APEA PREDITOR EXAM WITH QUESTIONS WITH VERIFIED ANSWERS [GRADED A+] REAL EXAM 100%, Exams of Nursing

Download APEA PREDITOR EXAM WITH QUESTIONS WITH VERIFIED ANSWERS [GRADED A+] REAL EXAM 100% and more Exams Nursing in PDF only on Docsity! APEA PREDITOR EXAM WITH QUESTIONS WITH VERIFIED ANSWERS [GRADED A+] REAL EXAM 100% Cranial Nerve VIII -- correct answer --Acoustic (Hearing and balance) Cranial nerve IX -- correct answer --Glossopharyngeal- swallowing and rise of the palate, gag reflex Cranial Nerve XI -- correct answer --Spinal Accessory (upper trapezius) Deep tendon reflex -- correct answer --Ankle- S1 primarily Knee- Lumbar 2,3,4 Supinator(brachioradialis)-C5,6 BicepTriceps-C6,7 Stroke risk scale -- correct answer --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 -- correct answer --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 -- correct answer --D. Grocery shopping 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. -- correct answer --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 -- correct answer --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 -- correct answer --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? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Primordial prevention -- correct answer --D. primordial prevention. Screening for lung cancer is not currently recommended in the general population, but it is secondary prevention. A test called the visual fields by confrontation is used to evaluate for: A. Peripheral vision B. Central vision C. Visual acuity D. Accomodation -- correct answer --A. Peripheral vision What is the most common cause of Cushing's syndrome? -- correct answer -- Administration of a glucocorticoid or ACTH. Iatrogenic Cushing's syndrome is the most common type. Exogenous glucocorticoid administration produces a Cushing's Syndrome that is reversible by discontinuation of the medication. A patient with no significant medical history has vericose veins. She complains of '"aching legs". The intervention that will provide the greatest the disease by a pediatric rheumatologist. The mother asks for information about the child's long-term prognosis. The appropriate reply is that: -- correct answer --most children with JRA achieve complete remission by adulthood, but its effects might cause lifelong limitations. Although the active disease does not continue into adulthood, the contractures, growth retardation, bone deformities, and visual impairment associated with JRA may lead to lifelong functional impairments. A comprehensive treatment program involving physical therapy, occupational therapy, nutrition, education, and regular opthalmologic care can limit residual functional limitations. Approximately 70% of the organisms found in canine oral and nasal fluids, and consequently in fresh dog bite wounds, are: -- correct answer -- Staphylococcus and Pasteurella multocida. All of these organisms are found in canine oral and nasal fluids, and cultured from fresh dog bite wounds, but the most common (70%) are Staph and Pasteurella multocida. Education of women with fibrocystic breast disease should include which of the following statements? -- correct answer --Caffeine may trigger breast pain. Avoidance of all methylxanthines (eg coffee, tea, chocolate) has been shown to reduce breast pain in women with fibrocystic breast disease. It is usually a benign condition, not a precursor of malignancy. Mammography is recommended once at age 35 years, at least every 1-2 years after 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: -- correct answer -- 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? -- correct answer --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. 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? -- correct answer --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? -- correct answer --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? -- correct answer -- 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? -- correct answer --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: -- correct answer --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: -- correct answer --a flouroquinolone twice daily for 3 weeks to 4 months. An elevated creatinine kinase (CK) is not diagnostic of a myocardial infarction (MI). CK may be elevated from an IM injection, surgery, ot any type of extensive skeletal muscle trauma or prolonged, strenuous physical exertion. ST segment depression on EKG usually indicates an ischemic myocardium, but, not necessarily, one post-MI. Elevated ST seghments reflect mycardial damage. MB bands are specific for myocardial smooth muscle. If these are elevated, the patient MAY HAVE had a very recent MI. The most accurate marker of cardiac damage, because it is more specific and sensitive than CK MB, is a troponin measurement. What is a secondary cause of hyperlipidemia? -- correct answer -- hypothyroidism Hypothyroidism is a common secondary cause of hyperlipidemia. In the evaluation of a patient with hyperlipidemia, a TSH should always be checked and corrected before attempting treatment for hyperlipidemia. Other possible causes of seconday hyperlipidemia include pregnancy, excessive weight gain, excessive alcohol intake, insulin resistance or deficiency, obstructive liver disease, and uremia. Some medications can produce secondary hypothyroidism too: thiazide diuretics, some beta- blockers, oral contraceptives, and corticosteroids. A 35-yo male presents with a complaint of low pelvic pain, dysuria, hesitancy, urgency, and reduced for of stream. The nurse practitioner suspects acute bacterial prostatitis. The NP would appropriately collect all of the following specimens EXCEPT a: sterile in-and-out catheter urine specimen. -- correct answer --A sterile in-and-out catheter specimen would identify only organisms in the bladder and would not differentiate between bladder, kidney, or prostate site infection. The sequence for obtaining specimens when prostat infection is suspected is: 1. voided urethral urine, 2. Voided mid-stream bladder urine, and 3. voided post-prostate massage urine. A 24 yo female taking an oral contraceptive has missed her last 2 pills. What should the nurse practitioner advise her to do to minimize her risk of pregnancy? -- correct answer --Double today's dose and tomorrow's dose and use a barrier method for the rest of the month. If 2 mills are missed on consecutive days, the next 2 days' doseages should be doubled and a barrier method recommended for the remainder of the cycle. A 50yo, non-smoker, with no co-morbidity presents to the clinica and is diagnosed with pna. His vital signs are normal except for temperature of 101.6 degrees. A sputum specimen is collected and sent for culture and sensitivity. What action should the nurse practitioner take today? -- correct answer --Start Clarithromycin (Biaxin) 500mg 2 times a day for 10 to 14 days. Most treatment guidelines for outpatient pna in non-smokers without co- morbidity and 60 years of age or younger, recommend erythromycin or Which item is NOT implicated in erectile dysfunction (ED)? -- correct answer --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: -- correct answer --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: -- correct answer --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? -- correct answer --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: -- correct answer --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? -- correct answer --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 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: -- correct answer --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? -- correct answer -- 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? -- correct answer --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 the most common cause of traveler's diarrhea? -- correct answer --e coli What bacteria is responsible for causing cat scratch disease? -- correct answer --bartonella henselae What are the 4 different components of tetralogy of fallot? -- correct answer --overriding aorta, pulmonary stenosis, right ventricular hypertrophy, and a ventricular septal defect What does the murmur auscultated in tetralogy of fallot sound like? -- correct answer --systolic murmur best heard at the left upper sternal border What does the murmur auscultated in a ventricular septal defect sound like? -- correct answer --systolic murmur best heard at the left lower sternal border Where is the aorta best auscultated? -- correct answer --at the second ICS to to the right of the sternum Where is the pulmonary artery best auscultated? -- correct answer --at the second ICS to the left of the sternum What is a scotoma? -- correct answer --a blind spot or aura that obstructs part of your vision Is presbyopia nearsightedness or farsightedness? -- correct answer -- farsightedness meaning it can be harder to see things up close, such as reading a newspaper and may need to hold it farther away or use reading glasses Is myopia nearsightedness or farsightedness? -- correct answer -- nearsightedness meaning it is hard to see things far away Do cataracts cause myopia or presbyopia? -- correct answer --myopia; meaning nearsightedness and they make things blurry that are farther away which is why driving at night becomes difficult What is the USPSTF's recommendation on scoliosis screening for adolescents? -- correct answer --insufficient When should adolescent girls be screened for scoliosis? -- correct answer -- as early as 10 years old and then again at age 12 When should adolescent boys be screening for scoliosis? -- correct answer -- between age 12-13 What is Auspitz sign? -- correct answer --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? -- correct answer --psoriasis When are pregnant women screening for gestational diabetes? -- correct answer --week 24-28 What is round ligament pain? -- correct answer --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 Which age group is rheumatic fever most common in? -- correct answer -- children ages 5-15 What are the major symptoms of rheumatic fever? -- correct answer -- carditis, arthritis, chorea, erythema marginatum (rash), subcutaneous nodules What are the minor symptoms of rheumatic fever? -- correct answer --fever, elevated ESR, prolonged PR interval How do we treat rheumatic fever? -- correct answer --refer to the hospital What is chorea? -- correct answer --abnormal involuntary movements What are the main s/s of rubeiola (measles) -- correct answer --Koplick spots + the 3 c's - cough, coryza, conjunctivitis GABHS infection puts individuals at the highest risk of developing what sequelae? -- correct answer --peritonsillar abscess, glomerulonephritis, rheumatic fever What is the diagnostic criteria for acute rheumatic fever? -- correct answer - -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? - - correct answer --wait 2-3 hours per drink consumed before breastfeeding again Can a mother take methadone while pregnant and breastfeeding? -- correct answer --yes Does subsequent mean before or after? -- correct answer --after What is the recommended treatment for Kawasaki disease? -- correct answer --refer to the ED, will likely need IVIG and high dose aspirin What are the s/s of Kawasaki disease? -- correct answer --fever + CREAM (conjunctivitis, rash, erythema of palms and soles, adenopathy cervical, mucous membranes) Kawasaki disease is caused by what? -- correct answer --an acute vasculitis of the small and medium blood vessels What is the main difference between Kawasaki disease and scarlet fever? -- correct answer --KD has conjunctivitis and scarlet fever does not The rash associated with acute rheumatic fever -- correct answer --erythema marginatum The rash associated with parvovirus aka slapped cheek aka fifth disease -- correct answer --erythema infectiosum What does erythema marginatum of rheumatic fever look like? -- correct answer --erythematous with a central clearing, not itchy The medical term for tennis elbow -- correct answer --lateral epicondylitis What is the leading cause of death in anorexia? -- correct answer --suicide Erikson stage from birth to 18 months -- correct answer --trust vs mistrust Erikson stage from 18 months to 3 years -- correct answer --autonomy vs shame and doubt What is ankylosing spondylitis? -- correct answer --an inflammatory condition affecting the spine causing chronic back pain and stiffness that improves with exercise and enthesitis What is the treatment for ankylosing spondylitis? -- correct answer --refer to rheumatology for possible DMARDs What are the s/s of polymyalgia rheumatica? -- correct answer --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? -- correct answer --PO steroids and refer to Rheumatology to confirm the diagnosis Where are the biggest food sources of vitamin B12? -- correct answer --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? -- correct answer -- nucleic acid amplification test Most cases of acute sinusitis are viral and how can we treat them? -- correct answer --treat the symptoms with intranasal steroids and saline rinses What is the difference between chronic vs gestational hypertension? -- correct answer --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? -- correct answer --if less than 45, do an ultrasound. if older than 45, do a diagnostic mammogram. An overactive bladder is what type of incontinence? -- correct answer --urge incontinence What is the recommended treatment for urge incontinence? -- correct answer --anticholinergics like oxybutynin What is the recommended treatment for stress incontinence? -- correct answer --alpha agonists like sudafed, TCAs What is the recommended treatment for BPH? -- correct answer --alpha blockers like terazosin, doxazosin, tamsulosin Alcohol and marijuana worsen which type of incontinence? -- correct answer --urge Which SSRI is safest in pregnancy? Which poses the most risk? -- correct answer --sertraline; paroxetine Infants born to women who smoke are at increased risk for what? -- correct answer --low birth weight and preterm delivery What is the best marker of an acute MI? -- correct answer --troponin When do troponins peak after a MI? -- correct answer --12 hours When should an infant be able to display a conjugate gaze (track you all the way across the room)? -- correct answer --6 months Which medication is approved in Peds for the prevention of febrile seizures? -- correct answer --diazepam Folic acid is which vitamin? -- correct answer --vitamin B9 A male patient presents to your clinic with a lump in his breast. How should we work this up? -- correct answer --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? -- correct answer --a penicillin or cephalosporin with beta lactamase coverage How long must a tick be attached to the skin in order for Lyme disease to be transferred? -- correct answer --48 hours When should kids be treated for hypertension? -- correct answer --if they also have diabetes, are symptomatic, have hypertension > 95th percentile, or when end organ damage is present ACEIs can cause what electrolyte abnormality? -- correct answer -- hyperkalemia A positive "drop arm" test is a sign of what? -- correct answer --torn rotator cuff The medical term for spoon shaped nails -- correct answer --koilonychia Koilonychia is a sign of what? -- correct answer --iron deficiency anemia How is influenza diagnosed? -- correct answer --a nasal swab What finding would be most likely to differentiate gout from septic arthritis? -- correct answer --fever would be indicative of septic arthritis Diphenhydramine has __________ properties and is contraindicated in which patient populations? -- correct answer --anticholinergic; elderly and those with glaucoma The medical term for flat feet -- correct answer --pes planus How does plantar fasciitis usually present? -- correct answer --as pain in the morning with resolution after several steps, but as it worsens the patient will start to complain of heel pain throughout the day and with walking Scope of practice for NPs is not influenced by which entity? -- correct answer --a court of law Used to establish a designated level of professional competence -- correct answer --licensure Treatment of subclinical hypothyroidism is generally not indicated unless the TSH is ___________. -- correct answer --greater than 10 In the presence of an elevated serum TSH, what is the next step in management? -- correct answer --repeat TSH plus free T4 Patients with a history of UC or Crohn's should have a colonoscopy how often? -- correct answer --every 1-5 years due to the increased risk of colorectal cancer What is the first line treatment for community acquired atypical pneumonia? -- correct answer --macrolides such azithromycin. If the pt cannot take a macrolide, then they can do levofloxacin or doxycycline What is metatarsus adductus? -- correct answer --the medical term for in- toeing What lab values need to be monitored in a patient on Tizanidine? -- correct answer --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)? -- correct answer --direct thrombin inhibitor The most effective treatments for acne related to increased sebum production are what? -- correct answer --oral contraceptives and isotretinoin Oral contraceptive regimen in which both the estrogen and progesterone concentrations vary throughout the cycle -- correct answer --quadriphasic Oral contraceptive regimen in which the estrogen and progestin doses are fixed throughout the cycle -- correct answer --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 -- correct answer --biphasic Oral contraceptive regimen in which the estrogen remains consistent and the progestin dose varies -- correct answer --triphasic Patients who are receiving beta blockers may find what treatment for allergies ineffective? -- correct answer --treatments containing epinephrine For a patient on warfarin who needs to receive a tetracycline antibiotic, how will we adjust their warfarin? -- correct answer --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? -- correct answer -- insomnia/sleep, ADHD, anxiety, depression What is the herbal, saw palmetto, often used for? -- correct answer --BPH What is the herbal, black kohosh, often used for? -- correct answer -- symptoms of menopause - hot flashes What is the herbal, St. John's wart, often used for? -- correct answer -- depression What are the intrauterine transplacental infections that can be passed from mother to infant? -- correct answer --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 -- correct answer --augmentin; doxy if there is a penicillin allergy Obese women should gain how much weight during pregnancy? -- correct answer --11-20 pounds Overweight women should gain how much weight during pregnancy? -- correct answer --15-25 pounds Normal weight people should gain how much weight during pregnancy? -- correct answer --25-35 pounds Underweight people should gain how much weight during pregnancy? -- correct answer --28-40 pounds What are the 4 components of Tetralogy of Fallot? -- correct answer --VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy What does the murmur of Tet of Fallot sound like? -- correct answer --harsh systolic murmur at the left upper sternal border What is a tet spell? -- correct answer --when the child turns blue during crying or feeding How do we treat thrush in infants? -- correct answer --application of nystatin to inside of the mouth, sterilize all pacifiers and bottle nipples; a topical antifungal may be applied to the nipples HMO and PPOs are called what? -- correct answer --managed care plans TCAs can cause what worsened problem in a patient with BPH? -- correct answer --urinary retention Signs of a ruptured ovarian cyst -- correct answer --nausea, vomiting, shoulder pain, fever Growing pains often start in what age group? -- correct answer --3-5 What antibiotics are considered safe in pregnancy? -- correct answer --beta lactams (cephalosporins, amox, augmentin), nitrofurantoin, vancomycin, metronidazole, clindamycin, and fosfomycin an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. It occurs when a viral infection, such as an upper respiratory infection, moves to and settles in the hip joint. -- correct answer --transient synovitis HCTZ can cause _________, whereas ACEI can cause _________ -- correct answer --hypokalemia; hyperkalemia Hyperparathyroidism can cause what? -- correct answer --hypercalcemia and thus, osteoporosis PID should improve after ____ of the antibiotic course. -- correct answer --3 days A loss of the central sulcus of the prostate on DRE is a sign of what? -- correct answer --BPH A woman who gets the MMR vaccine should wait at least __________ before getting pregnant. -- correct answer --4 weeks What is a major cause of cleft palate and lip? -- correct answer --smoking during pregnancy What is Auspitz sign? -- correct answer --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 -- correct answer --ciprofloxacin When should pediatrics be screened for hyperlipidemia? -- correct answer -- between 9 and 11 years old What is the tell-tale symptom of endometriosis? -- correct answer -- progressive dysmenorrhea How do you calculate ideal body weight for men? -- correct answer --start at 106 pounds and then add 6 for every inch above 5 feet How is lichen sclerosus treated? -- correct answer --topical steroids, topical calcineuronin inhibitors to suppress the immune system, topical or oral retinoids, phototherapy What is the tell-tale sign of malignant hypertension? -- correct answer -- 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? -- correct answer --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? -- correct answer -- worsened by stress or fatigue, improved by alcohol What is first-line treatment for trigeminal neuralgia? -- correct answer -- carbamazepine (tegretol) or amtriptyline Are Parkinsonian tremors unilateral or bilateral at first? -- correct answer -- unilateral Where is the TMJ best palpated? -- correct answer --anterior to the tragus What are the primary bacteria in dog bites? -- correct answer --staph, strep, and pasteurella What is the gold standard treatment of giant cell arteritis? -- correct answer --oral steroids and potential artery biopsy by rheum Who is a candidate for Truvada for Prep? -- correct answer --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? -- correct answer --within 72 hours of the exposure Who should be screened for HIV? -- correct answer --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? -- correct answer --only if they had pharyngeal gonorrhea, not vaginal or anal Tanner stage 1 female breast developmental -- correct answer --prepubertal Tanner stage 2 female breast development -- correct answer --thelarche; the breasts bud as a small mound and the areola increases in diameter Tanner stage 3 female breast development -- correct answer --the areola, breast, and nipple grow together in one mount Tanner stage 4 female breast development -- correct answer --the areola and nipple separate from the breast to form a secondary mound Tanner stage 5 female breast development -- correct answer --mature nipples project only Tanner stage 1 male genital development -- correct answer --prepubertal Gestational diabetes screening occurs between what weeks gestation? -- correct answer --24-48 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 ___________. -- correct answer --Murphy's sign; cholecystitis What are names of LABA medications? -- correct answer --salmeterol What is encopresis in children? -- correct answer --stool incontinence after the age of being toilet trained The medical term for being cross-eyed -- correct answer --strabismus What is atopic dermatitis? -- correct answer --eczema Tests used to diagnose developmental hip dysplasia -- correct answer -- Barlow and Ortolani maneuvers What is the female athlete triad? -- correct answer --disordered eating, amenorrhea, osteoporosis How do patients with aortic regurgitation typically present? -- correct answer --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? -- correct answer --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? -- correct answer --a venous hum murmur and an S3 When a headache accompanies a stroke, is this most often hemorrhagic or ischemic? -- correct answer --hemorrhagic AV nicking is most commonly seen on retinal exam of which chronic condition? -- correct answer --hypertension Within 6 months of being started on a TCA or SSRI, what is a common side effect that occurs? -- correct answer --weight gain When does otitis media with effusion usually occur? -- correct answer -- 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 -- correct answer --tinea cruris Tinea cruris "jock itch" is a common __________ infection and should be treated with what? -- correct answer --fungal; OTC antifungal cream What are teaching points for males to avoid contracting tinea cruris? -- correct answer --dry off after swimming and don't stay in a wet bathing suit Tinea cruris can affect the inner thighs but never what else? -- correct answer --the penis or scrotum On microscopic exam, what is most likely to be seen in the presence of a bacterial infection? -- correct answer --cocci and rods On microscopic exam, what is most likely to be seen in the presence of a candidal infection? -- correct answer --yeasts What are symptoms that someone will experience as soon as they are started on a SSRI and when will this resolve? -- correct answer --headache, nausea, insomnia, restlessness, agitation; will resolve in 2 weeks What causes the dry cough in people taking an ACEI? -- correct answer --the buildup of bradykinin which is usually degraded by ACE ACEI induced coughs usually begin how soon after starting the medication? - - correct answer --within 2 weeks COPD is often associated with what sequelae? -- correct answer --anxiety and depression When should an antiviral be started in a patient with shingles? -- correct answer --within 72 hours of the onset of symptoms What is the drug of choice for treating UTIs in male patients? -- correct answer --bactrim for 7-10 days What is the leading cause of CKD and ESRD in the united states? -- correct answer --diabetes What is the usual recommendation about administering MMR and varicella immunizations? -- correct answer --they should be given on the same day or at least one month apart What are the classic symptoms of an atopic pregnancy? -- correct answer -- amenorrhea, vaginal bleeding, abdominal pain What is sideroblastic anemia? -- correct answer --when the bone marrow is unable to incorporate iron into hemoglobin. This may be either inherited or acquired. Can a pregnant woman get the MMR vaccine while pregnant? -- correct answer --yes Why are the carotid arteries auscultated for bruits? -- correct answer --this is indicative of generalized atherosclerosis What is roseola? -- correct answer --a viral exanthem characterized by a high fever for 3 days then abrupt stopping of the fever and a maculopapular rash that blanches. also known as exanthem subitum. What are signs indicative of a meningitis infection? -- correct answer -- Kernig and Brudzinski's signs Cancer in the bone marrow that results in skeletal destruction -- correct answer --multiple myeloma What is the average age of diagnosis of multiple myeloma? -- correct answer --65 a skin disorder that causes the nose to enlarge and become red, bumpy, and bulbous -- correct answer --rhinophyma What are physical exam findings common in alcohol abuse? -- correct answer --tremors, macrocytosis (due to vitamin B12 and folate deficiencies common in alcoholics), hypertension, rhinophyma, peripheral neuropathy, teleangectasia, hepatosplenomegaly What is the first sign of sexual maturation in a male? -- correct answer --an increase in testicular size (tanner stage 2) The inability to name a familiar object -- correct answer --anomia Actinic keratosis is a precursor for what? -- correct answer --squamos cell carcinoma What is papilledema? -- correct answer --swelling of the optic nerve and disc secondary to increased ICP. Often co-occurring with a headache Is sexual activity safe during pregnancy? -- correct answer --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? -- correct answer - -a meniscal tear Can a pregnant woman be on levothyroxine during pregnancy? -- correct answer --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? -- correct answer --asthma where symptoms occur more than twice weekly People who do not have a spleen (asplenic) are at a greater risk of what? -- correct answer --more susceptible to bacterial infections What 2 things put someone at the highest risk of developing pancreatitis? -- correct answer --gallstones and alcohol abuse. Hypertriglyceridemia can also cause it. What are the RF for GI bleeding? -- correct answer --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? -- correct answer --a daily PPI What medication is first line for the treatment of asymptomatic bacteriuria or UTI in pregnancy? -- correct answer --nitrofurantoin Athletic amenorrhea increases one's risk of developing what? -- correct answer --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. -- correct answer --secondary; taking a daily aspirin to prevent another stroke after already having one What is Strattera (atomoxetine) used for? -- correct answer --ADHD; side effect includes increased BP and HR so monitor closely What is the drug Danazol and what is it used for? -- correct answer --an androgen used in the treatment of endometriosis and fibrocystic breast disease Danazol, an androgen, has what potential side effects? -- correct answer -- edema, hirsutism, hair loss, vocal changes The Mirena (Levonorgestrol) IUD stays in for how long? -- correct answer -- 5 years What is the most common cause of croup? -- correct answer --parainfluenza virus What are the two subsets of impetigo? -- correct answer --bullous (fluid filled) or nonbullous (honey crusts) Which protein is an important mediator of the inflammatory response and serves as a messenger at the site of antigen (allergen) invasion? -- correct answer --cytokines; they are released by mast cells in response to an invading antigen and recruit leukocytes and eosinophils Paroxysmal events associated with abnormal electrical discharges of neurons in the brain -- correct answer --seizures What is HELLP syndrome in pregnancy? -- correct answer --stands for hemolysis, elevated liver enzymes, and low platelets; is characterized by thrombocytopenia, hemolytic anemia, and liver dysfunction HELLP syndrome in pregnancy is due to what? -- correct answer -- endothelial dysfunction Patients with acute coronary syndrome typically have plaque erosion caused by what? -- correct answer --accumulation of hyaluronan and neutrophils Which diagnostic study is most helpful for differentiating Alzheimer's disease from dementia with Lewy bodies? -- correct answer --PET scan ADHD is a risk factor for both depression and what else? -- correct answer -- substance abuse Epididymitis with orchitis is commonly related to what? -- correct answer -- genitourinary infections Mycoplasma genitalium is most commonly associated with which disease presentation in men? -- correct answer --urethritis, especially if persistent or recurrent C. trachomatis stands for what common type of bacteria infection? -- correct answer --chlamydia Chlamydia passed from a mother to a newborn can result in which problems for the newborn? -- correct answer --conjunctivitis and pneumonia In a patient with patent ductus arteriosus, where is the murmur best heard? -- correct answer --localized at the left clavicle and is both systolic and diastolic What is the ductus arteriosus? -- correct answer --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? -- correct answer --diabetes, obesity, arthritis, cancer, Alzheimers Seborrheic dermatitis is basically the same thing as what? -- correct answer --eczema of the scalp The flow of air coming in and out of the lungs in one inhalation and one exhalation -- correct answer --peak expiratory flow What does an incentive spirometer measure? -- correct answer --peak expiratory flow Which hormones in late pregnancy can block insulin and cause gestational diabetes? -- correct answer --cortisol, estrogen, and placental lactogen Target shaped skin lesions as a result of a hypersensitivity reaction to certain infections and drugs -- correct answer --erythema multiforme An abnormal growth of squamos epithelium in the middle ear and mastoid -- correct answer --cholesteatoma The cremasteric reflex is assessed in infants for what purpose? -- correct answer --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? -- correct answer --diabetics, females, elderly A disorder that results in the destruction of platelets due to an autoimmune response -- correct answer --idiopathic thrombocytopenia purpura Pelvic inflammatory disease is most commonly caused by what? -- correct answer --chlamydia and gonorrhea A protruding abdominal mass after bending over, lifting, or coughing, and is painful with coughing, is often what in adults? -- correct answer --inguinal hernia Hiatal hernias cause what type of symptoms? -- correct answer --GERD What is the name of an immature female gamete? -- correct answer --oocyte The fused ovum and sperm once fertilization has occurred -- correct answer --zygote What are conditions that are often co-occurring with alopecia areata? -- correct answer --atopic dermatitis, vitiligo, thyroid disease, collagen- vascular diseases, Down syndrome The medical term for eczema -- correct answer --atopic dermatitis The leading cause of death in infants under the age of 1 -- correct answer -- sudden unexplained infant death How is varicella zoster transmitted? -- correct answer --via the respiratory tract The presence of pruritic papules, macules, and vesicles in various stages of healing -- correct answer --varicella zoster What is presbycusis? -- correct answer --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? -- correct answer --white, infections, smoking, hypertenson, diabetes, vascular disease, immune disorders, hormonal factors The fascia layer of the male anatomy that the anterior 2/3s of the testicle resides in -- correct answer --tunica vaginalis A subtype of strabismus that describes an inward turning of the eye -- correct answer --esotropia The abducens nerve (CN VI) is responsible for what? -- correct answer -- lateral movement of the eye outward Body lice primarily live where? -- correct answer --on bedding and clothing, not people Body lice are vectors for which diseases? -- correct answer --epidemic typhus, trench fever, relapsing fever Fifth disease is spread via how? -- correct answer --respiratory droplets What are other names of fifth disease? -- correct answer --parvovirus, slapped cheek disease What is the life span of lice? -- correct answer --30 days The hypersensitivity and pain crescendo experienced in conjunction with a migraine is thought to be related to the release of what? -- correct answer -- substance P; a neurotransmitter which functions as the pain transmitter of the dorsal horn and is responsible for causing nausea, vomiting, stress, and anxiety Where is the location of the tricuspid valve? -- correct answer --separates the right atrium and ventricle What does a tricuspid regurgitation murmur sound like? -- correct answer -- 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? -- correct answer --mid-late systolic murmur When can you hear the murmur associated with aortic regurg? -- correct answer --diastole only When can you hear the murmur associated with mitral valve stenosis? -- correct answer --diastole only What EKG changes may be present during episodes of angina? -- correct answer --transient ST elevation, T wave changes such as inversions, ST depressionals, Q waves Children and teens present with depression most commonly how? -- correct answer --irritability Are the sickling of RBCS in sickle cell anemia reversible? -- correct answer -- 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? -- correct answer --dopamine Where are T cells produced? -- correct answer --in the thymus Where are B cells produced? -- correct answer --in the bone marrow What is the pathophys behind a thyrotoxic crisis (aka thyroid storm)? -- correct answer --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? -- correct answer --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