question

Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of osteoporosis? a. Beta blockers b. Calcium channel blockers c. Ace inhibitors d. Diuretics

answer

Calcium channel blockers

question

Which of the following class of drugs is preferred treatment for a diabetic with stage II hypertension? a. Calcium channel blockers b. Alpha blockers c. Angiotensin converting enzyme inhibitor d. Loop diuretics

answer

Angiotensin converting enzyme inhibitor

question

You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had a diagnosis of hypertension. He doesn't check his blood pressure at home. He has a family history of hypertension. What are your recommendations? a. Start HCTZ 12.5mg daily, purchase a blood pressure cuff, and return to your office in 1 mth b. Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks. c. Order EKG, CMP, CBC, and lipid panel, and refer to cardiology. d. Order a cardiac stress test and lipid panel.

answer

Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks

question

You are treating a young adult female with HTN and migraine headaches. Which class of medications could you choose to treat both? Ace inhibitors Calcium channel blockers Beta blockers Angiotensin receptor blockers

answer

Beta blockers

question

A 42-year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements. Total: 210 LDL: 145 TG 162 HDL 52 What medication would you recommend? a. Low dose statin b. Low dose bile acid sequestrant c. Low dose fibrate d. Fish oil

answer

Low dose statin

question

You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan? a. Order a CBC and CMP. b. Order lipid level and serum creatine phosphokinase (CPK, creatine kinase) c. Order a 24 hr urine d. Recommend increasing his fluids and rest.

answer

Order lipid level and serum creatine phosphokinase (CPK, creatine kinase).

question

What would you advise this patient regarding taking his atrovastatin (Lipitor)? Continuing taking the medication until the labs are available Take atorvastatin every other day until labs are available Take half of the atorvastatin every other day until labs are available Stop taking the atorvastatin until the labs are available

answer

Stop taking atorvastatin until the labs are available.

question

A 58 year old male presents to your office with an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved with rest. Which of the following does this best describe? Acute myocardial infarction Gastroesophageal reflux disease Angina pectoris Acute costochondritis

answer

Angina pectoris

question

What is the most common cause of left ventricular hypertrophy in the United States? Mitral valve prolapse Chronic atrial fibrillation Pulmonary hypertension Chronic hypertension

answer

Chronic hypertension

question

Which of the following heart sounds is associated with heart failure? Still's murmer and S4 S3 S1, S2, and S4 S1, S2, and S3

answer

S3

question

While performing a routine physical exam on a 60-year-old hypertensive male, you notice a bruit over the carotid area on the left side of the neck. There is no induration of the skin. This patient is at higher risk for: Stroke and coronary heart disease Temporal arteritis and brain aneurysms Abdominal aneurysm and congestive heart gailure Dizziness and headaches

answer

Stroke and coronary heart disease

question

A 72-year-old female presents to your office with gradual difficulty breathing, non-productive cough, bilateral swelling of her feet, and a 10 pound weight gain. Upon examination you hear crackles and rhonchi with an S3 heart sound. What is the most likely diagnosis? COPD Renal hypertension Congestive heart hailure Asthma

answer

Congestive heart failure

question

What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds? Rest and increase fluids Diuretics, digoxin, and anti-hypertensive medications Nebulized albuterol and prednisone Anti-coagulation and cardiology evaluation

answer

Diuretics, digoxin, and anti-hypertensive medications

question

You are treating a 49-year-old female who presents with fatigue and palpitations. You check her apical pulse and she is irregular and tachycardic. You obtain an EKG and it reveals afib with rapid ventricular response. What is your treatment plan? You order a 2D echo. You admit her to the hospital for new onset afib. You perform cardiac massage and have her relax. You order a cardiology consult.

answer

You admit her to the hospital for new onset afib.

question

Upon examination of a 17-year-old during a sports physical, you hear a split S2 during inspiration that disappears during expiration. The patient denies chest pain and dyspnea. What will you tell the mother and patient regarding your findings? You advise the patient to avoid strenuous physical activity until further investigation You recommend a referral to cardiology. Due to the patient being an athlete, you recommend a stress echo Educate the mother and patient that this is a benign finding

answer

Educate the mother and patient that this is a benign finding.

question

The first sign of an asthma exacerbation is: Cough Wheeze Dyspnea Chest tightness

answer

Cough

question

According to the NAEPP-3 Guidelines for the Treatment and Management of Asthma, what is the gold standard for daily treatment of mild-persistent asthma? Inhaled steroids Long-acting bronchodliators Short-acting bronchodilators Combination therapies

answer

Inhaled steroids

question

You are treating an adult asthma patient and reviewing her metered dose inhaler (MDI) technique. She demonstrates her MDI technique by shaking the inhaler, placing the inhaler in her mouth, pressing the canister, and inhaling quickly. What is your response? You praise the patient for demonstrating the correct MDI technique You educate the patient taht, first, she should exhale fully, then shake the inhale, and finally, as she presses the canister, inhale slowly and fully You instruct the patient to take a faster, even inspiratory effort You educate the patient that she should always use a spacer or holding chamber with all MDI's

answer

You educate the patient that, first, she should exhale fully, then shake the inhaler, and finally, as she presses the canister, inhale slowly and fully.

question

An adult patient with a history of chronic obstructive lung disease (COPD) presents to your office with 1 day of worsening shortness of breath, wheezing, and non-productive cough. You determine he has a COPD exacerbation. What is your treatment plan? Chest x-ray Levaquin 500 mg QD for 7 days, Prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID 7 - 10 day prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID Z-pak, 7 - 10 day prednisone spurt, Atrovent inhaler 2 puffs QID

answer

7-10 days prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID

question

All of the following are useful in treating patients with COPD except: Antihistamines Anticholinergics Oral steroids Short-acting beta2-agonists

answer

Antihistamines

question

Which of the following is less likely to be found in a patient with emphysema dominant COPD? A cough that is productive with large amounts of sputum Prolonged expiration Exertional dyspnea Weight loss

answer

A cough that is productive with large amounts of purulent sputum

question

You are treating a patient in your office whom you suspect has chronic lung disease, but you are unsure if you should start treatment today. What do you consider ordering first? A pulmonary consult A chest x-ray An office spirometry A pulmonary function test

answer

An office spirometry

question

You are treating an elderly patient who tells you he has a history of allergies. His concern today is he is coughing more at night for the past 6 weeks and wheezing intermittently. He has no history of heart failure, smoking, or other lung disease. Your physical examination is unremarkable. What are your differential diagnosis(es) for cough? Select all that apply. Asthma Sinusitis Postnasal drip GERD

answer

Asthma Sinusitis Postnasal drip GERD

question

A chronic cough lasts longer than: a. 3 weeks. b. 1 month c. 6 months. d. 1 year.

answer

a. 3 weeks.

question

You are doing a cerumen extraction and touch the external meatus of your patient's ear. He winces and starts coughing. What is the name of this reflex? a. Baker phenomenon b. Arnold reflex c. Cough reflex d. Tragus reflex

answer

b. Arnold reflex

question

Julie has a postnasal drip along with her cough. You assess her for: a. Asthma. . b. Sinusitis. c. Allergic or vasomotor rhinitis. d. Influenza.

answer

c. Allergic or vasomotor rhinitis.

question

Your patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from: a. Metoprolol (Toprol XL). b. Tadalafil (Cialis). c. Clopidogrel (Plavix). d. Captopril (Capoten).

answer

d. Captopril (Capoten).

question

African American patients seem to have a negative reaction to which of the following asthma medications? a. Inhaled corticosteroids b. Long-term beta-agonist bronchodilators c. Leukotriene receptor agonist d. Oral corticosteroid

answer

b. Long-term beta-agonist bronchodilators

question

Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests (PFTs) are as follows: a normal total lung capacity, a decreased PaO2, and an increased PaCO2. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis? a. Asthma b. Emphysema c. Chronic bronchitis d. Influenza

answer

c. Chronic bronchitis

question

You are using the CURB-65 clinical prediction tool to decide whether Mabel whom you have diagnosed with community-acquired pneumonia (CAP) should be hospitalized or could be treated at home. Her score is 3. What should you do? a. Consider home treatment. b. Plan for a short inpatient hospitalization. c. Closely supervise her outpatient treatment. d. Hospitalize and consider admitting her to the intensive care unit (ICU).

answer

d. Hospitalize and consider admitting her to the intensive care unit (ICU).

question

Why do you suspect that your patient may have a decreased response to the tuberculin skin test (TST)? a. She is on a high-protein diet. b. She is an adolescent. c. She has been on long-term corticosteroid therapy. d. She just got over a cold.

answer

c. She has been on long-term corticosteroid therapy.

question

Marci has been started on a tuberculosis (TB) regimen. Because isoniazid (INH) may cause peripheral neuropathy, you consider ordering which of the following drugs prophylactically? a. Pyridoxine b. Thiamine c. Probiotic d. Phytonadione

answer

a. Pyridoxine

question

Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean? a. The tumor size cannot be evaluated, the cancer has not spread to the lymph nodes, and the distant spread cannot be evaluated. b. The cancer is in situ, it is spreading into the lymph nodes, but the spread otherwise cannot be evaluated. c. The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body. d. The cancer is about 5 cm in size, nearby lymph nodes cannot be evaluated, and there is no evidence of distant spreading.

answer

c. The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body

question

Nathan, a 32-year-old policeman, has a 15-pack year history of smoking and continues to smoke heavily. He gets irate during every visit when you try to talk to him about quitting. What should you do? a. Just hand him literature about smoking cessation at every visit. b. Wait until he is ready to talk to you about quitting. c. Just document in the record that he is not ready yet. d. Continue to ask him at every visit if he is ready yet.

answer

d. Continue to ask him at every visit if he is ready yet.

question

Your patient has decided to give Chantix a try to quit smoking. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking? a. He should stop smoking today. b. He should stop smoking tomorrow. c. His quit date should be in 1 week. d. He will be ready to quit after the first 30 days.

answer

c. His quit date should be in 1 week.

question

Which information should be included when you are teaching your patient about the use of nicotine gum? a. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa. b. Patients should not eat for 30 minutes prior to or during the use of the gum. c. Initially, one piece is chewed every 30 minutes while awake. d. Acidic foods and beverages should be encouraged during the nicotine therapy.

answer

a. The gum must be correctly chewed to a softened state and then placed in the buccal mucosa.

question

Your patient states he has a strep throat infection. Which of the following symptoms makes you consider a viral etiology instead? a. Fever b. Headache c. Exudative pharyngitis d. Rhinorrhea

answer

d. Rhinorrhea

question

What is the first-line recommended treatment against Group A B -hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis? a. Penicillin b. Quinolone c. Cephalosporin d. Macrolide

answer

a. Penicillin

question

Cydney presents with a history of asthma. She has not been treated for a while. She complains of daily symptoms but not continual, greater than 1 week and at nighttime. She has been using her rescue inhaler. Her FEV1 is 60% to 80% predicted. How would you classify her asthma severity? a. Mild intermittent b. Mild persistent c. Moderate persistent d. Severe persistent

answer

c. Moderate persistent

question

Joyce is taking a long-acting beta agonist for her asthma. What additional medication should she be taking? a. Inhaled corticosteroid b. Leukotriene receptor antagonist c. Systemic corticosteroid d. Methyl xanthenes

answer

a. Inhaled corticosteroid

question

Your patient is on Therabid for his asthma. You want to maintain his serum levels between: a. 0 to 5 µg/mL. b. 5 to 10 µg/mL. c. 5 to 15 µg/mL. d. 10 to 20 µg/mL.

answer

c. 5 to 15 µg/mL.

question

George has chronic obstructive pulmonary disease (COPD) and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD? a. Stage 1 mild COPD b. Stage 2 moderate COPD c. Stage 3 severe COPD d. Stage 5 very severe COPD

answer

a. Stage 1 mild COPD

question

Most nosocomial pneumonias are caused by: a. Fungi. b. Viruses c. Gram-negative bacteria. d. Pneumococcal pneumonia.

answer

c. Gram-negative bacteria.

question

Which of the following statements is true regarding tuberculin skin testing (TST)? a. Tests should be read 48 hours after the injection. b. The size of the TST reaction has nothing to do with erythema but is based solely on induration. c. It is a type V T-cell mediated immune response. d. The diameter of the induration is measured in centimeters.

answer

b. The size of the TST reaction has nothing to do with erythema but is based solely on induration.

question

Which obstructive lung disease is classified as reversible? a. Asthma b. Chronic bronchitis c. Emphysema d. COPD

answer

a. Asthma

question

You have taught Jennifer, aged 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate (PEFR) is 65%. What would you tell her? a. "Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow." b. "Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow." c. "Drive to the emergency room (ER) now." d. "Call 911."

answer

b. "Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow."

question

Which statement about adenocarcinoma of the lung is accurate? a. It is the least common type of lung cancer, representing approximately 5% to 10% of cases. b. It is the most prevalent carcinoma of the lung in both sexes and in nonsmokers, representing 35% to 40% of all tumors. c. It is more common in men than in women and occurs almost entirely in cigarette smokers. d. It is aggressive, with rapid growth and early local and distant metastases via the lymphatic and blood vessels.

answer

b. It is the most prevalent carcinoma of the lung in both sexes and in nonsmokers, representing 35% to 40% of all tumors.

question

Jason, aged 62, has obstructive sleep apnea. What do you think is one of his contributing factors? a. He is a recovering alcoholic of 6 years. b. His collar size is 17 inches. c. He is the only person in his family who has this. d. He is extremely thin.

answer

b. His collar size is 17 inches.

question

A patient is seen in the clinic with a chief complaint of hematuria. Which of the following data should be collected in order to make a differential diagnosis? a. "Do you have a history of liver disease?" b. "What medications are you currently taking?" c. "Have you noticed swelling in your ankles?" d. All of the above

answer

b. "What medications are you currently taking?"

question

The result of the patient's 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions? a. Repeat the test. b. Refer to a nephrologist. c. Measure the serum protein. d. Obtain a blood urea nitrogen (BUN) and creatinine.

answer

b. Refer to a nephrologist.

question

The patient is seen complaining of "leaking urine when I sneeze." Which of the following actions should the clinician take first? a. Order a cystometrogram b. Obtain a computed tomography (CT) scan c. Instruct the patient on Kegel exercises d. Prescribe Imipramine

answer

c. Instruct the patient on Kegel exercises

question

A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria? a. NSAIDs b. Beets c. Vitamin A d. Red meat

answer

a. NSAIDs

question

A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a diagnosis of lower UTI? a. Back and abdominal pain b. Fever, chills, costovertebral angle (CVA) tenderness c. Blood in urine and frequency d. Foul-smelling discharge, perineal itch

answer

c. Blood in urine and frequency

question

A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine showed greater than 10 leukocytes/mL, and a dipstick was positive for nitrites. What is probable diagnosis? a. Lower urinary tract infection b. Chlamydia infection c. Candidiasis d. Pyelonephritis

answer

a. Lower urinary tract infection

question

The patient presents with costovertebral angle (CVA) tenderness and a several day history of high fever and chills and dysuria. Which of the following diagnoses is most likely given the above information? a. Pyelonephritis b. Cystitis c. Renal calculi d. Bladder tumor

answer

a. Pyelonephritis

question

Which of the following information is essential before prescribing Bactrim DS to a 24-year-old woman with a urinary tract infection (UTI)? a. Last menstrual period b. Method of birth control c. Last unprotected sexual contact d. All of the above

answer

d. All of the above

question

A patient is seen in the office complaining of severe flank pain. The clinician should assess this patient for which risk factors for kidney stones? a. Hypertension b. Constipation c. Tubal ligation d. Diabetes

answer

a. Hypertension

question

The patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication? a. Diarrhea b. Parkinson's disease c. Closed-angle glaucoma d. Breast cancer

answer

c. Closed-angle glaucoma

question

The patient is diagnosed with overactive bladder (OAB). Which of the following instructions should be given to this woman? a. "Limit the amount of water that you drink." b. "Eliminate caffeine from your diet." c. "Wear panty liners." d. All of the above

answer

b. "Eliminate caffeine from your diet."

question

A 34-year-old patient was treated for a urinary tract infection (UTI) and has not responded to antibiotic therapy. Which of the following actions should be taken next? a. Send a urine specimen for microscopy looking for fungal colonies. b. Increase the dose of antibiotic. c. Order a cytoscopy. d. Order a different antibiotic.

answer

a. Send a urine specimen for microscopy looking for fungal colonies.

question

Which of the following are predisposing factors for pyelonephritis? a. Pregnancy b. Dehydration c. Smoking d. Alkaline urine

answer

a. Pregnancy

question

A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be managed? a. 3-day course of oral antibiotics b. Hospitalization c. Encourage cranberry juice intake d. 6-week course of antibiotics

answer

b. Hospitalization

question

A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses? a. Pancreatitis b. Peptic ulcer disease c. Diverticulitis d. All of the above

answer

d. All of the above

question

Which of the following instructions should be given to the patient with nephrolithiasis? a. Take ibuprofen 600 mg every 8 hours. b. Take Tums for stomach upset. c. Drink more black tea. d. Increase intake of vegetables like spinach.

answer

a. Take ibuprofen 600 mg every 8 hours.

question

Which of the following patients is at risk for developing urinary tract cancer? a. The 45-year-old woman who is 100 lbs overweight b. The 78-year-old man who smokes three packs of cigarettes a day c. The 84-year-old man who worked in the asbestos mines d. All of the above

answer

d. All of the above

question

A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer to a nephrologist for which of these appropriate treatments? a. Chemotherapy b. Nephrectomy c. Palliative treatment d. Radiation

answer

b. Nephrectomy

question

An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects bladder cancer. Which of the following information from the history would be considered a risk factor for this type of cancer? a. History of alcoholism b. Sedentary lifestyle c. Obesity d. 65-year smoking history

answer

d. 65-year smoking history

question

Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer? a. KUB (kidneys, ureter, bladder) x-ray b. Cystoscopy with biopsy c. Magnetic resonance imaging (MRI) d. Urine tumor marker (NMP22)

answer

b. Cystoscopy with biopsy

question

A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means. Which is the best response? a. "There is no such thing as Stage D cancer." b. "You have cancer that has spread to the surrounding tissue." c. "Your cancer has spread to other organs." d. "Your cancer can be cured by removing your bladder."

answer

c. "Your cancer has spread to other organs."

question

The patient is diagnosed with acute renal failure (ARF). Which of the following information obtained from the history should alert the provider that this is a case of prerenal azotemia? a. Recent heat stroke b. Nephrolithiasis c. Recent infection where gentamicin was used in treatment d. All of the above

answer

a. Recent heat stroke

question

The patient is diagnosed with acute renal failure (ARF). Which of the following conditions is the most common cause? a. Renal calculi b. Acute tubular necrosis c. Cardiac failure d. Acute glomerulonephritis

answer

b. Acute tubular necrosis

question

An 82-year-old woman with renal failure is seen in the clinic. The provider should question the patient about the intake of which of these substances that can cause renal toxicity? a. Ibuprofen b. Captopril c. Losartan d. All of the above

answer

d. All of the above

question

Which of the following clinical manifestations are consistent with a patient in acute renal failure (ARF)? a. Pruritis b. Glycosuria c. Irritability d. Hypotension

answer

a. Pruritis

question

Which of the following exam finding should be expected in a patient with chronic renal failure (CRF)? a. Weak, thready pulse b. Auscultatory crackles c. Hypotension d. Pleural friction rub

answer

b. Auscultatory crackles

question

Which of the following tests is most useful in determining renal function in a patient suspected of chronic renal failure (CRF)? a. Blood urea nitrogen (BUN) and creatinine b. Electrolytes c. Creatinine clearance d. Urinalysis

answer

c. Creatinine clearance

question

Which of the following foods should be limited in a patient with chronic renal failure (CRF)? a. Milk b. Bananas c. Soy sauce d. All of the above

answer

d. All of the above

question

The urine osmolality is greater than 500 mOsm/L in patients with postrenal acute renal failure (ARF). T or F

answer

F

question

Cigarette smoking is a risk factor for chronic renal failure (CRF). T or F

answer

T

question

Which of the following drug categories commonly prescribed for hyperlipidemia should not be given if the triglycerides are over 400 mg/dL? a. Folic acid derivatives b. Bile acid sequestrants Inhibitors c. HMG-CoA reductase d. Folic acid derivatives

answer

b. Bile acid sequestrants Inhibitors

question

Sandra has palpitations that are occurring with muscle twitching, paresthesia, and fatigue. What might a specific diagnostic test be to determine the cause? a. Serum calcium b. Electrocardiogram (ECG) c. Thyroid-stimulating hormone (TSH) test d. Complete blood cell count (CBC)

answer

a. Serum calcium

question

If chest pain may be alleviated with time, analgesics, and heat applications, what might the differential diagnosis be? a. Peptic ulcer b. Hiatal hernia c. Costochondritis d. Pericarditis

answer

c. Costochondritis

question

A blood pressure (BP) of 142/92 is considered: a. Normal. b. Prehypertension. c. Stage 1 hypertension. d. Stage 2 hypertension.

answer

c. Stage 1 hypertension.

question

Lifestyle modifications to manage hypertension include: a. Maintaining a body mass index (BMI) of 17. b. Restricting dietary sodium to 2 g per day. c. Encouraging 90 minutes of exercise per day. d. Limiting beer intake to 24 oz/day.

answer

d. Limiting beer intake to 24 oz/day.

question

Mary has hypertension and previously had a stroke. Which hypertensive drug would you order for her? a. ACE inhibitor b. Calcium channel blocker c. Angiotensin II receptor blocker (ARB) d. Beta blocker

answer

a. ACE inhibitor

question

Which high-density lipoprotein (HDL) level is considered cardioprotective? a. Greater than 30 b. Greater than 40 c. Greater than 50 d. Greater than 60

answer

d. Greater than 60

question

You are assessing Sigred for metabolic syndrome. Which of her parameters is indicative of this syndrome? a. Her waist is 36 inches. b. Her triglyceride level is 140 mg/dL. c. Her blood pressure (BP) is 128/84. d. Her fasting blood sugar (BS) is 108 mg/dL.

answer

a. Her waist is 36 inches.

question

Which type of angina do you suspect in Harvey who complains of chest pain that occurs during sleep and most often in the early morning hours? a. Stable angina b. Unstable angina hernia c. Variant (Prinzmetal's angina) d. Probably not angina but hiatal

answer

c. Variant (Prinzmetal's angina)

question

Which typical electrocardiogram (ECG) change is usually seen with cardiac ischemia? a. T-wave inversion b. ST-segment elevation c. Significant Q wave d. U-wave

answer

a. T-wave inversion

question

In which type of AV block does the PR interval lengthen until a beat is dropped? a. First-degree AV block block b. Second-degree Mobitz I AV block c. Second-degree Mobitz II AV d. Third-degree AV block

answer

b. Second-degree Mobitz I AV block

question

A Delta wave on the electrocardiogram (ECG) may be present in which condition? a. Prinzmetal's angina b. Bundle Branch Block c. Wolff-Parkinson-White syndrome d. Aortic stenosis

answer

c. Wolff-Parkinson-White syndrome

question

Which heart sound may be heard with poorly controlled hypertension, angina, and ischemic heart disease? a. A physiologic split S2 b. A fixed split S2 c. S3 d. S4

answer

d. S4

question

Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of: a. Severe asthma. b. A common valvular lesion. c. Severe hypertension. d. A previous coronary artery bypass graft (CABG).

answer

d. A previous coronary artery bypass graft (CABG).

question

The clinical risk factors for deep vein thrombosis (DVT), which include venous insufficiency, post stroke, and heart failure, fit into which of Virchow's Triad for being a causative factor for DVT? a. Venous stasis b. Vessel injury c. Hypercoagulability

answer

a. Venous stasis

question

George has cardiovascular disease (CVD), is 64 years old, has a total cholesterol of 280 mg/dL, has a systolic blood pressure (BP) of 158, and is being treated for hypertension. You are doing a Framingham Risk Assessment on him. Which assessment factor would give him the highest number of points on the scale? a. His age b. His cholesterol level c. His systolic BP d. The fact that he is on antihypertensive medication

answer

b. His cholesterol level

question

Which pain characteristic is usually indicative of cardiac pathology? a. Fleeting b. Moving c. Diffuse d. Localized

answer

c. Diffuse

question

What percentage of patients with angina pectoris will have simultaneous dyspnea, caused by transient increase in pulmonary venous pressures that accompany ventricular stiffening during an episode of myocardial ischemia? a. About 20% b. About 30% c. About 50% d. Almost all

answer

b. About 30%

question

Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should be used under the tongue every 5 minutes for three doses. What should be done if the pain has not been relieved after three doses? a. 911 should be called, and the patient should be transported immediately to the emergency department (ED). b. One more dose of NTG may be tried. c. The person should be given two aspirin to chew. d. A portable defibrillator should be located to ascertain the cardiac rhythm.

answer

a. 911 should be called, and the patient should be transported immediately to the emergency department (ED).

question

For the best therapeutic effect after a myocardial infarction (MI), thrombolytics should be adminis-tered within the first 3 hours (ideally 30 minutes) of presentation of symptoms. Studies have shown that thrombolytic therapy, however, can be of benefit up to how many hours after the initial presentation of symptoms of MI? a. 6 hours b. 8 hours c. 10 hours d. 12 hours

answer

d. 12 hours

question

When teaching patients post myocardial infarction (MI) about their nitroglycerine tablets, the clinician should stress that the tablets should remain in the light-resistant bottle in which they are pack-aged and not be put in another pill box or remain in areas that are or could become warm and hu-mid. Once opened, the bottle must be dated and discarded after how many months? a. 1 month b. 3 months c. 6 months d. As long as they are kept in this special bottle, they will last forever.

answer

c. 6 months

question

There are four stages of heart failure classified as A to D that describe the evolution and progression of disease. Patients in which stage have refractory symptoms of heart failure at rest despite medical therapy, are hospitalized, or require specialized interventions or hospice care? a. Stage A b. Stage B c. Stage C d. Stage D

answer

d. Stage D

question

Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure which makes it a good diagnostic test? a. B-type natriuretic peptide (BNP) b. C-reactive protein (CRP) c. Serum albumin d. Erythrocyte sedimentation rate (ESR)

answer

a. B-type natriuretic peptide (BNP)

question

Which assessment tool is used for peripheral artery disease? a. FAQ b. WIQ c. MMSE d. MOCA

answer

b. WIQ

question

Which diagnostic test has long been considered the "gold standard" for a diagnosis of venous thromboembolism? a. Ultrasound b. Magnetic resonance imaging (MRI) c. Ascending venogram d. D-dimer

answer

c. Ascending venogram

question

What defines an Acute UTI ?

answer

It is characterized by the onset of UTI in a previously symptom-free individual

question

What defines a Chronic UTI ?

answer

Chronic UTI's may be caused by Obstruction Antibiotic resistant bacteria Multiple strains of bacteria

question

What defines a Complicated UTI ?

answer

A Complicated UTI is accompanied by factors that complicate the infection

question

UTI's are most prevalent in which individuals?

answer

Sexually Active Adults Very young children Frail older adults

question

What are Predisposing factors to UTI's?

answer

Suppressed immune system Pregnancy Urinary obstruction Catheter dependency Neurogenic bladder Diabetes mellitus

question

What are the most frequently reported symptoms of a UTI?

answer

Dysuria Urinary frequency or urgency Nocturia Hematuria Low back or suprapubic pain Urinary incontinence Cloudy, foul-smelling urine

question

A Clean-catch, midstream urine sample for urinalysis may exhibit what characteristics?

answer

Cloudy appearance Alkaline pH Hematuria Elevated levels of nitrites Leukocyte esterase Urine sediments of RBCs, WBCs, mucus, and bacterial overgrowth

question

In a UA how many organisms are necessary per ml would be indicative of an infection?

answer

Sample showing more than 100,000 organisms/mL is indicative of infection PLUS presence of characteristic clinical symptoms

question

What is the GOLD STANDARD for diagnosing UTI?

answer

Laboratory confirmation / UA with microscopy and Urine Culture and Sensitivity

question

Name some differential dx's for UTI:

answer

Tumors Upper UTI Vaginitis STDs

question

Lower UTI's do not exhibit signs of what?

answer

Sepsis - characterized by: Fever Chills WBC casts CVAT

question

What is the primary antimicrobial management for an UNCOMPLICATED UTI for non-pregnan women?

answer

Nitrofurantoin seems most effective on gram-negative and gram-positive cocci; 100 mg orally (modified-release) twice daily for 5 days OR trimethoprim/sulfamethoxazole : 160/800 mg orally twice daily for 3 days OR The fluoroquinolones have widespread efficacy; not first line therapy for uncomplicated UTI

question

What is the primary antimicrobial management for a COMPLICATED UTI for a non-pregnant women?

answer

Primary Options ciprofloxacin : 500 mg orally twice daily for 7 days OR levofloxacin : 750 mg orally once daily for 5 days OR trimethoprim/sulfamethoxazole : 160/800 mg orally twice daily for 14 days

question

What is the treatment for a Fungal UTI?

answer

Fluconazole 200 mg qd 7-14 days

question

What is the treatment for chronic recurrent UTI's?

answer

Prophylactic treatment either on a daily basis or after sexual intercourse.

question

What are some important patient education items the clinician should instruct the patient on?

answer

Instruct patient to notify clinician if flank pain, hematuria, or lack of response to treatment occurs Advise patient to Complete full course of antibiotic therapy Increase fluid intake to eight 8-ounce glasses of H2O Take cranberry supplement and drink cranberry juice Wear cotton underclothes Avoid harsh soaps or feminine hygiene products Empty bladder frequently and completely Take showers instead of tub baths

question

What is Pyelonephritis ?

answer

An Upper UTI

question

Pyelonephritis is characterized by infecting what structures?

answer

Infects the renal pelvis Tubules or Interstitial tissue

question

Can Pyelonephritis be bilateral?

answer

Yes, it can be unilateral or bilateral.

question

What are predisposing factors to Pyelonephritis?

answer

Anatomical abnormalities such as ureterovesical reflux Urinary obstruction Stress incontinence Multiple or recurrent UTIs Renal disease Kidney trauma Pregnancy Metabolic disorders

question

What is the Clinical Presentation of Pyelonephritis?

answer

Sudden onset of: Fever Chills, Shaking, Nausea, Vomiting Unilateral or localized flank pain Fatigue Diarrhea In the ELDERLY the only presenting symptom may be mental status changes.

question

What may you find on the physical exam of a person with pyelonephritis?

answer

CVA Tenderness Marked tenderness on deep abdominal palpation

question

What is the management for patients with pyelonephritis?

answer

Oral antibiotics for mild cases Hospitalization for pregnant patients who are vomiting or dehydrated Treatment course should typically be 7-10 days for mild to moderate cases 14 days for severe 21 days for slow responders

question

After 48 hours of treatment of the patient for pyelonephritis, what steps should be considered?

answer

Reevaluate patient and cultures Renal US IVP DMSA Renal Scan IV antibiotics Increase fluid intake Avoid mechanical insertion of instruments for diagnostic studies

question

What is the follow up treatment for Recurrent Pyelonephritis?

answer

Reculture at 2, 6 and 12 weeks after ABX therapy

question

When do you refer the patient to a nephrologist?

answer

With Chronic pyelonephritis

question

What is the appropriate patient education to prevent pyleonephritis reoccurance

answer

Complete ABX therapy Prevent lower UTI's Increase fluid intake Report recurrence of symptoms immediately Take cranberry supplements and drink cranberry juice

question

What are the three principle triggers for asthma?

answer

Allergens and environmental factors Inhaled substances Food Additives Medications Infections URI's Psychological factors Stress

question

What is basic Asthma Mgmt?

answer

Identify exacerbating causes Daily monitoring of peak expiratory flow Written instructions to manage acute attack Education and follow up

question

If the patient has never been diagnosed with asthma before, should an initial referral be made to a pulmonologist?

answer

An aggressive approach at the initial diagnosis is recommended and a referral would be appropriate.

question

African Americans may have a negative reaction to long term beta agonist therapy alone. Therefore, they should be used in conjunction with an inhaled corticosteroid. T or F

answer

True

question

Intermittent Asthma Therapy Step 1 consists of:

answer

Controller - No daily medications needed Reliever - SABA PRN if less than twice a week

question

Persistent Asthma / Mild Persistent Step 2 consists of:

answer

Controller - Preferred daily Medications consisting of: Low Dose ICS (inhaled corticosteroid) OR LTRA (leukotrene receptor agonist) such as Cromolyn, Nedocromil, theophylline or Zileutin Reliever - SABA - PRN - not to exceed 3 to 4 times daily

question

Moderate Persistent Asthma Step 3 consists of:

answer

Controller - Preferred Daily Medications: Low Dose ICS (inhaled corticosteroid) and LABA OR Medium dose ICS Alternative Daily Medications OR Low Dose ICS (inhaled corticosteroid) PLUS either LTRA (leukotrene receptor agonist), thophylline or Zileutin Reliever - SABA PRN - not to exceed 3 to 4 times daily

question

Severe Persistent Asthma Step 4 consists of:

answer

Controller - Preferred Daily Medications: Medium Dose ICS (inhaled corticosteroid) PLUS LABA OR Medium Dose ICS (inhaled corticosteroid)PLUS either LTRA (leukotrene receptor agonist), thophylline or Zileutin Reliever - SABA PRN - not to exceed 3 to 4 times daily AND Consider short course of oral systemic corticosteroids.

question

Persistent Asthma Step 5 consists of:

answer

Controller - High Dose ICS + LABA and consider omalizumab for patients with allergies Reliever - SABA - Inhaled tx's at 20 minute intervals x 3 if needed Consider short course of oral systemic corticosteroids.

question

Persistent Asthma Step 6 consists of:

answer

Controller - High Dose ICS + LABA + oral systemic corticosteroids Consider Omalizumab for pts who have allergies Reliever - SABA - Inhaled tx's at 20 minute intervals x 3 if needed

question

What do Short Acting Beta 2 Agonists provide the asthma patient?

answer

They are the first line of defense for an acute attack, may be used prophylactically prn before exercise

question

What Short Acting Beta 2 Agonists medications are available?

answer

Albuterol - Ventolin and Proventil MDI 90 mcg/puff : 2 puffs q 4-6 h prn DPI 200 mcg/puff : 2 puffs tid - qid prn 5 min before exercise Nebulizer 5 mg/cc (0.5%) : 1,25 - 5 mg (0.25 - 1 ml) in 2 -3 ml of NS q 4 - 8 hr - may be mixed with Cromolyn

question

What are Blue Bloaters?

answer

Those patients with: Chronic bronchitis pulmonary hypertension Edema cyanosis polycythemia

question

What are Pink Puffers?

answer

Those patients with: Emphysema severe dyspnea Relatively normal ABGs "Barrel chest"

question

What are the common Clinical Presentations of a COPD patient?

answer

AP/lateral chest diameter 1:1 Distant breath sounds End-expiratory wheezes Prolonged exhalation Neck vein distension Pedal and ankle edema Clubbing Fatigue

question

COPD is Classified into how many Stages?

answer

4

question

What is the FEV 1 (%predicted) that represents Stage 1: Mild COPD?

answer

FEV 1 (% predicted) = 80 or greater

question

What are the typical s/s of Stage 1: Mild COPD?

answer

No abnormal signs Cough (+ sputum) Little or no dyspnea

question

What is the FEV 1 (%predicted) that represents Stage 2: Moderate COPD?

answer

FEV 1 (% predicted) = 50 - 79%

question

What are the typical s/s of Stage 2: Moderate COPD?

answer

Breathlessness Cough Variable abnormal signs Hypoxemia may be present

question

What is the FEV 1 (%predicted) that represents Stage 3: Severe COPD?

answer

FEV 1 (% predicted) = 30 - 49%

question

What are the typical s/s of Stage 3: Severe COPD?

answer

Dyspnea with any exertion or rest Wheeze and cough often prominent

question

What is the FEV 1 (%predicted) that represents Stage 4: Very severe COPD?

answer

FEV 1 (% predicted) = < 30%

question

What are the typical s/s of Stage 4: Very Severe COPD?

answer

Lung hyperinflation cyanosis peripheral edema polycythemia in advanced disease Hypoxemia and hypercapnia are common

question

A PFT with a FEV1/FVC ratio < 70% is diagnostic for COPD T or F

answer

True

question

What is the basic Management of COPD?

answer

Is based on COPD Stage: Inhaled beta - 2 agonist bronchodilators Inhaled anticholinergic bronchodilators Corticosteroids Xanthines Antibiotics Diuretics Mucolytics and expectorants

question

For the patient with COPD, what are the Requirements needed for Home 02?

answer

PaO2 of 55 mm Hg or less Oxygen saturation below 85% A PaO2 of 55 to 59 mm Hg if erythrocytosis (HCT of 56% or more), cor pulmonale (P wave more than 3 mm in leads II, III, and aVF), edema, or CHF Goal on 1-2 L/min for 15 hours day is O2 sat. of 90% or PaO2 of 60 mm Hg

question

What is basic education for the COPD patient?

answer

Smoking cessation Yearly influenza shot and every 5 year pneumovax Physical rehabilitation Support groups Teach pursed-lip breathing and O2 therapy Assess for depression and treat if present Discuss advance directives

question

What is Community Acquired Pneumonia?

answer

Acute infection of the lung parenchyma in pt who has acquired the infection in the community

question

Community Acquired Pneumonia is which leading cause of death in the United States. A. 2 nd B. 10 th C. 3 rd D. 6 th

answer

D. CAP is the 6th leading cause of death in the United States

question

What Pathogen is the most common in Community Acquired Pneumonia?

answer

Streptococcus pneumoniae accounts for 70% Followed by Pneumococcal pneumonia at 25 - 35 % Staphylococcus aureus Klebsiella pneumonia Moraxella catarrhalis (less common)

question

What are the classic signs and symptoms of Community Acquired Pneumonia?

answer

egophony -bronchophony -whispered pectoriloquy -bronchial breath sounds -dull percussion Crackles Pleural friction rub

question

What is the "Gold Standard" diagnostic testing for Community Acquired Pneumonia?

answer

Infiltrates on CXR

question

What is the Second most common pathogen for Community Acquired Pneumonia as an atypical pathogen, what is it?

answer

Mycoplasma pneumoniae Other pathogens responsible are: Legionella pneumoniae Chlamydia pneumonia Fungi Oral anaerobes Viruses

question

What is the Subjective Presentation of a patient with Community Acquired Pneumonia?

answer

Fever / Chills Cough - typically productive; purulent or rusty sputum Chest pain (pleuritic, increases with cough or inspiration 30% of cases) Myalgia

question

When treating Community Acquired Pneumonia, what should be considered?

answer

Note whether pt has had recent antibiotics Note whether there are any comorbidities (COPD, CHF) Initially cover for S. pneumoniae plus atypical pathogens (M. pneumoniae or C. pneumoniae) Usually improve in 72h. Resolution is 3d for fever, 6d for dyspnea, 14d cough and fatigue If not improving in 72h, consider nonresponse

question

What are diagnostic procedures to determine Bacterial vs Viral CAP?

answer

CXR Leukocyte Count Sputum Gram Stain

question

What is the Usual Antimicrobial Therapy for Uncomplicated CAP WITHOUT recent ABX therapy?

answer

Azithromycin 500 mg qd or 250 mg qd Clarithromycin (Biaxin) 500 mg bid Erythromycin 250-500 mg q 6 hour Doxycycline 100 mg bid

question

On the CURB-65 Criteria, when would you hospitalize a patient with Community Acquired Pneumonia?

answer

0-1 Low risk: consider OP 2 short IP stay or closely monitor OP >3 hospitalize and consider ICU

question

What is the Usual Antimicrobial Therapy for Uncomplicated CAP WITH recent ABX therapy (within 3 months)? (Use a different class of ABX no chosen previously)

answer

Moxifloxacin (Avelox) gemifloxacin (Factive) Levofloxacin (Levaquin) Azithromycin OR clarithromycin PLUS high-dose amoxicillin Azithromycin OR clarithromycin PLUS high-dose amoxicillin-clavulanate

question

Who is at risk for PVD?

answer

Those over the age of 50 Smokers Diabetics Overweight individuals (especially with hyperinsulism or metabolic syndromes, syndrome X Male gender Sedentary individuals Those with HTN or high cholesterol levels Family history of heart or vascular disease Those with CAD AA individuals

question

Reduced Pulses represent which Stage of PVD?

answer

Stage I

question

Intermittent Claudication represent which Stage of PVD?

answer

Stage II

question

According to Literature, 50% of the vessel may be occluded before symptoms occur. T or F

answer

False = 75%

question

Pain at rest represent which Stage of PVD?

answer

Stage III

question

Ulcers appear in which Stage of PVD?

answer

Stage IV

question

What are the 5 P's of PVD?

answer

PAIN PALLOR PULSELESSNESS PARALYSIS PARESTHESIA 3, 4 and 5 suggest surgical emergency

question

What is Classic Intermittent Claudication?

answer

Lower extremity symptoms confined to the muscles with a consistent (reproducible) onset with exercise and relief with rest.

question

Describe the "Atypical" leg pain in PVD?

answer

Lower extremity symptoms confined to the muscles with a consistent (reproducible) onset with exercise and relief with rest.

question

What is the Clinical Presentation for Asymptomatic PVD?

answer

Asymptomatic: Without obvious symptomatic complaint (but usually with a functional impairment).

question

What are the Inflammatory Blood Markers which can be drawn?

answer

D-Dimer Homocysteine CRP Interleukin 6

question

What are the symptoms of a Deep Vein Thrombus?

answer

Sometimes asymptomatic Swelling in affected extremity-usually unilateral Pain in the calf Leg cramps/tenderness/soreness Erythema Pallor Cyanosis

question

How is PVD diagnosed?

answer

Ankle-Brachial Index Test (ABI) The blood pressure in your arms and ankles is checked using a regular blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in your ankle is compared to the pressure in your arm to determine how well your blood is flowing. The index is determined by dividing ankle systolic BP by arm systolic BP.

question

How is the ABI calculated?

answer

Divide the highest ankle systolic pressure with the highest brachial pressure for the index. AHA ABI INTERPRETATION: >1.3 Noncompressible arteries 1.00-1.29 Normal 0.91-0.99 Borderline (equivocal) 0.41-0.90 Mild-to-moderate PAD 00.00-0.40 Severe PAD

question

Phelbitis occurs in the deep veins only. T or F

answer

F = only in superficial veins

question

What are the Goals in Managing PVD?

answer

Cholesterol and BP management Decrease Blood Viscosity Pentoxifylline, Dipyridamole or Warfarin Antiplatelet Agents ASA, Ticlopidine, Clopidogrel

question

Treatment of PVD is focused on what risk modification?

answer

Cardiovascular risk modifications Tobacco cessation Lifestyle modifications Diet-low cholesterol/low fat diet Medication Exercise training

question

What Percentage of people with a diagnosis of DVT develop a Pulmonary Emboli?

answer

33 to 40 % With a 15 % Mortality Rate

question

What does the Physical Assessment for a DVT consist of?

answer

Vascular assessment- palpation of peripheral pulses Evaluation of capillary refill Neurological exam-motor, sensory, reflex deficits may occur Homan's sign-pain in the posterior calf or knee with forced dorsiflexion of foot

question

What are the Signs and Symptoms of a Pulmonary Emboli?

answer

SOB/DOE HTN Tachypneatachycardia Diaphoresis Hemoptysis Low grade fever Chest pain Cough

question

What it the Gold Standard for DVT diagnosis?

answer

Venography

question

What is the common treatment for DVT?

answer

Anticoagulation Therapy - heparin, Low molecular heparins Arixtra Injections Warfarin (INR 2.0 - 3.0 target range) Thrombolytic therapy Surgical Intervention IVC filter Compression Stockings

question

What is the usual Patient Education / Teaching that is necessary for DVT?

answer

Avoid prolonged immobility Avoid as possible estrogen therapy in women Early ambulation-post surgical Hydration Compression stockings Take meds as directed Avoid tight fitting clothing-hose, stockings Low K diet in pts with Warfarin therapy

question

When obtaining a Hx for possible UTI what are some Questions to ask?

answer

Fever, n/v Pain LMP, type of contraceptive use New sexual partner Vaginal discharge

question

What are the treatment goals for DVT?

answer

PE prevention Resolution of DVT Prevention/reduction of post phelbitic syndrome or reoccurrence

question

What is the Oral Treatment for Acute Uncomplicated UTI?

answer

Bactrim or Septra 1 DS BID x 3 d Ciprofloxacin 250 mg BID x 3 d Amoxicillin 500 mg x 3 d Levofloxacin 250 mg qd x 3 d Nitrofurantoin 100 mg BID x 7 d Ofloxacin 200 mg BID x 3 d

question

Which patients should be considered for prophylactic coverage for recurrent UTI?

answer

2 or more symptomatic UTIs w/in 6 months 3 or > within 12 months

question

After diagnosing recurrent UTI what is the typical management?

answer

Prophylaxis should be initiated after previous UTI resolution is confirmed Daily dosing for 6 months Post-coital prophylaxis Self-medication (3-4 days of therapy when symptoms begin)

question

What is Patient Education for UTI?

answer

Complete the antibiotic regimen Proper hygiene Drink plenty of water (8 - 8oz glasses) Cotton undergarments Empty bladder after sexual intercourse Empty bladder frequently No tub baths or bubble baths.

question

What are the 3 most common disorders causing Chronic Pelvic Pain?

answer

Endometriosis Interstitial Cystitis IBS

question

Interstitial Cystitis is worsened by what?

answer

Intercourse Perimenstral status

question

What is Chronic Pelvic Pain?

answer

"Non-cyclic pain of 6 or more months' duration that is localized to the pelvis and is of sufficient severity to cause functional disability"

question

What is the common clinical presentation for UTI in males?

answer

Dysuria Urgency/ frequency Cloudy urine

question

What is Interstitial Cystitis?

answer

"Chronic inflammatory condition of the bladder clinically characterized by irritable voiding symptoms or urgency and frequency, in the absence of objective evidence of another disease"

question

What is the clinical presentation for Pyelonephritis?

answer

chills, fever flank pain CVA tenderness urinary symptoms may accompany

question

What are typical Bladder Irritants?

answer

cold remedies (Sudafed) chocolate carbonation colas citrus cranberry juice or pills vitamin C certain wines and beers Crystal Light candy and high sugar foods.

question

What are differential Diagnosis questions for a "Cough"?

answer

When did the cough start? When does it occur? What stimulates it and aggravates it? What alleviates the cough? Describe the quality of the cough. Is it productive or nonproductive?

question

Bacterial Infections compose what % of URI's?

answer

25%

question

What are the Principles of Mgmt of Asthma?

answer

Identification of exacerbating factors Daily monitoring of peak expiratory flow Written instructions to manage an acute attack Education and follow-up

question

Tuberculosis is caused by what?

answer

Mycobacterium tuberculosis

question

What are the Three Principle Asthma Triggers?

answer

Allergens and environmental factors Inhaled substances Food Additives Medications Infections URI's Psychological Factors Stress

question

What are the usual signs and symptoms of TB?

answer

Productive cough Purulent yellow sputum Repeated occurrences of coryza-like symptoms with rhinorrhea and nasal congestion Hemoptysis

question

How do you initially test for TB?

answer

TST (0.1 mL) intradermally must produce a wheal Read 72 hours after injection Erythema does not matter, solely the size of the induration Three categories of positive reactions: 5-mm, 10-mm, and 15-mm induration IGRAs

question

What does "induration" mean on a ppd test?

answer

It is the palpable, raised, hardened area or swelling where the test was performed

question

All First Line TB Drugs need to be taken on an empty stomach. T or F

answer

True If unable to comply, take medicine with food that does not contain Fat or Oils

question

Small cell lung cancers are:

answer

Oat cell Intermediate Combined

question

Non-small-cell lung cancers are:

answer

Squamous cell Adenocarcinomas Large cell carcinoma (giant cell)

question

What are the commonly prescribed first line drugs for TB?

answer

Isoniazid - May cause peripheral neuropathy (pyridoxine may be given prophylactically) May be associated with increased risk of seizures in patients with epilepsy May be Hepatoxic Rifampin - May cause thrombocytopenia (pyridoxine may be given prophylactically) Commonly causes rash without itching which resolves during the first few weeks. May elevate bilirubin which usually resolves Pyraxinamide - May cause rash, May be hepatotoxic, Syrup is available in place of pills Ethambutol - Periodic vision screening is required,due to optic toxicity Streptomycin - Use with caution in patients with mild to severe kidney problems. Hearing Screening tests are required due to aminoglycoside related toxicity

question

What are the Subjective Symptoms of Lung Cancer?

answer

Cough Sputum production, hemoptysis Dyspnea, wheezing Chest pain Pleural effusions

question

What are the Objective Signs of Lung Cancer?

answer

Wheezing that does not disappear after coughing Absent or decreased breath sounds Diminished resonance on percussion Decreased or increased tactile fremitus Clubbing Cachexia, weight loss, anemia

question

What is Central Sleep Apnea?

answer

Absent Airflow and Respiratory Effort May be caused by Neurologic Diseases

question

What is Obstructive Sleep Apnea (OSA)?

answer

Tongue and soft palate fall backward

question

What is the Management of Lung Cancer?

answer

Surgical resection Pneumonectomy, lobectomy Chemotherapy Radiation Follow-up

question

Sleep Apnea can be a mix of OSA and CSA. T or F

answer

True

question

What General Measures can be taken for the Medical Management of Sleep Apnea?

answer

Avoidance of alcohol, sedatives, hypnotics Weight loss, O2 therapy, nasal dilators

question

What Specific Measures can be take for Sleep Apnea?

answer

Position Therapy CPAP Oral Appliances

question

What are the 5 A's in Smoking Cessation?

answer

Ask Advise Assess Assist Arrange

question

What are the pharmacological therapies are available for Smoking Cessation?

answer

Bupropion (Wellbutrin) Varenicline

question

What is Bronchiectasis?

answer

Chronic necrotizing infection of the bronchi leading to permanently dilated airways, purulent sputum and hemoptysis.

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