Nurs 623 Test 1

Question Answer
Early stage-localized Lyme disease Days to 1 month after exposure-90% cases will have a rash with non specific fatigue, malaise, h/a, myalgias, arthralgias, cervical stiffness, lymphadenopathy, low-grade fever.
Erythema migrans Rash with a bull's eye appearance and is usually greater than 5 cm in size. Seen in early stage
Early stage-disseminated Days to 10 months after infection. Is without rash & presents with systemic manifestations like carditis which incl lymnphocytic meningitis, cranial nerve palsies & radiculo-
neuritis,
Early stage-disseminated Swelling of the joints, pain weakness or numbness in extremities, reduced ability to concentrate, and occasional palpitations.
Late disease months to years after exposure may have intermittent arthritis (50% respond to ABO tx) arthralgias, monoarthritis, of knee. Pt may experience neurological manifestations like neuro-
borreliosis, encephalop. neurocognitive impairment &
peripheral neurop
59 y/o male c/o a flulike illness, incl fever, chills & myalgia. He reports having a rash or red spot that grew in size on rt leg. What dx are you considering? Lyme disease
The exanthema of Lyme disease is: Erythema migrans
If Lt. untreated, this condition will progress to c/o that incl. multiple joint arthritis. Lyme disease
S/sx of HIV fever, sore throat, myalgia, h/a, cervical lymphadenopathy, and night sweats.
What risk factors play a role in the exposure to the disease sexual history and sexually transmitted disease, substance abuse, transfusion hx (1977-1985), infection hx, occupation hx.
Which statement about HIV postposture prophlaxis (PEP) for health-care workers is the most accurate? PEP should be started within hours of exposure
Which household solution should be used to clean a bathroom if sharing with a friend who has HIV? Nine parts H20 to one part bleach
Reuben, age 24, has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicate? A favorable prognostic trend
Clients with AIDS typically experience the neurological symptomatic triad consisting of: Seizures, depression, and paraethesias
What are the s/sx of different hypersensitivity reactions? Type 1 IgE Mediated immediate hypersensitivity response-true allergic response nose-allergic rhinitis
What are the s/sx of different hypersensitivity reactions? Type 2 Antibody mediated cellular cytotoxicity response may affect a variety of organs and tissues hemolytic anemia, granulocytopenia and thrombocytopenia
What are the s/sx of different hypersensitivity reactions? Type 3 Antibody-allergen immune complex response-delayed drug reactions. Serum sickness-fever, gen. ill feeling, hives, itching, joint px, rash, swollen lymph node. Can affect multiple organs & tissues throughout the body like arteritis, arthritis, & pneumon
What are the s/sx of different hypersensitivity reactions? Type 4 Delayed type cellular hypersensitivity response-contact dermatitis & PPD response, skin-eczema, local induration-wheal and flare response
Normocytic MCV 82-92 (normal sized RBCs), MCH 25-30 (normal color), MCHC 32-36
Microcytic MCV<80 (small RBCs), MCH 20-25, MCHC 27
Macrocytic MCV >96 (large RBCs), MCH 30-50 (dark color), MCHC 32-36
The current goal of tx for a patient with HIV infection is which of the following? Viral suppression of HIV to undetectable levels in the peripheral blood
The most cost-effective screening test for determining HIV status in which of the following? Enzyme-linked immunosorbent assay
An important complication of antiretroviral (ARV) therapy in patients with advanced AIDS is which of the following? Immune reconstitution inflammatory syndrome
Which drug category of ARV therapy is generally effective in crossing the blood-brain barrier and may be useful in managing HIV-associated dementia? Nonnucleoside reverse transcriptase inhibitors.
Eczema acute lesion are often excoriated, maculopapular, and inflamed.
flexural distribution In infancy and early childhood, oozing and crusting usu. the disease can go into remission or change to a flexural (antecubital fossae and neck area).
____ _______ usually lasts until 4-10 years old but continue into adulthood Flexural eczema
Treatment for eczema control s/sx because no cure exists. Decrease pruritis, prevent secondary infection, and educate pts so that they can control the disease themselves. Skin hydration, barrier-restoring thx. Eliminate triggers.
Psoriasis typical c/o is that itchy, red, inflamed and dry scaly plaques that are getting worse, Usu,. gradual onset, and is confined to a couple of areas, Can be explosive onset when linked to infection and lesion occur at site of trauma.
Auspitz sign Occurs when small bleeding areas appear at the areas that have traumatic removal of silvery scales of psoriasis,
Kobner's phenomenon the formation of new plaques at the sites of trauma
Goal of thx for Psoriasis to control the disease so that the pt does not feel physically or psychologically hindered by the lesions.
What is the firs course of action aimed at reducing epidermal proliferation and underlying dermal inflammation? Topical corticosteroids and other immunomodulatory agent and phototherapy
What are some examples of shampoos that can be used for psoriasis on scalp? Topical Tar and anthralin can be used in combination with topical steroids. Zetar, savuton pentrax are a couple of shampoos that can be gently massaged into the scalp
Where should topical steroid use be avoided? In dermal atrophy in facial and intertriginous areas
Phototherapy or exposure to the sun improves ____, but (sunburn ___ the disease). Psoriasis, exacerbate
UVB tx for 4-6 weeks causes remission in 60-90% of cases (especially in those with ______ psoriasis Guttate
PUVA tx photochemotherapy or ______+UVA can achieve 80-90% remission by inhibiting mitosis and stopping ____ replication psoralen, DNA
Severe incapacitating disease like seen with ___, ____, or ___ psoriasis, are tx with systemic thx. pustular, guttate and or arthritic psoriasis
For severe psoriasis, a rheumatologist or dermatologist may use systemic antimitotic agents such as Methotrexate, etretinate, and cyclosporine
_____ worsens/exacerbates psoriasis Stress
What dx is challenging to dx b/c s/sx overlap with other ds, like fibromyalgia, RA, lupus, chronic fatigue syndrome and MS Sjogren's syndrome
What are the s/sx of Sjogren's syndrome? a dry, gritty or burning sensation in the eyes, dry mouth, sore cracked tongue, burning throat, dry lips & nose , dry skin, chg in taste/smell, inc tooth decay, joint px, vaginal dryness, digest. prob., debilitating fatigue
Patients presents with an allergic dermatitis, how would you go about tx if it was localized vs generalized presentation? Acute- Calamine lotion, topical steroids, oatmeal bath (aveeno). Localized weeping lesions-moist compresses and simple drying agents and anti-itch lotions several x/day. ie Calamine. More severe-steroid creams Pred for 10-14 days (ween off)
Know the correct tx modalities for localized cellulitis and abscess formation.
-Cellulitis is a bacterial inf involving the dermis and subcut tissue
-Most cases are caused by _or _.
Group A beta hemolytic Strep or Staph Aureus
Typical lesion that is wide, diffused area that is red, warm and tender to palpate; the area is usually accompanied by severe edema Cellulitis
Tx for localized cellulitis is ___ or ___. For PCN allergy use___ and for dog bite tx with ___ dicloxacillin or Keflex (cephalexin) for 10-14 days. use Erythomycin for PCN allergy and Augmentin for dog bites.
Know the tx modalities for folliculitis: The goal of tx is what?? Once the skin is soften the clinician can open the ____ and trim away necrotic tissue. Then apply ___ ointment. To make the skin inhospitable to pathogens. Wash the skin BID with antibacterial soap. Pustules, polymyxin B, bacitracin, or Bactroban
Systemic abx are not more advantageous over ____ topical tx.
What is a chronic, relapsing disorder of keratin synthesis that is characterized by well-circumcised, raised, erythematous papules and plague. Psoriasis
Psoriasis is covered w silvery-white scaled, usu. involving extensor areas in adults such as the elbows and knees, the scalp, and in some forms, the _____ surfaces of the body. flexural
Other areas are the that psoriasis are found include the intergluteal _____ ; Umbilicus cleft
Intertriginous areas may be involved, but scales are ______ absent
When the micaceous scales (silvery-white scales) are traumatically removed, multiple small bleeding sites appear this is called Auspitz's sign
Another helpful diagnostic feature is the ____ phenomenon, in which intense trauma induces formation of new skin lesions. Kobner's
A collection of pus within the dermis and deeper skin tissues that manifest as painful, tender, fluctuant, and erythematous nodules, frequently surmounted by a pustule and surrounded by a rim a erythematous swelling . Skin abscess
An elevated , superficial lesion, similar to a vesicle but filled with purulent fluid; i.e. acne, impetigo Pustule
A flat circumcised area that is a change in the color of the skin less than 1 cm in diameter. i.e. freckle, flat mole, petechiae Macule
A flat nonpalpable, irregular-shaped macule more than 1 cm in dia. i.e. vitiligo, port-wine stains, Mongolian spots Patch
A irregular-shaped, elevated progressively enlarged scar; grows beyond the boundaries of the wound and caused by excessive collagen formation during healing; generally forms after surgery Keloids
A elevated, firm, circumcised area less than 1 cm in diameter i.e. wart, elevated mole, fibroma, insect bite papule
A small hemorrhagic spot, larger than a petechia, in the skin or mucous membrane forming a nonelevated, rounded or irregular, blue or purplish patch. Ecchymosis
A localized collection of blood, usu clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. Hematoma
A term caregivers use for general s/sx of a viral infection that has no clear cause Acute viral syndrome
S/Sx of Acute viral syndrome Fever, chills, or a rash, runny or stuffy nose, cough, sore throat, or hoarseness, h/a, or px, and pressure around eyes, muscle aches, joint px, SOB, wheezing, Abd px, cramps diarrhea, n/v, or loss of appetite
Tx of viral syndrome Antipyretics, antihistamines, decongestants, and antitussives
A multisystem inflammatory disease of infectious caused by the spirochete Borrelia burgdorferi. It is a tick borne illness. Lyme disease
This tick borne illness is transmitted primarily by the tick Lxodes scapularis
S/Sx of Lyme Disease Flu like illness early on: fever, chills, myalgia, rash or red spot that GREW in size.
Later s/sx of Lyme disease Malaise, fatigue, h/a, neck px, stiffness, generalized px, and can cause arthritis, memory loss, mood changes, peripheral neuropathy if left untreated.
Objective findings of Lyme Disease: Rash is seen in 90% of cases; bulls eye appearing rash that grows in size as it spreads, usually on axilla, groin, and waistband. Fatigue, h/a cervical stiffness, lymphadenopathy, malaise
Treatment for Lyme Disease Doxycycline 100mg BID is usu initial management
An infection transmitted by a louse or tick that is characterized by repeated episodes of fever, caused by several species of bacteria in the borrelia family Relapsing fever
This is transmitted by the ornithodoros tick. Tick-borne relapsing fever (TBRF)
This is transmitted by body lice and is the most common in Asia, Africa, and Central and South America, assoc with Borrelia recurrentis Louse-borne relapsing fever (LBRF)
Which relapsing fever occurs in multiple episodes and each episode may last up to 3 days. But people may not have a fever for up to 2 weeks and then it returns TBRF
Which relapsing fever commonly last 3 to 6 days and is often followed by a single, milder episode of fever. LBRF
Treatment for LBRF is oral single dose of ____, _______ or when contraindicated use ___. tetracycline, doxycycline or erythromycin
Treatment for TBRF is the same as tx for LBRF except the duration is __ to __days 7-10 days
A tick borne disease caused by Rickettsia rickettsii, which is cause of potentially fatal human illness in North and South America. Rocky Mountain Spotted fever
The types transmitted to humans by the bite incl. American dog tick, Rocky Mountain wood tick, and brown dog tick.
What are the first s/sx of Rocky Mountain Spotted fever that usu begins 2-14 days after the bite Fever and headache!
What are the classic signs in a case of RMSF a rash that first appears 2-5 days after onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to incl the trunk and sometimes the palms and soles.
Objective sign of RMSF difficult to dx rely on a thorough hx, rash and fever, low platelet count, low sodium levels, and elevated liver enzymes
Treatment of RMSF doxcycyline 100mg BID x 7 days . 10-14 days more serious cases
What has a typical presentation showing dermatomal pain followed by a rash in the affected area. Shingles
The first clinical presentation or episode involves genital ulceration, genital pain, discharge, and dysuria with ulcerative lesion of vulva, perineum, buttocks, cervix or vagina. Herpes Simplex Virus
Usually presents with a classic facial yellowish to golden crusting in a well individual. lesions can be pruritic, but usu non painful. Highly contagious Impetigo
This condition is a result of an acute infection from the Epstein-Barr virus (EBV) or less commonly cytomegalovirus (CMV). Infectious Mononucleosis
What is the most common mode of transmission of Mono saliva, AKA kissing disease.
What testing is done to diag Mono? First lab test should be ___, then a heterophile antibody test or _____. CBC, Monospost
Other test should incl ___ ___ ___(RPR) which can be positive in syphilis & Mono, throat cultures, serum liver, transaminase and serum bilirubin Rapid plasma reagin
What is the mainstay of treatment for Mono Symptom control with support rest recovery hydration NSAIDs gargling salt h20 throat lozenges APAP & if lymphadenopathy use Prednisone 40 daily followed by tapering, decr viral shedding but not s/sx duration
What is the causative org in shingles? Herpes Zoster Virus
What is the risk for outbreak In elderly, immunodeficiency, hx chicken pox, and stress can exacerbate outbreak.
What is the tx for shingles? Acyclovir, clean dressings, NSAIDs or gabapentin for pain and post herpetic neuralgia.
What is the acute presentation of leukemia? bone and joint px, gingival bleeding, fevers, chills bruise easily.
What is the chronic s/sx with leukemia? fatigue, night sweats, low-grade fevers, splenomegaly
Acute leukemia come from the most immature cells such as? Erythroblasts, megablast, monoblasts, myeloblasts, T lymphoblasts, and B lympoblasts
Which leukemia is most common in children 2-15 y/o , rarely in adults. ALL Acute Lymphoblastic Leukemia
Which leukemia has onset over the age of 60, & is most common leukemia in developed Western Countries. Have familial predisposition Chronic lymphocytic leukemia (CLL)
Which leukemia has onset in all ages but more common in pt >60 y/o and median age 42. More mature cells. Chronic myelocyctic or myelogenous leukemia (CML)
With CML gene sits on chromosome 22 called the ____gene is shuffled and sits next to Chromosome 9 called ___ of the ___ gene BCR gene, ABL of the ABL gene
What are the s/sx of CML in chronic phase? 1. 90% of pt are asymptomatic, abd fullness, fever r/t liver and spleen enlargement and increased WBC
What are the s/sx of CML in accelerated phase? More rapidly making defected cells can have bleeding, petechiae, ecchymosis, fever, opportunistic infection.
What are the s/sx of CML in blast phase? rapid immature cell production bone px, fever, C BC will show elevated WBC 50-200, 000, leukocytosis on blood smear
What is the tx for CML? Hydroxyurea, Interferron and Imatirub, prevent BRC and ABL production. 90% of pt are alive in 5 yrs.
What are the characteristics of CLL? these are the B cells bet immature and mature cell. Appearance is similar to mature B cell.
Weaker more fragile cell than the mature B cell and placing them can cause rupture, this is called? Where are these cells located? smudge cell. They are located in the lymph node, liver, and spleen and is the reason for enlargement of these organs
What is an autosomal recessive disorder that is inherited form of anemia where there aren't enough RBC to carry adequate oxygen throughout your body? Sickle Cell Anemia
What is a painful episode that occurs in people with this type of anemia? What causes it? Sickle cell crisis, it is caused when a sickle-shaped red blood cell (RBCs) block blood vessels.
A sickle cell crisis can also damage your tissues and cause organ failure, such as ___ and ___ failure liver and kidney
What are the s/sx of sickle cell and characteristics of px? Pain when a sickle cell crisis is evident occurs in the back, chest, abd, and extremities. May last for hours or days. Nause, anorexia, light headedness, anxiety or panic, heart palpitations and SOB
What are the objective s/sx of sickle cell? LGT, point tenderness and guarding, pinpoint pupils, inability to follow commands, tachycardia, systolic murmur, tachypnea, non palpable spleen
What is the tx of sickle cell? Folic acid supplement 1mg/day po, diet rich in complex B vit and Vit C, opioids for px, oxygen to prevent acidosis
What is the key to reversing sickle cell crisis? Significant rehydration!
What is the term used to describe the amount of HIV in your blood? Viral load
The more HIV there is in your blood (and therefore the higher your viral load) then the faster your ____ cell count will fall, and the greater risk of becoming ill CD4 cell count
What is the diagnostic cut off for determination of AIDS? <200 CD4 or an opportunistic infection or other AIDS defining illness, the person with HIV has progressed to AIDS. HIV drug resistance testing is completed.q
What is ringworm of the body? Tinea corporis
What is jock itch or ringworm of the groin? Tinea cruris
What is the development of discolored patches of skin which may be lighter or darker than surrounding skin? Tinea versicolor-pityriasis versicolor
What is ringworm of the scalp? Tinea capitis
What is athlete's foot? Tinea pedis
What is tinea of the hands? Tinea manuum
Most cases of tinea respond well to 2-4 weeks course of topical tx with ____ class drugs. For pt on systemic antifungals, physician consultation is recommended because systemically absorbed antifungals can cause ____ azole, hepatotoxicity
What is a skin disorder characterized by large blisters on the arms, legs, or middle of the body and in some the mouth or genitals? Bullous pemphigoid
These blisters develop on areas of skin that often ____, such as the lower abd, upper thighs or armpits & occurs when your ___ system attacks a thin layer below your outer layer of skin flex, immune
What are the s/sx of bullous pemphigoid? large blisters with clear fluid, may contain some blood, skin surrounding may be reddish or darker than usu,, may have eczema or hive-like appearance rather than blisters in some pt. can be very itchy
What is the primary feature of bullous pemphigoid? the appearance of large blisters that don't easily rupture when touched. More common in elderly
What is the tx for bullous pemphigoid? systemic corticosteroids and should be initiated as soon as skin biopsies and blood draws have been performed.
What ABX may be added to corticosteroids? Tetracyclines+niacinamide added. Also may added high potency topical corticosteroids
What are the characteristic s/sx with Sjorgren's Syndrome? Pt breath smells d/t dental caries and mucosal dryness, nose and throat beds are pale & may have sm fissures with beefy red tongue, and may be similar at vagina and anus. Dry gritty eyes, xerostomia caused by cessation of salivary secretions.
What are the key six characteristics of Sjorgren's? decreased tear production (Schirmer test), corneal damage, decreased saliva, labial gland bx,, autoantibodies
What is the management approach for Sjorgren's? Saline eye drops, hard candies and gum and mouth spray.
What condition has the characteristic finding with a bilateral macular rash( often shaped like a butterfly) across the cheeks and nose. System Lupus Erythematous (SLE)
What is the main goal of SLE? Symptom control, emotional support, Vit D level need to be checked r/t risk of osteoporosis, w calcium supplements.
What is used to tx SLE? Hydroxychloroquine, corticosteroids, and dehyroepiandrosterone. NSAIDS
What is the new drug used to SLE that has been shown to decrease disease activity, reduce flares and improve autoantibody-positive lupus? Benlysta
What other medications are used to treat SLE? Cellcept, Imuran, Methotrexate, and Cytoxan
What condition is the most common cause of generalized musculoskeletal pain in women aged 20-55? Fibromyalgia
What are the s/sx of fibromyalgia? Post -exercise malaise, fatigue, multiple joint px, h/a, imp memory and concentration, depressed mood, cognitive did, sore throat, restless sleep, myalgias.
For dx, pt must have widespread muscular px that is present for at least ___ months, and present in ___ of 18 trigger points on digital exam 3 months, and 11 of 18
What is the tx for fibromyalgia? Cont low impact exercise, Cognitive behavioral therapy, low dose Tricyclics and SSRIs (maybe)
The key physical findings of RA are ___ ___ polyarthritis and ___ stiffness, which typically lasts longer than 1 hr. peripheral symmetric, morning stiffness
What is the goal of tx with RA? reduce px and inflammation, early management PT/OT, heat, & cold, exercise, rest assistive devices, splints, meds, and wt loss
What condition is prevalent in middle age older adults, women more often than men, with bilat px shoulder, hips, & thighs worse in the morning. Polymyalgia rheaumatica
What diagnostic lab findings will be present with polymyalgia rheumatic? Increased sed rate, CRP, and normocytic anemia
What is the treatment for polymyalgia rheumatic? corticosteroids
What is the type of anemia where RBCs are destroyed and removed from the bloodstream before their normal lifespan is over? Hemolytic anemia
What lab tests are used to dx hemolytic anemia? CBC- increased RDW- which is a measure of anisocytosis that can occur in hemolytic anemia & thrombocytopenia, is noted with increased reticulocyte count. Peripheral bld smear, & serum lactate dehydrogenase (LDH), which is a criterion for hemolysis.
What other tests are used to dx hemolytic anemia? Serum haptoglobin-low which is a criterion for mod to sever hemolysis, and indirect bilirubin- usu <3mg/dL.
Low mean corpuscular volume (MCV) <80
Normal MCV 80-96
High MCV >96
Which anemia is small size RBCs <80fl; and causes Fe def, anemia of chronic ds (ACD), thalassemia, Sideroblastic anemia. Microcytic anemia
What are s/sx of microcytic anemia? tachycardia, palpitations, fatigue, ESOB, dyspnea, dizziness, pale mucus membranes, sallow-colored skin.
What is the management of microcytic anemia? FE def? ACD? Thalassemia? Sideroblastic? tx and eradicate the cause, transfuse if HCT < 27%, Fe def- increase dietary iron and/or sup, ACD-transfuse or growth factors to stim erythropoiesis, and Thalassemia-transfuse/folate sup with FE chelation, Sideroblastic-transfuse/VitB6
What conditions do you see Normocytic anemia? Anemia Chronic Disease, Acute blood loss, hemolysis, volume overload, (pregnancy and parenteral over hydration).
What is the management of Normocytic anemia? The first priority with Normocytic anemia is symptomatic tx. Correct anemia and stabilize underlying cause. (Erythropoietin-alpha, prednisone for AIHA, early delivery for pregnant mothers w HELLP, DIC-heparin (for thrombus), platelets, and FFP).
What conditions do you see with Macrocytic anemia? Vit B12 def (pernicious anemia), Folate def, antimetabolite drugs (ex. methotrexate), chronic alcoholism, liver disease
What is the tx for relapsing polychondritis? Tx of relapsing polychondritis usu involves admin of corticosteroid drugs (e.g. Prednisone), ASA, and NSAIDs like dapsone and/or colchicine.
What to do prior to tx of relapsing polychondritis? Careful cardiac auscultation and electrocardiography. Consideration given to do echocardiography to r/o aortic or mitral valve thickening or regurgitation to r/o valve ds, CXR and baseline pulmonary func test, and CT scanning to r/o airway stenosis
What are the major second-line drugs in RPC with Dapsone and Prednisone the first approach? cyclophosphamide, azathioprine, cyclosporine, methylprednisolone, and methotrexate.
A pt has an anaphylactic reaction, know the med dose, and delivery method of the medication to the patient EPI!, Step 1 admin aqueous epi 1:1000 dilution 0.3-0.5mg (0.3-0.5ml) IM into upper lat thigh in supine with head below heart level if possible. Step 2 : repeat epi every 5-15 mins, If hypotensive, position supine with feet elevated.
What is the approach for bronchodilation support if without laryngospasm? Albuterol 3ml (2.5mg) inhalation via nebulizer. Goes into more detail about IVF and intubation, but as primary care providers we shouldn't have to do that? Intubation IVF, then benadryl
Know first line thx for abscess formation, Lyme ds in terms of ABX of choice and what organism you are targeting? Doxycycline 100mg po BID up to 14 days for tx of lyme ds with targeting Borrelia
Which of the following is recommended tx for erythema migrans or early Lyme disease? Doxycycline 100 mg po BID x 21 days. Can do azithromycin 7-10 days & Amox or Cefuroxime 14-21 days,
Be able to ID seborrheic dermatitis and what tx modalities available for that Skin flakes on your scalp, hair, eyebrows, beard or mustache, patches of greasy skin covered with flaky white or yellow scales