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NR511 Midterm Exam Study Guide
General Study Tips and Recommendations
✓ Topics and content on guides are intended to focus student attention
when reading/studying and some topics may be repeated in multiple
chapters.
✓ Multiple test items are derived from the same topic areas to encourage
deeper comprehension.
✓ Students must have a broad understanding of content and not simply
memorize passages in textbooks or articles.
✓ Information contained in the chapters as well as boxes and table within the
chapters may
include test items.
✓ Exam questions represent various levels of cognitive learning. You are
expected to analyze, synthesis, and evaluate patient scenarios in order
to answer the questions.
✓ Students are expected to use clinical decision making to prioritize treatment
actions based on
the information provided in the exam question.
✓ Read all of the answers BEFORE reading the stem of the question. This will
help you focus on the key content and not get distracted by extraneous
information. Once you have selected your answer, read the question one
more time to ensure that the best answer has been chosen.
✓ Utilize your time well by not rushing. You will have plenty of time to read each
question for
understanding before you select your final answer.
Chapter 4 The Art and Diagnosis of Treatment
- Disease specificity (true positives) and sensitivity (true negatives)- all see course module These are statistical measures of a diagnostic test’s ability to correctly identify those with the disease, while specificity refers to correctly identifying those without the disease. High sensitivity is crucial for screening tests to ensure cases aren’t missed, whereas high specify is vital for confirmatory tests to aboid false positives.
- Clinical reasoning process: o Purpose of differential diagnoses: developing a differential diagnosis involves listing potential conditions that could explain a patients
- Systematic literature reviews: these are comprehensive summaries of all relevant studies on a particular clinical question. They use systematic methods to collect, collect, critically appraise, and synthesize findings, providing high level evidence to inform practice.
Chapter 10 Infectious and Inflammatory Neurological Disorders
- Rubella (German measles): rubella is a contagious viral infection characterized by distinctive red rash. While often mild in children, it can have serious consequences in pregnant women, potentially leading to congenital rubella syndrome in the fetus.
Chapter 11 Common Skin Complaints
- Telogen effluvium: A temporary form of hair loss that typically occurs after stress, illness, or hormonal changes, leading to hair shedding
- Management of intensely dry skin: involves regular moisturizing with emollients, avoiding harsh soaps, using humidifiers to maintain skin hydration.
- Management of urticarial: commonly treated with antihistamines to reduce
itching and swelling. Identifying and avoiding triggers is also crucial.
Chapter 12 Parasitic Skin Infections
- Scabies-symptoms; differential diagnosis: scabies presents with intense itching and a pimple like skin rash caused by mites burrowing into the skin. Differential diagnoses include eczema, contact dermatitis, and other pruritic conditions.
- Systemic treatment for scabies: oral ivermectin is an option, especially in cases unresponsive to topical treatments or in institutional outbreaks
- Lice treatment: involves topical pediculicides like permethrin and meticulous combing to remove nits.
- Dermatitis herpetiformis: a chronic intensely itchy skin condition associated with celiac disease, characterized by blistering skin eruptions.
- Pediculosis corporis: infestation of the body with lice, leading to itching and rash. Treatment includes improved hygiene and laundering of clothing and bedding.
- Determining the scope of the patient assessment: depends on the presenting complaint, patient history, and clinical judgement to decide between a focused or comprehensive assessment.
- Characteristics of cellulitis: a bacterial skin infection marked by redness, swelling, warmth, and pain, typically affecting the lower legs.
- Causes and characteristics of folliculitis: inflammation of hair follicles, often due to bacterial infection, presenting as small, red bumps or pustules.
- Diagnosing a cyst: based on clinical examination; may require imaging or biopsy if the diagnosis is uncertain.
- Hidradenitis suppurativa and Furuncle: hidradenitis supportive is a chronic skin condition causing abscesses and scarring, while a furuncle (boil) is an acute, painful nodule resulting from a staph infection.
- Differential diagnosis of swollen lymph nodes under the arm: includes infections, malignancies,
and autoimmune conditions
- Assessment findings for bullous impetigo: characterized by large, fluid- filled blisters, primarily caused by staphylococcus aureus.
- Non-pharmacologic management of impetigo: emphasizes hygiene measures, such as cleaning affected areas and keeping nails trimmed to prevent scratching.
- Patient teaching for a child with impetigo: keep sores covered, wash hands frequently, complete the full course of antibiotics, and avoid sharing personal items to prevent spread.
Chapter 15 Viral Skin infections
- Management of genital herpes: antiviral therapy with acyclovir, valacyclovir, or famciclovir. For initial outbreaks treatment lasts 7-10 days. Suppressive therapy is considered for frequent recurrences or during pregnancy to reduce vertical transmission risk.
- Characteristic of filiform warts: Long, narrow, flesh colored projections commonly found on the face, neck, or eyelids. Caused by HPV they grow rapidly and often require
- Assessment and diagnosis of common skin lesions: requires inspection, palpation, and often dermatoscopy. Docusment size color texture distribution and progression
- Pharmacological management of common skin lesions: acne- retinoids, benzoyl peroxide, oral antibiotics. Psoriasis- corticosteroids, vitamin D biologics. AK- cryotherapy or topical 5-FU
- reatment of acne/acne vulgaris: mild is with topical benzoyl peroxide or retinoids. Moderate is with topical and oral antibiotics. Severe is isotret referral
- Patient teaching when prescribing a topical retinoid for acne vulgaris: use at night and apply to clean dry skin expect initial worsening; full effect in 6-8 weeks. Use sunscreen
- Health teaching for patients with common skin lesions (acne): avoid harsh scrubbing or over- washing, non-comedogenic products only, adherence is key to improvement
- Causes and characteristics of actinic keratosis: caused by sun damage; presents as rough scaly erythematous patches considered precancerous
- Treatment of rosacea: topical metronidazole, azelaic acid, or ivermectin. Oral doxy for moderate-severe cases and avoid triggers such as heat alcohol or spicy foods
- Patient teaching for rosacea: use gentle cleansers and sunscreen keep a symptom diary to identify triggers
- Characteristics of seborrhea keratosis: stuck on appearance, warty or waxy brown-black lesions
- Individuals at risk for seborrhea keratosis: older adults especially with family history
- Differential diagnoses for seborrhea keratosis: melanoma is atypical, warts, AK, pigmented basal cell carcinoma
- Assessment of lipoma: soft mobile, painless sq mass. No treatment unless painful or cosmetically concerning.
- Risk factors for malignant melanoma: fair skin, family history, multiple nevi, blistering sunburns, and tanning bed use.
gritty sensation, and preauricular lymphadenopathy. No antibiotics needed.
- Subconjunctival hemorrhage- causes, diagnosis: caused by trauma, Valsalva, or spontaneous rupture of vessels. Bright red patch in the eye painless. Self-limited; no treatment needed
- Keratitis: inflammation of the cornea; causes include infection, trauma, or contact lens overuse. Presents with eye pain, redness, photophobia, decreased vision. Referral needed.
- Dry eye syndrome: caused by reduced tear production or increased tear evaporation presents with burning, foreign body sensation, eye fatigue. Treated with artificial tears, humidifiers, or cyclosporine drops.
- Treatment protocol for staphylococcal blepharitis: eyelid hygiene with warm compresses and lid scrubs. Consider topical antibiotic ointment if infection is present.
- Diagnosis of hordeolum: also known as a stye. Acute, painful red nodule on eyelif margin. Usually staph related. Warm compresses are first line.
- Individuals at-risk for development of epiphora: excessive tearing. Risk
increases with nasolacrimal duct obstruction, infections, trauma, eyelid malposition, or age- related changes.
Chapter 20 Visual Disturbances and Impaired Vision
- Diabetic retinopathy: caused by chronic hyperglycemia. Presents with blurred vision, floaters or vision loss. Requires annual eye exams. Control blood sugar, bp, and lipids. - Cataracts- symptoms and management: cloudy vision, glare, halos around lights, trouble with night driving. Managed with surgery when vision becomes significantly impaired. - Sudden vision loss and referral to ophthalmologist: sudden painless vision loss requires emergency referral to ophthalmology. Causes include retinal detachment, central retinal artery occlusion, or optic neuritis.
Chapter 21 Common Ear, Nose, and Throat Complaints
- Eustachian tube disorders: ear fullness, popping, hearing loss especially with altitude changes or congestion. Treated with decongestants, nasal steroids,
lymphadenopathy, and splenomegaly. Diagnosed with monospot or EBV titers. Supportive care and no contact sports for 3-4 weeks due to risk of splenic rupture.
Chapter 22: Hearing and Balance Disorders
- Eustachian tube disorders: see above
- Test to confirm middle ear fluid: tympanometry is sued to evaluate middle ear pressure and fluid
- Assessing, diagnosing and managing tinnitus: rule out underlying cause (ototoxic meds, hearing loss, vascular issues) may need refer to audiology. Treat with white noise, CBT or hearinig aids if needed
- Relationship between severe tinnitus and depression: chronic tinnitus can lead to depression, anxiety, and sleep disturbance. Psychosocial support is essential.
- Sensorineural hearing loss- assessment and management: often age related or noise induced. Audiometry confirms diagnosis. Treat with
hearing aids or cochlear implants.
- Differential diagnosis for sensorineural hearing loss: presbycusis, acoustic neuroma, Meniere disease, ototoxicity, and autoimmune disorders.
- Conductive hearing loss- causes and management: cerumen impaction, otitis media, otosclerosis, tympanic membrane perforation.
- General assessment of hearing loss: includes otoscopic exam, hearing screening, and audiometry
- Differential diagnoses for conductive hearing loss: cerumen impaction, foreign body, middle ear fluid, perforated TM, cholesteatoma,
Chapter 23: Inflammatory and Infectious Disorders of the Ear
- Diagnosis and management of acute otitis media: bluding TM, ear pain, decreased hearing. Treat with amoxicillin. Watchful waiting might be considered in older children with mild symptoms.
- Diagnosing sinusitis: symptoms more than 10 days facial pain, purulent drainage, bacterial if worsening after initial impropvement. Treated with amoxicillin-clavulanante.
- Diagnosing Epiglottitis: medical emergency sudden onset sore throat, drooling, muffled voice, tripod position. Do not examine throat refer to ED immediately.
- Diagnosing viral rhinitis: runny nose, congestion, sneezing and mild sore thoat self limiting
- Teaching plan for patient with allergic rhinitis: avoid triggers, daily saline rinses, use intranasal corticosteroids. Antihistamines. Chapter 86: Quality and Value-Based Payment: Making an Economic Impact on Health Care
- Medicare Advantage plans: also called part C. private insurance plans that include part A,B and often D. may offer extra benefits but limit provider
choice.
- Parts of Medicare coverage: A: hospital care, B: outpatient doctor visits, C: medicate advantage, D: prescription drugs.
- Third-party payers: private insurance companies, Medicaid and medicare and employer sponsored plans. They reimburse providers for patient care.
