Q: risk factors for hemorrhagic stroke?
C: a fib, hypertension, hyperlipidemia, carotid stenosis
A: hypertension
HTN – most common cause of intracerebral hemorrhages
chronic htn –> microaneurysms of arteries –> leaky/ruptured arteries –> stroke
Q: gestational age when fundus felt at pubic symphysis?
C: 12, 16, 20, 22 weeks
A: 12 weeks at pubic symphysis
20 weeks at umbilicus
36 weeks at xiphoid process
Q: boys misses school often, complains of abdominal pain, stained underwear is noticed?
A: constipation, depression, pinworms
constipation
family theory systems
individuals are best understood in the context of their families
families are best understood when they are viewed as a whole unit, interdependence between members creates cohesiveness and an equilibrium
all parts are interrelated and dependent on each other
if one part is damaged, affects the whole family
cranial nerve 12: name and function
hypoglossal
stick out tongue
Q: which rash needs treatment within 72 hours and why?
C: impetigo, cleft lip, herpes zoster, eczema
herpes zoster (shingles)
acyclovir most effective when started within 72 hours after the shingles rash appears
11 year old with completed childhood vaccines needs which vaccinations?
meningo, HPV x 2, Tdap, Influenza
A: diabetes med group that increases intestinal absorption of glucose and decreases post BG?
C: DPP-4, GLP-1, SGLT-2, biguanide
A: GLP-1
stimulates insulin release
decreases glucagon
slows gastric emptying
significant decrease of post-meal BG
ends in -glutide
ex) Trulicity, Victoza, Byetta
Q: causes of candida infection?
C: condom, UTI, diabetes
A: diabetes
others: antibiotics, pregnancy, immunocompromised, hormone imbalance, stress
family development theory?
ex) young girl that gets pregnant
micro-level perspective of patterned changes that occur in families through stages and across time
family relationships will change to make space for children and join in child rearing
Q: mexican cultural sensitivity?
C: hot/cold theory, on time appts, less vaginal exams, taboo to discuss family
hot and cold illnesses and medications
hot conditions: DM, rash, GERD, htn, pregnancy
cold conditions: cancer, indigestion, headache, menses cramps, URI
fetal alcohol exposure characteristics
microcephaly
epicanthal folds
flat nasal bridge
fish mouth or macrostomia
thin upper lip and short philtrum
brushfield spots
matching descriptions:
hordeolum
chalazion
blepharitis
pterygium
hordeolum: hurts, purulent itchy pimple on eyelid
chalazion: no pain, rubbery node on eyelid
blepharitis: crusty red eyelash base
pterygium: benign growth on conjunctiva r/t sun
matching descriptions:
scleroderma
psoriasis
roseola
scabies
scleroderma: overproduction of collagen that leads to tight/hard skin
psoriasis: silver plaques/scales
roseola (6th): HV6, high fever –> small pink raised bumps on trunk then extremity
scabies: severely itchy red-brown vesiculopapular lesions with burrows
Q: 15 y/o male with annular, maculopapular, pruritic hypopigmented rash on trunk area, no fever or adenopathy; what is the rash?
C: contact dermatitis, tinea versicolor, scabies, lyme disease
tinea versicolor
Q: kid with high fever that breaks in 3 days, then abrupt rash appears 1-3 days
C: 5th dz, 6th dz, rubella
A: 6th disease: roseola infantum
5th disease: erythema infectiosum: slapped cheek rash followed by lacy rash
Q: 9 mo. old born preterm at 32 weeks, still has palmar grasp, next action?
C: refer to neuro, refer to ortho, check DTR/muscle, nothing/normal
A: refer to neurology
persistence of the reflex beyond 6 months is usually present in spastic cerebral palsy
corrected gestation age = 36 w – 8 = 28 w = 7 mo.
palmar grasp normally disappears at 3-4 months
15 mo. old toilet training and parents are spanking, toilet training not working; what is rule of thumb?
do not start in times of stress
day time control by 2 years
night time control by 3 years
full control with no accidents by 4 years
10 y/o recommended TV and computer time?
less than 2 hours
diabetic retinopathy image
microaneurysms
neovascularizations
Q: recurrent otitis media and with choleastoma – next step?
C: monitor, treat with antibiotics, refer to ENT, surgery
A: surgery
prevent CN 8 damage and deafness
cholesteatoma: skin cyst behind ear r/t poor eustachian tube function
Q: what to assess in a child with complications related to frequent otitis media?
C: refer for hearing test, tympanic membrane/otoscope assessment
refer for audiometry and hearing test
should respond to name by 6-9 mo.
Q: comparing HbA1c data with other hospitals/organizations – term?
C: core competency, risk analysis, peer review, benchmarking
benchmarking
compare performance within an organization (by a physician or department or over time)
hospital-based quality improvement project, APRN reviewing colleague’s 4 charts/month to ensure diabetes protocols are met – process called?
core competency, force field analysis, peer review, risk analysis
peer review
diagnosis and management of cough, runny nose, malaise, no fever or adenopathy
common cold (viral rhinitis or URI)
rest, hydrate, OTC meds
no antibiotics
community acquired pneumonia- diagnostic test?
chest x ray
rule out bacterial (lobar), viral (infiltrates), aspiration (diffuse/localized)
strep pneumoniae gram + – macrolides (mycin)
Q: 40 y/o executive male with no disease, complains of impotence upon waking
C: refer to urologist, cause is stress of work, check PSA
stress
normal weber finding
no lateralization
sound heard equally bilaterally
fever, posterior cervical lymphadenopathy, tonsils with white exudate, petechial rash, myalgia – diagnosis?
infectious mononucleosis
cause is EBV “kissing disease”
- monospot heterophile AB test
incubate 1-2 months
no contact sports due to splenic rupture risk
oral steroids for airway obstruction
Q: married female needs reliable non-hormonal BCM
C: birth control pills, condom, nuvaring, copper IUD
copper IUD
TSH 8, treated with levothyroxine 0.25 mcg, recheck TSH 6- next action?
C: wait to change dose, increase dose and recheck
increase dose and recheck
optimal TSH on tx – 1.8 to 3.0 ( N = <5)
80 y/o male with headache and extreme eye pain
what is a danger sign?
C: increased tearing, visual acuity changes, nausea
nausea, vomiting, head pain, blurry vision, halos,
closed angle glaucoma –> CN 2 ischemia
sickle cell patients – what vitamins do they need?
folic acid, iron
folic acid
others: vitamin D, zinc, PS-23 pneumovax, hep B immunity
urinalysis – what findings indicate renal damage?
RBC casts
indicates blood coming from kidney, and not urethra
dx: glomerulonephritis or nephrotic syndrome
1st line treatment of acute gout
Indomethacin 50 mg tid (NSAID)
prednisone taper
heberden and bouchard nodes is associated with what type of arthritis?
osteoarthritis
DIP’s swollen
xray show osteophytes
better in AM, worsens through day
aggravated by activity
heberden image of hand
pregnancy category x drugs
methotrexate
warfarin (Heparin is ok)
isotretinoin (Vit A derivative)
DES
thalidomide
live vaccines: MMR, varicella, rota, flumist
influenza nasal spray
nasal spray vaccine = live attenuated
can be given to healthy, non-pregnant, 2-49 y/o
contraindications: aspirin meds, h/o wheezing, immunosuppressed, no spleen, antiviral medication use, chronic diseases