NR 511: DD--> Midterm 55 Questions with Answers 2023,100% CORRECT

NR 511: DD--> Midterm 55 Questions with Answers 2023 Herpes zoster aka Shingles - CORRECT ANSWER P: Unilateral, dermatonal, painful vesicular (blister). Erythematous papules to vesicles. Rupture to scabs. Infectious ...

NR 511: DD--> Midterm 55 Questions with Answers 2023 Herpes zoster aka Shingles - CORRECT ANSWER P: Unilateral, dermatonal, painful vesicular (blister). Erythematous papules to vesicles. Rupture to scabs. Infectious. DX: H& P, PCR/Titer TX: Antivirals (acyclovir- virs). Prednisone, Analgesics, amitriptyline (antidepressant), Gabapentin. Puritis Teaching - CORRECT ANSWER P: Unpleasant itching with frequent scratching due to local or systemic issues. Frequent in > 65 DX: H & P TX: Avoid strong soaps, tepid water, emollients, gentle towel drying, avoid alcohol based products. HAIR= ketocanazole 2% shampoo. HAIRLINE= hydrocortisone 1% (OTC) TID Urticaria (hives) - CORRECT ANSWER P: Sudden pale wheal/papule eruptions with severe itching. Resp. symptoms maybe present--> EPI EPI EPI Cholinergic urticaria= due to exercise, or increased body temp Dx: H&P TX: stop exposure to trigger, H1 non-sedation antihistamines (1st line), Fast acting=(2nd line) hydroxyzine, Benadryl, cyproheptadine Scabies - CORRECT ANSWER P: intense itching, especially at night. 1-2cm red papules, skin excoriation, crusting, scaling. INTRA DERMAL Burrows (black specks) DX: Mite presence, Burrow test, H & P essential TX: CLEAN CLEAN CLEAN. CONTACT precautions. Education: wash, wash, wash, cut nails, NO Sharing. MEDS: Permethrin (1ST line) Topical Scabicides= lindane (CNS toxicity and crosses all barriers). sulfur, crotamiton. Antihistamines and topical steroids (TRIAmithalne) SYSTEMIC= Ivermectin (200mcg/KG x 2 doses 1-2 weeks apart. DD: Bites, dermatitis, CKD, psoriasis, impetigo, folliculitis Pediculosis - CORRECT ANSWER P: nits (tear-shaped/wingless) firm in place (HALLMARK), pruritis. EARLY= red erythematous macs/paps. Crust, scaling. Allergy= wheals DX: H & P, thorough inspection DD: Dandruff (NOT on hair shaft but in at hair plug, slide easily off) TX: KILLLL with suffocation or chemicals. MEDS: (1st line) shampoo, cream/lotion, alcohol, ivermectin, permethrin. MEDS (2nd line)= lindane (TOXIC, not for eldery or children < 2). Itching up to a week with TX. Fungal skin infections (general) - CORRECT ANSWER RISK: immunocompromised, older population, diaper kids, diabetics, steroid and antibiotic treatments, invasive lines P:papular rash with satellite lesions DX: inspection, H& P TX: MEDS: antigungal creams, AF pills. EX: EDU: keep dry and cool, allow circulation Fingal Skin infections: ORAL THRUSH - CORRECT ANSWER Candida P: white creamy patches can be easily scraped leaving erythematous patches, tender areas with possible bleeding. TX:Nystatin 100,000u/ml 4-5x daily. Swish and swallow. Fungal skin infections: Balanitis - CORRECT ANSWER P: tender small, red, eroded patches or small white round lesions with red base on glans FSI: Onchomycosis AKA: Tinea unguium - CORRECT ANSWER Nail bed infections P: white or yellow discoloration, nail thickening with separation from nail bed. TX: nystatin, clotrimazole, miconazole, naftifine, terbinafine, ciclopirox Tinea corporis - CORRECT ANSWER Body Scaly borders and central clearing, ring shaped (ring worm). Tinea Pedis - CORRECT ANSWER Athletes foot and between toes Tinea Cruris - CORRECT ANSWER Jock itch Tinea vesicolor - CORRECT ANSWER Slight elevated brown papules and plaques that scale when rubbed with hypopigmentation,. Pruritis found in trunk and shoulders. Cellulitis: Bacterial - CORRECT ANSWER P: spreading infection of epidermis wide warm diffuse erythematous area tender to palpation. Systemic= fever, chills, malaise, lymphadenopathy Folliculitis: Bacterial - CORRECT ANSWER P: yellow-white tender pustules, bumpy without itching. Pustules-> red macules-> fade to hyperpigmented area with hair in middle (HALLMARK) DX: gram stain & Culture TX: gently cleansing BID with AB soap. I&D= large and soft pustules Cyst - CORRECT ANSWER P: occurs over long period of time. Cheesy white discharge with odor. DX: H&P culture Furuncle AKA boil - CORRECT ANSWER Acute infectious process of hair follicle or oil gland P: red, tender, lump where pus fills Hidradenitis suppurativa - CORRECT ANSWER tender and inflamed lesion in axilla, groin, or anal region, with numerous scars and sinus tracts. NOT CYSTS Impetigo - CORRECT ANSWER Highly CONTAGIOUS common in infants and children in school. STAP A, GROUP A OR B Hemolytic strep. P: vesiculopustular pruritic lesions--> infection . Red, crusty rash that spreads/grows, face/extremities. Plaques-> vesicles-> adherent yellow-crusts with red margins DX: H&P C/S TX: mupirocin 2% BID x 5 days (topical), cephalexin x 7 days, dicloxacillin x 7 days Teaching: keepppp clean, dont share! , keep nails short. Genital herpes and warts - CORRECT ANSWER Cause: HPV Warts do not have roots (smooth/round underside) NO rubbing = spreading Easily treatable but recur P: Blistering, itching, oain on urination, fever, HA, tired, anorexia TX: valacyclovir for suppression. dermatitis - CORRECT ANSWER P: long term inflammation of skin that is itchy, swollen, and cracked skin DX: an itch that rashes ATOPIC D: severe pruritis, TRIAD: asthma, exzema, allergic rhinitis CHILDREN: AC and popliteal Acne (acne vulgaris) - CORRECT ANSWER P: small to large red bumps which may or may not be pus-filled and painful DX: H& P TX: benzoyl perixide (Benzac)= 1st line Oral antibiotics= cystic or pigment changes/scarring T: sunscreen, wash face BID actinic keratosis - CORRECT ANSWER risk for cancer, are pre-cancers and lead to squamous cell carcinoma P: flesh-colored, hard and SANDPAPER feel Dx: lesion presentation and on sun-exposed area TX: cryotherapy and referral!!! Rosacea - CORRECT ANSWER P: blushing/flushing and visible blood vessels. Sometimes small pus-filled bumps that flare for weeks-months. DX: family correlation, chronic sun exposure, recent stress, excess alcohol, hormone changes, motes, mental stress TX: Metronidazole cream (6-8 weeks for it to work) T: avoid triggers and protect from sun exposure seborrhea keratosis - CORRECT ANSWER @ risk: white women P: unsightly lesion with itching and clothing irritation. Dark keratin plugs with horny cysts on service NOT cancerous DD: benign pigmented nevi, basal cell carcinoma, and MM TX: Lipoma - CORRECT ANSWER P: benign rubbery smooth round mass of compressible tissue with soft texture. malignant melanoma - CORRECT ANSWER Very aggressive thickness impacts prognosis @ RISK: increased age, immunocompromised, exposure to tanning bed and sun Red Eye - CORRECT ANSWER DD: conjunctivitis, hordeolum, glaucoma (Acute), iritis, abrasions, dry eye, hemorrhage, cellulitis, sclerites, Bacterial conjunctivitis - CORRECT ANSWER Red eye, crusted eyelids, normal acuity. May have photophobia, watery and itchy eye. ** Purulent and crusted in AM TX: Gentamicin, sulfacetamide, macrolide (-mycin), bacitracun, cipro, trimethoprim, neomycin, levofloxacin, T: proper instillation of drops. no contact for 24 hours after med admin Viral conjunctivitis - CORRECT ANSWER present w/wo cold P: itchy, red eyes with clear or no dc. potential preauricular LN swelling and tenderness ( HALLMARK). Proper eye drop administration is important TX: Pyrimidine (may be toxic) Oral: -cyclovirs blepharitis - CORRECT ANSWER inflammation of eyelid margin Cause: staph and dysfunction of Meibomian glad TX: Bacitracin 0.5% Resistance? quinolone or sulfa/corticosteroids or erythromycin Chalazion - CORRECT ANSWER P: cyst or lump/swelling in eyelid due to blockage of gland: NOT PAINFUL Tx: referral if present past 4 weeks for I& D or steroid injections hordeolum: STYE - CORRECT ANSWER P: red painful lump on eyelid edge TX: none necessary Epiphora - CORRECT ANSWER overflow tears on face Risk: elderly and allergy ridden individuals TX: topical antibioticd if infection or trauma. DO NOT USE steroids or anesthetic drops Dry eye - CORRECT ANSWER P: feeling of sand in eyes, hot irritated and gritty feeling. Possible redness. blurred vision, lack of tears, bruning, itching, foreign body feeling, photosensitivity, loss of glass of corneya DX: slit-lamp or Schirmer test TX: teaching (1st line) T: wearing goggles when swimming; using a preservative-free artificial tears preparation; taking frequent rest periods from the computer and hand-held electronic devices otitis externa - CORRECT ANSWER P: tenderness of pinna and over tragus, erythematous canal, history of swimming TX: heat, ice, tylenol or ibuprofen. TOPICAL for extreme cases: cipro/hydrocort, neomy/polymy T: dry out ear Acute Otitis Media - CORRECT ANSWER P: red and bulging TM with visible effusion, decreased TM mobility, canal red. TX: amoxicillin 40-45mg/kg/day PO in 2 divided doses x 10 days PERFORATED TM: cipro/dexamethasone, ofloxacin 0.3% T: referral: change in hearing/speech Return in 48-72hrs if not resolved , allergy to amoxicillin, strep throat - CORRECT ANSWER P: scratchy, discomfort, pain, difficulty swallowing, cervical LN swelling, fever, fatigue, enlarged tonsils, white/yellow exudate. DX: rapid strep, throat culture TX: PCN V 500mg PO BID x 10 days DD: mono if their are posterior cervical LN enlargement--> DO A MONOSPOT peritonsillar abscess - CORRECT ANSWER P: gradual onset of severe unilateral sore throat, odynophagia, fever, otalgia, and cervical lymphadenopathy. Trismus (lock jaw speaking). TX: Refer to ER for airway patency and prevention of sepsis epiglottitis - CORRECT ANSWER P: throat pain, difficulty swallowing, copious oral secretions, respiratory difficulty, stridor, fever, no pharyngeal erythema, or cough TX: requires emergency care. IV antibiotics Barotrauma - CORRECT ANSWER pressure-related ear pain P: pressure in middle ear TX: nasal steroids and oral decongestants Hoarseness (dysphonia) - CORRECT ANSWER P: changes in pitch of voice. Weak, scratchy, or husky DD: papillomatosis TX: laryngoscopy Rhinitis (Hay fever) - CORRECT ANSWER IgE mediated type 1 response to irritants P: pale, violaceous turbinate, sneezy, runny nose, watery/itchy eyes Dx: H & P TX: education Cataracts - CORRECT ANSWER P: Painless, progressive vision loss with complaints of night vision distortions and bothersome glares of lights on at night take Vitamin E, vitamin c, beta carotene, careful driving at night open angle glaucoma - CORRECT ANSWER slow loss of peripheral vision. tunnel vision closed angle glaucoma - CORRECT ANSWER Emergency, acute onset of pain with vision loss due to sudden increase in IOP sensorineural hearing loss - CORRECT ANSWER hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness • Sensorineural loss: exposure of loud noises, inner ear infection, tumors, congenital anomalies, familial disorders, aging, Meniere's disease, medications, trauma. o Referral to ENT for sudden onset conductive loss o Diagnostics: Weber sound heard louder in good ear Conductive hearing loss - CORRECT ANSWER • Conductive loss: bone conduction is greater than air conduction presbycusis cerumen impaction o Diff Dx. Serous otitis media: bilateral symmetrical high-frequency hearing loss o Diff Dx: Cerumen impaction: Otitis externa o Diagnostics: Weber conductive loss present when sound is heard louder in bad ear Various tests: Weber, Rinne, Schwalbach Tinnitus - CORRECT ANSWER • Causes: middle ear fluid, severe HTN P: ringing or buzzing noise in ear DX: Evaluation: orthostatic BP measurements, tympanometry, reflex measurement, or acoustic reflectometry to assess for presence of fluid in middle ear. TX:play background music during daytime and before sleep, smoking cessation, decrease caffeine intake/chocolate/alcohol. Rest well as fatigue increases tinnitus. Gum chewing and swallowing is encouraged • Mental health Screenings are important= depression is associated with tinnitus DD for OTALGIA (ear pain) - CORRECT ANSWER Barotrauma , OE, AOM, cerumen impaction, dental disease, sinuses disease, perf. TM, EMJ Cerumen impaction - CORRECT ANSWER Causes: ear canal hair, hearing aids, bony growths, previous impaction, Q-tips, foreign bodies Cerumen impaction is the cause of a conductive hearing loss; differential diagnosis would be otitis externa Specificity - CORRECT ANSWER The number of non-diseased individuals correctly diagnosed divided by the number of non-diseased people. EX: In above scenario, 720 non-diseased people tested true negative. Divide that by 800 non-diseased and the specificity =90% Specificity: -High: a high percentage of healthy individuals will show a normal result -Low: getting a positive result when it is not present-a high number of false positives-meaning a healthy person has a disease when they actually do not. •If a diagnostic study has high specificity, then a high percentage of healthy individuals will show a normal result Sensitivity - CORRECT ANSWER •Sensitivity: is the proportion of true positives out of all patients with a designated condition •Highly sensitive tests will lead to positive findings for patients with a disease number of diseased individuals correctly diagnosed divided by the total of diseased individuals. EX: 1000 people population, 200 are diseased (prevalence of 20%). Of 200 with illness, 160 people test positive and 40 negatives. 160 true positives of 200 total diseases = 80% accuracy aka Sensitivity. Traditional Medicare Reimbursement - CORRECT ANSWER •How clients cover their out-of-pocket expenses when on traditional Medicare •Typically, the client will obtain a secondary insurance plan to cover the 20% client out-of-pocket expenses •Part A: Inpatient hospital stay; Skilled nursing care; Hospice; Home care •Part B: Outpatient services; Provider visits; Surgery; Lab tests; Medical equipment; Preventative exams •Part C: Wellness services; Vision exams; Hearing exams; Eye glasses; Hearing aids •Part D: Prescription drugs •NPs are reimbursed at 85% of the physician's fee - CORRECT ANSWER