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NR576 STUDY GUIDE 2026
COMPREHENSIVE ANSWER DIGEST
◉Identify at least three examples of flow disorders (intra and/or extra thorax). Answer: Intrathorax flow disorders: originate from obstruction of distal/smaller airways
- asthma
- bronchiolitis
- vascular ring
- solid foreign body aspiration
- lymph node enlargement pressure
- These types of disorders cause expiratory effort in infants and also in children less than 5 years of age (bronchiolitis)
- Extrathorax flow disorders: originate from obstruction of the larger airways
- rhinitis with nasal obstruction, nasal polyp
- cranio-facial malformation
- obstructive sleep apnea
- tonsil-adenoid hypertrophy
- laryngo-tracheo-malacia
- larynx papilloma
- Diphtheria
- croup, epiglottitis
- thymus hypertrophy
- Infants or children ages 5 and younger are affected, and they have clinical findings of inspiratory stridor ◉Identify at least three examples of volume disorders (intra and/or extra thorax). Answer: - Intrathorax volume disorders include lung parenchyma disorders
- pneumonia (infection, aspiration)
- atelectasis
- pulmonary edema
- near drowning
- These disorders affect inspiratory effort
- Extrapulmonary volume disorders
- pneumothorax, pneumomediastinum
- cardiomegaly, heart failure (perfusion)
- pleural effusion (including empyema, hematothorax)
- anemia
- metabolic acidosis
- CNS infections: meningitis, encephalitis
- encephalopathy (typhoid, DHF, metabolic)
- psychologic (anxiety, usually adolescent)
- poisoning (salycylate, alcohol)
- trauma capitis
- CNS disease sequelae
- These disorders cause deep rapid breathing ◉Discuss diagnosis for asthma. Answer: Essential elements to consider- HX- cough (especially nocturnal), recurrent wheeze, recurrent episodic dyspnea, recurrent chest tightness Symptoms worsen in relation to specific factors- changes in weather, exercise, environmental allergens, GERD, Beta blockers, sensitivity to ASA, strong emotional expression To establish the diagnosis of asthma, episodic symptoms of airflow obstruction must be present, airflow obstruction must be at least partially reversible, and must rule out other diagnoses. Spirometry measurements are helpful in diagnosis & in evaluation of management
The diagnosis is made by demonstrating the reversibility of the airway obstruction from the pre- and post- PFTs. Reversibility is defined as a 15% or greater increase in the FEV after 2 puffs of a beta-adrenergic agonist have been inhaled. When spirometry is non-diagnostic, bronchial provocation testing maybe useful with histamine, methacholine, or exercise. ◉Discuss risk factors and for asthma. Answer: Risk Factors Family or personal history- allergic rhinitis, eczema/atopic diseases Residing in urban area Exposure to smoke or air pollution Cockroaches and dust Viral respiratory infections Cold air intolerance obesity ◉Discuss diagnosis treatments for asthma. Answer: *Short acting bronchodilator (albuterol) is a mainstay of treatment for ALL asthma patients
Mild Persistent Symptoms > 2 times per week, but not daily; OR 3- 4 times per month at nighttime Moderate Persistent Daily symptoms OR >1 night per week but not nightly Severe persistent Symptoms throughout the day; often 7 nights per week ◉Describe appropriate tests in the work up for dyspnea. Answer: - CXR: rule out tumors, TB, pneumonia, and other major pulmonary disorders
- CBC with differential: rule out anemia and infection
- Peak expiratory flow test (in office): to determine the degree of expiratory airflow obstruction in patients with asthma and COPD
- EKG, Echo
- Spirometry: to determine obstructive, restrictive and mixed lung disease ◉Discuss clinical findings and PFTs for asthma. Answer: o Subjective: c/o breathlessness, unable to talk, short sentences, profuse sweating, c/o air hunger. In patients who are severely obstructed, there may be no wheezing and only cough may be present. Wheezing, persistent and recurrent cough, difficulty breathing, tightness in chest, endurance problems during exercise. Symptoms are usually worse at night.
o Objective: Nasal discharge, mucosal swelling, frontal tenderness, nasal polyps, and allergic "shiners" (dark discoloration beneath both eyes). Allergic rhinitis and eczema often accompany the dx of asthma.
- Asthma PFTs o Mild intermittent asthma- FEV1: >80%, PFT >20% o Mild persistent asthma- FEV1: >80%, PFT 20%-30% o Moderate persistent asthma- FEV1: 60%-80%, PFT >30% o Severe persistent asthma- <60%, PFT >30% ◉Discuss clinical findings and PFTs for chronic bronchitis, emphysema, and COPD. Answer: o Subjective: frequent colds, persistent morning cough, upper respiratory infections, dyspnea, fatigue, SOB. Hemoptysis, loss of appetite, nausea, dizziness. Sleep sitting up on >3 pillows to relieve dyspnea. Paroxysmal nocturnal dyspnea. o Objective: In emphysema, hyperinflation of chest, flattening of diaphragm, tachypnea, use of accessory muscles of respiration, end expiratory wheezes may be heard on forced expiration. Coarse crackles during acute exacerbation.
- Chronic Bronchitis (chronic productive cough) o more common form of COPD
◉Identify the population most commonly affected by bacterial prostatitis. Answer: o Acute - Sexually active men 30 to 50 years
- Chronic bacterial prostatitis common in men older than 50 years old
- Athletes who run long distance are predisposed
- Complaints of fever, chills, LBP, malaise, arthralgia, myalgia, frequency, urgency, dysuria, nocturia, and bladder outlet obstruction o Chronic bacterial prostatitis- men over age 50 years of age. Symptoms often absent , perineal pain, lower abdomen pain, scrotal or penile pain, pain with ejaculation, dysuria, irritative voiding ◉Discuss the physical exam characteristics of acute bacterial prostatitis. Answer: Abdominal exam to detect distended bladder, costovertebral angle tenderness, genital exam, and digital rectal exam Acute bacterial prostatitis- warm, tense, swollen , boggy and very tender prostate. Most common pathogen Strep faecalis and staph aureus ◉Discuss how the Phren sign can differentiate between testicular torsion and epididymitis. Answer: Epididymis characteristic is relief
of discomfort with elevation of testis. Positive Prehn's sign = pain relief. Testicular torsion elevation of the affected testicle does NOT relieve the pain (Negative Prehn's sign = pain is NOT relieved) Epididymis Positive Prehn's sign = pain relief. Neg = no pain relief = testicular torsion). ◉Discuss common symptoms reported from a patient with BPH. Answer: Affects men age 40 years and older. Obstructive symptoms include
- Decreased stream • Hesitancy
- Postvoid dribbling • Sensation of incomplete bladder emptying
- Overflow incontinence • Inability to voluntarily stop the urine stream
- Urinary retention • Straining Irritative symptoms include
- Nocturia • Urinary frequency
- Urinary urgency • Dysuria Urge incontinence
◉Identify the population most affected by testicular cancer. Answer: Males between the ages of 15 and 35 ◉Explain spinal stenosis. Answer: Narrowing of the spinal canal w/ compression of nerve roots
- Congenital or acquired (age)
- Most commonly from enlarging osteophytes at the facet joints, hypertrophy of the ligamentum flavum and protrusion/buldging of the intervertebral discs
- May produce symptoms by directly pushing on nerve or interrupting the blood supply to nerve Common source of chronic low back pain, seen most with aging. All older people have some degree of this ◉Discuss common characteristics (subjective findings) of patients with lumbar spinal stenosis. Answer: - Radicular complaints in calves, buttocks, upper thighs
- Pain w/ walking or prolonged standing o Vascular claudication - pain stops w/ rest o Psuedoclaudication - pain doesn't stop immediately at rest
- Short term relief by leaning forward/stooping
- Sometimes relief w/ sitting
- Pain in back/leg when sleeping on back at night
- Pain w/ walking/standing ◉8. Discuss common characteristics (objective findings) of patients with lumbar spinal stenosis. Answer: - Muscle weakness
- Impaired proprioception
- Diminished reflexes
- Sensory changes (numbness/tingling)
- Bowel or bladder symptoms o Sphincter tone decreased o Don't confuse w/ prostate problems in older men ◉Identify the red flags associated with back and neck complaints which warrant further investigation. Answer: T-Trauma U-Unexplained weight loss N-Neurologic symptoms A-Age> F-Fever I-Iv Drug user S-steroid use H-Hx of CA (prostate, renal, breat, lung)
◉DeQuervain's Tenosynovitis. Answer: - Inflammation involving the synovial sheaths and tendons of the abductor pollicis longus and extensor pollicis longus, and brevis tendons (snuff box)
- Pain at base of thumb or at the radial styloid process on abduction and extension of the thumb or on radial side of wrist with lifting
- Generally seen in patients that perform pinch-grip activities like using hand tools, sewing, assembly
- More often middle-aged women ◉DeQuervain's Tenosynovitis-Exam. Answer: o Allen's test o Phalen's test (negative) o Tinel's sign (negative) o Confirmed by Finkelstein's test (grasp the thumb in the palm while you deviate the wrist to the ulnar side) o Xray only if history of trauma ◉DeQuervain's Tenosynovitis-treatment. Answer: o Rest, splinting for 3-6 weeks o NSAIDS o Injected corticosteroids o Tendon release surgery.
◉Carpal Tunnel Syndrome:. Answer: - Peripheral nerve compression of the medial nerve
- Caused by repetitive flexion and extension of the wrist or direct compression of medial nerve
- Pain and/or numbness are usual presenting symptoms o Burning, tingling, or itching numbness of the hand and fingers, especially the thumb, middle, and index fingers
- Most often dominant hand - may be bilateral
- Pain increases with wrist flexion or extension
- Paresthesia and numbness along thumb, index, long and radial half of ring fingers
- Nighttime wakening of N/T in affected limb
- Positive Phalen's test, Positive Tinel's sign ◉Carpal Tunnel syndrome diagnostics. Answer: o Median nerve conduction velocity study most useful o xray if limited wrist movement only ◉Carpal Tunnel Treatment. Answer: o Rest, splinting o NSAIDS, NO CORTICOSTEROIDS o Vitamin B6, and management of concurrent diseases o Often resolves after pregnancy if symptoms related
◉Discuss how acute low back pain without neurological dysfunction does not warrant radiological imaging. Answer: Acute back pain may have several differential diagnoses. If pain isn't found to be related to any neurological complaints, radiological imaging is not warranted. ◉Identify the roles of TSH. Answer: Pituitary "messenger" to thyroid to increase or decrease thyroid hormone production. used to diagnose hypothyroidism. TSH and FT4 should be used to follow treatment. If the TSH is low or insufficiently elevated in the presence of low T4, central hypothyroidism caused by hypothalamic or pituitary disease should be excluded before starting replacement therapy. ◉Identify the CDC recommended antibiotic class for treatment of acute bacterial prostatitis. Answer: Flouroquinolones (Ciprofloxacin, levofloxacin, ofloxacin, or norfloxacin) Alternatives to a fluoroquinolone include Doxycycline 100 mg Q 12 hours; and TMP-SMX [160 mg/800 mg] (Bactrim DS) one tab Q 12 hours ◉Identify at least one treatment for BPH. Answer: - Medication (conservative):
- Alpha Blockers (Terazosin, Tamsulosin)
- 5 - alpha Reductase Inhibitors (finasteride, dutasteride)
- Surgical
- TURP (transurethral resection of the prostate) ◉Identify treatment options for obesity based on BMI and comorbid conditions. Answer: Overweight BMI: 25-29.9kg/m Obesity BMI: 30-40 kg/m Severe (morbid) obesity BMI: >40kg/m Treatment options: lifestyle changes (diet, exercise- 45 - 60 minutes/day), managing behavior (i.e. H.A.L.T. - hungry, angry, lonely, tired, behavior modification), reduce caloric intake, drugs (i.e. fenfluramine/Fen Phen, dexfenfluramine/Redux, phentermine, diethylopropion, orlistat). Surgical intervention (vertical-banded (mason) gastroplasty and roux-en-Y bypass) for BMI over 40 OR over 35 with comorbities A structured weight loss diet is most effective. Encourage formal programs or weight loss groups (WW, etc.). Diet goals should include a program with
