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Essential Medical Guidelines for Adults: Preventive Care and Health Management, Exams of Nursing

A concise overview of essential medical guidelines for adults, covering various aspects of preventive care and health management. It outlines recommended screening schedules for common health conditions, including cancer, cardiovascular disease, and infectious diseases. The document also includes information on the use of common herbal supplements, their potential benefits, and associated risks. Additionally, it provides a summary of key concepts related to healthcare policy, nursing theory, and pain management.

Typology: Exams

2024/2025

Available from 12/16/2024

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When should adults get the PNA vaccine? - ANS-Age 19-64: smoker, asthma, COPD, DM, ETOH, is immunocompromised or living in facility Age 65+: PPSV23 AND PCV How often should you get a physical exam? - ANS-Once from 11-14, 15-17, 18 - 21 Every 5 - 6 years from ages 20 - 59 Every 2 years from age 60+ When should you check lipid panel? - ANS-Starting at age 20 and every 5years unless

200 mg/dL When should mammography and prostate screening begin? - ANS- Mammography: starting between 40-50 and continue as long as she has 10+ more years Prostate: At 40 if family hx of AA. At 50 for everyone else When should you have baseline ECG in place? - ANS-Age 40 When should colorectal screening start? - ANS-Age 50. Annual FOBT withflex sig q 5 years and colonoscopy q 10 years When should glaucoma testing start? - ANS-Age 40 and yearly When should herpes zoster be given? - ANS-Age 50 - 60 When can Pap smear be discontinued? - ANS-Age > 65-70 with three consecutive normal tests and no abnormal tests in last 10 years Top 4 killers in the US of everyone - ANS-Heart disease, colorectal cancer, Lowe respiratory disease (COPD, asthma, flu, PNA), CVA stroke Cancer with highest mortality in both men and women? - ANS-Lung What is the most common cancer in women in the US? - ANS-Breast What is the most common cancer in men in the US? - ANS-Prostate Who should get hep A vaccine? - ANS-Military, travelers, men who have sex with men

ANCC AGACNP Certification Exam

(Latest 2024/ 2025 Update) 100% Correct

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Who should have hep B vaccine? - ANS-Healthcare workers and high risk patients What is ginger used for and what should you watch for? - ANS-Nausea,dyspepsia, constipation, colic INCREASED RISK OF BLEEDING What is ginseng used for and what should you watch for? - ANS-Increaseoverall well- being, Lower cholesterol, reduce fatigue, enhance libido INCREASED RISK OF BLEEDING, mania with MAOIs, May inhibit opioids What is St. John's wort used for and what should you watch for? - ANS-Depression, anxiety, sleep disorders, BPH INCREASED RISK OF CLOTTING, many drug interactions, may increase efficacy of opioids What is echinacea used for and what should you watch for? - ANS-Commoncold Anaphylaxis, hepatotoxicity, nephrotoxicity, increased sedation during anesthesia What is gingko Biloba used for and what should you watch for? - ANS-Memory and concentration, claudication and glaucoma INCREASED RISK OF BLEEDING, increased blood pressure Black cohosh use and warning - ANS-Menopausal discomfort INCREASED RISK OF BLEEDING Large amounts may cause seizures, visual changes and bradycardia What is evening primrose used for and what should you watch for? - ANS-Menopausal discomfort May elevate blood glucose May increase the risk of seizures What is kava kava used for and what should you watch for? - ANS-Improverelaxation without messing with clarity High doses can lead to HTN, liver damage, visual impairment and dry skin Do not use with ETOH May worsen Parkinson's What is garlic used for and what should you watch for? - ANS-Indigestion,respiratory complaints, increase energy INCREASED RISK OF BLEEDING What are the two titles of HIPAA? - ANS-Title 1: projects health insurance coverage for workers and their families when they lose their job (Cobra)

Title 2: requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers Who is required to follow HIPAA? - ANS-Health care providers, clearinghouses, and health plans What are the two goals of healthy people 2020? - ANS-1) Increase thequality and years of healthy life

  1. Eliminate health disparities among Americans What diagnoses must NPs report to the Department of Health? - ANS-Gonorrhea Chlamydia Syphilis HIV TB Animal bites to animal control What is covered in Medicare A? - ANS-Hospital, SNF, home care servicesand hospice What is covered by Medicare B? - ANS-Known as supplemental medical insurance, pays for physicians visits, outpatient services, lab and diagnostics, medical equipment and flu shots Medicare pays 80% and patient pays 20% What is Medicare C? - ANS-Medicare Advantage - combines A B into oneplan What is Medicare D? - ANS-Limited prescription drug coverage Monthly premium required, only available if you have part A What do the State Practice Acts do? - ANS-- authorize boards of nursing ineach to establish authority for licensure
  • define scope of practice and prescriptive authority How is licensure and certification different? - ANS-Certification is granted by nongovernmental agencies once mastery of specialized knowledge is demonstrated. Licensure is by the state when a person is qualified. What are the components of decisional capacity? - ANS-The ability tounderstand, reason, differentiate good and bad, and communicate Who was the first NP in the US? - ANS-Loretta Ford, who worked with Dr. Henry Silver at the University of Colorado and began the NP in pediatrics in 1964 due tophysician shortages

How did the inpatient NP develop? - ANS-As a result of managed care,hospital restructuring and decreases in medical residency programs Roles of NP - ANS-Clinicians, consultants, educators, and researchers What makes an experiment study? - ANS-Randomization and control group What is deductive reasoning? Vs. inductive - ANS-Deductive reasoning usesgeneral premises to make specific predictions Inductive is the process of developing a generalization after specific information has been studied What are the USPSTF recommendation grades? - ANS-A recommended withhigh evidence of benefit, B recommended with moderate net benefit, C recommended inselect individuals with small benefits, D not recommended due to harm, I insufficient evidence What does a sensitive test mean? - ANS-- identifies those who have thedisease (true positives)

  • it will have minimal false negatives
  • it helps rule out disease What does a test with high specificity mean? - ANS-- identifies the truenegatives
  • has minimal false positives
  • rules in the positive disease What is Nightingale's theory of nursing - ANS-Based on creating a restorative environment Fresh air, light, nutrition, cleanliness, warmth What is Fay Abdullah's theory of nursing? - ANS-Care for the whole personincluding physical, spiritual and social What is Orem's theory of nursing? - ANS-Focused on professional and technological operations. The nurse diagnoses and plans the care and then manages it. What is Roger's theory of nursing? - ANS-Individual is seen as an energyfield existing within the universe What is Leininger's theory of nursing? - ANS-Culture care Describe the WHO's ladder for pain management - ANS-Step 1: aspirin,apap, or NSAID +|- adjuvants Step 1: maintain step 2 and add low opioid (codeine, hydrocodone, oxy, tramadol)

Step 3: add stronger opioids What is a fever? What numbers should you watch for? - ANS-- elevated body temperature above normal (37 Celsius)

  • 101.5 F = 38.3 C Tension headaches - ANS-Most common type in adults. Mechanism is uncertain but though to be related to muscle contraction. Produces generalized bilateral pain that is described as frontotemporal band like discomfort. Pain is described as mild to moderate, non-throbbing pain, tightness, or pressure with a gradual onset that may last hours. It is associated with hunger, depression or stress. Treatment is over the counter analgesics and relaxation. Migraine headache description - ANS-Unilateral, lateralized throbbing headache that occurs episodically; May be dull or throbbing. Builds up gradually and may last for several hours or longer Types of migraines - ANS-classical (with aura) and common (without aura) How do you manage migraines? - ANS-- avoid triggers
  • relaxation and stress management
  • prophylactic daily meds can be considered if attacks occur more than 3-4 times a month
  • for acute attach, rest in quiet dark room and take sumatriptan Cluster headaches - ANS-Mostly affecting middle aged men May be precipitated by ETOH Severe, unilateral, periorbital pain occurring daily for several weeks Usually last less than 2 hours What is critical thinking in nursing practice? - ANS-Patient driven, purposeful,outcome- focused thought based on both knowledge and experience What drug is used as PEP for anthrax? - ANS-Doxycycline What are the symptoms and treatment of organophosphate poisoning? - ANS- Symptoms: AMS, diaphoresis, lacrimation, miosis, urination, defecation, bradycardia and diffuse wheezing Treatment: atropine to block muscarinic effects, pralidoxime chloride reactivates the enzyme cholinesterase (reversing muscle paralysis and CNS depression) What do you use in cyanide poisoning? - ANS-sodium nitrite What clinical features increase the likelihood of MI? - ANS-Radiation of painto both arms, a third heart sound, and hypotension

What is the most likely finding in lab on a person with diarrhea - ANS-Metabolic acidosis as the stool due to the loss of alkaline salts A pregnant woman comes in with a soft 2/6 ejection systolic murmur. When should you be concerned? - ANS-This is normal along with an S3. Do not be concerned unless symptoms of HF develop. Diastolic murmurs and S4 are abnormal however. What should you recommend for an incidental adrenal mass? - ANS-Overnight dexamethasone suppression test What symptoms and monitoring indices are consistent with cardiac tamponade? - ANS-- Diastolic equalization of right atrial, pulmonary artery diastolic andPAWP

  • distant heart sounds, pulsus paradoxus, distended jugular veins Which ion is primarily responsible for rapid depolarization if the cardiac myocyte? - ANS-Sodium What findings are associated with pericarditis? - ANS-Sharp, pleuritic chest pain that is improved with leaning forward or sitting up, widespread ST Elevation or PR depression and a pericardial friction rub The length of time recommended for fibrinolytic therapy in a thrombotic CVA is: - ANS- 3.5- 4 hours What is the optimal hemoglobin level? - ANS- 11 - 12 What is HBsAg, and what does it indicate? - ANS-Hep B surface antigen. Protein on the surface of the virus. Detected in both acute and chronic Hep B infections.INDICATES THAT THE PERSON IS INFECTIOUS. what is Anti-HBs? - ANS-Antibody to HBsAg; indicates recovery andimmunity to hepatitis B. What is anti-HBc? - ANS-Total Hep B core antibody. Appears at onset ofinfection and persists for life. What is HBeAg, and what does it indicate? - ANS-It indicates that the virus isreplicating and the person is contagious What is the treatment for active, chronic Hep B? - ANS-Tenofovir or entecavir What is spasticity? - ANS-clasp knife when the limb is rapidly moved. It moves freely for a short distance, "catches momentarily" and forces the practitioner to use more force until it reaches a point of release

What is the DESC model of conflict resolution? - ANS-D describe the situation E express concerns S suggest alternatives C state the consequences IgM antibody to hepatitis B core antigen (IgM anti-HBc) - ANS-Positivity indicates recent infection with hepatitis B virus (<6 mos). Its presence indicates acute infection. What is normal calcium level? - ANS-8.5-10.5 mg/dL What is calcitriol? - ANS-the active form of Vit D (1,25 (OH)2 D3). There is a deficiency of this with hypoparathyroidism which means it should be given after thyroidectomy to increase the absorption of calcium. What is calcitonin? - ANS-a hormone secreted by the thyroid that has the effect of lowering blood calcium What is a Lisfranc injury? - ANS-An injury involving the lisfranc joint, which iscomposed of 5 tarsometarsal joints. What side effects do you worry about with Bactrim? - ANS-SJS, bone marrow suppression, electrolyte abnormality, nausea, hepatotoxicity, photosensitivity What are the SEs of ciprofloxacin? - ANS-Diarrhea, headache, drowsiness,insomnia, QT prolongation When should women have screening for osteoporosis? - ANS-Screeningevery 2 years with Dexa bone scan in women > 65 years old When is lung cancer screening recommended? - ANS-annual screening withlow-dose CT for adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within the past 15 years What volume is normal in the pericardial sac? - ANS- 50 ml What is first degree heart block? - ANS-Prolonged but fixed PR interval > .20seconds ( little boxes); prolonged conduction of atrial impulses without loss of any impulses What is second degree heart block? - ANS-Wenkebach (mobitz 1): PR continues to get longer and longer until a QRS is dropped. "Longer longer longer drop, that is a wenkebach" Mobitz type 2: the PR is lengthened but constant. But then a dropped QRS occurs What is third degree AV block? - ANS-Complete heart block. No conduction (relationship) between the atria and ventricles. P-waves and QRS are unrelated on ECG. P-waves at normal rate (SA node pace); QRS 40 - 60 beats/min (AV node pace).

When should you consider a G tube? - ANS-If supplemental feeding is needed > 6 weeks When should parenteral nutrition be used? - ANS-When GI tract cannot beused. And use the central line if > 2 weeks. What is normal sodium? - ANS- 135 - 145 mEq/L What is normal urine sodium? - ANS- 10 - 20 mEq/L What is normal serum osmolality? - ANS- 275 - 295 mOsm/kg What does high/low urine sodium mean? - ANS-Greater than 20 means renal salt wasting (problem with the kidney). Less than 20 suggests renal retention to compensate What does hypotonic hypovolemia mean? - ANS-Serum osm < 280 = state ofbody water excess If urine Na < 10: dehydration, diarrhea, vomit If urine Na > 10: diuretics, ACE is, mineralcorticoid deficiency What causes hypervolemic, hypotonic hyponatremia? - ANS-Edema, CHF,liver disease, advanced renal failure RESTRICT FLUIDS What causes hypertonic hyponatremia? - ANS-Hyperglycemia What causes hypokalemia? - ANS-1. Reduced intake of K2. Increased entry of K into the cell

  1. Increased loss of K via the kidneys
  2. Alkalosis
  3. GI losses What signs on ECG suggest hypokalemia? - ANS-Decreased amplitude,broad T waves, prominent U waves, PVCs, v-tach, or v fib What is the management of hypokalemia? - ANS-- PO replace if > 2.5 and noECG changes
  • IV replacement at 10 mEq/hr if can't take PO
  • if < 2.5 or severe symptoms, may give 40/L/hr If K is not improving with replacement, which electrolyte should you check? - ANS- Mg++

What causes hyperkalemia? - ANS-The most common cause is renal failure. Hyperkalemia is also common with massive cell destruction (e.g., burn or crush injury, tumor lysis); rapid transfusion of stored, hemolyzed blood; and catabolic states (e.g., severe infections). What finding on EKG suggests hyperkalemia? - ANS-Tall, peaked T waves What is the treatment for hyperkalemia? - ANS-- Kayexalate

  • insulin 10 units with one amp D Which electrolyte should be given in DKA? - ANS-Potassium, unless K > 5. What is Battle's sign? - ANS-Bluish discoloration on the area behind the ears(mastoid process). Associated with basilar skull fracture. What are the signs of a basilar skull fracture? - ANS-Racoon eyes = bilateral periorbital ecchymosis Battle's sign = retroauricular ecchymosis Clear rhinorrhea or otorrhea or blood begins the tympanic membrane. What medications often cause esophageal irritation or "pill esophagitis"? - ANS- Tetracyclines (antibiotics ie doxycycline), NSAIDs, potassium chloride, iron, quinidine, alendronate What disease is heberden's nodes associated with? - ANS-Osteoarthritis.These are hard bong swellings that develop in the DIPs. Bouchards are found in the PIPs. What joint deformity is found in Rheumatoid arthritis? - ANS-Swan neckdeformity of the fingers and boutonniere deformity of the thumb What is the most common cause of acute scrotal pain in adults? - ANS-epididymitis and testicular torsion What is reactive arthritis? - ANS-1) Previously known as Reiter's Syndrome 2) inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis, uveitis), urethritis
  1. most commonly a post-infectious complication after acute gastroenteritis or colitis What components make up the qSOFA score? - ANS-SBP < or = 100 RR > or = 22 New or worsened mentation What is appropriate treatment for metastatic ovarian cancer? - ANS-Surgical debulking followed by cisplatin or carboplatin plus paclitaxel chemotherapy regimen

What is a reticulocyte? - ANS-Immature red blood cell. Normal is 0.5-2.5% How do defamation, libel and slander differ? - ANS-Defamation - the act ofmaking a damaging, false statement about a person to someone else as if the statement is fact Slander - spoken Libel - written or printed Which electrolyte should be given in DKA? - ANS-Potassium, unless K > 5. What is Battle's sign? - ANS-Bluish discoloration on the area behind the ears(mastoid process). Associated with basilar skull fracture. What are the signs of a basilar skull fracture? - ANS-Racoon eyes = bilateral periorbital ecchymosis Battle's sign = retroauricular ecchymosis Clear rhinorrhea or otorrhea or blood begins the tympanic membrane. What medications often cause esophageal irritation or "pill esophagitis"? - ANS- Tetracyclines (antibiotics ie doxycycline), NSAIDs, potassium chloride, iron, quinidine, alendronate What disease is heberden's nodes associated with? - ANS-Osteoarthritis.These are hard bong swellings that develop in the DIPs. Bouchards are found in the PIPs. What joint deformity is found in Rheumatoid arthritis? - ANS-Swan neckdeformity of the fingers and boutonniere deformity of the thumb What is the most common cause of acute scrotal pain in adults? - ANS-epididymitis and testicular torsion What is reactive arthritis? - ANS-1) Previously known as Reiter's Syndrome 2) inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis, uveitis), urethritis

  1. most commonly a post-infectious complication after acute gastroenteritis or colitis What components make up the qSOFA score? - ANS-SBP < or = 100 RR > or = 22 New or worsened mentation What is a pheochromocytoma? - ANS-A catecholamine-secreting tumor of the adrenal medulla. Usually presents with headaches, palpitations, diaphoresis, and severe hypertension that occur in spells. Others symptoms include tremors, weakness, anxiety or abdominal pain

What is Cushing's syndrome? - ANS-Elevated cortisol in the blood elevated glucose higher insulin needs risk for DM and CVD What are the symptoms of Cushing's syndrome? - ANS-Central obesity, moon face with buffalo hump, poor wound healing, hypertension, weakness, headache What is Addison disease? - ANS-Adrenal insufficiency. Autoimmune adrenalitis. Symptoms include fatigue, weakness, weight loss, orthodontic hypotension, N/V. If not caught, can lead to hypotension, hyponatremia, hyperkalemia, and hypoglycemia. what does VDRL test for? - ANS-syphilis (specifically neuro?) What is normal calcium levels (total and ionized)? - ANS-Total: 8.5-10.5mg/dL Ionized: 4.5-5.5 mg/dL What are the symptoms of hypocalcemia? - ANS-THINK INCREASED. Increased DTRs, muscle cramps, carpopedal spasm (trousseaus sign - when you put tourniquet on and wrist spasms), convulsions, chvosteks sign (sustained cheek blink), prolonged QT interval Signs of hypercalcemia are - ANS-SLUGGISH: lethargy, headache,weakness, muscle flaccidity, heart block, anorexia, nausea, and vomiting. What is the treatment for hypercalcemia? - ANS-Underlying cause. Normal saline with furosemide if Ca > 12 (is emergency). In malignancy, bisphosphonates are safe and effective. Calcitonin. What is the cause and what are the labs of respiratory acidosis? - ANS-Decreased ventilation (somnolence and confusion) pH < 7. PCO2 > 45 What is the cause and what are the labs of respiratory alkalosis? - ANS- Hyperventilation (anxiety and tingling) pH > 7. pCO2 < 35 What labs are associated with metabolic acidosis? - ANS-Low pHLow bicarbonate (HCO3) Seen in diarrhea and DKA What is an anion gap? - ANS-When the two largest negatives are subtracted from the largest positive are greater than the number 12. [(Na+) + (K+)] - [(HCO3 + Cl-)]

Calculated in metabolic acidosis What is metabolic alkalosis? - ANS-High pH, high HCO3 > 26 usually caused by an excessive loss of metabolic acids (from vomit, suction, diuretics) How do you remember respiratory vs. metabolic in acid/base imbalances? - ANS- ROME: respiratory opposite, metabolic equal What are the categories of burns? - ANS-1st degree: dry red no blisters2nd: partial thickness with blisters! 3rd: full thickness with dry leathery black pearly waxy can extend to muscle and bone What is the rule of 9's in burn management? - ANS- 9 head, 9 left arm, 9 rightarm, 18 anterior torso, 18 posterior torso, 1 genitals, 18 left leg, 18 right leg Describe fluid resuscitation in burns - ANS-- Fluid resuscitation begins at thetime of the burn injury.

  • Use the parkland formula: 4 mL/kg * TBSA in the first 24 hours
  • half of all fluids should be given in the first 8 hours When should a burn patient be treated at a burn center? - ANS-Partialthickness burn over 10% of body Burn on face, hands, feet, genitals or major joints Chemical burn Third degree/Full thickness burns Inhalation injury Any concomitant trauma or complicating medical disorders Any patients requiring additional support that is unavailable When should you prescribe antibiotics for bites? - ANS-If bite is on face, hand, or there are any signs/symptoms of infection, you should prescribe 3-7 days of abx with coverage of both staph and anaerobes. What are the most common organisms of inpatient cellulitis? - ANS-Gramnegative organisms, s. aureus, strep Which drug has the greatest sensitivity/specificity for CA-MRSA? - ANS- Trimethoprim/sulfamethoxazole (Bactrim) What is Ipecac? - ANS-It is a substance that induces vomiting (usuallyprolonged). What are the s/s and treatment of a acetaminophen intoxication? - ANS-S/S:around 24- 48 hours: nausea and vomiting with RUQ pain and signs of hepatotoxicity Treatment: emesis for recent ingestion, gastric lavage and activated charcoal

What are the s/s and treatment of a salicylate (aspirin) intoxication? - ANS-S/S: n/v, tinnitus, dizziness, headache, dehydration, hyperthermia, apnea, metabolic acidosis Treatment: emesis for recent ingestion, gastric lavage and activated charcoal What are the signs and treatment of organophosphate (insecticide) poisoning? - ANS- N/V/D, salivation, headache, blurred vision and miOsis = cOnstriction, bradycardia mental confusion Treatment: activated charcoal and atropine What are the signs and treatment of antidepressant toxicity? - ANS- Confusion, blurred vision, urinary retention, hypotension, hypothermia, seizures Treatment: gastric lag age/charcoal, sodium bicarbonate, Seizure control, dantrolene sodium to treat serotonin syndrome What are the signs and treatment of narcotic toxicity? - ANS-Drowsiness,hypothermia, resp depression, pinpoint pupils, cocaine = mydriasis, coma Treatment: emetics are contraindicated, gastric lavage/charcoal, naloxone, butorphanol What are the signs and treatment of a benzo overdose? - ANS-Drowsiness,confusion, slurred speech, resp depression, hyporeflexia Treatment: flumazenil, gastric lavage and charcoal What are signs of transplant rejection? - ANS-Immediate failure of organ(watch for urine output) and flu like symptoms WHAT DO YOU DO: immediate biopsy What drugs are people who have transplant on? - ANS-One from each class:1. Calcineurin anhibitor (tacrolimus or cyclosporine)

  1. Antmetabolite (azathioprine, mycophenolate)
  2. Steroid (prednisone) Malignant melanoma may metastasize and has high mortality. What do you watch for? - ANS-Asymmetry, border irregularity, color variation, diameter > 6 mm, elevation and enlargement. Yes to 2 = referral basal cell carcinoma - ANS-Most common and least severe type of skin cancer; often characterized by light or pearly nodules. Slow growing (1-2 cm after years). Punch biopsy and surgical excision. squamous cell carcinoma - ANS-Type of skin cancer more serious than basal cell carcinoma; often characterized by scaly red papules or nodules. Develop over a few months. Scalp bleeding can arise from actinic keratosis. Treatment is Mohs. actinic keratosis - ANS-a precancerous skin growth that occurs on sun-damaged skin. Rough, flesh colored, pink. Treatment is liquid nitrogen.

seborrheic keratosis - ANS-a benign beige brown black plaques skin growth that has a waxy or "pasted on" look. 3-20 mm in diameter. Treatment often none or liquid nitrogen. When should a burn patient be intubated? - ANS-Burns to the face, singednares or eyebrows, dark soot/mucous from nares and/or mouth What should you recommend for stasis dermatitis? - ANS-Keep legselevated while seated What is the treatment for the dawn phenomenon? - ANS-Increase the insulindose at bedtime What is the best treatment for bacterial UTI secondary to Foley cath? - ANS- Ciprofloxacin What is the best treatment for acute pyelonephritis? - ANS-Ceftriaxone What legislation allowed NPs to be recognized Medicare providers in all geographical areas with their own provider number? - ANS-Balanced budget act How do you evaluate cytology only in a tumor - ANS-Fine needle biopsy What is the treatment for HYPERnatremia? - ANS-hypovolemic - normal saline until BP improves then D5W or 1/2 normal saline isovolemic - replace water deficit with free water (D5W) hypervolemic: eliminate excess sodium, loop diuretics and free water (D5W), may need dialysis What is the common lab finding in alcoholic liver disease? - ANS-AST to ALTratio is > 1, and often > 2 What is balanitis? - ANS-Inflammation of the glans penis or clitoris. More commonly refers to males. Can occur at any age. May be the first sign of DM in many men. What is Legionella pneumonia? - ANS-Common cause of community acquired PNA. OFTEN COMPLICATED BY GI symptoms. Diagnosis is made by urinary antigen detection, blood or sputum cultures. What are signs of cardiac tamponade? - ANS-Muffled heart sounds. Jugular vein distention. Decreased BP. Pulsus paradoxus (an exaggerated decrease in BP with inspiration). Dyspnea. Tachypnea. Tacycardia.

What is prepatellar bursitis? - ANS-"Carpet layer knee." Bursa enlarged fromconstant irritation. NO EFFUSION. What labs do you check for von Willebrands disease? - ANS-CBC, aPTT, Pt,risocetin cofactor assay and vWF Ag assay, factor VIII:C activity What is Ober's test? - ANS-To test for iliotibial band syndrome What are side effects of statin meds? - ANS-fatigue, myalgia, increased liver enzymes When should women be screened for osteoporosis? - ANS-Starting at age 65 50 - 65 if they have risk factors History of fx after age 50 from standing position Rheumatoid arthritis Glucocorticoid use HRT use What are signs of HIV? - ANS-Cough, intermittent chills, subjective fevers, myalgias, anorexia, mild skin pallor, cobblestoning and course rhonchi What is chronic prostatitis? - ANS-3 months of dysuria with the same bacterial strain on repeated cultures What do you expect to see on pulmonary function tests of an acute asthma exacerbation? - ANS-Decreased FEV1:FVC ratio, increased total lung capacity and residual volume, peak exploratory flow rate of less than 200 L/min (less than 40% of patient's personal best) What side effect should you watch for with ARBs? - ANS-Hyperkalemia What is the classic finding of aortic stenosis? - ANS-A harsh, crescendo- decreshendo systolic murmur that is loudest over the second right intercostal space What are the liver lab findings for hepatitis A? - ANS-ALT is generally higher than AST When initiating clopidogrel, what should you watch for? - ANS-TTP(thrombocytopenic purpura):

  1. Thrombocytopenia
  2. Microangiopathic hemolytic anemia
  3. Neuro changes
  4. Renal function abnormalities
  5. Fever

Diagnosis: peripheral blood smear What is the leading cause of blindness in the elderly? - ANS-age-relatedmacular degeneration What is the antidote for moderate serotonin syndrome? - ANS- Cyproheptadine What does "the worst headache I have ever had" suggest? - ANS-Subarachnoid hemorrhage. Get a head CT. Is Lyme disease a reportable disease in all states? - ANS-Yes What is varus stress? - ANS-Force that moves the joint away from the midline Which beta blocker is cardioselective? - ANS-Atenolol What is a concerning side effect of SSRIs? - ANS-QT prolongation What is CLL? - ANS-Chronic lymphocytic leukemia. A clonal malignancy of B lymphocytes. Most common leukemia! More common in men than women. Median age of onset is 72. Enlarged lymph nodes are the most common sign, with splenomegaly, hepatomegaly, pallor, fatigue and early satiety. What is the most common finding in CML? - ANS-Philadelphia chromosome What are the components of metabolic syndrome? - ANS-1. Central obesity

40 in med and > 35 in women

  1. dyslipidemia: triglycerides > 150
  2. prehypertension > 130/
  3. elevated fasting blood glucose level > 100
  4. HDL < 40 in men and < 50 in women YOU NEED 3 What is the Somogyi effect? And what is the treatment? - ANS-- nocturnal hypoglycemia leading to a surge of counterregulatory hormones, leading to hypoglycemia around 0300 and in turn to hyperglycemia in the AM
  • treatment is to omit or reduce PM insulin What is the Dawn phenomenon? How is it treated? - ANS-Hyperglycemia upon awakening in the morning. Caused when the tissues become desensitized to insulin nocturnally.

Treatment: Can't confirm this unless BS is checked 0200-0400 and on awakening (if both are high, then add or increase nighttime insulin How do you distinguish between DKA and HHNK in terms of presentation? - ANS- Both: polyuria, weakness, changes in LOC, dehydration, hypotension, tachycardia DKA: N/V, diffuse abd pain, fruity breath, ketones in urine, glucose > 300 HHNK: coma (usually has longer onset), no ketones, glucose > 600 What do you use to diagnose hyperthyroidism? - ANS-Thyroid radioactiveiodine uptake and scan Highly iodine uptake = graves Low iodine uptake = subacute thyroiditis What is SIADH? - ANS-Syndrome of inappropriate antidiuretic hormone. Increased ADH = inappropriate water retention = increased serum osm = low sodium in blood but high sodium in urine What is diabetes insipidus? - ANS-- disorder caused by inadequate amounts of ADH which causes excessive water loss

  • Related to pituitary or hypothalamus damage OR renal tubule insensitivity to ADH
  • hypernatremia AND increased serum osm AND decreased urine sodium What is pheochromocytoma? - ANS-A rare condition characterized by an adrenal medulla tumor that produces excessive caecholamines (epinephrine, norepinephrine) resulting in severe hypertension, diaphoresis, severe headaches, palpitations, tachycardia. How do you diagnose and treat pheochromocytoma? - ANS-Check plasma free metanephrines CT of adrenals to confirm tumor Surgical removal of tumor May use phentolamine preoperatively What is first line antibiotic treatment for chronic prostatitis? - ANS-Fluroquinolones like Levaquin How should patients take iron supplements? - ANS-With orange juice (notwith calcium!!!) How does capsaicin work? - ANS-Depolarization of depleted sensoryneurons What is the cause of hypocalcemia in ESRD? - ANS-Decreased conversion of vitamin D

When should men be screened for prostate cancer with a PSA? - ANS-Menages 55- 69 should make an individual decision with their clinician. Men over 70 should not have routine screening. What is beta thalassemia? - ANS-- a condition in which the synthesis of thebeta-globin chains is decreased or absent.

  • excess alpha chains
  • microcytic anemia Why should you stop hydrochlorothiazide when a patient is having gout flares? - ANS-It can increase uric acid levels What diagnosis do you suspect in a 30 year old female with double vision and complaints of difficulty swallowing who is otherwise healthy? - ANS- Myasthenia Gravis. Give pyridostigmine or neostigmine, anticholinesterase medications What is the strongest and lowest evidence in the hierarchy? - ANS-Expertopinion is lowest Meta-analysis is highest What increases the risk of gout? - ANS-Age, genetics, thiazide diuretics, Koop diuretics, African American race, alcohol, meat, seafood, fruit juice high in fructose What is the S3 heart sound? - ANS-S3 is "Ken-tuck-y" - the soundassociated with increased fluid states (CHF and pregnancy) What is the S4 heart sound? - ANS-S4 is "Ten-ne-ssee" - the soundassociated with a stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension) How do you grade murmurs? - ANS-1: barely audible 2: faint 3: moderate, easily heard 4: loud with a THRILL 5: very loud heard with stethoscope off the wall 6: loudest How do you remember valvular disease? - ANS-MS ARD MR ASS What do you hear in mitral stenosis? - ANS-S1 murmur, low pitched mid diastolic, apical crescendo rumble What do you hear in mitral regurgitation? - ANS-Systolic murmur at 5th ICS, musical blowing high pitched

What do you hear in aortic stenosis? - ANS-Systolic rough harsh blowing at2nd ICS What do you hear with aortic regurgitation? - ANS-Diastolic blowing murmur at 2nd ICS What is the JNC recommended BP for adults over the age of 60 without comorbidities?

  • ANS-< 150/ What is the JNC recommended BP for adults younger than 60 without comorbidities? - ANS-< 140/ What is the recommendation for BP in adults with CKD or DM? - ANS-<140/ What is the first line drug of choice for HTN? - ANS-Thiazide diuretics like hydrochlorothiazide and chlorthalidone Increase secretion of sodium and water WATCH FOR: low K, Mg, Na, and high glucose and calcium What should I know about ACE inhibitors? - ANS-The - prils. Cause vasodilation and block sodium and water retention. CONTRAINDICATED IN PREG ANDBILATERAL RENAL ARTERY STENOSIS. May cause cough, taste disturbance, hyperkalemia, renal impairment What should I know about ARBS? - ANS-The - tans. Similar to the ACEinhibitors. Watch for hyperkalemia. CONTRAINDICATED IN PREGNANCY What should I know about CCBs? - ANS-Verapamil, diltiazem, amlodipine (and other pines). May cause headache, flushing and bradycardia, edema. CAUTION IN 2nd and 3rd heart block. What does a split S2 suggest? - ANS-Atrial septal defect When should you use synchronized vs unsynchronized fibrillation? - ANS- Use unsynchronized when the person is in v tach or v fib. If you use it with a fib, you could cause v fib. What should I know about beta blockers? - ANS-The - lols. NOT first line therapy. Watch and avoid with asthma/COPD. CAREFUL WITH DM AS THEY CAN MASK EARLY SIGNS OF HYPOGLYCEMIA. What is Beck's triad of cardiac tamponade? - ANS-My Depressed Heart
  • Muffled heart sounds
  • Distended neck veins
  • Hypotension Metastatic cancer puts you at risk What should I know about peripheral alpha 1 antagonists? - ANS-The - sins.Cause vasodilation. May be used for BPH. MAY CAUSE syncope, orthostasis, headache, nausea What should I know about central alpha-2 agonists? - ANS-Like clonidine. Cause vasodilation and slow the heart rate. Do not discontinue abruptly. What are the fluid resuscitation goals for sepsis within the first hour? - ANS-Broad spectrum antibiotics. As well as fluid at 30 ml/kg if hypotension or lactate > 4 What are the absolute contraindications for fibrinolytic therapy for acute STEMI? - ANS-- prior intracranial hemorrhage
  • intracranial mass or neoplasm
  • ischemic stroke within 3 months
  • suspected aortic dissection
  • active bleeding (including menses)
  • significant closed head or facial trauma within the last 3 months
  • intracranial or intraspinal surgery within 2 months What lab monitoring is required for people on amiodarone? - ANS-TFTs,LFTs, PFTs (thyroid, liver, lungs) What do you hear in constrictive pericarditis? - ANS-A pericardial knock What is the classic sign of pericarditis and how it is treated? - ANS-Pain thatimproves with sitting up. Indomethacin 50 mg 3x daily plus colchicine How long should someone be on anticoagulation prior and post cardio version for afib? - ANS- 3 weeks prior. 4 weeks post. What is Wolff-Parkinson-White syndrome? - ANS-ventricular preexcitation syndrome. Accessory conduction pathway from atria to ventricle (bindle of kent) bypassing AV node. Ventricles partially depolarize early, making a delta wave on EKG (aslow rise in the initial QRS). May lead to recurrent entry and supraventricular tachycardia. How do you distinguish cardiac tamponade vs. constructive pericarditis - ANS- Cardiac tamponade: pulsus paradoxus (a decrease of BP or an increase in systemic venous return with inspiration), hypotension, JVD, muffled heart sounds Constrictive pericarditis: JVD, pericardial knock, Kussmaul's sign: the lack of an inspiratory decline or increase in CVP)

Which artery is associated with 80% of all inferior MIs? - ANS-Right coronaryartery What is Cullen's sign? - ANS-It is the presence of superficial edema and bruising around the umbilicus - it is suggestive of acute pancreatitis or an intraabdominal bleed. What is the obturator sign? - ANS-passive internal rotation of the flexed hipleading to RLQ pain (indicative of acute appendicitis) What is the psoas sign? - ANS-pain elicited by extending the hip with theknee in full extension or by flexing the hip against resistance retrocecal appendicitis What is Murphy's sign? - ANS-acute pain and inspiratory arrest elicited by palpation of the RUQ during inspiration (indicative of acute cholecystitis) Which medication is most commonly associated with hypoglycemia? - ANS-Glyburide What is normal aortic valve diameter vs. severe aortic stenosis? - ANS- 3 - 4 cm^2 is normal. Less than 1 is severe. What is a Iridotomy for Glaucoma? - ANS-Surgical incision made throughcornea to remove portion of iris to facilitate aqueous drainage (closed - angle). What is closed acute angle glaucoma? - ANS-Symptoms: unilateral headache, worst of lives, ciliary flush, photophobia and nausea. Refer to optho immediately as it could lead to blindness. What is the treatment for chlamydia? - ANS-Azithromycin What is used to treat gonorrhea? - ANS-Ceftriaxone What is the diagnosis and treatment for a "strawberry cervix" with green-grey discharge? - ANS-Trichimonas vaginitis. Use metronidazole. What is part of the HITECH Act? - ANS-Meaningful use - e-prescribing,engaging in health information exchange and submitting information re quality measures What meds should be given in a carcinoid crisis? - ANS-Octreotide andglucocorticoids What murmur is heard with a mitral valve prolapse? - ANS-Late systolicmurmur

Which lab is often positive in SLE? - ANS-Antinuclear antibody What labs are associated with lithium use? - ANS-Low sodiumHypothyroidism High calcium High glucose Is specialty certification required in all states? - ANS-NOPE What medications cause changes in taste or smell? - ANS-Levodopa, metformin, allopurinol, ACE inhibitors, anticholinergics, anhistamines, CCBs, aldactone, propranolol Should you use activated charcoal with lithium? - ANS-No What are some common eye side effects of meds? Digoxin, diphenhydramine, sildenofil, lovastatin? - ANS-Dig - yellow vision and halos Diphen - acute angle glaucoma Lovastatin - lens opacity Sildenofil - bluish tinge and ischemic optic neuropathy What is the treatment for infective endocarditis from a prosthetic valve? - ANS- Ampicillin/Sulbactam and gentamicin plus rifampin What is the most common cause of PNA in the elderly? - ANS-Streppneumonia When should galantamine be prescribed? - ANS-Mild dementia What is the A1C goal for adults over the age of 65? - ANS- What would you see on blood smear with ETOH and homeless? - ANS- Hypersegmented PMNs What is steathorrhea? - ANS-Loose greasy stools found in chronicpancreatitis What does the ARMA trial say about tidal volume in ARDS? - ANS-A low tidal volume is best (< 6 mL/kg of ideal body weight) A plateau pressure < 30 is goal How is H. pylori diagnosed? - ANS-Biopsy, serological testing for H. pylori antibody, or urea breath test What is the treatment for h. Pylori? - ANS-Two antibiotics and a PPI

MOC: metronidazole + omeprazole + clarithromycin x 7 days AOC: amoxicillin + omeprazole + clarithromycin x 7 days MOA: metronidazole + omeprazole + amoxicillin x 7 - 14 days How do you calculate MAP? - ANS-(SBP + 2DBP)/3 or [(1/3 of SBP) + (2/3 ofDBP)] What is the most common cause of intrinsic renal failure? - ANS-Ischemicinjury (then nephrotoxins) What is pectus excavatum? - ANS-A markedly sunken sternum and adjacent cartilages (also called a funnel breast). Associated with mitral valve prolapse. What is serotonin syndrome? - ANS-increased heart rate, sweating, dilatedpupils, tremors, twitching, hyper reflexes, hyperthermia, agitation, confusion, disorientation, hallucinations Rare and life-threatening event caused by serotonergic drugs What is Goodpasture's syndrome? - ANS-Autoimmune disease that attacks the basement membranes of the lungs, alevoli, and glomerulus - it is caused by viral infections and surgery of the lung or kidneys. Requires: glomerulonephritis, pulp monarch hemorrhage, and anti-GMB antibodies What is appropriate treatment for newly diagnosed immune thrombocytopenia? - ANS- Prednisone 1 mg/kg/day What are indications for an urgent referral to vascular surgeon for an ulcer? - ANS- Cellulitis, gangrene, presence of visible tendon or bone, sever infection, ABI < 0.5 What foods should you avoid with monoamine oxidase inhibitors? - ANS-Fermented, aged cheeses, red wine, chocolate What is a hypertensive emergency? Treatment? - ANS-BP >180/120associated with end organ damage Treatment: blood pressure should be lowered 25% within minutes to 1 - 2 hours and then over the next few days What ECG changes are seen in angina? - ANS-ST depression in stable angina ST elevation in prinzmetals What is normal total cholesterol? - ANS-Less than 200

What is normal triglycerides? - ANS-less than 150 What is optimal LDLs? - ANS-Less than 100 What is optimal HDL? - ANS-higher than 60 mg/dL Who would benefit from statin therapy? - ANS-- anyone with clinical evidenceof ASCVD

  • LDL > 190
  • diabetics with LDL between 70 - 189
  • anyone with ASCVD of 7.5% or higher and LDL between 70 - 189 Where would you see EKG changed in a lateral MI? - ANS-1 and aVL Where would you see EKG changes in an inferior MI? - ANS-II, III, aVF Where would you see EKG changes in an anterior MI? - ANS-V leads, or V3and V4 When is revascularization indicated in chest pain? - ANS-Unrelieved chestpain > 30 minutes and < 6 hours What is the difference in etiology between endocarditis and pericarditis? - ANS- Peri: most often virus, could be renal or MI Endo: most often bacteria, could be recent surgery or dental work, prolonged use of IV What is the difference in symptoms between endo and pericarditis? - ANS-Peri: pain worsened with deep breathing, relieved by sitting forward Endo: fever, malaise, night sweats, weight loss, generalized sick feeling What is the difference in physical signs between endo and pericarditis? - ANS- Peri: pericardial friction rub Endo: maybe murmur, oslers nodes on fingers, Janeway lesions on palms, Roth spots on retina What lab/diagnostics are seen in endo vs pericarditis? - ANS-Peri: STelevation , depression of PR Endo: left shift of bands How do you diagnosis a left bundle branch block on an ECG? - ANS-Widened QRS. THEN LOOK AT V1: it QRS deflecting downward, then this is left. If QRS is upward, then this is right What is the most reliable physical finding in predicting severe aortic stenosis? - ANS- Delayed carotid upstroke

Why do ARBs not cause dry cough? - ANS-They cause less bradykinin (metabolite) formation What are the causes of bowel perforation? - ANS-PUD, diverticulitis,appendicitis What are common causes of PUD? - ANS-H. pylori and NSAIDsSmoking Stress NOT SMOKING OR DIET What would you see on labs for active Hep A infection vs recovered infection? - ANS- Active: anti-HAV + IgM Recovered: anti-HAV + IgG What would you see on labs for active Hep B infection? - ANS-HBsAg,HBeAg (indicating high viral load, that person is infectious), anti-HBc, IgM What would you see on labs for chronic Hep B infection? - ANS-HBsAg, Anti-HBe, anti- HBc, IgM, IgG What is the treatment for hepatitis C? - ANS-Tenofovir or entecavir How do you diagnosis diverticulitis? - ANS-CT scan What would you see on labs for recovered Hep B infection? - ANS-Anti-HBc,Anti- HBsAg What is the treatment for diverticulitis? - ANS-Broad spectrum antibiotic like metronidazole ciprofloxacin What is Murphy's sign? - ANS-- acute pain elicited by palpation of the RUQduring inspiration

  • SIGNIFYING CHOLECYSTITIS What is the treatment for cholecystitis? - ANS-Pain management, NPO, IVF,broad spectrum antibiotics, surgical consult for lap chole What signs might you see in pancreatitis? - ANS-If hemorrhagic:
  • grey turners sign: flank discoloration
  • Cullen's sign: umbilical discoloration What is Ranson's criteria? - ANS-Determines severity of acute pancreatitis. Includes evaluation of: George - greater than 55 years old