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NR667 Chamberlain CEA Week 8 Exit Exam Test Questions with Answers
- Blood Flow Lungs ® Pulmonary Veins ® Left
Atrium ® Aorta ® Body Tissues ® Vena Cava ® Right Atrium ® Right Ventricle ® Pulmonary Arteries ® Lungs
- Symptoms with right vs left side heart blockage · Blockage on the left side of the
heart backs up and causes lung symptoms · Blockage on the right side of the heart backs up and causes body symptoms (peripheral edema)
- HNC8 HTN Guidelines Defined as 140/
Treatment algorithm: Less than 60 years old - 140/ > 60 years old - Defined as 150/ (more leniency b/c we do not want to drop their BP too low)
- What hypertension medication should someone ACE or ARB (protects kidneys)
with DM and/or CKD be on?
- What HTN medication should an African Ameri-
can pt be on?
- What HTN medications should be used in pa-
tients with heart failure?
CCB
Carvediolol and Thiazide diuretics
- Common side effects from ACE inhibitors cough, angioedema
- What HTN medication is contraindicated if an
ACE inhibitor caused angioedema?
ARB
NR667 Chamberlain CEA Week 8 Exit Exam Test Questions with Answers
- What HTN medication should a heart failure pt
NEVER be on?
CCB
(These cause the heart to "relax" which is not good in HF pts)
- 2 types of CCBs Dihydropyridines & Non-dihy-
dropyridines
- What are dihydropyridine CCBs used for? BP control
- Example of a dihydropyridine CCB and side ef-
fects Amlodipine Bradycardic side ettects, peripheral edema, constipation
- What are non-dihydropyridine CCBs used for? arrhythmias
- Example of a non-dihydropyridine CCB and side cardizem
effects
- The atria (top chambers of the heart) work on
which electrolytes?
- The ventricles (bottom chambers of the heart)
work on which electrolytes?
- Conditions in the atria needs medications that
work on K+ or Ca such as ..
- Conditions in the ventricles needs medications
that work on K+ or Na such as .. Tachycardic side ettects/palpita- tions - these meds were peripher- ally and have a rebound tachycar- dia K+ (potassium) and Ca (calcium) Na (sodium) and K+ (potassium) Cardizem (CCB) or Amiodarone (potassium channel blocker) Amiodarone (potassium channel blocker)
Which structural heart condition can cause syn- cope or near-syncope?
- Which structural heart condition cause a harsh, high-pitches sound that can be heard in the neck or on the right side of the chest near the 2nd intercostal space? Aortic regurgitation/insuflciency
- Which structural heart condition is very loud and Mitral regurgitation/insuflciency can be heard on the lower left side of the chest?
- What are the 2 most common places for a AAA? infra-renal and ascending aorta
- Which aortic aneurysm requires surgery right away? Stanford A (ascending)
- Which aortic aneurysm is often treated medical- Stanford B (descending) ly or with a possible graft (but does not often need surgery)?
- What is a medical intervention that should be done for a patient with a Stanford B aneurysm?
- What class medication should NEVER be given to a patient with an aneurysm or any sort of connective tissue disorder?
- What are the 4 fat-soluble vitamins? (stay in the body for a long time)
- What percentage of pulmonary emboli or DVTs are provoked? Keep BP low flouroquinolones (end in "floxicin") ADEK 70%
- at least 3 months
How long should a patient with a provoked PE or DVT be treated with an anticoagulant?
- How long should a patient with a non-provoked at least 3 months, but could be life- PE or DVT be treated with an anticoagulant? long if any recurrence
- What is the Virchow's triad? 3 broad categories of factors that are thought to contribute to throm- bosis
- What are things that could contribute to a pro- voked PE or DVT?
- What are the 3 things that make up the Vir- chow's triad?
- What testing should be done first to look for peripheral artery disease? Anesthesia, immobility, pregnancy, hypercoagulable state, DVT, cancer, hormone replacement Venous stasis Hypercoagulability Endothelial injury ankle-brachial index (BP will be lower on the ankles vs arms)
- What test will confirm a diagnosis of PAD? angiography
- Symptoms of PAD pale, waxy, hairless legs pain with ambulation that improves with cessation of ambulation
- Treatment for PAD stents of bypass of vessels Anti-platelet medications Statins for lipid management Lifestyle modifications and man- agement of co-morbidities (dia- betes)
"I See All Leads" II, III, & eVF: Inferior V1 & V2: Septal V3 & V4: Anterior V5 & V6: Lateral
- What procedure is commonly done for A-fib pa- Ablation tients?
- When ordering imaging studies, when is con- trast needed?
- What are the 5 traits of metabolic syndrome? (Need to have 3 for a diagnosis) When looking for anything vascular
- Male waist >40in or female waist > 35 in
- HTN: BP >130/
- Trigylcerides >
- Serum HDL < 40 in males or < 50 in females
- Hyperglycemia: fasting glucose > 100
- What is the BP goal for patients with diabetes? 130/80 (to protect the kidneys)
- What condition causes a blood sugar > (600-1200), hyperosmolality, and often causes neuro impairment? Hyperglycemia Hyperosmolar State (HHS)
- What A1C reading indicates diabetes? 6.5% or greater
- When a patient has diabetes, what should their A1C be to be considered "well controlled"?
- What should the A1C be before adding a second 8.0% medication?
- What is the first-line treatment (medication) for a patient with Type 2 diabetes? Biguanides (Metformin)
- Which diabetic medication class is often used as Sulfonylureas (glupizide, gly- a 2nd line treatment but causes hypoglyccemia? buride, glimepiride)
- What class of diabetic medication is contra-indi- GLP- 1 cated with a personal or family history of thyroid carcinoma?
- Which class of diabetic medications cause glu- cose to be excreted through the bladder and has a side effect of frequent UTIs and yeast infec- tions? SGLT2 inhibitors (end in "gliflozin")
- What insulin is long acting? Lantus (20- 24 + hours)
- S/S of hypothyroidism fatigue, diflculty losing weight, constipation, cold intolerance, menorrhagia, coarse nails, brittle hair, delayed relaxation phase of DTRs, hypothermia, goiter
- What will labs look like for hypothyroidism? Elevated TSH and decreased T
- Treatment of hypothyroidism Levothyroxine
- Therapeutic/starting doses of levothyroxine Therapeutic is typically 1mcg/kg/day Start low (25-50mcg) and increase as needed
- 6 - 8 weeks
- Primary and secondary adrenal insufficiency Primary: impairment of the adrenal glands, 80% autoimmune, can be infectious cause or adenoma Secondary: cause by lack of ACTH production in the pituitary gland, abrupt withdrawal of glucocorti- coids
- S/S of adrenal insufficiency (Addison's) fatigue, weight loss, hypotensive, hypoglycemia, muscle weakness, nausea, vomiting, abd pain, tan- ning of skin, and salt craving in pri- mary AI *cold, hypotensive, and often stop making urine
- Treatment glucocorticoids & mineralocorti- coids (for primary AI) Glucocorticoids only (for sec- ondary AI)
- S/S of Cushing's syndrome thin skin, muscle atrophy and weakness, uncontrolled HTN, ab- dominial obesity, striae, rounded face
- What is the primary test used to diagnose Cush- 24 hours urine free cortisol ing's syndrome (excess of cortisol)?
- diabetes insipidus (DI) Inadequate arginine vasopressin secretion or inadequate renal re- sponse
- s/s of diabetes insipidus Excessive thirst and urination
- Diagnostic workup for diabetes insipidus 24 - hour testing of:
- urine osmolality (concentrated urine)
- creatinine
- fluid intake (>70mL/kg)
- urine specific gravity (<1.005 / low)
- urine glucose (negative) Water deprivation test
- to ditterentiate between cental and nephogenic Consider MRI of brain
- SIADH Overproduction of antidiuretic hor- mone (ADH, aka vasopressin)
- SIADH symptoms Impaired water excretion (retain- ing water), - in return water will exceed urine output and cause low sodium (hyponatremia)
- Social determinants of health (per health People economic status 2030 - the 5 overarching domains): education access and quality health care access and quality neighborhood and built environ- ment social and community context
- Palliative Care Made for comfort - Not end of life care
- proof that the defendant's breach caused the injury
- assault the intentional act of making some fear that you will cause them harm
- battery The intentional act of causing phys- ical harm to someone
- What is an adverse effect of long-term use of a PPI? osteoporosis and vit B12 deficiency
- Barrett's esophagus - Metaplastic columnar epithelium replacing stratified squamous ep- ithelium
- develops due to chronic GERD
- increased risk of cancer
- Causes and signs of an upper GI bleed Causes: peptic ulcer, esophageal varices, Mallory-Weiss tears S/S: dark, cottee ground emesis or stool
- Management of H. Pylori Triple - Quad therapy:
- 2 antibiotics: clarithromycin, amoxicillin, metronidazole (Flagyl), tetracyclines
- PPI
- Sometimes Bismuth is added
- Is H. Pylori grain + or Gram - bacteria? Gram -
- Gram + bacteria
Staphylococci Streptococci Enterococci
- Gram - bacteria - E. coli
- Klebsiella - Proteus - Haemophilus influenzae - Pseudomonas aeruginosa
- Microcytic anemia (types) iron deficiency, thalassemias, lead poisoning
- What do labs look like with Iron deficiency ane- mia? Low ferritin and increase TIBC
- Normocytic anemia (types) Acute blood loss, Anemia of chronic disease
- Macrocytic anemia (types) B12 deficiency Folate deficiency Pernicious anemia
- Aplastic anemia can present as what type of ane- Normo or macrocytic (get a bone mia?
- MCV (mean corpuscular volume), MCH, and RDW marrow biopsy) MCV - size of blood cells MCH - color/redness RDW - red cell distribution - If el- evated, there are immature RBCs. The RDW elevates with almost all anemias expect thalassemia
- What meds are used C. Diff? Flagyl or Vanco PO
Surface = right now antigen - active infection/sick
- Hepatitis C testing HCV (+) doesn't indicate whether its acute of chronic If viral copies are present, virus is acute
- if AST:ALT ratio is 2:1 what may this indicate alcoholic liver damage/alcohol abuse
- S/S of diverticulitis - Constant LLQ pain present for sev- eral days
- fever, n/v, (possible constipation or diarrhea) - Rebound tenderness, positive Rovsing's sign, board-like ab- domen
- Crohn's Disease vs Ulcerative Colitis Crohn's - mouth to anus UC - only in the colon
- Treatment of acute flair of irritable bowel dis- eases steroids
- Chronic management of irritable bowel disease 5 - ASA
- What is an adverse affect of Zofran? prolonged QT wave
- What should an H2 blocker be taken? before meals (spiciest meal)
- S/S of macular degeneration Gradual or sudden, painless loss of central vision
- S/S of acute angle closure glaucoma painful, injected eye with halos around light May have n/v Elevated eye pressure *True ophthalmologic emergency
- S/S of open angle glaucoma Progressive peripheral visual field loss, then central vision loss "Cupping" is noted on fundoscopic exam
- S/S of detached retina flashing lights, floaters, shadowy peripheral vision, gray curtain over part of view
- What is chronic inflammation of the meibomian Chalazion gland that is painless and described as a "bead" in the eyelid
- What is an abscessed hair follicle and/or seba- ceous gland with an acute onset of edematous, erythematous, and warm abscess on the upper or lower eyelid? Hordeolum (stye)
- Treatment of chalazion warm compresses (antibiotics are NOT indicated)
- treament of hordeolum (Stye) hot/warm compresses 2 - 3 x per day Empiric antibiotics for preseptal cellulitis Possible refer to ophthalmologist for I&D
- Mononucleosis often causes adenopathy in which chains? posterior cervical
- What reaction is common penicillins are given to Rash someone with Mono?
- What can be caused by untreated periodontal abscesses? bacterial endocarditis
- First-line treatment of periodontal abscess Augmentin
- Retropharyngeal abscess life-threatening infection in the lat- eral pharyngeal space that has the potential to occlude the airway *ENT emergency
- Treatment of retropharyngeal abscess IV ceftriaxone or clindamycin
- What are the 4 D's of epiglottitis? Dysphagia Dysphonia Drooling Distress
- How is epiglotitis treated? Ceftrioxone Oxygen therapy Possible intubation/surgery
- Lymph nodes are known as "trash cans" of the body
- Lymphoma s/s night sweats, unexplained weight loss, drenching sweats
- When treating lymphoma, what is often caused? pleural ettusion or tumor lysis syn- drome
- Osteoarthritis is often: unilateral
- Rheumatoid arthritis is often: bilateral
- How is Rhematoid Arthritis diagnosed? rheumatoid factor (RF)
- treatment of rheumatoid arthritis Steroids: early and extremis DMARDs: chronic management
- systemic lupus erythematosus s/s butterfly rash, joint pain, fatigue
- Treatment of lupus Hydroxychloroquine, NSAIDs, im- munosuppressants, DMARDs, cor- ticosteroids Belimumab Sunlight, diet and exercise, avoid- ance of stress, smoking cessation
- Treatment of Multiple Sclerosis (MS) Monoclonal antibodies for chronic managment Steroids for acute flares
- myasthnia gravis (MG) Chronic autoimmune disor- der in which antibodies de- stroy nerve/muscle communica- tion, causing chronic long-term muscle weakness
- Guillain-barre Acute bacterial or viral infection triggers demyelination ascending vs descending may be fatal if respiratory muscles attected
