Exam 1: NSG554/ NSG 554 (NEW 2023/ 2024) – Nurse Practitioners in Primary Care I Exam Review | 100% Correct | Complete Guide with Verified Answers
Exam 1: NSG554/ NSG 554 (NEW 2023/
2024) – Nurse Practitioners in Primary Care I
Exam Review | 100% Correct | Complete
Guide with Verified Answers
QUESTION
Influenza A/B/C
Answer:
Incubation period 1-4 days
Fever lasts 1-7 days
Elderly patients may present without respiratory symptoms but lassitude and confu- sion
Children may present with more GI symptoms especially in influenza B
QUESTION
Influenza antiviral therapy
Answer:
Should be started within 48 hours of disease onset
QUESTION
Neuraminidase inhibitors: oral oseltamivir
Answer:
75 mg BID for 5 days drug of choice for patients that are of any age, pregnant
No great for patients with GI bleeding or decreased motility
QUESTION
Neuraminidase inhibitors: Inhaled zanamivir
Answer:
10mg 2 inhalations BID for 5 days
for uncomplicated influenza in patients 7 years or older contraindicated in those with
asthma/lung dx
QUESTION
Neuraminidase inhibitors: IV peramivir
Answer:
600 mg single dose outpatient tx for uncomplicated infection in 18+
used when there is concern for decreased absorption of oseltamivir
QUESTION
Trivalent influenza vaccine vs Quadrivalent
Answer:
Protects against A,B, C .. Quad with additional protection against strain of B
QUESTION
High dose trivalent inactivated influenza vaccine
Answer:
For those 65 years and older
containing four times more hemagglutinin to enhance immune system response
QUESTION
Fluzone
Answer:
not recommended for adults over 65
QUESTION
Influenza vaccine contraindications
Answer:
severe allergic reaction, hx of Guil- lian-Barre syndrome, egg allergy (can receive is rxn is only
hives); recombinant vaccine is egg free
QUESTION
Adenovirus infections: incubation
Answer:
4-9 days rhinitis, pharyngitis, mild malaise without fever
QUESTION
Rocky Mountain Spotted Fever
Answer:
Exposure to tick bite in endemic area (NC, TN, OK, MS, AK)
Symptoms begin 2-14 days after bite with onset of fever, chills, HA, N/V, myalgias, restlessness,
insomnia, irritability
QUESTION
Rocky Mountain Spotted Fever: rash
Answer:
Faint macule that progress to macu- lopapules and then petechiae appears between day 2 and 6
of fever
initially involves wrists & ankles, spreading centrally to arms, legs, and trunk over the next 2-3
days (soles/palms is common)
facial flushing, conjunctival injection, hard palate lesions may occur
severe: pneumonitis, delirium, hepatomegaly, splenomegaly, jaundice, myocarditits
QUESTION
Rocky Mountain Spotted Fever: Laboratory findings
Answer:
Thrombocytopenia, hyponatremia, elevated LFTs
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Primary prevention
Removed/reduce disease risk factors
Primary prevention examples
immunizations, counseling, smoking cessation, healthy eating
Secondary prevention
Promotes early detection of diseases
Secondary prevention examples
routine screenings (mammogram, Pap smear, blood pressure, colonoscopy)
Tertiary prevention
aimed at limiting established disease
Tertiary prevention examples
partial mastectomy/chemo to reduce breast cancer
Active immunity
A form of acquired immunity in which the body produces its own antibodies against disease-causing antigens.
ex: flu shot
Passive immunity
An individual does not produce his or her own antibodies, but rather receives them directly from another source
ex: breastfeeding, plasma or immunoglobulin use
MMR contraindications
Allergy to gelatin and neomycin
Immunocompromised
Herd immunity
The resistance of a group to an attack by a disease to which a large proportion of the members of the group are immune
Live attenuated influenza vaccine (LAIV)
Given intra nasally for ages 2-49
contraindicated for those that are pregnant, immunocompromised, hx of lung conditions
Inactivated influenza vaccine
Given IM, for those 6 months or older; over 65 should have higher dose
contraindicate for those with egg allergy or hx of Gullian-Barre
Influenza A & B treatment
Susceptible to Oseltamivir and Zanamivir (only given via inhalation and contraindicated for those with COPD), IV peramivir
Do not give adamantanes as they are resistant (amantadine and rimantadine)
Herpes zoster rash
-Tingling, pain, eruption of vesicles in a dermatomal distribution, evolving to pustules and then crusting
-thoracic and lumbar roots most common (trunk)
-usually a single unilateral dermatome
Herpes zoster treatment
Antivirals such as famciclovir, valacyclovir orally within the first 72 hours of onset and for 7 days or until lesions have crusted
Increased risk of herpes zoster
Increased age, immunocompromised
Herpest Zoster complications
Postherpetic neuralgia
Risk of Guillian-Barre for 2 months
Dengue (Aedes mosquito)
Incubation 7-10 days
those in tropical and subtropical locations most at risk
1 of the 2 most common vector-borne diseases in humans
Dengue (Aedes mosquito) laboratory findings
Leukopenia is characteristic and elevated transaminases
for diagnosis: IgM or IgG ELISAs after febrile phase
Dengue (Aedes mosquito) S&S
Sudden onset of high fever, chills, sever myalgias/arthalgias. headache and retroorbital pain
Severe dengue is defined by presence of plasma leakage, hemorrhage or organ involvement
Dengue (Aedes mosquito) treatment
supportive care: fluids, blood products, vasopressors, acetaminophen
avoid NSAIDS due to risk for bleeding
Yellow Fever (Aedes mosquito)
Zoonotic flavivirus infection transmitted by Aedes mosquito
Tropical and subtropical South America and Africa
Yellow Fever (Aedes mosquito) S&S: Mild
Incubation 3-6 days
Mild form- malaise, headache, fever, retroorbital pain, nausea, vomiting, photophobia; Relative bradycardia, conjunctival injection and facial flossing may be present
Yellow Fever (Aedes mosquito) S&S: Severe
Initial symptoms are mild but a brief fever remission lasting hours to a few days is followed by a period of intoxication manifested by fever, relative bradycardia (Faget sign), hypotension, jaundice, hemorrhage, delirum
Yellow Fever: Laboratory findings
Leukopenia, elevated liver enzymes, bilirubin, proteinuria
Early stages (up to 10 days) can be diagnosed with RT-PCR in blood
Later stages ELISA to measure IgM 3 days after onset of symptoms ( west nile, zika can give false-positive)
- yellow fever virus-specific IgM antibody and negative ELISA panel to confirm diagnosis
Yellow Fever: treatment
supportive, no antivirals
Yellow Fever: Prevention
Live-attenuated 17D strain vaccine, single dose
contraindicated in those with egg allergies, immunocompromised, over the age of 60 or breastfeeding, pregnant
Recommended for those over 9 months
Zika Virus (Aedes Mosquito)
Flavivirus transmitted from mosquito or sexual transmission from males to females (can persist in semen for months), vertical transmission from mothers to fetus
Zika Virus (Aedes Mosquito): S & S
incubation period is about 10 days
acute onset fever, maculopapular rash usually pruritic, non purulent conjunctivitis, arthralgia (mimics chikungunya virus); symptoms up to 7 days
Zika Virus (Aedes Mosquito): laboratory findings
diagnosed through IgM after 4+ days of symptom onset or IgG after 7+ days
Zika Virus (Aedes Mosquito): Complications
- Congenital microcephaly: associated with brain calcifications,
- Guillian-Barre syndrome
- focal macular pigment mottling, chorioretinal atrophy, congenital glaucoma,
Zika Virus (Aedes Mosquito): treatment
No antivirals, Sofosbuvir?, no aspirin or NSAIDs
No vaccine, avoid during pregnancy
Chikungunya Fever
Considered a classic “arthritogenic” virus
may coinfect with zika, yellow fever, plasmodia and dengue
Chikungunya Fever: S&S
Incubation period of 1-12 days
Abrupt fever onset, headache, intestinal complaints (diarrhea/vomiting/pain), myalgias and arthalgias/arthritis affecting the small, large and axial joints.
simultaneous involvement of more than 10 joints and presence of tenosynovitis (esp in the wrist) is characteristic
joint symptoms last for 4 months-years
maculopapular rash
Chikungunya Fever: Laboratory findings
mild leukopenia, thrombocytopenia
radiographs during acute phase of joints are normal, bone lesions may be present with chronic symptoms
confirmed with elevated IgM titers or fourfold increase in convalescence IgG levels during ELISA
Chikungunya Fever: Treatment
NSAIDS and corticosteroids
Chloroquine may be useful in managing refractory arthritis
Chronic disease: DMARDs
Influenza A/B/C
Incubation period 1-4 days
Fever lasts 1-7 days
Elderly patients may present without respiratory symptoms but lassitude and confusion
Children may present with more GI symptoms especially in influenza B
Influenza antiviral therapy
Should be started within 48 hours of disease onset
Neuraminidase inhibitors: oral oseltamivir
75 mg BID for 5 days
drug of choice for patients that are of any age, pregnant
No great for patients with GI bleeding or decreased motility
Neuraminidase inhibitors: Inhaled zanamivir
10mg 2 inhalations BID for 5 days
for uncomplicated influenza in patients 7 years or older
contraindicated in those with asthma/lung dx
Neuraminidase inhibitors: IV peramivir
600 mg single dose
outpatient tx for uncomplicated infection in 18+
used when there is concern for decreased absorption of oseltamivir
Trivalent influenza vaccine vs Quadrivalent
Protects against A,B, C .. Quad with additional protection against strain of B
High dose trivalent inactivated influenza vaccine
For those 65 years and older
containing four times more hemagglutinin to enhance immune system response
Fluzone
not recommended for adults over 65
Influenza vaccine contraindications
severe allergic reaction, hx of Guillian-Barre syndrome, egg allergy (can receive is rxn is only hives); recombinant vaccine is egg free
Adenovirus infections: incubation
4-9 days
rhinitis, pharyngitis, mild malaise without fever
Rocky Mountain Spotted Fever
Exposure to tick bite in endemic area (NC, TN, OK, MS, AK)
Symptoms begin 2-14 days after bite with onset of fever, chills, HA, N/V, myalgias, restlessness, insomnia, irritability
Rocky Mountain Spotted Fever: rash
Faint macule that progress to maculopapules and then petechiae appears between day 2 and 6 of fever
initially involves wrists & ankles, spreading centrally to arms, legs, and trunk over the next 2-3 days (soles/palms is common)
facial flushing, conjunctival injection, hard palate lesions may occur
severe: pneumonitis, delirium, hepatomegaly, splenomegaly, jaundice, myocarditits
Rocky Mountain Spotted Fever: Laboratory findings
Thrombocytopenia, hyponatremia, elevated LFTs
Dx confirmed by immunohistologic or PCR demonstration of R rickettsii in skin biopsy or cutaneous swabs of eschars
usually antibody response doesn’t happen until week 2
*indirect fluorescent antibody test is most common
Rocky Mountain Spotted Fever: Treatment
Doxycycline 100 mg BID for 4-10 days
Chloramphenicol (50-100 mg/kg/day in four divided doses PO or IV for 4-10 days) for pregnant women
Medication should be continued at least 3 days after defervesce
Molluscum contagiosum: S & S
Caused by poxvirus
Presents as single or multiple dome-shaped, waxy papule 2-5 mm in diameter that are umbilicated
At first lesions are firm, sold, flesh colored but at maturity become soft, whitish/pearly grey and may suppurate
Sites of involvement: face, lower abdomen, genitals
Molluscum contagiosum
Spread by wet skin to skin contact, considered a sexually transmitted infection
common in patients with AIDS, helper T cells less than 100/mcL
Molluscum contagiosum: Diagnosis
clinically based on the distinctive central umbilication of the dome-shaped lesion sparing the palms and soles
time to remission is 13 months
Molluscum contagiosum: Treatment
Curettage or applications of liquid nitrogen
light electrosurgery with fine needle
Cantharadin (applied in office then washed off by patient 4 hours later)
Variola-Smallpox: S & S
severe headache, acute onset fever, prostration and rash (uniform progression from macules to papule to firm, deep-seated vesicles or pustules)
West Nile virus: S&S/rash
Circulates between birds and mosquitoes
Incubation period of 2-14 days
acute fever, nonpruritic maculopapular rash
Classifications of pneumonia
- Community acquired (CAP)
- Nosocomial (hospital acquired/ventilator associated)
community acquired pneumonia
most commonly caused by S pneumoniae, M pneumoniae, or C pneumoniae
treatment of macrolide + beta lactic (high dose amoxicillin or amoxicillin clavulanate) or a respiratory fluoroquinolone
mononucleosis: S & S
Incubation: 30-50 days; fever usually resolves in 10 days
Fever, sore throat, fatigue, malaise, anorexia, myalgia, lymphadenopathy
LAD= posterior cervical area, sometimes tender
Hoagland sign – eyelid edema
Rash= maculopapular or petechial
mononucleosis: laboratory findings
- lymphocytic leukocytosis, atypical lymphocytes
mononucleosis: testing
Heterophile sheep cell agglutination antibody test
mononucleosis spot test (monospot): generally positive within 4 weeks, false negative early on
Acute illness= increase in IgM antibody to EB virus capsid antigen and increase IgG to VCA
mononucleosis: complications
secondary bacterial pharyngitis
ulular edema, tonsilitis, gingivitis
splenic ruptures (increase risk with previous trauma)
more rare: acalculous cholecystitis, fulminant hepatitis, myocarditis
mononucleosis: treatment
no antivirals indicated
supportive care: Tylenol, NSAIDs, throat gargles
corticosteroids not recommended if uncomplicated
if airway obstruction (drooling, enlarged nodes)= steroids indicated
if throat culture is also + for beta hemolytic streptococci= 10 days penicillin or azithromycin
avoid ampicillin and amoxicillin- assoc. with rash
more rare complications treated systematically (splenectomy)
Outpatient management of CAP
for health patients with no abx use within 3 months: macrolide (clarithromycin or azithromycin) or doxycycline
for patients with comorbidities, recent abx use or immunocomprised: respiratory fluoroquinolone (moxifloxaicin, levofloxacin) or a macrolide + a beta-lactam (amoxicillin/ amoxicillin clavulanatate
Impetigo
contagious and autoinoculable infection of the epidermis caused by staphylococci or streptococci
Impetigo: S&S
Lesions of macules, vesicles, bullae, pustules and honey-colored crusts that when removed leave denunded red areas
face/exposed areas most involved
Ecthyma: deeper form caused by staph/strep with ulceration and scarring on extremities
Impetigo: Laboratory findings
gram stain and culture confirm diagnosis
temperate climates: usually s. aureus
tropical climates: usually streptococcus
Impetigo: treatment
soaks and scrubbing
topical agents such as bacitracin first line for small areas
for widespread/immunocompromised: systemic antibiotics: Cephalexin 250 mg QID or doxy
no sharing towels/bleach showers or tubs after use
MMRV vaccine
First dose age 12-15 months
second dose age 4-6 years
ASA avoided at least 6 weeks after due to r/f Reye syndrome
MMRV risk
Febrile seizures 5-12 days after vaccination among infants aged 12-23 months
Rashes secondary to varicella 15-42 days after
DTaP
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP or DTaP