An elderly male of Mediterranean descent has a routine complete blood count (CBC) done for an annual physical. The following are his lab test results:
... [Show More] hemoglobin of 13.0 g/dL, a hematocrit of 39%, and an MCV of 72 fL. His PSA result is 3.2 ng/mL. The urinalysis shows no leukocytes and few epithelial cells. Which of the following laboratory tests are indicated for this patient?
A) Serum iron, serum ferritin, total iron binding capacity (TIBC), and the red
cell differential width (RDW).
B) Serum B12 and folate level with a peripheral smear.
C) CBC with white cell differential and urinalysis.
D) Urine culture and sensitivity with microscopic exam of the urine - ANSWER-A
large ethnic group from Southeast Asia is the Filipinos (from the Philippine Islands). Alpha thalassemia is more common in this ethnic group compared with beta thalassemia, which is more common in people of Mediterranean descent.
alpha-thalassaemia and beta-thalassaemia traits are two commonly encountered haemoglobinopathies in South East Asia. Both present with hypochromia and microcytosis.
How to answer ? - ANSWER-You must go through three steps to answer this question correctly:
First step: A hemoglobin of less than 13.5 g/dL in males (but not in females) is indicative of anemia. An MCV of 72 fL is indicative of microcytic anemia (norm 80-100 fL). Second step: The MCV will direct you in the differential diagnosis (microcytic, normocytic, or macrocytic). Third step: The differential diagnosis for microcytic anemia is iron deficiency and alpha/beta thalassemia trait/minor for the exams.
In iron-deficiency anemia, the following results are found: decrease---- and elevated --- - ANSWER-Decreased (serum ferritin and serum iron levels).
Elevated (TIBC/transferrin levels and the RDW).
The gold standard test to diagnose any anemia involving abnormal hemoglobin (thalassemia, sickle cell, - ANSWER-HGB electrophoresis
In alpha or beta thalassemia trait or minor, the following results are found: Normal to high ------ and normal ------ - ANSWER-Normal to high (serum ferritin and serum iron levels) Normal (TIBC/transferrin levels)
Remember iron deficiency...
Decreased (serum ferritin and serum iron levels).
Elevated (TIBC/transferrin levels and the RDW).
Alpha thalassemia - ANSWER-Filipinos
Beta thalassemia - ANSWER-Mediterranean
The red cell distribution width (RDW) is a measure of the variability in size of RBCs (or anisocytosis). An elevated RDW is indicative of ..... Anemia - ANSWER-Iron deficiency
According to the HIPAA of 1996, which of the following examples demonstrates noncompliance?
A) The sign-in sheet on the front desk is covered so that other patients' names are not visible to new patients.
B) The medical assistant calls the patient who is in the waiting room using his/her first name.
C) A patient's chart that is hanging on the door of the examination room is turned backward.
D) The nurse practitioner calls the daughter of an elderly diabetic patient and leaves a detailed message on her answering machine regarding her mother's laboratory results. III. - ANSWER-Correct Answer: Option D D) The nurse practitioner calls the daughter of an elderly diabetic patient and leaves a detailed message on her answering machine regarding her mother's laboratory results.
Option b ok- can use or first name
Option D demonstrates two examples of HIPAA noncompliance. First, there is no mention that the patient gave consent for her daughter to have access to her medical information. Second, the NP did not follow the "minimum necessary requirement" rule when she left a detailed message on the daughter's answering machine. 2) The best action in this case is for the NP to call the elderly patient's home and to leave only her name, the name of the clinic, and phone number that the patient can call back.
"Will performing this action prevent the disease or the social condition from happening?" If it does, then it is considered as .........prevention (if it does not, then it is ........prevention). - ANSWER-Does then primary of not then secondary
Primary
Prevent Disease/Injury/Condition) - ANSWER-Youth violence prevention (e.g., youth recreational center for high-risk inner-city youth, mentoring teens, teaching teens better communication skills).
Bullying prevention (e.g., antibullying school programs).
Personal safety promotion (e.g., seatbelts, airbags, helmets).
Disease prevention (e.g., immunizations, using sunscreen).
Healthy lifestyle promotion (e.g., sleep 7-8 hours/night, avoid sunlight 10 a.m. to 4 p.m., healthy diet, exercise).
Promotion of OSHA laws (e.g., workplace
Secondary Prevention (Detect Disease/Condition as Early as Possible) - ANSWER-Any laboratory test to screen for a disease (e.g., CBC for anemia, TSH for thyroid disease).
U.S. Preventive Services Task Force (USPSTF) screening recommendations (e.g., mammograms, PSA, purified protein derivative [PPD]).
Screening for high-risk behavior (e.g., asking a patient about the number of sexual partners), screening for suicide risk (e.g., assess suicide risk, check for signs and symptoms of depression).
Personal actions to detect cancer (e.g., BSE, GSE).
Tertiary Prevention (Limiting Further Harm and Disability) - ANSWER-All types of rehabilitation (e.g., cardiac rehab, PT, OT, speech therapy, addiction/drug rehab).
Support groups (e.g., breast cancer patients, alcoholics with Alcoholics Anonymous).
Exercise for an obese person (if the person is healthy, then it is primary prevention).
An 18-year-old female presents in the college health clinic complaining of a strong odor in her vagina. She reports that she had an abortion about 3 weeks ago and recently completed her prescription of antibiotics. The NP performs a vaginal speculum exam and notes a large amount of grayish to off-white discharge coating the patient's vaginal walls. It has a milk-like consistency. During microscopy, the slide reveals mature squamous epithelial cells with numerous bacteria noted on the cell borders. The vaginal pH is at 6.0. Which of the following conditions is most likely?
A) Trichomoniasis B) Bacterial vaginosis C) Candida vulvovaginitis D) Hormonal changes - ANSWER-BV
1) The vaginal pH is alkaline (pH of 6.0). 2) Rule out Candida because it is classified as a yeast organism (not a bacteria). 3) Rule out Trichomonas because it is a protozoa or unicellular flagellated organism. 4) The odor and discharge are not due to hormonal changes in an 18-year-old female.
BV
(CAN) - ANSWER-Bacterial vaginosis (BV) has an alkaline pH (vagina normally has an acidic pH of 4.0).
BV is not considered an STD (it is caused by an imbalance of vaginal bacteria). The sex partner does not need to be treated. It is a vaginosis (not a vaginitis).
BV does not cause inflammation (the vulvovagina will not be red or irritated). The microscopy slide will have very few WBCs and a large number of clue cells.
****Alkaline, not std, clue cell (remember by CAN)
Candida
WTC
RI
WP-HS
NGI - ANSWER-vaginal discharge in Candida infection is of a white color with a thick and curd-like consistency.
It frequently causes redness and itching in the vulvovagina due to inflammation.
microscopy in candidiasis will show a large number of WBCs, pseudohyphae, and spores ("spaghetti and meatballs").
Candida yeast is normal flora of the gastrointestinal (GI) tract and in some women's vaginas.
Trichomonas infection (or trichomoniasis)
CBG
RI
STD - ANSWER-Vaginal dc copious, bubbly, and green in color.
It causes a lot of inflammation resulting in itching and redness of the vulvovagina.
It is considered a sexually transmitted infection. The sex partner also needs treatment.
A previously healthy 30-year-old complains of an acute onset of fever and chills accompanied by a productive cough with purulent sputum and a loss of appetite. The patient denies receiving an antibiotic in the previous 3 months. The NP diagnoses community-acquired pneumonia (CAP). The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) treatment guidelines recommend which of the following as the preferred first-line treatment for this patient?
A) Macrolides
B) Antitussives
C) Cephalosporins
D) Fluoroquinolones with gram-positive bacteria activity - ANSWER-Macrolide
According to the IDSA and the ATS treatment guidelines, outpatient treatment of CAP in healthy patients (no comorbidities) are the macrolides (azithromycin, clarithromycin, or erythromycin).
Macrolide
(ACE) - ANSWER-azithromycin, clarithromycin, or erythromycin
Which of the following antibiotics is preferred treatment for healthy adults diagnosed with uncomplicated CAP? A) Azithromycin (Zithromycin) 500 mg on day 1, then 250 mg daily for 4 days.
B) Dextromethorphan with guaifenesin (Robitussin diabetes mellitus [DM]) 1 to 2 teaspoons PO QID as needed
C) Cephalexin (Keflex) 500 mg PO QID × 10 days D) Levofloxacin (Levaquin) 500 mg PO daily × 7 days - ANSWER-Azithromycin
Possible side effects that may be seen in a patient who is being treated with hydro-chlorothiazide for hypertension are:
A) Dry cough and angioedema
B) Swollen ankles and headache
C) Hyperuricemia and hyperglycemia
D) Fatigue and depression - ANSWER-C
Example B is caused by calcium channel blockers (CCBs). Look for a hypertensive patient with swollen ankles (not associated with heart failure) and headache.
Example C is caused by the thiazide diuretics (hyperuricemia and hyperglycemia)
Example D is caused by beta-blockers. Look for a patient with hypertension who complains of increased fatigue and depression (avoid if possible in depressed patients).
CDC Mortality Statistics:
Disease causing the most deaths overall: ______disease.
Cancer with the highest mortality: ______ cancer. - ANSWER-heart [Show Less]