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AANP Review > SM > Flashcards

SM Flashcards

1
Q

Which findings would make you refer the patient to a gastroenterologist?

A

Unintentional weight loss is a red flag in this patient that would warrant referral for an EGD. Some other red flags for Barrett’s esophagus or esophageal cancer would be difficulty or painful swallowing, bleeding, or early satiety. Common presentations of GERD including heartburn that may mimic chest pain and a dry cough. Alcohol use can put the patient at higher risk for worsening GERD so this statement would require patient education. The patient is on omeprazole which is a proton pump inhibitor and the most effective class out of our first line options. However, if the patient can no longer afford a PPI, we could trial an H2 blocker instead.

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2
Q

Acute pancreatitis

A

Patients experience a sudden onset of acute upper abdomen pain, which they often state radiates to their back. As the pancreatitis progresses, they may have bruising on their flank (Turner’s sign) and/or around their umbilicus (Cullen’s sign). These patients need to go to the emergency room for prompt treatment.

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3
Q

Patient presented with several concerns including RUQ pain. He states that he is a daily drinker what would be our priority lab?

A

Aspartate aminotransferase (AST)/ Alanine transaminase (ALT), he states he is having RUQ pain, and is a heavy drinker, so checking liver function would be a priority.

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4
Q

Quadruple therapy is used to treat H. pylori infections in areas where there is high antibiotic resistance.

A

Quadruple therapy for treatment of H. pylori includes Metronidazole (Flagyl), Tetracycline, a proton pump inhibitor and bismuth subsalicylate (Pepto-Bismol). Quadruple therapy can be used in those who have failed triple therapy or have persistent H. Pylori. It is also utilized in areas of high antibiotic resistance to the components of triple therapy.

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5
Q

Risk factors for cholecystitis

A

The four main risk factors for cholecystitis are being
- female
- being over 40 years of age,
- being overweight,
- being fertile.

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6
Q

Triple therapy for treatment of H. pylori may include which of the following drugs

A

Traditional triple therapy for H. pylori consists of a proton pump inhibitor, Amoxicillin and Clarithromycin. Metronidazole can be utilized instead of Amoxicillin if patient allergies are present.Triple therapy is a 14 day treatment of antibiotics followed by 2-4 continuing weeks of the PPI.

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7
Q

First-line medications for gastroesophageal reflux disease (GERD)

A

Proton pump inhibitors (PPI). The most common PPIs are pantoprazole (Protonix) and omeprazole (Prilosec).

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8
Q

Psoas sign

A

While lying supine and raising her right leg against resistance. A sign that is positive as it elicits abdominal pain is suspicious for appendicitis.

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9
Q

Markle test

A

markle test is performed by having the patient jump or drop their heels suddenly if you feel pain suspect appendicitis.

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10
Q

Obturator sign

A

elicited by internally rotating the right hip while monitoring for right lower quadrant pain if its positive you should suspect appendicitis.

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11
Q

Risk factors for colorectal cancer requiring earlier or more frequent testing

A
  1. family history of a first degree relative with colorectal cancer
  2. irritable bowel disease- either Crohn’s disease or ulcerative colitis, and colonic polyps
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12
Q

At what age does the The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screening

A

between ages 50-75 years.

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13
Q

Treatment of diverticulitis

A

Mild cases of diverticulitis can be treated in the outpatient setting, with close followup. If the patients worsen or do not improve in 48-72 hours on antibiotics and a clear liquid diet, they should be referred to the emergency department. Augmentin (amoxicillin/clavulanic acid), or ciprofloxacin with flagyl (metronidazole) are the antibiotics of choice.

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14
Q

Where is the pain in diverticulitis located

A

Pain with diverticulitis is localized to the left lower quadrant, and may be accompanied by a change in bowel habits and nausea or vomiting.

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15
Q

Patient eligibility prior to starting Zofran.

A

EKG because it can cause QT
prolongation.

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16
Q

Ulcerative colitis (UC)

A

Ulcerative colitis (UC) is an inflammatory bowel disease that affects only the colon. Patients will present with bloody diarrhea, often with mucus. Abdominal pain, weight loss, and fatigue are all common symptoms of UC as well. Another key clue in this question is her history of ankylosing spondylitis - this condition is found in 15-40% of patients with UC.

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17
Q

Signs and symptoms of gastroenteritis.

A

Nausea, vomiting, and stomach pain

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18
Q

Gastroenteritis treatment

A

Bland diet, increased water intake, and Zofran (Ondanestron). Increased water intake and a bland diet (breads, bananas, applesauce) are recommended in treatment of gastroenteritis to prevent dehydration and promote gut rest in order to allow for recovery of the patient. Zofran can also be prescribed to help with nausea.

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19
Q

Magnesium carbonate (Magnesite) side effects

A

Diarrhea and hypotension, but may help with leg cramps and headaches.

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20
Q

Crohn’s disease

A

Crohn’s disease is a type of inflammatory bowel disease (IBD)
characterized by “skip lesions” which are throughout the GI tract. It can also be characterized by fistulas and strictures throughout the intestines.

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21
Q

Will you need to write down the normal lab values as soon as you see them on AANP

A

YES, THEY ONLY GIVE THE NORMAL ONCE AND ASSUME YOU KNOW IT THERE AFTER.

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22
Q

JNC 8 hypertension guidelines,

A
  1. Patients less than 60 years old do not need treatment with antihypertensives until the blood pressure reaches >140/90.
  2. In patients 60 years old or greater, we do not need to initiate antihypertensive treatment until their blood pressure is >150/90 according to the JNC 8 guidelines. here are variations in these cutoffs if the patient has either diabetes or chronic kidney disease.
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23
Q

What should be check prior to starting this patient on a HMG-CoA Reductase.

A

The nurse practitioner should get a baseline CK level.

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24
Q

Which type of murmurs radiate

A

Only systolic murmurs radiate

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25
Q

Where does a systolic Mitral regurgitation murmur radiate

A

Axilla

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26
Q

Mitral regurgitation is a systolic murmur that radiates to the axilla where can it be heard best

A

At the apex of the heart

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27
Q

What is the goal blood pressure in this patient according to AHA/ACC guidelines

A

The goal blood pressure in patients is <130/<80 mmHg.

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28
Q

According to AHA/ACC guidelines what would be considered stage I hypertension

A

Stage 1 hypertension is a blood pressure of 130-139/80-89 mmHg and we would initiate antihypertensives if the patient’s ASCVD risk score was 10% or greater.

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29
Q

According to AHA/ACC guidelines what would be considered stage II hypertension

A

Stage 2 hypertension is ≥140/90 mmHg.

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30
Q

What ASCVD risk score would we start treatment of hypertension medications

A

10% or greater

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31
Q

When would be a good time to start a patient on high-intensity statins

A

patients with LDL >190, high risk conditions such as cardiovascular diseases, diabetes, or CKD. Patients over 65 years old should also be considered for high intensity statins.

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32
Q

Rhabdomyolysis

A

muscle proteins start to break down and be released into the bloodstream

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33
Q

What is the biggest risk factor with Rhabdomyolysis

A

Renal failure

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34
Q

What is a good blood pressure medication to use in patients with osteoporosis

A

thiazide diuretics

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35
Q

Which of the following drug classes does Aspirin (Bayer) belong to

A

Antiplatelet

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36
Q

Which of the following drug classes does warfarin or heparin belong to

A

anticoagulant

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37
Q

What does over fifty percent of infective endocarditis relate to

A

IV drug use

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38
Q

What valve is affected with IV drug users

A

IV drug users typically have their Tricuspid messed up

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39
Q

What blood pressure medication would you want to avoid in a patient with an heart failure comorbidity

A

Amlodipine (Norvasc) because of issues with swelling

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40
Q

What ABI score indicates PAD

A

A score of less than 0.9 indicates peripheral arterial disease.

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41
Q

Raynaud’s treatment

A

Typically calcium channel blockers

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42
Q

How do we treat a Diastolic murmur in primary care

A

WE DONT THEY ARE ALWAYS SENT OUT! Refer the patient to a cardiologist for further evaluation

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43
Q

Risk factors for peripheral arterial disease

A
  1. BMI of greater than 30
  2. Diabetes mellitus
  3. Atherosclerosis
  4. Cerebrovascular disease
    Smoking is the biggest risk factor for PAD, but conditions like hypertension, diabetes, heart disease, and hyperlipidemia can all put this patient at an increased risk.
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44
Q

What are symptoms of acute drug-induced hepatitis in a patient that started a statin a few weeks ago

A

Abdominal pain coupled with the jaundiced sclera are clues that his high intensity statin is causing acute hepatitis, and we would need to draw liver function test on patient to see where they are at.

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45
Q

What is the antidote for acetaminophen (Tylenol)

A

N-acetylcysteine

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46
Q

How could we check for heart failure

A

1: Echocardiogram
2: Brain Natriuretic Peptide (BNP) level
3: Chest x-ray
4: electrocardiogram (EKG)
5: CBC and CMP

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47
Q

PAD signs and symptoms

A

intermittent claudication where there is pain in the lower extremities that is quickly relieved with rest. The lower extremities may also be cool to touch with decreased pedal pulses and non-healing ulcers.

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48
Q

Normal hemoglobin level

A

12-18 with women being on the lower end and men being on the higher end.

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49
Q

Hematocrit to hemoglobin ratio

A

3/1

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50
Q

Normal Hematocrit level

A

36-54% or 3x the hemoglobin

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51
Q

Normal MCV level

A

80-100

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52
Q

What is always helpful when deciding between anemias

A

MCV

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53
Q

What is a low MCV known as

A

Microcytic Anemia and its normally Iron deficiency anemia

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54
Q

Most common symptom of any type of anemia

A

Fatigue

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55
Q

What is the biggest risk factor for Iron deficiency anemia in the 1st year of life

A

Cows milk

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56
Q

Macrocytic anemia

A

MCV greater than 100

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57
Q

What are some examples of macrocytic anemia

A

B12 and folate

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58
Q

How are we going to tell the difference between B12 and Folate anemia

A

Its going to be based off symptoms like B12 will have neurological symptoms such as paresthesias, which is numbness and tingling in the hands and feet, but in B12 neurological symptoms it could be gait or memory that is affected.

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59
Q

What surgery typically leads to B12 deficiency anemia

A

Patients that have had gastric bypass or some stomach altering surgery because of the loss of the intrinsic factor.

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60
Q

What diabetes medication if used long term can lead to B12 deficiency

A

Metformin

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61
Q

What are microcytic anemias

A

Iron and lead anemia

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62
Q

Normal lead level

A

less than 5 an abnormal level will be greater than 5

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63
Q

Signs and symptoms of lead intoxication

A

cognitive delays and behavioral problems

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64
Q

Mnemonic to remember our microcytic anemias

A

L = Lead
I = Iron
T = Thalassemia

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65
Q

What is a normal total cholesterol

A

Less than 200, this is the total cholesterol in the blood, things that impact our total cholesterol is smoking, diet, and physical activity.

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66
Q

HDL

A

40-60 and the higher end is better

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67
Q

LDL

A

less than 100

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68
Q

Triglycerides

A

less than 150

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69
Q

How often should we order a standard lipid profile on a patient

A

Every 5 years unless they are having symptoms, how alot of risk factors, or they are already being trated.

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70
Q

Which is our bad cholesterol LDL or HDL

A

LDL

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71
Q

The main culprit for atherosclerosis that clogs up arteries.

A

LDL

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72
Q

Which is our good cholesterol HDL or LDL

A

HDL, and its cardio protective and helps us remove cholesterol from the body.

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73
Q

Mnemonic to remember our macrocytic anemias

A

F= Folate
A= Macrocytic Anemia
B= B12

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74
Q

What does our Triglycerides tell us

A

Its a really good indicator of insulin resistance and true dietary intake.

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75
Q

Triglycerides greater than 500 put us at a increase risk for

A

Pancreatitis

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76
Q

What is always important before starting a Statin

A
  1. Always ask about muscle pain
  2. LFTs
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77
Q

Rhabdomyolysis

A

You want to get a CK level, if its rhabdo it will be 5x the normal limit. YOU WILL DC THE STATIN

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78
Q

What can Rhabdomyolysis lead to

A

Acute renal failure.

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79
Q

What two organs do we worry about statins messing up

A

Renal and liver

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80
Q

What lab do you monitor for warfarin

A

INR

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81
Q

Therapeutic INR for someone on warfarin

A

2-3

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82
Q

Warfarin antidote

A

Vit K

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83
Q

If a patient was to come in with a INR less than 10 but not bleeding how would we proceed

A

Hold a dose and adjust the dose

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84
Q

If INR is greater than 10 what do we do?

A

Give them Vit K, PO or IV depends if they are actively bleeding. Even if its only 5 or 6 if they are actually bleeding we are going to give them vit K.

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85
Q

What two labs can we use to evaluate the pancreas

A

Amylase and Lipase

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86
Q

What are the two main labs to evaluate the liver

A

AST and ALT

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87
Q

What two labs are inflammatory markers

A

ESR and CRP

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88
Q

What does a D-dimer test for

A

Blood clot

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89
Q

Diabetes diagnosis

A

6.5 or greater

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90
Q

What random plasma glucose level is suggestive of diabetes

A

Greater than 200 with symptoms

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91
Q

What level on the 2 hour glucose tolerance test is suggestive of diabetes

A

200 or greater

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92
Q

When is Fenofibrate used

A

Fenofibrate is especially effective at protecting the pancreas when triglycerides are >500.

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93
Q

Fundoscopic exam findings in patients with HTN

A

Copper wire arterioles, AV nicking, and flame hemorrhages

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94
Q

Fundoscopic exam findings in patients diabetes

A

In a patient with diabetic retinopathy, we may see cotton wool spots, neovascularization, or microaneurysms.

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95
Q

If we had a patient come in with papilledema what would we do?

A

Papilledema could indicate a number of things like a dangerously, extremely high blood pressure, increased ICP, brain tumor, etc. They would need to go to the ER ASAP.

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96
Q

What are Thiazide diuretics known to cause

A
  1. Hyperglycemia
  2. Hyperlipidemia
  3. Uric acid
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97
Q

What sorts of food contain high levels of vitamin K.

A

Turnip greens, beef liver, and mayonnaise its important to follow these guidelines because This is because vitamin K is the antidote to warfarin, and can reverse the patient’s international normalized ratio (INR.) Foods high in vitamin K,

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98
Q

What category is ACE Inhibitors

A

Category D, this is not safe to give in pregnancy

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99
Q

How could we attempt to correct supraventricular tachycardia in a primary care practice

A

The patient should be instructed to perform a Valsalva maneuver as described in the correct answer. This maneuver stimulates the vagus nerve and slows the conduction through the atrioventricular node, which in turn lowers the patient’s overall heart rate.

100
Q

Differential diagnoses for chest pain

A
  1. Hiatal hernia
  2. Pericarditis
  3. Peptic ulcer
    4.
101
Q

What is pulsus paradoxus

A

occurs when there is a decrease in blood pressure by greater than 10 mmHg specifically on inhalation. Pulmonary causes include severe COPD exacerbations, pulmonary embolism, obstructive sleep apnea, status asthmaticus, etc. Severe hypovolemia can also create this pressure change due to lack of circulation.

102
Q

Which of the following murmurs would be the most likely for the nurse practitioner to be able to palpate a thrill?

A

mitral stenosis is a diastolic murmur, and they are normally loud enough to hear a thrill. We do not treat in primary care they are sent to Cardio.

103
Q

Systolic murmurs are considered benign in nature. Do you typically here a thrill with them?

A

No

104
Q

What are some Systolic murmurs

A

Mitral regurgitation, aortic stenosis, and mitral valve prolapse are all systolic murmurs

105
Q

JNC 8 guidelines

A
  1. Guidelines for hypertension state that a patient less than 60 years old or those with chronic kidney disease (CKD) or diabetes need treatment with antihypertensives starting at ≥140/90 mmHg.
  2. A goal blood pressure in these patients is <140/90 mmHg once they have started treatment.
  3. In patients 60 years or older without chronic kidney disease or diabetes, treatment with antihypertensives are initiated at a blood pressure ≥150/90 mmHg. A goal blood pressure for these patients is <150/90 mmHg.
106
Q

What patients is it contraindicated to use Amiodarone (Pacerone) in?

A

patients with thyroid disorders

107
Q

Symptoms of a second degree AV heart block

A

fatigue, dyspnea, chest pain, syncope, and even sudden cardiac arrest

108
Q

What heart medications are not to be given in second degree AV heart block

A

Calcium channel blockers, such as Diltiazem (Cardizem), are contraindicated in patients with second degree, and some other meds are Other medications that should be avoided in these patients include digoxin and beta blockers.

109
Q

The gold standard of diagnosis for an abdominal aortic aneurysm

A

Abdominal ultrasound

110
Q

Patients who should receive prophylactic antibiotics prior to dental procedures

A

Past history of infective endocarditis, those with a prosthetic valve, and transplant patients with a valvulopathy. For those patients, it is appropriate to administer amoxicillin (Amoxil) approximately 1 hour before the procedure.

111
Q

Who are at risk for developing a pulmonary embolism

A

patients who are immobile, taking estrogen therapy, have clotting abnormalities (such as Factor V Leiden thrombophilia)

112
Q

Penicillin uses

A
  1. Pregnancy safe
  2. Pneumonia, otitis media, group A strep, sinusitis, animal bites, mastitis
113
Q

Amoxicillin (Amoxil) which is a PCN is good for treating what things?

A
  1. Pneumonia if they meet the criteria
  2. Acute otitis media if no ABX in the last month
  3. Group A strep
  4. Can be used for sinusitis but Amoxicillin/clavulanate potassium (Augmentin) penetrates the bones better so often is the first choice.
114
Q

Amoxicillin/clavulanate potassium (Augmentin) this is also a PCN is good for treating?

A
  1. Sinusitis
  2. Dog Bites
  3. Acute otitis media if they have HAD ABX in the last month
115
Q

PENICILLIN G (BICILLIN) IM is often given for what

A

Syphilis

116
Q

Dicloxacillin (Diclocil) which is a PCN, is good for what

A

Mastitis

117
Q

What are some other ABX that can be given for Mastitis

A
  1. Cephalexin
  2. Keflex
  3. Clindamycin ( lots of GI side effects)
118
Q

If a patient has a allergy to PCN can they still receive cephalosporins?

A

Yes, if their reaction is not Ige mediated.

119
Q

Cephalosporins overview
- Pregnancy category B they are safe

A
  1. Most start with Ceph or Cef examples; Cephalexin (Keflex), Cefdinir (Omnicef)
  2. Treatment for; Infected post-op wounds, Otitis media ( if the patient has had ABX in the last month, treatment for sinusitis if first line has failed, skin complaints.
    • Cephalexin & Keflex is used for above the waist skin complaints.
  3. Ceftriaxone (Rocephin) IM is used to treat Gonorrhea.
120
Q

Macrolides Overview
- Pregnancy category B they are safe

A

All the MYCIN’S (Azithromycin, erythromycin)
* MACROLIDE = Mycin
* Always remember just because one macrolide causes n/v does not mean they are will. These are known for GI side effects. Its not a allergy
- MACROLIDES are 1st line treatment for
1. Pneumonia if they met the correct criteria
2. They can also be used for group A strep, but not first line.

121
Q

Pregnancy category B

A
  1. PCN
  2. Cephalosporins
  3. Macrolides
122
Q

Pregnancy category C

A

Sulfonamides
Fluoroquinolones

123
Q

Sulfonamides (Trimethoprim/sulfamethoxazole) AKA Bactrim

A
  • Can be used to treat UTIS
    - Bactrim is commonly used for uncomplicated UTI’s.
  • Also is ok to use in other below the waist skin complaints such as purulent cellulitis

** They need to be educated BIG BIG BIG WARNING if that develop a rash to let us know, because of Stevens Johnson syndrome. **

124
Q

Stevens Johnson syndrome

A

Starts with flu like symptoms and turns into a rash and goes into blisters, the entire top layer is being peeled off and shedded, its very painful and can be dangerous.

125
Q

Sulfa allergy what can you not take

A

Bactrim

126
Q

Tetracyclines
- Cycline

** Examples: Doxy,

A
  • Not pregnancy safe
  • Side effects N/V/D and photosensitivity!!! WEAR SUNSCREEN
  • Can be used to treat
    1. Pneumonia ( if they meet criteria)
    2. Rocky mountain/ Lyme disease
    3. Purulent Cellulitis
    4. Chlamydia= Doxy
127
Q

Chlamydia & Gonorrhea

*** We do not CO-treat these still according to the CDC we only treat if they tested positive.

A
  1. Chlamydia= doxy is now 1st line
  2. If your patients has Chlamydia & Gonorrhea= Doxy for the Chlamydia, and they will need the IM Rocephin for the Gonorrhea.
128
Q

Tetracyclines and children

A

when they are given to children we need to educate the parents about teeth staining.

129
Q

Fluoroquinolones
- Floxacin’s
** Examples: Ciprofloxacin, Levofloxacin (Levaquin)

HEEL PAIN REPORT ASAP

A

*** This is HEAVY duty ABX ( we save this til we really really need it)
* Pregnancy category C
** 1st line in
- UTI’s Cipro 1st line
- Pneumonia if they meet the criteria like asthma, copd, heart failure, or other co-morbidities or have been treated in the last
- Travler’s diarrhea
- Diverticulitis
- Chronic prostatitis

130
Q

What blood pressures would be considered stage 2 hypertension according to the AHA/ACC guidelines?

A

According to the AHA/ACC (American Heart Association and American College of Cardiology) guidelines,.a blood pressure of 120-129/<80 mmHg would be considered an elevated blood pressure. Stage 1 hypertension is a blood pressure of 130-139/80-89 mmHg and we would initiate antihypertensives if the patient’s ASCVD risk score was 10% or greater. Stage 2 hypertension is a systolic pressure ≥140 or a diastolic pressure >90 mmHg. The goal blood pressure is <130/80 mmHg with the AHA/ACC guidelines.

131
Q

What would the nurse practitioner expect to see on an EKG that reveals atrial fibrillation?

A

The EKG of patients with atrial fibrillation will reveal absent P waves and will be irregularly irregular, or have variable intervals between QRS complexes. With atrial fibrillation, QRS complexes are narrow rather than wide. If an EKG reveals P waves embedded in the QRS complexes, the likely diagnosis is supraventricular tachycardia (SVT) while inverted T waves usually indicates ischemia.

132
Q

What is the criteria for metabolic syndrome? Select all that apply by choosing two of the following answer choices.

A
  1. Diagnostic criteria for metabolic syndrome includes the following: Waist circumference greater than 35 inches in women and 40 inches in men.
  2. Triglycerides greater than 150 mg/dL, HDL less than 50 mg/dL in women and 40 mg/dL in men.
  3. Blood pressure greater than 130/85 mmHg and fasting blood sugar greater than 110 mg/dL.

***A patient must meet three or more of the criteria to be diagnosed with metabolic syndrome.

133
Q

signs of diabetic retinopathy on the physical exam

A

neovascularization and microaneurysms

134
Q

Addison’s disease symptoms

A

fatigue, weight loss, nausea, vomiting, abdominal pain, myalgia, hypotension, and hyperpigmentation.

135
Q

Addison’s disease overview. Everything is low except K+.

A

Addison’s disease, is in charge of producing cortisol and aldosterone. Aldosterone then regulates sodium retention and potassium excretion in the body. When this system is impaired in Addison’s disease, it results in electrolyte abnormalities including
** hyperkalemia (normal K+ 3.6- 5.2)
** hyponatremia ( Normal 135-145)

136
Q

Hyperparathyroidism presenting signs

A

Abdominal pain, nausea, vomiting, fatigue, confusion, muscle weakness, and bone pain

137
Q

Presentations of iron deficiency anemia

A
138
Q

When assessing peripheral neuropathy in a diabetic patient, which of the following tests would be the most appropriate to perform

A

Monofilament test

139
Q

The nurse practitioner has elicited a positive Chvostek’s sign by tapping the face near the ear where the facial nerve runs.

A

A positive sign is when the patient elicits facial twitching and is indicative of hypocalcemia.

140
Q

Systemic lupus erythematosus (SLE)

A

malar rash, arthritis in two or more joints, photosensitivity, nasal/oral ulcerations, serositis, renal disorders, neurological disorders, immunological disorders (platelet count <100,000/m), cardio-pulmonary involvement and a positive antinuclear antibody test.

141
Q

Flagyl

A

Used to treat
- Trich
- BV
-Diverticulitis
- Giardia

142
Q

what is the big thing you need to educate with Flagyl

A

DO NOT DRINK CAN CAUSE A RASH

143
Q

CLINDAMYCIN

A

USED TO TREAT PURULENT CELLULITIS
*** AT RISK FOR FATAL COLTIS
** CAN CAUSE C DIFF SUPERINFECTION

144
Q

NITROFURANTOIN (MACROBID)

A

This is first line treatment for UTI ( so is bactrim and Cipro)

145
Q

Vanco

A
  • current 1st line for C-Diff
  • treatment in MRSA
146
Q

Vancomycin Side effects

A
  • Ototoxicity
  • nephrotoxicity
  • RED MAN SYNDROME
147
Q

Rifapin

A

Turns pee red and all other secretions
liver toxicity monitor LFT

148
Q

What ABX are used to treat purulent cellulitis

A

B= Bactrim
C= Clindamycin
D= Doxy

149
Q

Mechanism of action for this medication?empagliflozin (Jardiance) f

A

This class blocks glucose reabsorption by the kidneys and therefore increases glucosuria

150
Q

PCOS increases risk for many complications,

A

Infertility, type 2 diabetes, ovarian, and endometrial cancer, coronary heart disease,

nonalcoholic fatty liver disease, and central obesity.

151
Q

What can Radioactive iodine lead to

A
  1. swollen salivary glands
  2. bone marrow suppression
  3. infertility
152
Q

Sulfonylureas

A

Sulfonylureas such as Glipizide cause weight gain due to the increase in insulin levels throughout the body. In addition, the weight gain associated with thiazolidinediones is largely due to fluid retention.

153
Q

Metformin work by

A

This medication decreases gluconeogenesis and decreases insulin resistance

154
Q

Left ventricular hypertrophy and uncontrolled hypertension often-times lead to what heart sound

A

s4

155
Q

Pantoprazole (Protonix) and omeprazole (Prilosec)

A

Are the most common PPI

156
Q

Ulcerative Colitis

A

Ulcerative colitis (UC) is an inflammatory bowel disease that affects only the colon. Patients will present with bloody diarrhea, often with mucus. Abdominal pain, weight loss, and fatigue are all common symptoms of UC as well. Another key clue in this question is her history of ankylosing spondylitis - this condition is found in 15-40% of patients with UC.

157
Q

Gastroenteritis signs and symptoms

A

Nausea, vomiting, and stomach pain

158
Q

Treatment for Gastroenteritis

A

Bland diet, increased water intake, and Zofran (Ondanestron)

159
Q

Crohn’s disease

A
  • Type of inflammatory bowel disease
  • *skip lesions** This is a KNOW NAME FOR THIS
  • Other common signs can include watery diarrhea with or without blood and mucus, weight loss, fever, and fistulas.
160
Q

AHA/ACC guidelines these are more strict

A
  • Normal l120/80 or less
  • Elevated 120-129 greater than 80
  • Treatment for them will be life style modifications

Stage 1: 130-139/ 80-89
- Assess ASCVD risk to determine whether to start medications or not.
- stage 1is all about ASCVD risk

Example 118/86 they are stage 1 HTN because the diastolic blood pressure

Stage2: > 140 or > 90
- Start meds no matter what

GOAL BLOOD PRESSURE ONCE WE ARE TREATING HTN LESS THAN 130/80

161
Q

Go to meds for HTN

A

Ace, ARBS, CCBs, and Thiazides

162
Q

Ace-I (Prils)

A
  • Dry, hacking cough
  • Possible angioedema
  • Risk for hyperkalemia same with ARBS
  • May see a slight worsening in kidney function initially.
  • Discontinue
    • GFR drops > 30% or below 30
    • Cr increases > 30%
  • This ARE NOT GIVEN TO PREGNANT WOMEN
    ** These are renal protective
    ** We need to monitor renal function closely
163
Q

Thiazide diuretics
*** Preferred in Black patients

A

** May increase three things
1. Uric acid
2. Triglycerides
3. Glucose
** Do not use in patients with GFR less than 30
***This med is good for patients with osteoporosis messes with the calcium in the urine.

164
Q

CCB
*** Preferred in black patients

A

Calcium channel blockers have two classes
1. Dihydropyridines (Pine) endings
- Ex: Amlodipine (Norvasc)
2. Non- dihydropyridines NEVER GIVE TO A PATIENT WITH HEART FAILURE!!!!!
-Verapamil (Verelan)
- Diltiazem (Cardizem)

**Main S/E; Edema/Headache
** Really should avoid in a patient with history of GERD because of vasodilation it can make things worse.
**

165
Q

Complications of HTN

A

***Microvascular (if diabetes is present)
1. Retinopathy
2. Neuropathy
3. Nephropathy

*** Macrovascular “big things”
1. MI
2. Stroke
3. Heart failure

166
Q

Fundoscopic exam with HTN

A

**Papilledema send them to out big concern
** AV nicking
*** Copper wire arteries
these can be reversed with BP control

167
Q

How often should renal function be checked in a patient with HTN

A

Annually if they have issues more.

168
Q

Hypertension highlights

A

*** Stage 1 or greater, start meds with ASCVD risk > 10% so if we have a pressure of 131/79 and their risk is 10% or greater you will go ahead and start treatment with lifestyle modifications.

*** HTN is one of the leading causes of CKD

169
Q

Uncomplicated cases of Salmonella

A

Treatment will be symptomatic as the infection is typically self-limiting and only lasts about four days on average.

170
Q

How long can Proton pump inhibitors (PPIs) be used

A

short-term treatment for 4-8 weeks.

171
Q

Long term effects of Proton pump inhibitors (PPIs)

A

PPI’s can lead to osteoporosis, clostridium difficile, and vitamin B12 deficiency when used long term. If problems persist past 8 weeks of PPI use, the patient should be referred to gastroenterology for further evaluation.

172
Q

If a patient has a history of osteoporosis what would be the best treatment in GERD

A

H2 blocker if they have tried TUMS, because PPI increase the chances of osteoporosis

173
Q

Pain in the left upper quadrant

A

pancreas, and even the stomach are what is in the LUQ, and this patient is likely experiencing pancreatitis. To help heal the pancreas, eating non-fatty foods, and sometimes even a clear liquid diet, is prescribed.

174
Q

Cullen’s sign and Turner’s sign

A

Cullen’s sign is identified as bluish discoloration around the umbilicus of a patient, while Turner’s sign is bluish discoloration along the flank. Both signs are indicative of possible intra-abdominal bleeding which can be seen with conditions such as necrotizing pancreatitis, ruptured ectopic pregnancy, etc. The patient may be tender to palpation, but it is not a distinguishing factor. If either or both of these signs are noted by the provider, the patient needs to be immediately referred to the ED for further evaluation.

175
Q

What is the best way to confirm acute appendicitis

A

CT scan

176
Q

What is considered a “red flag” for colorectal cancer

A

** A new onset of ribbon-like stool
** Red or dark blood in the stool, loss of appetite, weight loss, and fatigue. Bright red blood with anal pain upon defecation can be due to anal fissures or hemorrhoids.
**

177
Q

Which of the following signs may be present when a patient has acute appendicitis

A
  1. Obturator sign is positive if inward rotation or flexion of the right hip causes RLQ pain.
  2. Rovsing’s sign is positive if palpation of the LLQ causes the patient pain in the RLQ.
  3. Psoas/iliopsoas sign is positive if there is RLQ pain when the patient is supine and raises their right leg against resistance applied by the provider.
178
Q

Where do the majority of colon cancer cases or colon polyps occur

A

Descending colon

179
Q

H. Pylori in a patient who has recently took a PPI would best be done by what means?

A

Fecal antigen. Given the recent PPI use, the fecal antigen is the best option at this time. The urea breath test may not be accurate if a proton pump inhibitor (PPI) such as omeprazole (Prilosec) has been used within the last couple weeks.

180
Q

Ulcerative colitis

A

Affects only the colon

181
Q

What is an early sign of a bowel obstruction

A

*** High pitched bowel sounds

*** Side note about later stages. In later stages, the bowel sounds dissipate altogether. Severe abdominal pain and bilious vomit are also more likely to be seen in the later stages as the obstruction progresses.

182
Q

The nurse practitioner is reviewing the lab results of a patient who has been on famotidine (Pepcid) for eight weeks. Which abnormal lab results are likely caused by daily use of this medication?

A

1: Decreased liver function tests (LFT)
2: Decreased platelet count

183
Q

We suspect our patient has cholecystitis, what sign will sign will we use

A

Murphy’s sign

184
Q

sign used to evaluate a possible appendicitis
COME BACK TO THIS ONE AND ADD THEM ALL IN ON HERE.!!!

A

Blumberg sign is also used to evaluate a possible appendicitis. This is also known as rebound tenderness and is done by deeply palpating the abdomen and assessing if the patient experiences pain upon releasing your hand.

185
Q

McMurray’s test

A

diagnose a meniscus injury.

186
Q

Bacterial vaginosis

A

** Clue cells are a hallmark sign of BV, or bacterial vaginosis. Along with the milky white discharge, this is a classic presentation. BV is not contagious, and is treated with oral Flagyl twice a day x 7 days. Only the patient will need to be treated, not her partner. She should be educated to not douche as this is a high risk factor for BV.
** grey, thin, “fishy” smelling vaginal discharge

187
Q

Trichomoniasis

A

** A strawberry cervix,which presents as an erythematous cervix with hemorrhages, is a hallmark finding of trichomoniasis.
** wet mount that shows mobile trichomonads that move with help of flagella is a positive test for trichomoniasis
** Partners should also be treated as trichomoniasis is a sexually transmitted infection.
*** Classic symptoms that occur with trichomoniasis include lower abdominal pain, green-yellow, frothy, and malodorous discharge, and pain and itching around the vagina.

188
Q

HPV testing age

A

Routine HPv testing begins at age 21 in the presence of an abnormal pap-smear.

189
Q

Chlamydia is left untreated, which of the following may occur

A

Correct Answer 1: Pelvic Inflammatory Disease (PID)

Correct Answer 2: Ectopic Pregnancy

Correct Answer 3: Urethral strictures

Correct Answer 4: Infertility

190
Q

saw palmetto

A

Saw palmetto is an herbal supplement used by patients who have benign prostatic hyperplasia (BPH)

191
Q

Chlamydia.

A

** Nucleic acid amplification test (NAAT)
** Chlamydia is typically treated with 1g oral azithromycin, without co-treatment for gonorrhea. Another treatment option for chlamydia is 100mg doxycycline twice a day for 7 days.

192
Q

Report notes that there are atypical squamous cells and can not exclude high-grade squamous intraepithelial cells (ASC-H).

A

Refer for colposcopy

193
Q

Cipro

A

Fluoroquinolones have a black box warning for achilles tendon rupture.

194
Q

A middle aged patient presents to the clinic for a follow up after requiring lithotripsy for several kidney stones. When reviewing the report from the urologist, it is noted that the patient had stones composed of calcium oxalate specifically. Which of the following foods should the patient be educated to avoid to ideally

A

check_boxChocolate
check_boxSpinach
check_boxRhubarb
check_boxTangerines

195
Q

A middle aged patient presents to the clinic for a follow up after requiring lithotripsy for several kidney stones. When reviewing the report from the urologist, it is noted that the patient had stones composed of calcium oxalate specifically. Which of the following foods should the patient be educated to avoid to ideally

A

check_boxChocolate
check_boxSpinach
check_boxRhubarb
check_boxTangerines

196
Q

What lab is not a part of a routine urinalysis with microscopic exam

A

***Bacteria culture

A complete urinalysis (UA) consists of a gross evaluation, dipstick analysis and a microscopic examination of urine sediment. A UA can be used to screen

197
Q

Epididymitis.

A

The key findings here are the positive Phren’s sign and the unilateral, swollen scrotum. For patients under 35, doxycycline is the drug of choice. For patients over 35, we choose ciprofloxacin.
*** A positive Prehn’s sign is associated with epididymitis.

198
Q

vulvovaginal candidiasis infection

A

Vulvovaginal candidiasis, commonly referred to as a yeast infection, is one of the most common causes of vaginal irritation and discharge. It can be identified by pseudohyphae, spores, and bud cells present on a wet mount. Patients also commonly describe a chunky white vaginal discharge and intense itching.

199
Q

Nucleic acid amplification test (NAAT) is the test of choice for what stds.

A

chlamydia and gonorrhea

200
Q

If a patient has a UTI and its needing ABX, but she is on warfarin what ABX should we not give

A

Bactrim (Trimethoprim/Sulfamethoxazole). Sulfamethoxazole is a competitive inhibitor of the CYP2C9 enzyme which is responsible for metabolizing warfarin. Therefore, in those taking warfarin, we want to avoid bactrim as it can cause delayed metabolism of the warfarin, increasing the risk of bleeding in the patient.

201
Q

testicular cancer

A

* males 15-35 years old
* presents as a singular sided “heaviness.”
*** solid mass
*** need for referral.**

202
Q

Leading bacteria in UTI’s

A

Escherichia coli

203
Q

A patient presents with severe colicky flank pain

A

This patient is suffering from nephrolithiasis, or a renal calculi. This is most commonly caused by a buildup of calcium oxalate, and occurs most frequently in males.

*** Acyclovir (Zovirax) as herpes simplex suppressive treatment puts the patient at a higher risk of this.

**Most stones pass within 48 hours
*** This patient should hydrate well, can take NSAIDs for pain, and should strain his urine to try and catch the stone.

204
Q

What finding is consistent with benign prostatic hyperplasia

A

A prostate with BPH typically feels enlarged, symmetrical, smooth, and rubbery

205
Q

In a patient with prostatitis

A

In a patient with prostatitis, the provider would feel a warm, tender, swollen, and boggy prostate.

206
Q

Possible prostate Cancer

A

If a provider felt an asymmetrical firm, fixed painless nodule, they should suspect possible prostate cancer.

207
Q

A complicated UTI at 28 weeks

A

a complicated urinary tract infection (UTI). At 28 weeks along, she is now in the third trimester making cephalexin (Keflex) the most appropriate and safe choice

208
Q

How to diagnosis syphilis

A

Rapid plasma reagin test

209
Q

Important teaching on PAP

A

The transformation zone is the most common place for abnormal cells to develop in the cervix. The transformation zone consists of both squamous epithelial cells as well as endocervical cells. Obtaining an adequate sample from this zone is critical as otherwise possible precancerous or cancerous cells may be inadvertently missed.

210
Q

Normal Vaginal PH

A

Vaginal pH level is usually between 3.8 and 4.5, which is moderately acidic. The pH level can vary depending on your age and health. In some cases, changes to pH may indicate an underlying health condition, such as a vaginal infection.

***A high vaginal pH level — above 4.5 — provides the perfect environment for unhealthy bacteria to grow. Having a high vaginal pH puts you at risk for these infections:

*** BV and Trich is with a high PH which is acidic

211
Q

Alpha blockers

A

Alpha blockers, like terazosin, cause vasodilation. Because of this, they can cause a massive drop in blood pressure, and dizziness for patients - especially during the first dose. It is important to educate patients on this risk and have them take their medication before bedtime to avoid any complications from dizziness.

212
Q

What serologic test is used to initially screen a patient for syphilis

A

Rapid plasma reagin (RPR)

213
Q

what in a patient patient’s past medical history is considered a risk factor for this type of cancer

A

Cryptorchidism puts you at a high risk for testicular cancer

214
Q

Chronic kidney disease (CKD)

A
  1. Stage I has a GFR still >90 mL/min, but there is kidney damage.
  2. Stage II is 60-89mL/min
  3. Stage III is GFR of 30-59 mL/min
  4. Stage IV is 15-29 mL/min
  5. Stage V, or end stage, is a GFR < 15mL/min
215
Q

The glomerular filtration rate (GFR) as a patient ages

A

The glomerular filtration rate (GFR) decreases as patients age as well as in kidney disease or failure. The GFR and creatinine usually have an inverse relationship. Therefore, as a patient develops kidney disease, their creatinine will rise.

216
Q

Gonorrhea

A

Treat with 500 mg intramuscular ceftriaxone (Rocephin) today and bring back in 3 months to retest

217
Q

Hordeolum AKA stye

A
  • Rim of the eyelid
  • Small
  • Acute
  • Rim of the eyelid
    SYMPTOMS
    Painful bump on the eyelid
    Swollen eyelid
    Redness, swelling, and tenderness of the eyelid
    Sensitivity to light
    Visible pus at the centre of the lump
    A scratchy feeling in the eye
    The feeling of something in the eye
    Crusting along the affected eyelid
    More tears than usual
      CAUSES  it develops when Zeis glands (oil glands at the eyelash follicle) become infected.  The infection is usually caused by a bacteria called Staphylococcus aureus.
218
Q

Chalazion

A
  • The conjunctival side, where meibomian glands are located
  • Large
  • Chronic
  • A slow-growing lump

SYMPTOMS
Painless bump on the eyelid
Swollen eyelid
Blurry vision
Redness and swelling on the bump
Mild irritation, causing the eyes to water

CAUSES
It develops when the meibomian glands (oil glands in the eyelid) become clogged. These glands keep the eye moist. When blocked, these glands start retaining oil. Eventually, the fluid drains and a hard lump develops on the eyelid.

219
Q

Actinic keratosis

A

Actinic keratosis is considered the most common precancerous lesion of squamous cell carcinoma in older adults. Actinic keratosis is a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of the hands, forearms, scalp, or neck

220
Q

Senile actinic keratosis.

A

Senile purpura presents as bright, purple-colored patches located on the forearms and hands and are benign. Lentigines, also known as “liver spots,” are brown-colored macules located on the hands and forearms of older adults and are benign.

221
Q

Seborrheic keratoses

A

Seborrheic keratoses are soft, wartlike benign lesions that frequently appear on the back and trunk of older adults.

222
Q

Erysipelas

A

Erysipelas is a subtype of cellulitis involving the upper dermis and superficial lymphatics. It is distinguished by well-demarcated borders, marked erythema, and warmth. It occurs commonly in the face.

223
Q

Rosacea

A

Rosacea is a common skin condition that causes redness and visible blood vessels on the face. It may also produce small, red, pus-filled bumps.

224
Q

Tinea unguium is also known as

A

(onychomycosis)

225
Q

Tinea unguium (onychomycosis) is a fungal infection

A

is a fungal infection of the nails, usually the great toe

226
Q

First line treatment for Tinea unguium (onychomycosis) is

A

oral terbinafine (Lamisil) for 12 weeks

227
Q

When should a patient diagnosed with a carbuncle return for a follow-up visit

A

Within 48 hours

228
Q

Treatment for a Carbuncle

A

The patient should be treated with doxycycline or minocycline PO BID × 10 days or clindamycin TID to QID for 10 days if methicillin-resistant Staphylococcus aureus (MRSA) is suspected. The patient should return within 48 hours, as there is usually improvement within 48 to 72 hours after starting antibiotics.

229
Q

Bowen’s disease is

A

squamous cell cancer (SCC) of the epidermis that has not invaded the dermis yet

230
Q

Bowen’s disease (squamous cell cancer (SCC) ) best treatment is

A

Radiation therapy
Curettage and electrodessication

231
Q

a chronic inflammatory disease of the cheeks, chin, and nose, with dry, reddened eyes

A

Acne rosacea

232
Q

Rule of 9s for burn fix this one .

A

The calculation is based on the rule of nines for the body surface of an adult: 9% for each arm and the head, and 18% for each leg, anterior trunk, or posterior trunk. For children, it is 9% for each arm, 14% for each leg, and 18% for anterior trunk or posterior trunk.

232
Q

Acrochordons

A

Also known as a skin tag.

232
Q

Cherry angiomas

A

A cherry angioma is a smooth, cherry-red bump on the skin. Although cherry angiomas usually appear on the trunk of the body, they can occur nearly anywhere. The cause of cherry angiomas is malformed arterioles in the skin, and the growths usually appear on people over the age of 40

232
Q

Tinea cruris

A

Also known as jock itch, typically in the groin area.

232
Q

Condylomata lata

A

secondary syphilis with infectious white papules in the vulvar area that look like white warts (condylomata lata). Condylomata lata may be skin-colored, white, pink, or yellowish. Additional data for secondary syphilis diagnosis includes alopecia, lymphadenopathy, maculopapular rash on the soles of the feet, and a rapid plasma reagin result of 1:8 (normal = 1:1).

232
Q

Roseola infantum (exanthema subitum)

A

Roseola infantum is a common viral rash that is caused by the human herpesvirus. The most common ages of onset are between 6 months and 2 years. The rashes are maculopapular (small, round, pink colored) rashes that first appear on the trunk and then spread to the extremities.

232
Q

Lanugo in a older child happens because of why?

A

The appearance of fine, downy body hair should be documented as lanugo, commonly associated with anorexia nervosa.

232
Q

infection with the eggs of parasites (worms) that are commonly found in the intestines of dogs and cats

A

Larva migrans

232
Q

Pityriasis versicolor

A

Used to be known as tinea versicolor, is a fungal infection caused by a type of yeast that is normally present on the skin but has grown out of control. Pityriasis versicolor is diagnosed by clinical appearance and a sample of the skin scrapings placed on a KOH wet mount, which reveal short hyphae and budding cells.

232
Q

Condyloma acuminata

A

anogenital warts, may present as single lesions or in groups. They range from skin-colored to erythematous to brown and may be flat, dome-shaped, cauliflower-like, or plaque-like. They are typically asymptomatic.

233
Q

Examination reveals lesions that are raised and have a silvery-white appearance. When the nurse practitioner palpates the lesion, a small piece falls off, and some bleeding is noted. What is this finding called?

A

Auspitz sign

234
Q

In the adult population, which secondary skin lesion is commonly seen in patients with chronic atopic dermatitis?

A

Lichenification

235
Q

Hypertrophic scar

A

These present as erythematous and glossy areas of induration. They may be painful or pruritic. Hypertrophic scars may develop at sites of recent lacerations, burns, surgical wounds, vaccination sites, or insect bites. They do not grow past the margins of the original injury. Hypertrophic scars can be linear or diffuse in shape. They develop within a few weeks of injury, rapidly grow for 3–6 months, and then plateau and regress in size. Conservative management is recommended, as is first-line treatment for hypertrophic scars, including corticosteroid tape, plasters, and injections. Hypertrophic scar development can be prevented with timely wound healing. Patients should be instructed to avoid activities that stretch a new scar, as this leads to inflammation and scar tissue growth.

236
Q

Atrophic scars

A

often develop secondary to acne vulgaris and appear indented.

237
Q

keloid

A

A keloid (C) has a similar presentation to a hypertrophic scar but invades healthy tissue outside of the original injury site

AANP Review (1 decks)

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