Sarah Michelle crash course
Sarah Michelle crash course Study
Guide Review Questions with Definitive
Solutions, Rated A+ 2023-2024.
Treatment for Rocky Mountain Spotted Fever - Answer: Doxycycline for any age
and regardless of pregnancy
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Sarah Michelle crash course Study
Guide Review Questions with Definitive
Solutions, Rated A+ 2023-2024.
Treatment for Rocky Mountain Spotted Fever - Answer: Doxycycline for any age
and regardless of pregnancy
Presentation of Rocky Mountain Spotted Fever - Answer: Rash on palms of hands
and soles of feet pops up after 3-5 days of initial treatment
Presentation of Lyme Disease - Answer: Bulls eye rash
Lyme disease is also known as... - Answer: Erythema migrans
Treatment for Lyme disease over 8 years old - Answer: Doxycycline
Treatment for Lyme disease less than 8 years old - Answer: Amoxicillin
Aphthous Stomatitis vs herpes - Answer: Aphthous Stomatits: kanker sore inside
the mouth Herpes: painful clustered vesicles located outside the mouth
Treatment for herpes - Answer: Antivirals with 48-72 hours
Valtrex or Acyclovir
Impetigo - 2 causes of bacteria - Answer: Staph aureus & strep pyogenies
Impetigo presentation - Answer: Honey crusted lesions
2 types of Impetigo treatment - Answer: Bullous: PO antibiotics
If actinic keratosis is left untreated, what can it develop into? - Answer:
squamous cell carcinoma
sqamous cell carcinoma presentation - Answer: Slow growing scaly ulcerated,
bleeds easily if squamous cell CA is suspected and a visible lesion is present, the next step
should be - Answer: Refer to dermatology
ABCDEs of melanoma - Answer: asymmetry, border, color, diameter >6 mm,
evolving
seborrheic keratosis: do lesions need to be removed - Answer: No- they are
benign
most common type of skin cancer - Answer: basal cell carcinoma
basal cell carcinoma presentation - Answer: Shiny, waxy, pearly
May see telangiectasia with this
basal cell carcinoma : what should we do if we see this - Answer: Refer to derm
Another name for atopic dermatitis - Answer: Eczema
eczema (atopic dermatitis) presentation - Answer: Pruitic, itch scratch cycle.
Located on flexor surfaces (like back of knees, axilla, elbows).
Eczema, atopic dermatitis - treatment - Answer: Topical corticosteroids
3A's - Answer: Asthma, allergies, atopic dermatitis
Plaque Psoriasis presentation - Answer: Silvery scales, itches
auspitz sign, psoriasis - Answer: pinpoint bleeding after a scale is removed or
after
Koebner phenomenon - Answer: new psoriatic plaques form over areas of skin
trauma. Trauma to skin leads to having plaque in that spot
Plaque psoriasis treatment - Answer: Topical steroids
Contact dermatitis treatment - Answer: avoid offending agents, corticosteroids
Shingles presentation - Answer: Severe, piercing, burning, stabbing nerve pain
along a dermatome Vesicular rash in same area appears a few days after pain Typically unilateral Lesions last 3-5 days
Scabies treatment - Answer: Permethrin 5% cream (Remember you have 5
fingers) Starve mites by sealing them in a bag for about 10 days. Wash everything in house with hot water. Usually have to repeat treatment
chicken pox prevention - Answer: Live attenuated vaccine
Only to be given after 12 months old
When can children return to school after chickenpox - Answer: When all the
lesions are crushed over
Molluscum contagiosum presentation - Answer: Flesh-colored papules w/
central umbilication. Contagious
anthrax presentation - Answer: Ulcerated, black, and painless
Who would you typically see anthrax in? - Answer: Cattle farmers
Anthrax treatment - Answer: Ciprofloxacin for another 2 months
alternative treatment doxycycline
Hidradenitis suppurativa presentation - Answer: Painful and reoccurring in axillae
Hidradenitis Suppurativa Treatment - Answer: Warm compress and antibiotics
If large abscess- may need incision and drainage to obtain cultures
Folliculitis - Answer: inflammation / infection of the hair follicles
Follliculitis treatment - Answer: Mupirocin
If severe: PO abx like PCN or Keflex
Leukoplakia - Answer: Cannot be scraped off tongue
Refer to dentist Most commonly seen in HIV patients May be detrimental with enamel
Candidiasis (Thrush) - Answer: Thick, white, raised patches in the mouth
Can be scraped off
Candidiasis (Thrush) treatment - Answer: Nystatin swish and spit
Encopresis - Answer: a childhood disorder characterized by repeated defecating
in inappropriate places, such as one's clothing after already being toilet trained. Child resists having bowel movements, causing impacted stool to collect in the colon and rectum and lead to leakage.
Encopresis Treatment - Answer: Daily laxatives until BM is soft and regular
H2 blockers- end in dine (rantadine, famotidine). Provides relief in 1-2 hours for 6- 12 hours. As compared to PPIs , they are not as fast, but are stronger (omeprazole, pantoprazole). They provide relief after several hours and relieve up to days
Which lab is elevated in pancreatitis - Answer: Serum amylase
Hirschsprung's disease presentation - Answer: Failure to pass meconium in the
first 48 hours of life
cachexia - Answer: a condition of physical wasting away due to the loss of weight
and muscle mass that occurs in patients with diseases such as older adults, advanced cancer or AIDS hepatitis panel with the following results: - HBsAg, + IgG Anti-HBc, - IgM Anti-HBc, +HBsAb. Which of the following is the correct interpretation of these findings? -
Answer: Immune due to previous infection
HBsAg is the surface antigen used to determine if a hepatitis B infection is present.The Anti-HBc is the core antibody. The core antibody will always remain positive after an infection has occurred and can be further broken down into the IgG and IgM to determine if the infection is current or resolved. HBsAb (sometimes called the Anti-HBs) is used to detect the surface antibody which
indicates the patient has immunity from Hepatitis B. Immunity from Hepatitis B occurs either from past infection or from the immunization. This patient has a positive IgG, meaning they had an infection that is now gone. Since their HBsAb is positive, they are now immune to hepatitis B due to the previously resolved infection. A 60 year old female presents with dull, aching back pain in her lower back and occasional weakness in her left foot. She states that the pain is relieved when she
sits down and rests. What does the nurse practitioner suspect? - Answer: Spinal
stenosis Low back pain that is relieved by sitting is a sign of spinal stenosis. Weakness or "foot drop," burning in the buttocks and thigh, and abnormal reflexes can all be signs of spinal stenosis as well. Spinal stenosis is most common in patients older than 50 years old and is many times due to osteoarthritis. The pain is often described as dull or aching. A 37 year old female patient presents with unusual complaints of continued fatigue, increasing bone pain, and nausea. She has had several visits in the last several months but no resolution of symptoms. Which of the following is the most likely differential for this patient given her presenting symptoms and history? -
Answer: Some of the classic symptoms of hyperparathyroidism include
abdominal pain, nausea, vomiting, fatigue, confusion, muscle weakness, and bone pain. A patient with depression may have the symptom of fatigue, but would not necessarily present with the other symptoms. Patients with iron deficiency
sudden eye pain, tearing, and blurry vision unilaterally. While using a black lamp in the darkened exam room, the nurse practitioner notices a fern-like line in the
corneal surface. Which diagnosis is most likely? - Answer: Herpes keratitis
Herpes keratitis is an infection of the cornea due to herpes simplex virus (HSV). This is diagnosed by examining the eye under a black lamp and visualizing the cornea. In herpes keratitis, fern-like lines will be seen on the cornea. This is typically treated with antivirals like acyclovir (Zovirax Her results note AS-CUS (atypical squamous cells of undetermined significance) and the patient is wondering if this means she needs to be tested for HPV. What
should the nurse practitioner tell her? - Answer: Since ASCUS is noted, we can
order HPV testing now. SCUS stands for atypical squamous cells of undetermined significance. This can result on a pap smear for many reasons ranging from intercourse too close to the pap smear being completed, to a vaginal infection or HPV. Guidelines now recommend HPV testing in women over 30 years old during their routine pap smear and in any women with ASCUS noted on their pap smear regardless of age.
All of the following are associated with Crohn's disease - Answer: Fistulas
Affects any part of the GI tract from mouth to anus Skip lesions
. Abdominal pain, weight loss, and fatigue are all common symptoms of Crohn's disease as well.
Ulcerative colitis - Answer: Ulcerative colitis is an inflammatory bowel disease
that affects only the colon. Patients will present with bloody diarrhea, often with mucus. Abdominal pain, weight loss, and fatigue are all common symptoms of Crohn's disease as well. severe colicky flank pain that has been coming and going for the last day or so. He states the pain comes in waves and lasts anywhere from 20-60 minutes. What medication, if reported as taking by this patient, may put him at a higher risk for
this condition? - Answer: Medications like acyclovir, sulfadiazine, and indinavir
can all increase risk for nephrolithiasis." Which cranial nerve can be affected by a large cholesteatoma that is not
removed? - Answer: CN VII
Cholesteatomas can damage the facial nerve (CN VII) and may cause facial paralysis if not removed. This is why it is important to refer these patients to ENT after identification of a cholesteatoma. While cholesteatomas can cause hearing loss, it is a conductive hearing loss and not a sensorineural hearing loss. suspected gallstones, and the ultrasound results indicate there are no gallstones present. However, the patient continues to have symptoms of acute cholecystitis.
a patient with suspected rheumatoid arthritis. Her sedimentation rate is elevated and her rheumatoid factor is positive. What is the next step in her treatment? -
Answer: Refer the patient to rheumatology
he goal for these patients is to reduce the overall amount of joint damage by providing early, aggressive treatment. Primary care may prescribe patients medications to aid in pain relief, but it is imperative to refer for further treatment. follow up after recently being treated with Omeprazole (Prilosec) for 8 weeks. He reports that he hasn't noticed much improvement and still has acid reflux almost every day. He also reports recently having some difficulty swallowing. What
should the provider do next? - Answer: Refer the patient for an
esophagogastroduodenoscopy (EGD) GERD should be treated for 4-8 weeks with a proton pump inhibitor. If symptoms persist past this point, the provider should refer the patient to gastroenterology for an EGD to rule such conditions as peptic ulcer disease (often caused by H Pylori or long term use of NSAIDs.)
Tegretol (carbamazepine) side effects - Answer: Order a routine CBC (complete
blood count) at today's visit to monitor for possible agranulocytosis as well as Steven-Johnson syndrome. Signs and symptoms of agranulocytosis include tachycardia, hypotension, sudden fever, and a severe reduction in the amount of white blood cells. Tegretol often begins taking effect in 1-2 weeks,
A 63 year old patient diagnosed with COPD has a CAT (COPD Assessment Test) score of 6 and has not had any severe exacerbations in the last year, placing them
in treatment Group A. Which medications might this patient be on? - Answer:
Levoalbuterol (Xopenex), Fomoterol (Perforomist) Patients in COPD group A should be prescribed a bronchodilator - either a short acting or a long acting bronchodilator depending on the patient's response. Therefore, this patient could be prescribed levoalbuterol (a SABA) or fomoterol (a LABA) from the list above. diagnosed with a trichomoniasis infection. What is the treatment for this
infection? - Answer: Metronidazole (Flagyl) PO for both the patient and her
partner
Mastitis treatment - Answer: Dicloxacillin (Dycill)
Erythromycin and Clindamycin are great alternative options to treat this patient's acute mastitis if allergic to pcn
routine pap smears? - Answer: Pap smear guidelines state that women should
receive routine pap smears every 3 years starting at age 21 despite current sexual activity. When a woman turns 30, she can receive routine pap smears every 5 years if human papillomavirus (HPV) testing is done with it.
Which statement made by this patient would prompt further investigation for
potential cataracts? - Answer: "I am having increased difficulty seeing things at a
distance" Adults presenting with cataracts will usually complain of bilateral vision changes. These changes may include difficulty seeing things at a distance when compared to things close by due to the myopic shift that occurs with cataracts. A classic problem that patients present with is the increased difficulty with night driving. They may also have foggy or cloudy vision and the presence of bilateral leukocoria on exam.
Central vision loss is related to? - Answer: Central vision loss is related to
macular degeneration instead. Which of the following is the most common presenting symptom of lung cancer? -
Answer: Chronic cough
Upon examination, you note mild erythema bilaterally as well as bilateral 3.1 mm, flat, white growths encroaching onto the cornea. What is the most likely
diagnosis? - Answer: Pterygium
Pterygiums are benign overgrowths of the conjunctiva that frequently present as eye redness and irritation. One distinguishing feature is that it encroaches onto the cornea. Patient's with these usually do not seek treatment until it causes discomfort or vision changes.
Pinguecula - Answer: a harmless yellowish triangular nodule in the bulbar
conjunctiva on either side of the iris that stops at the limbus. PiNguecula= Near Nose can turn into a Pterygium In order to diagnose a patient with a chronic obstructive pulmonary disease
(COPD) exacerbation, all of the following are used for diagnosis - Answer:
Increased sputum production Increased sputum purulence Dyspnea Diabetic medications listed are considered to be cardioprotective given the
patient's cardiac history? - Answer: Dulaglutide (Trulicity), Canagliflozin
(Invokana)
medications that contribute to bone density loss - Answer: Long term PPI
(Omeprazole (Prilosec)) use, depo provera, and SSRI medications all contribute to