Review Flashcards
(464 cards)
1
Q
When viewing the chest x-ray film of a 25 year-old adult male recently diagnosed with pulmonary tuberculosis, which lobe of the lung is most likely to be affected: a lower lobes b middle lobes c upper lobes d lateral lobe
A
c. upper lobes
2
Q
A 60 year-old obese female with hx of DM type 2 is seen by the NP. She has been taking metformin 500 mg PO BID with sitagliptan (Januvia) 10 mg in the morning. She is complaining of a tingling sensation with some numbness on both her lower legs, which has been present for several months. Which of the following is recommended for his patient:
A. A1C, serum B12 level, serum folate level
B A1C, CBC with differential, creatinine
C Serum potassium, serum sodium, serum magnesium
D Fasting blood glucose, eGFR, SED rate
A
A. A1c, serum B12 level, serum folate level
3
Q
A 13 year-old is brought in by his mother. She reports that her son has rashes on his left arm for several weeks that do not itch or hurt. During the skin examination, the NP notices several 2 mm discrete smooth papules with central umbilication on the adolescent's left hand and arm. The lesions do not appear irritated. Which is the most likely diagnosis?: A Verruca vulgaris B Molluscum contagiosum C Condyloma acuminatum D Folliculitis
A
B Molluscum contagiosum
4
Q
An 18 year-old presents to the college health clinic with a two-day history of fever, malaise, myalgia, and dry cough. During the physical exam, the pharynx was erythematous with mild tonsillar hypertrophy with no exudate. There are bluish white small spots on the buccal mucosa by the second molars bilaterally. Which of the following conditions is most likely? A Rubella B Rubeola C Varicella D Herpes simplex type I
A
B Rubeola
They are describing KOPLIK spots
5
Q
A 62 year-old Asian woman is complaining of episodes of tinnitus in both ears. She denies hearing loss and vertigo. Which of the following should the NP perform initially?
A Prescribe Antivert and advise the patient to return for follow-up in one week
B Refer the patient to an ENT specialist
C Review the patient’s current medications including OTC drugs
D Perform a careful examination of the head, eyes, ears, and neck
A
C. Review the patient’s current medications including OTC drugs
*Remember “SOAPE” - Follow the steps and do NOT jump ahead.
Subjective - Review meds
Objective - Perform exam
Assessment - tinnitus
Plan - Prescribe Antivert
Evaluation - Make referral if pt does not respond or is worse
6
Q
A 40 year-old woman presents with swelling behind her left knee after running a 5K race. She deines problems with walking and bending her knees. Upon physical exam, the NP palpates a soft round cystic mass in the posterior popliteal space that is not tender to palpation. Which of the following conditions is most likely? A Baker's cyst B DVT C Lymphedema D Venous insufficiency
A
A Baker’s cyst
7
Q
A 17 year-old male college athlete presents with a complaint of a sore throat with enlarged “glands” on his neck for the past 3 weeks. He denies coryza. On PE, the posterior pharynx is bright red color with no exudate. The tonsils appear erythematous. The uvula is at midline. There is posterior cervical lymphadenopathy. The rapid strep test is positive. The NP suspects that the pt may have mono. Which of the following antibiotics is indicated for this patient?:
A Amoxicillin
B Clarithromycin
C Doxycycline
D Levaquin
A
B Clarithromycin
Never give Amoxicillin to someone with mono due to 80-90% risk for non-allergic amoxicillin drug rash.
8
Q
Mrs S is a 35 year-old female with a hx of ADD and COPD. She is complaining of headaches and nervousness. The pt is taking prescription medications and herbal teas. Which of the following is the most likely cause?:
A Isosorbide mononitrate
B Atrovent
C St John’s Wort
D Ritalin
A
D Ritalin
This is 1st line for ADD
9
Q
EYES:
_______ are larger than _______ and are darker in color
A
veins
arteries
10
Q
The ______ (and ____ ______) are responsible for central vision; Are the areas with the sharpest vision
A
macula; fovea centralis
11
Q
The ______ (CN__) contains rods and cones (photoreceptors)
A
retina; II
12
Q
The ______ of the retina are responsible for color.
A
cones
13
Q
The ______ of the retina are responsible for night vision and black and white contrast
A
rods
14
Q
Blurred disc margins are called ___________ and are a sign of increased ______ as seen in severe HTN, bleeding, tumor, swelling in the brain
A
papilledema
ICP
15
Q
Papilledema is a sign of increased ICP. Manifestations of ICP are changes in ______, _____, & _______, and _____, seizures, & ____
A
LOC, behavior, vision
headache; vomiting
16
Q
Blepharitis presents with bilateral ______ and _____ edge of the eyelids.
May have fine _______.
Is more common with seborrheic dermatitis.
A
red; swollen
scales
17
Q
Blepharitis treatment includes to ______ _____ in _____ ____ & _____ ______.
A
scrub eyelids
warm water baby shampoo.
18
Q
If an infection is suspected with blepharitis, treat with __________ _________ such as _________
A
antibiotic ointment
Cipro
19
Q
EYES:
A __________ is a traingular-shaped white to yellowish superficial growth on the _______ side and is bilateral. Is caused by long term ____ damage. Prevention is to wear sunglasses,
A
pterygium
nasal
UV
20
Q
EYES:
A ______ is a white to yellowish small round superficial lesion on EACH SIDE of the cornea, caused by long-term ____ damage. Prevention is to wear sunglasses,
A
pinguecula
UV
think of “ping-pong”. PINGuecula —> ping-pong —> BOTH SIDES of the cornea like a ping pong bouncing back and forth
21
Q
EYES: A _______ is a small PAINLESS nodule on the upper and lower eyelids
A
chalazion
THINK - Being LAZy is PAINLESS
22
Q
EYES:
There is ___ ______ needed for a chalazion. If it is large, a ____ _____ can be used QID. If persistent or recurring, refer to rule out basal cell/meibomian gland cancer, and refer to ophthalmologist.
A
No treatment
warm compress
23
Q
EYES:
A _____ _____ is a bilateral white-gray ring on edge of cornea in elderly. It DOES / DOES NOT impede vision?
A
senile arcus
does NOT
24
Q
EYES:
Senile arcus is due to _____ ______. It is a _____ finding in the elderly. If the age is > 50, check a _____ profile.
A
lipid deposits; normal
lipid
25
EYES:
A ________ is a soft yellow flat cholesterol plaque on the upper/lower lids by the inner canthus and/or palpebrum.
Order a _______ ______ profile to rule out hypercholesterolemia.
xanthelasma
| fasting lipid
26
EYES:
| A _________ can be removed by trichlorocetic acid, surgery, or lasers by a plastic surgeon.
xanthelasma
27
```
EYES:
A _______ (or "____") is an acute onset localized lesion on the eyelid that HURTS. It is a small abscess.
```
hordeolum or "stye"
| THINK - "Hordeolum - Hurts" - H ---> H
This is different from a chalazion that is painless.
28
EYES:
A hordeolum or "stye" is due to staph. Treatment is to avoid _____ _____ and to apply _____ ______ ____, as well as a possible prescription of topical eye antibiotics.
wearing makeup
| warm compresses QID
29
EYES:
| An acute onset of red eye with dried, yellow-green crusting on the eyelids upon awakening: _________ ________
bacterial conjunctivitis
30
EYES:
| Treatment for bacterial conjunctivitis is topical ophthalmic __________ every 2-4 hours for 2 days.
fluoroquinolones
31
EYES:
A very contagious acute onset of red eye in one or both eyes that is itchy and has periauricular lymphadenopathy: __________ _________
viral conjunctivitis or "pink eye"
32
EYES:
Treatment for viral conjunctivitis is to keep away from ______ for ___ _____.
A fluoroscein exam IS/ IS NOT needed?
school; one week
| IS NOT
33
EYES:
Allergic conjunctivitis features bilateral _____ eyes with increased __________ with __________ conjunctiva. May be seasonal or more frequent.
itchy
| tearing; reddened
34
EYES:
Treatment for allergic conjunctivitis is to use ____ _____ _____ and to avoid allergens. _______ may be used for short-term use only, otherwise hyperemia may occur.
cool eyelid compresses
| Visine
35
EYES:
Allergic conjunctivitis:
An antihistamine with mast cell stabilizer may be used, such as _________. Put the drops in the ________ for extra relief.
Patanol; refrigerator
36
What does Snellen 20/60 signify?
The patient can see at 20 feet what a person with normal vision can see at 60 feet
37
With a Snellen chart exam, the patient is always at ____ feet (the ____ of the result)
20
| numerator
38
By age ____ a child should have 20/20 vision
6
39
An eye exam in a patient with diabetic retinopathy will show _______ _____ ______. These are neovascularization (new and fragile arterioles) and ____________ due to the neovascularization that result in "dot and blot" hemorrhages.
cotton wool spots
| microaneurysms
40
Cotton wool spots are a symptom of ________ _________.
diabetic retinopathy
41
Symptoms of diabetic retinopathy are _____ vision, ______, and ___________ (blind spot on visual field)
blurred
floaters
scotoma
42
AV nicking is caused by ________ __________ and is where an ________ is pressing down on a _____.
hypertensive retinopathy
| arteriole; vein
43
_______ and _______ _____ arterioles are seen in hypertensive retinopathy
Copper; silver-wire
44
EYES:
_______ _______ is caused by a Herpes simplex virus or shingles of the _________ nerve (CN5) affecting the ophthalmic branch.
herpes keratitis
| trigeminal
45
Herpes keratitis:
| Classic scenario is one where the patient complains of acute onset of blurred _____, _______, and _____ in one eye.
blurred, tearing, pain
46
Herpes keratitis:
| Physical exam with fluorescein stain shows a _____-____ _____ on the cornea on the affected eye
fern-like lesion
47
Herpes keratitis:
Treatment is to ______ to _____ ASAP or ____.
Herpes culture. Will be on acyclovir for a few weeks.
refer to ophthalmologist or ER
48
EYES:
A ______ _____ has an acute onset of severe eye pain, foreign body sensation, tearing, and injected sclera. Physical exam is with ________ (lower lids).
corneal abrasion
| fluorescein ---> "Floor-lower" - FLUORescein to LOWER lids.
49
NPs never ______ an eye - send to ophthalmologist.
patch
50
Treatment for a corneal abrasion is topical _____ therapy with __________ ointment, or a _________ eye drop. For severe eye pain, narcotics can be given.
antibiotic
| erythromycin; fluroquinolone
51
Contact lens abrasions have a higher risk of infection with _________, and this is why they need to be removed every night. Topical antibiotic therapy with a __________ is recommended, and ____ patching!
pseudomonas
fluoroquinolone
NO
52
In open-angle or "primary open angle" glaucoma, ______ _______ is seen on physical exam.
disc cupping.
| Think that CUPS are OPEN to help remember.
53
Open-angle glaucoma is rarely __________. It is caused by high _____. It is seen in those of _________-_________ descent.
symptomatic
IOP
African-American
Think of "when things are OPEN, you DON'T have symptoms. But when things are closed down, you're going to see symptoms" to help remember the difference between open and closed-angle glaucoma.
54
Treatment for open-angle glaucoma is ____ ______ _____.
beta blocker eyedrops
55
Acute angle-closure glaucoma is a __________ ________.
ophthalmologic emergency
56
Angle closure glaucoma, in contrast to open-angle glaucoma, is symptomatic. Symptoms are ______ _____ ____ with decreased visual acuity, N/V, and _______ around lights.
severe ocular pain
| halos
57
angle-closure glaucoma:
| Drainage of aqueous fluid is ________, causing increased _____ which results in ischemic damage to the retina.
blocked
| ICP
58
angle-closure glaucoma - Things (in vision) are ______. Treatment is to send to _________.
hazy
| ED
59
________-_______ _______ _______ is a PAINLESS loss of central vision which often affects both eyes.
age-related macular degeneration
60
Age-related macular degeneration:
| The macula is for ______ _______ and the ______ _____ is used to test for this condition.
central vision
| Amsler grid
61
The red reflex test is a screening test for ________. No glow, dull, or white reflection are abnormal. In childhood, this could indicate a _______ _______.
cataracts
| retinal blastoma
62
Cataracts: Affects the lens of the eyes and are common in the elderly. The lens becomes progressively cloudy which affects vision. The ____ ____ will be missing from the affected eye.
red reflex
63
Cataracts:
Classic presentation is where someone presents with ______ vision, increased sensitivity to _______, poor night vision, problems with ______ while driving at night, and sees
______ around lights.
blurred;
glare
headlights
halos
64
Allergic rhinitis:
| Nasal turbinates are _____, ______, ______ and _____ with mucus discharge.
boggy, bluish, pale; swollen
65
Allergic rhinitis: First-line treatment is ________ _______ sprays such as _______ and ________
intranasal steroid
| Nasocort and Flonase
66
Allergic rhinitis: Use ______ _____ in home
HEPA filters
67
Nasal polyps: Avoid _______ (increased sensitivity)
ASA
68
Epistaxis: Two types: anterior and posterior. _______ are more common. Anterior nosebleeds are caused by bleeding at _________ __________ (lower one-third of anterior nose)
anterior
| Kiesselbach's plexus
69
Posterior nosebleeds are more _____ and the patient should go to ____.
severe
| ED
70
Treatment for nosebleeds includes instructing the patient to sit and _____ _____ and _____ _____ half of nose for ___ to ___ minutes.
lean forward; pinch lower
| 15 to 20
71
Nosebleeds treatment:
Apply topical nasal _________ such as
_______.
decongestant
| Afrin
72
Nasal septum perforation:
The cartilage does not _______.
Refer to _______.
regenerate
| ENT
73
Vertigo has many causes (benign to life-threatening conditions): __________ ______, vestibular neuritis, acoustic neuroma, multiple sclerosis, brainstem timors and bleeding
Meniere's disease
74
Meniere's disease has recurrent attacks of ________ with N/V that may last several hours
vertigo
75
Meniere's disease is a TRIAD of:
_______
_______
_______ ______
vertigo
tinnitus
HEARING LOSS
*These are the 3 cardinal S&S of Meniere's. MUST have HEARING LOSS to have Meniere's!
76
To have Meniere's, the patient MUST have ______ ______
hearing loss
77
Meinere's disease can be treated with low-salt diet, avoidance of alcohol & caffeine, and meds such as ______, dimenhydrinate, ______, Promethazine, and antiemetics
meclizine; antihistamines
78
Acoustic neuroma has a ______ onset of one-sided hearing loss with _______ that is insidious.
gradual
| tinnitus
79
Acoustic neuroma is a ______ tumor causing compression of CN 8. Treatment is _________.
benign
| surgery
80
________ is recurrent vertigo lasting under one minute caused by sudden changes in head position (looking up, lying down, getting up/rolling over in bed). May lose balance and fall.
BPPV
81
BPPV is characterized by vertigo caused by _____ _____ in _______ ________
sudden changes
| head position
82
BPPV can be remedied by adjusting the _________ ________ in the vestibular system of the ear (cochlea). This is called the _______ ______.
canalith crystals
| Epley maneuver
83
BPPV is the only vertigo that can be cured _______.
quickly
| via the Epley maneuver
84
Vestibular neuritis and labrynthitis are caused by _____ _______. Treatment is with ________ taper, meclizine, and _________.
viral infection.
methylprednisolone
scopolamine
85
Vestibular neuritis and labrynthitis have a sudden onset of severe vertigo with N/V for _____ days, with gradual lessening of symptoms.
1-2
86
A normal Weber test is where the person hears sound ______ in ______ _______
equally; both ears
| no lateralization
87
Rinne test:
Bone
Better
Blockage
When bone is better than air, there is a blockage, which means conductive hearing loss
The blockage is either serous otitis media, a foreign body, or cerumen
88
Rinne test:
| ____ conduction should be better than _____ conduction
Air; bone
89
Weber test: _________ to one side is abnormal
lateralization
90
A negative Rinne test is always considered _______.
abnormal.
91
A Rinne test that is negative means that BC > AC, which is ________.
abnormal
92
A positive Rinne test is ________ and means that ____ > ____.
normal; AC > BC
93
A "positive" Rinne test means that it is _______.
normal
94
Weber test: Example:
If sound lateralizes to the right ear, it means that the patient either has _________ hearing loss in the right ear, or ___________ hearing loss in the left ear
conductive
| sensorineural
95
Acute otitis media:
| The most objective finding is _______ ______ per ______ _______ _______.
Decreased mobility
| tympanogram flat line
96
Acute otitis media:
| Treatment for children and adults is _________.
Amoxicillin
THINK - "AOM - AMO"
Acute otitis media - AMOxicillin
97
Acute otitis media:
| If the person had antibiotics in the past month, treat with __________.
Augmentin
98
Otitis media with effusion (serous otitis media):
The TM is not ______. It may look translucent but filled with clear serous fluid and you may see fluid level and ______ ________. Mild hearing loss with ________ sounds.
red
air bubbles
popping
99
A complication of otitis media:
Acute ___________. Pain, swelling, redness behind affected ear accompanied by fever and AOM symptoms. Refer to ER for hospitalization.
mastoiditis.
100
A cauliflower-like or round white growth draining purulent and foul-smelling discharge with hearing loss, due to chronic OM. Refer to ENT. Needs antibiotics and surgical debridement. What is this? ___________
cholesteatoma
101
What is the most common bacteria of Otitis externa or "swimmers ear"?
pseudomonas aeruginosa
102
Swimmer's ear or otitis externa has ________ _____ discharge and a swollen and red ear canal. There is pain with manipulation of the pinna and/or tragus of the ear.
purulent green
103
treatment for otitis externa is ______ ______ and _________ combination such as ________ or Cipro HC. Keep water out of ear.
topical steroid
| antibiotic; Cortisporin
104
Acute bacterial rhinosinusitis:
Hx of persisent URI symptoms for 10+ days, or a cold that resolved, but symptoms return and worsens. Complains of unilateral facial pain or pressure or toothache (upper molar pain) with nasal congestion, purulent nasal discharge and/or postnasal drip.
Pathogens are strep pneumoniae and H. influenzae most of the time.
Frontal sinusitis presents with _______ _______ or pain ________ ______ eye.
frontal headache
| behind one
105
Maxillary sinusitis presents with ______ pain and ____ ______ _____ pain
facial
| upper molar tooth
106
1st-line treatment for acute bacterial rhinosinusitis is ___________. If they are allergic to PCN, then give ________. May also give symptomatic relief such as saline irrigations, nasal steroids, and NSAIDs for pain.
Augmentin
| doxycycline
107
```
Infectious mono:
Classic case:
Teenager presents with hx of:
1 __________
2__________
3__________
for several weeks.
```
1 sore throat
2 enlarged posterior cervical nodes
3 fatigue
108
The etiology of mono is the ______-______ _____.
Epstein-Barr virus
109
Epstein-Barr virus (cause of mono): EBV infection can cause __________ and _________ cancers, as well as ________ and __-____ _______. It can infect other organs such as the brain, spinal cord, optic nerve, and heart.
nasopharyngeal; oral
| Hodgkins; T-cell lymphoma
110
Mono: Testing
Monospot test is not recommended for general use b/c it produces both false positives and false negatives.
____ _____ are usually not needed for typical cases, but are the gold standard.
A _____ shows increased WBCs and __________.
Peripheral smear is _________ with the presence of atypical lymphocytes with lymphocytosis .
_____ are elevated in most patients.
EBV titers
CBC; lymphocytosis
abnormal
LFTs
111
With mono, suspect ___________/__________.
splenomegaly/hepatomegaly
112
With mono, do a _______ abdominal exam with palpation and percussion. Order an _______ ______ of the __________.
gentle
abdominal ultrasound
spleen
113
Mono treatment:
Symptomatic.
______.
Avoid _____ ______ and ______ ______.
Rest.
| contact sports; heavy lifting
114
Mono treatment:
| Patient should avoid contact sports and heavy lifting for a minimum time of _____ to ____ _______.
4 to 6 weeks
115
Oral leukoplakia:
White colored thick patch, can be cheeks, gum, tongue, etc. It is _________. If on tongue, rule out cancer of the tongue by a _________.
painless
| biopsy
116
sialolithiasis:
Salivary duct stone/calculi. White colored nodule under the tongue. Usually asymptomatic. May c/o pain _____ ______. Refer to ENT.
before meals
117
Aphthous stomatitis (canker sores)
A ______ ______ ______ ulcer on the tongue or cheeks. complains of pain with eating or drinking acidic foods.
Treatment is _______ _________ swish and swallow.
```
painful shallow annular
Magic mouthwash (viscous lido, Benadryl, Maalox ina 1:1:1 ratio)
```
118
Peritonsillar abscess/cellulitis:
Has a _____ _________ with red mass on area of tonsils. Has a high fever. Severe sore throat and _______ with _______. Refer to ER ASAP. It is a complication of pharyngitis.
displaced uvula
| pain; swallowing
119
Diphtheria:
Presents with a ____-to _______ colored _______ that is ______ to _________. Swollen neck. Refer to ER.
Notify _________ ______ department for contact tracing.
gray to yellow; pseudomembrane
hard to displace
State health
120
```
Diphtheria:
Treatment is
1_____
2____
3_____
```
1 antibiotic
2 antitoxin
3 strict isolation
121
Diphtheria:
For close contacts such as household members:
Obtain _______/_______ swabs for C. diphtheriae cultures
nasal/pharyngeal
122
Benign findings of mouth/pharynx:
______ _______: A bony protuberance/growth on the hard palate at midline
_______ _________: Uvula that is split into two sectionsn
Torus palatinus
| Fishtail uvula
123
Most common skin cancer is _______ ________ ________
basal cell carcinoma
124
Basal cell carcinoma appears ______ or _______ (___-tone) with ______ edges and __________
waxy; pearly (flesh-tone)
| raised TELANGIECTASIA
125
Actinic keratosis:
| Multiple dry scaly lesions that do not heal on areas of the skin ________ to _______ ______.
exposed; chronic sunlight
126
Actinic keratosis is treated with ______
5-Flouracil
127
Actinic keratosis is a precursor lesion of ______ _____ skin cancer
squamous cell
128
Squamous cell cancer:
Chronic _______ _______ rough textured lesion with ______ borders. Sometimes crusting or bleeding. Common locations are rim of the ears, lips, nose, face and tops of the hands. The precursor lesion is actinic keratosis.
red scaly
| irregular
129
Squamous cell cancer:
| Treatment is _____ ________ if on face/cartilage.
Moh's microsurgery
130
An important risk factor for skin cancer (both non-melanoma and melanoma) is:
_______ ________ as a child.
History of _________.
_____ skin.
Excessive chronic exposure to UV light from sun and tanning beds.
Moles.
Positive family history.
blistering sunburn
sunburns
Light
131
Important risk factor for skin cancer:
| Avoid sun exposure at the time of day when the sun is most damaging, which is from ____ to _____
10 AM to 3 PM
132
```
Melanoma:
Remember the ABCDE rule:
A
B
C
D
E
```
```
Asymmetry
Border
Color
Diameter
Evolving
```
133
Acral lentiginous melanoma is the most common type of melanoma in ______-_____ individuals. Most common locations are the ______, _______ surface, and ______ areas. Remove shoes to inspect.
Remove shoes.
Palms.
Soles of feet.
dark-skinned
| palms, plantar; subungal
134
Acral lentiginous melanoma:
| Look for _______ _______ to ____ bands on the nailbed.
longitudinal brown black
135
___________: a darkened band under or within the nail plate located on a fingernail that may be seen in Blacks, Latinos, and Asians. It can resemble subungal melanoma which can be fatal if not caught early. In Whites, rule out subungal melanoma. If this is only in ONE nail, it is _______.
melanonychia
| ABNORMAL
136
```
Bacterial meningitis:
Has an acute and rapid onset of the classic triad of:
______ _____
______ ________,
and rapid change in _______ ______
```
high fever
nuchal rigidity
mental status
137
bacterial meningitis:
| has generalized rashes ranging from ______ to ________ to purple-colored lesions (purpura)
petecchiae
| ecchymosis
138
Bacterial meningitis:
| For close contacts exposed to it, give ______ as early as possible after exposure to patient's oral secretions.
Rifampin
139
Bacterial meningitis:
| ______ (treatment) changes color of urine to reddish orange and can stain contacts. Do not give to pregnant women.
Rifampin
140
Diagnosing bacterial meningitis:
| _______ sign is for nuchal rigidity. Patient supine. Raise _______ and flex _____ toward ______.
Brudzinski
| head chin chest
141
Brudzinski sign for bacterial meningitis:
| Positive result if patient automatically _______ ______ ____
bends both hips
142
Diagnosing bacterial meningitis:
_______ sign is for the hip. Patient supine. Flex patient's hips and knees in a right angle, then slowly straighten/extend the leg. Positive result is when the patient complains of pain during ___________ or ______.
Kernig's
extension
resisting
143
MCV4 (Menactra, Menveo):
| Give one dose of Menactra or Menveo at age ___ to ___ years
11 to 19
144
MCV4 (Menactra, Menveo)
First year living in college residence halls, military recruits: Give one dose of Menactra or Menveo if never had a dose, age ___ to ___.
19 to 21
145
Rocky Mountain Spotted Fever:
Onset of fever, HA, myalgia, N/V, and anorexia. Spot-like red rashes (______) start within 2 to 5 days of fever onset, located on the ________/_______ and on the _____/_____, which spread toward the ______ and becomes generalized. Can be life-threatening.
petechiae
hands/palms
feet/soles
trunk
146
Rocky Mountain Spotted Fever:
Due to the deer/dog tick bite infected with _______ _______. States where 60% of cases are found are North Carolina, Tennessee, Oklahoma, Arkansas, and Missouri.
rickettsia ricketsii
147
Rocky Mountain Spotted Fever:
| Treatment is with ___________
doxycycline
148
Rocky Mountain Spotted Fever:
______ ____ ______ for rash to appear, start doxycycline immediately if RMSF is suspected. >20% fatality rate if not treated.
Do not wait!
149
The ticks that cause Rocky Mountain Spotted Fever are in _____ _____/____ of TN, NC, Oklahoma, Arkansas, Missouri
grassy areas / fields
150
Erythema Migrans aka Lyme Disease:
Acute onset target rash or "______-_____" shaped red-colored rash that feels hot to touch on the extremities or trunk. Some have migratory oligoarthritis (swollen red and painful joints) - the ____ _____ of the knee.
bulls-eye
| bulge sign
151
Lyme Disease (erythema migrans):
Treatment is _______.
Use DEET.
For clothing, use ________.
Doxycycline
| permethrin
152
Rosacea (acne rosacea):
Fair skinned Celtic (Irish, Scot, English) middle-aged woman with history of chronic symmetric redness, small pustules, papules, and telangiectases on central areas of the face. Easy flushing with ETOH and spicy foods.
First-line treatment is to _____ ______ of flushing.
Afterward, ________ _____ once to twice daily is indicated.
```
Avoid triggers (ETOH, excessive sun)
metronidazole gel
```
153
Rosacea (acne rosacea):
A patient with rosacea has been taking metronidazole gel for her acne rosacea and it is not working. What is the next step?
Put her on PO ___________ or ___________ daily
tetracycline or doxycycline
154
Derm Review: Primary Lesions:
| Changes in skin color (flat and non-palpable), < 1 cm. Example are freckles. What are these? _______
macules
155
Derm Review: Primary Lesions:
Palpable solid lesions < 1 cm in diameter
Ex. Comedones, acne
What are they?
papules
156
Derm Review: Primary Lesions:
Raised solid lesions > 1 cm
Ex. Basal cell cancer, hydradenitis suppurativa nodule
What are these?
nodules
157
Derm Review: Primary Lesions:
Circumscribed elevated lesions that contain pus
ex. acne pustules
pustules
158
Derm Review: Primary Lesions:
Elevated superficial blister filled with serous fluid - larger than 1 cm in size
Ex. bullous impetigo, 2nd degree burn
bulla / bullae
159
Derm Review: Primary Lesions:
Elevated raised skin lesion <1 cm in diameter and filled with serous fluid.
Ex. herpes simplex, herpes zoster
vesicle
160
Derm Review: Primary Lesions:
Solid raised lesion with flat top > 1 cm in diameter
Ex. psoriasis
plaque
161
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Thickening of the epidermis with exaggeration of normal skin lines (due to chronic itching): _____________
Lichenification
162
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Flaking skin: _______
scale
163
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Results from drying of exudate: ________
crust
164
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Eroding of epidermis and dermis (if deep, can involve subQ tissue): ___________
ulceration
165
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Permanent fibrotic change following damage to the dermis: ________
scar
166
KNOW THESE! Know how to distinguish between primary and secondary lesions!
Secondary skin lesions (changes/complications of primary lesion, skin trauma):
Overgrowth of scar tissue common in Blacks, Asians: ______
keloids/ hypertrophic scars
167
Thermal burns:
Red to bright red skin and tenderness/pain:
_________ degree (___________)
first degree (superficial)
168
Thermal burns:
Painful red skin, bullae (blisters), redeened/weepy skin:
_________ degree (________ ________)
second (partial thickness)
169
Thermal burns:
Pain sensation absent.
Pale/white color, charred skin, leather-like texture.
_____ degree (_____ _________)
third (full thickness)
170
For treatment of burns in someone allergic to sulfa, an alternative to Silvadene is ________.
Bacitracin
171
If a patient presents with thermal facial burns with soot around the nose/mouth, singed eyebrows/nasal hair/eyelashes, facial burns, and/or black particles in sputum, hoarseness, suspect _____ ______ ______. Assess for airway patency, breath sounds, wheezing, respiratory distress. ABCs are always the priority! Refer to ED. On exam will be given 4 people and asked who should be seen right away - go by ABCs!
smoke inhalation injury
172
American Burn Association defines minor burns as:
Age 10 to 50 years: < ____ % TBSA ____ _____ burns
Age < 10 or > 50 years: < ____ % TBSA ______ ____ burns
10; partial thickness
| 5; partial thickness
173
Minor burns should meet these criteria:
| Does not involve the _____, _____, _____, _____
Face, perineum, hands, feet
174
Minor burns should meet these criteria:
Does not cross ______ _____.
Is not ________.
major joints
| circumferential
175
A restaurant cook who is 22 years old is in the urgent care center for burns due to spilling hot cooking oil. On PE, the NP notes bright red skin with several bullae on the patient's left arm and chest and bright red skin on the right thigh.
1. What is the patient's diagnosis?
2. What is the TBSA?
1. Partial thickness thermal burns (2nd degree) of the left arm and chest with superficial thickness (1st degree) burns on the right lower leg and foot.
2. 36% (serious burn)
176
All of the following are true statements about thermal burns except:
1. If debris, jewelry, and/or clothing is stuck to the skin, it can be removed gently.
2. Avoid ice-cold water when cooling the skin.
3. Do not rupture intact blisters.
4. Saran wrap plastic can be used as temporary dressing for large burns until patient reaches the hospital.
1. If debris, jewelry, and/or clothing is stuck to the skin, it can be removed gently.
177
For thermal burns, do not forget to check _________ status. Analgesics can be given PRN for pain.
Td/Tdap
178
Cellulitis: The causative bacteria is ________ or _______.
streptococcus; staph aureus incl. MRSA
179
Cellulitis: Acute skin infection. Localized skin _____ with _______ __________. Skin feels warm/hot and tender.
erythema
| diffused margins
180
Lymphangitis:
Look for ______ _______ that follow _______ ________ deep under the skin emerging from the infected area (cellulitis). Go to hospital for ____ ____.
red streaks
lymphatic channels
IV abx
181
Erysipelas:
Bright red plaque or induration with sharp or well-demarcated elevated margins on the _____ or _____ ____. Uncommon. If located on the _____, refer to ER for IV abx.
face; lower legs
| face
182
Also known as a boil or skin abscess - due to an infection of a hair follicle (staph, MRSA, group A strep). Red, tender, dome-shaped lesion that drains purulent discharge when it ruptures. Patient will say they have a spider bite.
________
furuncle
"For uncle" - one spot
(carbuncle - a "car full of uncles" - more than 1 furuncle)
183
A cluster of coalesced boils which are connected subcutaneously. Tender to palpation. Common location is the area behind the neck. Purulent discharge.
__________
carbuncle
184
Furuncles and carbuncles treatment:
First-line tx of abscesses is _____ with ___ ______.
If at risk for bacterial endocarditis, give abx prophylaxis. Check _____ ______ status.
If abscess is < ____ cm in size, no PO abx needed.
I&D local anesthesia
tetanus vaccine
< 5
185
For nonpurulent cellulitis (mild), give ______ or ____ (antibiotic).
Keflex dicloxacillin
186
For purulent cellulitis (probably MRSA), do a _____ _____. Follow up within 48 hours.
Give ______ x 10 days or _________.
If osteomyelitis is suspected, or a MRI. Infections in joint spaces are NOT GOOD
would culture
| Bactrim; Clindamycin
187
Human bites:
_____ bites have the highest rate of infection (anaerobic and aerobic bacteria). Can cause infection especially if over a joint.
Hand
188
What antibiotic is used for human bites?
Early: ___________
Later: ___________ (route of administration)
Augmentin
| IV antibiotics
189
what antibiotic is used for cat and dog bites?
| _________ or _________
Augmentin Bactrim
190
Animal bites:
_____ bites have a higher rate of infection compared to ____ bites.
Evaluate need for ________ prophylaxis.
_____ booster if > 5 year interval.
Cat
dog
rabies
Tetanus
191
Bite wounds are best to have heal by _____ ______ instead of suturing, and other wounds at higher risk of infection, such as puncture wounds, crush injuries, wounds > ____ hours old, immunocompromised, diabetics, venous stasis.
secondary intention
| 12
192
Bite wounds treatment:
| ________ COPIOUSLY, debride, dress wound, check ____ (how often?) for infection
Irrigate
| daily
193
Tetanus vaccination:
The initial series for infants up to age 6 includes _____ doses.
Is needed every _____ years for lifetime.
5
| 10
194
Tetanus vaccination:
| Common reaction is ______ at _____ ______ in ____-____ hours.
pain injection site
| 24-48
195
Tetanus vaccination:
Clean minor wounds. If last tetanus dose was 10+ years ago, give one booster of ___ or _____.
For contaminated wounds, give one dose if last dose was given ____+ years ago.
Td; Tdap
| 5
196
Tetanus vaccination:
If the patient has a clean wound but the last tetanus vaccine was given > 10 years ago, give the _____ booster to "catch up"
Tdap
197
Natural disaster emergency wound management:
| Give ____ or ____ vaccine if needed
Td Tdap
198
Impetigo: Acute onset of round red rash with fragile bullae, when breaks, ______ ______ ______ form from dried exudate. Very pruritic and contagious. Usually caused by strep or staph.
honey-colored crusts
199
Impetigo treatment:
Give _________ if patient has few lesions (3 or 4).
Give __________ PO QID or _________ otherwise.
PhisoHex solution when showering
Restrict athletes from contact sports until healed (especially ________.)
Bactroban
Keflex; Azithromycin
wrestlers
200
For mildest form of acne, (non-inflammatory, open and closed comedones), first-line treatment is _________ _______
topical retinoids (all topicals, like tretinoin (Retin-A)
201
For 2nd mildest stage of acne (mild papulopustular and mixed (mild papules, pustules, comedones), give
_______,
a ______ ________,
and a ______ ________
BP (benzoyl peroxide); topical antibiotic; topical retinoid
202
For moderate acne (moderate papulopustular and mixed acne, moderate papules, pustules, and comedones):
Give Topical retinoid,
AND ________ _________
AND topical benzoyl peroxide
oral antibiotic (tetracycline, minocycline)
203
For severe acne (nodular), refer to dermatologist, consider ________.
Accutane
204
Acne treatment:
| Category C drugs are _______ ________
topical retinoids
205
Topical retinoid side effects:
| Irritation, dry skin, flaking, redness during first ____ weeks. After washing face, wait _____ minutes before applying.
4
| 30
206
Acne treatment:
Tetracycline is a Category ____ drug due to staining of tooth enamel in infants/children. Avoid before age ____. Do not mix tetracycline with ______, _____, or _____.
D
8
antacids, dairy, iron
207
Pressure ulcers:
| Stage I: ___________. NO breaks on skin. Skin may feel warm or cold.
Nonblanchable
208
Pressure ulcers:
| Stage II: Loss of _______ and _____. Is a _____ ulcer.
epidermis; dermis
| superficial
209
Pressure ulcers:
Stage III: Full thickness. Damage extends down to _____
_____ and _____ layer. _____ is present.
SubQ tissue; fat; Slough
210
Pressure ulcers:
Stage IV: Full-thickness skin loss. Ulcer with undermining and extends down to _____, ____, and _______. Wound has ______ and ______.
muscle, bone, tendon.
| eschar; slough
211
Pressure ulcers:
| If eschar or slough is present, you will be unable to _____ it until it is removed.
stage
212
A decubitus wound appears "infected". What is the best method to obtain a culture and sensitivity of the wound?
tissue biopsy - punch biopsy
213
Dressing types for pressure ulcers:
Alginates are used for ______ ulcers (moderate to heavy). The rope-like form turns to gel-like substance. It is derived from _______ ________.
exudative
| brown seaweed
214
Heel eschar:
____ _____ ______ stable, hard, dry eschar in ischemic limbs. Do not remove intact and stable eschar that is adherent, dry, and without redness or moisture.
Do not debride
215
If eschar becomes ______ (wet, drains, boggy, loose), it should be debrided. Otherwise, never debride stable eschar. Use _____ ______ to offload pressure on the heel.
unstable
| heel protectors
216
Skin tears or flaps on elderly:
1. _____ with ____ ______.
2. Afterward, approximate wound edges. Apply topical abx cream/ointment. Depending on size and location, secure with ________ _______ or use hydrogels, alginates, foam dressings, or skin glue.
Irrigate normal saline
| butterfly strips
217
Recurrent episodes of painful large, tender, red nodules, abscesses and pustules in the axilla, groin, perianal, or inframammary areas due to occlusion of the hair follicles and pilosebaceous glands. Results in multiple scars and sinus tracks in the skin and odor. Adversely effects the quality of life. Has exacerbations and remissions. What is this?
Hidradenitis suppurativa
218
Hidradenitis suppurativa treatment:
Avoid skin trauma. wear loose clothes. avoid excessive heat, friction.
Stop _______ and ______ _____.
Stop using __________.
smoking; lose weight
| deoderant
219
Hidradenitis suppurativa treatment:
For mild to moderate: ________ QD to BID for several months (due to their anti-inflammatory effects).
Topical _________ for showering daily
doxycycline or a "cycline"
| chlorhexidine 4%
220
Immune-modulated inflammatory skin disease with hx of chronic and recurrent itchy rashes that are erythematous plaques covered with fine silvery scales located over lower back and gluteal folds, scalp, elbows, knees, extensor surfaces. What is this?
psoriasis
221
Psoriasis:
| The _______ sign is when you scrape off plaque and it increases pinpoint areas of bleeding
Auspitz
222
Psoriasis:
| The _________ _______ is when a skin injury produces new psoriatic plaques
Koebner phenomenon
223
Psoriasis often manifests with ________ ______
pitting fingernails
"Pitting fingernails ---> Psoriasis" (P and P)
224
A skin manifestation of nummular, coin-shaped lesions is ______________.
psoriasis
225
Psoriasis treatment:
| _______ _________. Beware that they can cause skin atrophy and with high potency can cause _____ _____ ________.
topical corticosteroids
| HPA axis suppression
226
Psoriasis treatment:
Adults: Initially a moderate potency such as _______.
Infants, face, intertriginous areas: low-potency such as _____________
Kenalog
| hydrocortisone 1%
227
Psoriasis treatment:
For thicker-skin areas such asa scalp and soles of feet, use a ______-potency topical steroid such as ________ in solution/foam/shampoo
high
| flucocinonide
228
Psoriasis treatment:
| Topical retinoids: Tazorac is a Category ___ drug
X
229
Psoriasis treatment:
| PUVA is a combo of psoralen oral med (derived from ____) combined with _____ ____ therapy
tar
| UVA light
230
Psoriasis treatment:
| Systemic Cat X drugs: ________ and Acetritin
Methotrexate
231
Psoriasis treatment:
TNF-a inhibitors such as Enbrel suppress immunity and there is a risk of ___ _______, severe bacterial infection, etc. Check chest-x-ray, CBC, avoid _____ vaccines.
TB reactivation
| live
232
Eczema vs atopic dermatitis:
Eczema is always _________. Contact dermatitis can be located anywhere on the body.
Eczema is on the classic locations of hands, _____ side of elbow/knees, neck, face.
symmetrical/bilateral
| flexural
233
Eczema:
Avoid ____ clothes.
Avoid _____ skin. Use emollients immediately after taking a shower.
Avoid bathing in _____ _____.
Use kitchen rubber gloves when dishwashing.
wool
dry
hot water
234
What is Rhus dermatitis?
Contact dermatitis caused by poison ivy. Has lots of blisters. Zanafel.
235
Severe generalized pruritis that is WORSE AT NIGHT and family members have the SAME SYMPTOMS is _____.
scabies
236
Scabies:
Locations on the body include sides and _____ of _____, ______,
__________ area, and
________
web of fingers
wrist - flexor aspect
periumbilical
penis
237
Scabies in an immunocompromised person can involve entire skin. ________ scabies involves crusting and is very infectious but not pruritic, and can look like psoriasis. For this type, treat with ________ PO with topical permethrin
Norwegian
| invermectin
238
A _____ rash appears serpenginous, excoriated, crusted, scaly, and vesicular.
serpenginous
239
Scabies:
| ______ contacts must be treated
close
240
Scabies - permethrin -
| Leave on for ____ to ____ hours, then rinse off. Repeat in ___ to ____ _____.
8 14
| one to two weeks
241
Scabies:
| _________ lotion is neurotoxic and contraindicated in pregnancy, infants, children <10 yrs old, seizures.
Lindane
242
A "herald patch" which is round to oval pink with fine scales from 2 to 5 cm in size, and in 1-2 weeks smaller rashes appear on the trunk area that follows a "Christmas tree" pattern, and is asymptomatic, is ________ ______. It resolves in 1-2 months.
Pityriasis rosea
243
dermatophytes (____ _____) cause superficial skin infections. The name is based on the location of infection. Scrape lesions and send for fungal C&S. KOH smear will show _______ and _____.
Tinea fungi
| hyphae; spores
244
______ ______ is a fungal infection on the scalp. It's scaly round patches that itch. The hair becomes fragile at roots and break (black dot sign). May have inflamed lesions which can result in permanent patchy alopecia (kerion).
Tinea capitis
245
Tinea capitis is treated with __________.
Griseofulvin
246
_______ ______ is a fungal infection on the body with annular red rash with scaling that slowly enlarges with central clearing. Pruritic.
tinea corporis
247
Tinea corporis (ringworm) is treated with _______ ________ treatment.
azole topical
248
______ _______ is a fungal infection of the groin. It is erythematous annular that sometimes extends to the buttocks. Usually associated with tinea pedis. It is treated with ______ _______ treatment.
Tinea cruris
| azole topical
249
______ ______ is a fungal infection of the feet/hands with scaling on the soles. There is another type where skin feels wet, strong odor vesicles and bullae that rupture "two feet and one hand" disease (dominant hand that is used for scratching the feet becomes infected too)
Tinea pedis
250
Tinea pedis is treated with either ______ or ______ creams.
terbinafine; miconazole
251
___________ ________ is a rash caused by a superficial fungal infection (dermatophytes). Areas are HYPOPIGMENTED or light brown color. Located on the chest, shoulders, and back. May itch.
tinea versicolor.
| Think "versiCOLOR" - hypoPIGMENTED
252
Tinea versicolor - on lab microscopy with KOH slide, look for _______ and _____.
Is treated with ketoconazole shampoo.
***Tinea versicolor is also treated with _________ _______ (______ _____ lotion)
```
hyphae; spores
selenium sulfide (Selsun Blue)
```
253
Herpes whitlow (herpes simplex) HSV 1 or HSV 2 infection is an abrupt onset of small red papules/bumps which become vesicular. Extremely painful, tingling, burning sensation. Usually located on the index finger or thumb. Treated with rest, elevation, and NSAIDs. The cheapest antiviral to treat this is _____ _____.
ORAL acyclovir.
| NOT topical cream! It is very expensive!
254
Paronychia with abscess: Acute infection of the cuticle or soft tissue around the fingernail. The infected area appears red and swollen with purulent exudate trapped under the cuticle area. Treatment is ______ with ____ ____ to drain abscess. Soak finger TID with _____ ____.
I&D; #11 scalpel
| epsom salt
255
How is subungal hematoma treated?
| By ________.
trephination.
Use #18 gauge needle and heat up tip. Position straight at 90 degrees and apply steady pressure until blood starts to drain. Remove. Press nail gently to evacuate the blood. May lose nail, but it usually grows back.
256
Systemic lupus erythematosus:
Chronic autoimmune multisystem disease that affects nearly all organs of the body. Cause is unknown. More common in women. May have concurrent Raynaud phenomenon. Presents with a ____ (____) _____. The ANA is usually positive. Usually has lymphadenopathy and joint swelling, pain, optic neuritis.
malar (butterfly) rash
257
Systemic lupus erythematosus:
| Is treated with SPF ___ or >, and _________.
55; Plaquenil
258
A skin condition caused by the poxvirus. Has DOME-SHAPED LESIONS WITH CENTRAL UMBILICATION (WHITE PLUG). More common in children, spread by skin to skin contact. Can be an STD in sexually active teens/adults if found in genitals (test for STDs). What is this?
_________ ________
molluscum contagiosum
259
Treatment for molluscum contagiosum is ________ _______
watchful waiting
260
Rubella (3-day measles or "German measles"):
Can cause major birth defects if the mother is infected in the first 12 weeks of ehr fetus's development.
A pregnant woman has a negative rubella titer. When should the MMR be administered?
Only in the postpartum period or later! NEVER during pregnancy!
261
Rubeola:
About 2-3 days before onset of rash (prodromal period), tiny white spots or small white papules appear on the buccal mucosa, called _______ ________.
Koplik's spots
*** Think rubeOla - kOplik ---> both have an O.
Rubella does not have an "O".
262
Name this infection/condition:
About 2-3 days before onset of rash (prodromal period), tiny white spots or small white papules appear on the buccal mucosa. About day 3-5, a papulosquamous rash appears first on the face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. When rash appears, fever may spike to 104.
Rubeola
263
Auscultation areas for murmurs:
| Aortic valve area:
2nd ICS, RIGHT sternal border
264
Auscultation areas for murmurs:
| Pulmonic valve area:
2nd ICS, LEFT sternal border
265
Auscultation areas for murmurs:
| Erb's point (diastolic murmurs):
3rd ICS, LEFT sternal border
266
Auscultation areas for murmurs:
| Mitral area: (diastolic)
5th ICS by the MCL
| the APEX!!!!
267
First-line diagnostic test for murmurs:
echo with doppler
268
```
Systolic murmurs:
Pneumonic is MR ASS is an MVP" which stands for:
MR:
AS:
S:
MVP:
```
mitral regurgitation
aortic stenosis
systole
mitral valve prolapse
269
Name the cardiac murmur:
Blowing or high-pitched holosystolic/pansystolic murmur that may radiate to the LEFT AXILLA. Is at the apex of the heart, 5th ICS by the MCL:
mitral regurgitation
270
***Name the cardiac murmur:
A SYSTOLIC ejection murmur. May radiate to the NECK.. At the 2nd ICS by the right upper sternum, at the base (top) of heart:
Aortic stenosis
271
Name the cardiac murmur:
| Mid-SYSTOLIC click with late systolic murmur at the apex, 5th ICS by the MCL:
Mitral valve prolapse with regurgitation
272
```
Diastolic murmurs:
Pneumonic is "MS ARD-e" which stands for:
MS:
AR:
D:
e:
```
mitral stenosis
aortic regurgitation
diastole
Erb's point
273
Name the cardiac murmur:
Low-pitched diastolic rumbling murmur that is loudest at the apex. Dyspnea is the most common symptom. A-fib is common. At the 5th ICS by the MCL.
Mitral stenosis
274
Name the cardiac murmur:
| Early diastolic decrescendo blowing murmur. Best heard at 3rd and 4th ICS at the left sternal border (Erb's point).
Aortic regurgitation
275
```
A 70 year-old reports a history of rheumatic fever as a child. She reports being short of breath when climbing up the stairs during the past few months. During the cardiac exam, the NP hears a low-pitched diastolic rumbling murmur with a loud S1 heart sound that is best heard in the apex. Which of the following is most likely?
1 Aortic regurgitation
2 Mitral stenosis
3 Mitral regurgitation
4 tricuspid regurgitation
```
2 Mitral stenosis
276
```
During the routine physical exam of a 60 year-old female, the NP notices a late diastolic murmur. It is a high-pitched decrescendo murmur that is located on the 3rd ICS at the left sternal border (Erb's point). Which of the following is most likely?
1 Aortic regurgitation
2 mitral stenosis
3 mitral regurgitation
4 tricuspid regurgitation
```
1 Aortic regurgitation
277
```
A medium-pitched harsh mid-systolic murmur best heard at the right side of the sternum at the second ICS of the chest. It radiates into the neck. Which of the following is most likely?
1 Aortic stenosis
2 pulmonic stenosis
3 aortic regurgitation
4 mitral stenosis
```
1 Aortic stenosis
278
Heart sounds: S1 to S4:
S1= Systole
S2= Diastole
S3 = _____ _______ (_______ _______)
Early diastole (ventricular gallop)
279
S3 indicates _____ ________. It is more common in ________/______ _______.
HEART FAILURE
| CHILDREN/YOUNG ADULTS
280
S3 (early diastolic heart sound) is a ____ ______ during pregnancy. It is abnormal after the age of ____.
normal finding
| 40
281
S4 indicates ____ ______. The most common cause is _____. Can be a normal finding in the elderly.
late diastole.
| LVH
282
S3 and S4 - how to remember who they are common in:
| "3 is less than 4" - S3 is the ______, S4 is the ______.
children; elderly
| Children are younger than elderly
283
***Murmurs: Grading system:
Important to focus on just grades I - IV for exam.
Grade I: Heard only at ________ _______ (no thrill)
Grade II: _____ to _____ murmur (no thrill)
Grade III: _____ murmur that is ______ _____ (no thrill)
Grade IV: ______ ______ _____ is _______
optimal conditions
mild to moderate
loud; easily heard
First time thrill is palpated
284
*** A-fib:
Evaluate each patient for need of antithrombotic therapy (____ ____ _____ raises risk).
***INR SHOULD BE ___ to ____!
heart valve abnormality
| 2 - 3
285
*** A-fib:
Classic presentation is someone who complains of sudden onset of heart palpitations accompanied by weakness, dizziness, fatigue, dyspnea. They may complain of chest pain and feeling like passing out (pre-syncope to syncope). Rapid and irregular pulse may be more than 110 per minute with hypotension. Is the _____ _______ arrhythmia in the US. People with a-fib should NEVER take __________!
most common
| stimulants
286
A-fib:
| Use the _________ score to assess for a-fib stroke/emboli risk.
CHA2D2-VASc
287
A-fib and the CHA2D2-VASc score: (see p. 39)
What are the highest risk factors to start anticoagulation?
________ history and ______
stroke/TIA/thromboembolism hx
| Age 75 or older
288
A-fib and the CHA2D2-VASc score:
If score equal to or > ____, (moderate to high risk), recommend chronic anticoagulation with coumadin, Pradaxa, Xarelto, or Eliquis. Those with valvular problems can ONLY have ________.
2
| warfarin
289
A-fib and chronic anticoagulation:
Factor Xa inhibitors do not require regular blood testing or dietary restrictions (Pradaxa, Xarelto, Eliquis). Warfarin not only requires INR monitoring (needs to be 2-3), but also has drug interactions. People in warfarin CANNOT take _______ durgs!
Sulfa
290
Factor Xa inhibitors drug interactions:
| ________, _________, and _____ reduce absorption
Antacids, H2 blockers, PPIs
291
Warfarin drug interactions:
______ drugs
_______
NSAIDS
Sulfa
| macrolides
292
What is warfarin used for?
Valvular and non-valvular A-fib
293
Warfarin: It takes ___ to ___ days for INR to change.
2 to 3
294
Warfarin:
| _______ is an antagonist
Vitamin K
295
```
Warfarin education:
Too much vitamin K will decrease INR. High vit K foods are
B
C
B
G
M
```
```
broccoli
cabbage
brussel sprouts
green leafy vegetables
mayonnaise
```
296
Warfarin dosing - Adjustments of maintenance dose:
INR 3.1 to 4.0 without presence of bleeding - decrease maintenance dose by ____% per week.
INR 4.1 to 5.0 without presence of bleeding -
_____ ____ dose. ______ weekly dose by ____%.
10%
| Hold one; Decrease 10%
297
PSVT: Abrupt onset of palpitations that end abruptly. Initial treatment is usually ______ _______. Attacks last a few seconds or several hours. Heart rate of ____ to ____ beats/minute.
vagal maneuvers
| 160 to 240
298
pulse deficit:
| Count the ____ and ____ radial pulses at the same time, then subtract the difference between the two.
apical; radial
299
Pulsus paradoxus:
| Defined as a decrease in the systolic BP of > ___ mmHg during _______.
10
| inspiration
300
pulsus paradoxus:
Certain pulmonary and cardiac conditions that compress the chambers of the heart (impair diastolic filling) can cause exaggerated decrease of the systolic pressure of more than 10 mm Hg (a drop of less than _____ mmHg is NOT pulsus parodoxus.
Cardiac cause: cardiac tamponade, pericardial effusion, acute MI, constrictive pericarditis
Pulmonary cause: severe _______, tension pneumo, emphysema
10
| asthma
301
Orthostatic hypotension:
A decrease in the systolic BP of at least ____ mmHg or the diastolic BP of at least ____ mm Hg within ___ minutes upon standing which may be accompanied by symptoms such as lightheadedness, dizziness. The best way to check BP to detect orthostatic hypotension is in the ______ and _____ positions
20
10
3 minutes
supine and standing
302
Impending AAA rupture;
| Elderly male who is a _____ or ___-______. C/O sudden onset of severe abdominal pain accompanied by severe ___ ____ pain
smoker; ex-smoker
| low back
303
What is the most common cause of sudden death in young healthy athletes?
hypertrophic cardiomyopathy
304
During sports physical ask if there is a family hx of _______
cardiomyopathy
305
Acute infective endocarditis (bacterial endocarditis):
| _____ presents in 90% of patients, chills, anorexia, malaise, night sweats, weight loss. About 95% have _____ _____.
Fever
| heart murmurs
306
Acute infective endocarditis (bacterial endocarditis):
| Some patients have petechiae, splinter hemorrhages in nailbed, _______ ____, ____ ____, or ____ ____.
Janeway lesions
Osler's nodes
Roth spots
307
Endocarditis PROPHYLAXIS:
1st-line: _______ __ hour before procedure
PCN-allergic: Either _____, ____, or ______.
Is post-treatment prophylaxis recommended?
Amoxicillin; 1
Keflex; Cleocin, Zithromax
NO
308
Endocarditis prophylaxis for high-risk patients:
______ ____ ____, hx of infective endocarditis, many cyanotic congential heart diseases, ______ _____, or other stigmata of endocarditis (Osler's nodes, etc)
Prosthetic heart valves
| heart failure
309
Endocarditis prophylaxis procedures:
D
A
B
dental work
adenoidectomy (and tonsillectomy)
bronchoscopy (or any invasive resp. tract procedure)
310
HTN is a major risk factor for stroke, MI, vascular disease, an d CKD. Rule out SECONDARY HTN if:
A
T
R
Age (< 30 when diagnosed) or > 50
Target organ damage
Renovascular cause
311
```
HTN target organ damage:
P
U
L
C
H
K
```
```
PVD
UA with protein, RBCs
LVH
Carotid plaques
Heart failure
Kidneys
```
312
HTN secondary hypertension causes:
| ______ ______ stenosis
renal artery
313
Renal artery stenosis (causes of secondary hypertension - NEVER use ____ or _____ (antihypertensives)
Presents with a ____ in the _____ _____/flank or ____ kidneys
ACEIs or ARBS
bruit; upper abdomen
enlarged
314
Renal artery stenosis:
Diagnostic testing includes ______ _____ ultrasound, creatinine, and renal function.
The ____ kidney is always lower than the left.
Duplex doppler
| right
315
Secondary hypertension:
Pheochromocytoma:
Triad: ______, _______, and ______. Random episodes. Gradually resolves within hours.
headache, sweating; tachycardia
316
Secondary hypertension:
Cushing's:
Classic findings of abdominal obesity with proximal muscle wasting (large abdomen with skinny arms and legs) with roundish face and acne. Striae red to purple color on the breasts, abdomen, arms, thighs, dorsal hump. Ask patient if taking __________.
Labs are late-night salivary ______ and 24-hour _____ _______ _______.
steroids
cortisol
urinary free cortisol
317
Addison's disease causes the opposite of HTN. It is aka primary adrenal insufficiency, hypocortisolism. Severe loss of cortisol and aldosterone. Craving of ______ foods, ______ face, knuckles, palmar creases, wrists. Fatigue, N/V, diarrhea, weak muscles, ________.
salty
hyperpigmented
hypotension
318
Addison's disease:
Labs show elevated ______, low ________. Dx lab is morning serum ______, salivary cortisol, ______ stimulation tests, basal renin, and aldosterone levels.
potassium; sodium
| cortisol; ACTH
319
Coarctation of the aorta can cause secondary hypertension. Normally, the SBPs of the legs are higher than arms. In coarctation of the aorta, the BP is ______ in the legs.
lower
320
```
Other causes of secondary HTN:
S
E
N
D
```
Stimulants
Estrogens
NSAIDs
Diet
321
American College of Cardiology (ACC) vs JNC-8 for staging of HTN:
ACC JNC-8
normal < ____ normal < ______
elevated (preHTN) ___-___ ____ to _____
Stage 1 ___ to ____ _____ to _____
Stage 2 ____ to ____ ____ to _____
ACC JNC-8
normal < 120 <120
elevated 120 - 129 120 - 139
Stage 1- 130 - 139 140 - 159
Stage 2- > or equal to 140 > 160
322
How should BP be measured?
Measure after patient has _____ ____ _____.
Support arm (resting on a table)
Measure BP in ___ ____, and use _____ reading arm for measurements afterward.
Take 2 readings per visit 1-2 minutes apart and _____ readings.
emptied their bladder
both arms; higher
average
323
How to diagnose HTN:
Two readings taken at least one minute apart and average them, taken on __ to ___ separate visits.
If BP is > _____/_____ or higher, the patient has HTN.
The goal BP for most patients is < ____/____
2 to 3
130/80
130/80
324
ACC recommendations for HTN:
| 1st-line treatment is _________.
Lifestyle
325
```
ACC recommendations for HTN:
1st line treatment is lifestyle to include:
weight loss
heart healthy diet (DASH)
restrict sodium
increase _____
reduce alcohol
exercise
```
potassium
326
Lifestyle plus medication for tx of HTN:
Diabetic, CKD, hx of MI, ACS, stroke, CKD
High risk of ASCVD (10 year ASCVD risk of ___% or higher).
Pay more attention to _______ status and psychosocial stress as risk factors for HTN.
10
| socioeconomic
327
What drugs should be avoided with patients who have HTN, arrhythmias, seizures, stroke, mania, post-MI?
Any _________.
stimulants
328
JNC-8 HTN tx guidelines:
| For CKD and diabetes BP of 140/90, include _____ or ____
ACEI or ARBs
329
JNC8 guidelines in treating BPs 140/90 in
Blacks: _____ and ______
Non-blacks: ______, _____, ____, and ____. (____ work for everyone)
CCBs and thiazides
| thiazides, ACEIs, ARBs, CCBs. (CCBs work for everyone)
330
ACC's goal for BP is < ____/_____ (this is their definition of HTN)
130/80
331
BP treatment for HTN in someone with SOB and JVD (heart failure) is ______ or ______ once stable.
ACEI or ARB
332
If question asks about treatment for HTN with heart failure, pick ____ or _____
ACEIs or ARBs
333
ACC recommends an ______ for tx of HTN in those with a-fib
ARB
334
ACC recommends ______, ______, and/or _____ in treating HTN in pregnancy.
Avoid ACEI, ARB
methyldopa, nifedipine, and/or labetalol
335
Thiazide diuretics work by increasing excretion of Na+, K+, and chloride, and decreasing ______ _______ excretion
urinary calcium
336
Thiazides:
| ________ is a longer-acting choice
Chlorthalidone
337
```
Side effects of thiazide diuretics:
H
H
H
H
```
hyperglycemia (careful with DM)
hyperlipidemia
hyperuricemia (can precipitate gout)
hypokalemia and hyponatremia
338
Thiazide diuretics help with osteoporosis by ______ ______ ____ _____ of ________. It has a favorable effect on bone mineral density and long-term use decreases risk of _______ fractures.
slowing down urinary excretion; calcium
| hip
339
Thiazide diuretics:
| Do not use in people with severe _______ allergy
sulfa
340
Thiazide diuretics:
| Contraindicated in those with _______.
gout
341
Loop diuretics examples:
| ________ and ________
Lasix, Bumex
342
Potassium-sparing diuretics:
S_________
A_______
T_________
spironolactone
amiloride
triamterene
343
Potassium-sparing diuretics:
Contraindications:
________
hyperkalemia
344
Avoid combining potassium-sparing diuretics with _____/_____.
ACEI/ARBs
345
Can you give a patient with a true sulfa allergy HCTZ?
NO. Use a K+-sparing diuretic like triamterene
346
An adverse effect of spironolactone includes
| __________ and hyperkalemia
galactorrhea
347
All ______ should be on an ACE
diabetics
348
What is a rare adverse event with ACEI/ARBs that may be life-threatening?
Angioedema
349
Beta 1 receptors are in the ______ and ______
heart; kidneys
| "ONE heart"
350
Beta 2 receptors are in the ______, liver, GI tract, uterus, muscle
lungs
| TWO lungs
351
Beta blockers: Do NOT ________ ________.
discontinue abruptly; wean slowly.
352
beta blockers: acute withdrawal can cause exacerbation of _______ symptoms
ischemic
353
```
Beta blockers:
Adverse effects:
B
B
E
D
```
bronchospasm (b/c lots of beta receptors on lungs)
bradycardia
exacerbation of PAD
depression, fatigue, ED
354
HTN and COPD - do NOT use ____ _____!
beta blockers
355
Beta blockers contraindications:
H
H
B
Heart failure.
heart block
bradycardia
356
***Diabetic patients on beta blockers: Can blunt or worsen the __________ ________.
hypoglycemic response
357
Calcium channel blockers are indicated for HTN, ________ HTN, _________, cardiomyopathy, and ______ ______ prophylaxis.
pulmonary; Raynaud's
| migraine headache
358
Calcium channel blockers:
______ are more potent vasodilators and have little to no negative effect on cardiac contractility or conduction. Used for HTN and chronic stable angina.
Suffix: PINE
Dihydropyridines
359
Calcium channel blockers:
___________ have a greater depressive effect on cardiac conduction and contractility. Less potent vasodilators. Used for HTN, chronic stable angina, arrhythmias. Ex. Verapamil, diltiazem.
non-dihydropyridines
360
Calcium channel blockers:
Contraindications:
_____ _____
____ _____
heart block
| heart failure
361
Calcium channel blockers:
Side effects:
______ and ________
edema; constipation
362
alpha-1 blockers: blocks alpha receptors in peripheral arterioles resulting in profound peripheral vasodilation
Relaxes smooth muscles in the ______ and _____ & can therefore treat both HTN and ______.
prostate; bladder
| BPH
363
BPH can be treated with both ______ and _______
terazosin; doxazosin
364
Do NOT mix CCBs with _______ _______, b/c it can elevate serum levels of verapamil, felodipine, nifedipine, nicardipine, etc
grapefruit juice
365
Dizziness and postural hypotension can result after starting _______ __ _______.
Alpha 1 blockers
366
Peripheral arterial disease or Chronic venous insufficiency?
| Shiny pale skin on the lower leg. Hairless and dry skin.
peripheral arterial disease
367
Peripheral arterial disease or Chronic venous insufficiency?
brawny to brown color. thicker skin. lymphedema. pitting edema. pigmentary changes (hemosiderin). varicose veis, spider veins in lower extremity
chronic venous insufficiency
368
Peripheral arterial disease or Chronic venous insufficiency?
| Pedal and posterior tibial pulse decreased to non-palpable. Increased cap refill time
Peripheral arterial disease
369
Peripheral arterial disease or Chronic venous insufficiency?
palpable pusles
no gangrene.
Venous leg ulcers esp on the medial malleolus delayed healing
Chronic venous insufficiency
370
Peripheral arterial disease or Chronic venous insufficiency?
| Intermittent claudication. Painful. If severe, rest pain, gangrene, LE ulceration
Peripheral arterial disease
371
Peripheral arterial disease or Chronic venous insufficiency?
| Aching sensation and lower extremity heaviness that worsens as day progresses
Chronic venous insufficiency
372
Peripheral arterial disease diagnosed when ankle-brachial index on duplex ultrasound is < ____.
1.0
373
Peripheral arterial disease or Chronic venous insufficiency?
| Treatment is CV risk reduction (statins), smoking cessation, long-term antiplatelet treatment, revascularization surgery
Peripheral arterial disease
374
Peripheral arterial disease or Chronic venous insufficiency?
Treatment is ASA 300 mg daily, pentoxifylline, horse chestnut extract, compression hose therapy, elevate legs above heart x 30 min 3-4 times daily
Chronic venous insufficiency
375
***Peripheral arterial disease or Chronic venous insufficiency?
Exercise by walking daily helps develop collateral circulation
Peripheral arterial disease
376
With peripheral arterial disease, exercising by walking daily helps ______ ______ ______.
develop collateral circulation
377
Chronic venous insufficiency: Elevate legs to decrease swelling. Leg exercises such as ______ and _____ ____- (not prolonged)
walking
| ankle flexion
378
Peripheral arterial disease:
| Do NOT ___ _____ ____!
wear compression hose
379
What is the ankle brachial index used for?
| To evaluate the severity of _____ ________ in ___.
arterial blockage; PAD
380
How is the ankle brachial index performed?
BP cuff measures the resting _______ of the ankle compared to the _____ of the brachial artery.
Anything < ____ is abnormal.
SBP
SBP
1.0
381
DVT:
Classic presentation is swelling of affected limb accompanied by erythema. May be painful or asymptomatic. Lower leg/calf circumference difference of > ___ cm.
> 3 cm
382
If a person has a positive _______ sign, then they have a DVT! (for the exam only)
Homan's (pain on dosiflexion of foot)
383
How is calf circumference measured?
| Measure ____ ___ below the ______ _____.
10 cm; tibial tuberosity
384
Superficial thrombophlebitis:
Venous inflammation caused by thrombosis of a superficial vein. More common on the LE. Caused by IV catheter, injury, septic. Usually benign/self-limiting. Classic case is red and ____-____ superficial vein (______, _____ _____) that is painful and tender to touch. May mimic cellulitis. If septic phlebitis, refer to ED.
cord-like
| indurated, palpable cord
385
Superficial thrombophlebitis:
Treatment depends on causation. If septic, 50% mortality rate, large of severely inflamed, refer to hospital. Mild cases can be treated with ____ and ______. _____ _____ or ACE bandages.
NSAIDS; ASA
| compression stockings
386
Primary Raynaud's disease is mostly seen in _______.
females
387
Primary Raynaud's disease:
Adult female complains of recurrent episodes of cold, numb, and painful fingertips triggered by _____ ____ and/or ______. Finger and toes change color (white, blue, red) which resolves ________. Higher risk with __________ ________.
cold weather
stress
spontaneously
autoimmune disorders
388
What med is used to treat Raynaud's symptoms?
| ______ _______ _______ (long-acting) such as ____ or _______.
calcium channel blockers
| nifedipine; amlodipine
389
Heart failure symptoms:
| Left = ____ (orthopnea, PND, cough with pink, frothy sputum, edema)
lung
390
Heart failure symptoms: _____ = RUQ (GI)
right (side)
391
Heart failure - which side is failing - right or left?
| Orthopnea, PND, cough with pink, frothy sputum, edema
left
392
Heart failure - which side is failing?
| PE shows S3, crackles, decreased breath sounds, wheezing
Left
393
Heart failure - which side is failing?
PE shows JVD, enlarged liver, enlarged spleen
CXR shows enlarged heart size, interstitial edema
right
394
Heart failure - which side is failing?
| symptoms of anorexia, nausea, RUQ pain and lower extremity edema
Right
395
Preferred treatment (1st line) for heart failure is _____ ______ once patient is stabilized.
ACE inhibitor
396
***NYHA Functional Capacity for patients with heart disease:
Fill in the symptoms for each classification:
Class I:
Class II:
Class III:
Class IV:
Class I: NO limitations of physical activity by symptoms
Class II: Ordinary physical activity results in fatigue, dyspnea, or other symptoms
Class III: Marked limitation in normal physical activity
Class IV: Has symptoms at rest or with any physical activity
397
What is the "gold standard" for diagnosing STEMI or NSTEMI?
EKG
398
Which leads correspond to anterior wall (in diagnosing MI)?
V2 and V3
399
Hypercholesterolemia:
| Total cholesterol goal is < ____. Value of ____ is high.
< 200; 240
400
Lipid profile: LDL should be < ____
For DM, goal should be _____.
If no risk factor, LDL < ____ is acceptable.
100
70
129
401
Lipid profile:
| HDL goal is > ____ for men and > ____ for women
40; 50
402
Triglycerides: should be < ____
150
403
When triglycerides are > ____, the primary goal is to LOWER THEM FIRST to prevent pancreatitis before addressing the ___ cholesterol
500
| LDL
404
What is 1st-line tx for dyslipidemia?
| Therapeutic ______ ________, avoid alcohol, weight loss, exercise. If trigs >800, consider drug therapy
lifestyle changes
405
What are first-line MEDS for high triglycerides?
fibrates
| Statins and fish oils are more for LDLs
406
Fibrates:
| fenofibrate, gemfibrozil. Do not combine gemfibrozil with _________ due to risk of _______ failure
statins; hepatic
407
Avoid or be very careful with combination of statins and ______ it increases risk of hepatotoxicity and rhabdomyolysis
niacin
408
A contraindication to fibrates is ________ dysfunction, _________ disease, severe _____ disease
hepatic; gallbladder; renal
409
Bile acid sequestrants:
| Common side effects are _______, bloating, _____ pain
flatulence; abdominal
410
Which drug class is best at lowering LDL levels?
statins
411
The test for rhabdomyolysis is ______ _______
creatine kinase
412
For a patient with VERY high LDL (190 or > but no ASCVD risk), or ASCVD or equivalents such as hx of MI, CAD, CVA, TIA, the treatment is with a ______ ________ ______ such as _______ or _________
high intensity statin
| Lipitor or Crestor
413
Moderate-intensity statins are indicated for those with ________, LDL ____ to ______, or older than 75 years or not a candidate for high-intensity statin
diabetes
| 70 to 189
414
The most common cause of death for diabetics is ______ _______
heart disease
415
What is this?
Sudden onset of dyspnea and cough, which may be productive with pink-tinged sputum. Tachycardia, pallor, feelings of impending doom.
pulmonary emboli
416
How is anaphylaxis treated in the outpatient clinic?
epi 1:1000 IM or subQ before calling 911 if NP is alone.
417
*** anaphylaxis is what type of allergic reaction?
Type I IgE-mediated
418
Right lung has ___ lobes
| Left lung has ___ lobes
3
| 2
419
Normal respiratory drive responds to _______ in _____ ____
changes arterial CO2
420
Lung Auscultation:
Base/lower lobes have ____ breath sounds
Bronchi/upper airways have _____ to _____ breath sounds
vesicular
| bronchial to bronchovesicular
421
Lung percussion:
Resonant is ________.
Dull indicates _____ _____ or over _____, _____, or ____.
Hyper-resonant indicates _________.
normal
lobar pneumonia
bones, liver, heart
emphysema
422
Name this physical exam technique:
| Patient will say "99" - palpate both sides on the back - use finger pads (one hand over each lung and compare sides)
tactile fremitus
423
upper airways:
More fremitus (vibrations) in the lower lobes is _________.
Increased fremitus on one lobe indicates:
Decreased fremitus indicates:
normal
lobar pneumonia
emphysema/COPD
424
Egophony is when the patient says "____" and it sounds like "___". This is _______.
eee
aaa
abnormal
425
The patient says "eee" and it sounds like "aa". This is ______ egophony and indicates ______ ______ over affected lobe (_________).
positive; lobar pneumonia
| consolidation
426
USPTF recommendation lung cancer screening recommends Adults age ____ to ____ years old with a ___ pack-year or __ - __ pack year history have an annual screening
55; 80
| 30; 40 - 50
427
A 30 pack-year history means a person smoked ___ pack per day for ____ years
one
| 30
428
***USPTF recommendation for lung cancer screening is a ___-_____ ____ ___ ____ for adults aged 55 to 80 with a 30 or 40-50 pack-year history
low-dosed helical CT scan
429
What is a pack-year?
Multiply the number of packs smoked per day by the # of years the person has smoked.
430
***What is the definition of COPD?
| What is the O2 sat in COPD?
A FEV1/FVC ratio of < 70% of expected diagnostic
| < 92%
431
How does COPD look on a chest x-ray?
hyperinflation/hyperexpansion with increased chest size and flattened diaphragms
432
Name the condition:
| Irreversible loss of elastic recoil of the lungs and alveolar damage.
COPD
433
Severity of airflow limitation is staged for COPD using the _____ criteria.
GOLD Global Strategy of the Diagnosis, Management, and Prevention of COPD
434
Chronic bronchitis: Defined as chronic _____ with increased _____ _____ on most days for at least ____ months per year for at least ____ consecutive years
cough
mucus production; 3
2
435
Chronic bronchitis has a copious amount of ____ to ____ color sputum
whitish
| yellow
436
Emphysema has an increased _____ ____, and ____ breath and heart sounds.
Expiratory phase is markedly ______.
_____-_____ breathing is helpful.
AP diameter; decreased
prolonged;
Pursed-lip
437
Physical exam findings in emphysema include:
Percussion: _______
tactile fremitus:__________
Egophony: ______
hyperresonant
decreased
decreased
438
Name the condition:
| Acute onset fever/chills with productive cough of yellow to green to rusty colored sputum and pleuritic chest pain
Community-acquired pneumonia
439
with community acquired pneumonia, rusty/blood-tinged sputum is indicative of: ________ ________
streptococcus pneumoniae
440
with community acquired pneumonia, on physical exam the lung sounds will be ______/_____, _______, and ______ sounds
crackles/rales; wheezing
| bronchial
441
With ccommunity-acquired pneumonia, if consolidation is present, there will be positive ______ ______,
______, and
____ _______
tactile fremitus
egophony
whispered pectroliquy
442
***A pneumonia with lobar consolidation is indicative of _______ pneumonia
bacterial
443
The gold standard in diagnosing pneumonia is a ______ ____ with ____ and/or _____ _____ accompanied by clinical signs and symptoms
chest x-ray; infiltrates; lobar consolidation
444
After treating pneumonia, repeat chest x-ray in ___ _____ especially in high risk patients like _______.
6 weeks; smokers
445
In a RML pneumonia, there will be _______ (_____ _____ color) at middle lobe of right lung.
consolidation (white opaque)
446
Labs for pneumonia will show a WBC > 11.0 and elevated ________ (> ___%) with a ____ ____ (>__% increase) in _____ cells
neutrophils; 70%; left shift; 6%
| band
447
For pneumonia, the ______ score is used to determine if the patient should be treated inpatient or outpatient. If score is > ___, should be hospitalized.
CURB65
| 1
448
```
CURB65 score for determining inpatient vs outpatient treatment:
C
U
R
B
____ years or older
```
```
Confusion
Urea - BUN > 19
Resp rate > 30
BP - systolic < 90
Age 65
```
449
*** The most common causes of community-acquired pneumonia are:
1.
2.
1. strep pneumoniae
| 2 H. influenzae
450
Pathogens of community-acquired pneumonia:
Most common cause of death is:
_______ ______
strep pneumoniae
451
```
Pathogens of community-acquired pneumonia:
___ _____ (smokers, COPD)
```
H. influenzae
452
Community-acquired pneumonia OUTPATIENT treatment:
| 1st-line: ________
macrolides - Azithromycin, clarithromycin
453
Community-acquired pneumonia OUTPATIENT treatment IF patient had abx within last 3 months:
______/______ PLUS __________/________
Alternative:
______
azithromycin/clarithromycin
amoxicillin/Augmentin
doxycycline
454
Atypical pneumonia/Mycoplasma pneumonia:
Top 2 atypical bacteria are:
1
2
1 mycoplasma pneumoniae
| 2 chlamydia pneumoniae
455
Name the process identified by this classic case scenario.
Presents with malaise, fever, headache, myalgias, non-productive cough sometimes accompanied by sore throat, sinus congestion, or acute AOM. Chest x-ray shows bilat infiltrates. Breath sounds progress to rales/rhonchi, and/or wheezes within a few days
atypical pneumonia
456
According to the Infectious Disease Society of America and the American Thoracic Society Treatment Guidelines, all of the following are false statements regarding the diagnosis of outpatient cases of CAP except:
1. Demonstrate infiltrate on CXR is necessary to diagnose CAP.
2. An increase in the neutrophils and a shift to the left is necessary to diagnose CAP
3. A positive sputum culture is necessary to diagnose CAP
4. Routine microbiologic diagnostic testing to identify the causative organism is mandatory for outpatient cases of CAP per IDSA.
1. Demonstrate infiltrate on CXR is necessary to diagnose CAP
457
To diagnose pneumonia, the CXR must show:
demonstrable infiltrate on chest radiograph
458
The gold standard to diagnose pneumonia is the _____
CXR
459
Most common bacteria in pneumonia post-influenza is _____ ______ & ______ _______
strep pneumoniae & staph aureus
460
A viral URI (the ____ ____) is of the nose and pharynx only. Duration of __ to __ days with spontaneous resolution.
Physical exam: Lungs are clear; rhinitis with _____ mucus
common cold
7; 10
clear
461
Treatment for the common cold includes symptomatc only. Includes dextromethorphan for cough, ________ for nasal congestion, and ______. Increase fluids and rest.
pseudoephedrine
| guiafenesin
462
Acute bronchitis:
Recent hx of common cold. Paroxysmal or severe coughing x __ ______ or longer.
Cough is dry or sometimes productive of _____ phlegm. Caused by adenovirus, flu, chlamydia pneumoniae
2 weeks
| clear
463
Bronchitis: Symptomatic treatment - no antibiotics!
Antitussives: dextromethorphan, Tessalon Perles, honey
Wheezing: albuterol inhalers
Mucolytic: __________
guiafenesin
464
Name the condition:
| Chronic airway inflammation that results in hyperresponsive airways and bronchoconstriction which is REVERSIBLE
asthma
