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ADA screening for DM in Children - correct answer>>-symptomatic children (polyuria, polydipsia, polyphagia, blurred vision) regardless of risk factors -asymptomatic children after puberty or 10 years of age or older if overweight or obese (>85th percentile). Plus 1 of the following: *T2DM in 1st or 2nd degree relative *high risk racial/ethnic group *signs of insulin resistance (HTN, dyslipidemia, acanthosis nigricans, PCOS, SGA) *maternal hx of DM or GDM during the child's gestation Statistics - correct answer>>- leading causes of death: Heart disease, cancer, lung disease - leading cause of cancer death: lung - leading cause of death in adolescents: accidents - most common cancer: skin. - in males: prostate. in females: breast suicide: males more successful, women more attempts. highest rate is older white males. Osgood-Schlatter: - correct answer>>knee pain in young adults, overuse. Repetitive stress pain, tenderness, swelling at the tendon's
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ADA screening for DM in Children - correct answer>>-symptomatic children (polyuria, polydipsia, polyphagia, blurred vision) regardless of risk factors
30, and LDL = 200. In addition to starting Therapeutic Lifestyle Changes, the nurse practitioner should start the patient on:
pseudohyphae w/KOH prep. Treatment: oral diflucan or vaginal miconazole or terconazole PSEUDOHYPHAE, CLOTRIMAZOLE CREAM Proton Inhibitors - correct answer>>Increased risk of fractures(postmenopausal women), Pneumonia, Clostridium difficile infection, hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, and kidney disease Bacterial Conjunctivitis tx - correct answer>>Eye drops or ointment: Polytrim, trimethoprim, polymyxin, macrolide A patient with an elevated WBC (>11k) accompanied by neutrophilia (>70%) and the presence of bands is what kind of shift and prognosis? - correct answer>>-Shift to the left
Primary Prevention - correct answer>>- individual actions: eating nutritious diet, exercise, seatbelts, gun safety. IMMUNIZATIONS squamous epithelial cells with stippling appearance, no lactobacilli and many WBCs is
postcoital bleeding.
strong odor from vaginal discharge.
itching in the vaginal area.
molluscum contagiosum. - correct answer>>postcoital bleeding To assess a patient's ability to think abstractly, a nurse practitioner could ask the patient: - correct answer>>the meaning of a common proverb. Auspitz sign - correct answer>>droplets of blood when scales removed = psoriasis Bacterial vaginosis - correct answer>>etiology: unclear, likely polymicrobial, associated with G. vaginalis, M. hominid, others. thin, homogeneous, white, gray, adherent, often increased, discharge is foul odor(fishy), itching is occasionally present, pH 5-7(alkaline- no active bacilli in vagina), "fishy" smell, microscopic > 20 clue cells/HPF, few or no WBCs. Treatment: metronidazole topical, oral Flagyl, clindamycin vaginal cream, oral tinidazole (Tindamax) CLUE CELLS, METRONIDAZOLE GEL OR ORAL, CLINDAMYCIN CREAM Omeprazole (Prilosec) - correct answer>>interacts with with Warfarin (Coumadin), diazepam (Valium), Carbamazepine (Tegretol), Pheytoin (Dilantin),
start methocarbamol (Robaxin).
discontinue amitriptyline and begin gabapentin (Neurontin). - correct answer>>discontinue amitriptyline and begin gabapentin (neurontin) To assess spinal function at the S1 level, which deep tendon reflex should be tested?
Treatment: topical and/or vaginal estrogen if symptomatic and/or recurrent UTI. (Oral estrogen as solo intervention likely inadequate) Diverticulitis: Treatment s/s: - correct answer>>Antibiotics and clear liquids and increased fiber (some say no nuts or seeds). (7 to 10 days ABT) Ciprofloxacin (500 mg PO twice daily) plus metronidazole (500 mg PO three times daily). Amoxicillin-clavulanate (875/125 mg twice daily) is an acceptable alternative. The criteria for patients with acute uncomplicated diverticulitis to be treated in the outpatient setting include: ●Reliability to return for medical reevaluation if condition worsens ●Compliance with outpatient treatment plan ●Abdominal pain is not severe ●No higher than a low-grade fever ●Can tolerate oral intake ●No or minimal comorbid illnesses ●Available support system Approximately six weeks following the resolution of symptoms of acute diverticulitis, patients who have not had a recent colonoscopy should undergo one to exclude other possible diagnoses (such as colonic neoplasia) and to evaluate the extent of the diverticulosis. Recomendations for surgery: Patients in whom elective surgery has been recommended following a single attack of diverticulitis include younger patients (variously defined in the literature as less than 40 or 50 years of age) and those who are immunosuppressed. Neuroblastoma- - correct answer>>painful abd mass fixed first irregular, crosses midline. Most common side is adrenal glands. Weight loss fever. HORNERS syndrome. RACOON eyes, bone pain, HYPERTENSION. 1-4 year olds. Dx ultrasound PUNT to nephro. NEURO think brain in middle crosses midline. **Urine catecholamines and anemia
Koplick Spots - correct answer>>white with red ring inside cheek from rubeola or mumps Tertiary Prevention - correct answer>>- AA, support groups, education for those with the disease, rehab, exercise programs for obese Which of the following signs/symptoms are often associated with headaches due to an intracranial tumor? - correct answer>>Pain worse in supine position; focal neurological signs Acute rhinosinusitis tx - correct answer>>Wait 10 days then Amoxicillin or Augmentin (If allergy, use fluouroquinolones/tetracyclines) MRSA - correct answer>>Tx: Autism - correct answer>>Impairment in social communication and social interaction. Restricted, repetitive patterns of behavior, interests and activities. Red flags: delayed language/communication milestones, regression in social and language skills, sibling with autism screen at 9, 18, 24 and 30 months or when concerns are raised by parents Genital Herpes - correct answer>>causative organism: human herpes virus 2 clinical findings: painful, ulcerated lesions, marked lymphadenopathy with initial lesions. Women=thin vaginal discharge if lesion at vagina or intoitus with recurrence symptoms vary- asymptomatic transmission common treatment: oral acyclovir (Zovirax), famciclovir (Famvir), valacyclovir(Valtrex), dose and length of treatment depends on the medication choice and the clinical presentation. Diverticulosis: Treatment s/s: - correct answer>>Diverticu-lO-sis has nO inflamation: Both diverticulitis and *osis are similar to umbilical hernia in that a vein running through the muscle of the bowel muscle weakens the area and pressure causes a hernia "out pouching". RETINOBLASTOMA - correct answer>>leukocoria: Hallmark sign white spots in eye. Cancer. Red light reflex negative
What are first and second line antibiotics for acute otitis media? - correct answer>>1. Amoxicillin
acetaminophen.
prednisone.
aspirin.
ibuprofen. - correct answer>>ibuprofen Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection? - correct answer>>CD4 count and viral load slapped cheek and lacy exanthem - correct answer>>Erythema Infectiosum or Fifths disease Intertrigo tx - correct answer>>Nystatin
Side effects of metronidazole (oral or vaginal) include a metallic taste, nausea (in 10 percent of patients), transient neutropenia (7.5 percent), a disulfiram-like effect with alcohol, prolongation of International Normalized Ratio in patients taking vitamin K antagonists (eg, warfarin), and peripheral neuropathy. Erythema infectiosum - correct answer>>(5th disease)- "slapped cheeks" 5-14 y.o. LACY, spreads to upper arms lgs trunks dorsum of hands and feet. Rash can last up to 40 days. Fever, rash, runny nose, headache. EXAM humanparovirus19, no labs for it. Most common bacterial pathogen causing pneumonia - correct answer>>strep pneumoniae, but most pathogens 6 months to 5 years are viral Biphosphonates: Alendronate (Fosamax) Risedronate (Actonel) - correct answer>>Erosive esophagitis, abdominal pain, Stop immediately if symptoms: esophagitis (chest pain, difficulty swallowing, burning (mid back) jaw pain (osteonecrosis) Contraindicated: Active GI disease (GERD, PUD), CKD, esophageal stricture/varices prednisone - correct answer>>management of polymalgia rheumatica A 12-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and:
white blood cell levels.
fecal occult blood test.
hemoglobin levels.
urine dipsticks. - correct answer>>hemoglobin levels A 3-year-old patient presents at an inner-city clinic with fever, cough, malaise, and loss of appetite. The patient lives with several relatives, including a grandmother
who also has a cough. Which of the following diagnostic tests would be most appropriate for the patient? - correct answer>>Sputum culture Thumb sign - correct answer>>swelling of the epiglottis, which may be visible on a lateral radiograph in patients with Epiglottitis Lung Cancer Screening - correct answer>>- 55 - 74yo with >30y pack smoking history and who quit <15y ago. LDCT annually med of choice for polymyalgia rheumatica - correct answer>>prednisone Urticaria tx - correct answer>>Benadryl or Zyrtec Shingles - correct answer>>Prodrome: itching burning photophobia fever headache malaise. Acute phase: Dermatomal rash 3-4 days, unilateral, macupapular rash progresses to vesicles then pustules 3-4 days. Convalescent phase: 2-3 week rash resolves. Dx PCR. Tx: acyclovir, zostrix, gaba, amitriptyline. (one dermatone) Gonococcal urethritis and vaginitis 1 million cases daily WW- abx resistance prevalent - correct answer>>causative organism: neisseria gonorrhoeae (gram - bacteria) clinical findings: irritative voiding symptoms, occasional purulent discharge, often w/o symptoms in either gender Microscopic exam: large number of WBCs STI most likely to give penile DC also called the "drip" Treatment: ceftriaxone 250 mg IM as a one time dose plus azithromycin 1 g PO x 1 dose If you find Gonorrhea ALWAYS tx for chlamydia CEFTRIAXONE 10 month old child with runny nose, rash, cough, with tiny white papules with red areola in mouth what does this suggest? - correct answer>>Measles ADHD - correct answer>>hyperactive, impulsive, inattentive. Present prior to 12 years. Symptoms last > 6 months,
Tell the neighbor to check on the woman daily and report back.
Document the data and report the information to risk management.
Call the patient's family and inquire about the concerns. - correct answer>>report the case to proper authorities Which of the following best describes psoriatic lesions in an elderly patient? - correct answer>>Red, sharply defined plaques with silvery scales Steeple Sign - correct answer>>tapering of the upper trachea on a frontal chest radiograph reminiscent of a church steeple suggestive of Croup Active Immunity - correct answer>>- via immunization or a person who was exposed to agent helical CT pulmonary angiography - correct answer>>test for PE Actinic Keratosis tx - correct answer>>Topical 5 fluoracil 5-FU cryotherapy What is the classic triad of symptoms for mononucleosis? - correct answer>>1. sore throat
Trunk like rash: - correct answer>>Roseola: measles MASTITIS - correct answer>>red firm tender area fever chills, flu like symptoms. Dicloxacillin, or Keflex. If you suspect MRSA, do Bactrim or clinda. treatment of bacterial pneumonia in children: - correct answer>>High dose amoxicillin, augmentin or 3rd generation cephalosporin (cefdinir). if type 1 reaction to PCN use clindamycin or azithromycin electric shock unilateral facial pain - correct answer>>trigeminal neuralgia serum ferritin level - correct answer>>distinguish iron deficiency anemia from other anemias In most cases, the first manifestation of Alzheimer's disease is:
impaired judgment.
decrease in short-term memory.
disorientation in time and place.
decrease in long-term memory. - correct answer>>decrease in short-term memory A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step that should be taken in order to make a diagnosis? - correct answer>>Palpate structures around the shoulder. Galeazzi's Sign (aka Allis sign) - correct answer>>uneven knee heights - Developmental Displasia of the Hip
bronchiolitis - correct answer>>Lower resp. tract illness that occurs when an infecting agent causes inflammation and obstruction of the small airways (bronchioles). Common under 2 years of age. Management: supportive. No bronchodilators or steroids Anaphylaxis - correct answer>>- Pruritus/uticaria or angioedema AND EITHER respiratory compromise OR hypotension/end organ dysfucnction
rifampin (Rifadin) for 5 months.
isoniazid (Nydrazid) for 9 months.
pyrazinamide for 6 months.
ethambutol for 6 months. - correct answer>>osioniazid (nydrazid) for 9 months A patient who is 28 weeks pregnant reports a single episode of vaginal bleeding. History indicates normal prenatal progress to date, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate intervention to aid in the diagnosis of this case? - correct answer>>Ultrasound Gower's Maneuver - correct answer>>patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength = muscular dystrophy
Anthrax - correct answer>>Tx: doxycycline/fluoroquinolones Seborrheic Dermatitis tx - correct answer>>Rotation of prescription/non-prescription antifungal shampoo (Ketoconazole/metronidazole), Capitrol shampoo, selenium sulfide, selsun blue (adults / children) ciclopirox shampoo, topical stroid gel (hydrocortizone face, ears hydrocortizone cream), eyelids - baby shampoo cystic fibrosis - correct answer>>*Effects lungs, GI and sweat glands. *Autosomal recessive *Routine screening in all states *Presents with recurrent lower respiratory infections and persistent productive cough *Weight loss and greasy BM common *Mucous blocks ducts of the pancreas Genital warts (Condyloma acuminata) - correct answer>>Causative organisms: HPV (commonly HPV-6 & 11) Clinical findings: verruca-form lesions can be subclinical or unrecognized Treatment: prevent w/immunization, topical podofilox, liquid nitrogen, cryoprobe, trichloroacetic acid, bichloracetic acid, surgical removal, or topical imiquimod (only indicated for external warts treatment). trichloroacetic acid use acceptable in pregnancy DO NOT USE IF PREGNANT: podofilox, podophyllin, sinecatechins and imiquimod IMIQUIMOD Erythema toxicum - correct answer>>A rash of small yellow or white bumps surrounded by red skin. Can appear anywhere on the body. Disappears on its own in about two weeks. Common in newborns, usually showing up two to five days after birth. Alpha fetal protein test - correct answer>>AT 16 WEEKS TEST FOR AFP Low- Downs High-Neural tube deficits Beta thalassemia is more common with what ethnicity? - correct answer>>Mediterranean people