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NR511 Midterm Diff Diagnosis Exam-
Graded A
The ability of a test to correctly identify those who do not have the disease
of true negatives divided by total # of people who do not have the disease - ANS-
specificity ability of a test to correctly identify pt has disease true positives divided by # of people who have disease - ANS-sensitivity pain, tingling, stabbing, unilateral vesicular rash along dermatome - ANS-herpes zoster how is herpes zoster diagosed? - ANS-history and physical, PCR assay white macules or patches usually on sun exposed areas, premature graying of hair - ANS-vitiligo what labs are done for vitiligo? - ANS-cbc, peripheral smear (detect pernicious anemia), thyroids, ANA mask of pregnancy hyperpigmentation of face during pregnancy - ANS-cholasma (melasma) how is cholasma diagnosed? - ANS-wood's lamp examination diffuse, generazlied, hyperpigmentation, especially on skin creased d/t increased adrenocorticotropic hormon - ANS-addison's disease what labs are done to detect addison's disease? - ANS-NA, K, cortisol, ACTH level, ca, CBC, TSH, B12, RH factor what are the characteristics of malignant melanoma? - ANS-asymmetrical, irregular borders, color changes, diameter >6mm, evolving, raised health teaching for those with pruritus - ANS-short, tepid showers, no baths, no scratching, cool compresses, emollients what is "soak and smear" and what does it help with? - ANS-soak skin for 20 mins and apply ointment to wet skin to prevent pruritus
What is urticaria? First line treatment class and drugs? Prevention/teaching? - ANS-hives/wheals 2nd gen nonsedating H1 antihistamines- loratadine, fexofenadine cool temps, no hot showers, avoid tight clothes topical treatment for urticaria? - ANS-pramoxine 1-2mm red papules interdigital web staples, wrists, axillary folds, and periumbilical? - ANS-scabies what does an intraepidermal burrow from scabies look like? - ANS-white with black specks linear how is an intraepidermal burrow from scabies diagnosed? - ANS-burrow ink test- mark with ink, ink will go into tunnel how is scabies diagnosed? - ANS-place drop of mineral oil, scrape off with blade, place on slide, look under microscope treatment and teaching for scabies - ANS-wash all clothes and bedding in hot water and detergent scabicide lotions antihistamines and topical steroids for pruritus example of scabicides lotion - ANS-permethrin and malathion lotion red, small, erythematous, macules or papules, pruritus worse at night, mostly scalp - ANS-pediculosis (lice) how is pediculosis diagnosed? - ANS-wood light exam, magnifying glass Treatment of pediculosis first line second line - ANS-Topical insecticides are effective such as permethrin, pyrethrins, and malathion are considered first line Lindaine and ivermectin are second line petroleum jelly or other occlusive substances can be used to suffocate lice. Reapplication in 7-10 days recommended to kill any newly hatched lice. what is the prevention/education for pediculosis - ANS-avoid sharing clothes/hats, use special combs to remove nits, pt and family to be treated, itching will continue after tx due to inflammation differential diagnosis for scabies (5) - ANS-dermatitis
Wide, diffused, erythematous, warm, tender to touch rash with severe edema and fever, chills and malaise. Diagnose.... - ANS-cellulitis causes of folliculitis - ANS-friction, gram + bacteria, immunocompromised, poor hygeine, exposure to chemicals Pt presents with yellow/white tender pustules surrounded by erythema, on different areas of the scalp, denies itching. diagnose... - ANS-folliculitis Patient presents with a bump on the upper back, upon assessment, there is a cheesy, white, malodorous discharge. Pt states it has been there for 4 months now. Diagnose - ANS-epidermal inclusion cyst Numerous hypertrophic scars and sinus tracts found on the axillae with extremely tender and inflamed skin d/t chronic apocrine glands disease - ANS-hidradenitis suppurativa Extremely tender, bright red in color, location in groin, developed over several days, pus draining from center diagnose. - ANS-furuncle multiple boils, develops into large erythematous lump that drains from multiple openings, can be hyperpigmented - ANS-carbuncle Treatment of carbuncles and furuncles - ANS-mupirocin topical, heals spontaneously in 2 weeks, warm compresses differential diagnoses of swollen axillary lymph nodes - ANS-impetigo lymphadenopathy folliculitis contagious, red, rash on face and extremities, turns into vesicles with yellow crusts Diagnose - ANS-impetigo contagious, red, rash on face and extremities, turns into vesicles with yellow crusts Diagnose - ANS-impetigo Nonpharmacological Treatment for impetigo - ANS-NS, or plain tap water, or burrow solution for 10-20 mins 4 times a day will help debride crusts so lesions can dry out bump present for months, asymptomatic unless on plantar region, no skin lines crossing surface, centrally located capillaries that bleeding with paring, dome shaped, gray brown hyperkeratotic masses with black dots
diagnose. - ANS-wart What are the three systemic antivirals used to treat genital herpes? - ANS-famcyclovir, valcyclovir, acyclovir in dermatitis ________ occurs before ________ - ANS-itchiness before rash The ability of a test to correctly identify those who do not have the disease
of true negatives divided by total # of people who do not have the disease - ANS-
specificity ability of a test to correctly identify pt has disease true positives divided by # of people who have disease - ANS-sensitivity pain, tingling, stabbing, unilateral vesicular rash along dermatome - ANS-herpes zoster how is herpes zoster diagosed? - ANS-history and physical, PCR assay white macules or patches usually on sun exposed areas, premature graying of hair - ANS-vitiligo what labs are done for vitiligo? - ANS-cbc, peripheral smear (detect pernicious anemia), thyroids, ANA mask of pregnancy hyperpigmentation of face during pregnancy - ANS-cholasma (melasma) how is cholasma diagnosed? - ANS-wood's lamp examination diffuse, generazlied, hyperpigmentation, especially on skin creased d/t increased adrenocorticotropic hormon - ANS-addison's disease what labs are done to detect addison's disease? - ANS-NA, K, cortisol, ACTH level, ca, CBC, TSH, B12, RH factor what are the characteristics of malignant melanoma? - ANS-asymmetrical, irregular borders, color changes, diameter >6mm, evolving, raised health teaching for those with pruritus - ANS-short, tepid showers, no baths, no scratching, cool compresses, emollients what is "soak and smear" and what does it help with? - ANS-soak skin for 20 mins and apply ointment to wet skin to prevent pruritus What is urticaria?
insect bites liver disease folliculitis What treatment is used for scabies - ANS-scabicide lotion and ivermectin systemic antiparasitic Difference between pediculosis and dandruff? - ANS-dandruff slides off hair shaft easily and does not originate on hair shaf 3 risk factors for developing fungal skin infection - ANS-hot, moist areas, immunocompromised pts, pts on abx Treatment of oral candidiasis (thrush) (3) - ANS-clotrimazole troches (dossolve), miconazole buccal tabs, nystatin swish and swallow White vaginal discharge (cottage cheese), burning, itching, dysuria - ANS-vaginal candidiasis Sexually active male with small erythematous eroded patches tender to touch, rash, and itching of glans penis - ANS-balanitis An obese female with red, itchy, weepy rash with maceration in the perianal, groin and interdigital areas - ANS-intertriginous candidiasis treatment of intertriginous candidiasis? - ANS-nystatin powder a male who works as a dishwasher in Olive Garden presents with a painful abscess on the 1st finger of the right hand which looks red, hot, swollen? what is it? - ANS-candidal paronychia what is the treatment and prevention of candidal paronychia? - ANS-incision and drainage warm compresses A female bartender presents with yellow fingernails for months. She denies any pain or itching at site. What is the diagnosis - ANS-subungual candida what is the treatment of onychomycosis? 2 class and examples of drugs - ANS-topical antifungals- terbinafine, nystatin, miconazole, ciclopirox Wide, diffused, erythematous, warm, tender to touch rash with severe edema and fever, chills and malaise.
Diagnose.... - ANS-cellulitis causes of folliculitis - ANS-friction, gram + bacteria, immunocompromised, poor hygeine, exposure to chemicals Pt presents with yellow/white tender pustules surrounded by erythema, on different areas of the scalp, denies itching. diagnose... - ANS-folliculitis Patient presents with a bump on the upper back, upon assessment, there is a cheesy, white, malodorous discharge. Pt states it has been there for 4 months now. Diagnose - ANS-epidermal inclusion cyst Numerous hypertrophic scars and sinus tracts found on the axillae with extremely tender and inflamed skin d/t chronic apocrine glands disease - ANS-hidradenitis suppurativa Extremely tender, bright red in color, location in groin, developed over several days, pus draining from center diagnose. - ANS-furuncle multiple boils, develops into large erythematous lump that drains from multiple openings, can be hyperpigmented - ANS-carbuncle Treatment of carbuncles and furuncles - ANS-mupirocin topical, heals spontaneously in 2 weeks, warm compresses differential diagnoses of swollen axillary lymph nodes - ANS-impetigo lymphadenopathy folliculitis contagious, red, rash on face and extremities, turns into vesicles with yellow crusts Diagnose - ANS-impetigo contagious, red, rash on face and extremities, turns into vesicles with yellow crusts Diagnose - ANS-impetigo Nonpharmacological Treatment for impetigo - ANS-NS, or plain tap water, or burrow solution for 10-20 mins 4 times a day will help debride crusts so lesions can dry out bump present for months, asymptomatic unless on plantar region, no skin lines crossing surface, centrally located capillaries that bleeding with paring, dome shaped, gray brown hyperkeratotic masses with black dots diagnose. - ANS-wart
PO contraceptives used to treat acne can interact with ____________ - ANS-antibiotics- tetracyclines marigold and tea tree oil topically is used to treat ________ - ANS-acne Benign subcutaneous fat tumors that are round, soft & mobile, made of adipose tissue - ANS-lipoma Differentiate between bacterial, allergic and viral conjunctivitis. - ANS-bacterial- purulent drainage allergic- stringy, mucoid viral- clear, watery purulent, thick drainage from eyes, crusty eyelids, sandy, gritty feeling, normal eyesight, photophobia Diagnose? - ANS-Bacterial conjunctivitis Stringy mucoid discharge, itching, burning, concurrent w/ rhinorrhea, and sneezing Diagnose. - ANS-allergic conjunctivitis watery, clear discharge from eyes, enlarged preauricular lymph nodes, upper respiratory infection, highly contagious Diagnose. How is it diagnosed? - ANS-Vital conjunctivitis Rapid adenovirus test if available Which eye disorder is this? redness around iris (peri-limbis), wbc floaters, percipitates on endothelium on wood's lamp exam, visual acuity may be affected, photophobia, poor light reflex - ANS-iritis Which eye disorder includes mid-dilated, nonreactive or sluggish pupils, nausea, vomiting, headache, decreased visual acuity, increased intraoccular pressure? - ANS- acute glaucoma Which eye disorder is this? Scaling, erythema, edema at eyelids, crust in eyelash follicles w/ pustules that may bleed - ANS-blepharitis Treatment of staph blepharitis, and ulcerative blepharitis first line and second like - ANS-1st : bacitracin or erythromycin ointment 2: quinolone or sulfacetamine +corticosteroid What is the difference between a hordeolum and chalazion - ANS-hordeolum- painful chalazion- painless, nystagmus and distortion of vision
non pharm treatment of hordelum and chalazion - ANS-warm compresses, gentle massage, gentle scrubs w/ baby shampoo, no eye makeup/lenses What is are the characteristics and management of a dry eye? - ANS-gritty, irritation, loss of glossy cornea, blurred vision refer if blurred vision burning itching of eyes, associated w/ Sjogren's syndrome, can lead to blindness d/t keratinization of cornea and conjunctiva - ANS-keratoconjunctivitis sicca (KCS) treatment of dry eye - ANS-Artificial tears and ointment Artificial tear sacs NS drops Antiinflammatory and immunomodulatory agents- corticosteroids, cyclosporine Individuals at risk for epiphoria - ANS-(excessive tearing) elderly allergies lacrimal obstruction excessive tx of dry eye bells palsy Which eye disorder is this? Painless, gradual, progressive loss of vision, reduced vision when unaffected eye covered, age related, glare when driving at night - ANS-cataracts How is cataracts diagnosed? - ANS-The Lens Opacities Classification system III, Catquest-9SF questionnaire and visual functioning index- What eye disorder is this? "missing portions of words", decrease in peripheral vision, poor night vision, slow increase in intraocular pressure overtime d/t blocking of aqueous humor fluid - ANS- open angle glaucoma Diagnosis of open angle glaucoma - ANS-Measurement of intraocular pressure, visual field testing, visual acuity, dilated eye exam which eye disorder is this?Increased cup size to optic nerve ratio, thinning of disc rim, presence of disc hemorrhages, defects in visual fields - ANS-open angle glaucoma Characteristics and treatment of acute otitis media - ANS-bulging, red tympanic membrane, diminished hearing, inflammed eustachian tube Tx- amoxicillin/clavulanate PCN allergy- doxycycline or levofloxacin
what is the results of the rinne test for sensorineural hearing loss? conductive - ANS-air >bone air=bone or air Antibiotic choice for group A beta hemolytic streptococcal pharyngitis? 1st line, kids? allergies to PCN? - ANS-1st line - penicillin 250mg TID or 500mg *10d BID, amoxicillin for children allergies to PCN- erythromycin PO *10d, azithromycin for children Differential diagnosis for pharyngitis in presence of swollen lymph nodes? (5) - ANS- infectious mononucleosis bacterial pharyngitis tonsilitis HIV herpes Differential diagnoses for sinusitis (5) - ANS-rhinitis wegener's granulomatosis sarcoidosis migraines dental abscess What is trismus? - ANS-locked jaw , restricted ROM of jaw trismus, drooling, dysphagia, unilateral ear pain, ipsilateral throat pain, progression of strep throat, requires tonsillectomy or drainage is known as what? refer or treat? - ANS-peritonsillar abscess refer to ED to maintain airway What does Medicare Part A cover? - ANS--Pays for hospital -deductible $1,316 per year What does Medicare Part B cover? - ANS-provider and outpatient services deductible $183 per year What is the purpose of Medicare Advantage Plans? - ANS-additional benefits + medicare benefits with lower co payments and costs Impetigo occurs in which age groups - ANS-children/infants if a diagnostic study has a high __________, then a high percentage of healthy individuals will show a normal result - ANS-specificity highly _________ tests will lead to positive findings for patients with a disease - ANS- sensitive What is medicare Part A? Part B?
Patients with bacterial conjunctivitis should refrain from work/school until.... - ANS-24h after abx tx or clinical improvement : decrease in redness and discharge Treatment of bacterial conjunctivitis - ANS--mycin ointments, or ciprofloxacin drops treatment for viral conjunctivitis ophthalmic solution and PO antivirals - ANS-pyrimidine acyclovir chalazion lasts >4 weeks without any improve... what should you do? - ANS-refer to ophth for I/D, bx and glucocorticoid injections What is the slit-lamp exam + a Schirmer test used to diagnose? - ANS-dry eye Schirmer test quantifies lacrimal secretions Corticosteroid eye drops and anesthetic drops should or should not be used for epiphoria? - ANS-should not bright red blood in sharply defined area of eye surrounded by normal appearing conjunctiva indicates? - ANS-subconjunctival hemorrhage rash on forehead with eye swelling, redness, pain, fever, tingling of skin, allodynia, cloudy or clear cornea, tx with antiviral acyclovir - ANS-Herpes Zoster ophthalmicus criteria for sinusitis diagnosis - ANS-upper resp infection for at least 7d, presence of 2 or more symptoms ; colored nasal discharge, poor response to decongestants, facial pain aggravated by postural change, headache 2 types of meds that can relieve pressure from barotrauma - ANS-nasal steroids or oral decongestants acoustic reflectometry, tympanometry, acoustic reflex measurement are used to detect?
- ANS-middle ear fluid in patients with tinnitus foods to avoid that can decrease tinnitus - ANS-chocolate, alcohol, smoking, salt, caffeine pt has persistent sore throat, fever, malaise and has not response to tx, what tests should be performed? - ANS-infectious mono and streptococcal abx sensitivity then monospot test severe throat pain, difficulty swallowing, copious oral secretions, stridor, fever, no pharyngeal erythema or cough - ANS-epiglottitis
what 3 tests should be performed when pharyngitis is suspected? - ANS-monospot, strept rapid, throat cx differential diagnosis of hoarseness? - ANS-papillomatosisWhat is the atopic triad? - ANS-atopic dermatitis, allergic rhinitis, asthma red rash, itchy, stinging of face, burning, on forehead, cheeks, nose and chin - ANS- rosacea location of atopic dermatitis in infants and older children - ANS-Infants and young children - cheeks and diaper area Older children - flexural surfaces Treatment for rosacea first line... how long does it take to reach therapeutic response? 2nd line... - ANS-topical metronidazole cream takes up to 6-8 weeks for therapeutic response 2nd line- PO abx- tetracycline, doxycycline patient teaching for rosacea - ANS-avoid sun, avoid heat, shorter exercise periods with longer cool down periods, protect face from cool air noncancerious skin growths in elderly causing itching and irritation from friction raised, scaly, hyperpigmented, brown-gray, stuck on - ANS-seborrheic keratosis Risk factors for seborrheic keratosis - ANS-elderly, light skinned, sun exposure, inherited differential diagnoses for seborrheic keratosis - ANS-melanoma, basal cell carcinoma, benign pigmented nevi scaly, dry, rough patch, sandpaper like, in sun exposed areas diagnose. - ANS-actinic keratosis Topical treatment for actinic keratosis - ANS-fluorouracil cream, or imiquimod cream Painless, slow growing, non healing bleeds easily, crusting, elevated papules, waxy appearance - ANS-basal cell carcinoma and squamous cell carcinoma Treatment of acne vulgaris- mild, mod, severe - ANS-mild- first line - benzoyl peroxide moderate - oral abx - for those at risk for scarring, nodules, want quick relief--- clindamycin, erythromycin severe- isotretinoin , hormonal therapy
non pharm treatment of hordelum and chalazion - ANS-warm compresses, gentle massage, gentle scrubs w/ baby shampoo, no eye makeup/lenses What is are the characteristics and management of a dry eye? - ANS-gritty, irritation, loss of glossy cornea, blurred vision refer if blurred vision burning itching of eyes, associated w/ Sjogren's syndrome, can lead to blindness d/t keratinization of cornea and conjunctiva - ANS-keratoconjunctivitis sicca (KCS) treatment of dry eye - ANS-Artificial tears and ointment Artificial tear sacs NS drops Antiinflammatory and immunomodulatory agents- corticosteroids, cyclosporine Individuals at risk for epiphoria - ANS-(excessive tearing) elderly allergies lacrimal obstruction excessive tx of dry eye bells palsy Which eye disorder is this? Painless, gradual, progressive loss of vision, reduced vision when unaffected eye covered, age related, glare when driving at night - ANS-cataracts How is cataracts diagnosed? - ANS-The Lens Opacities Classification system III, Catquest-9SF questionnaire and visual functioning index- What eye disorder is this? "missing portions of words", decrease in peripheral vision, poor night vision, slow increase in intraocular pressure overtime d/t blocking of aqueous humor fluid - ANS- open angle glaucoma Diagnosis of open angle glaucoma - ANS-Measurement of intraocular pressure, visual field testing, visual acuity, dilated eye exam which eye disorder is this?Increased cup size to optic nerve ratio, thinning of disc rim, presence of disc hemorrhages, defects in visual fields - ANS-open angle glaucoma Characteristics and treatment of acute otitis media - ANS-bulging, red tympanic membrane, diminished hearing, inflammed eustachian tube Tx- amoxicillin/clavulanate PCN allergy- doxycycline or levofloxacin
Treatment of chronic otitis media - ANS-refer to ENT, aural toileting, systemic abx Follow up of pt with acute otitis media - ANS-f/u in 48-72h if not resolved, f/u after completing abx, f/u 4-6 weeks after tx, monthly otoscopic exams Which ear disorder results in no infection, air bubbles behind tympanic membrane, no redness, conductive hearing loss? - ANS-otitis media w/ effusion Which ear disorder is this? Mastoiditis, inflammation of tympanic membrane, discharge, pain when pinna pulled up or when pressing tragus - ANS-acute otitis externa treatment of acute otitis externa - ANS-abx + steroids: Ciprofloxacin/ Dexamethasone, Ciprofloxacin/ Hydrocortisone Which ear disorder results in retracted tympanic membrane, and fluid in eustachian tube? - ANS-eustachian tube dysfunction diagnose. Noncancerous growth behind tympanic membrane, granulation tissue, crust, foul smelling drainage - ANS-cholesteatoma what are the differential diagnoses of hoarseness? - ANS-cancer, vocal cord paralysis, viral laryngitis, smoke inhalation characteristics of mononucleosis? - ANS-POSTERIOR CERVICAL LYMPH SWELLING, fever, sore throat, nuchal stiffness, hepatosplenomegaly spread through saliva and epstein barr virus teaching for patients with mononucleosis - ANS-do not play contact sports or activities d/t risk of splenic rupture how is mononucleosis diagnosed - ANS-monospot test what are the tests used for hearing assessment? - ANS-audiometry- tone and speech impedance- mid ear pressure Weber and rinne- hearing loss what is the result of the weber test for sensorineural hearing loss? conductive hearing loss? - ANS--sound is heard louder on unaffected side -sound is heard louder on affected side what is the result of a normal rinne test? - ANS-sound is heard twice as long through air than bone
