that is worse at bedtime • Family member will have same symptoms o Apply cream to skin from neck to soles of feet. Leave on for at least 8-14 hours then rinse off. Repeat in 1 week o Scabies never go to scalp! o Treat everyone. Wash sheets and all other items in house in hot water --Scabies never go to scalp TREAT EVERYONE 91. Pityriasis Rosea: Symptoms: May be itchy Herald patch appears 2 weeks before full breakout Christmas tree pattern Rash on the hands or soles of the feet 92. Pityriasis Rosea: Treatment: Resolves on its own in about 4-6 weeks Test for secondary syphilis with RPR then VDRL as screening • If positive then do FTA-ABS if this is positive patient has syphilis; treat appropriately 12 | P a g e 93. Tinea Corporis (body-think of core): symptoms: Ring like itchy rash, slowly enlarges with central clearing 94. Tinea Corporis (body-think of core): Treatment: Most respond to topical an- tifungals, if severe do oral Lamisil Med ends with azole on exam 95. Tinea Capitis (scalp-think of baseball cap): symptoms &Treatment: Scaly round itchy patches on the scalp. Hair becomes fragile at the roots and breaks (black dot sign) Treatment: Oral meds only (Griseofulvin, terbinafine, fluconazole, or itraconazole) Obtain baseline LFT and repeat in 2 weeks o Gold standard: § Griseofulvin QD- BID x 6-12 weeks Avoid hepatotoxic substances (alcohol, statins, acetaminophen) Avoid sharing combs, headgear, towels, pillows, and clothes with others 96. Tinea Cruris (groin):symptoms and treatment: Erythematous annular (ring-shaped) rash located in the groin area which can sometimes extend to buttocks Usually associated with tinea pedis Treatment: • Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days 97. Tinea Pedis (Hands/Feet- think pedicure):symptoms and treatment: Symp- toms: • Scaling of the soles • Skin feels wet, strong odor, vesicles and bullae that rupture • "Two feet and one hand" disease (dominant hand used for itching the feet becomes infected) Treatment: Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days 98. Onychomycosis aka tinea unguium (fingernail or toenail fungus): Symp- toms and treatment: Symptoms: Elderly with yellow-colored nails Thickened nails with debris Treatment: Mild cases fingernails: o Topical Penlac 15 | P a g e • NSAIDs • Allopurinol • PCN **HIV patients are at a higher risk for SJS & TEN** 107. Acanthosis Nigricans: symptoms: Velvety hyperpigmented patches most common on back of neck or skin folds • Usually associated with diabetes, metabolic syndrome, obesity, and cancer of the GI tract 108. Scarlet Fever (Scarlatina): Symptoms: "Sandpaper textured-pink rash with sore throat" Strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates (peels/sheds) Associated with strep throat 109. Lichen Planus: symptoms & Treatment: Symptoms: • Small flat topped, red to purple bumps that may have white scales/flakes • Wispy grey white streaks called Wickham's striae • Found on the inner wrists, forearms, and ankles. If on scalp causes hair loss • Can be found in vulva and vagina with soreness, burning, and rawness Treatment: Topical Steroids (even in vaginal area for Lichen Sclerosus) 110. Anthrax: Symptoms & treatment: Symptoms: Animals/hides/hair/wool Lesions begin as papules that enlarges quickly within 24-48 hrs. Develop necrosis and ulceration (sort of like a recluse spider bite) Not contagious Treatment: Doxycycline, Cipro, or Levaquin BID x 7-10 days If you suspect BIOTERRORISM treat for 60 days Prophylaxis antibiotics are Cipro and Doxy 111. Hidradenitis Suppurativa: Symptoms & Treatment: Symptoms: Recurrent episodes of painful large and tender red nodules, abscesses, and pus- tules in the axilla (most common), groin, perianal, and inframammary Due to occlusion of the hair follicles and pilosebaceous glands (apocrine glands) 16 | P a g e Treatment: •Avoid skin trauma, wear loose light clothing, avoid excessive heat, and friction Smoking cessation, lose weight if obese Avoid deodorant Doxycycline QD to BID x several months 112. Blepharitis (inflammation of the eyelids): Symptoms/treatment: Symp- toms: Bilateral red and swollen edges of eyelids May have fine scales More common with seborrheic dermatitis Treatment: Scrub eyelids in warm water and baby shampoo 113. Pterygium (Surfer's eye): Symptoms/Treatment: Symptoms: Triangular- shaped white to yellow superficial growth On nasal side Caused by long term UV damage Treatment: Surgical remove if it grows into the pupil Prevention: wear sunglasses 114. Pinguecula (think of Ping-Pong): Symptoms/Treatment: Symptoms: White to yellowish small round superficial lesion on each side of the cornea Caused by long-term UV damage Treatment: • Prevention: wear sunglasses 115. Chalazion: Symptoms & Treatment: Symptoms: Small painless nodule Chronic inflammation of the meibomian gland (specialized sweat gland) Grows gradually 17 | P a g e Treatment: • Hot compress QID if large otherwise no treatment 116. Hordeolum (Stye): Symptoms and Treatment: Symptoms: Painful • Swollen • Red, warm, abscess, and it's acute Think Hordeolum "Hurts" Treatment: • Hot compress until it drains QID • Avoid wearing eye make-up • Erythromycin or dicloxacillin QID if preseptal cellulitis develops 17 o Refer to oph- thalmology for I&D 117. Senile arcus: Symptoms and Treatment: Symptoms: White-gray ring on edge of cornea in elderly and is bilateral Normal finding in elderly Result of lipid deposit Treatment: None Age less than 50 check lipid profile 118. Xanthelasma: Symptoms and treatment/ DX: Symptoms: • Soft yellow flat plaques on the upper and lower lids by the inner canthus or palpebrum • Cholesterol plaques Dx: • Order fasting lipid profile to rule out hypercholesteremia Treatment: • Trichloroacetic acid, surgery, laser 119. Allergic Conjunctivitis (Keratoconjunctivitis): Symptoms & Treatment: - Symptoms: Typically, bilateral itchy eyes with "stringy discharge and increased tearing" Type I sensitivity (IgE) Rhinitis and allergic shiner Treatment: PO (oral) antihistamines Eye drops olopatadine (Patanol), Visine (short term or episodic use only) Cool compresses and avoid allergens *May be called keratoconjunctivitis on ANCC 120. Bacterial Conjunctivitis: Symptoms and treatment: Symptoms: • Acute on- set of red eye • Dried yellow-green crusting on eyelids on awakening 20 | P a g e Leading cause of blindness in the elderly and more common in smokers Treatment: Give Amsler grid or refer to ophthalmologist if Amsler grid is not an option 129. Retinal Detachment: Symptoms & Treatment: Symptoms: Sudden onset of floaters Looking through the curtain Flashes of light Painless Treatment: ER STAT 130. Dacryocystitis: background& symptoms & treatment: Background: Infec- tion of lacrimal sac/tear duct usually caused by blockage Common in infants, adults over 40 also have higher risk of developing Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery eye/excess tearing Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; sys- temic antibiotics 7-10 days 131. Allergic Rhinitis: Background & symptoms & treatment: Background: In- flammatory changes of nasal mucosa due to allergies Atopic family history (asthma, eczema) May have seasonal or daily symptoms Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip, Blue-tinged or pale boggy (spongy) nasal turbinate's Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamci- nolone (Nasacort Allergy) 1-2 sprays QD • Antihistamine Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN. 21 | P a g e Avoid in infants and children • Avoid triggers 132. Epistaxis (Nosebleed): Background & Treatment: Background: Anterior nosebleed more common. Caused by bleeding at Kisselbach's plexus Treatment: Have the pt. blow their nose first Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal septum and hold for 10 minutes 133. Meniere's Disease: Symptoms: Vertigo Hearing loss Tinnitus 134. Meniere's Disease Mnemonic: VAST: Vertigo (Episodic) Aural (auditory) fullness Sensorineural Hearing Loss (Fluctuating) Tinnitus (Subjective) 135. Meniere's Disease Treatment: Usually, self-limiting. Treat acute attacks Antihistamines for vertigo Meclizine, dimenhydrinate Antiemetics for nausea/vomiting o Promethazine, prochlorperazine 136. Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX: Symp- toms: Ages 30-60 Gradual onset, one-sided Sensorineural hearing loss, tinnitus that is insidious; CN 8 Facial numbness and pain if it compresses CN 5 Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing loss and tinnitus. If it compresses on CN 5 will have facial numbness and pain Treatment: Surgery 137. Cholesteatoma symptoms and treatment: Symptoms: Cauliflower Foul-smell 22 | P a g e Hearing loss (typically conductive unless it's way inner than can have sensorineural) If erodes bones in face affects CN VII Treatment: SURGERY 138. Battle Sign (Basilar Skull Fracture):: Bruising behind the ear (mastoid area) appear within 1-3 days after trauma Parietal bone is most fractured. Linear fracture most common leaking of clear fluid from nose and eyes, raccoon eyes Look for clear, golden serous discharge from the ear or nose treat immediately- Refer to ER 139. Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX & Treat- ment: Symptoms: Vertigo lasting <1 minute caused by sudden head movements and position changes May lose balance and fall Due to calcium carbonate crystals (otoconia) being trapped in the semicircular canals Dx: Gold Standard: Dix-Hallpike Epley Maneuver in clinic or at home by pt Test won't ask how to conduct treatment just be able to associated Epley with BPPV 140. Vestibular Neuritis and Labyrinthitis: Cause/ Symptoms/ TX: Viral infec- tion/Inflammation Symptoms: Sudden/rapid onset of severe vertigo with nausea/vomiting for 1-2 days and then symptoms lessen • Sensorineural hearing loss and tinnitus Treatment: Ondansetron (Zofran) Methylprednisolone taper 25 | P a g e a cough when supine) Frontal sinusitis: § Frontal headache or headache behind one eye Maxillary sinusitis: § Facial pain and upper molar tooth pain Transillumination: Compare each side. Affected side may be duller or smaller Treatment: Either immediate antibiotic treatment or observation First Line: Aug- mentin 2000 mg/125 mg BID x 5-7 days Symptom relief: Saline irrigations, nasal steroids, NSAIDs for pain Do not use antihistamines or decongestants Penicillin Allergy: Levofloxacin 750 mg QD x 5-7 days or Doxycycline BID x 5-7 days 146. Infectious Mononucleosis: cause/sx/dx/tx: Epstein Bar Virus (Herpes Virus Family) Symptoms: Sore throat with tonsillitis. May have whitish tonsillar exudates • Posterior lymphadenopathy • Severe fatigue present for many weeks • Maculopapular rash • Hepatomegaly and or splenomegaly Classic Triad: Fever, Pharyngitis, Lymphadenopathy Dx: • Monospot (heterophile antibody) Treatment: Symptomatic • Rest • Avoid contact sports and heavy lifting for at least 4-6 weeks. A Ruptured spleen is a rare but serious sequela of mono May do an abdominal US to clear patient for sports Test Tip: If the patient has strep throat and mono, avoid using Amoxicillin as the antibiotic of choice. The patient may develop a rash with this drug. Macrolides are a good option (Clarithromycin). Levofloxacin works as well but it is overkill 147. Strep Throat:Cause, symptoms, TX: Cause: • Group A streptococcal bacteria (Streptococcus pyogenes)• Most common cause of sore throat is viral (rhinovirus, adenovirus, RSV) • Strep is most common in school-aged children SX: 26 | P a g e • Abrupt onset of fever, sore throat, and pain on swallowing • Absence of viral symptoms (coryza, cough, hoarseness, runny nose, watery eyes) • Tender anterior cervical lymphadenopathy • Scarlatiniform rash (sandpaper rash) • Children: May have abdominal pain and diarrhea TX: First line-Pencillin V or amoxicillin suspension immediate or XR QD x10 days ANAPHYLAXIS HX: z pack or clindamycin 148. Strep Throat, Nonpuruluent SSTI Risks: o Rheumatic fever, scarlet fever, acute poststreptococcal glomerulonephritis, poststreptococcal reactive arthritis (de- velops within 1 month after strep) 149. Strep throat, purulent risks: • Suppurative (Pus): Tonsillopharyngeal abscess, cellulitis, OM, sinusitis 150. Strep throat • Centor Criteria:: • Be able to connect Centor Criteria with Strep Throat Fever (1 point) Anterior cervical lymphadenopathy (1 point) Tonsillar exudate (1 point) Absence of cough (1 point) Age 3-14 (1 point) Age 15-44 (0 points) Age >44 (-1 point) Score of 0-1 unlikely need to test for strep; score of 3-4 confirm with rapid strep test 151. Hypertension Retinopathy: Cotton wool, Retinal arterioles constriction • Copper/silver wire arterioles 27 | P a g e 152. Diabetic Retinopathy:: damage to the retina as a complication of uncontrolled diabetes Symptoms: • Cotton wool spots (moderate retinopathy) • Micro-aneurysms • Neovascularization 153. Koplik's Spots: Symptoms: • "Clusters of small size red papules with white centers in the buccal mucosa by lower molars" • Caused by Rubeola (Measles) o Rubeola and Koplik's have an "O" • Fever, conjunctivitis, coryza, cough • Morbilliform rash 154. Hear Murmurs: Gold standard DX: Echocardiography (TEE) 155. Systolic murmurs occur when?: During S1 156. mitral regurgitation: Radiates to axilla 5th intercostal space (ICS) by mid clavicular line (MCL), apex, apical area 157. Aortic Stenosis (mid systolic ejection):: Radiates to neck! Higher risk of sudden death • Location: oAortic area, 2nd ICS by right upper sternum; at the base of the heart by the right upper sternum; base of heart on the right side of sternum 158. Diastolic murmurs occur when: S2 Heart sound 159. diastolic murmurs are always: PATHOLOGICAL-indicative of heart disease 160. Mitral stenosis (Mid/late diastolic): Afib most common risk-emboli risk narrowing of the mitral valve Only murmur you listen to with your Bell **Dyspnea most common symptom** 161. Heart Murmur Grading System:: Grades I-VI : 30 | P a g e 175. Anticoagulation Therapy Goal: INR 2-3 176. Orthostatic Hypotension: A decrease in the systolic BP of at least 20 mmHg or the diastolic BP of at least 10 mmHg within 3 minutes upon standing 177. Coarctation of the Aorta: Background/ SX/ DX: Background: • Normally SBP is higher in the legs than the arms. • If patient has coarctation of aorta the SBP is higher in the arms than legs. Symptoms: • Pulses in legs won't be palpable • The radial pulse will be bounding • The BP will be high • A heart murmur may be present Dx: • Echo, ECG, cardiac MRI or cardiac CT 178. hypertension: Stage 1 (140-159/90-99) 179. Hypertension: If Goal BP is not reached at month, increase the dose on the initial drug and/or add a second drug: • If Goal BP is not reached at 1 month, increase the dose on the initial drug and/or add a second drug 180. Thiazide diuretics; do not give to a patient with a allergy: Do not give thiazide diuretics to a patient who has a sulfa allergy 181. Ace inhibitors: -pril: HTN, HF. AD: angioedema, cough, hypotension, hyper- kalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use contra- ception (teratogenic), avoid sports drinks/salt substitutes (extra K) 182. ARB drugs: -sartan Losartan Valsartan 31 | P a g e 183. HTN drug of choice for diabetics: Ace inhibitors or ARBS these protect kidneys 184. Do not use Ace drugs and together: Do not use Ace drugs (lisinopril) and Arb drugs (losartan) together 185. Beta bocker: -olol Avoid abrupt discontinuation: wean slowly to avoid rebound HTN 186. Calcium channel blocker: "CA" Calan, Procardia, Cardizem Slow the HR and decrease BP (check HR and BP before). Inhibits mvmt of Calcium ions across membrane or cardiac and arterial muscle cells. Results in slowed impulse conduction, depression of myocardial constractility, dilation of coroanry arteries. SE: Constipation Procardia sometimes causes peripheral edema 187. First line treatment of HTN for african americans: CCB or Thiazide CCB: cardizem, diltiazem 188. New York Heart Association (NYHA) Function Capacity: Heart failure clas- sification: Class II: ordinary activity results in fatigue and dyspnea **Symptoms 1st appear** 189. Left sided heart failure effects ?: Lungs S3, crackles, decreased breath sounds, wheezing 190. Right sided heart failure effects?: Edema JVD (jugular vein distention) Dyspnea on exertion 191. BMI (body mass index): Underweight - Less than 18.5 Normal - 18.5 - 24.9 Overweight - 25 - 29.9 Obese - 30 - 39.9 192. Hypercholesterolemia: excessive cholesterol in the blood statin first line 32 | P a g e **When triglycerides are extremely high , goal ist o lower them to prevent pancreati- tis** 193. Prior to starting statins you should: check Liver function tests (LFT's) 194. Rhabdomylosis, what drug do you hold?: Hold statin and hydrate 195. Pulmonary embolism: most common cause is a DVT cough may be productive and pink tinged tachycardia, pallor and the feeling of impending doom 196. Anaphylaxis is a mediated reaction: IgE Give 1:1000 IM or Subq then call 911; have one give epi and then one call 911 197. Percussion: Resonance: low pitched, hollow sounds heard over normal lung tissue 198. Percussion: Dull: Heard over fluid filled organs such as the heart or liver. Pleaural effusion or lobar pneumonia 199. Percussion: hyper-resonant sound: emphysema 200. Spirometry helps diagnose: COPD FEVI less than 80% predicted FEV1/FVC ratio of <0.7 is diagnostic for COPD 201. #1 risk factor for COPD: smoking 202. COPD gold guidelines: Anticholinergics are first line for COPD (ipratropi- um/Atrovent) 203. chronic bronchitis: Productive cough that occurs >3 months/year for 2 con- secutive years --> dirty-chest appearance on CXR Typically are "blue bloaters" (overweight and cyanotic) ***Clinical Diagnosis*** 204. common side effect of ACE inhibitors: Dry cough. Increased potassium levels in the blood (hyperkalemia) Fatigue.