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All diastolic murmurs are pathological. Murmurs Grades I-barely IIaudible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM - ---CORRECT ANSWER-->III first time audible, IV first time thrill Fundal height 12 weeks - ---CORRECT 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? - ---CORRECT ANSWER-->Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - -- CORRECT ANSWER-->Increase Medication
3 ways to assess cognitive function in patient with signs/symptoms of memory loss - ---CORRECT ANSWER-->Mini mental exam 4 month old with strabismus, mom is worried...... - ---CORRECT ANSWER-->tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - ---CORRECT ANSWER-->Growth chart 6 month old closed anterior fontanel. - ---CORRECT ANSWER-->XRAY Abnormal cells on PAP, what do you do next? - ---CORRECT ANSWER-
Refer for Colposcopy CAGE ACRONYM - ---CORRECT ANSWER-->Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - ---CORRECT ANSWER-->Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - ---CORRECT ANSWER-->CN 3,4, Definition of metabolic syndrome - ---CORRECT ANSWER-->cluster of conditions that increase risk of heart disease, stroke, diabetes.
Legg-Calve-Perthes Disease - ---CORRECT ANSWER-->Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - ---CORRECT ANSWER-
Pancreatitis Low HGB, Low HCT, High MCV indicates what? - ---CORRECT ANSWER- Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - ---CORRECT ANSWER-- Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - -- CORRECT ANSWER-->Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - -- CORRECT 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? - ---CORRECT ANSWER-->Vascular dementia
Treatment for Gonorrhea? - ---CORRECT 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: - ---CORRECT ANSWER-->IUD Basal cell cancer - ---CORRECT ANSWER-->Waxy, pearly, telangiectasia, ulcer center lesion
- most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - ---CORRECT ANSWER-->Scaly red to yellow located in sun exposed area
- a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - ---CORRECT 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 - ---CORRECT ANSWER-->Make a hole and drain the blood
Moderate acne treatment - ---CORRECT 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 - ---CORRECT ANSWER-->MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta - ---CORRECT ANSWER-->COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs.
Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - ---CORRECT ANSWER-->> 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. - -
- CORRECT ANSWER-->Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - ---CORRECT ANSWER-->HTN retinopathy intraocular pressure (IOP) - ---CORRECT ANSWER-->Fluid pressure inside the eye; measured with tonometry Rovsing sign - ---CORRECT ANSWER-->pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - ---CORRECT 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 - ---CORRECT ANSWER-->SDH
migraine headache - ---CORRECT 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,
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? - ---CORRECT ANSWER-->HPV test if not done. Refer for colposcopy Chlamydia trachomatis - ---CORRECT ANSWER-->Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment - ---CORRECT 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. - ---CORRECT ANSWER-->tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children - ---CORRECT ANSWER-
motor vehicle Tanner 2 - ---CORRECT ANSWER-->Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - ---CORRECT 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. - ---CORRECT ANSWER--
vascular dementia presbycusis - ---CORRECT 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 - ---CORRECT ANSWER-->Ultrasound Romberg test - ---CORRECT 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 - ---CORRECT ANSWER-->r/o bilirubin preeclampsia treatment - ---CORRECT ANSWER-->bed rest, laying on her side Molluscum contagiosum treatment - ---CORRECT ANSWER->Currettage, liquid nitrogen pyloric stenosis - ---CORRECT ANSWER-->non bilious vomiting, olive like firm mass palpated on right upper quadrant
Osteoporosis Risk Factors (ACCESS) - ---CORRECT 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 - ---CORRECT ANSWER-->VITAMIN D 600-800, CALCIUM
OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH Carotid bruit - ---CORRECT ANSWER-->abnormal flow of blood through the carotid artery Carotid bruit - ---CORRECT ANSWER-->abnormal flow of blood through the carotid artery due to atherosclerotic disease Common causes of GERD - ---CORRECT 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 - ---CORRECT 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 - ---CORRECT ANSWER-->CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose Weber test - ---CORRECT 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 - ---CORRECT 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 - ---CORRECT ANSWER-->Dullness Assessment on patient with ascites - ---CORRECT ANSWER-->Dullness to percussion
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 - ---CORRECT ANSWER-->TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - ---CORRECT ANSWER-->a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - ---CORRECT 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 - ---CORRECT 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) - ---CORRECT 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) - ---CORRECT 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 - ---CORRECT 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 - ---CORRECT 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. Retinoblastoma - ---CORRECT ANSWER-->white reflection in child's pupil
