NR661/ NR 661 VISE (Latest 2023/ 2024 Update) Complete Guide with Questions and Verified Answers| 100% Correct- Chamberlain
NR661/ NR 661 VISE (Latest 2023/ 2024
Update) Complete Guide with Questions and
Verified Answers| 100% CorrectChamberlain
Q: acute maxillary sinusitis – etiology
Answer:
inflammation of the maxillary sinus due to viral, bacterial, or fungal infection or allergic reaction
Q: acute sinusitis
Answer:
symptoms last < 12 weeks · Common bacterial causes: strep pneumoniae, haemophilus influenzae, Moraxella catarrhalis · Common viral causes: rhonovirus, coronavirus, flu A and B, parainfluenza, RSV Q: recurrent acute sinusitis Answer: at least 3 episodes of acute bacterial sinusitis in a year Q: chronic sinusitis Answer: symptoms of varying severity > 12 weeks; further classified with or without nasal polyps,
abnormal findings on CT scan or nasal endoscopy
· Gram negative is more likely
· Staph aureus
· Pseudomonas aeruginosa
· Anaerobic organisms
Q: sinusitis – presentations
Answer:
· Fever may or may not be present
· Persistent symptoms of URI (> 10-14 days)
· Congestion, purulent nasal discharge
· headache, sore throat,
· Pain and pressure over cheeks and upper teeth suggest maxillary
· Pain and pressure over eyebrows suggest frontal
· Pain and pressure/tenderness behind and between eyes suggests ethmoid
· cough, anosmia, halitosis, postnasal discharge, periorbital edema
Symptoms > 10 days that worsen after initial improvement, persistent purulent nasal discharge,
fever, unilateral face or tooth pain is more likely a bacterial infection
Q: sinusitis – diagnostics
Answer:
CBC (elevated WBC),
sinus x-rays for recurrent disease
transillumination: opacification with air-fluid levels if sinus cavity is infected
CT scan for recurrent disease
Consider c and s for treatment resistant infections
Q: sinusitis — nonpharmacological
Answer:
Avoid environmental irritants,
Humidified air
treat otitis media,
sleep with HOB elevated to aid with drainage,
Good hand hygiene
blowing nose, not sniffing.
Q: sinusitis — pharmacological
Answer:
First line- Augmentin 875 mg/125 mg PO BID for 5 days,
Allergic to Penicillin then Doxycycline 100mg BID for 5-7 days OR 200mg PO daily for 5-7
days Levofloxacin 500mg PO daily for 10-14 days Monifloxacin 400mg PO daily for 5-7 days
Macrolides no longer recommended due to high resistance
Analgesics for headache and fever
Saline irrigation
Q: sinusitis – f/u, referral
Answer:
Follow up:
1 week or until clinically free of infection
Referral:
May refer to ENT for recurrent infections or resistance to tx
Consider immediate referral if periorbital cellulitis
ER if meningitis suspected
Q: hyperlipidemia – etilogy
Answer:
may be familial, dietary, obesity, hypothyroid, renal disorders, thiazide or beta blocker use,
alcohol and/or caffeine intake
Q: hyperlipidemia – presentation
Answer:
· Xanthomata (lipid deposits around the eyes)
· Corneal Arcus prior to age 50 years (white iris), normal
· Angina
· Bruits
· MI
· Stroke
Q: hyperlipidemia – diagnositics
Answer:
· Fasting/nonfasting lipid profile (total cholesterol, LDL, and HDL minimally affected by eating)
· Glucose,
· UA and creatinine (for detection of nephrotic syndrome which can induce dyslipidemia),
· TSH (for detection of hypothyroidism)
Q: hyperlipidemia – diagnosis
Answer:
ldl >= 190mg/dL
Q: hyperlipidemia – non-pharmacologic mgt
Answer:
lifestyle modification of diet and exercise
Q: hyperlipidemia – pharmacologic mgt
Answer:
Those who benefit most from statin therapy include:
· hx of CVD or stroke,
· LDL 190 or greater,
· DM with LDL 70-189,
· no evidence of ASCVD or DM but have LDL 70-189 PLUS an estimated ASCVD risk of 7%
or greater
· High risk:
o Atorvastatin 40 or 80 mg daily
o Rosuvastatin 20 or 40 mg daily
· Moderate risk:
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