APEA Predictor Test Bank| Questions with Correct Answers| 2024/2025 Update with Complete S, Exams of Health sciences

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APEA Predictor Test Bank| Questions with Correct Answers| 2024/2025 Update with Complete Solution Graded A+ What is the biggest side effect of colchicine? ✔✔diarrhea How would you describe the appearance of molluscum contagiosum? ✔✔papules that are umbilicated and contain a caseous plug How do we treat a broken clavicle in an infant? ✔✔no treatment; it should heal on it's own At what week of pregnancy is the uterus palpable just above the pubic symphysis? ✔✔week 12 At what week of pregnancy is the fundus palpable halfway between the pubic symphysis and umbilicus? ✔✔week 16 At what week of pregnancy is the fundus of the uterus at the umbilicus? ✔✔week 20 At what week of pregnancy is the fundus of the uterus halfway between the xiphoid process and umbilicus? ✔✔week 28 At what week of pregnancy is the fundus just below the xiphoid process? ✔✔week 34 Increased sweat production is a sign of what endocrine disorder? ✔✔hyperthyroidism What is Paget's disease? ✔✔there is localized increased bone turnover and blood flow resulting in the breakdown of bone and replacing it with weakened and highly vascular bone putting the indiv at increased risk of fractures How do we treat Paget's diseease? ✔✔bisphosphonates How should pregnant women wear their seatbelt? ✔✔with the shoulder strap like a normal person and then the groin strap below the belly and across the hips What is another name for fifth disease? ✔✔parvovirus aka slapped cheek disease aka erythema infectiosum Which type of prevention are vaccinations? ✔✔primary When should patients begin antiretroviral therapy for HIV infection? ✔✔as soon as it is detected, even if in the acute phase What are the first generation antihistamines? ✔✔diphenhydramine (benadryl) and chlorpeniramine (actifed) What are s/s of the secondary stage of syphilis? ✔✔rash on hands and feet, lymphadenopathy, fever What is the recommended treatment for chronic bacterial prostatitis? ✔✔a fluoroquinolone (cipro or levo) + bactrim What is the recommended treatment for acute prostatitis? ✔✔cipro (if not STI related) or ceftriaxone What are s/s of an intraductal breast papilloma? ✔✔clear to bloody unilateral nipple discharge (bilateral is usually benign), and also a wart like lump palpated in the nipple area If a pregnant woman has syphilis, what should we do? ✔✔treat it with penicillin while she is pregnant because there is risk for spontaneous abortion What is the causative organism of mastitis? ✔✔staph What is the first line treatment for mastitis? ✔✔keflex (a cephalosporin). If that doesn't work, then try another antibiotic. If that STILL doesn't work, then refer for an ultrasound What is one of the biggest risk factors for cervical cancer? ✔✔numerous sexual partners Preeclampsia most commonly shows up at what time in pregnancy? ✔✔around week 20 How do we treat UTIs in a pregnant woman? ✔✔can either do penicillin, cephalosporin, or a macrolide (can NOT do doxy or a fluoroquinolone) When do fibrocystic breasts tend to flare up and cause tenderness and lumps? ✔✔about 10 days before menses What can be a sequelae of an ectopic pregnancy? ✔✔pelvic inflammatory disease and infertility due to scarring of the fallopian tube (salpingitis) What is the Coomb's test and when is this completed? ✔✔test given 8 weeks in to pregnancy to determine a woman's RH compatibility If a patient's Coomb's test is positive, what do we do? ✔✔nothing, she is RH positive so we do not need to treat If a patient's Coomb's test is negative, what do we do? ✔✔give rhogam at 28 weeks and 72 hours after birth What is the only form of non-hormonal contraception other than barrier methods such as condoms? ✔✔IUD The vaginal ring for contraception must be taken out how often? ✔✔every 3 weeks If a patient is on birth control and is currently having breakthrough bleeding, then what do we do? ✔✔increase the progesterone How do we treat temporal arteritis? ✔✔steroids If a patient is on birth control and they miss one pill, what should they do? ✔✔double up If a patient is on birth control and they miss two pills, what should they do? ✔✔double up for 2 days If any woman comes in with painless vaginal bleeding between periods (esp if she is postmenopausal), what should you do? ✔✔do a pregnancy test and then refer for endometrial biopsy to rule out endometrial cancer In terms of the breasts, _____________ is used for screening and _____________ is used for diagnosis. ✔✔mammogram; ultrasound When do we screen for group B strep in pregnancy? ✔✔weeks 35-37 When do we perform alpha fetoprotein screening in pregnancy? ✔✔15-20 weeks Alpha fetoprotein screening in pregnancy can help determine the presence of what in pregnancy? ✔✔spina bifida and anencephaly What is placenta previa? ✔✔when the placenta blocks the cervical opening of the uterus What is placenta abruptio? ✔✔when the placenta either fully or partially detaches from the uterine wall When does placental abruption most commonly occur? ✔✔in the third trimester What is the major difference in symptomalogy between placenta abruptio and placenta previa? ✔✔a placental abruption is painful whereas placenta previa is painless If a pregnant woman comes in with painless vaginal bleeding, what should we be considering? ✔✔placenta previa What is the recommended treatment for polymyalgia rheumatica? ✔✔steroids Patients with SLE are going to have what abnormal labwork? ✔✔elevated ESR and CRP How do we treat lupus flares? ✔✔steroids What are common sequelae of fibromyalgia? ✔✔insomnia and depression What is a great treatment option for fibromyalgia? ✔✔amitriptyline (a TCA) because it helps with chronic pain, sleep, and depression How is fibromyalgia diagnosed? ✔✔when at least 8 out of 11 points bilaterally are tender to touch and the symptoms have lasted longer than 3 months What is slipped capital femoral epiphysis? ✔✔when the femoral head of the hip is out of place What is the hook test? ✔✔used to assess for a bicep tendon issue How do we treat any rotator cuff injuries? ✔✔wear a sling to stabilize the arm and refer to ortho How long do migraine headaches last? ✔✔4-72 hours How can we abort cluster headaches? ✔✔calcium or 100% oxygen application Which type of headaches come with lacrimation and sinus symptoms? ✔✔cluster headaches What does the apprehension test assess for? ✔✔used to assess for stability of the shoulder or knee; assesses for stability How does the parathyroid gland regulate calcium? ✔✔when parathyroid hormone is released, it pulls calcium out of the blood and into the circulation in response to hypocalcemia. it also increases absorption of calcium from the intestine What is the first line treatment for trigeminal neuralgia? ✔✔carbamazepine (tegretol) or amitriptyline. also want to do gabapentin or something for nerve pain What is the recommended treatment for Bell's palsy? ✔✔steroids and anti-virals How is the pain of trigeminal neuralgia vs temporal arteritis different? ✔✔in trigeminal neuralgia, the pain is like a shock hitting the side of your face whereas temporal arteritis is more like a headache What are the preventative treatment options for migraines? ✔✔beta blockers, amitriptyline, venlafaxine, topamax, valproate What is Addison's disease? ✔✔adrenal insufficiency; the patient will be low in cortisol and sodium but their potassium will be high What are s/s of Addison's disease? ✔✔bronze or discolored skin, salt cravings a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta ✔✔molar pregnancy What bacteria is the leading cause of urethritis? ✔✔neisseria gonorrhea What is the most common cause of hypercortisolism? ✔✔excessive ACTH production How do we treat developmental hip dysplasia in a child under 6 months? ✔✔Pavlik harness; if older than 6 months may need surgery It is recommended that all children younger than __________ with sickle cell anemia take daily prophylactic antibiotics. What antibiotic is this? ✔✔5 years old; penicillin When can cervical cancer screening stop if no abnormal screening history is present? ✔✔age 65 When should breast cancer screening begin and end with a biannual mammogram? ✔✔age 50- 74 When should colorectal cancer screening stop? ✔✔age 85 Who qualifies for a low dose CT scan for lung cancer screening purposes? ✔✔age 50-80 years anyone who currently smokes or has stopped smoking within the last 5 years What does an ASC-US (atypical squamos cells of undetermined significance) pap smear result necessitate? ✔✔Do HPV testing with this. If positive, repeat in one year if age 21-24 or send for colposcopy if older than 25. If negative, repeat pap in 3 years. Which pap smear result is considered to be HPV positive? ✔✔LSIL If a patient has LSIL with a negative HPV test, what would you do? ✔✔repeat in 1 year If a patient has LSIL with no HPV test or a positive HPV test, what should you do? ✔✔refer for colposcopy If a patient's pap results show NILM, what should you do? ✔✔repeat in 3 years If a patient's pap results show ASC-H or HSIL what should you do? ✔✔refer for colposcopy The valgus stress test assesses what? ✔✔the medial collateral ligament The varus stress test assesses what? ✔✔the lateral collateral ligament The Lachman's test assesses what? ✔✔the ACL The McMurray's test assesses for what? ✔✔a torn meniscus The anterior drawer test assesses what? ✔✔the acl The posterior drawer test assesses what? ✔✔the posterior cruciate ligament (pcl) A. Urticaria B. No remarkable clinical symptoms C. A green mucoid penile discharge D. A penile ulcer ✔✔B. No remarkable clinical symptoms To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: A. The meaning of a common proverb B. What action the patient would take if their was a fire in the house C. To count backwards from 100 by 7s D. To spell a word backward. ✔✔A. The meaning of a common proverb A common rule to follow when prescribing many medications for the elderly is to: A. Give most medications in the morning to allow slowed body functions to have time to adjust to the drug. B. Start at a lower dose than what is commonly prescribed for adults, and increase the dose slowly. C. Perform a creatinine clearance test for baseline data on all person over age 70 before starting on new medications. D. Give medication with a full glass of water to promote absorption and limit harm to the kidneys. ✔✔B. Start at a low dose than what is commonly prescribed for adults, and increase the dose slowly. A 72 year old female presents with a medical history unremarkable except for the occasional headache. She enjoyed emotional health throughout marriage and childrearing, although her family history is significant for strokes and nervous breakdowns. Since her husband died a year ago, however, she has been waking every morning at 3am, is reluctant to go out although she has family member living nearby, and feels a continual urge to sleep. She cannot discuss her late husband without crying. Differential diagnoses would include: A. Stroke, depression, and hyperthyroidism B. Depression, Unresolved grief, and hypothyroidism C. Migraine, anxiety disorder, and hypertension D. Dementia, delirium, and pna ✔✔B. Depression, Unresolved grief, and hypothyroidism The parent of a 13-year old diagnosed with seizure disorder calls to report that the child is exhibiting symptoms of a cold, but has no fever. The nurse practitioner should advise the parent that development of fever may: A. make the seizure medication less effective B. Lower the seizure threshold C. Increase the seizure threshold D. Have no effect on the seizure threshold ✔✔B. Lower the seizure threshold After a 3-week camping trip, an 11-year old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: A. trimethoprim-sulamethoxazole (Bactrim) B. Azithromycin (Zithromax) C. Metronidazole (Flagyl) D. Doxycycline (Doryx) ✔✔D. Doxycycline An 88 year old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? A. Folstein Mini-Mental State examination B. Geriatric Depression Scale C. Minnesota Multiphasic Personality Inventory Myers-Briggs Test ✔✔A. Folstein Mini-mental state examination During development of a treatment plan for an 84 year old patient with hypothyroidism, the nurse practitioner has to keep in mind the worsening of: A. renal insufficiency B. Osteoporosis C. Dementia D. Anemia ✔✔B. Osteoporosis A 16 year old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She hasn't missed any doses and uses no other medication. Which of the following is appropriate? A. Modifying use B. Double dosing for 2 days C. Changing to Ortho-Novum 1/35 D. Providing reassurance ✔✔D. Providing reassurance The management of choice for polymyalgia rheumatica includes: A. whirlpool B. Prednisone C. Anelgesics D. Celebrex ✔✔B. Prednisone A 50 year old male presents with a chief complaint of malaise. Further questioning reveals that his primary concern is delayed ejaculation. He is currently taking the following medications: atenolol (Tenormin), 50 mg daily; paroxetine (Paxil), 20 mg daily; loratadine (Claritin-D), 1 tablet daily; and hydrochlorthoriazide (HCTZ), 25 mg daily. The most likely cause of the patient's concern would be: A. loratadine B. hydrochlorthoriazide (HCTZ) C. lisinopril (Zestril) D. paroxetine (Paxil) ✔✔D. Paroxetine (Paxil) A 3 year old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? A routine laboratory assessment of a 12 year old patient with a family history of thalassemia and anemia reveals Tanner II presentation and Hct=355. In addition to a complete blood count (CBC), the nurse practitioner should order which of the following? A. serum folic acid B. Vitamin B12 level C. Hemoglobin Electrophoresis D. 24-hour urine creatinine ✔✔C. Hemoglobin electrophoresis A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? A. Nitrazine test B. Non-Stress test C. Ultrasound D. Bimanual cervical exam ✔✔C. Ultrasound The common bacteria responsible for pneumonia in older adults residing in the community is: A. Staphylococcus aureus B. Streptococcus pneumoniae C. Pseudomonas Aeruginosa D. Moraxelle catarrhalis ✔✔B. Strep Pneumo A 40 year old male patient presents with a 2 week history of rectal pain and itching. He reports a past history of constipation, and finding spots of bright red blood on toilet paper several times a week. Rectal exam reveals a tender, swollen, bluish, ovoid mass. The stool guaiac test is negative. Which of the following actions should the nurse practitioner take? A. Prescribe diphenoxylate/atropine( Lomotil) B. Schedule a colonoscopy to rule out colon cancer C. Repeat the guaiac test three times and obtain complete blood count D. Prescribe bulk forming agents and hydrocortisone suppositories. ✔✔D. Prescribe bulk forming agents and hydrocortisone suppositories. A 17 year old female is suspected of having polycystic ovary syndrome. In addition to testosterone, the most appropriate diagnostic tests to order would be: A. BUN, creatinine, electrolytes, and dehydroepiandrosterone(DHEA) B. CBC, BUN, creatinine, and estrone C. Fasting blood sugar (FBS), complete blood count (CBC), BUN, and sex hormone binding globulin D. Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), prolactin, and thyroid- stimulating hormone (TSH) ✔✔D. FSH, LH, TSH Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? A. Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells B. Squamous epithelial cells with clear cytoplasm and distinct borders, many lactobacillus rods, and occasional WBC C. Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus rods, and many WBC D. Hyphae and spores, few lactobacillus rods, and occasional WBC ✔✔Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, and many white cells. A patient is referred with a diagnosis of diabetes mellitus, hypertension, and coronary artery disease. The patient is on both insulin and a beta blocker. Assuming that the patient will continue the beta blocker, it will be important to educate the patient on the recognition of hypoglycemia. Which symptom would be most indicative of hypoglycemia in this patient? A. edema B. Tachycardia C. Palpitations D. Sweating ✔✔D. Sweating A 67-year old with type 2 diabetes mellitus, congestive heart failure, and mild coronary artery disease is currently taking Digoxin, 0.25mg daily; HCTZ, 25mg daily; Metformin 500mg daily; glipizide 10mg daily; and Atorvastatin (Lipitor) 20mg HS. Which of the following is an accurate statement regarding the regimen? A. The glipizide will increase the risk of potassium depletion. B. The digoxin will increase the risk of hypoglycemia C. The HCTZ will predispose the patient to Digoxin toxicity D. The atorvastatin will worsen the diabetes. ✔✔C. The HCTZ will predispose the patient to Digoxin toxicity The initial therapy for a 3 week old infant with uncomplicated symptoms of gastroesophageal reflux disease includes of the following positions and change in diet? A. Prone position and rotate formulas in order to find one that causes less reflux B. Smaller, more frequent feedings while holding infant C. Semisupine position and offer more ounces of formula less frequently D. Lateral position and start small amounts of solid food with formula ✔✔Smaller, more frequent feedings while holding infant. Which of the following best describes psoriatic lesions in an elderly patient? A. Shiny, purple, smooth lesions B. Localized erythematous vesicles C. Erythematous plagues with central clearing D. Red, sharply defined plaques with silvery scales ✔✔D. Red, sharply defined plaques with silvery scales A 68-yo female presents with a new onset of left-sided throbbing headache. She has noticed some spots in her visual fields that come and go. She is being treated with an NSAID for arthritis. Sedimentation rate is elevated, but all other lab values are WNL. The headache is most likely due to: A. TIA A. 100 mg/dl B. 126 mg/dl C. 140 mg/dl D. 180 mg/dl ✔✔B. 126 mg/dl A nurse practitioner orders pulmonary rehabilitation for a 75 yo patient with COPD. Expected outcomes of this program include all the following EXCEPT: A. enhanced quality of life B. Increased lung capacity C. Decreased in-patient hospitalizations D. Improved exercise capacity ✔✔B. Increased lung capacity A 2month old infant is presented for examination and immunizations. History includes an uncomplicated full-term delivery and hepatitis B virus immunization shortly after birth. Examination is unremarkable except for a diffusely erythematous (not beet red) macular rash in the diaper area., sparing the inguinal folds. No satellite lesions are noted . The infant's rash is most likely caused by. A. Candida albicans infections. B. Eczema C. Seborrheic dermatitis D. Contact dermatitis ✔✔D. Contact dermatitis A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T=100F (37.8C). The patient does not apear toxic and can tolerate fluids. An appropriate plan should include: A. barium enema and nothing by mouth B. Clear liquids and antibiotics C. low-fiber diet and referral to gastroenterologist D. hospital admission for IV antibiotics ✔✔B. Clear liquids and antibiotics. Which of the following criteria differentiates a TIA from a stroke? A. focal symptoms B. Amnesia of incident C. Slowness of onset D. Absence of residual symptoms ✔✔D. absence of residual symptoms A patient with macular degeneration has difficulty seeing objects: A. from a distance B. In the center of the visual field C. At reading distance D. In the peripheral fields ✔✔B. In the center of the visual fields. Trigeminal neuralgia manifests itself primarily with: A. electric-shock-like unilateral facial pain B. Unilateral facial asymmetry C. Burning bilateral facial pain D. jaw pain extending to the neck ✔✔A. Electric-shock-like unilateral facial pain A 65-yo male presents to a clinic complaining of increasing fatigue, dyspnea on exertion, and ankle edema during the day. He has a history of mild hypertension, for which he saw his physician years ago. The physician advised the patient to decrease his salt intake. On physical exam, the patient is tachycardic, positive for jugular venous distension, and positive for S3, with a systolic murmur. Chest xray reveals cardiomegaly with vascular redistribution. The nurse practitioner's diagnosis should be: A. mycardial infarction B. pneumonia C. Heart failure D. pleural effusion ✔✔C. Heart failure An 88-yo patients has had a gradual onset of hearing loss in the left ear. Examination shows a large accumulation of cerumen in the external auditory canal. Assuming there is no neural loss, the nurse practitioner would expect the Weber test to: A. lateralize to the left B. lateralize to the right C. Be inconclusive D. Not lateralize ✔✔A. Lateralize to the left. A 38-yo male experiences a sudden onset of acute abdominal pain radiating to his groin. He is having difficulty walking and is nauseated. He denies any trauma or previous groin injuries. Examination reveals diffuse swelling of the left testicle and negative cremasteric reflex. The most likely diagnosis is: A. Testicluar cancer B. Testicular torsion C. Appendicitis D. Epididymitis ✔✔B. Testicular Torsion Research findings have shown that, in order to improve the longevity of a patient who has COPD, the treatment of choice is: A. oxygen B. Anticholinergic drugs C. Systemic steroids D. Exercise ✔✔A. Oxygen A 15 year old patients returns for contraceptive services 2 weeks after a diagnosis of trichomonas vaginitis and treatment with 2gm of metronidazole (Flagyl). She reports that discharge and itching are gone, but she is urinating frequently, accompanied with alot of burning. The patient has not resumed sexual activity and has menstrated since her last visit. Examination reveals mild suprapubic tenderness, no leukorrhea, and a normal wet mount. Gonococcal culture and chlamydia tests are negative. Which diagnostic test should be performed immediately? A. Urine pregnancy test B. Microscopic exam of urine C. A negative Rovsing's sign D. Positive Prehn's sign ✔✔Rebound tenderness at McBurney's point Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? A. Pain worse in supine position; focal neurological signs B. Hyperreflexia; personality changes C. Acute onset; increasing pain over hours to days D. Pupillary constriction; stupor ✔✔A. Pain worse in supine position; focal neurological signs A 65 yo female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical exam, there is pain on ROM, with no weakness noted. Lab studies show a low hemoglobin and elevated SED rate. Which of the following is the most likely diagnosis? A. Polymyositis B. Osteoarthrits C. Polymyagia Rheumatica D. Fibromyalgia ✔✔Polymyalgia Rheumatica A 39 yo patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. The patient now presents to a nurse practitioner's office with a fever of 101.2 and a cough productive of thick, yellow-green, foul-smelling sputum. The nurse practitioner should encourage smoking cessation and prescribe: A. theolphylline B. A PCN antibiotic C. an inhalable corticosteroid D. a macrolide antibiotic ✔✔D. A macrolide antibiotic Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection: A. WBC count and viral load B. CD4 count and viral load. C. CD4 count and Western blot test D. CD4 count and enzyme-linked immunosorbent assay (ELISA) ✔✔B. CD4 count and viral load The best lab test to distinguish iron deficiency anemia from other anemias is: A. Serum ferritin level B. Mean corpuscular hemoglobin concentration C. Mean corpuscular volume D. Transferrin saturation ✔✔A. Serum ferritin level The follow-up exam of a 12 month old treated 2 weeks ago for bilateral otitis media reveals a normal left tympanic membrane and a right tympanic membrane with visible serous fluid levels and decreased mobility. An appropriate plan should include: A. Consultation with an audiologist B. Prescription for an oral decongestant C. Follow-up evaluation of the ears in 2 months D. Referral to an ENT specialist for surgical consultation ✔✔C. Follow-up evaluation of the ears in 2 months. Which of the following lab test should a nurse practitioner order when the suspected diagnosis is temporal arteritis? A. Antinuclear antibody B. Electrolyte profile C. Erythrocyte sedimentation rate (ESR) D. Complete Blood Count (CBC) ✔✔C. Erythrocyte Sedimentation Rate (ESR) A 47-yo patient presents with complaints of upper abdominal discomfort with nausea and burning after eating. The patient is not currently taking any medications. The most likely differential diagnoses would include: A. colitis and peptic ulcer disease B. Colitis and small bowel disease C. Gastritis and Crohn's disease D. Gastritis and peptic ulcer disease ✔✔D. Gastritis and peptic ulcer disease. To assess spinal function at the S1 level, which deep tendon reflex should be tested? A. Patellar B. Cremasteric C. Achilles D. Anal wink ✔✔C. Achilles A 66- yo patient presents with bilateral otis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 x 4. The patient should be evaluated for: A. HIV infection B. Myelodysplastic syndrome C. Congenital lymphoproliferative disease D. non-Hodgkin's lymphoma ✔✔A. HIV infection A nurse practitioner is suturing a simple laceration on an 11-yo patient. The use of lidocaine with epinephrine is contraindicated in all of the following areas EXCEPT the: A. Scalp B. Nose C. Fingers D. Earlobe ✔✔A. Scalp Cranial nerve III, IV, VI ✔✔Eye movement Cranial Nerve V,VII,X,XII ✔✔Voice and speech Cranial Nerve VIII ✔✔Acoustic (Hearing and balance) Cranial nerve IX ✔✔Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI ✔✔Spinal Accessory (upper trapezius) Deep tendon reflex ✔✔Ankle- S1 primarily Knee- Lumbar 2,3,4 Supinator(brachioradialis)-C5,6 BicepTriceps-C6,7 Stroke risk scale ✔✔CHADS2 C-Congestive heart failure H-Hypertension A-Age >75 years D- Diabetes S-prior Stroke/TIA In the majority of children, the first permanent teeth start to erupt at the age of 6 years. Which of the following are the first permanent teeth to erupt in this time period? A. First Molars B. Second Molars C. Lower or upper incisors D. Canines ✔✔A. First Molars All of the following are classified as activities of daily living (ADLs) except: A. ability to feed self B. Ability to manage bladder and bowel elimination C. Personal hygiene and grooming D. Grocery Shopping ✔✔D. Grocery shopping You note the following result on a routine urinalysis of a 37-year old primigravida who is at 30 weeks gestation. Leukocyte=trace, nitrite=negative, protein=2+, blood=negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? A.HELLP syndrome B. Pregnancy-induced hypertension (pre-eclampsia) C. Eclampsia of pregnancy D. Primary hypertension ✔✔B. Pregnancy-induced hypertension (pre-eclampsia). Classic triad of symptoms of preeclampsia include hypertension, edema (weight gain), and proteinuria. The mother of a 12 month old infant reports to the nurse practitioner that her child had a high fever for several days, which spontaneously resolved. After the fever resolved, the child developed a maculopapular rash. Which of the following is the most likely diagnosis? A. Fifth Disease (erythema infectiosum) B. Roseola infantum (exanthema subitum) C. Varicella D. Infantile maculopapular rashes ✔✔B. Roseola Infantum (Exanthema subitum) A 70-year old male patient complains of a bright red-colored spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on Bayer aspirin, 1 tablet a day. Which of the following is most likely? A. Corneal abrasion B. Acute bacterial conjunctivitis C. Acute uveitis D. Subconjunctival hemorrhage ✔✔D. Subconjunctival hemorrhage. Bright red blood in a sharply defined area surrounded by normal-appearing conjunctiva indicates subconjunctival hemorrhage. A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH is 4.0. There are very few leukocytes and no RBCs are seen on the wet smear. Which of the following is most likely? A. Atrophic vaginitis B. Bacterial Vaginosis C. Trichomoniasis D. This is a normal finding. ✔✔A. Atrophic vaginitis. Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of estrogen. Normal pH of the vagina is 4.0-5.0 (acidic) The most common type of skin malignancy is: A. Squamous cell cancer B. Basal skin cancer C. Melanoma D. Dysplastic nevi ✔✔B. Basal skin cancer. It is several times more common that squamous cell skin cancer according to the NIH. Koplik's spots are associated with: A. Poxvirius infections B. Measles C. Kawasaki's disease D. Reye's syndrome ✔✔B. Measles. S/S include fever over 101, coryza, cough, conjunctivitis, rash, and koplik's spots on buccal mucosa At what level of prevention would you classify for lung cancer? age 40, and then annually beginning at age 50 years. Oral contraceptives may help reduce cyclical pain and swelling. Congenital heart disorders present with symptoms at: ✔✔birth, infancy, or in childhood. A common misconception is that congenital disorders always present symptomatically at birth. They can present at various times throughout childhood and are classified as cyanotic or acyanotic. Cardiac disorders in infants and children may be acquired from rheumatic fever or kawasaki syndrome. A 21-yo patient presents with abdominal guarding, rigid abdominal musculature, rebound tenderness at McBurney's point, and leukocytosis. What is the most likely diagnosis? ✔✔Appendicitis. McBurney's point is the RLQ abdominal landmark for the appendix. Rigid abdominal musculature, rebound tenderness, and positive psoas sign (inflamed psoas muscle), indicates inflammation of the peritoneum. Cholecystitis presents with RUQ pain and positive Murphy's inspriatory arrest. Ilcerative colitis presents with LLQ pain. Pain associated with pancreatitis is typically in the epigastric region. Atenolol (Tenormin) should be avoided in: ✔✔a 43-yo female with asthma. Atenolol is a beta blocker. It should be avoided in pateints with asthma or other bronchospastic conditions. These patients often require beta stimulation, not beta blockade. Although atenolol is a beta 1-selective agent, at higher doses beta 2 receptors (bronchial and vascular) are blocked. Beta blockers, specifically atenolol, are beneficial post-myocardial infarction because they have demonstrated a reduction in morbidity and mortality. All of the following interventions with pediatric patients are appropriate EXCEPT: ✔✔Pre- medicate the patient prior to all painful interventions. Pre-medication is not warranted prior to all painful interventions. For example, premedication is not warranted prior to routine immunizations but it certainly is prior to suturing. Pain management should be an integral part of patient management. Infants with veliac disease (gluten eneteropathy) are at risk for multiple complications. The most urgen complication of this disease is: ✔✔Intususseption or volvulus. Intuseusseption and volvulus are surgical emergencies. Delay releasing the invaginated or "telescoped" bowel (intususseption), or releasing the twisted bowel (volvulus) may result in tissue death and gangrene, perforation, peritonitis, and/or sepsis, and fatality. There is also a high rate of intususseption and volvulus among infants with cistic fibrosis. Which activities are NOT characteristic of preschool children? ✔✔Always follow rules during playground games. Since preschoolers are just beginning to learn moral behaviors, they often cheat to win. While most preschoolers toilet independently, accidents occasionally occur and bed-wetting is not unusual. The use of a security item such as a blanket is common. A 38-yo pregnant patient at 18 weeks gestation, complains of feeling light-headed when standing. Which of the following is an appropriate response by the NP? ✔✔Blood pressure normally decreases during pregnancy and can cause this symptom. Blood pressure normally decreases during pregnancy, reaching the lowest point during the second or third trimesters and rising there after. Patient education to rise slowly from sitting or lying is important. Low blood glucose may be the etiology, but an oral glucose tolerance test at this point is not indicated. A fasting blood glucose could be ordered, however, an electrocardiogram is not indicated. An 80 year old Caucasian female has heart failure. What symptom is an early indicator of failure? ✔✔Weight gain. Early signs of heart failure include weight gain (the most sensitive indicator), S3 gallop, dyspnea on exertion, peripheral edema. Moderate signs include nocturnal cough, tachycardia. Late signs include ascities, frothy sputum, and hypotension. A 6 yo had an acute onset of fever, pharyngitis, and headache 2 days ago. Today, he presents with cervical lymphadenopathy and sandpaper textured rash everywhere except on his face. A rapid streptococcal antigen test is positive. The remainder of the assessment in unremarkable. What is the most likely diagnosis and the most appropriate action? ✔✔Scarlet fever; treat with antibiotics. This disease is due to infection with Group A Beta-hemolytic streptococcus. The rash is thought to be due to a systemic reaction to the toxin produced by the microorganism. The rash fades with pressure and ultimately desquamates. A deep, nonblanching rash on the flexor surfaces of the skin is referred to as pastia lines. A patient has been diagnosed with hypothyroidism and thyroid hormone replacement therapy is prescribed. When should the nurse practitioner check the patient's TSH? ✔✔6 weeks. The half-life of levothyroxine, the treatment of choice for thyroid replacement, is 7 days. The earliest that meaningful changes will be observed is at 4-6 weeks. Therefore, the NP should wait a minimum of 4-6 weeks before checking the patient's TSH. A 15 yo malue has a history of cryptorchidism which was surgically repaired. Because of this information, it is essential for the nurse practitioner to teach him about: ✔✔testicular self- examination. Cryptorchidism, even with surgical repair, is associated with increased risk for testicular cancer. The treatment of choice for chronic bacterial prostatitis (CBP) is: ✔✔a flouroquinolone twice daily for 3 weeks to 4 months. The treatment of chice is a flouroquinolone twice daily for 3 weeks to 4 months. The cure rate with Bactrim-DS is only about 30-40%. A 25 yo female has a history of frequent candidal vaginal infections in the past year. She is in a monogamous sexual relationship and uses and IUD for contraception. Of the following, which is the most likely underlying conidition predisposing her to recurring candidal vaginitis? ✔✔Diabetes. A common underlying cause of frequent infections is diabetes mellitus. Pregnancy increases the incidence of candidiasis, but is unlikely a factor with this patient. Which of the following is NOT a characteristic of the S3 heart sound? ✔✔The sound is high- pitched and occurs just prior to the S1 heart sound. The S3 heart sound is low-pitched and occurs just after the S2 heart sound. It is produced by rapid ventricular filling and is best auscultated in the mitral area. It is a common finding with right-sided heart failure, rapid growth, and the last trimester of pregnancy. Generally, full term infants who are breadt-fed have sufficient stores of iron to last through the first 4-6 months of life. Earlier supplementation may be m=necessary for premature infants, infants who are breastyfed exclusively beyond the first 6 months of age, and infants who begin drinking cow's milk prior to 1 year of age. Which item is NOT implicated in erectile dysfunction (ED)? ✔✔Urinary tract infection (UTI) Many systemic disease like diabetes, hypo/hyperthyroidism, Cushing's syndrome can result in ED> Many medications can cause ED, particularly the antihypertensives (Vasotec) and the antidepressants (Paxil). Other activities like heavy smoking, drug abuse, and alcoholism can also lead to ED. Expected spriometry readings when the patient has chronic emphysema include: ✔✔Increased total lung capacity (TLC). Residual volume is increased, Volume Capacity is decreased, FEV-1 in decreased, and total lung capacity is increased with emphysema. RV, VC, and FEV-1 spirometry readings are the same whether COPD is due to chronic emphysema or chronic bronchitis, however, TLC is normal or only slightly increased with chronic bronchitis. Physical exam findings consistent with emphysema include all of the following EXCEPT: ✔✔pallor and cyanosis of the mucosa and nailbeds. Pallor and cyanosis is typical of chronic bronchitis (type B COPD, the "blue boater"_. Emphysema (Type A COPD, the "pink puffer") is not associated with pallor or cyanosis. Increased AP dianeter produces a "barrel chest". The normal chest is elliptical whereas the barrel chest is round. The muscles of the thorax appear thin and wasted while the accessory muscles of respiration are hypertrophied. Breath sounds are minished and cough is weak and ineffective. Which laboratory test is useful in the diagnosis of spontaneous abortion? ✔✔Serial quantitative beta-huma chorionic gonadotropin levels. Serial quantitative beta-human chorionic gonadotropin levels are the most useful for diagnosing spontaneous abortion. The levels progressively decline. The most acceoted recommendation regarding skin cancer prevention is: ✔✔avoidance of excessive sun exposure. Avoidance of excessive sun exposure is the most accepted recommendation for prevention of skin cancer. All the other items are recommended by particular groups, but are not as widely accepted. Clinicians should remain alert for suspicious lesions in fair-skinned men and women >65 years, those with atypical moles, those with > 50 moles. These groups have a substantially increased risk for melanoma. What prophylaxis medication is recommended for the patient under 35 years of age with a positive ppd? ✔✔isoniazid (INH) The CDC recommends administration of isoniazid to persons under 35 years of age with a positive PPD. The goal of this treatment is to prevent progression from latent infection to active infection. The other medications are used to treat active TB, but not for prophylaxis. The diagnosis of Meniere's disease is based on: ✔✔The exclusion of other pathologies. Most cases of Meniere's disease are idiopathic and the diagnosis is based on the exclusion of other pathologies. Central vertigo is present with many vestibular problems. Low frequency hearing loss is more commonly associated with Meniere's disease. MRI is helpful to rule out acoustic neurome, but not to diagnose Meniere's disease. The reason beta-adrenergic blockers should be avoided in patients with diabetes is because they may: ✔✔Mask symptoms of hypoglycemia. Beta blockers may mask the peripheral signs of hypoglycemia like jitteriness and tachycardia. However, beta blockers will not mask diaphoresis. Therefore diabetics on betablockers should be taught to look for this specific symptom as a possible indication of hypoglycemia. An adult female patient is seeking information about her ideal weight. She is 5 feet 7 inches tall. Using the "height-weight formula" what is her ideal body weight? ✔✔135 lbs The height-weight formula is a quick method of determining ideal weight. Females allow 100 lbs for the first 5 feet of height plus 5 lbs for each additional inch. Males allow 106 lbs for the first 5 feet plus 6 lbs for each additional inch. This method can only be used as an estimate because it does not account for body composition or age. The nurs practitioner is caring for a 19 year old female college student with iron deficiency anemia secondary to heavy menstrual bleeding. An appropriate INITIAL treatment for this patient is: ✔✔Oral ferrous sulfate. With iron deficiency anemia, iron stores of the body must be replenished as well as the underlying cause corrected. A daily iron supplement is used initially. The most common form is ferrous sulfate. Intramuscular iron dextran is usually not needed, but may be required in the presence of a malabsorption disorder, inflammatory bowel disease, intolerance to oral iron, or blood loss too great to be compensated by oral iron. A male patient with chronic atrial fibrillation takes a generic brand of Coumadin (warfarin). He should report all of these to his health care provider EXCEPT: ✔✔one missed dose of warfarin. This patient takes warfarin for prevention of emboli secondary to chronic atrial fibrillation. According to the NHLBI and ACCP, warfarin is the standard of care when anticoagulation is required for this condition. Warfarin is a drug with a narrow therapeutic index. This means that fluctuation in its level (increased or decreased) can potentiall cause big changes in its therapeutic effect. Consequently, warfarin levels are checked frequently to maintain therapeutic levels. If changes such as medication substitutions occur, warfarin levels should be checked in 3-7 days. Levels should be checked minimally every 4-6 weeks once regulation has occurred. While it is important NOT to omit doses of warfarin, this is the least important of all the choices because the effect of warfarin lasts beyond 24 hours. Which of the following medication or medication class that does NOT have dizziness or vertigo as potential adverse side effects? ✔✔Meclizine (Antivert) Dizziness is associated with a sensation of body movement when there is no body movement occurring. (The person is spinning and the room is not). Vertigo is the sensation that the person is still and the room is spinning. There is no associated muscle weakeness or visual disturbance with either of these conditions. The most common causes are related to drug ingestion, hypotension, inner or middle ear pathology, and positional vertigo. Dizziness is an adverse reaction associated with certain antibiotics (gentomycin and strptomycin) and high-dose salicylates. Vertigo is associated with certain inner ear pathology such as labyrinthitis and Meniere's disease. Meclizine is a long-acting antihistamine which is used to treat chronic vertigo. A PPD is considered positive at 5 millimeters or more for which population? ✔✔Confirmed or suspected HIV infection, injecting drug users, close contacts of a TB case, persons with a chest X-ray suggestive of TB A PPD greater than or equal to 10 mm is considered positive for injecting drug users known to be HIV negative, occupants of long-term care facilities, age less than 4 years, groups with a high prevalance for TB, the medically underserved, and healthcare workers. A PPD is considered positive at 15mm or more in those with no known risk factors. What is Auspitz sign? ✔✔the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques A positive Auspitz sign is indicative of what? ✔✔psoriasis When are pregnant women screening for gestational diabetes? ✔✔week 24-28 What is round ligament pain? ✔✔a deep, sharp, stabbing or stretching sensation that begins or worsens with movement and can be unilateral or bilateral. This is a normal and benign part of pregnancy What are the components of the fetal biophysical profile? ✔✔nonstress test (heart rate monitoring), amniotic fluid analysis, fetal movements, fetal tone, and fetal breathing How is the fetal biophysical profile performed? ✔✔via ultrasound and fetal heart rate monitoring When is the fetal biophysical profile often performed? ✔✔in the third trimester, often after week 28-32 What is a normal kick count in pregnancy? ✔✔at least 10 kicks in a consecutive two hour period How much weight should an underweight woman gain in pregnancy? ✔✔28-40 pounds How much weight should a normal weight woman gain in pregnancy? ✔✔25-35 pounds How much weight should an overweight woman gain in pregnancy? ✔✔15-25 pounds How much weight should an obese woman gain in pregnancy? ✔✔11-20 pounds Underweight and normal weight woman should be gaining how much weight per week in their second and third trimesters? ✔✔1 pound Overweight and obese women should be gaining how much weight per week in their second and third trimesters? ✔✔0.5 pounds What is the biggest risk associated with scabies? ✔✔secondary infection due to itching What do scabies look like on the skin? ✔✔red papular bumps that have s shaped burrows on them; may have fluid coming from them Sickle cell anemia is what type of anemia? ✔✔normocytic How is sickle cell anemia diagnosed? ✔✔hemoglobin electrophoresis Which age group is rheumatic fever most common in? ✔✔children ages 5-15 What are the major symptoms of rheumatic fever? ✔✔carditis, arthritis, chorea, erythema marginatum (rash), subcutaneous nodules What are the minor symptoms of rheumatic fever? ✔✔fever, elevated ESR, prolonged PR interval How do we treat rheumatic fever? ✔✔refer to the hospital What is chorea? ✔✔abnormal involuntary movements What are the main s/s of rubeiola (measles) ✔✔Koplick spots + the 3 c's - cough, coryza, conjunctivitis GABHS infection puts individuals at the highest risk of developing what sequelae? ✔✔peritonsillar abscess, glomerulonephritis, rheumatic fever What is the diagnostic criteria for acute rheumatic fever? ✔✔2 major criteria OR 1 major + 2 minor criteria PLUS evidence of a recent strep infection When can a breastfeeding mother breast feed again after drinking alcohol? ✔✔wait 2-3 hours per drink consumed before breastfeeding again Can a mother take methadone while pregnant and breastfeeding? ✔✔yes Does subsequent mean before or after? ✔✔after What is the recommended treatment for Kawasaki disease? ✔✔refer to the ED, will likely need IVIG and high dose aspirin What are the s/s of Kawasaki disease? ✔✔fever + CREAM (conjunctivitis, rash, erythema of palms and soles, adenopathy cervical, mucous membranes) Kawasaki disease is caused by what? ✔✔an acute vasculitis of the small and medium blood vessels What is the main difference between Kawasaki disease and scarlet fever? ✔✔KD has conjunctivitis and scarlet fever does not The rash associated with acute rheumatic fever ✔✔erythema marginatum The rash associated with parvovirus aka slapped cheek aka fifth disease ✔✔erythema infectiosum What are the s/s of polymyalgia rheumatica? ✔✔chronic pain in the proximal joints (shoulders and hips) bilaterally with stiffness lasting for more than 45 minutes What is the recommended treatment for polymyalgia rheumatica? ✔✔PO steroids and refer to Rheumatology to confirm the diagnosis Where are the biggest food sources of vitamin B12? ✔✔fish, meat, poultry, eggs, and dairy products, also fortified breakfast cereals and fortified nutritional yeasts What is the gold standard for the diagnosis of herpes? ✔✔nucleic acid amplification test Most cases of acute sinusitis are viral and how can we treat them? ✔✔treat the symptoms with intranasal steroids and saline rinses What is the difference between chronic vs gestational hypertension? ✔✔chronic htn is present before 20 weeks gestation or 12 weeks after delivery; gestational hypertension is after 20 weeks gestation Which is the recommended diagnostic when a patient has a breast lump? ✔✔if less than 45, do an ultrasound. if older than 45, do a diagnostic mammogram. An overactive bladder is what type of incontinence? ✔✔urge incontinence What is the recommended treatment for urge incontinence? ✔✔anticholinergics like oxybutynin What is the recommended treatment for stress incontinence? ✔✔alpha agonists like sudafed, TCAs What is the recommended treatment for BPH? ✔✔alpha blockers like terazosin, doxazosin, tamsulosin Alcohol and marijuana worsen which type of incontinence? ✔✔urge Which SSRI is safest in pregnancy? Which poses the most risk? ✔✔sertraline; paroxetine Infants born to women who smoke are at increased risk for what? ✔✔low birth weight and preterm delivery What is the best marker of an acute MI? ✔✔troponin When do troponins peak after a MI? ✔✔12 hours When should an infant be able to display a conjugate gaze (track you all the way across the room)? ✔✔6 months Which medication is approved in Peds for the prevention of febrile seizures? ✔✔diazepam Folic acid is which vitamin? ✔✔vitamin B9 What is the dosage preferred for folic acid deficiency? ✔✔1-5mg daily Dosage of folic acid in pregnancy to prevent neural tube defects ✔✔400mcg daily What are ECG changes you may see on a patient with hypokalemia? ✔✔tachyarrhythmas, ST depression, prolonged QT, and U wave present What are ECG changes you may see on a patient with hyperkalemia? ✔✔peaked T waves A U wave present on EKG is thought to represent what? ✔✔repolarization of the purkinje fibers What is considered legal blindness? ✔✔20/200 or worse What is the pain of temporal arteritis like? ✔✔new onset headache, jaw pain with chewing Are nexplanon and norplant (levonorgestrol) combined contraceptives or progesterone only? ✔✔progesterone only Breastfeeding women cannot have which type of anti-contraceptive? ✔✔anything with estrogen in it; this includes things like cocps What is the treatment of choice for community acquired, uncomplicated pneumonia? ✔✔amoxicillin Vitamin B12 deficiency anemia is a type of ____________ anemia. ✔✔pernicious; macrocytic Prostate infection or inflammation can cause a sharp rise in PSA values. When should this value go back down to normal levels and be checked after an acute infection? ✔✔4 weeks The most common cause of atypical pneumonia in adults ✔✔mycoplasma pneumoniae An herbal supplement thought to help BPH ✔✔saw palmetto A male patient presents to your clinic with a lump in his breast. How should we work this up? ✔✔clinical breast exam, mammogram, AND ultrasound If a patient with strep comes back after 48 hours with no improvement on antibiotics, what should you then prescribe? ✔✔a penicillin or cephalosporin with beta lactamase coverage Is age less than 18 years a risk factor for an ectopic pregnancy? ✔✔no; but personal history of PID, an IUD, previous ectopic pregnancy, previous tubal surgery, pathology, or ligation all are risk factors What is Tanner stage 5 of breast development in females? ✔✔projection of the nipple only What are two common classes of drugs that interact with grapefruit juice? ✔✔statins and CCBs Ankle inversion is a common complaint from a patient with what? ✔✔a lateral ankle sprain How can we best diagnose coarctation of the aorta? ✔✔by comparing the upper and lower extremity blood pressures What is the most important risk factor for developing breast cancer in women of average risk? ✔✔age hey ✔✔stopped at top of page 7 What is the recommended treatment for blepharitis? ✔✔erythromycin 1cm ribbon 5x daily for 7 days What is the recommended treatment for severe anorexia with delusions? ✔✔2nd atypical antipsychotics What lab values need to be monitored in a patient on Tizanidine? ✔✔LFTs and BP at baseline and 1 month after the max dose is achieved (can cause hepatotoxicity and hypotension) What class of drug is dabigatran (pradaxa)? ✔✔direct thrombin inhibitor The most effective treatments for acne related to increased sebum production are what? ✔✔oral contraceptives and isotretinoin Oral contraceptive regimen in which both the estrogen and progesterone concentrations vary throughout the cycle ✔✔quadriphasic Oral contraceptive regimen in which the estrogen and progestin doses are fixed throughout the cycle ✔✔monophasic Oral contraceptive regimen in which in the estrogen dose remains the same for the first 21 days of the cycle, while progestin is lower in the first half and higher in the second half ✔✔biphasic Oral contraceptive regimen in which the estrogen remains consistent and the progestin dose varies ✔✔triphasic Patients who are receiving beta blockers may find what treatment for allergies ineffective? ✔✔treatments containing epinephrine For a patient on warfarin who needs to receive a tetracycline antibiotic, how will we adjust their warfarin? ✔✔tetracyclines depress prothrombin activity, same as warfarin, so we need to decrease the warfarin to avoid an increase in INR and significant bleeding What is the herbal, valerian root often used for? ✔✔insomnia/sleep, ADHD, anxiety, depression What is the herbal, saw palmetto, often used for? ✔✔BPH What is the herbal, black kohosh, often used for? ✔✔symptoms of menopause - hot flashes What is the herbal, St. John's wart, often used for? ✔✔depression What are the intrauterine transplacental infections that can be passed from mother to infant? ✔✔think TORCH; toxoplasmosis, Other (syphilis, varicella zoster, parvovirus) Rubella, Cytomegalovirus and Herpes simplex, as well as tuberculosis. Note that chlamydia is NOT transplacental, but rather transvaginal during childbirth The antibiotic of choice for a dog bite ✔✔augmentin; doxy if there is a penicillin allergy Obese women should gain how much weight during pregnancy? ✔✔11-20 pounds Overweight women should gain how much weight during pregnancy? ✔✔15-25 pounds Normal weight people should gain how much weight during pregnancy? ✔✔25-35 pounds Underweight people should gain how much weight during pregnancy? ✔✔28-40 pounds Pregnant women should increase their daily caloric intake by how many calories per day? ✔✔300 Immunizations are considered to be what level of prevention? ✔✔primary Children can start to ride a tricycle around age _____ ✔✔3 A gray or white ring present around the peripheral iris ✔✔arcus senilis What causes arcus senilis? ✔✔it is a normal, benign condition with aging, but can also occur in younger people as a result of high cholesterol and triglycerides How is a diagnosis of neuroblastoma confirmed? ✔✔via serum catecholamine testing and a biopsy A woman who gets the MMR vaccine should wait at least __________ before getting pregnant. ✔✔4 weeks What is a major cause of cleft palate and lip? ✔✔smoking during pregnancy What is Auspitz sign? ✔✔the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques Treatment of choice for pyelonephritis ✔✔ciprofloxacin When should pediatrics be screened for hyperlipidemia? ✔✔between 9 and 11 years old What is the tell-tale symptom of endometriosis? ✔✔progressive dysmenorrhea What is treatment for first-line endometriosis? ✔✔cyclic OCPs and NSAIDs How is endometriosis diagnosed? ✔✔via transvaginal ultrasound What are risk factors for the development of cervical cancer? ✔✔HIV, immunocompromised, low socioeconomic status, smoking, hispanic, DES daughters, long term contraceptive use What does the D in melanoma stand for? ✔✔greater than 6mm in diameter or 1/4 of an inch Boutonniere deformities are indicative of what disease? ✔✔rheumatoid arthritis What are the potassium sparing diuretics? ✔✔spironolactone, triamterene, amiloride, eplenerone What class of diuretic is bumetanide? ✔✔a loop diuretic, same as lasix What is Chovstek's sign? ✔✔a contraction of ipsilateral facial muscles subsequent to percussion over the facial nerve, indicative of hypocalcemia What is Trousseau's sign? ✔✔a carpopedal spasm induced by ischemia secondary to the inflation of a sphygmomanometer cuff, indicative of hypocalcemia Calcium is in an inverse relationship with what electrolyte? ✔✔phosphorous When you see the trigger word "christmas tree", what rash should you consider? ✔✔pityriasis rosea What is the recommended treatment for pityriasis rosea? ✔✔nothing; it is a viral rash and can last up to two months before clearing on it's own Causing harm or damage ✔✔deleterious How do you calculate ideal body weight for men? ✔✔start at 106 pounds and then add 6 for every inch above 5 feet How is lichen sclerosus treated? ✔✔topical steroids, topical calcineuronin inhibitors to suppress the immune system, topical or oral retinoids, phototherapy What is the tell-tale sign of malignant hypertension? ✔✔retinopathy and blurred vision; characterized by a diastolic BP of greater than 130 What is the difference between a Parkinsonian tremor and an essential tremor? ✔✔a Parkinson tremor is also known as a resting tremor and is seen at rest, may look like pill-rolling. an essential tremor is bilateral, symmetric and seen when the hands are doing something What can worsen and improve an essential tremor? ✔✔worsened by stress or fatigue, improved by alcohol What is first-line treatment for trigeminal neuralgia? ✔✔carbamazepine (tegretol) or amtriptyline Are Parkinsonian tremors unilateral or bilateral at first? ✔✔unilateral Where is the TMJ best palpated? ✔✔anterior to the tragus What are the primary bacteria in dog bites? ✔✔staph, strep, and pasteurella What is the gold standard treatment of giant cell arteritis? ✔✔oral steroids and potential artery biopsy by rheum Who is a candidate for Truvada for Prep? ✔✔if you are an IV drug user, have had a sexual partner with HIV in the last 6 months, do not consistently use a condom and engage in anal or vaginal sex, or have been diagnosed with a STD in the last 6 months Post exposure prophylaxis for someone with HIV should be completed when? ✔✔within 72 hours of the exposure Who should be screened for HIV? ✔✔everyone at least once from age 13-64 if low risk, and then more frequently if high risk Should patients undergo gonorrhea testing to confirm a cure after receiving treatment? ✔✔only if they had pharyngeal gonorrhea, not vaginal or anal Tanner stage 1 female breast developmental ✔✔prepubertal When you ask the patient to take a deep breath in and then palpate over the RUQ abdomen. Positive when pain is elicited. This is a sign of ___________. ✔✔Murphy's sign; cholecystitis What are names of LABA medications? ✔✔salmeterol What is encopresis in children? ✔✔stool incontinence after the age of being toilet trained The medical term for being cross-eyed ✔✔strabismus What is atopic dermatitis? ✔✔eczema Tests used to diagnose developmental hip dysplasia ✔✔Barlow and Ortolani maneuvers What is the female athlete triad? ✔✔disordered eating, amenorrhea, osteoporosis How do patients with aortic regurgitation typically present? ✔✔they will have a long asymptomatic period followed by exercise intolerance, then dyspnea at rest. The left ventricle eventually fails unless the aortic valve is replaced. What does the rash of fifth disease (a viral exanthem) look like? ✔✔maculopapular rash that blanches easily and may be accompanied by joint aches What cardiac abnormalities are expected to be heard on auscultation of a pregnant patient? ✔✔a venous hum murmur and an S3 When a headache accompanies a stroke, is this most often hemorrhagic or ischemic? ✔✔hemorrhagic AV nicking is most commonly seen on retinal exam of which chronic condition? ✔✔hypertension Within 6 months of being started on a TCA or SSRI, what is a common side effect that occurs? ✔✔weight gain When does otitis media with effusion usually occur? ✔✔either before or after an episode of acute otitis media. This effusion is not infected fluid but it is considered a breeding ground for bacteria. This should not be treated with antibiotics. The medical term for jock itch ✔✔tinea cruris Tinea cruris "jock itch" is a common __________ infection and should be treated with what? ✔✔fungal; OTC antifungal cream What are teaching points for males to avoid contracting tinea cruris? ✔✔dry off after swimming and don't stay in a wet bathing suit Tinea cruris can affect the inner thighs but never what else? ✔✔the penis or scrotum On microscopic exam, what is most likely to be seen in the presence of a bacterial infection? ✔✔cocci and rods On microscopic exam, what is most likely to be seen in the presence of a candidal infection? ✔✔yeasts What are dermatophytes? ✔✔fungi On microscopic exam, what is most likely to be seen in the presence of a dermatophytic (fungal) infection? ✔✔hyphae that are long, thin, and branching (such as in the case of tinea pedis, tinea cruris, and tinea corporis) The medical term for ringworm ✔✔tinea corporis What is the most common cause of viral pneumonia in peds? ✔✔RSV Viral pneumonia is the most common type of pneumonia in children of what ages? ✔✔6 months to 5 years What is the simplest way to screen for nutritional adequacy in older adults? ✔✔measure their weight How are scabies treated? ✔✔via permethrin and good hygiene What are common side effects of NSAIDs? ✔✔renal impairment, acute renal failure, gastritis What is the most common cause of pernicious anemias? ✔✔vitamin B12 deficiency How should oral iron supplements be taken? ✔✔on an empty stomach with something acidic and high in calcium such as orange juice Group A strep pharyngitis can be accompanied by what symptoms other than the classic Centor criteria? ✔✔abdominal pain, nausea, and vomiting A stool specimen that is positive for WBCs is a sign of what? ✔✔a viral or bacterial infection The only type of incontinence that would not benefit from pelvic floor therapy is what? ✔✔overflow incontinence What do the skin manifestations of a penicillin allergy look like? ✔✔hives A depressed patient is started on an SSRI. When should another antidepressant be tried if there is no response? ✔✔8-12 weeks If the number of bacteria on a urinalysis are greater than ____________________, this is indicative of a UTI. ✔✔100,000 What are signs of a ruptured TM other than the obviously ruptured TM? ✔✔muffled hearing and bright red blood in the canal Osgood Schlatter disease produces pain where? ✔✔in the knees Growing pains usually occur when? ✔✔at nighttime Children with complaints of midbone pain should be worked for what MNM differential? ✔✔acute lymphocytic leukemia NSAIDs should be used in caution with what patient population? ✔✔anyone with hypertension because they cause sodium retention and increase blood pressure What is the most common cause of secondary dysmenorrhea? ✔✔endometriosis; symptoms include spotting in between periods, cervical stenosis or displacement, nodular or tender uterosacral ligaments When should AAA screening be performed via US? ✔✔once for all males age 65-75 who have ever smoked What is responsible for the transmission of poison ivy? ✔✔the oils from the plant itself. So the only way someone can pass it on to another person is if they still have oil from the plant on their skin (like if they haven't bathed). Note that the fluid inside the blisters is not contagious Actinic keratosis is a precursor for what? ✔✔squamos cell carcinoma What is papilledema? ✔✔swelling of the optic nerve and disc secondary to increased ICP. Often co-occurring with a headache Is sexual activity safe during pregnancy? ✔✔it can expose someone to STDs and it can also stimulate preterm labor due to stimulation of the lower uterine segment and release of oxtocin A report of "knee locking" is a classic complaint of what? ✔✔a meniscal tear Can a pregnant woman be on levothyroxine during pregnancy? ✔✔yes, she should continue it and have TSH checked monthly because she may need a higher dose as thyroid hormone needs increase during pregnancy What characterizes mild persistent asthma? ✔✔asthma where symptoms occur more than twice weekly People who do not have a spleen (asplenic) are at a greater risk of what? ✔✔more susceptible to bacterial infections What 2 things put someone at the highest risk of developing pancreatitis? ✔✔gallstones and alcohol abuse. Hypertriglyceridemia can also cause it. What are the RF for GI bleeding? ✔✔age 75 or older, warfarin use, daily NSAID use, chronic steroid use, PMHx of GI bleed When two or more RF for a GI bleed are present, we should not start a patient on aspirin without what? ✔✔a daily PPI What medication is first line for the treatment of asymptomatic bacteriuria or UTI in pregnancy? ✔✔nitrofurantoin Athletic amenorrhea increases one's risk of developing what? ✔✔osteoporosis; this is because there is a loss of body fat and body fat is what produces estrogen so estrogen levels decline An intervention being performed to prevent the occurrence of the same event happening again is an example of ___________ prevention. Give an example. ✔✔secondary; taking a daily aspirin to prevent another stroke after already having one What is Strattera (atomoxetine) used for? ✔✔ADHD; side effect includes increased BP and HR so monitor closely What is the drug Danazol and what is it used for? ✔✔an androgen used in the treatment of endometriosis and fibrocystic breast disease Danazol, an androgen, has what potential side effects? ✔✔edema, hirsutism, hair loss, vocal changes The Mirena (Levonorgestrol) IUD stays in for how long? ✔✔5 years What is the most common reason for persistent gonorrhea infections? ✔✔failure of the patient to abstain from unprotected sexual intercourse What class of drug is theophylline? What does it do? ✔✔methylxanthine; it's a bronchodilator Beta blockers are contraindicated in which cardiovascular condition? ✔✔variant (prinzmetal) angina bc they may induce coronary vasospasm from unopposed alpha receptor activity What class of drug is Ropinirole (requip) and what is it used for? ✔✔dopamine agonist; restless leg syndrome Are males or females more likely to commit suicide? ✔✔males What is the ductus arteriosus? ✔✔provides the fetus with a pathway from the pulmonary artery to the aorta in utero in order to skip the lungs What are examples of some conditions that have multifactorial inheritance? ✔✔diabetes, obesity, arthritis, cancer, Alzheimers Seborrheic dermatitis is basically the same thing as what? ✔✔eczema of the scalp The flow of air coming in and out of the lungs in one inhalation and one exhalation ✔✔peak expiratory flow What does an incentive spirometer measure? ✔✔peak expiratory flow What happens in the luteal phase of the menstrual cycle? ✔✔LH and FSH decrease, the ruptured follicle closes after an egg has been released and forms the corpus luteum, which produces progesterone. Estrogen and progesterone remain high and it is those two things that cause the lining of the uterus to thicken further in preparation for fertilization What is a sign of the initial appearance of measurable histamines in a patient with allergic rhinitis? ✔✔sneezing The bacteria responsible for syphilis is called what? ✔✔treponema pallidum The STI, chancroid, is caused by what responsible bacteria? ✔✔haemophilus ducreyi What is the most common cause of septic arthritis? ✔✔staph aureus The STI, mycoplasma genitalium, is unique in what way? ✔✔it lacks a cell wall and has a terminal tip-like structure which allows it to attach to and enter other cells. It then modulates the host's immune response What are the 3 secondary causes of type 2 diabetes? ✔✔prolonged physical or emotional stress, pregnancy, drugs such as steroids and hormonal contraceptives How does hyperinsulinemia in PCOS work? ✔✔insulin resistance occurs in all places except for the ovary which remains sensitive to insulin. This insulin upregulates androgen production. Which drug classes are responsible for causing urinary retention? ✔✔antihistamines, TCAs, antispasmodics, bronchodilators, antipsychotics, carbidopa levodopa A 75 year old patient is experiencing progressive confusion and memory deterioration. Which condition mimics dementia that this patient should be tested for? ✔✔neurosyphilis Which hormones in late pregnancy can block insulin and cause gestational diabetes? ✔✔cortisol, estrogen, and placental lactogen Target shaped skin lesions as a result of a hypersensitivity reaction to certain infections and drugs ✔✔erythema multiforme An abnormal growth of squamos epithelium in the middle ear and mastoid ✔✔cholesteatoma The cremasteric reflex is assessed in infants for what purpose? ✔✔to assess for retractile testicles; this occurs when the reflex is too strong and it pulls the testicle out of the body and into the groin; this is normal and should go away by puberty Patient populations who may present atypically when having a MI include who? ✔✔diabetics, females, elderly A disorder that results in the destruction of platelets due to an autoimmune response ✔✔idiopathic thrombocytopenia purpura Pelvic inflammatory disease is most commonly caused by what? ✔✔chlamydia and gonorrhea A protruding abdominal mass after bending over, lifting, or coughing, and is painful with coughing, is often what in adults? ✔✔inguinal hernia Hiatal hernias cause what type of symptoms? ✔✔GERD What is the name of an immature female gamete? ✔✔oocyte The fused ovum and sperm once fertilization has occurred ✔✔zygote What are conditions that are often co-occurring with alopecia areata? ✔✔atopic dermatitis, vitiligo, thyroid disease, collagen-vascular diseases, Down syndrome The medical term for eczema ✔✔atopic dermatitis The leading cause of death in infants under the age of 1 ✔✔sudden unexplained infant death How is varicella zoster transmitted? ✔✔via the respiratory tract The presence of pruritic papules, macules, and vesicles in various stages of healing ✔✔varicella zoster What is presbycusis? ✔✔age related hearing loss Age is the most common cause of presbycusis, but what other conditions may play a role in quickening the onset of this? ✔✔white, infections, smoking, hypertenson, diabetes, vascular disease, immune disorders, hormonal factors What does a tricuspid regurgitation murmur sound like? ✔✔best heard at the left sternal border, on both systole and diastole. Increases with inspiration When can you hear the murmur associated with pulmonic stenosis? ✔✔mid-late systolic murmur When can you hear the murmur associated with aortic regurg? ✔✔diastole only When can you hear the murmur associated with mitral valve stenosis? ✔✔diastole only What EKG changes may be present during episodes of angina? ✔✔transient ST elevation, T wave changes such as inversions, ST depressionals, Q waves Children and teens present with depression most commonly how? ✔✔irritability Are the sickling of RBCS in sickle cell anemia reversible? ✔✔initially, yes they are reversible with oxygenation. But repeated episodes cause the cells to become irreversibly sickled. When the brain is exposed to something rewarding, it responds by increasing the release of what? ✔✔dopamine Where are T cells produced? ✔✔in the thymus Where are B cells produced? ✔✔in the bone marrow What is the pathophys behind a thyrotoxic crisis (aka thyroid storm)? ✔✔T3 and T4 are overproduced which leads to increased production of epinephrine and severe hypermetabolism What causes a reduction in the number of RBCs in pregnancy? ✔✔iron deficiency anemia due to blood volume expansion and a decrease in hemoglobin levels so the iron stores are depleted because they are needed to be used for the expanded blood volume When should the ductus arteriosus close in an infant? ✔✔within the first 1-2 days of birth The minimum arterial pressure exerted during relaxation and dilation of the ventricles ✔✔diastole Lyme disease is caused by what spirochete present on ticks? ✔✔borrelia burgdorfei What are the potential sequelae of strep pharyngitis? ✔✔acute glomerulonephritis, peritonsillar abscess, toxic shock disease, rheumatic heart disease (although rare) The medical term for pubic lice aka crabs ✔✔phthirus pubis Petechiae noted on the cervix during a pelvic exam is a sign of what disease process? ✔✔trichomoniasis; also called "strawberry cervix" What is the difference between a folliculitis and a furuncle? ✔✔folliculitis is an inflammation of the follice whereas a furuncle is an abscess that results from folliculitis Urea is eliminated by the kidneys, but where does it come from originally? ✔✔from the liver as a byproduct of protein metabolism What are the 5 primary structures of the immune system? ✔✔lymph nodes, thymus, tonsils, spleen, bone marrow Bacteria most commonly responsible for pyelonephritis ✔✔e coli What causes back pain in pregnancy? ✔✔curvature of the lumbosacral vertebrae What is dacrocystitis? ✔✔inflammation of the nasolacrimal duct due to duct obstruction or infection What are potential causes of blepharitis? ✔✔bacterial infection, dry eyes, rosacea What are s/s of croup? ✔✔hoarseness, cough, inspiratory stridor, possible respiratory distress due to narrowing of the larynx Women who become pregnant later in life have an increased risk of what? ✔✔breast cancer What are things women can do to decrease their risk of breast cancer? ✔✔regular physical activity, breastfeeding Does an increase or decrease in blood pH affect the rate and degree of sickling in sickle cell anemia? ✔✔a decrease in blood pH increases the rate What is the difference between Prinzmetals and stable (classic angina)? ✔✔Prinzmetals may occur randomly and while at rest, whereas stable angina is usually only with physical activity Why may infection of the palatine tonsils become serious very quickly? ✔✔the area is composed of loose connective tissue What are cutaneous xanthomas? ✔✔localized lipid deposits caused by elevated lipids or LDL Uterine prolpase is caused by stretching of the uterine ____________ ✔✔ligaments What causes bacterial vaginosis? ✔✔a decrease in lactobacillus species within the vagina What is the Lachman's test and what does it identify? ✔✔used to assess for ACL tear; the knee is held passively at 30 degrees flexed and then one hand stabilizes the femur while the other applies a gentle anterior force to the proximal tibia. If it moves beyond it's normal ROM, there may be an ACL tear When should the testicles fully descend into the scrotum by in an infant? ✔✔6 months of age. If not descended by this time, then refer to Urology at 6 months although surgical correction (orchipexy) may not be performed until 1 year What is another name for the moro reflex? ✔✔the startle reflex; both arms should extend outwards when this is positive If a moro reflex in an infant is only positive in one arm, then what do you need to consider? ✔✔examine the clavicle for a potential fracture Which model is used to designate risk factors for melanoma? ✔✔think HARMM; history, age, regular dermatologist absent, mole changing, male gender What is a sign of an ankle fracture on physical exam? ✔✔point tenderness over the posterior malleolus with an inability to bear weight after 4 or more steps What is an acoustic neuroma? ✔✔something pressing, likely a tumor, on the acoustic nerve that results in dizziness, loss of balance, facial numbness, hearing loss, and tinnitus The axillary lymph nodes drain lymphatic fluid from where? ✔✔breast, upper abdomen, upper back, pectoral region, and upper limbs International travelers to endemic areas are at a risk for what form of hepatitis? ✔✔hepatitis A because it can be transmitted through contaminated food or drink Adrenarche is the early presence of pubic hair in girls aged __________ ✔✔5-8 years old A condition that presents with symptomatic limb ischemia upon exertion is termed: ✔✔atherosclerotic peripheral arterial disease The largest salivary gland is the parotid gland, and where does it drain to? ✔✔Stensen's duct which has an opening on the buccal mucosa opposite the second molar The varus stress test assesses for a tear in which part of the lower extremities? ✔✔lateral meniscus The valgus stress test assesses for a tear in which part of the lower extremities? ✔✔medical meniscus To evaluate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen where? ✔✔about midway betwee the umbilicus and symphysis pubis while elevating the cervix and uterus with the other hand A feeling of constantly needing to pass stool ✔✔tenesmus Severe constipation resulting from intestinal obstruction ✔✔obstipation What does the vaginal discharge associated with trich look like? ✔✔profuse, yellowish green that is malodorous What does the discharge associated with bacterial vaginosis look like? ✔✔gray or white, thin, malodorous (fishy) and not profuse The nurse practitioner instructs the patient to place on hand behind his back and touch his shoulder blade. This shoulder movement elicits what? ✔✔internal rotation How do we test for flexion and extension of the shoulder? ✔✔extension is asking the patient to move their arm behind themself. Flexion is asking the patient to move their arm in front of the body Symptoms related to Shaken Baby Syndrome are due to what? ✔✔uncontrollable cerebral edema and hypoxia What are the symptoms of Shaken Baby Syndrome? ✔✔blindness, inability to perform previously learned milestones, flaccid muscle tone Koplik's spots are indicative of what disease? ✔✔measles (rubeola) The medical term for measles ✔✔rubeola What do Koplik's spots of measles look like? ✔✔small white specks that resemble grains of salt on a red background Round or oval shaped lesions surrounded by erythematous mucosa found anywhere on the oral mucosa ✔✔aphthous ulcers Excessive or prolonged menstrual flow occurring at regular intervals ✔✔menorrhagia Intermenstrual bleeding (aka spotting in between periods) ✔✔metrorrhagia Polymenorrhea is when there are fewer than ________ between periods ✔✔21 days Oligomenorrhea is when there are more than _______ between periods; or only 4-9 menstrual cycles per year ✔✔35 days A patient who is unable to touch his left scapula with his right hand likely has what? ✔✔a rotator cuff tear A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for what? ✔✔cardiovascular disease, stroke, renal disease The ethmoidal sinuses are located where? ✔✔between the eyes Where do the sphenoid sinuses lie? ✔✔just behind the ethmoid sinuses Where do the maxillary sinuses lie? ✔✔around the nasal cavity What describes a stage III pressure ulcer? ✔✔full thickness tissue loss and subcutanous fat may be present, but bone, tendon, or muscle are not exposed Dislocation of the elbow joint caused by the sudden pull on the extended pronated forearm ✔✔nursemaid's elbow Localized tenderness over the ankle joint is a sign of what? ✔✔a ligamentous injury; point tenderness and inability to bear weight is more of a sign of an ankle fracture Describe renal adaptation of the newborn ✔✔the kidneys are structurally complete but physiologically immature. the infant is at increased risk of metabolic acidosis due to the kidneys inability to concentrate urine and adapt to fluid and electrolyte stress Where is the best place to locate the twelfth rib? ✔✔between the spine and lateral chest What is biliary colic? ✔✔pain in the epigastric region or RUQ that radiates to the right scapula or shoulder; indicative of cholecystitis Costochondritis occurs when there is inflammation of the cartilage where? ✔✔that connects the ribs to the sternum What aggravates costochondritis? ✔✔movement of the chest, trunk, and arms Which segments of the spine control the plantar reflexes? ✔✔lumbar 5 and sacral 1 A softening of the skin at the angles of the mouth which may be due to nutritional deficiency ✔✔angular cheilitis Angular cheilitis can be caused by what? ✔✔nutritional deficiency What causes actinic cheilitis? ✔✔excessive exposure to sunlight; most often affects the lower lip Intention tremors appear with movement and worsen when? ✔✔as the target gets closer Nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event ✔✔vasovagal syncope Which conditions are known to cause polyuria? ✔✔lithium toxicity, uncontrolled diabetes, disorders of the posterior pituitary and hypothalamus (hypogonadism), and hypokalemic nephropathy Breath sounds heard over the periphery of the lung fields are what? ✔✔vesicular; they are quiet and wispy What do bronchovesicular breath sounds sound like? ✔✔full inspiratory phase with a shortened and quieter expiratory phase Thenar atrophy suggests what? ✔✔a median nerve disorder Does the ulnar nerve innervate the pinky or the thumb? ✔✔pinky The pregnant woman who has a BMI of less than 18.5 should gain how many pounds in pregnancy? ✔✔28-40 pounds The pregnant woman who has a BMI of 18.5-24.9 (normal) should gain how many pounds in pregnancy? ✔✔25-35 pounds The pregnant woman who has a BMI of 25-29.9 (overweight) should gain how many pounds in pregnancy? ✔✔15-25 pounds The pregnant woman with a BMI over 30 should gain how many pounds in pregnancy? ✔✔11- 20 pounds A BMI of less than _____ is considered underweight ✔✔18.5 The term used to refer to skin that is peeling ✔✔exfoliation What will a basal cell carcinoma on the eyelid look like? ✔✔papule with an ulcerated center, most often on the lower lid and medial canthus What is Rovsing's sign? ✔✔positive for appendicitis; palpation on the LLQ elicits pain in the RLQ What causes plantar warts? ✔✔human papillomavirus; usually occur on the sole of the foot In second degree uterine prolapse, where is the cervix located? ✔✔at the introitus