AANP FNP Certification Exam with complete solution
All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly audible.
... [Show More] IV- first time thrill V-Steth edge VI-entire steth. EXAM - correcy answer-III first time audible, IV first time thrill
Fundal height 12 weeks - correcy answer-Fundal Height 12 weeks above symphysis pubis. EXAM
Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus.
2 cm more of less from # of wk gestation is normal if more or less order US
3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - correcy answer-Iron, TIBC
3 months of synthroid, TSH increased, T4 normal, what do you do? - correcy answer-Increase Medication
3 ways to assess cognitive function in patient with signs/symptoms of memory loss - correcy answer-Mini mental exam
4 month old with strabismus, mom is worried...... - correcy answer-tell her it is normal.
4 month old wont keep anything down, what is the main thing you look at? - correcy answer-Growth chart
6 month old closed anterior fontanel. - correcy answer-XRAY
Abnormal cells on PAP, what do you do next? - correcy answer-Refer for Colposcopy
CAGE ACRONYM - correcy answer-Cut down Annoyed by criticism
Guilty about drinking Eye opener drink
Causes of tachycardia - correcy answer-Fever Anemia
Hypotension
Cranial nerves responsible for extraocular eye movements - correcy answer-CN 3,4,6
Definition of metabolic syndrome - correcy answer-cluster of conditions that increase risk of heart disease, stroke, diabetes.
diagnose trichomoniasis - correcy answer-wet prep
Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - correcy answer-Pelvic US
Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - correcy answer-Anterior septum
Definitive diagnosis of acute bacterial prostatitis - correcy answer-urinalysis and culture
GERD treatment - correcy answer-H2 is first line, give hs Grade 3 cells on Pap, treatment? - correcy answer-LEEP excision
Fingernail hematoma treatment? - correcy answer-drill hole and drain blood?
Increased risk of ectopic pregnancy - correcy answer-Salpingitis, or history of abortion, PID,
Koplick spots - correcy answer-Measles (rubeola). Grains of salt lesions inside mouth in Measles
Koplick spots - correcy answer-Measles (rubeola). Grains of salt lesions inside mouth in Measles
Legg-Calve-Perthes Disease - correcy answer-Avascular necrosis of the proximal femoral head
Lipid level of 1500, increased risk for? - correcy answer-Pancreatitis
Low HGB, Low HCT, High MCV indicates what? - correcy answer- Macrocytic anemia, B12 Def
Man with BPH, prostate feels on digital exam? - correcy answer-Enlarged, symmetrical, smooth
Man with HTN, CAD, present femoral pulses but absent pedal - correcy answer-Arterial Insufficiency
McMurray's Sign
(+) palpable or audible click while extending with varus stress - correcy answer-Meniscus tears
Lachman's Test - correct answer-pivot shift test (ACL tear)
Newborn with foot turned in, what do you do? - correct answer-refer to orthopedist
Osgood-Schlatter disease - correct answer-Knee pain.
inflammation or irritation of the tibia at its point of attachment with the patellar tendon
Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? - correct answer-Alzheimer's
Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - correct answer-Refer to oncologist
Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - correct answer-Tinea Corporis
Pt presents with "bag of worms:, indicates? - correct answer-Varicocele
Pt with atopic dermatitis, look for what other diseases? - correct answer- Asthma
Pt with bleeding after menopause - correct answer-endometrial biopsy, need to screen for cancer
Pt with hx of PID, increased rick for? - correct answer-Infertility
Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? - correct answer-This is good. Want higher than 350
Pt with hx of htn and stroke, now having memory loss. What does this indicate? - correcy answer-Vascular dementia
Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - correcy answer-slap cheek, PVB19, rash hands / feet Fetal death and birth defects
Quick assessment of patients fall risk? Timed Get up and Go - correcy answer-Timed Get up and Go
Red beefy tongue? - correcy answer-pernicious anemia
Rotator cuff injury presentation - correcy answer-disturbs sleep, arm weakness, dull ache
Shingles near eye - correcy answer-immediate referral to ophthalmology
Signs and symptoms of Roseola (6ths disease) ? - correcy answer-Viral infection
Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage
-Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash
-Seizures may occur during this period.
-On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs.
-High fever, pink flat or raised rash
Treatment for chronic alcoholism: - correcy answer-12 step program
Treatment for Gonorrhea? - correcy answer-Rocephin 250mg IMx1 plus
Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM
Report to health department
Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - correcy answer-IUD
Basal cell cancer - correcy answer-Waxy, pearly, telangiectasia, ulcer center lesion
-most common type of skin cancer caused by UV exposure. Metastatic is rare
Actinic Keratosis - correcy answer-Scaly red to yellow located in sun exposed area
-a precancerous skin growth that occurs on sun-damaged skin
Actinic Keratosis - correcy answer-Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area
-a pre squamous cell carcinoma occurs on sun-damaged skin biopsy
cryo or 5fu cream
subungual hematoma tx - correcy answer-Make a hole and drain the blood
Moderate acne treatment - correcy answer-Without inflammation: Topical retinoid
Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered)
PLUS ADD
Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne)
Minocycline- long term use has been linked with pseudotumor cerebri
Oral contraceptives for hormone related
Spironolactone
heart murmur with holosystolic or pan systolic
Heart mumur with mid systolic - correcy answer-MR - radiate axilla, 5th ICS MCL, apex,
AS - radiate neck, 2ICS right sternal border MR ASSH
Coarctation of Aorta - correcy answer-COA: bounding radial and weak femoral pulse
increase blood pressure in arms, and lower pressure in lower legs.
-congenital cardiac condition characterized by a narrowing of the aorta
-
Murmur Grade III - VI - correcy answer-Loud murmur easily heard JVD caused by - correcy answer--tension pneumothorax,
-Rt. sided heart failure,
-cardiac tamponade,
-traumatic axphysia from
Increase in portal pressure(LIVER) in venous side or cor pulmonale
pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - correcy answer-endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles.
Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - correcy answer-PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet,
PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - correcy answer-Smoking cessation Pulmonary rehabilitation
Pharmacologic therapy Supplemental oxygen
TB... PPD is positive if area of induration is: - correcy answer->5 mm in an immunocompromised patient or close contact
>10 mm in immigrant, health care workers, drug user
>15 mm in a patient who lives in an area where TB is very rare.
what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - correcy answer-Croup/Epiglottitis
AV nicking (Arterioles pressing on vein of the eye) - correcy answer-HTN retinopathy
intraocular pressure (IOP) - correcy answer-Fluid pressure inside the eye; measured with tonometry
Rovsing sign - correcy answer-pain in the RLQ when the LLQ is palpated (indicative of appendicitis)
Pencil-like stools occur in an obstruction of what - correcy answer-Sigmoid descending colon
It's a thin narrow stool and possible causes include colon cancer, diarrhea,
IBS. Refer for GI colonoscopy
headache after trauma - correcy answer-SDH
migraine headache - correcy answer--paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries.
4-12 hours,
abortive triptans
prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate
Vitamin B12 - correcy answer-Folate shares a close relationship with this other B Vitamin.
Vitamin B12 - correcy answer-Cognitive deficits, glossitis, pernicious anemia,
Folate shares a close relationship with this other B Vitamin.
88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. - correcy answer-be changed to NSAID, SED rate is a sign of inflammation
Which medication causes low sperm count for a patient - correcy answer- SSRI
grandiosity - correcy answer-Exaggerated belief in or claims about one's importance or identity.
Bipolor
ADHD - correcy answer-A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity.
pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? - correcy answer-HPV test if not done. Refer for colposcopy
Chlamydia trachomatis - correcy answer-Doxycycline (+ ceftriaxone for gonorrhea coinfection)
Genital warts treatment - correcy answer-Cryotherapy OR
Podophyllotoxin cream - OR
Imiquimod (Aldara cream)
HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - correcy answer-tell the pt. that he is qualified to be diagnosed with AIDS according to CDC
Most common cause of death in children - correcy answer-motor vehicle
Tanner 2 - correcy answer-Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker
Tanner 4 - correcy answer-Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum
pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. - correcy answer-vascular dementia
presbycusis - correcy answer-a gradual loss of sensorineural hearing that occurs as the body ages
a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - correcy answer- Ultrasound
Romberg test - correcy answer-cerebellar
-ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed
-expected finding: client should be able to stand with minimal swaying for at least 5 seconds
Direct Coombs test - correcy answer-r/o bilirubin
preeclampsia treatment - correcy answer-bed rest, laying on her side
Molluscum contagiosum treatment - correcy answer-Currettage, liquid nitrogen
pyloric stenosis - correcy answer-non bilious vomiting, olive like firm mass palpated on right upper quadrant
horizontal nystagmus that stops when eye is close to midline in a college student - correcy answer-Ménière's disease ?
Nystagmus test - correcy answer-the involuntary jerking of the eyes as a person gazes to the side
eating, painful lump noted on the jaw that comes and go. - correcy answer- sialolithiasis).
Etopic Pregnancy: Risk Factors - correcy answer-Previous ectopic pregnancy
Prior fallopian tube surgery
Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Pelvic inflammatory disease
Endometriosis
cigarette smoking
age older than 35 years history of infertility
use of assisted reproductive technology, such as in vitro fertilization (IVF)
Which among the list can cause increase in respiration - correcy answer- Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)?
Which among the list can cause increase in respiration - correcy answer- hypercapnia
Osteoporosis Risk Factors (ACCESS) - correcy answer-A-lcohol Use C-orticosteroid Use
C-alcium low E-strogen low
S-moking
S-edentary lifestyle/s
ACCESS leads to OSTEOPOROSIS
to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - correcy answer-VITAMIN D 600-800, CALCIUM 1000-1200.
OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION.
LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH
Carotid bruit - correcy answer-abnormal flow of blood through the carotid artery
Carotid bruit - correcy answer-abnormal flow of blood through the carotid artery due to atherosclerotic disease
Common causes of GERD - correcy answer-risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil
Common causes of GERD - correcy answer-risk factors- alcohol,
anticholinergic, CCB, BB
chocolate peppermint, fatty, spicy, citrus foods, hormones,
obesity, pregnancy, smoking,
theophylline
Zeprexa. What lab and intervention to put in place - correcy answer- CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT
monitor CBC for low WBC weight- BMI q 3m
b/p, mental status, lips, prolactin, glucose
Weber test - correcy answer-Sensorineural loss Weber test(top of head) no laterization, normal finding, does not lateralize to either ear, bilateral hearing loss, if hear better in left ear, right sensorineural loss
Weber test - correcy answer-Sensorineural loss Weber test (top of head) no laterization- normal, does not lateralize to either ear- bilateral hearing loss, if hear better in left ear, right sensorineural loss.
SUN- sensorial lateralize unaffected ear CAFFE- Conductive lateralize to affected ear
Assessment on patient with ascites - correcy answer-Dullness
Assessment on patient with ascites - correcy answer-Dullness to percussion
Varus Stress Test - correcy answer-application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint
LCL
Varus Stress Test - correcy answer-TEST LCL (lateral-vaRus)
McMurrays- Meniscus CLICK
application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint
LCL
German Measles (Rubella) - correcy answer-Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from
measles by presence of neck lymphadenopathy and absence of Koplik spots.
patient with IOP of 32mmHg, what do you expect during fundoscopic exam
- correcy answer-
patient with IOP of 32mmHg, what do you expect during fundoscopic exam
- correcy answer-increase cup-to-disc ratio retinal hemorrhage
optic nerve asymmetry and pallor measured w tonometry
BPH and urge incontinence - correcy answer-anticholinergics/oxybutynin, impamine/tricyclic/antidepressant
Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH
BPH and urge incontinence - correcy answer-TX anticholinergics/oxybutynin,
impamine/tricyclic antidepressant
seasonal affective disorder (SAD) - correcy answer-a mood disorder caused by the body's reaction to low levels of sunlight in the winter months
intussusception - correcy answer-telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE
MASS
intussusception - correcy answer-telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE
MASS CURRENT JELLY STOOL
IBS (irritable bowel syndrome) - correcy answer-An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation.
due to Small intestinal bacterial overgrowth, or SIBO
IBS (irritable bowel syndrome) - correcy answer-SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool.
Caused by: Small intestinal bacterial overgrowth, or SIBO
TX fiber, avoid gas foods, antispasmodics, decrease life stress
Osteoporosis treatment - correcy answer-TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise
Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ
Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth
Statins increase bone mineral density
Osteoporosis treatment - correcy answer-TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE
CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID,
Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ
Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth
BONE DENSITY >2.5
Retinoblastoma - correcy answer-white reflection in child's pupil
for staph aureus infection (skin) with pus - correcy answer-MRSA- TX Bactrim or tetracyclines?
hyperparathyroidism - correcy answer-high calcium
Hyperthyroidism treatment - correcy answer-methimazole, PTU- propylthiouracil (preferred in pregnancy)
Radioactive iodine, Beta blockers
Mammography Screening - correcy answer--Age 45 - 54 yearly mammogram
-55 and older every 2 years
Fifth's Disease (Erythema Infectiosum) - correcy answer-B19: lytic infection, respiratory transmission
Sx: flushed rash/fever in kids Px: fever, get better in a week
pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - correcy answer-TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin.
chlamydia in pregnancy - correcy answer-Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM
papilledema - correcy answer-optic disc swollen w/ blurred edges due to increased ICP EXAM
actinic keratoses - correcy answer-Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM
Allergic Conjunctivitis - correcy answer-"stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner.
COPD - correcy answer-COPD- Gold 1-2- SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM
Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue.
Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA
+ ICS.
Gold 3-4- refer
SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN
CN IX Glossopharyngeal - correcy answer-- Shoulder shrug/ ROMBERG test EXAM
CN V Trigeminal - correcy answer-Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - correcy answer-ears 8 EXAM
CN VII Facial - correcy answer-BELLS EXAM ACEI contraindicated - correcy answer-pregnancy
Safe to give varicella/MMR - correcy answer-Do not give <12 mo. EXAM QUESTION
Acne Vulgaris - correcy answer-common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide.
Acne Rosacea - correcy answer-- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM
Cataracts - correcy answer-is on EXAM in elderly night vision issues. Opaque
Kawasaki disease - correcy answer-- acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM
Erythema migrans - correcy answer-Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM
Rocky Mountain Spotted Fever - correcy answer-Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. EXAM
Addison's - correcy answer-Addison's- deficient in cortisol (think low sodium, blood sugar, but Increase K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM
rheumatoid arthritis - correcy answer-Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM
Osteoarthritis - correcy answer-Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen.
EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM
Osteoporosis - correcy answer-OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM
Fibromyalgia polymyalgia - correcy answer-Fibro- 11/18 points. Widespread pain for at least three months. EXAM. polymyalgia Tx prednisone 12 months. Must taper off. RISK for Temporal arteritis, DX BX, elevated ESR
Serotonin syndrome - correcy answer-Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM
Fundal Height - correcy answer-Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS
Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus.
2 cm more of less from # of wk gestation is normal if more or less order US.
Psoriasis - correcy answer-Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.
(Koebner phenomenon- new psoriatic plaques form over skin trauma) (Auspitz sign- pinpoint bleeding when plaques are removed).
TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic.
D
Dacrocystitis - correcy answer-Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents.
Acne Rosacea - correcy answer-Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM
Parathyroid hormone - correcy answer-PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM
Diabetic Retinopathy - correcy answer-Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED
HTN Retinopathy - correcy answer-Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM
Wilms Tumor - correcy answer-Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM
Primary Amenorrhea - correcy answer-Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics.
Aphthous stomatitis - correcy answer-Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash.
Temporal arteritis - correcy answer-Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids.
Atopic Dermatitis (eczema) - correcy answer-Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy lesions" they become lichenified from itching.
First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM
Tinea Corporis - correcy answer-ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending
Cellulitis - correcy answer-Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS.
Erysipelas - correcy answer-Group A strep, painful, Upper dermis, clear demarcated, cheeks, shins.
TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d.
MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.
Varicella Zoster - correcy answer-"contagious 48 h. before, until all lesions crusted over" low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. "initially on trunk, then scalp and face" TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM
Impetigo - correcy answer-Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM
Scarlet fever- scarlantina - correcy answer-"sandpaper textured-pink rash with sore throat" strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM
Lichen planus - correcy answer-LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES..
WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS.
Causes hep C, medications, contact with chemicals. EXAM
Spider bite - correcy answer-fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam
Pityoris rosea - correcy answer-Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM
Corneal abrasion - correcy answer-Corneal Abrasions- Round/Irregular. Was on EXAM.
Acute Angle Closure Glaucoma - correcy answer-acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM
Conductive - correcy answer-Conductive: Lateralization to bad ear. Rinne- BC > AC.
Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM
Koplik spots - correcy answer-Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM
Sensorineural - correcy answer-Sensorineural: Lateralization to good ear. Rinne- AC > BC.
OME - correcy answer-Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless.
Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM
Presbycusis - correcy answer-sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM
OE - correcy answer-Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM
Sinusitis - correcy answer-TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE
Meiniers disease - correcy answer-VERTIGO TINNITUS, HEARING LOSS. nystagmas
Mono - correcy answer-test heterophile antibody test. ON EXAM
MR. ASS - correcy answer-(Systolic Murmur) Only systolic murmurs will radiate to a location on the exam.
Mitral Regurg - correcy answer-(Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL.
Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb.
All diastolic murmurs are pathological. Grades Murmurs - correcy answer-I- barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM
MVP - correcy answer-MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC.
S3- HF,
S4-LVH stiffening, - correcy answer-S3- HF, Kentucky, early diastole. Abn
>35. Bell EXAM
S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM Isolated Systolic HTN - correcy answer-CCB
PAD/ PVD - correcy answer-PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM
CVI - correcy answer-CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM
blood pressure - correcy answer-BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.
Thiazide diuretics - correcy answer-no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM
Statin - correcy answer-Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM
Pulses paradoxus - correcy answer-Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM
Emphysema - correcy answer-Emphysema Lungs- Percussion- HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM
Acute Bacterial Pneumonia- CXR - correcy answer-middle lobe. ON EXAM
OSA - correcy answer-does not include Microglossia which is an absent tongue congenital. EXAM
TB - correcy answer-fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes.
TPO - correcy answer-TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos.
But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM
hyperthyroid - correcy answer-Hyperthyroid- Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY
RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.
A1C > 9 - correcy answer-If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM
Parathyroid - correcy answer-For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM
cushings - correcy answer-Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec
K. You must draw cortisol levels in the morning.
Fructosamine test - correcy answer-checks sugar for past 2-4 weeks.
triglycerides - correcy answer-causes pancreatitis >500. If >500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM
Pancreatitis - correcy answer-diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring" epigastric pain. Fever, n/v.
EXAM TOPICS
Metformin - correcy answer-Metformin - monitor BUN, Creatinine. contraindicated renal and liver disease
ARF creatinine up and GFR down.
affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea flatulence
CT: hold 24 hr before and 48hr after
Polycythemia vera - correcy answer-slow growing blood cancer. blood too thick, clots. bone marrow to many RBC. risk bleed , anemia, CBC
CCB - correcy answer-BLE edema- walk around
Kava Kava - correcy answer-anxiety and insomnia, don't mix w sedating benzos.
Bipolar med - correcy answer-lithium- monitor TSH, toxicity bind to TH cause hypothyroidism.
Depression med
acute Anxiety/ panic med
GAD med - correcy answer-depression SSRI panic benzo, Xanax, ativan
GAD SSRI
SNRI- Buspar, Effexor, Cymbalta- Taper OFF
SNRI/ Benzo Discontinuation - correcy answer-Buspar, Effexor, Cymbalta and Benzo Taper OFF
Thiazide GLUT- - correcy answer-Glyceridemia Lipidemia
Uricacidemia Triglyceridemia HYPO-Kalemia
ACE/ARB contraindications - correcy answer-pregnancy Renal failure
Renal Stenosis
METABOLIC SYNDROME - correcy answer-METABOLIC SYNDROME NO THIAZIDES,CCB (HF)
NO TZD ACTOS (Pioglitazone)
GIVE Metformin, ACE or ARB- kidney protective, BB- causes hypoglycemia,
Triglyceride < 300 what do we do first?
Triglyceride in 300 plus risk for what do we do? - correcy answer- Lifestyle modification
Pancreatitis, Niacin then add, fenofibrates
Serotonin syndrome ss - correcy answer-hyper rigidity, fever, myoclonus, dilated pupils, AMS, hyper reflexes, from SSRI or mix w MAOI and TCA
NSAID contraindicated in - correcy answer-HF and ARF increase BP impair renal prostaglandin and sodium retention
strabismus - correcy answer-misalignment of eyes, abnormal after 6 months
macular degeneration - correcy answer-loss of central vision retinal detachment - correcy answer-floaters, curtain, flashes
Xanthelasmas - correcy answer-sharply demarcated yellowish deposit of cholesterol underneath the eye
Red reflex absent - correcy answer-retinoblastoma (leukorrhea) , cataracts, glaucoma.
Will have white reflex
Mono, return to play and Dx - correcy answer-4-6 weeks when spleenolmegaly resolves
Mono spot/ Heterophile
Viral stomatitis - correcy answer-ulcer on cheek (Aphthous)- viral canker sore
cholesteatoma - correcy answer-chronic sinusitis or OM. cauliflower, foul- smell, hearing loss.
erodes bones in face affects facial CN 7. Benign- risk hearing loss refer SURGERY Acute Closed Angle Glaucoma
Vs
Open Angle - correcy answer-Acute: Sudden pain, halos, cupping, dilated, cloudy , IOP, HA, refer ED
Open (primary) : CN 2, gradual loss peripheral vision first
Papilledema - correcy answer-Swollen, optic disc, increase cup to disc ratio, HA, ICP, HTN,
Acyclovir (cheapest) - correcy answer-200mg 5 x day
Pt on PPI, has osteoporosis has a cough, - correcy answer-refer for EGD r/o Barrett's.
allergic rhinitis - correcy answer-blue pale turbinate clear drainage. Tx inhaled corticosteroids
hordeolum Vs chalazion
blepharitis - correcy answer-hordeolum: painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin.
chalazion does not hurt
Blepharitis always unilateral, Tx baby shampoo warm compress Sialolithiaisis - correcy answer-painful lump, calculi or salivary stones. sub mandibular gland whartons; duct.
Roseola infantum- Sixth disease - correcy answer-viral, young children, high Fever 3-4 days followed by maculopapular rash
Herpetic keratitis - correcy answer-ocular herpes - blurr vision, inflammation of eye; gritty feeling, conjunctivitis, sharp pain, and photophobia- AVOID SUN
REFER OPTHO Tx acyclovir [Show Less]