Prepare for the 3P APEA Nurse Practitioner certification exam with these practice questions and answers. This guide covers clinical assessment, diagnosis, and treatment planning.
Q: What would cause decrease in Digoxin levels
Answer: Antacids
Q: Taking Pyridium for UTI, what can Pyridium cause?
Answer: Hemolytic Anemia
Q: What can PCOS result in?
Answer: increased insulin levels, Androgens, hirsutism
Q: What is a hypertensive used in pregnancy
Answer: Methyldopa
Q: What is a characteristic of Placenta Previa?
Answer: painless red bleeding
Q: What is a characteristic of Rheumatoid arthritis ?
Answer: Red hot joints
Q: Medications that cause ototoxicity
Answer: Aminoglycosides, nasal decongestants, antihistamines
Q: Treatment period for enterobiasis
Answer: 2 weeks
Q: CBC Interpretation
Answer: MCV – mean corpuscular volume help diagnose different types of anemia (High=macrocytic like B12, Low=microcytic like Fe anemia)
Q: Rhogham given at how many weeks gestation?
Answer: 27 weeks
Q: Janesway lesions
Answer: Happen with endocarditis, non painful lesions seen on hands and feet, Osler same but painful
Q: Warfarin management – forgot a dose?
Answer: If under 12 hours take missed dose, if over skip and need INR redraw
Q: Taking an ACE or ARB what to know?
Answer: ACE (dry hacking) cough starts 1-2 weeks after med started, ACE (Lol) ARB (sartan) first line in HTN avoid initially in african americans, angioedema can occur
Q: Contraindication for hydrochlorithiazide
Answer: sulfa allergy, asthma, PCN hypersensitvity
Q: Murmurs Systolic
Answer: MR=Mitral regurge (SOB/Fatigue HF)Peyton Manning=phys murmur (asymptomatic)AS=Aortic Stenosis (Angina, syncope HF)MVP=Mitral valve prolapse (palps, CP, “click”)
Q: Diastolic Murmurs (ABnormal)
Answer: AR= Aortic Regurge (angina, HF, dizzinness, CP)MS=Mitral stenosis (Dyspnea, Afib)
Q: Motivated
Answer: Systole-S1 closure of AV Mitral/tricuspid valve (lub)Mitral, Tricuspid, atrioventricular valves
Q: Apples
Answer: Diastole s2 closure of the aortic pulmonic valves (dub)aortic pulmonic semilunar
Q: Abnormal (extra) heart sounds
Answer: S3- CHF; possible normal for adolescent athletes,S4 LVH poorly controlled HTN, unstable angina
Q: Assessment of PAD
Answer: antiplatelets (Plavix, ASA), Pentoxifylline (decreases blood viscosity) to treat, ankle brachial index to check, angiography gold standard to diagnose
Q: Coronary artery Disease tx
Answer: Atorvastatin/rovustatin- use high dose meds for LDL>150, watch for LFTs and arthralgia. Change type and dose if problems. Stabilization of plaque with statins
Q: HF treatment
Answer: ACEI, ARB, or ARNI with BB and aldosterone receptor antagonist
Q: Scabies Treatment (Sarcopter Scabiei)
Answer: Topical Permethrin massaged from head to soles of feet and wach off with shower or bath after 8-14 hours. Treat again in 1 week
Q: Names of skin findings
Answer: Macule; freckle <1 cm, Papule Macule >1 cm chloasma, Papule <0.5cm elevated nevi (molluscum wart), Plaque (psoriasis, lichen planus), Nodule 0.5-2 cm lipoma, vesicle (herpes simplex contact derm,
Q: Keloid
Answer: hypertrophic scar that is invasive beyond point of original injury
Q: Skin continued
Answer: Bulla-second degree burn, friction burnWheal- raised, mosquito bite, hiveScales;dandruffCrusts-scab from abrasian, impetigo
Q: Tinea
Answer: Fungal infections; Tinea capitis-round patchy scales on scalp (cradle cap) treatment Grisefulvin take with high fat meal 4-6 weeks 500 mg tinea corporis -red and scaly plaque on trunk (ring worm) Treatment is an azole for 2 weeks
Q: Melanoma How do you assess
Answer: ABCDE Asymmetry, border, color, diameter >6 mm, elevation
Q: Psoriasis
Answer: silvery white scales, nails are pitted; positive Auspitz sign- pinpoint bleeding occurs when lesions are scraped
Q: Shingles (Herpes Zoster)
Answer: Unilateral dermatomal rash- painful as it progresses to vesicles, Acyclovir within 48-72 hours or symptoms. May only transmit chickenpox virus to susceptible patients that have not gotten exposed or vaccinated yet.Post herpetic neuralgia pain is longer than 1 month after rash has resolved.
Q: Contact dermatitis
Answer: papules or vesicles 5mm or less, scaling, crusting, oozing. Tx corticosteroids/antihistamines
Q: Acne Vulgaris
Answer: Inflamm disorder where androgen-dependent sebaceous glands produce excess sebum. Areas most commonly affected are face, anterior and posterior chest, arms and shoulders. Treatment: Erythromycin/Benzyl peroxide=limit exposure to sunlight peroxide can decrease resistance to erythromycin
Q: Atopic dermatitis
Answer: Patchy plaque like rash with inflammation. common in people with other atopic illnesses (asthma, allergic rhinitis)
Q: Eye Findings in HTN and DM
Answer: AV nicking-arteries indent and displace veins, cotton wool spots-gradual vision loss, flame hemorrhages- blot and dot hemorrhages
Q: Tx of acute sinusitis in adults and pediatrics
Answer: Viral symptomatic tx only, is bacterial- amoxicillin first line symptoms>10 days purulent nasal discharge, fever, unilateral face or tooth pain
Q: Snellen test
Answer: Test for visual acuity; CN II
Q: What medications can cause ototoxicity
Answer: Aminoglycosides (tx otitis externa) , loop diuretics, quinine, ASA
Q: Rhinitis
Answer: Eosinophils due to WORMS, wheezes, weird diseases. Most effective tx for allergic rhinitis- Fluticasone Flonase
Q: Acute bacterial rhinosinusitis
Answer: For empiric tx of patients with acute bacterial rhinosinusitis who are allergic to penicillin, the best alternative first line therapy is Doxycycline
Q: Which immunoglobulin is responisble for the symptoms in the patient with allergic rhinitis?
Answer: IgE
Q: Assessment of a 4 year old visual acuity resulted in 20/30 in L eye and 20/40 in R eye.
Answer: Means vision is normal for his age, 20/20 vision at 6 years old
Q: Distinctive feature of cataracts
Answer: Absent red reflex
Q: Meclizine
Answer: Given for patients who present with Positional vertigo
Q: Pterygium
Answer: growth on conjunctiva of fleshy tissue, sx redness, swelling, yellow spot or bump dry itchy like sand in eye
Q: Eye emergencies
Answer: papillaedema (increase ICP, swollen optic disc engorged tortuous retinal veins), Acute closed angle glaucoma is unilateral eye pain rapid onset and loss of vision
Q: Presentation with foreign body in eye
Answer: only remove with wet cotton swab if not able to send to opthamologist
Q: Meniere’s Disease
Answer: A 45 year old patient complains of vertigo, tinitus, and pressure in the right ear
Q: Hyperopia
Answer: Light that is focused behind the retina causes the visual disturbance
Q: Mononuleosis
Answer: Most commonly caused by EBV can be passed sexually
Q: Which medication is most commonly associated with hypoglycemia
Answer: Glyburide
Q: How does myxedema present and what is its indicative of
Answer: found in patients with hypothyroid, hypothermia, thickening of the tongue, and disorientation
Q: Assessment findings PCOS
Answer: Hirsutism, hyperinsulinemia, elevated lipids, abnormal hair, acne
Q: Assessment finding and RX for hyperthyroidism
Answer: M/C cause is Graves’ disease, finding include tachyC, Afib, weight loss, hyperactivity, warm, moist skin, flushed
Q: Hyperprolactinemia
Answer: Menstrual dysfunction, ED, pain in breast, loss of libido, lactation, vaginal dryness, infertility
Q: Hyperandrogenism
Answer: High levels of Androgens in females, sx include acne, seborrhea, hair loss on scalp, increased body or facial hair, infrequent or absent menstruation, Can be caused by PCOS
Q: DM
Answer: A1c over 6.5 or fasting glucose over 126, initiate Metformin at initial diagnosis
Q: Assessment of neuropathy
Answer: In distal lower extremities, long effect of hyperglycemia, paresthesias and burning
Q: Treatment and Presentation of Giardiasis
Answer: Foul smelling stools, abdominal pain, flatulence spread fecal-oral route. Tx is Metronidazole 250 mg TID
Q: Presentation and assessment of Cirrhosis
Answer: Coagulopathy, variceal bleed, hepatic encephalopathy, extrahepatic sx- neuro, psychiatric, arthralgia, autoimmune disorders, glucose intolerance. Pt early stage of cirrhosis likely to have thrombocytopenia
Q: Assessment of Hepatitis
Answer: Malaise, fever, jaundice, fatigue, weight loss, joint pain, dark urine, RUQ pain, liver enlargement, pancytopenia. Elevated ALT/AST, bili, alk phos
Q: GERD
Answer: Pyrosis (heartburn), burning beneath sternum, regurgitation, postnasal drip, throat clearing, chronic cough, chronic sore throat, hoarseness. Tx 8 week course of PPI
Q: H Pylori Algorithm
Answer: Amoxicillin BID, Clarithromycin BID, PPI BID x 14 days. If PCN allergy tx would change to Metronidazole BID, Clarithromycin BID, PPI BID x 14 days
Q: Which of the following symptoms associated with GERD is considered an alarm symptom?
Answer: Odynophagia (Pain with swallowing, maybe w/wo difficult swallowing)
Q: Crohn’s Disease
Answer: Chronic bloody diarrhea- fatigue, abdominal pain, prolonged diarrhea, with/without bleeding, weight loss and fever. Skip lesions, cobblestone appearance and fistulas common. Slow progressive inflammation small intestine and or large intestine or TI. TX- Budesonide 5-aminosalicylates
Q: Common pathogens that cause Gastroenteritis
Answer: Common pathogen gastroeneritis <1 y.o., adults (norovirus, enteric adenovirus, astrovirus), campylobacter jejuni in children, Salmonella most common foodborne illness, Giardia Lambia most common parasitic
Q: Pyloric Stenosis Presentation
Answer: narrowing of the pyloric sphincter due to hypertrophy of pyloric muscle- forceful vomiting usually 2-3 weeks of age
Q: Hepatitis B
Answer: Bloodborne/body fluids highly infectious, patients who test positive for HBV and HCV should also be screened for HIV due to common transmission routes
Q: Pinworm infection
Answer: Enterobiasis vermicularis- Helminths can be transmitted by the bite of blood sucking insects. TX: 3 doses of medication sep by 3 weeks Pyrantel Pamoate- two weeks apart and retest in two weeks post tx
Q: Ulcerative Colitis
Answer: Only present in colon
Q: Pancreatitis
Answer: Pancreas Enzymes amylase and lipase are inactivated when the pH is below 5. which of the folowwing is NOT an enzyme produced in the panceas? Pepsin
Q: Small Bowel Obstruction
Answer: Abd pain, vomiting, inability to pass gas. Proximal- nausea and vomiting more present. Pain described as crampy and intermittent
Q: ALL
Answer: Most common type of leukemia in children. Signs and symptoms fever thrombocytopenia, anemia, gingival swelling, bone pain
Q: Beta Thalassemia
Answer: Mediterranean descent, genetic disorder, decreased or absent production of hemoglobin results in microcytic/hypochromic anemia. TX: Desferal removes excess iron in patients
Q: Lymph nodes
Answer: Posterior auricular drain lymphatic fluid from the posterior part of the temoporparietal region.Facial nodes drain from the eyelids, the conjunctiva, and skin and mucous membranes of the nose and cheekThe infraorbital or maxillary buccinators and supamandibular lymph nodes drain fluid from the eyelids, conjunctiva, and skin and mucous membranes of nose and cheek. Tonsillar lymph node is located at the angle of the mandible
Q: Lymph continued
Answer: -Deep cervical nodes drain fluid from the head and neck,-Anterior mediastinal lymph nodes drain fluid from the thymus, thyroid, and anterior part of the pericardium-Axillary- fluid from breast-internal iliac lymph receive lymph from all pelvic viscera, deep part of the perineum, and the gluteal region-sup/inf mesenteric drain into small and large intestines
Q: Iron Def Anemia
Answer: Microcytic/Hypochromic anemia occurs when Iron loss exceeds iron intake and iron stores deplete. (blood loss). Pica, atrophic glossitis.
Q: Vitamin B 12 Deficiency (Pernicious anemia, cobalmin def)
Answer: Macrocytic/Megoblastic, B12 is water soluble vitamin necessary for RBC production. Results from a decrease in intrinsic factor due to the autoimmune destruction of parietal cells leading to reduced vitamin B12 absorption. S/S:cog impairment, fatigue, ataxia, weakness, neuropathy, glossitis, mouth ulcers
Q: When and how long to take iron supplementation for?
Answer: Take 1-2 hour before meal, empty stomach, with Vitamin C. Take for 4-6 months, after iron was replaced continue to take for 12 weeks. Repeat CBC
Q: Rh incompatibility
Answer: hemolutic disease of the fetus and newborn desctruction of RBC’s by maternal IgG antibodies. Can lead to jaundice, anemia, fetal hydrops. Rhogam shot at 28 weeks and 72 hours of delivery to prevent
Q: Sickle Cell
Answer: Repeated episodes of sickling can cause the cells to become irreversibly sickled. Hemoglobin electroparesis confirms dx. it is autosomal recessive characterized by ischemic tissue injury and chronic severe hemolytic anemia.
Q: BPH
Answer: Enlargement of the prostate that narrows the urethral lumen. Risk factors Elevated PSA increased age, genetics, black and Asian. Firm smooth prostate enlarged- usually nontender, hesitancy, dribbling, incomplete bladder emptying. Avoid caffeine, ETOH, diuretics. Alpa 1 adrenergic antagonist – immediate relief, relaxes smooth muscle in the prostate (tamsulosin). 5 alphs reductase inhibitor (finasteride)- long term therapy takes 6-12 months. inhibits conversion of testosterone to DHT.
Q: Hydrocele
Answer: peritoneal fluid collection in scrotum. Painless swelling in scrotum, feels heavy, transillumination of scrotum (will light up brightly)
Q: Penile Cancer
Answer: Squamous cell carcinoma; risk factors: HPV, AIDS, uncircumcised, smoking, psoriasis, cryptochordism. Thick white plaques, large scaly growths. Bleeding is late sign
Q: Erectile Dysfunction
Answer: Treatment PDE-5 inhibitor, usual reason HTN meds, antidepressants, antiandrogens, recreastional drugs
Q: High risk of penile and testicular cancer development
Answer: Cryptochordism
Q: Prostatitis
Answer: Inflammation of the prostate usually bacterial origin. S/S: frequency, urgency, fever, enlarged boggy warm prostate. Tx Chronic prostatitis: Ciprofloxacin or Fluoroquinolones for 4-12 wk tx or Bactrim. 4-6 weeks tx guided by results of C&S. NOT KEFLEX. Levofloxacin yes
Q: Determining testicular torsion from Epididiymitis
Answer: Testicular torsion- acute onset testicular pain and loss of cremasteric reflex on affected side. Most common acute ain in prepubertal boys- epididymitis, but testicular torsion must be ruled out. Symptoms onset testicular torsion- few hours vs epididiymitis- few days and pain with cremasteric reflex
Q: Gonorrhea/Chlamydia tx
Answer: Doxycycline 100 mg BID x 14 days, and Ceftriaxone x1 IM
Q: Migraine Treatment
Answer: Rescue- Triptans, prophylactic- Beta Blockers, antidepressants, anticonvulsants. (Topamax, Propranolol, Inderal)
Q: Migraines presentation
Answer: Mostly inulateral, crescendo, cool, quiet dark rooms usually lasts 4-72 hours.
Q: Tension Headaches
Answer: Bilateral pressure, tightness, band like, waxes and wanes. Fiorcet can help pain, Butalbital
Q: Cluster Headaches
Answer: ALWAYS unilateral, begins around the temple or eye. excruciating/explosive, sudden onset. Lasts 30-90 min can be up to 180 mins associated symptoms includes red eye, tears rhinorrhea. Most common at night.
Q: Secondary headache underlying causes
Answer: Person with VP shunt – headache upon awakening, Meningitis accompanied with stiff neck/fever, brain tumor- frequent headaches worsens when coughing or sneezing.
Q: Parkinson’s disease
Answer: Deficiency of Dopamine and destruction of cells in the substantia nigra. Presentation: Bradykinesia(slow movement and decrease speed), rigidity, resting tremor (pill rolling, appears in hands and arms, legs, jaw, and face), postural instability. Dx is supported with therapeutic response to Levodopa. Tx: Dopaminergic agents, Carbidopa/levodopa (do not give in pts with narrow angle glaucoma)
Q: Anticholinergics and confusion in the elderly
Answer: Beer’s List- list of meds you should not give to the elderly; anticholinergics, scopolamine, ALL “mines” Meclizine, promethazine. High risk of confusion, dry mouth, constipation. Antispasmodics (atropine, dicyclomine)
Q: Cranial Nerves
Answer: I-OlfactorySmellII-Visual AcuityOptic nerve,III-Occulomotormuscle fx (focus)and pupil responseIV-Trochlear-superior oblique muscle (down, out, and inward eye movements)V-Trigeminal- Opthalmic, maxillary, mandibularVI-Abducens-lateral rectus musclesVII-Facial- facial expression, sense of taste, spit and tears, outer parts of earVIII-Vestibulocochlear- hearing and balanceIX-Glossopharyngeal- sense of taste back of tongue, voluntary movement back of throat, sensory informationX-Vagus-XI-AccessoryXII-Hypoglossal
Q: Patho meningitis
Answer: Inflammation of the brain and spinal cord meninges resulting from bacteria, virus, or fungi. Meningeal headache is caused by meningeal irritation. Macrolides/clindamycin not first choice tx. usually Ceftriaxone cephalosporin
Q: TIA
Answer: Transient Ischemic Attack- differs from stroke because symptoms resolve within a few hours
Q: Seizures
Answer: Uncontrolled electrical activity within the brain. first line treatment is generalized tonic clonic. Keppra- partial seizures
Q: Scoliosis
Answer: Lateral curvature of the spine greater than 10 degrees. structural scoliosis=true deformity not a structural problem
Q: RA vs OA
Answer: RA=Worn cartilage, bone loss, thickened synovial membrane. joints are hot, swollen, Autoimmune, eats away boneOA=extremely worn cartilage and bone spurs, Positive Heberden and Bouchards nodes, bony and hard
Q: Treatment OA
Answer: Exercise, Weight loss, and RICE, Tylenol NOT recommended. SHort acting NSAIds ok. Cymbalta (multiple joints affected), duloxetine, and Tramadol longer acting. Refer to ortho for injections
Q: Sprain vs Strain
Answer: Ligaments are fibrous tissue that attach to bones, A sprain is a stretch or tear in a LIGAMENT. A train is a stretch or tear in a muscle or tendon. Tx is RICE for both.
Q: Ortolani’s click
Answer: a “click” is heard or felt as dislocation is reduced (good until one year)
Q: Barlows Maneuver
Answer: Feeling of a slip of the femoral head slips away from the Acetabulum (toward the butt)
Q: Meningitis signs
Answer: Positive Kernig (flex hips 90 degreed pain with extension of leg), Brudzinski (involuntary flexion of legs when neck is flexed)
Q: Adams sign
Answer: examiner stands behind pt looks for spinal curvature, pt bends over and touches toes(-) functional scoliosis if curve straightens out(+) structural scoliosis if curve remains*if no scoliosis present = no Adam’s Sign indicated
Q: Fat pad sign
Answer: test for elbow fracture
Q: McMurray Test
Answer: Audible palpable click when knee is raised with tibia externally rotated and then straightened, medial meniscus tear assessment
Q: Gout and treatment
Answer: Acute joint pain with swelling, warmth, and erythema begins abruptly and involves single joint. Normal uric acid levels are common during acute attack. Colchicine for acute gout long term is Allopurinol (urate lowering agents dosed 2 or more attacks/year renal stones. decreases production of uric acid. for preventative attacks.
Q: GTPAL
Answer: Gravida # of times women has been pregnant, multiples=1Term=number of children >37 weeks or morePreterm=20-37 weeksAbortion or miscarriagesL=living children, twins./multiples count individually
Q: Fundal Height
Answer: Distance from the pubic bone to the top of the uterus measure in centimeters. After 24 weeks fundal height should match the number of weeks youve been pregnant
Q: Preeclampsia
Answer: BP >140/90 and proteinuria (300 mg/24 hour) or edema, pulmonary edema, visual impairments, renal or hepatic function. Tx: magnesium sulfate, antihypertensives, corticosteroids for long development
Q: Naegeles Rule
Answer: First day of LMP-3 months+7 days+add one year
Q: Placenta previa
Answer: Bright red, painless bleeding in a woman>20 weeks gestation. Abnormal placement of the placenta near or covering the internal cervical os
Q: First line treatment of UTI in pregnancy
Answer: Nitrofurantoin/Macrobid
Q: Rhogam
Answer: At approx 28 weeks gestation, within 72 hours of delivery and any maternal hemorrhage, ectopic pregnancy, abortion.
Q: Vaccines that are safe in pregnancy
Answer: Flu vaccine, TdAP
Q: Abruptio Pacentae
Answer: Profuse to absent vaginal bleeding, abnormal painful uterine contractions, uterine tenderness, board-like uterus on palpation.
Q: Bulimia Presentation
Answer: Recurrent episodes of eating binging and purging. Russells sign= scarring on knuckles from induced vomiting. Avoid Bupropion (seizures/electrolytes), tx: SSRIs Prozac/sertraline
Q: Depression and treatment
Answer: Depression usually treated with SSRI for a unipolar -sertraline/escitolopram. 4 weeks of treatment then re-evalfor dose adjustmentfor minimum of 6 monthsCymbalta- cant get off the couchBuspar- AnxietyAnxiety and depression coexist use GAD 7 scale to dx
Q: Eval for mood disorder
Answer: SIGECAPSS-sleep issueI-interests lackG-GuiltE-EnergyC-ConcentrationA-AppetiteP-Psychomotor agitationS-Suicidality
Q: Presentation of Bipolar and MDD
Answer: Major depressive disorder or bipolar 5 or more symptomsAnhedonia- loss of pleasure or interest in things that previously provided joy or pleasure
Q: Hormones in depression
Answer: Serotonin- calmness and relaxed stateNorepinephrine and dopamine inhance productivity, ambition, concentrationGABA- feelins of calmnessNMDA- excitatory neurotransmitter
Q: Munchausen by proxy
Answer: caregiver makes up or causes an illness or injury in a person under his or her care
Q: Suicide screening
Answer: 3 questions: Are you thinking of hurting yourself, whats your plan, do you have means or a gun?At risk, prior attempt, adolescents, males, elderly white males highest risk.
Q: Asthma
Answer: Mild intermittent- symptoms 2 or less days per week or 2 less nights per month with short exacMild persistent- symptoms greater than 2/week but less than once per dayModerate persistant- daily symptoms or more than 3-4 nights per monthSevere persistant- continual symptoms or frequents symptoms >1 night per month
Q: Asthma Diagnostic
Answer: Spirometry, pulmonary function tests, allergy testing, peak flowTX: Mild int- SABA
Q: COPD
Answer: Progressive pathological changes to the airway and/or alveoli due to increased inflammatory response to pollutants or inhaled irritants. Gold standard dx: spirometry with bronchodilation. Progressive dyspnea, cough with or without sputum, prolonged expiratory phase, wheezing on forced exhalation, barrel chest tripod position late phase
Q: Empyema
Answer: Presence of pus in the pleural space. Develops when pulmonary lymphatics become blocked leading to an outpouring of contaminated lymph flui into pleural space. Fever, cyanosis, tachyC, pleural pain.
Q: Pleural Effusion
Answer: Presence of fluid in the pleural space from blood or lymphatic vessels. Dyspnea, atelactasis, pleural pain. Dullness on percussion. , mediastinal shift
Q: Treatment of CAP
Answer: Mycoplasma- walking pna, Strep pna- will kill your patient. TX Macrolide i.e. Azithromycin. Infant Amoxicillin, school age amox or macrolide.Outpatient previously healthy- Macrolide OR DoxycyclineOutpatient recent ABs- Resp flouroquinolone OR advanced macrolide (azithromycin) plus high dose amoxicillinOutpatient comorbidities no recent AB-Advanced macrolide OR resp fluoroquinoloneOutpatient comorbidities recent AB- resp fluoroquinolone or advanced macrolide plus beta-lactam
Q: Pertussis
Answer: Lasts six weeks to two months. Caused by Bordatella Pertussis, tx macrolide (Azithromycin) or sulfonamide (Bactrim), everyone in household treated, Pregnant women get Dtap shot 27/28 weeks.
Q: TB
Answer: Dx Quantiferon gold, T spot, TB skin test. Tx is very liver toxic: Isoniazid, Rifampin. DO TREAT LATENT but not infectious. Sx: Fever cough >3 weeks, hemoptysis, weight loss, night sweats.
Q: Croup
Answer: Acute viral illness barking cough, stridor, cough, hoarseness subglottal swelling. No tongue depressors can spasm. Racemic epi?
Q: Chlamydia
Answer: Most common STI in US, genital ulceration, lymphadenopathy, ocular trachoma, proctitis. Often asymptomatic, cervical motion tenderness, Nucleic acid amplification test (NAAT) and Gen probe gold standard. Tx azithromycin if pregnant Amoxicillin. Can cause PID
Q: Gonorrhea
Answer: Common with Chlamydia. Ceftriaxone 500 mg x1, highsuspension for chlamydia give doxycycline. Purulent discharge , blood tinged, prostatitis
Q: Bacterial Vaginosis
Answer: not an STD, more common in sexually active females. Fishy smell, watery discharge, clue cells. increased alkalosis. Tx is Flagyl Metronidazole. Lactobacillus is diminished or absent
Q: Genital Herpes
Answer: Herpes Simplex virus type 1 or 2, transmitted direct contact with active lesions or with virus containing fluid. Is a virus, Tx is antivirals pt can be infectious while shedding virus.
Q: HPV
Answer: 6 and 11 cause genital warts 16 and 18 can cause cervical cancer. Soft painless, flesh colored warts can be cauliflower like if perianal.
Q: Syphilis
Answer: Primary, secondary, latent and tertiary. Primary chancre at site, secondary systemic rash, latent is asymptomatic, tertiary is neuro symptoms. Tx is Benzathine pcn G IM.
Q: Trichomoniasis
Answer: Caused by Protozoan, copious pale yellow to grey green discharge. NAAT to dx, Flagyl to treat. Can cause Petechaie on the cervix, is a protozoal pathogen
Q: Pediculosis Pubis
Answer: Treat with Permethrin (Nix), pubic hair, inflammation in groin area
Q: Last and early signs in HIV
Answer: Fever usually one of first symptoms, fatigue, swollen nodes, sore throat. Late stages: Rapid weight loss, recurring fever, night sweats, fatigue, sores, chronic diarrhea, swollen glands. If TD4 under 200 than progressed to AIDS
Q: Stress Incontinence vs urge vs overflow
Answer: Overflow- unable to empty, urinary retention with underachieve bladder or blockage. Muscle of bladder underactive or obstructed. tx Bethanechol, foley cath, alpha blocker finasteride for BPH, FlomaxUrge- Bladder is active detrusor muscle overactive constant urge. tx: oxybutynin anticholinergicStress- amount of bladder is normal has too little tone near exit, bladder leaks out with any activity. weak pelvic muscles sphincter intontinence. Tx Pseudophedrine
Q: First line treatment UTI
Answer: Nitrofurantoin, Macrobid. Pyridium can be used to help pain- do not use longer than 3 days can cause hemolytic anemia. Pregnancy-Amoxicillin or Nitrofurantoin <3rd trimester. Avoid quinolones or sulfa
Q: UTI
Answer: Positive leukocytes and nitrites on UA. Assessment findings pain, burning, urgency frequency fever chills
Q: When to adjust meds with kidney disease
Answer: If GFR less than 60 adjust meds
Q: Assessment of Breast cancer
Answer: Painless, firm fixed mass, skin or nipple changes, nipple discharge, swelling, lymph enlargement, Pagets disease scaly nipple lesion.Peau d orange, nipple retraction, redness, persistent itching, warm skin.
Q: Who does and doesnt get combined oral contraceptive and contraindications
Answer: Do not give COC to a women of child bearing age that also has migraines with an aura
Q: How to assess and tx dysmenorrhea
Answer: Painful cramping with menstruation pelvic exam has to be normal tx with heating pad non pharmacological, NSAIDs, oral contraceptives.
Q: Assessment and tx of PMS symptoms
Answer: depression, anger, anxiety, confusion, soacial withdrawal, irritability, breast tenderness, bloating, HA, swelling.
Q: estrogen replacement
Answer: CONTRAindicated in women with breast cancer, undiagnosed vaginal bleeding, pregnancy, clots, and active liver disease
Q: PEDS: Medication
Answer: Sinusitis- Augmentin, DDAVP desmopressin acetate for enuresis, succimer for lead
Q: PEDS ESRD
Answer: Erythropoeitin is safe for use in children
Q: Surbstance abuse and assessment PEDS
Answer: Risk factor-ADD tx is atomoxetine
Q: Contraindications to decongestants in Peds
Answer: FDA discourages the use of OTC decongestants to under 2 years old
Q: Acromegaly presentation
Answer: Gigantism is peds, giantism is adults. Presents with bone overgrowth big hands, face, and feet. Overproduction of pituitary gland.
Q: Patients with aortic regurgitation
Answer: present with dyspnea and angina
Q: endocarditis tx
Answer: zosyn/vanco
Q: mechanism of action of prostaglandin with transposition of the great vessels
Answer: provide vasodilation and adequate oxygenation
Q: HTN and CAT acronym
Answer: CCB-amlodipineACE/ARB- “pril”Thiazide or chlorthalidonenephropathy or diabetic start with ACE/ARBblack- thiazide first