All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM
III first time audible, IV first time thrill
Fundal height 12 weeks
Fundal Height 12 weeks above symphysis pubis. EXAM
Fundus 16 weeks between symphysis pubis and umbilicus.
Fundus at 20 weeks is at umbilicus.
2 cm more of less from # of wk gestation is normal if more or less order US
3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order?
Iron, TIBC
3 months of synthroid, TSH increased, T4 normal, what do you do?
Increase Medication
3 ways to assess cognitive function in patient with signs/symptoms of memory loss
Mini mental exam
4 month old with strabismus, mom is worried……
tell her it is normal.
4 month old wont keep anything down, what is the main thing you look at?
Growth chart
6 month old closed anterior fontanel.
XRAY
Abnormal cells on PAP, what do you do next?
Refer for Colposcopy
CAGE ACRONYM
Cut down
Annoyed by criticism
Guilty about drinking
Eye opener drink
Causes of tachycardia
Fever
Anemia
Hypotension
Cranial nerves responsible for extraocular eye movements
CN 3,4,6
Definition of metabolic syndrome
cluster of conditions that increase risk of heart disease, stroke, diabetes.
diagnose trichomoniasis
wet prep
Elderly presents with atrophic vaginitis, small uterus, palpable 4×5 ovary, what do you do next?
Pelvic US
Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located?
Anterior septum
Definitive diagnosis of acute bacterial prostatitis
urinalysis and culture
GERD treatment
H2 is first line, give hs
Grade 3 cells on Pap, treatment?
LEEP
excision
Fingernail hematoma treatment?
drill hole and drain blood?
Increased risk of ectopic pregnancy
Salpingitis, or history of abortion, PID,
Koplick spots
Measles (rubeola). Grains of salt lesions inside mouth in Measles
Koplick spots
Measles (rubeola). Grains of salt lesions inside mouth in Measles
Legg-Calve-Perthes Disease
Avascular necrosis of the proximal femoral head
Lipid level of 1500, increased risk for?
Pancreatitis
Low HGB, Low HCT, High MCV indicates what?
Macrocytic anemia, B12 Def
Man with BPH, prostate feels on digital exam?
Enlarged, symmetrical, smooth
Man with HTN, CAD, present femoral pulses but absent pedal
Arterial Insufficiency
McMurray’s Sign
(+) palpable or audible click while extending with varus stress
Meniscus tears
Lachman’s Test
pivot shift test (ACL tear)
Newborn with foot turned in, what do you do?
refer to orthopedist
Osgood-Schlatter disease
Knee pain.
inflammation or irritation of the tibia at its point of attachment with the patellar tendon
Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of?
Alzheimer’s
Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do?
Refer to oncologist
Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling?
Tinea Corporis
Pt presents with “bag of worms:, indicates?
Varicocele
Pt with atopic dermatitis, look for what other diseases?
Asthma
Pt with bleeding after menopause
endometrial biopsy, need to screen for cancer
Pt with hx of PID, increased rick for?
Infertility
Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate?
This is good. Want higher than 350
Pt with hx of htn and stroke, now having memory loss. What does this indicate?
Vascular dementia
Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus?
slap cheek, PVB19, rash hands / feet Fetal death and birth defects
Quick assessment of patients fall risk? Timed Get up and Go
Timed Get up and Go
Red beefy tongue?
pernicious anemia
Rotator cuff injury presentation
disturbs sleep, arm weakness, dull ache
Shingles near eye
immediate referral to ophthalmology
Signs and symptoms of Roseola (6ths disease) ?
Viral infection
Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage
-Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash
-Seizures may occur during this period.
-On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs.
-High fever, pink flat or raised rash
Treatment for chronic alcoholism:
12 step program
Treatment for Gonorrhea?
Rocephin 250mg IMx1 plus
Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM
Report to health department
Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years:
IUD
Basal cell cancer
Waxy, pearly, telangiectasia, ulcer center lesion
-most common type of skin cancer caused by UV exposure. Metastatic is rare
Actinic Keratosis
Scaly red to yellow located in sun exposed area
-a precancerous skin growth that occurs on sun-damaged skin
Actinic Keratosis
Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area
-a pre squamous cell carcinoma occurs on sun-damaged skin
biopsy
cryo or 5fu cream
subungual hematoma tx
Make a hole and drain the blood
Moderate acne treatment
Without inflammation: Topical retinoid
Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered)
PLUS ADD
Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne)
Minocycline- long term use has been linked with pseudotumor cerebri
Oral contraceptives for hormone related
Spironolactone
heart murmur with holosystolic or pan systolic
Heart mumur with mid systolic
MR – radiate axilla, 5th ICS MCL, apex,
AS – radiate neck, 2ICS right sternal border
MR ASSH
Coarctation of Aorta
COA: bounding radial and weak femoral pulse
increase blood pressure in arms, and lower pressure in lower legs.
-congenital cardiac condition characterized by a narrowing of the aorta
Murmur Grade III – VI
Loud murmur easily heard