Medical Terminology and Concepts, Exams of Nursing

Download Medical Terminology and Concepts and more Exams Nursing in PDF only on Docsity! ANCC AGACNP Certification Questions With Complete Solutions A pregnant woman comes in with a soft 2/6 ejection systolic murmur. When should you be concerned? Correct Answers This is normal along with an S3. Do not be concerned unless symptoms of HF develop. Diastolic murmurs and S4 are abnormal however. actinic keratosis Correct Answers a precancerous skin growth that occurs on sun-damaged skin. Rough, flesh colored, pink. Treatment is liquid nitrogen. basal cell carcinoma Correct Answers 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. Black cohosh use and warning Correct Answers Menopausal discomfort INCREASED RISK OF BLEEDING Large amounts may cause seizures, visual changes and bradycardia can LABA be used as monotherapy in persistent asthma Correct Answers No! Cancer with highest mortality in both men and women? Correct Answers Lung Cluster headaches Correct Answers 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 Cranial nerve I Correct Answers Olfactory (smell) Cranial nerve II Correct Answers Optic - vision Cranial nerve III Correct Answers Oculomotor - eye movement and pupillary cOnstriction Cranial nerve IV Correct Answers Trochlear - down and inward eye movement Cranial nerve IX Correct Answers Glossopharyngeal - taste & senses, swallowing, gag reflex Cranial nerve V Correct Answers Trigeminal - chewing face & mouth touch & pain Cranial nerve VI Correct Answers Abducens - lateral eye movement Cranial Nerve VII Correct Answers Facial - controls most facial expressions & secretion of tears & saliva & taste Cranial nerve VIII Correct Answers Vestibulocochlear or acoustic How do you diagnosis diverticulitis? Correct Answers CT scan How do you differentiate the leukemia's? Correct Answers CLL - often found incidentally with smudge cells on a blood smear AML - bone marrow failure: bleeding, fatigue infection ALL: pancytopenia, blasts in smear CML: Philadelphia chromosome How do you distinguish between DKA and HHNK in terms of presentation? Correct Answers 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 How do you distinguish cardiac tamponade vs. constructive pericarditis Correct Answers 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) How do you evaluate cytology only in a tumor Correct Answers Fine needle biopsy How do you grade murmurs? Correct Answers 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 manage migraines? Correct Answers - 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 How do you remember respiratory vs. metabolic in acid/base imbalances? Correct Answers ROME: respiratory opposite, metabolic equal How do you remember valvular disease? Correct Answers MS ARD MR ASS How do you tell gastric ulcer from duodenal? Correct Answers Gastric is not relieved by food Most common with chronic NSAID use Epigastric pain 1-3 hours after eating How do you test for multiple myeloma? Correct Answers Serum and urine assessment for monoclonal protein How does capsaicin work? Correct Answers Depolarization of depleted sensory neurons How does the PCWP usually relate to the PA pressure? Correct Answers The PCWP is usually lower than the diastolic number of the PA pressure How is H. pylori diagnosed? Correct Answers Biopsy, serological testing for H. pylori antibody, or urea breath test How is licensure and certification different? Correct Answers Certification is granted by nongovernmental agencies once mastery of specialized knowledge is demonstrated. Licensure is by the state when a person is qualified. How long should someone be on anticoagulation prior and post cardio version for afib? Correct Answers 3 weeks prior. 4 weeks post. How often should you get a physical exam? Correct Answers Once from 11-14, 15-17, 18-21 Every 5-6 years from ages 20-59 Every 2 years from age 60+ How should patients take iron supplements? Correct Answers With orange juice (not with calcium!!!) If a patient has the "worst headache of my life" that comes on suddenly, what is the differential and plan Correct Answers Subarachnoid hemorrhage CT Lumbar puncture if CT is negative squamous cell carcinoma Correct Answers 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. Tension headaches Correct Answers 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. The length of time recommended for fibrinolytic therapy in a thrombotic CVA is: Correct Answers 3.5-4 hours Top 4 killers in the US of everyone Correct Answers Heart disease, colorectal cancer, Lowe respiratory disease (COPD, asthma, flu, PNA), CVA stroke Types of migraines Correct Answers classical (with aura) and common (without aura) What are causes of low DLCO? Correct Answers Emphysema Pulmonary fibrosis *Anemia* What are characteristics of primary biliary cirrhosis? Correct Answers Significantly elevated alk phos Fatigue Itching What are common causes of PUD? Correct Answers H. pylori and NSAIDs Smoking Stress NOT SMOKING OR DIET What are indications for an urgent referral to vascular surgeon for an ulcer? Correct Answers Cellulitis, gangrene, presence of visible tendon or bone, sever infection, ABI < 0.5 What are partial seizures? (Also known as focal and local) Correct Answers Simple - NO LOSS OF CONSCIOUSNESS Complex - there is impaired LOC What are side effects of statin meds? Correct Answers fatigue, myalgia, increased liver enzymes What are signs of cardiac tamponade? Correct Answers Muffled heart sounds. Jugular vein distention. Decreased BP. Pulsus paradoxus (an exaggerated decrease in BP with inspiration). Dyspnea. Tachypnea. Tacycardia. What are signs of HIV? Correct Answers Cough, intermittent chills, subjective fevers, myalgias, anorexia, mild skin pallor, cobblestoning and course rhonchi What are signs of transplant rejection? Correct Answers Immediate failure of organ (watch for urine output) and flu like symptoms WHAT DO YOU DO: immediate biopsy What are some common eye side effects of meds? Digoxin, diphenhydramine, sildenofil, lovastatin? Correct Answers Dig - yellow vision and halos Diphen - acute angle glaucoma Lovastatin - lens opacity Sildenofil - bluish tinge and ischemic optic neuropathy What are the absolute contraindications for fibrinolytic therapy for acute STEMI? Correct Answers - 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 are the categories of burns? Correct Answers 1st degree: dry red no blisters 2nd: partial thickness with blisters! 3rd: full thickness with dry leathery black pearly waxy can extend to muscle and bone What are the causes of anion gap metabolic acidosis? Correct Answers MUD PILES CAT Methanol/Metformin Uremia DKA What are the four clinical stages of syphilis? Correct Answers Primary - painless infuriated ulcer (people don't come in) Secondary - flu, skin rash on palms/soles, lymphadenopathy, malaise, anorexia, alopecia, arthralgia Latent - seropositive but asymptomatic Tertiary - leukoplakia, cardiac insuffiency, aortic aneurysm, meningitis, hemiparesis, hemiplegia What are the labs associated with thalassemia? Correct Answers Low except for NORMAL TIBC and normal ferritin What are the labs in hypovolemic shock? Correct Answers Everything is low except SVR is high to compensate What are the liver lab findings for hepatitis A? Correct Answers ALT is generally higher than AST What are the main symptoms of pneumoconiosis and silicosis? Correct Answers Often asymptomatic. Will see a pleural plaque on X-ray What are the most common organisms of inpatient cellulitis? Correct Answers Gram negative organisms, s. aureus, strep What are the notifiable diseases for the CDC? Correct Answers Hep B and C Smallpox Malaria MMR pertussis Vancomycin resistant What are the presenting signs of multiple myeloma? Correct Answers Bone pain, fractures, weakness, anemia, hypercalcemia, spinal cord compression, renal failure What are the s/s and treatment of a acetaminophen intoxication? Correct Answers 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? Correct Answers 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 SEs of ciprofloxacin? Correct Answers Diarrhea, headache, drowsiness, insomnia, QT prolongation What are the signs and treatment of a benzo overdose? Correct Answers Drowsiness, confusion, slurred speech, resp depression, hyporeflexia Treatment: flumazenil, gastric lavage and charcoal What are the signs and treatment of antidepressant toxicity? Correct Answers 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? Correct Answers 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 organophosphate (insecticide) poisoning? Correct Answers N/V/D, salivation, headache, blurred vision and miOsis = cOnstriction, bradycardia mental confusion Treatment: activated charcoal and atropine What are the signs of a basilar skull fracture? Correct Answers Racoon eyes = bilateral periorbital ecchymosis Battle's sign = retroauricular ecchymosis Clear rhinorrhea or otorrhea or blood begins the tympanic membrane. What are the signs of a basilar skull fracture? Correct Answers Racoon eyes = bilateral periorbital ecchymosis Battle's sign = retroauricular ecchymosis Clear rhinorrhea or otorrhea or blood begins the tympanic membrane. What are the signs of chlamydia? Correct Answers Often asymptomatic Dysuria Spotting in women Dyspareunia (painful sexual intercourse) What are the two titles of HIPAA? Correct Answers 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 What are the USPSTF recommendation grades? Correct Answers A recommended with high evidence of benefit, B recommended with moderate net benefit, C recommended in select individuals with small benefits, D not recommended due to harm, I insufficient evidence What are the Vaughan-Williams Class I drugs? Correct Answers Primary sodium channel blockers What are the Vaughan-Williams Class II drugs? Correct Answers Beta blockers (best evidence of reduced mortality particularly in patients with reduced EF or MI) What are the Vaughan-Williams Class III drugs? Correct Answers Potassium channel blockers What are the Vaughan-Williams Class IV drugs? Correct Answers Verapamil, Diltiazem (CCBs) What benefit do you get from interrupting sedation daily for people on mechanical ventilation? Correct Answers - decreased duration of ventilation - decreased ICU stay - decreased 1 year mortality What causes hyperkalemia? Correct Answers 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 causes hypertonic hyponatremia? Correct Answers Hyperglycemia What causes hypervolemic, hypotonic hyponatremia? Correct Answers Edema, CHF, liver disease, advanced renal failure RESTRICT FLUIDS What causes hypokalemia? Correct Answers 1. Reduced intake of K 2. Increased entry of K into the cell 3. Increased loss of K via the kidneys 4. Alkalosis 5. GI losses What causes hypovolemic shock? Correct Answers Loss of greater than 20% of blood volume What causes pre-renal failure? Correct Answers Conditions OUTSIDE the kidney that impair renal perfusion I.e. shock, dehydration, cardiac failure, burns, diarrhea, vasodilation/sepsis What clinical features increase the likelihood of MI? Correct Answers Radiation of pain to both arms, a third heart sound, and hypotension What components make up the qSOFA score? Correct Answers SBP < or = 100 RR > or = 22 New or worsened mentation What components make up the qSOFA score? Correct Answers SBP < or = 100 RR > or = 22 New or worsened mentation What diagnoses must NPs report to the Department of Health? Correct Answers Gonorrhea Chlamydia Syphilis HIV TB Animal bites to animal control What diagnosis do you suspect in a 30 year old female with double vision and complaints of difficulty swallowing who is otherwise healthy? Correct Answers Myasthenia Gravis. Give pyridostigmine or neostigmine, anticholinesterase medications What disease is heberden's nodes associated with? Correct Answers Osteoarthritis. These are hard bong swellings that develop in the DIPs. Bouchards are found in the PIPs. A person would not suppress their cortisol level as a result of exogenous admin of cortisol What does a prolonged QT interval suggest? Correct Answers Hypocalcemia What does a sensitive test mean? Correct Answers - identifies those who have the disease (true positives) - it will have minimal false negatives - it helps rule out disease What does a split S2 suggest? Correct Answers Atrial septal defect What does a test with high specificity mean? Correct Answers - identifies the true negatives - has minimal false positives - rules in the positive disease What does CURB-65 stand for? Correct Answers Confusion blood Urea nitrogen (>19 mg/dL) Respiratory rate (>30 breaths per min) Blood pressure (sBP <90 or dBP <60) age (65 or older) What does high/low urine sodium mean? Correct Answers Greater than 20 means renal salt wasting (problem with the kidney). Less than 20 suggests renal retention to compensate What does hypotonic hypovolemia mean? Correct Answers Serum osm < 280 = state of body water excess If urine Na < 10: dehydration, diarrhea, vomit If urine Na > 10: diuretics, ACE is, mineralcorticoid deficiency What does induced paralysis in ARDS do? Correct Answers Increase oxygenation What does paradoxically split S2 suggest? Correct Answers Aortic stenosis - aortic valve closure may no longer precede pulmonic valve closure What does SIADH result in? Correct Answers Often Euvolemic hyponatremia What does the ARMA trial say about tidal volume in ARDS? Correct Answers A low tidal volume is best (< 6 mL/kg of ideal body weight) A plateau pressure < 30 is goal what does VDRL test for? Correct Answers syphilis (specifically neuro?) What drug is used as PEP for anthrax? Correct Answers Doxycycline What drugs are people who have transplant on? Correct Answers One from each class: 1. Calcineurin anhibitor (tacrolimus or cyclosporine) 2. Antmetabolite (azathioprine, mycophenolate) 3. Steroid (prednisone) What drugs are used for spasticity in MS? Correct Answers Baclofen, tizanidine, dantrolene What drugs would be given for suspected v tach? Correct Answers Amiodarone or lidocaine What ECG changes are seen in angina? Correct Answers ST depression in stable angina ST elevation in prinzmetals What ECG changes suggest hyperkalemia? Correct Answers Wide QRS and peaked T waves Give calcium gluconate! What finding on EKG suggests hyperkalemia? Correct Answers Tall, peaked T waves What findings are associated with pericarditis? Correct Answers Sharp, pleuritic chest pain that is improved with leaning forward or sitting up, widespread ST Elevation or PR depression and a pericardial friction rub What foods should be recommended for folate deficiency? Correct Answers Bananas, pb, fish, green leafy veggies, iron- fortified foods What foods should you avoid with monoamine oxidase inhibitors? Correct Answers Fermented, aged cheeses, red wine, chocolate What is anti-HBc? Correct Answers Total Hep B core antibody. Appears at onset of infection and persists for life. what is Anti-HBs? Correct Answers Antibody to HBsAg; indicates recovery and immunity to hepatitis B. What is appropriate treatment for metastatic ovarian cancer? Correct Answers Surgical debulking followed by cisplatin or carboplatin plus paclitaxel chemotherapy regimen What is appropriate treatment for newly diagnosed immune thrombocytopenia? Correct Answers Prednisone 1 mg/kg/day What is balanitis? Correct Answers 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 Battle's sign? Correct Answers Bluish discoloration on the area behind the ears (mastoid process). Associated with basilar skull fracture. What is Battle's sign? Correct Answers Bluish discoloration on the area behind the ears (mastoid process). Associated with basilar skull fracture. What is Beck's triad of cardiac tamponade? Correct Answers My Depressed Heart - Muffled heart sounds - Distended neck veins - Hypotension Metastatic cancer puts you at risk What is best course of action of CML? Correct Answers Outpatient imatinib Bone marrow transplant is only cure What is beta thalassemia? Correct Answers - a condition in which the synthesis of the beta-globin chains is decreased or absent. - excess alpha chains - microcytic anemia What is calcitonin? Correct Answers a hormone secreted by the thyroid that has the effect of lowering blood calcium What is calcitriol? Correct Answers 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 cardiogenic shock? Correct Answers pump failure Decreased CO and SVO2 but everything else is high! What is chronic prostatitis? Correct Answers 3 months of dysuria with the same bacterial strain on repeated cultures What is CLL? Correct Answers 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 closed acute angle glaucoma? Correct Answers Symptoms: unilateral headache, worst of lives, ciliary flush, photophobia and nausea. Refer to optho immediately as it could lead to blindness. What is covered by Medicare B? Correct Answers 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 covered in Medicare A? Correct Answers Hospital, SNF, home care services and hospice What is critical thinking in nursing practice? Correct Answers Patient driven, purposeful, outcome-focused thought based on both knowledge and experience What is Cullen's sign? Correct Answers It is the presence of superficial edema and bruising around the umbilicus - it is suggestive of acute pancreatitis or an intraabdominal bleed. What is Cushing's syndrome? Correct Answers Elevated cortisol in the blood 🔜 elevated glucose 🔜 higher insulin needs 🔜 risk for DM and CVD What is Cushing's triad? Correct Answers 1. Widening pulse pressure What is ginger used for and what should you watch for? Correct Answers Nausea, dyspepsia, constipation, colic INCREASED RISK OF BLEEDING What is gingko Biloba used for and what should you watch for? Correct Answers Memory and concentration, claudication and glaucoma INCREASED RISK OF BLEEDING, increased blood pressure What is ginseng used for and what should you watch for? Correct Answers Increase overall well-being, Lower cholesterol, reduce fatigue, enhance libido INCREASED RISK OF BLEEDING, mania with MAOIs, May inhibit opioids What is Goodpasture's syndrome? Correct Answers 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 HBeAg, and what does it indicate? Correct Answers It indicates that the virus is replicating and the person is contagious What is HBsAg, and what does it indicate? Correct Answers 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 Ipecac? Correct Answers It is a substance that induces vomiting (usually prolonged). What is kava kava used for and what should you watch for? Correct Answers Improve relaxation 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 Legionella pneumonia? Correct Answers Common cause of community acquired PNA. OFTEN COMPLICATED BY GI symptoms. Diagnosis is made by urinary antigen detection, blood or sputum cultures. What is Leininger's theory of nursing? Correct Answers Culture care What is Medicare C? Correct Answers Medicare Advantage - combines A B into one plan What is Medicare D? Correct Answers Limited prescription drug coverage Monthly premium required, only available if you have part A What is metabolic alkalosis? Correct Answers High pH, high HCO3 > 26 usually caused by an excessive loss of metabolic acids (from vomit, suction, diuretics) What is Murphy's sign? Correct Answers - acute pain elicited by palpation of the RUQ during inspiration - SIGNIFYING CHOLECYSTITIS What is Murphy's sign? Correct Answers acute pain and inspiratory arrest elicited by palpation of the RUQ during inspiration (indicative of acute cholecystitis) What is mycoplasma pneumonia? Correct Answers -*Common in younger people, atypical* -RX: Z pack Walking pneumonia What is Nightingale's theory of nursing Correct Answers Based on creating a restorative environment Fresh air, light, nutrition, cleanliness, warmth What is normal aortic valve diameter vs. severe aortic stenosis? Correct Answers 3-4 cm^2 is normal. Less than 1 is severe. What is normal calcium level? Correct Answers 8.5-10.5 mg/dL What is normal calcium levels (total and ionized)? Correct Answers Total: 8.5-10.5 mg/dL Ionized: 4.5-5.5 mg/dL What is normal CI? Correct Answers 2.5-4 What is normal CO? Correct Answers 4-8 L/min pelvic girdle lasting more than 4 weeks. Often accompanied by systemic symptoms in individuals between 70-80 years old. LOW DOSE PREDNISONE. What is prepatellar bursitis? Correct Answers "Carpet layer knee." Bursa enlarged from constant irritation. NO EFFUSION. What is Ranson's criteria? Correct Answers Determines severity of acute pancreatitis. Includes evaluation of: George - greater than 55 years old WA - WBCs > 200 Got - glucose > 200 Lazy - LDH > 350 After - AST > 250 He - Hct drop of > 10 Broke - BUN increase > 5 C - calcium < 8 A - arterial O2 < 60 B - base deficit > 4 E - estimated fluid sequestration What is reactive arthritis? Correct Answers 1) Previously known as Reiter's Syndrome 2) inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis, uveitis), urethritis 3) most commonly a post-infectious complication after acute gastroenteritis or colitis What is reactive arthritis? Correct Answers 1) Previously known as Reiter's Syndrome 2) inflammatory arthritis of large joints, inflammation of eyes (conjunctivitis, uveitis), urethritis 3) most commonly a post-infectious complication after acute gastroenteritis or colitis What is recommended to treat tumor lysis syndrome? Correct Answers IV rasburicase, which is used to reduce uric acid level What is Roger's theory of nursing? Correct Answers Individual is seen as an energy field existing within the universe What is Rovsing's sign? Correct Answers RLQ pain upon palpation of LLQ SIGNIFYING APPENDICITIS What is second degree heart block? Correct Answers 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 seen in autonomic dysreflexia? Correct Answers Low HR INCREASED BP What is septic shock? Correct Answers sepsis and persisting hypotension REQUIRING VASOPRESSORS What is serotonin syndrome? Correct Answers increased heart rate, sweating, dilated pupils, tremors, twitching, hyper reflexes, hyperthermia, agitation, confusion, disorientation, hallucinations Rare and life-threatening event caused by serotonergic drugs What is SIADH? Correct Answers Syndrome of inappropriate antidiuretic hormone. Increased ADH = inappropriate water retention = increased serum osm = low sodium in blood but high sodium in urine What is spasticity? Correct Answers 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 St. John's wort used for and what should you watch for? Correct Answers Depression, anxiety, sleep disorders, BPH INCREASED RISK OF CLOTTING, many drug interactions, may increase efficacy of opioids What is status epilepticus? Correct Answers May be life threatening) Seizure more then 10 minutes long, repetitive without periods of consciousness This may lead to - Hypoxia, trauma, hyperthermia, hypoglycemia, aspiration, dehydration. What is steathorrhea? Correct Answers Loose greasy stools found in chronic pancreatitis What is thalassemia? Correct Answers a form of inherited autosomal recessive blood disorder characterized by abnormal formation of hemoglobin. Treatment: Can't confirm this unless BS is checked 0200-0400 and on awakening (if both are high, then add or increase nighttime insulin What is the DESC model of conflict resolution? Correct Answers D describe the situation E express concerns S suggest alternatives C state the consequences What is the diagnosis and treatment for a "strawberry cervix" with green-grey discharge? Correct Answers Trichimonas vaginitis. Use metronidazole. What is the difference in etiology between endocarditis and pericarditis? Correct Answers 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 physical signs between endo and pericarditis? Correct Answers Peri: pericardial friction rub Endo: maybe murmur, oslers nodes on fingers, Janeway lesions on palms, Roth spots on retina What is the difference in symptoms between endo and pericarditis? Correct Answers Peri: pain worsened with deep breathing, relieved by sitting forward Endo: fever, malaise, night sweats, weight loss, generalized sick feeling What is the first line drug of choice for HTN? Correct Answers Thiazide diuretics like hydrochlorothiazide and chlorthalidone Increase secretion of sodium and water WATCH FOR: low K, Mg, Na, and high glucose and calcium What is the hallmark of ALL? Correct Answers pancytopenia with circulating blasts Tumor lysis syndrome is more common (caused by chemo, resulting in increased potassium, uric acid, phosphorus, decreased calcium) What is the hallmark of CLL? Correct Answers lymphocytosis What is the hallmark of CML? Correct Answers Philadelphia chromosome What is the JNC recommended BP for adults over the age of 60 without comorbidities? Correct Answers < 150/90 What is the JNC recommended BP for adults younger than 60 without comorbidities? Correct Answers < 140/90 What is the leading cause of blindness in the elderly? Correct Answers age-related macular degeneration What is the LEEN process? Correct Answers Listen empathize explain negotiate What is the management of hypokalemia? Correct Answers - PO replace if > 2.5 and no ECG changes - IV replacement at 10 mEq/hr if can't take PO - if < 2.5 or severe symptoms, may give 40/L/hr What is the MOA of Ipratropium (Atrovent)? Correct Answers Selectively blocks the muscarinic receptors, leading to a localized anticholinergic response What is the most common bacterial STI in the US? Correct Answers Chlamydia What is the most common cancer in men in the US? Correct Answers Prostate What is the most common cancer in women in the US? Correct Answers Breast What is the most common cause of acute scrotal pain in adults? Correct Answers epididymitis and testicular torsion What is the most common cause of acute scrotal pain in adults? Correct Answers epididymitis and testicular torsion What is the most common cause of ARDS? Correct Answers sepsis What is the most common cause of bloody diarrhea? Correct Answers E. coli What is the most common cause of hypertrophic cardiomyopathy? Correct Answers Genetic mutation What is the most common cause of intrinsic renal failure? Correct Answers Ischemic injury (then nephrotoxins) What is the S3 heart sound? Correct Answers S3 is "Ken-tuck- y" - the sound associated with increased fluid states (CHF and pregnancy) What is the S4 heart sound? Correct Answers S4 is "Ten-ne- ssee" - the sound associated with a stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension) What is the Somogyi effect? And what is the treatment? Correct Answers - 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 Stark Law? Correct Answers It is illegal to refer a medicare or medicaid patient to a designated health care service for which the referring doctor or a member of their immediate family have a financial relationship (ownership, compensation agreement). What is the strongest and lowest evidence in the hierarchy? Correct Answers Expert opinion is lowest Meta-analysis is highest What is the student's t-test? Correct Answers - used to compare the means of a value for 2 different groups - continuous data - can be 1-tailed or 2-tailed What is the symptoms of bacterial vaginosis? Correct Answers Fishy smelling discharge that is watery and gray What is the treatment for active, chronic Hep B? Correct Answers Tenofovir or entecavir What is the treatment for atypical PNA? Correct Answers A macrolide like clarithromycin What is the treatment for cardiogenic shock? Correct Answers Aspirin and IV fluids. NO NITRO IF LOW BP What is the treatment for chlamydia? Correct Answers Azithromycin What is the treatment for cholecystitis? Correct Answers Pain management, NPO, IVF, broad spectrum antibiotics, surgical consult for lap chole What is the treatment for diverticulitis? Correct Answers Broad spectrum antibiotic like metronidazole ciprofloxacin What is the treatment for gonorrhea? Correct Answers ceftriaxone 250 mg IM once + azithromycin 1 g PO once (to cover chlamydia) What is the treatment for h. Pylori? Correct Answers 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 What is the treatment for hepatitis C? Correct Answers Tenofovir or entecavir What is the treatment for hypercalcemia? Correct Answers Underlying cause. Normal saline with furosemide if Ca > 12 (is emergency). In malignancy, bisphosphonates are safe and effective. Calcitonin. What is the treatment for hyperkalemia? Correct Answers - Kayexalate - insulin 10 units with one amp D50 What is the treatment for HYPERnatremia? Correct Answers 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 treatment for infective endocarditis from a prosthetic valve? Correct Answers Ampicillin/Sulbactam and gentamicin plus rifampin What is the treatment for ITP? Correct Answers steroids IV gamma globulin node. Ventricles partially depolarize early, making a delta wave on EKG (a slow rise in the initial QRS). May lead to recurrent entry and supraventricular tachycardia. What is: mild dyspnea, low grade fevers, night sweats, muscle and joint pain, chronic cough, rash on lower extremities and now in arms Correct Answers Sarcoidosis - good prognosis with spontaneous remission What joint deformity is found in Rheumatoid arthritis? Correct Answers Swan neck deformity of the fingers and boutonniere deformity of the thumb What joint deformity is found in Rheumatoid arthritis? Correct Answers Swan neck deformity of the fingers and boutonniere deformity of the thumb What lab monitoring is required for people on amiodarone? Correct Answers TFTs, LFTs, PFTs (thyroid, liver, lungs) What lab values are associated with lithium? Correct Answers Hyponatremia Hypothyroidism Hyperglycemia Hypercalcemia What lab would confirm the diagnosis of RA? Correct Answers Anti-cyclic citrullinated peptide antibodies (anti-CCP) What lab/diagnostics are seen in endo vs pericarditis? Correct Answers Peri: ST elevation , depression of PR Endo: left shift of bands What labs are associated with lithium use? Correct Answers Low sodium Hypothyroidism High calcium High glucose What labs are associated with metabolic acidosis? Correct Answers Low pH Low bicarbonate (HCO3) Seen in diarrhea and DKA What labs are seen with iron deficiency? Correct Answers Low everything EXCEPT HIGH TIBC What labs do you check for von Willebrands disease? Correct Answers CBC, aPTT, Pt, risocetin cofactor assay and vWF Ag assay, factor VIII:C activity What labs do you see in anemia of chronic disease? Correct Answers MCV and MCHC normal Low serum iron and low TIBC High ferritin What labs would you see in DIC? Correct Answers Plts < 150,000 Fibrinogen < 170,000 Prolonged PT/PTT What legislation allowed NPs to be recognized Medicare providers in all geographical areas with their own provider number? Correct Answers Balanced budget act What lung findings are consistent with asbestosis? Correct Answers Pleural plaques, pleural effusions, reticulonodular infiltrates What makes an experiment study? Correct Answers Randomization and control group What medications cause changes in taste or smell? Correct Answers Levodopa, metformin, allopurinol, ACE inhibitors, anticholinergics, anhistamines, CCBs, aldactone, propranolol What medications often cause esophageal irritation or "pill esophagitis"? Correct Answers Tetracyclines (antibiotics ie doxycycline), NSAIDs, potassium chloride, iron, quinidine, alendronate What medications often cause esophageal irritation or "pill esophagitis"? Correct Answers Tetracyclines (antibiotics ie doxycycline), NSAIDs, potassium chloride, iron, quinidine, alendronate What meds should be given in a carcinoid crisis? Correct Answers Octreotide and glucocorticoids What murmur is heard with a mitral valve prolapse? Correct Answers Late systolic murmur What side effects should you expect with bupropion? Correct Answers Insomnia, agitation, QT prolongation What sign would you expect with mesenteric infarct? Correct Answers Pain our If proportion to physical exam findings What signs might you see in pancreatitis? Correct Answers If hemorrhagic: - grey turners sign: flank discoloration - Cullen's sign: umbilical discoloration What signs on ECG suggest hypokalemia? Correct Answers Decreased amplitude, broad T waves, prominent U waves, PVCs, v-tach, or v fib What symptoms and monitoring indices are consistent with cardiac tamponade? Correct Answers - Diastolic equalization of right atrial, pulmonary artery diastolic and PAWP - distant heart sounds, pulsus paradoxus, distended jugular veins What symptoms are seen in folic acid deficiency? Correct Answers Glossitis (but also in pernicious anemia) No neuro signs!! What test is used to diagnosis myasthenia gravis? Correct Answers Tension test What test would you use to diagnosis syphilis? Correct Answers A VDRL/RPR (CSF would be neurosyphilis with greater than 20 WBCs) What type of pleural effusion is associated with criteria? Correct Answers Exudative What volume is normal in the pericardial sac? Correct Answers 50 ml What will the serum BUN/Cr ration be in the different kidney failure? Correct Answers Prerenal: > 10:1 Intrarenal: 10:1 Postrenal: 10:1 What will the specific gravity be in the different causes of renal failure? Correct Answers Prerenal: > 1.015 (high) Intrarenal: < 1.015 (low) Postrenal: < 1.015 (low) What will urine sodium be in the different kidney diseases? Correct Answers Prerenal: < 20 Intrarenal: > 40 Postrenal: > 40 What would you see on blood smear with ETOH and homeless? Correct Answers Hypersegmented PMNs What would you see on labs for active Hep A infection vs recovered infection? Correct Answers Active: anti-HAV + IgM Recovered: anti-HAV + IgG What would you see on labs for active Hep B infection? Correct Answers HBsAg, HBeAg (indicating high viral load, that person is infectious), anti-HBc, IgM What would you see on labs for chronic Hep B infection? Correct Answers HBsAg, Anti-HBe, anti-HBc, IgM, IgG What would you see on labs for recovered Hep B infection? Correct Answers Anti-HBc, Anti-HBsAg When can Pap smear be discontinued? Correct Answers Age > 65-70 with three consecutive normal tests and no abnormal tests in last 10 years When initiating clopidogrel, what should you watch for? Correct Answers TTP (thrombocytopenic purpura): 1. Thrombocytopenia 2. Microangiopathic hemolytic anemia 3. Neuro changes 4. Renal function abnormalities 5. Fever Diagnosis: peripheral blood smear When is hospitalization recommended for asthma? Correct Answers If initial FEV1 < 30% of predicted When is lung cancer screening recommended? Correct Answers annual screening with low-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 When should you check lipid panel? Correct Answers Starting at age 20 and every 5 years unless > 200 mg/dL When should you consider a G tube? Correct Answers If supplemental feeding is needed > 6 weeks When should you have baseline ECG in place? Correct Answers Age 40 When should you prescribe antibiotics for bites? Correct Answers 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. When should you use synchronized vs unsynchronized fibrillation? Correct Answers Use unsynchronized when the person is in v tach or v fib. If you use it with a fib, you could cause v fib. When widened QRS and peaked T waves indicate hyperkalemia, what is the treatment? Correct Answers Calcium When would you give methynaltrexone? Correct Answers For opioid induces constipation When would you treat a pregnant woman or hypertension? Correct Answers If DBP > 100 or evidence of end organ damage. Most women can reduce or stop their antihypertensives during the second or third trimester. Where would you see EKG changed in a lateral MI? Correct Answers 1 and aVL Where would you see EKG changes in an anterior MI? Correct Answers V leads, or V3 and V4 Where would you see EKG changes in an inferior MI? Correct Answers II, III, aVF Which antibiotics are safe for UTI during pregnancy? Correct Answers Penicillins, including amoxicillin, ampicillin. Nitrofurantoin Cephalosporins, including cefaclor, cephalexin. 7-10 day course Which artery is associated with 80% of all inferior MIs? Correct Answers Right coronary artery Which beta blocker is cardioselective? Correct Answers Atenolol Which BP meds are contraindicated in pregnancy? Correct Answers ACE and ARBs Which drug has the greatest sensitivity/specificity for CA- MRSA? Correct Answers Trimethoprim/sulfamethoxazole (Bactrim) Which electrolyte should be given in DKA? Correct Answers Potassium, unless K > 5.5 Which electrolyte should be given in DKA? Correct Answers Potassium, unless K > 5.5 Which hypoglycemic agent should be avoided in hear failure? Correct Answers TZDs Which infection is most likely to affect the cervix, endometrial lining, Fallopian tubes, and pelvic cavity? Correct Answers Chlamydia Which infection is most likely to affect the cervix, endometrial lining, Fallopian tubes, and pelvic cavity? Correct Answers Chlamydia Which ion is primarily responsible for rapid depolarization if the cardiac myocyte? Correct Answers Sodium Which lab is often positive in SLE? Correct Answers Antinuclear antibody Which medication is most commonly associated with hypoglycemia? Correct Answers Glyburide Which medication used to treat afib can cause torsades de pointes? Correct Answers Sotalol Which selective immunoglobulin deficiency has a high risk of reaction to receiving blood products? Correct Answers IgA Which treatment decreased morbidity and mortality in COPD? Correct Answers Oxygen