Of the following, which should be performed first in evaluating a 48 y old woman with an acute asthma flare?

• O2 sat
• ABG
• FEV1 or PEFR
• CXR

FEV1 or PEFR

the others do not register until later in the disease process

• Active immunity onset is about 1m and has a duration of years to lifelong.
• Passive immunity onset is within hours and has a duration of 6-9m.

Neomyacin and gelatin

(same as varicella zoster)

Who has the greatest risk for tetanus?

1. deep wound obtained gardening
2. lac obtained cutting beef
3. human bite
4. abrasion from fall

• anyone outside ages 2y-49y
• pregnant
• cardiac disorder
• immune suppressed
• hx egg or chicken protien allergy
• hx of gullian barre
• ASTHMA or rad
• renal dysfunction
• hemoglobulinopathies

T/F

Immunoglobin (antiserum) is a concentrated solution of antibodies derived from pooled donated blood?

Yes

it is an example of passive immunity

T/F

Guardasil is an immunization indicated for the prevention of cervical and vulvular malignancies as well as genital warts.

True

its schedule is 0, 2, 6m

T/F

Flumist is live in the nose but not in the chest.

• C  have you felt you should CUT down drinking?
• A  have people annoyed you to stop?
• G  ever feel guilty about drinking?
• E  ever have an EYE opener?

T/F

3 positive responses on the CAGE questinairre is an accurate indicator of alcohol abuse?

• AST>ALT (within 3x ULN)
• MCV increase (mild macrocytosis w/o anemia)
• Triglycerides increase. isolated from other lipid panel labs.

A  alcohol

S  statins

T  tylenol

According to the ACS, when do women begin BSEs?

No, the recommendation is that two samples from three consecuative specimens at home be brought.

If postive, colonoscopy.

Annualy at age 50y if they have a life expectancy of >10y.

Men at high risk (AA men, and men with strong famly hx of one or more 1st degree relatives dx before age 65y should begin at age 45y.

Cervial Ca screening should begin approx 3y after the woman begins sexual intercourse but no later than 21y. This is to be done annualy with conventional PAP or every 2y with liquid based PAP tests.

At or after age 30, women with 3 consecuative normal PAPs may get screened every 2-3y with a PAP (reg or liquid) or every 3 with an HPV DNA test.

• Microcytic:  small cell with MCV <80
• Normocytic: normal cell size with MCV 80-96
• Macrocytic: large cells with MCV >96

Hemoglobin is the source of RBC color. The MCH (mean cell hemoglobin) or the MCHC (mean cell hemoglobin concetration) is the lab to eval.

Normochromic: MCHC is 31-37

Hypochromic: MCHC is <31

Give the hematocrit reference range:

TF

MCV (mean corpusle volume) is a measurement of RBC size.

T/F

MCH or MCHC is a measurement of cell color.

T/F

An RDW, red cell distribution width, is a measurement of the variation in RBC cell size.

T/F

The retic count is a direct indicator of bone marrow function.

T/F

Reticulocytes are immature RBCs produced during anema and are a direct index of bone marrow function.

blood loss (GI bleed)

anemia of chronic disease.(SLE)

Hg down

Hct down (good 1:3 ratio)

RBC down

MCV OK

MCHC OK

RDW Ok

What is the body's most important source of iron supply?

• animal based foods
• vege based foods
• enriched grains
• recycled iron contents from aged RBCs

You advised a person who is a vegan to supplement the diet with:

• Vit A
• Iron
• Vit B12
• Folic acid

A 68 yo woman presents with a 6m hx of increasingly severe peripheral numbness and oral irritation (red beefy tounge). Labs

Hg 6.2  Hct: 20%  RBC 2.1 mil  MCV 132  RDW 19

WBC morph: hypersegmentated neutrophils

PE shows pale conjunctive and a grade II/IV murmur over precordium without radiation.

Whats the dx?

B12 deficiency anemia.

Neuro s/s are very common with this anemia

Macrocytic, normochromic, elevated RDW

On an empty stomach

Not with food and never with antacids.

1. Strep pneumoniae 20-43%  gram pos.
2. H. flu  22-35%  gram neg
3. M. cat 2-10% gram neg.

Amoxicillin or Augmentin, or cefdinir (omincef)

If no improvement in 72h, switch to high dose augmentin or . quinilone

Bactrim, Zpak, or Doxy(DRSP failure risk)

if not better in 72h:

levaquin or clinda

which of the following meds is appropriate for a woman with acute rhinosinusitis who received AB therapy 3w ago, no allergies.

• azithromyacin
• hi dose augmentin
• cefdinir (omnicef)
• clinda

in your pt with conductive hearing loss from OM, what would you expect the Weber test to show?

(weber test is the tuning fork ontop of the head)

T/F

Concerning presbycusis (normal hearing loss r/t age). A slowly progressive, symetric predominately high frequency loss in present.

corticosteroid nasal spray

and

leukotriene modifiers such as Singulair (montelukast)

needs 1-4w to work

1st gen. oral antihistamines (benadryl) or 2nd gen like fexofenadine (zyrtec) or lortadine (claritin)

anticholinergic effects:

• dry mouth
• blurred vision
• urinary retention (do not use in BPH)
• sedation
• tachy
• hyperpnea

which med is appropriate for a 29 yo pt machine operator with allergic rhinitis that is acutely ill:

• nasal cromolyn
• benadryl
• flunisolide nasal spray
• lortadine (claritin)

a 58 yo man presents with c/o bilat itchy eyes occuring intermittenly throughout the year. 20/30 OU,OS,OD. bilat.hyperemic bulbar and palpebral conjuntiva present and small amount of rope like pale yellow d/c. He has:

• bacterial conjunctivitis
• blepharoconjunctivitis
• alllergic conjunctivitis
• dye eye syndrome

a 28 yo women c/o 3d hx of sore throat and fatigue. findings include exudative pharyngitis, tender anterior and posterior cervical nodes. and RUQ and LUQ tenderness.

what is it?

• s. pyogenes pharyngitis
• infectious mono
• hodgkin disease
• gonococcal pharyngitis

which of the following is a common vision problem for the person with untreated open angle glaucoma?

• peripheral vision loss
• blurring of near vision
• difficulty with far vision
• need for increased light

vision loss reported in macula degeneration is usually described as

central

peripheral

unilateral

bilater

T/F

a pt with angle closure glaucoma (emergency) will present with

1. unilateral acutely red painful eye
2. vision change including halos
3. firm eyeball

true

refer to opthamology immediately

T/F

in a pt with anterior uveitis, the s/s are: dully painful red eye, vision change, constricted pupil,nonreactive and irregularly shaped.

T/F

Acute anterior uveitis results most commonly as a result of blunt ocular trauma

true

T/F

The hallmark signs of anterior uveitis are cells and flare in the anterior chamber. If the anterior chamber reaction is significant, small gray to brown endothelial deposits known as keratic precipitates may arise

[image]

what is this?

A chalazion is a lump in the eyelid that is caused by inflammation of a gland within the skin. Typically, this lump grows over days to weeks and is occasionally red, warm, or painful.
Chalazia are different from hordeolums in that they form as a result of gland obstruction and sterile inflammation as opposed to a purulent infection of the cilium. Chalazia tend to be larger, less painful, and occur less acutely than hordeolums

Chalazia usually are nontender, nonerythematous, and nonfluctuant. Large chalazia may be tender secondary to size effects

T/F

Presbyopia is the hardening of the lens of the eye resulting in near vision problems. It effects nearly all persons =>45y resulting in the need for reading glasses.

T/F

Senile cataracts is the clouding of the eye's lens causing progressive vision dimming, distance vision problems. Risk factors include: smoking,poor nutrition, sun exposure.,corticosteroid tx.

T/F

Open angle glaucoma is a painless gradual increase in IOP leading to optic atrophy and loss of peripheral vision. tx with topical miotics, Bb,or sx is recc.

T/F

angle closure glaucoma is an optic emergency caused by a sudden increase in IOP causing a unilateral acutely red, painful eye with vision change including halos around lights. Eyeball will be firm when compared to the other.

T/F

chicken pox are 2-3mm vesicles that start on trunk and appear on limbs 2-3d later

An actinic keratosis is a skin lesion that appears as a rough, scaly patch on your face, lips, ears, back of your hands, forearms, scalp and neck. The cause is frequent or intense exposure to ultraviolet (UV) rays, typically from the sun. Precancerous

T/F

In smallpox all lesions appear at the same time

A asymetric

B boarders irrregular

C color not uniform

D diameter > 6mm (pencil eraser)

E evolving

=> 2 features, 100% sensative and 98% specific

you see a 25 yo man with acanthosis nigricans and consider ordering a:

• FBS
• LFT
• RPR
• ESR

FBS

Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin, usually present in the posterior and lateral folds of the neck, the axilla, groin, umbilicus, and other areas.

This occurs due to insulin spillover (from excessive production due to obesity or insulin resistance) into the skin

[image]

T/F

Across North America, MRSA is the most common reason for new onset ulcerating skin legions.

True

Hypothyroidsim

skin  thick & dry

reflexes hung up patellar reflex

mentation  cant make sense

wt change  small

stool  constipation

menstrual issue menorrhagia

heat/cold  easily chilled

Hyperthyroidism

skin  smooth, silky

reflexes hyperreflexia

mentation mind racing

wt change  loss

stool frequent, low volume loose

menstrual issue  oligomenorrhea

heat/cold  heat intolerance

T/F

Psoriasis commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes on a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals.

true

[image]

In contrast to eczema, psoriasis is more likely to be found on the extensor aspect of the joint.

[image]

what is this?

Pityriasis rosea is a rash that occurs most commonly in people between the ages of 10 and 35, but may occur at any age. The rash can last from several weeks to several months. Usually there are no permanent marks as a result of this condition, although some darker-skinned persons may develop long-lasting flat brown spots that eventually fade. It may occur at anytime of year, but pityriasis rosea is most common in the spring and fall.

Pityriasis rosea usually begins with a large, scaly, pink patch on the chest or back, which is called a "herald" or "mother" patch. It is frequently confused with ringworm, but antifungal creams do not help because it is not a fungus

it usually occurs only once in a lifetime.

T/F

significant gyperglycemia and ketoacidosis result from lack of insulin

t/f

major risk factors in DM II are heredity and obesity

t

t/f

lantus (insulin g) is considered due to its extended duration of action

t/f

Lispro's (humalog) onset of action is less than 15m

t/f

according to the ADA, testing for type II DM in asymptomatic, undiagnosed pts yunger than 45y is done every 3y.

t/f

according to the ADA, testing for type II DM in astymptomatic, undiagnosed individuals should be considered when there is a hx of HDL less than 35

t/f

criteria for the dx of type II DM include: a plasma glucose of 126 or greater after an 8h fast on more than one occasion

t

t/f

the goal in treating a pt with DM and HTN should be a SBP of less than 130 and a DBP of less than 80

t/f

in caring for the pt with DM, microalbuminuria should be screened for yearly if UA is negative for protien

t/f

the mechanism of action of sulfonylureas is tht it is a product that enhances insulin release.

t/f

when caring for the DM pt with HTN, the NP should consider ACEIs first line tx. the "prils"

t/f

creatinine should be monitored with the use of a biguanide.

t/f

the ALT should be monitored in the pt using thiazolidinedione (TZD)

t/f

all the following are risks for lactic acidosis in the pt on metformin:

renal insufficiency

dehydration

radiographic contrast dye

t/f

all of the following are risk factors of secondary  hyperglycemia in the DM pt.

niacin

corticosteroids

thiazide diuretics

t/f

according to the american thyroid association, men and women > 35y should be screened every 5y

t/f

Graves' disease is a thyroid disorder characterized by goiter, exophthalmos, "orange-peel" skin, and hyperthyroidism. It is caused by an antibody-mediated auto-immune reaction, but the trigger for this reaction is still unknown. It is the most common cause of hyperthyroidism in the world, and the most common cause of general thyroid enlargement in developed countries

t/f

in the pt with elevated (>5), normal 0.4-4,  TSH the calc or levothyroxine is 1.6mcg/kg/day in adults

start at 50% anticipated dose

>50% during pregnancy

>33% as soon as pregnancy is confirmed

increase by 25% q 4w and check no sooner than 6-8w

true

AACE guidelines recc.tx in  pts. with TSH >5 if th pt has a goiter or if thyroid antibodies are present.

The presence of s/s compatable with hyopthyroidism, infertility, pregnancy,or imminent pregnancy would also favor tx.

t/f

the eval of a palpable thyroid nodule, in the absence of hyperthroid sx,the presentations of begign and malignant lesions are the same.

true

the risk that a thyroid nodule is malignant is about 5%

initial testing is a TSH and then a thryoid scan. A COLD spot on the scan indicated malignancy. then a fine needle bx is advised for dx.

Untx hyper/hypo thyroidism or both?

Dry skin: hypo

fine tremor: hyper

Hung up DTR:  hypo

AMS: both

Atypical presentation in elder: both

thyroid enlargement; both

Mennorhagia: hypo

Exopthalmos: hyper

Lid retraction: hyper

t/f

normal BMI is 18.5-24.9 km/m2

t/f

increases thyroid disorder risk in increased in the elderly.

t/f

normal T4 and elevated TSH is most consistant with subclinical hypothyroidism

t/f

the most common cause of hypothyroidism is autoimmune thyroiditis

t/f

a decreased TSH is likely to be found in Graves Disease.

true

Graves' disease is the most common form of hyperthyroidism. It occurs when your immune system mistakenly attacks your thyroid gland and causes it to overproduce the hormone thyroxine (T4)

Of the folowing which would be found in a pt with Graves disease:

• muscle tenderness
• dry skin
• eyelid retraction
• delayed patellar reflex

t/f

The mechanism of action of radioactive iodine in tx of Graves disease is to destroy the overactive thyroid tissue.

t/f

Propranolol is helpful in tx tremor seen with hyperthyroidism

t/f

In prescribing T4 tx for the elderly pt, the T4 dose is 75% or less than that of younger persons.

t/f

PE of the pt with hypothyroidism would include delayed relaxation phase of the DTR

which of the following is likely to be found in the person with untx hypothroidism:

1. hypo k
2. hypo natremia
3. hypertriglyceridemia
4. microcytic anemia

the findings of a painless thyroid mass in a 35yo female with a TSH of <0.1 is most consistant with:

• autonomouly functioning adenoma
• Graves disease
• Hashimmoto disease
• thyroid malignancy

t/f

A fixed, painless throid mass accompanied by hoarseness and dysphagia should raise the suspicion of a thyoid malignancy.

t/f

a fine needle bx is the best way to distinguish a malignant from a begign thyroid nodule.

t/f

bone thinning is a possible s/e of excessive levothroixine use.

t/f

Optimally, TSH should be reassesed after levothyroxine dosage adjustment at 6-8w

t/f

Periodic monitoring for hypothyroidism is indicated in the presence of Down Syndome.

t/f

the wt gain associated with hypothyroidism is usually only 5-10 lbs

Risk Factors for thyroid disease are:

• Down syndrome: hypo
• the elderly: hypo/hyper with atypical presentation
• use of lithium or amiodarone: hypo
• female gender: hypo/hyper
• postpartum period: tranient hypo
• hx of head/neck irradiation: hypo