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oxacin - Answer fluoroquinolones terol - Answer beta agonist tropium - Answer inhaled anticholinergic "prevents bronchospasm" ipratropium (atrovent) one or ide - Answer inhaled steriods -lol - Answer beta blocker triptan - Answer migraine (constricts cerebral arteries--to not overuse) mycin - Answer macrolide -pam - Answer benzo -dine - Answer h2 blockers (famotidine) prazole - Answer proton pump inhibitor -ide - Answer thiazide diuretic -pril - Answer ace inhibitor -sartan - Answer ARB -lol - Answer Beta Blocker -pine - Answer calcium channel blocker---first line for ISH -gliptan - Answer diabetic med--no hypoglycemia -sin - Answer alpha adrenergic blockers (tx BPH) 4 indications for cxr with acute cough - Answer abnormal VS rales, consolidation
75 years old fever Who gets PPSV23 vaccine?? - Answer -single dose 65 or older -single dose 19-64 if chronic illness, smoker, group home -Immunocompromised receive another dose at 5 YEAR interval -ALWAYS get dose at 65 even if received earlier doses as long as 5 Years has passed!! Bacteria responsible for most pneumonia deaths - Answer Strep pneumonae (Gram -)
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Three most common bacteria - CAP - Answer S. Pneumoniae Mycoplasma pneumoniae (walking pneumonia) Chlamydophila pneumoniae Best initial antibiotics for pneumonia if no antibiotic exposure in last 3 months - Answer Doxycycine or Macrolide (Azithromycin or Clarithromycin) ----because they cover for atypicals Best initial antibiotics for pneumonia if comorbidities or antibiotics in 90 days - Answer -Resp quinolone (levofloxacin, gemifloxacin, moxifloxacin) or IF ALLERGY -Beta-lactam (PCN or cephalosporin) PLUS macrolide How long course of antibiotics for pneumonia - Answer 3 days longer than s/s of infection. Pneumonia severity index??? - Answer CRB- -Confusion -RR > -BP low -Age > What confirms COPD on PFTs??? - Answer FEV1/FVC <70% COPD staging - Answer Bigger number more severe What med is crucial for COPD patient - Answer SABA!! Where are beta1 receptors - Answer Heart Where are beta2 receptors - Answer Lungs What is the maintenance drug of choice for all levels of asthma? - Answer Inhaled corticosteroid. What classifies persistent asthma? - Answer >2 days /wk symptoms; nighttime sx
3 x month How do postitive PPD readings differ for immunocompromixed patients? - Answer smaller size of induration positive if immunocompromized (>15 mm if healthy, >5mm if HIV) What does Baciille Calmette Guerin vaccine protect against? - Answer BCG vaccine for TB. Given in other countries. At what age should you do a f/u CXR after treatment for pneumonia - Answer Anyone over 40
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Foods other than meat rich in iron - Answer dried peas and beans; dark green leafy veggies When will iron deficient patient start to feel better after placed on supplement - Answer in a few days Replacement dose of Fe for anemia - Answer 150-200 mg/d of elemental iron What lab value represents adequate iron supplementation has occurred (supplements can stop?) - Answer serum ferritin (normal iron stores) How do labs for anemia of chronic disease differ from IDA? - Answer Normocytic, normochromic...but can be also Microcytic/ Hypochromic. Serum iron is decreased, but TIBC and Serum Ferritin are normal...Fe will not HELP!!! Thalassemia - Answer hereditary; microcytic, hypochromic...premature hemolysis. Will have normal Fe, TIBC, Ferritin, and RDW!!! DO NOT GIVE FE!!!! Pernicious anemia - Answer B12 deficiency often ABSORPTION problem..not dietary deficiency! Macrocytic What other nutrient should you check with a B12? - Answer Folate!! Elevated levels of MMA and homocystiene indicate what ???? - Answer Sensitive measures of B12 deficiency...B12 needed for metabolism of these MCV>100 - Answer Pernicious anemia s/s of pernicious anemia - Answer dementia, neuopathy, weakness, elderly, vegans, alcholics, bariatric patients B12 supplementation - Answer Vit B12 IM every day for one week----then weekly x4----than monthly for life when do monocytes elevate? - Answer after 24 hours of illness what does it mean if polys and lymphocytes are close numerically? - Answer think "viral" Another name for Neutrophils - Answer segs or polys What if polys are high on WBC - Answer bacterial what do bands mean? - Answer bone marrow thinks you are SICK! Sending out immature cells for backup What if wbc count normal, but shift to left or right?? - Answer May be early in infection, or pt immunosuppressed.
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what is a shift to the left? - Answer increase in number of bands or "baby" neutrophils in blood smear..indicative of active infection What is the major concerning sequelae from pseudotumor cerebri? - Answer loss of vision characteristics of migraine - Answer unilateral crescendo 4-72 hours n/v; photophobis acute treatment for migraine?? - Answer triptans--arterial constriction; expensive...do not overuse or will become ineffective prophylaxis for migraines - Answer Topiramat; depakote; beta-blockers who should NEVER get a tryptan?? - Answer CAD!! or HTN h/a with band-like squeeze? - Answer tension h/a Sudden severe brief unilateral facial pain?? intense, sharp, stabbing - Answer trigeminal neuralgia --CN V ---trigeminal nerve treatment for trigeminal neuralgia - Answer carbamazepine Treatment for bell's palsy? - Answer High dose steroids! 60 mg x5days prevents future sequelae What maneuver provokes BPV ---benign positional vertigo? - Answer Dix Hallpike Treatment for vertigo? - Answer Antihistamines: meclizine, dimenhydrinate Benzos--alprazolam...for vertigo from hell!! what neurotransmitter is part of the underlying patho in Parkinsons?? - Answer Dopamine how is parkinson's diagnosed? - Answer response to dopaminergic therapy Treatment for Parkinsons... - Answer levodopa...carbodopa What drug may help with physiologic tremors? - Answer beta blocker dementia?? - Answer memory impairment PLUS at defecit of at least 1 of aphasia, apraxia, agnosia, executive function important w/u in assessment for dementia - Answer TSH, B12, Folate, RPR, HIV, CBC, CMP..imaging to r/o injury or bleed
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cranial nerve. (eg, if the tongue deviates to the right, the right side of CNXII is damaged). Gram + bugs - Answer staph strep enterococcus What are the beta lactams? - Answer pcns, cephalosporins The rules with PCN allergy?? - Answer NEVER give cepholasporing if pt had anaphalaxis or hives with PCN. If morbilliform rash...may give. Does augmentin cover atypical pathogens?? - Answer NO! Doxy or macrolide!!! What does PCN cover? - Answer All gram + except MRSA, MSSA What does Augmentin cover? - Answer Gram +, Gram -, B-lactamase ...but NOT MRSA OR MSSA!! What history would make you suspect a pathogen that produces beta lactamase - Answer antibiotic in last 90 days Tetracyclines - Answer Gram -, Atypicals, MRSA!!! Doxy Minocycline Vibramycin Can you use doxy to treat strep?? - Answer NO! Gram + Sulfonamides - Answer Bactrim Gram -; MRSA!!!! What are the best options for MRSA - Answer Clindamycin, Tetracyclines, Bactrim 1st gen Cephalosporin - Answer Keflex---Gram + 2nd gen Cephalosporin - Answer Cefuroxime, Gram + and Gram - Should you use cefuroxime to treat infection in pt. who has received antbx in last few months?? - Answer NO...probably betalactamase producer.. 3rd generation cefalosporin - Answer Cefixime (suprax), Ceftibuten ...weak gram -, gram +...beta lactamase!!! should you use ceftibuten to treat infection in pt. who has received antbx in last few months?? - Answer YES! Beta lactamase cover
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Extended spectrum 3rd gen Cephalosporins - Answer Rocephin (ceftriaxone), cefdinir Gram +, Gram -, B-lactamases!!! Macrolides (Later gen) - Answer Azithromycin, Clarithromycin Atypical pathogens! NOT STREP! Fluoroquinolones 2nd gen - Answer Cipro---gram - ; atypical pathogens why is cipro a poor choice to treat CAP? - Answer strep pneumo Gram+....doesn't cover for DRSP Respiratory Fluoroquinolones --3rd gen - Answer Levofloxacin---the idiot's antibiotic! Kill everything except MRSA. SAVE AS LAST RESORT Resp Fluoroquinolones--4th gen. - Answer moxifloxacin, gemifloxacin, gatifloxacin Gram+, Gram-, Atypicals, Beta lactamase, DRSP DO NOT USE BELOW THE BELT!! What is the most effective fasting time for lipid panel?? - Answer Most accurate after 12 hour fast. What are the CHD equivalents when deciding whether or not to treat hyperlipidemia?
- Answer Diabetes symptomatic CAD PAD AAA What cardiac class may cause exercise intolerance - Answer Beta Blockers -lol slows heart rate. What diuretic bp med should not be given to a patient with hx of severe reaction to bactrim - Answer HCTZ...has a sulfonamide ring!!! Where would the PMI be felt in a pt. with hert failure? - Answer 5th intercostal space to LEFT of midclavicular line. The most common arrhythmia from valvular heart disease is... - Answer Atrial fibrillation Microscopic exam of tinea would show? - Answer hyphae what is the process of screening for Lyme disease?? - Answer H&P first! ELISA then confirm with Western blot if positive. skin lesion which is a solid mass up to 1 cm is described as a - Answer papule.
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Hallmark finding with B12 and folate deficiencies??? - Answer macrocytosis 35 yo with normal paps since 18. Normal pap and hpv..when should she be tested again??? - Answer 5 YEARS....ACOG says testing no more than every 5 years in women over 30 if BOTH tests are negative and adequate screening has taken place. If PAP ONLY ---rec is every 3 YEARS. HPV testing in combo with pap is more sensitive. HPV testing is more SPECIFIC in women over 30. HPV testing ALONE is NOT recommended. A localized tumor in the prostate gland associated with early stage prostate CA is likely to produce... a. urinary hesitancy b. low back pain c. urinary frequency d. an absence of symptoms - Answer D! these produce no symptoms or clinical manifestations. Thus PSA screening. hematuria is not a common clinical manifestation in ... a. early prostate CA b. BPH c. bladder CA d. Renal CA - Answer A. localized tumors in prostate are not associated with hematuria. often have no s/s. How soon after a diagnosis of acute prostatitis can a PSA be accurate? - Answer 4 weeks....infection or inflammation can cause a shharp rise in PSA values. Elective PSA should be deferred for four weeks. Earlier checks will result in elevated levels not associated with cancer...causing unnecessary patient anxiety. What is the recommendation of the American Cancer Society for initial screening of an AA male for prostate CA? - Answer Discussions starting at 40-45 years....AA males and those with first degree relative with prostate CA before age 65 are HIGH RISK. What is the PSA threshold? - Answer 4.0 ng/mL A carotid bruit in an elderly patient indicates what? - Answer Indicates artery disease in other places. Those with carotid bruit have double stroke risk. Other vessels should be evaluated. MORE LIKELY TO DIE OF CARDIOVASCULAR DISEASE THAN CEREBROVASCULAR DISEASE How long will it take to evaluate the effectiveness on acetylcholinesterase inhibitor drugs like donezepil used in Alzheimer's? - Answer 6-12 months. Eval includes family report. MMSE, ADL assessment, and side effects.
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What are the presenting symptoms, treatment for temporal arteritis? - Answer Dx with biopsy. Chronic vasculitis...new onset HA, abrupt visual disturbance, jaw claudication, unexplained fever or anemia, elveated sed rate. Avg. age of onset 72 yo. Which fingers are not affected by carpal tunnel? - Answer Fifth finger (pinky) Anosmia...what cranial nerve should be evaluated. - Answer I-olfactory (1 nose!) Elderly pt. at increased risk for stroke..Daily ASA is an example of what kind of prevention? - Answer PRIMARY....would be secondary if history of stroke. When should you consider imaging for low back pain in a pt without red flags or hx or cancer, advanced age, or hx of trauma? - Answer 4 weeks at earliest In what part of the hip does osteoarthritis cause pain? - Answer The anterior hip. Finkelstein test - Answer DeQuervians tenosynovitis What is first line drug for osteo arthritis pain not relieved by nonpharm methods?? - Answer Tylenol 650mg qid! Less risk than nsaids. Try first According to Ottawa ankle rules..when should you image a sprain? - Answer midfoot pain/bone tenderness, bone tenderness at base of the 5th metatarsal or unable to bear weight for 4 steps Should you routinely screen TSH in pregnant women? - Answer Only if hx of hypothyroidism, family hx, or s/s. NP scope of practice is influenced by a number of factors. Which of the following does not? a.code of ethics b.state and federal laws c.Court of law d.Educational preparation - Answer c. Court of law it is established legally, ethically, and by boards of nursing and professional organizations. It sets the boundaries and indicates what is permitted legally, etc. It is NOT influenced by court of law and varies from state to state. Who determines NPs legal authority to practice in any state? - Answer The state legislature of the state. rules and regs may be promulgated by state boards of nursing that reflect scope of practice of nurse practitioners specific to that state. what constitutes malpractice? - Answer There must be a duty, a breach of that duty, and subsequent injury due to the breach.Comparison of performance is based on the standard of care delivered by nps.
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How should you treat a patient diagnosed with Gonorrhea? - Answer Treat both gonorrhea and chlamydia. They are so often found together. What class of drugs should be avoided in CHF? - Answer ca channel blockers (verapamil) can cause bradycardia...reduce contractility...worsen heart failure Where do direct and indirect inguinal hernias occur??? - Answer direct-hesselbach's triangle indirect-internal inguinal ring What is Medicare Part A? - Answer hospital insurance; also covers some skilled nursing facilities
. No enrollment fee for most and they are charged montlhly premium based on number of eligible quarters they contributed. What cranial nerve allows you to stick tongue out and move side to side - Answer XII-Hypoglossal What cranial nerve allows you to close eyes tightly, wrinkle forehead, and smile? - Answer VII-Facial CN partly responsible for speaking and tongue movement? - Answer X-Vagus Which mitral valve disorder results from redundancy of the mitral valve's leaflets?? - Answer MVP What is kava kava? - Answer herb used to treat anxiety, fibro, hyperactivity and ADD. HEPATOTOXICITY possible ...monitor liver function. A common early finding in patients with chronic aortic regurg is... - Answer LV hypertrophy Test of choice for dysplasia of hip in 3 month old... - Answer Ultrasound...xray not useful b/c hip bones still not ossified at this age. What is the presentation clinically of MVP? - Answer benign, assymptomatic. Most common valve problem in adults. CLICK What workup needs to be done for fatigue and malaise? - Answer CBC, BMP, TSH, UA What is the triad of normal pressure hydrocephalus? - Answer gait difficulty, cognitive disturbance, urinary incontinence What is a case control study? - Answer looks at "what happened"...ideal for discovering cause and effect. Groups would be analyzed to find out what risk factors were present in the "case" groups (those with outcome being studied) vs the control groups...those without those outcomes
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What class of meds is used to treat ISH? - Answer Calcium channel blockers...amlodipine, felodipine, etc What is the presenting complaint and common precipitating events of epididmytis? - Answer -scrotal pain- sexual activity, heavy physical exertion, bicycle or motocycle riding. (under 35 commonly STD related) How would you manage a patient with symptoms of diabetes and a glucose of 302??
- Answer "glucose toxic" Diabetes-2 criteria-sx and glucose > Use insulin for glucose toxicity! Oral agents wont work. RTC tomorrow for recheck of glucose. What happens to TIBC in iron deficiency anemia - Answer INCREASES--- What is the diff between major and minor depression?? - Answer number of symptoms >5/9 MAJOR <4 Minor How would a pt. with acute cholecystitis present?? - Answer URQ or epigastric pain; nausea; very still b/c peritoneal inflammation causes increased pain with movement;
- murphy's sign----ELDERLY likely to not have this or classic sx!! What does leukocytosis indicate?? - Answer infection of unknown origin (bacterial or viral) Niacin. USE, ADVERSE AFFECTS - Answer Increases HDL; DECREASES GLUCOSE TOLERANCE, flushing, hypotension, gout flares. Take at night with ASA to reduce sx. Tolerance improves over time. What is the correlation with hyperlipidemia and TSH? - Answer If lipids elevated, check TSH. ..may be secondary to hypothyroidism. It is safe to NOT treat hyperlipidemia until TSH is less than 10...if they are still elevated start a statin. Pre-HTN? - Answer 120-139 OR 80- Stage 1 HTN? - Answer 140-159 OR 90- Stage 2 HTN - Answer >or=160 OR > or = 100 diastolic "2 drugs today" What are HTN treatment goals for most patients?? - Answer <140/ HTN treatment goal for pt. with diabetes or chronic kidney disease - Answer <130/
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What interventions are commonly needed with MVP? - Answer Usually none...recommend physical activity. Mostly as symptomatic A murmur that becomes softer as pt. moves from supine to standing... - Answer physiologic. benign. Mid-systolic murmur gets louder as pt. moves from supine to standing... - Answer think hypertrophic cardiomyopathy!! How does grade III systolic murmure compare to S1 other heart sounds?? - Answer Louder than S2, softer than s S3 heart sound - Answer heard in early diastole; noted in presence if ventricular overload, heard best with bell when is S4 heard? - Answer In presence of poorly controlled hypertension recommended LDL level in persons with DM and CAD? - Answer < ECG in pt. with dig toxicity would show/ - Answer AV block PSOAS sign illicits abdominal pain with - Answer passive extension of the hip obturator sign illicits abdominal pain by - Answer PASSIVE FLEXION AND INTERNAL ROTATION OF THE HIP Mcmurray test - Answer meniscal tear Test where examiner applies pressure to top of head with neck bending forward to illicit pain/numbness in upper extremities? - Answer spurling Goal INR when treating dvt? - Answer 2.0-3. how frequently should INR be checked? - Answer Every 4-6 weeks if stable...once weekly if underlying condition can affect coagulation. In treating DM, microalbuminuria should be checked how often? - Answer yearly if urinalysis negative for protein. A1C provides info on glucose control over the last how many days - Answer 90 - Goal A1C in type II? - Answer < or =6. AT what interval should TSH be checked after levothyroxine dose changed? - Answer 6-8 weeks What is the anticipated replacement need of t4? - Answer 1.5 mcg/kg/d
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What is a treatment option for PID with w/ PCN allergy? - Answer quinolone with flagyl PID tx??? - Answer Rocephin 250 IM plus Doxy bid x 14 days with or without flagyl x 14 days Antibiotic for syphillis?? - Answer PCN ; if allergy tetracycline or rocephin what three vaccines are not given until 1 year of age - Answer hep A, MMR, varicella
