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NCC Exam - WHNP > Primary Care > Flashcards

Primary Care Flashcards

12% of exam, ~21 questions 1. Problem Recognition, Management, & Referral (Evaluation, Diagnosis, Treatment, Referral) 2. Health Screening, Education, Counseling (Risk Assessment, Disease Prevention, Counseling, National Screening Guidelines) (134 cards)

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1
Q

two meds for mild acne treatment?

A

benzoyl peroxide

retinoic acid derivatives (tretinoin)&raquo_space; avoid during pregnancy

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2
Q

3 meds for moderate acne treatment?

A

benzoyl peroxide
retinoic acid derivative
antibx (clindamycin, erythromycin)

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3
Q

2 meds for mod-severe acne treatment (oral)

A

antibx (doxy/minocycline)

COCs (w/ low androgenic content)

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4
Q

treatment for severe cystic acne?

A

isotretinoin (accutane) oral
C/I DURING PREGNANCY & LACTATION
can refer for management if isotretinoin is needed

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5
Q

what is the hallmark of most plant dermatoses?

A

linear eruption

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6
Q

examples of irritant contact dermatitis

A

hot/cold
chemical
friction

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7
Q

examples of allergic contact dermatitis

A

poison ivy/oak
nickel
rubber compounds
some topical meds

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8
Q

pharm tx for contact dermatitis?

A

topical corticosteroid
systemic corticosteroid if severe/widespread (avoid 1st trimester)
antihistamines for allergic pruritus

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9
Q

how is eczema characterized on exam?

A

pruritis, erythamous, dry, scaly, excoriated, possibly lichenified patches of skin

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10
Q

what tests might you order for a pt with eczema at risk for a significant bacterial infection?

A

CBC. herpes culture

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11
Q

pharm tx options for eczema? (7ish)

A

1) topical or PO antibx considered if at risk (bactroban)
2) PO antihistamine (benadryl) for pruritus at night
3) daytime histamine
4) maybe topical corticosteriod during exacerbation
5) last option is a PO steroid if widespread
6) could mayyybe consider PO immunosuppressant
7) can also consider vitamin D 2000 IU for symptom relief

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12
Q

what do we see symptomatically in patients with basal cell or squamous cell carcinoma?

A

painless, slow-growing lesion that will not heal (areas of sun exposure or burns or chronic inflammation)

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13
Q

what do we see symptomatically in patients with malignant melanoma?

A

nevus change: color, diameter increase, border
pruritus early
bleeding/ulceration/discomfort later

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14
Q

BCC lesion

A

waxy, semitransluscent nodule w/ rolled borders

central ulcerations, telangiactasias

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15
Q

SCC lesion

A

re/reddish brown plaque/nodule

scaly/crusted surface w/ erosions or ulceration

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16
Q

ABCDEs of metastatic melanoma

A 
asymmetry
border irregularity
color variant
diameter >6 mm
elevation
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17
Q

dx of malignant skin lesions?

A

biopsy

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18
Q

tx for BCC/SCC (4)

A 
excising lesions (Mohs')
cryo
curettage
fluorouracil or imiqimod
**referral
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19
Q

tx for MM

A 
excising lesion
lymph node dissection
chemo/radiation/excising metastasis
f/u long term
**referral
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20
Q

tinea is what type of infection?

A

fungal
ringworm, athlete’s foot, jock itch
CONTAGIOUS

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21
Q

symptoms of tinea

A

itching, burning, inflamed rash, hair loss, nail thickening

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22
Q

tinea lesion presentation

A

lesion with central clearing surrounded by red, scaly border

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23
Q

2 dx moves for tinea

A

KOH microscopy + for hyphae

fungal culture

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24
Q

options for treating tinea corporis, cruris, pedis

A

topical antifungals: azoles and allylamines (lamisil)

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25
options for treating tinea capitis, unguium
PO antifungals (not during pregnancy): griseofulvin, itraconazole
26
psoriasis is what type of condition?
chronic immune-mediated disorder
27
symptoms of psoriasis? (5)
red papules/plaque on elbows, knees, scalp most common pruritus in folds (groin, axillae, antecubital/popliteal) joint pain fever chills
28
4 characteristic features of psoriasis on physical exam
clear borders erythemous plaque base overlapping silvery scales Auspitz sign (removal of scales = blood droplets)
29
fingernail psorias sign?
pittling/stippling
30
if uncertain, how to dx psoriasis?
biopsy
31
nonpharm option for psoriasis?
phototherapy
32
pharm options for mild psoriasis? (3)
topical steroids retinoid gel (C/I pregnancy) vit D3 analogs
33
pharm options for severe psoriasis (3)
biologic immune modulators methotrexate (c/i pregnancy, lactation) cyclosporine (c/i pregnancy, lactation)
34
who might we refer a psoriasis pt to?
derm if symptoms not controlled w/ topical meds or if severe | rheum if arthritic symptoms
35
what kind of condition in vitiligo?
progressive, decreased production of melanin, skin becomes depigmented
36
if vitiligo is present in an older woman, what else should be considered? (4)
thyroid, RA, DM, alopecia
37
vitiligo symptoms
discoloration patches on skin, sun-exposed areas often show first maybe graying of hair
38
tx for vitiligo?
not really, can do UVB to repigment or photochemotherapy | maybe topical steroids early to help with re-pigmentation
39
what is the Koebner phenomenon
new patch of vitiligo appears 10-14 days after getting a tattoo
40
allergic rhinitis produces which kind of antibodies?
IgE along with histamine release
41
symptoms of allergic rhinitis (5)
congestion, clear rhinorrhea, sneezing, itchy eyes/throat/nose, sore throat/cough from postnasal drip
42
PE findings allergic rhinits (5)
``` pale, boggy mucosa clear, thin rhinorrhea nasal crease from rubbing nose allergic shiners (dark discoloration below eyes) injected conjunctiva/tearing ```
43
gold standard test for determining specific allergens
skin tests
44
tx for allergies
avoid the allergen!
45
1st line pharm tx for allergies
antihistamine (1st benadryl, and 2nd gens claritin)
46
other pharm tx for allergies (4)
decongestants nasal corticosteroids mast cell stabilizers/intranasal cromolyns (prophylaxis) montelukast
47
what is conjunctivits?
inflammation of conjunctiva
48
types of conjunctivitis?
viral (adenovirus) bacterial (staph, strep, GC, CT) allergic (type 1, IgE mediated
49
differentiating conjunctivitis by symptoms
V: acute, uni or bi lateral w/ watery discharge B: acute, uni THEN bi lateral with mucopurulent discharge (sticky eyelids) A: chronic, bilateral, stringy/clear/watery discharge, tearing, itching
50
which bacterial conjunctivitis poses risk to eyesight?
gonoccoal
51
tx for viral conjunctivits?
none, cold compresses, symptom management
52
tx for bacterial conjuncitivits?
broad-spectrum antibx: erthromycin
53
tx for gonococcal or chalmydial infection?
systemic antibx, ceftriaxone, azithromycin, doxy, erythromycin base
54
when would you refer a conjunctivitis patient?
pain, photophobia, blurred vision, herpes simplex/zoster infx
55
pharm treatment for allergic conjunctivitis?
topical antihistamines and vasoconstrictor
56
PE findings for otitis media?
full/bulging TM absent/obscured landmarks decreased mobility of TM distorted light reflex
57
first line antibiotic tx for otitis media
amoxicillin, if it doesn't work, augmentin or zithromax or bactrim if allergic to penicillin
58
when would you refer an otitis media pt?
extended infx, mastoiditis, perfed TM hearing loss recurrent infx
59
acute sinusitis is caused by...
virus or bacteria (h. influ, strep pneumonia)
60
chronic sinusitis...
prologned infection, incomplete treatment, reinfection
61
PE findings of sinusitis (4)
low grade fever or afebrile mucopurulent discharge swollen, gray/dull red, pale nasal mucosa pain on palpation of sinuses
62
when do you consider antibx for sinusitis? (3)
sxs > 10 days sxs worsen after 5-6 days after initial improvement high fever & facial pain or purulent discharge for 3 or more days
63
first line antibx tx for sinusitis?
augmentin (or doxy or levo if allergic to penicillin)
64
other pharm tx options for sinusitis (symptom management)
decongestant | steroids
65
(4) when to refer a sinusitis pt?
periorbital swelling/severe facial pain failure to respond to 2 courses antibx suspected anatomic abnormality chronic sinusitis or >3 episodes of sinusitis in a year
66
types of pharyngitis?
viral (rhinovirus, adenovirus) | bacterial (GABHS, N. gon)
67
differentiating viral vs bacterial pharyngitis on PE?
V: mild erythema of throat, little/no exudate B: erythema of throat, exudate, ANTERIOR CERVICAL LYMPHADENOPATHY tender
68
when is a rapid strep test indicated?
``` 2+ of: fever no cough tonsillar exudate tender anterior cervical adenopathy ```
69
pharm tx for GABHS?
penicillin, erythromycin in penicillin allergy
70
pharm tx gonococcal pharyngitis
ceftriaxone, azithromycin if penicillin allergic
71
when would you refer a pharyngitis patient?
suspected peritonsillar abscess | epiglottis
72
what is the definition of asthma?
a chronic inflammatory disorder of the airways (REVERSIBLE) resulting in obstruction of the airways
73
what are the 4 classifications of asthma?
intermittent mild persistent moderate persistent severe persistent
74
intermittent asthma: daytime symptoms
2xweekly or less
75
intermittent asthma: nocturnal symptoms
2xmonthly or less
76
intermittent asthma: use of SABA
2xweekly or less
77
mild persistent asthma: daytime symptoms
more than 2xweekly but not daily
78
mild persistent asthma: nocturnal symptoms
3-4xmonthly
79
mild persistent asthma: use of SABA
more than 2xweekly, not daily, no more than once daily
80
moderate persistent asthma: daytime symptoms
daily
81
moderate persistent asthma: nocturnal symptoms
more than 1xweekly but not nightly
82
moderate persistent asthma: use of SABA
daily
83
severe persistent asthma: daytime symptoms
continual daily
84
severe persistent asthma: nocturnal symptoms
frequent
85
severe persistent asthma: use of SABA
continuous daily
86
when can asthma symptoms worsen?
at night!
87
symptoms (4) of asthma
SOB, cough, wheeze, chest tightness
88
what might you find on exam for a pt with asthma? (3)
hyperresonance to percussion wheezing prolonged expiratory phase
89
dx test for asthma?
pulmonary function test and spirometry and peak expiratory flow
90
meds for stage 1 asthma
SABA PRN | corticosteroids for severe exacerbation
91
meds for stage 2 asthma
low dose inhaled corticosteroids | SABA PRN
92
meds for stage 3 asthma
low/med dose inhaled corticosteroids LABA SABA PRN
93
meds for stage 4 asthma
high does inhaled corticosteroids LABA SABA PRN
94
how is constipation typically defined?
less than 3 BMs per week
95
6 red flags of constipation
``` pain (abdominal/rectal), n/v weight loss melena, rectal bleeding fever new onset older than 50 years ```
96
drug of choice for prevention/chronic constipation
bulk-forming agent (psyllium husk)
97
second drug of choice for chronic constipation
osmotic laxative
98
choice treatment for acute constipation
milk of magnesia
99
when should you NOT use a stool softener or laxative
suspected obstruction or impaction
100
symptoms of internal hemorrhoids?
painless | bright red bleeding with defecation
101
symptoms of external hemorrhoids?
itching, pain, bleeding with defecation
102
nonpharm tx for hemorrhoids if symptomatic
fiber/bulk/fluids sitz baths witch hazel
103
pharm tx for symptomatic hemorrhoids
topic anesthetic/steroid ointments/suppositories bulk-formers stool softeners
104
what is IBS?
chronic functional disorder characterized by abdominal pain and change in bowel habits
105
Rome criteria frequency of pain/discomfort for IBS?
3xmonthly for 3 consecutive months
106
Rome criteria for IBS associated with 2+ of:
improvement with defection onset associated with change in stool frequency onset associated with change in stool form
107
alarm symptoms of ibs (5)
``` pain/diarrhea that interferes with sleep recurrent n/v evidence of GI bleed unintentional weight loss persistent diarrhea or severe constipation ```
108
what is PUD?
chronic ulcerative disorder of upper GI tract
109
what infx is common causative agent of PUD?
h pylori
110
peptic ulcer pain
1-3 hrs after meal typically relieved with food early morning pain common
111
gastric ulcer pain
food can worsen symptoms
112
alarm symptoms for gastric cancer/complicated PUD (5)
``` bloody/black stools unintended weight loss dysphagia persistent pain bloody/coffee ground vomit ```
113
pharm treatment for PUD not w/ h. pylori
histamine-2 receptor antagonist | PPIs
114
pharm treatment for PUD from h pylorti
either: triple therapy: PPI, amoxicillin, clarithromycin quad therapy: bismuths ub, mentronidazole, tetracycline, PPI
115
when would you refer PUD pt?
alarm symptoms, new onset pain in pts older than 45
116
what is cholecystits?
acute or chronic inflammation of the gallbladder
117
symptoms of cholecystitis?
RUQ pain
118
PE findings of cholecycstitis
fever | murphy's sign (deep palpation of right subcostal region causing inspiratory arrest)
119
gold standard for dx gallstones/cholecystitis?
US
120
tx for sympomatic gallstones
cholecystectomy
121
tx for asymptomatic gallstones
expectant
122
what is GERD?
recurrent episodes of reflux where gastric contents move from stomach to the esophagus
123
symptoms associated with GERD
``` heartburn acid regurg occur 30-60 min after eating nocturnal aspiration hoarseness/cough/bronchospasm ```
124
pharm tx for GERD
antacid H2 receptor antagonists PPIs
125
when would you refer a GERD pt?
``` dysphagia weight loss blood loss n/v early satiety anorexia ```
126
most common cause of lower UTIs?
E coli
127
what is bacterial colony count for dx infx
100,000
128
first line tx for UTI
bactrim 3 day | nitrofurrantoin 5 day
129
how is recurrent UTI defined?
2 in 6 mo | 3 in 1 year
130
symptoms of pyelonephritis (7)
``` chills/fever dysuria frequency urgency n/v flank/abdominal pain hematuria ```
131
PE findings for pyelonephritis
CVA tenderness | fever
132
tx for pyelonephritis
PO fluroquinolone 7 days or bactrim 14 days
133
PE urolithiasis
hematuria
134
gold standard for dx urolithiasis
non contrast CT

NCC Exam - WHNP (6 decks)

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