https:\/\/learnexams.com\/search\/study?query=<\/a><\/p>\n\n\n\nwhat is specificity of a test (equation)<\/p>\n\n\n\n
true negatives \/ #false pos + true neg<\/h1>\n\n\n\n
what is sensitivity of a test (equation)<\/p>\n\n\n\n
true positives \/ #false negative + true positives<\/h1>\n\n\n\n
what is the prevalence of a disease
number of cases at a given time<\/p>\n\n\n\n
what is the incidence of a disease
the number of new cases that occur over a period of time<\/p>\n\n\n\n
what is the positive predictive value (definition not equation)
how likely it is that the positive result is actually positive<\/p>\n\n\n\n
what is the negative predictive value (definition not equation)
how likely it is that the negative is really negative<\/p>\n\n\n\n
what is the positive predictive value (equation)<\/p>\n\n\n\n
true positives \/total tested positives (false pos and true pos)<\/h1>\n\n\n\n
what is the negative predictive value (equation)<\/p>\n\n\n\n
true negatives \/ total tested negatives (false neg and true neg)<\/h1>\n\n\n\n
what does low specificity of a test mean?
you get higher incidence of false positives<\/p>\n\n\n\n
what does low sensitivity of a test mean
high occurrence of false negatives<\/p>\n\n\n\n
what does high specificity of a test mean
accurately identifies truly undiseased people<\/p>\n\n\n\n
what does a high sensitivity of a test mean
correctly identifies actually positive diseased patients<\/p>\n\n\n\n
T or F : the HPI is a breakdown of the chief complaint
true<\/p>\n\n\n\n
what is needed to make sound clinical decision (3)
EBP \/ research
Clinical practice guideline
algorithms (evidence based)<\/p>\n\n\n\n
patients on medicare usually have _<\/em><\/strong> % out of pocket costs
20<\/p>\n\n\n\nHow do traditional medicare patients pay for the 20% out of pocket costs that they have when on this plan
usually get secondary insurance<\/p>\n\n\n\n
medicare part A covers (4)
inpatient hospital
SNF
hospice
home health<\/p>\n\n\n\n
medicare part B covers (7)
outpatient services, MD visit, surgery, lab, equipment, preventative exams<\/p>\n\n\n\n
traditional medicare includes which parts ? are they free?
A and B ; no – part B has a premium and usually both have 20% out of pocket costs<\/p>\n\n\n\n
medicare part c includes
wellness services, vision, hearing, glasses, hearing aids and sometimes dental<\/p>\n\n\n\n
medicare part D includes
prescriptions<\/p>\n\n\n\n
which parts of medicare are part of the advantage plan
A B and D are usually bundled and SOMETIMES C<\/p>\n\n\n\n
what is the difference between traditional medicare and advantage plan
advantage – through a private insurance that follows medicare standards – usually part A B and D<\/p>\n\n\n\n
medicare – government run, usually only part A and D<\/p>\n\n\n\n
Who qualifies for Medicare? (3)
Persons 65 years or older<\/p>\n\n\n\n
people with permanent kidney failure<\/p>\n\n\n\n
person who has been on some social security program for at least 24 months \/ disability<\/p>\n\n\n\n
who has lower copayments – medicare traditional or medicare advantage
advantage<\/p>\n\n\n\n
how are medicare advantage carriers paid by CMS?
subsidies per member \/ per patient<\/p>\n\n\n\n
what is the reimbursement percentage for NPs
85% of physician reimbursement<\/p>\n\n\n\n
what are the 7 categories of third party payers
medicare
medicaid
indemnity (fee for service)
managed care orgs
workers comp
VA
auto liability<\/p>\n\n\n\n
what is a third party payer system
An organization other than the patient and the provider (insurance company) is paying for services<\/p>\n\n\n\n
what is a papule
A raised area of the skin that is generally smaller than 1 centimeter<\/p>\n\n\n\n
What is a macule?
a flat lesion that differs in color from surrounding skin (<1 cm in diameter)<\/p>\n\n\n\n
typically brown, red, white<\/p>\n\n\n\n
what is a nodule
under the skin elevated mass <2cm<\/p>\n\n\n\n
what is a plaque (skin)
a raised area > 1 cm<\/p>\n\n\n\n
what is a vesicle
fluid filled sac <1cm<\/p>\n\n\n\n
what is a blister AKA bullae
fluid filled sac >1cm<\/p>\n\n\n\n
what is urticaria
wheal or hive<\/p>\n\n\n\n
what is the difference between erosions and ulcers
ulcers = dermis and epidermis<\/p>\n\n\n\n
erosion = epidermis<\/p>\n\n\n\n
what are petechiae
tiny non-raised red or purple spots that appear on the skin from rupturing of the capillaries<\/p>\n\n\n\n
what does skin atrophy look like
thinning skin, like paper<\/p>\n\n\n\n
what is telangiectasia?
capillary ruptures<\/p>\n\n\n\n
look like varicose veins or petichiae with lines<\/p>\n\n\n\n
nummular versus annular
annular – circle with central clearing<\/p>\n\n\n\n
nummular – circle with no central clearing<\/p>\n\n\n\n
what are verrucous lesions
wart like<\/p>\n\n\n\n
what is lichenification
thickening of the skin<\/p>\n\n\n\n
what is a xanthoma
yellow tumor \/ yellow bump – can have fatty contents<\/p>\n\n\n\n
most defining characteristic on assessment of fungal skin infections
papular rash with satellite lesions<\/p>\n\n\n\n
how to diagnose fungal skin infection
presentation<\/p>\n\n\n\n
most common fungal skin infection
candida albicans<\/p>\n\n\n\n
nonspecific treatment for fungal infections
reduce moisture, antifungal<\/p>\n\n\n\n
who is most at risk for fungal infections (10)
immunocompromised (with altered cell immunity)
AIDs
old
young
DM
on ABX
steroid treatment
chemo
invasive parenteral catheterization
internal monitoring device<\/p>\n\n\n\n
tinea corporis
ringworm of the body (fungal)<\/p>\n\n\n\n
tinea pedis
A ringworm fungus of the foot (athletes foot)<\/p>\n\n\n\n
how tinea appears
annular lesions with scaly borders and central clearing<\/p>\n\n\n\n
tinea cruris
ringworm of the groin \/ jock itch (fungus)<\/p>\n\n\n\n
balanitis
candidiasis of glans penis<\/p>\n\n\n\n
tinea vesicolor
fungal infection of skin caused by yeast (not ringworm fungus).<\/p>\n\n\n\n
how does tinea versicolor present
flat to slightly elevated brown papules and plaques that scale when rubbed<\/p>\n\n\n\n
have areas of hypopigmentation<\/p>\n\n\n\n
where does tinea versicolor mostly occur
trunk and shoulders<\/p>\n\n\n\n
what is onychomycosis or tinea unguium
fungal infection of the nail<\/p>\n\n\n\n
how does onychomycosis present
white or yellow nail discoloration, thickening, and separation of nail from nail bed<\/p>\n\n\n\n
treatment for onychomycosis (6)
Topicals:
nystatin (nyamyc pedi dry nystop,) clotrimazole, miconazole, naftifine (naftin), terbinafine, ciclopirox<\/p>\n\n\n\n
who is at risk for dry skin and why
older adult ; dehydration, polypharmacy, diuretics<\/p>\n\n\n\n
education for older adult with dry skin
tepid water with mild cleansing cream or soap<\/p>\n\n\n\n
general presentation of bacterial skin infection
warm, red, pain, withOUT sharp demarcation<\/p>\n\n\n\n
cellulitis
infection of epidermis and SQ
usually with skin break<\/p>\n\n\n\n
folliculitis – what is it and its presentation
infection of hair follicle<\/p>\n\n\n\n
papules common<\/p>\n\n\n\n
impetigo
bacterial skin infection common to children<\/p>\n\n\n\n
how does impetigo present
honey, colored crusted lesions filled with pus on nose, lips<\/p>\n\n\n\n
progress from vesicle to pustule to lesion<\/p>\n\n\n\n
what is the difference between impetigo and ecthyma
ecthyma – ulcerated with eschar , punched out appearance<\/p>\n\n\n\n
impetigo – bullous or non bullous but not usually with eschar<\/p>\n\n\n\n
organisms that cause impetigo and ecthyma
impetigo: group A or group B hemolytic strep<\/p>\n\n\n\n
ecthyma: group A hemolytic strep<\/p>\n\n\n\n
bullous versus nonbullous impetigo
bullous: flaccid bullae with clear, yellow fluid, usually on trunk (can crust, but not as crusty as nonbullous)<\/p>\n\n\n\n
nonbullous: papules that become vesicles but usually on face and extremities (usually more crusted appearance than bullous, more honey crusting)<\/p>\n\n\n\n
nonskin symptoms of impetigo \/ ecthyma
regional lymphadenopathy<\/p>\n\n\n\n
besides Group a and b strep, what other organisms can cause impetigo and ecthyma
less likely but:
Staph aureus
MRSA<\/p>\n\n\n\n
treatment for S. Aureus impetigo or ecthyma
dicloxacillin<\/p>\n\n\n\n
cephalexin<\/p>\n\n\n\n
both 250mg to 500mg QID for 10 days<\/p>\n\n\n\n
treatment for streptococcus impetigo or ecthyma
dicolaxillin<\/p>\n\n\n\n
penicillin<\/p>\n\n\n\n
cephalexin<\/p>\n\n\n\n
treatment for MRSA impetigo or ecthyma
doxicycline<\/p>\n\n\n\n
clindamycin<\/p>\n\n\n\n
sulfamethoxazole\/trimethoprim (Bactrim)<\/p>\n\n\n\n
what is an epidermal inclusion cyst
benign nodule that contains normal , viable epidermis<\/p>\n\n\n\n
what is the common presentation of an epidermal inclusion cyst
HX of present at site for months to years without change<\/p>\n\n\n\n
what is inside an epidermal inclusion cyst
white cheesy odorous discharge<\/p>\n\n\n\n
What is a furuncle?
deeper infxn at hair follicle aka hair follicle abscess<\/p>\n\n\n\n
difference between furuncle and epidermal inclusion cyst
furuncle – very acute, inflammatory, few days to form<\/p>\n\n\n\n
inclusion cyst – slow, not inflammatory<\/p>\n\n\n\n
what is inside a furuncle or carbuncle
purulent yellow or green discharge (abscess)<\/p>\n\n\n\n
what are cholinergic urticaria and where do they present
hives \/ wheals that are exercise, anxiety, heat induced<\/p>\n\n\n\n
occur on trunk and arms<\/p>\n\n\n\n
what is the treatment for urticaria
antihistamines<\/p>\n\n\n\n
when should epi be given in hives situation
when rash around neck face or if symptomatic of anaphylaxis<\/p>\n\n\n\n
what is the type of reaction that occurs in hives
type 1 hypersensitivity<\/p>\n\n\n\n
what is a type 1 hypersensitivity<\/p>\n\n\n\n
\n- IgE MEDIATED<\/li>\n\n\n\n
- involves MAST CELLS and BASOPHILS<\/li>\n\n\n\n
- URTICARIA, ANAPHYLAXIS, ASTHMA<\/li>\n<\/ul>\n\n\n\n
what is atopic dermatitis
aka eczema<\/p>\n\n\n\n
scaly patchy dry on elbows or knees<\/p>\n\n\n\n
can be red and swollen<\/p>\n\n\n\n
cardinal sign of atopic dermatitis
severe pruritis – itching comes before the rash<\/p>\n\n\n\n
treatment for atopic dermatitis (nonpharmacologic)
avoid soap
apply emollient<\/p>\n\n\n\n
common place for atopic dermatitis (esp in kids)
antecubital fossa
popliteal fossa<\/p>\n\n\n\n
medication management for atopic dermatitis
topical corticosteroids
Burrows solution (aluminum triacetate)
silver nitrate<\/p>\n\n\n\n
typically avoid antihistamines as they do not usually help<\/p>\n\n\n\n
herpes simplex virus presentation
oral (type 1) genital (type 2) blistering \/ vesicular lesions<\/p>\n\n\n\n
when to treat herpes simplex
in immunocompromised individuals with symptoms<\/p>\n\n\n\n
what is the treatment for herpes simplex
famciclovir<\/p>\n\n\n\n
valacyclovir<\/p>\n\n\n\n
What is herpes zoster?
shingles<\/p>\n\n\n\n
how does herpes zoster present<\/p>\n\n\n\n
\n- Densely grouped vesicular rash.<\/li>\n\n\n\n
- Erythema.<\/li>\n\n\n\n
- Pain, tenderness and paraesthesia may precede rash.<\/li>\n\n\n\n
- Vesicles become pustular and form crusts.<\/li>\n<\/ul>\n\n\n\n
unilateral along a dermatome (nerve path)<\/p>\n\n\n\n
which dermatome is most common in shingles
thoracic or lumbar<\/p>\n\n\n\n
stages of shingles lesions
papular to vesicular to rupture to crust to scab<\/p>\n\n\n\n
what is the first line treatment for acne
benzoyl peroxide<\/p>\n\n\n\n
when are oral ABX indicated in acne
risk for scarring or pigment changes, have nodulocystic acne<\/p>\n\n\n\n
havent responded to topical after 2-3 months or cant tolerate<\/p>\n\n\n\n
especially if on back, arms<\/p>\n\n\n\n
patient education for acne
sunscreen needed when treating with all medications for acne<\/p>\n\n\n\n
wash face BID with antibacterial soap<\/p>\n\n\n\n
who is most at risk for scarring from acne
hispanic males<\/p>\n\n\n\n
acne is more common in _<\/em><\/strong> and more severe in _<\/em><\/strong>
common in females<\/p>\n\n\n\nsevere in males<\/p>\n\n\n\n
mild acne presentation
non inflammatory
small papules occasionally<\/p>\n\n\n\n
moderate acne presentation
inflammatory lesions
papules
pustules<\/p>\n\n\n\n
severe acne presentation
nodules
cystic
scar formation<\/p>\n\n\n\n
in a female with severe cystic acne, what should be ruled out
acne coblongata ; rule out PCOS<\/p>\n\n\n\n
Acne fulminans presentation
only in young males; rare<\/p>\n\n\n\n
acute, largely inflammatory, ulcerated lesions<\/p>\n\n\n\n
\n- systemic fever, chills, flu symptoms<\/li>\n<\/ul>\n\n\n\n
class of ABX used in oral treatment for acne
-cyclines \/ tetracyclines<\/p>\n\n\n\n
esp minocycline<\/p>\n\n\n\n
What is rosacea?
Condition characterized by redness and dilation of blood vessels<\/p>\n\n\n\n
does rosacea have comedones
not usually but can have small pus filled bumps for a few months before subsiding<\/p>\n\n\n\n
what are the causes of rosacea (9)
mites, stress, hormones, neurovascular, infection, sun exposure, alcohol, hot drinks , H. pylori<\/p>\n\n\n\n
what is the main treatment for rosacea and what should the patient know about treatment
metronidazole cream ; takes up to 6 to 8 weeks to see change<\/p>\n\n\n\n
patient education in rosacea when under treatment
sunscreen
protect face from cold air and wind and sun<\/p>\n\n\n\n
common people affected by rosacea
some genetic link, more common women and in EURO descendent<\/p>\n\n\n\n
seborrheic keratosis presentation
benign skin growth can appear as waxy, papule or warty crusted stuck on brown or grey<\/p>\n\n\n\n
“as if they could be picked off”<\/p>\n\n\n\n
where does seborrheic keratosis occur mostly
trunk, face, arms<\/p>\n\n\n\n
who most commonly gets seborrheic keratosis
white skin<\/p>\n\n\n\n
are seborrheic keratosis cancerous or precancerous?
neither, they are benign, not precancerous or cancerous<\/p>\n\n\n\n
what are the treatments for seborrheic keratosis if needed
treatment often not needed but can be removed with cryotherapy \/ liquid nitrogen, electrodessication and curettage<\/p>\n\n\n\n
what are the DDX for seborrheic keratosis
pigmented nevi
basal cell carcinoma
melanoma<\/p>\n\n\n\n
what are actinic keratosis \/ how do they present (AKA senile keratosis)
precancerous , sun exposure<\/p>\n\n\n\n
can be pink, red, rough \/ sand paper like usually on sun exposed areas<\/p>\n\n\n\n
what does actinic keratosis turn into if becomes cancerous and how long does progression typically take
squamous cell carcinoma<\/p>\n\n\n\n
2 year transition<\/p>\n\n\n\n
what should you do if you suspect actinic keratosis
refer to derm<\/p>\n\n\n\n
high risk individual for actinic keratosis (6)
sun exposure
men
light skin
wrinkles
senile lentigines
over 50<\/p>\n\n\n\n
what is the treatment for actinic keratosis
5-FU (flourouracil) cream (BID for 3-4 weeks) or liquid nitrogen cryotherapy or imiquimod (twice week for 16 weeks)<\/p>\n\n\n\n
risk factors for malignant melanoma
age
immunosuppression
exposure to indoor tanning<\/p>\n\n\n\n
if melanoma is > 4 mm deep prognosis is
bad<\/p>\n\n\n\n
What are the ABCDEs of melanoma?
asymmetry
border
color
diameter (under 1 cm okay)
evolution<\/p>\n\n\n\n
where can melanoma occur other than skin
subungual \/ under the nail especially of thumb and hallux<\/p>\n\n\n\n
mucus membranes<\/p>\n\n\n\n
conjunctiva<\/p>\n\n\n\n
what is a lipoma
fatty tumor, benign<\/p>\n\n\n\n
presentation of lipoma
rubbery, smooth, moveable, compressable<\/p>\n\n\n\n
common areas for lipomas
neck, trunk, forearms, thigh and armpit<\/p>\n\n\n\n
management of lipoma
watch for rapid growth<\/p>\n\n\n\n
liposuction<\/p>\n\n\n\n
excision<\/p>\n\n\n\n
what is scabies
Contagious disease caused by the itch mite<\/p>\n\n\n\n
sarcoptes scabies mite<\/p>\n\n\n\n
how does scabies present
intense itching , worse at night<\/p>\n\n\n\n
burrows<\/p>\n\n\n\n
small 1-2mm red papules<\/p>\n\n\n\n
transmission of scabies
direct contact<\/p>\n\n\n\n
DDX for scabies
atopic dermatitis, contact dermatitis, folliculitis<\/p>\n\n\n\n
treatment for scabies
topical permethrin is first line, followed by lindane or spinosad<\/p>\n\n\n\n
systemic treatment – ivermectin<\/p>\n\n\n\n
if ivermectin is required to treat scabies what is the dose
200 mcg per kg once with a repeat dose in 1-2 weeks<\/p>\n\n\n\n
when would you use steroids for scabies
severe hypersensitivity to mites<\/p>\n\n\n\n
where does scabies usually occur (7)
interdigit webs, groin fold, axillary fold, wrists, periumbilical, penis, ankles<\/p>\n\n\n\n
where does scabies typically occur in small children
palms, soles, face, neck, scalp<\/p>\n\n\n\n
what are the diagnostics for scabies
burrow ink test – felt tip blue or green pen over burrow – wipe away with alcohol – remaining ink will show borrow<\/p>\n\n\n\n
scrapings – drop one drop mineral oil over burrow, scrape with scalpel put on slide with another drop oil and cover – will show mites or poop<\/p>\n\n\n\n
if the patient develops a secondary bacterial infection from scabies, treat with
dicloxacillin
cephalex<\/p>\n\n\n\n
what is pediculosis capitis
head lice<\/p>\n\n\n\n
presentation of pediculosis capitis
nits on the hair shaft – like dandruff but the difference is the nits wont fall out like dandruff, need nit comb<\/p>\n\n\n\n
patient education when treating pediculosis capitis
itching may continue a week after treatment because the inflammatory process takes a while to subside<\/p>\n\n\n\n
treatment option for resistant lice
oral ivermectin 200mcg per kg 1 dose and repeat in 10 days<\/p>\n\n\n\n
typical treatment for head lice
permethrin shampoo, malathion, lindane shampoo<\/p>\n\n\n\n
all done once and repeat in 1 week if needed<\/p>\n\n\n\n
what is a furuncle
staph abscess that forms in hair follicle<\/p>\n\n\n\n
if a furuncle or carbuncle occurs in the axilla – what should you also consider as DDX
hidradenitis suppurativa<\/p>\n\n\n\n
What is hidradenitis suppurativa?
condition of sweat gland infection chronically. results in sores, odor, drainage<\/p>\n\n\n\n
furuncles are caused primarily by what organism
S. Aureus<\/p>\n\n\n\n
treatment for furuncle \/ carbuncle
solitary furuncle: warm compress may be enough to promote drainage<\/p>\n\n\n\n
large furuncle or carbuncle: treat like abscess. incision and drainage with oral abx if needed when MSSA. if MRSA may need IV ABX<\/p>\n\n\n\n
warts are caused by
HPV<\/p>\n\n\n\n
warts can spread by
abrading the skin, rubbing, shaving, nail biting<\/p>\n\n\n\n
typical wart appearance
sharply demarcated, firm and rough. may be pedunculated (cauliflower like)<\/p>\n\n\n\n
treatment for warts
irritants that encourage immune response (salicylic acid plasters or solutions) and:<\/p>\n\n\n\n
bichloracetic acid<\/p>\n\n\n\n
trichloracetic acid<\/p>\n\n\n\n
podophyllum resin<\/p>\n\n\n\n
electrocautery, cryotherapy<\/p>\n\n\n\n
viral conjunctivitis often caused by
adenovirus<\/p>\n\n\n\n
hallmark symptom of viral conjunctivitis
preauricular lymph node swelling<\/p>\n\n\n\n
viral conjunctivitis symptoms especially in adenovirus (4)
may have cough, cold symptoms<\/p>\n\n\n\n
may have itching but not bad, red eyes with clear or no drainage , profuse tearing bilateral<\/p>\n\n\n\n
preauricular lymph node swelling<\/p>\n\n\n\n
irritation or foreign body sensation in eye<\/p>\n\n\n\n
herpes simplex conjunctivitis presentation
skin vesicles<\/p>\n\n\n\n
preauricular lymphadenopathy<\/p>\n\n\n\n
watery discharge<\/p>\n\n\n\n
dendrite appearance<\/p>\n\n\n\n
Herpes conjunctivitis Tx
opthalmic pyrimidine<\/p>\n\n\n\n
oral acyclovir<\/p>\n\n\n\n
does viral conjunctivitis need treatment
not usually except in herpes conjunctivitis<\/p>\n\n\n\n
bacterial conjunctivitis presentation
patient wakes up and eye is shut with crust, will see strands of mucous in eye typically unilateral<\/p>\n\n\n\n
allergic conjunctivitis
rhinorrhea
itching
watering eyes<\/p>\n\n\n\n
when should you culture bacterial conjunctivitis<\/p>\n\n\n\n
\n- no treatment after 2-3 weeks<\/li>\n\n\n\n
- recurring<\/li>\n\n\n\n
- severe<\/li>\n<\/ul>\n\n\n\n
suspect chlamydia or gonorrhea<\/p>\n\n\n\n
what is the treatment for chlamydial conjunctivitis
azithromycin 1G one dose<\/p>\n\n\n\n
OR<\/p>\n\n\n\n
doxycyline 100mg BID 7 days<\/p>\n\n\n\n
what is the treatment for typical bacterial conjunctivitis
first line: broad spec topical agents (ointment or drop opthalmic)<\/p>\n\n\n\n
polymycin and other mycins<\/p>\n\n\n\n
floxacins<\/p>\n\n\n\n
what is the treatment for allergic conjunctivitis (4 classes)
mast cell stabilizer drops<\/p>\n\n\n\n
antihistamine drops<\/p>\n\n\n\n
NSAID drops<\/p>\n\n\n\n
combination mast\/antihist drops<\/p>\n\n\n\n
all the antihistamine eye drops end in
-astine<\/p>\n\n\n\n
what is the NSAID drop for allergic conjunctivitis
ketorolac<\/p>\n\n\n\n
what are the mast cell stabilizer eye drops for allergic conjunctivitis (3)
lidoxamide
nidocromil
pimurulast<\/p>\n\n\n\n
what are the combo mast cell stab and antihistamine eye drops for allergic conjunctivitis (4)
olopatadine
azelastine
ketotifen
epinastine<\/p>\n\n\n\n
what are cataracts
Partial or total opacity of the normally transparent lens<\/p>\n\n\n\n
how does cataract progress
gradual , PAINLESS, progressive loss of vision<\/p>\n\n\n\n
doe vita E, C, beta carotene prevent cataracts
nope<\/p>\n\n\n\n
age related cataracts symptoms
bilateral, may have blurred or distorted vision, with a glare at night or in bright light<\/p>\n\n\n\n
cataracts symptoms (general)
halos around light
gradual painless loss of vision
reduced color perception
myopia (loss distance vision)<\/p>\n\n\n\n
treatments for cataracts
surgery<\/p>\n\n\n\n
what is blepharitis
inflammation of the eyelid margins caused by staph<\/p>\n\n\n\n
can be ulcerative or non<\/p>\n\n\n\n
non ulcerative blephiritis
seborrhea and greasy scaling of eyelid margin<\/p>\n\n\n\n
ulcerative blepharitis
involved follicles and Meibomian glands<\/p>\n\n\n\n
has pustules at base of hair follicle that bleed and crust<\/p>\n\n\n\n
symptoms of (both types) blepharitis
foreign body sensation<\/p>\n\n\n\n
itchy<\/p>\n\n\n\n
burning<\/p>\n\n\n\n
photophobia<\/p>\n\n\n\n
tearing<\/p>\n\n\n\n
unilateral or bilateral<\/p>\n\n\n\n
edema, erythema<\/p>\n\n\n\n
what would you see in blepharitis if using a woods lamp
ulcerations, redness, scaling<\/p>\n\n\n\n
treatment for blepharitis
initially bacitracin opthalmic or erythromycin qD or BID 7-10 days<\/p>\n\n\n\n
if resistant treat with floroquinolone \/ floxacin OR sulfacetamide\/corticosteroid combo<\/p>\n\n\n\n
what is the sulfacetamide \/ corticosteroid combo used for blepharitis
10% sulfacetamide \/ prednisolone 0.2%<\/p>\n\n\n\n
severe blepharitis associated with rosacea: treatment
doxycylcine 100mg BID or tetracycline 250mg QID<\/p>\n\n\n\n
for several weeks then taper down<\/p>\n\n\n\n
what is a chalazion
Cyst due to blockage of the meibomian gland. not painful<\/p>\n\n\n\n
treatment for chalazion
warm compress, refer if more than 4 week duration (I\/D, biopsy, injxn with glucocorticoid) , 1:1 dilution water and no tear shampoo to wash<\/p>\n\n\n\n
what is a hordeolum
a stye — acute infection \/ block of meibomian gland (versus chalazion is chronic , not as inflammatory )<\/p>\n\n\n\n
treatment for hordeolum
warm compress
clean with 1:1 baby shampoo and water,<\/p>\n\n\n\n
if signs of infection occur, erythromycin, cipro, or sulfacetamide ointments can be used<\/p>\n\n\n\n
treatment for resistant or recurrent hordeolum \/ stye
oral cephalexin<\/p>\n\n\n\n
dry eyes are often reported as
feeling of sand in the eyes especially with blinking<\/p>\n\n\n\n
what is important when assessing a patient with dry eyes
good history taking<\/p>\n\n\n\n
diagnostic for dry eyes
slit lamp exam
Schirmer test<\/p>\n\n\n\n
slit lamp test
Similar to a microscope that is used to examine the structures of your eye. This can help diagnose cataracts and ensures all parts of your eye are working correctly<\/p>\n\n\n\n
schirmer test
a test that measures lacrimal gland flow by placing special filter paper strips inside the lower eyelid for 5 minutes<\/p>\n\n\n\n
quantify lacrimal secretion<\/p>\n\n\n\n
education for dry eyes
goggles when swimming, preservative free artifical tears, rest from electronics, dont rub it<\/p>\n\n\n\n
What is keratoconjunctivitis sicca?
dry eyes<\/p>\n\n\n\n
what is the TRIAD for dry eyes
burning , itching, foreign body sensation<\/p>\n\n\n\n
what is epiphora
excessive tearing<\/p>\n\n\n\n
who is at risk for epiphora
elderly<\/p>\n\n\n\n
allergies<\/p>\n\n\n\n
treatment for epiphora if caused by trauma or infection
topical ABX<\/p>\n\n\n\n
what should not be used in epiphora and why
corticosteroid eye drops, anesthetic drops – may block healing<\/p>\n\n\n\n
causes of epiphora
obstruction of duct<\/p>\n\n\n\n
paradox to dry eye<\/p>\n\n\n\n
what is subconjunctival hemorrhage
Hemorrhage over the sclera.
Painless
Normal vision
DT minor trauma: cough, sneeze<\/p>\n\n\n\n
risk factors for subconjunctival hemorrhage
valsalva \/ constipation, blood thinners, DM, HTN<\/p>\n\n\n\n
herpes zoster ophtalmicus
shingles of the eye<\/p>\n\n\n\n
presentation of herpes zoster opthalmicus
rash forehead
swelling eyelid
pain
redness
inflammation of conjunctiva, cornea
photophobia<\/p>\n\n\n\n
treatment for herpes zoster opthalmicus
Acyclovir 800 mg 5x\/day<\/p>\n\n\n\n
start within 72 hours of onset<\/p>\n\n\n\n
what is sinusitis
inflammation of the sinuses<\/p>\n\n\n\n
presentation of sinusitis – ethmoid
behind eye pain<\/p>\n\n\n\n
presentation of sinusitis – maxillary
cheek pain, nasal discharge, poor response to decongestant,<\/p>\n\n\n\n
DX of sinusitis
URI for 7 days, then 2 of the following<\/p>\n\n\n\n
colored nasal discharge
facial pain
poor response to decongestants
headache<\/p>\n\n\n\n
if the patient meets the 7 day criteria for sinusitis – they likely have what type of sinusitis
bacterial<\/p>\n\n\n\n
risk factors for sinusitis
smoking, asthma, deviated septum<\/p>\n\n\n\n
preceded by URI<\/p>\n\n\n\n
treatment for bacterial sinusitis
Amoxicillin\/clauv (augmentin) 875mg q12H<\/p>\n\n\n\n
doxycycline<\/p>\n\n\n\n
steam<\/p>\n\n\n\n
otitis externa presentation
itching and drainage from the external auditory canal, difficult to visualize the tympanic membrane bc of swelling, manipulation of tragus is painful; associated w swimming, foreign bodies<\/p>\n\n\n\n
otitis media presentation
red, bulging TM, possible effusion, light reflex diminished, mobility is decreased<\/p>\n\n\n\n
pediatric treatment for otitis media
amoxicillin 40-45mg\/kg\/day in 2 divided doses<\/p>\n\n\n\n
treatment of otitis externa
dry ears
no swimming 4-6 weeks<\/p>\n\n\n\n
traimcinolone to outer ear<\/p>\n\n\n\n
if bacterial suspected use acetic acid \/ aluminum acetate or cipro\/hydrocortisone or neomyc\/polymyx B\/hydrocortisone or ofloxacin<\/p>\n\n\n\n
if patient immunocompromised or DM how do you treat otitis externa
systemic ABX :
cephalosporins
penicillins<\/p>\n\n\n\n
treatment for uncomplicated otitis media
can observe and wait to treat if symptoms persist after 48 to 72 hours<\/p>\n\n\n\n
treat with tylenol \/ ibuprofen<\/p>\n\n\n\n
treatment for otitis media if no daycare attendance and no ABX within 90
amoxcillin 40-45mg\/kg\/day in 2 doses x 10 days<\/p>\n\n\n\n
treatment for otitis media if daycare attendance and no ABX within past 90 days (HIGHER RISK OF RESISTANT ORGANISM)
high dose;<\/p>\n\n\n\n
80-90mg\/kg\/day in 2 doses x 10 days amoxicillin<\/p>\n\n\n\n
not to exceed 1000mg per dose<\/p>\n\n\n\n
What is acute angle closure glaucoma?
immediate medical intervention required<\/p>\n\n\n\n
\n- increased intraocular pressure due to decreased outflow of aqueous humor, resulting in compression of the optic nerve that can lead to permanent blindness<\/li>\n<\/ul>\n\n\n\n
symptoms of acute angle closure glaucoma
PAIN
Headache
Significant blur
Nausea\/vomiting
Red eye
halos around lights
loss of peripheral vision, can progress to loss of central vision<\/p>\n\n\n\n
acute angle closure glaucoma most often occur in persons who are
Asian descent , Eskimo descent<\/p>\n\n\n\n
55 to 70 year olds<\/p>\n\n\n\n
more often in females<\/p>\n\n\n\n
Causes of acute angle closure glaucoma
can be induced by rapid dilation<\/p>\n\n\n\n
treatment for acute angle closure glaucoma
IV mannitol
acetazolamide
topical pilocarpine<\/p>\n\n\n\n
follow by peripheral iridectomy
or laser iridotomy<\/p>\n\n\n\n
what are the fundoscopic findings of acute angle closure glaucoma
pale optic disc
excavated cupping
increased cup to disc ratio<\/p>\n\n\n\n
strategy to relieve middle ear pressure due to barotrauma
nasal steroid
oral decongestant<\/p>\n\n\n\n
hallmark of viral conjunctivitis
preauricular lymph node<\/p>\n\n\n\n
when does sinusitis need referral to specialist
mastoiditis, meningitis, infection of surrounding structures other than the sinus<\/p>\n\n\n\n
ethmoid sinusitis pain location
behind the eye, high on the nose<\/p>\n\n\n\n
most common sinus affected in sinusitis
maxillary<\/p>\n\n\n\n
poor response to decongestants, purulent nasal discharge, pressure over the cheek indicate
sinusitis<\/p>\n\n\n\n
confirmation symptoms of sinusitis
URI for 7 days prior to having at least 2 of the following:
colored discharge
poor response to decongestants
facial pain
headache<\/p>\n\n\n\n
causes of sensorineural hearing loss
Aging (presbycusis)*
Acustic injury from sudden or prolonged exposure to loud noises
Perilymph fistula
Congenital (TORCHES)
Meniere’s disease
Drug\/toxin-induced
Acoustic neuroma
Pseudotumor cerebri
CNS disease
Endocrine disorders
Sarcoidosis<\/p>\n\n\n\n
causes of conductive hearing loss
excess cerumen, otosclerosis, otitis media<\/p>\n\n\n\n
type of hearing loss involving the 8th cranial nerve
sensorineural<\/p>\n\n\n\n
what is the Weber test
tuning fork on top of head<\/p>\n\n\n\n
what does the weber test show
shows which ear is affected :<\/p>\n\n\n\n
if sensorineural loss – it is better heard on the GOOD ear<\/p>\n\n\n\n
if conductive loss – it is better heard on the BAD ear<\/p>\n\n\n\n
what is the rinne test
Vibrating tuning fork held from ear and then placed on mastoid. wait until patient cant hear it then move to beside the ear and see if they can hear it<\/p>\n\n\n\n
what do the results of the rinne test mean
if can hear beside ear after moved away from mastoid then AC > BC which is normal<\/p>\n\n\n\n
if cant hear beside ear after moved away from mastoid then BC > AC which indicates conductive loss of hearing<\/p>\n\n\n\n
when to refer hearing loss to otolaryngology
if a patient presents with sudden sensorineural hearing loss what should you do<\/p>\n\n\n\n
type of hearing loss in presbycusis
sensorineural<\/p>\n\n\n\n
what is the Schwabach test
fork on patient mastoid and yours – if patient hears shorter than you – this is suggestive of SNHL, if patient hears longer than you, this is suggestive of CHL<\/p>\n\n\n\n
what is tinnitus
ringing or buzzing in the ears<\/p>\n\n\n\n
ear sound that can be heard with severe HTN (DBP over 120)
tinnitus<\/p>\n\n\n\n
foods to avoid in tinnitus
caffeine, salt, chocolate, alcohol<\/p>\n\n\n\n
causes of tinnitus
loud noise, vascular, paraganglioma, schwannoma, ototoxic drugs, presbycusis,<\/p>\n\n\n\n
high pitched tinnitus is typically a result of\u2026.
SNHL – may suggest cochlear injury<\/p>\n\n\n\n
low pitched tinnitus is typically a result of
Meniere or idiopathic<\/p>\n\n\n\n
medications used in tinnitus (5)
misoprostol
lidocaine
benzodiazepines
carbamazepine
dexamethasone<\/p>\n\n\n\n
*note that efficacy of drugs is not yet identified and treatment is typically aimed and lessening impact and living with it<\/p>\n\n\n\n
What is mononucleosis?
viral disease caused by Epstein-Barr virus, attacks B lymphocytes<\/p>\n\n\n\n
symptoms of mononucleosis
fever
pharyngitis
adenopathy
fatigue
atypical lymphocytosis<\/p>\n\n\n\n
lab results seen in mononucleosis
WBC – 10 – 20<\/p>\n\n\n\n
\n50% lymphocytes<\/p>\n<\/blockquote>\n\n\n\n
absolute lymphocyte > 4500<\/p>\n\n\n\n
abnormal LFTs<\/p>\n\n\n\n
\n10% abnormal lymphocytes<\/p>\n<\/blockquote>\n\n\n\n
what test is used for mononucleosis
heterophile test
monospot
EBV<\/p>\n\n\n\n
incubation time for mono
4 to 8 weeks<\/p>\n\n\n\n
transmission of mononucleosis
saliva<\/p>\n\n\n\n
exam findings in mononucleosis
posterior cervical lymph nodes inflamed<\/p>\n\n\n\n
erythema on pharynx<\/p>\n\n\n\n
tonsillar exudate<\/p>\n\n\n\n
What is the epiglotitis?
inflammation of elastic cartilage that covers the laryngeal inlet during swallowing<\/p>\n\n\n\n
rapidly progressive cellulitis of the epiglottis that may cause complete airway obstruction<\/p>\n\n\n\n
symptoms of epiglottitis (7)
throat pain
dysphagia
copious oral secretions
drooling
respiratory difficulty
stridor
fever
NO pharyngeal erythema or cough<\/p>\n\n\n\n
if a patient presents with sudden sensorineural hearing loss what should you do
refer to otorhinolaryngologist for further treatment and diagnosis<\/p>\n\n\n\n
sensorineural hearing loss (nerve deafness)
hearing loss caused by damage to the auditory receptors of the cochlea or to the auditory nerve due to disease, aging, or prolonged exposure to ear-splitting noise<\/p>\n\n\n\n
s\/s of epiglottitis in children
stridor
restlessness
nasal flaring
accessory muscle use<\/p>\n\n\n\n
Pharyngitis
inflammation of the pharynx that causes discomfort, scratchiness, pain and difficulty swallowing<\/p>\n\n\n\n
If pharyngitis is accompanied by fatigue, fever, and cervical lymphadenopathy you should evaluate the patient with what
monospot
rapid 10 minute strep test
throat culture<\/p>\n\n\n\n
Treatment in adults with NKA to OCN who are suspected of having Group A beta hemolytic streptococcal pharyngitis
10-day course of penicillin V potassium (Pen-vee K 500mg PO BID or 250mg PO QID)<\/p>\n\n\n\n
or<\/p>\n\n\n\n
benzathine penicillin (Bicillin 1.2 million units IM once)<\/p>\n\n\n\n
or azithromycin 500mg PO if allergic to penicillin<\/p>\n\n\n\n
what commonly occurs with pharyngitis
tonsillitis<\/p>\n\n\n\n
when do group A beta-hemolytic streptococcal infection
in the winter and spring<\/p>\n\n\n\n
when does viral pharyngitis typically occurs
fall and winter<\/p>\n\n\n\n
what age do infectious pharyngitis and tonsillitis typically occur
5-10<\/p>\n\n\n\n
pharyngitis s\/s
mild to severe throat pain
pruritus of the throat
fever
swollen throat
dysphagia
red throat
tonsillar exudates<\/p>\n\n\n\n
how is herpangia and hand-foot-mouth disease diagnosed
coxasackie viral cultures and serologies<\/p>\n\n\n\n
viral pharyngitis treatment
mostly supportive care unless influenza a symptoms then you can give amantadine 100mg BID and oseltamivir 75mg BID x 5 days<\/p>\n\n\n\n
If streptococcal pharyngitis is not treated it can cause and _<\/em><\/strong><\/em>.
scarlet fever and rheumatic fever<\/p>\n\n\n\nDysphonia
hoarseness; voice with harsh quality and low pitch; weakness, raspiness, change from usual quality<\/p>\n\n\n\n
Dysphonia is caused by?
viral infection of the larynx (laryngitis)
natural aging process
laryngeal cancer
GERD
growths on vocal cords like cysts, papillomas, polyps, and nodules<\/p>\n\n\n\n
dysphonia is a cardinal sign of what type of cancer
laryngeal cancer<\/p>\n\n\n\n
why does dysphonia occur
vocal cord inflammation and edema result in vocal fold movement that is asymmetrical with reduced waves and incomplete vibratory closure<\/p>\n\n\n\n
when should dysphonia be worked up for cancer
hoarseness persisting for more than several weeks (2)
or if the patient has
SOB
Stridor
cough
hemoptysis
throat pain
unilateral otalgia
weight loss<\/p>\n\n\n\n
If dysphonia lasts more than 2 weeks and is not caused by an infection what should you do
refer to otolaryngologist for Laryngoscopy<\/p>\n\n\n\n
Dysphonia differential diagnosis
papillomatosis; related to an infection<\/p>\n\n\n\n
acute pharyngeal infections most common among adolescents and youth (2)
peritonisilar cellulitis and peritonsilar abcess<\/p>\n\n\n\n
location of pertionsial abcess
unilateral between the tonsil and the superior pharyngeal constrictor muscle<\/p>\n\n\n\n
s\/s of peritonsillar abscess
severe unilateral sore throat
odynophagia
fever
otalgia
asymmetric cervical adenopathy
Trismus (lock jaw or “hot potato voice”)
toxic appearance (poor eye contact, unable to recognize parents, irritability, drooling, inability to be consoled, exudates, halitosis)
deviation of soft palate and uvula if severe<\/p>\n\n\n\n
strep tonsils infection always has the potential for progressing to\u2026\u2026.
peritonisllar abscess<\/p>\n\n\n\n
Rhinitis
inflammation of the nasal mucosa; hay fever<\/p>\n\n\n\n
allergic rhinitis (hay fever) results from
immunoglobulin E (IgE) mediated type 1 hypersensitivity<\/p>\n\n\n\n
causes of allergic rhinitis
airborne irritants affecting eyes, nose, sinuses, throat, bronchi<\/p>\n\n\n\n
S\/S of allergic rhinitis
pale or violaceous, boggy turbinites
nasal congestion
rhinorrhea
sneezing
pruritus of nasal passage, conjunctiva, and roof of mouth
postnasal drainage
dennie lines<\/p>\n\n\n\n
usually persist and are seasonal in nature<\/p>\n\n\n\n
treatment for allergic rhinitis
antihistamines
intranasal corticosteroids (takes 2 weeks for full relief)
avoidance of triggers<\/p>\n\n\n\n
viral rhinitis s\/s
watery rhinorrhea
nasal congestion\/speech
forced mouth breathing<\/p>\n\n\n\n
Rebound rhinitis
can occur with overuse of nasal decongestants<\/p>\n\n\n\n
nasal congestion without rhinorrhea<\/p>\n\n\n\n
how to treat rebound rhinitis
immediately stop all topical decongestants use; takes 2-3 weeks<\/p>\n\n\n\n
atopic triad is used to determine
genetic predisposition toward allergic reactivity in all atopic conditions<\/p>\n\n\n\n
atopic triad consists of
asthma
allergic rhinitis
eczema<\/p>\n\n\n\n
a patient that has the atopic triad is assumed to have a preferential production of what<\/p>\n","protected":false},"excerpt":{"rendered":"
Midterm Exam Review – NR511 \/ NR 511 (Latest 2024 \/ 2025) : Differential Diagnosis & Primary Care Practicum – Chamberlain NR-511 Differential Diagnosis & PrimaryCare PracticumMidterm Exam ReviewWhat is specificity of a test (equation)\u2713 True negatives \/ #false pos + true negWhat is sensitivity of a test (equation)\u2713 True positives \/ #false negative + […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-131420","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131420","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=131420"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/131420\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=131420"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=131420"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=131420"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}