Practice Review Questions – Flashcards

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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
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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
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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
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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
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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).
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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.
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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
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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
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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
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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
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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
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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
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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.
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The first sign of an asthma exacerbation is: Cough Wheeze Dyspnea Chest tightness
answer
Cough
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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
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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
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All of the following are useful in treating patients with COPD except: Antihistamines Anticholinergics Oral steroids Short-acting beta2-agonists
answer
Antihistamines
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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
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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
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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.
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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
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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.
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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).
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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
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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
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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).
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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.
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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
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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.
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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.
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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
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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
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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
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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
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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.
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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
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a. Stage 1 mild COPD
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Most nosocomial pneumonias are caused by: a. Fungi. b. Viruses c. Gram-negative bacteria. d. Pneumococcal pneumonia.
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c. Gram-negative bacteria.
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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.
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Which obstructive lung disease is classified as reversible? a. Asthma b. Chronic bronchitis c. Emphysema d. COPD
answer
a. Asthma
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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."
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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.
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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.
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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?"
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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."
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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
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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
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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
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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
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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
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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
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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
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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
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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
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d. All of the above
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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
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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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