Updated FNP1 Midterm Exam


Antifungal classes

triazoles, imidazoles
Oral: Always in tinea capitus, caution in renal /hepatic impairment.
do NOT use ketoconazole

Cellulitis in foot

-look between each toe, can often have tinea pedis as well as cellulitis and will treat fungal and bacterial.

Antibiotic Classes


How to take blood pressure

-Feet flat on ground
-Seated quietly for 5 minutes with back supported
-Arm at level of heart
-Appropriate size blood pressure cuff
-Baseline BP established (give arm 1 min rest then inflate 20 mmHG above that)
-Deflate cuff 2mmHG/second
-Take readings 2-

Accurate BP cuff

Width of cuff = 80% of arm and cover 2/3 length of arm.


JNC: > 140/90 & > 150/90
ACC/AHA: 130-139/80-89 & > 140/90

Hypertension urgency vs. emergency

Urgency: severely elevated blood pressure (180 mm Hg or more systolic, o 110mm Hg or more diastolic)
without acute target organ injury
. Patients may still c/o headache, lightheadedness, nausea, SOB, palpitations, epistaxis, or anxiety
Emergency: severe b

How to determine which patient needs to go to the ER vs. outpatient - HTN urgency vs emergency

Can be outpatient if you
CAN rule out acute organ injury
, if you
rule out or suspect acute organ injury, the patient needs to be hospitalized / emergency.

Influenza vaccine - which vaccine is recommended

No live virus vaccine for pregnant women.

How often should you get the influenza vaccine

influenza vaccination for all individuals ?6 months of age who do not have contraindications.

Patient education with influenza vaccine

-Vaccination can cause redness, mild swelling, or soreness where you got the shot (if you got a shot), a mild fever, mild rash, headache or body aches

Pneumonia vaccine (when to get PCV23 vs PSV13)

Patients greater than or equal to age 65 get 1 dose PCV23
Age 19 to 64 with chronic medical conditions (heart, lung, liver, diabetes, alcoholism, and smoking) receive 1 dose PCV23
Revaccination recommended
q5-10 years
for the at risk population listed abo

Benign vs pathologic murmurs

B:Characteristics include a systolic (rather than diastolic) murmur; soft sound; short duration; musical or low pitch; varying intensity with phases of respiration and posture (louder in supine position); and murmurs that become louder with exercise, anxi

The Seven S's: Key Features of Innocent Murmurs

Sensitive (changes with child's position or with respiration)
Short duration (not holosystolic)
Single (no associated clicks or gallops)
Small (murmur limited to a small area and nonradiating)
Soft (low amplitude)
Sweet (not harsh sounding)
Systolic (occu

When to refer murmur to cardiology

Abnormal physical exam findings / patient presentation, symptomatic patient; a history that is positive for features that increase the risk of structural heart disease; and characteristic auscultatory features of a non-innocent heart murmur

Community acquired pneumonia (presentation, etiology / bacteria, treatment)

Bacteria: Streptococcus pneumoniae (most common)
S/S: fever, cough, shortness of breath, dyspnea, and pleuritic chest pain, tachypnea, increased work of breathing, and adventitious breath sounds, including rales/crackles and rhonchi, chills, fatigue, mala

Atypical / Mycoplasma pneumonia (presentation, etiology / bacteria, treatment)

Etiology: mild nature & intrinsic
resistance of M. pneumoniae to penicillins
. Typically community acquired and mild.
Mycoplasma pneumoniae
S/S: Illness onset is gradual; headache, malaise, low-grade fever, and sometimes sore throat. Cough typic

First / second line treatment for constipation

1st -
increase fluid & fiber (25-30g daily) intake
/ diet modifications
2nd - bulk-forming laxatives such as psyllium or methylcellulose

BPH treatment plan

Lifestye changes:
voiding in the sitting position (rather than standing), avoiding fluids prior to bedtime or before going out, Reducing consumption of mild diuretics such as caffeine and alcohol, Double voiding to empty the bladder more completely

Chlamydia presentation / treatment (male & female)

Male: often asymptomatic, or urethritis - mucoid or watery urethral discharge, and dysuria is often a prominent complaint
Female: mostly
, but if symptoms - urinary frequency and dysuria, change in vaginal DC.
Tx: Azithromycin 1 G PO

Gonorrhea presentation / treatment (male & female)

Male: discharge that is purulent or mucopurulent in color, and copious in amount
Female: asymptomatic at times, or vaginal pruritus and/or a mucopurulent discharge. Some women may complain of intermenstrual bleeding or menorrhagia
Tx: Azithromycin 1 G PO

HPV presentation / treatment (male & female)

Male & Female: genital warts
Tx: wart removal; TCA/BCA, Podophyllotoxin (podofilox) and podophyllum resincryo, cryo, laser

Herpes presentation / treatment (male & female)

Male & Female:
painful genital ulcers / lesions
, dysuria, fever, tender local inguinal lymphadenopathy, and headache, dysuria, pruritus
Tx: Acyclovir & Valacyclovir

Different types of alopecia

Nonscarring (Areata): clinical signs of inflammation are usually mild or absent and destruction of the hair follicle does not occur.
Scarring (Cicatricial): inflammatory disorders of the scalp that lead to
permanent hair loss

Hair Pull test interpretation

Identifies active hair loss and should be performed on every patient who presents with a complaint of hair loss.
50 to 60 hair fibers are grasped close to the skin surface and tugged from the proximal to the distal end.
The easy extraction of more than si

Alopecia Tx based on underlying causes

Alopecia areata (nonscarring):-Patchy: Intralesional and topical corticosteroid-Extensive loss: Topical immunotherapy then systemic glucocorticoids

UTI diagnostics / patient education

UA - + Nitrite, Leukocytes, and/or blood most commonly
-Urine dipstick is most minimal diagnostic
Urine culture is definitive diagnostic test
Test of cure urine cultures should be collected on men.

Interpreting UA

Nitrates turn to nitrites in the presence of Gram-negative bacteria (e.g. E. Coli)
-Leukocytes (WBC) seen in infection.
-Blood in urine, have urine rechecked to ensure hematuria has gone away with infection.

RUQ anatomy

Biliary: cholecystitis, cholelethiasis, cholangitis
Colonic: colitis, diverticulitis,
Hepatic: abscess, hepatitis, mass
Pulmonary: pneumonia, embolus
Renal: nephrolithiasis, pylenophritis
Liver, stomach, gallbladder, duodenum, right kidney, pancreas, an

LUQ anatomy

Cardiac: angina, MI, pericarditis
Gastric: esophagitis, gastritis, peptic ulcer
Pancreatic: mass, pancreatitis
Renal: nephrolithiasis, pyleo
Vascular: aortic dissection, mesenteric ischemia
Liver, stomach, pancreas, left kidney, spleen, and the left adr

RLQ anatomy

Colonic: appendicitis, colitis, diverticulitis, IBD/IBS
Gynecologic: ectopic pregnancy, fibroids, ovarian mass, torsion, PID
Renal: nephrolithiasis, pyleo
appendix, reproductive organs, right ureter.

LLQ anatomy

Colonic: appendicitis, colitis, diverticulitis, IBD/IBS
Gynecologic: ectopic pregnancy, fibroids, ovarian mass, torsion, PID
Renal: nephrolithiasis, pyleo
left ureter, reproductive organs

Suprapubic pain causes

Colonic: appendicitis, colitis, diverticulitis, IBD/IBS
Gynecologic: ectopic pregnancy, fibroids, ovarian mass, torsion, PID
Renal: nephrolithiasis, pyleo, cystitis

Pleural effusion causes

pleural infection, heart failure, and malignancy are the most common.
-CHF, pneumonia

Cardiac (chest pain) emergency in clinic.. First steps..

Rule out something more serious
-Should have a CXRAY and EKG.
-Thorough history & PE

GERD lifestyle changes

weight loss and elevation of the head end of the bed
-& selective elimination of dietary triggers

Influenza treatment

1. Neuraminidase inhibitors; e.g.
zanamivir, oseltamivir, and peramivir
(active against A&B)
-shortens the duration of symptoms by approximately one half to three days
-best if given within 24 to 30 hours and in patients with fever at presentation

Red eye: benign vs. red flag presentations

Change in vision, photophobia, severe pain, abnormal extraocular movements, altered cranial nerve exam.

Red flag diagnoses w/ immediate ophthalmology referral

Acute angle closure glaucoma, orbital cellulitis, Open globe injury

What is the difference between a hordeolum, chalazion, and blepharitis?

H: painful, erythema, and edema to eyelid
C: "painless" lump on eyelidBoth treated with warm compresses and lid scrubs.
B: Only one recommended to use antibiotic on eyelid margins.

Scabies (PICTURE, how to treat, patient education)

Treatment: Put on
5% Permethrin cream at night before bed from neck down and wash off in the morning. Repeat in one week.
Can also treat with antihistamine for pruritus.
Patient education: Wash everything on hot, dry everything on hot. Clean EVERYTHING. V

Pityriasis Rosea

Etiology: Assumed to be viral (can have predomes)
S/S: the eruption begins with a "herald" or "mother" patch, a single round or oval, sharply delimited, pink or salmon-colored lesion on the chest, neck, or back usually 2 to 5 cm in diameter.
A few days or

Contact dermatitis (PICTURE, how to treat, etiology, patient education)

-inflammation of the skin resulting in redness, itching, and/or scale
-Common causes: poison ivy, oak, and sumac, nickel, fragrances, latex, soap and cleansers, resins, and acrylics, topical meds, rubber. People with other skin conditions, dry skin, and l

How do you explain to the patient what scabies is and how they got it?

-It is an infestation of the skin by the mite Sarcoptes scabiei. Transmission of scabies usually occurs through direct and prolonged skin-to-skin contact, as may occur among family members or sexual partners.

Cellulitis (PICTURE, how to treat, etiology, patient education)

CM: Superficial localized swelling, erythema, pain, and warmth to the area involved and frequently produce pus.

Stress incontinence

Patho: Overall: intra-abd pressure increase -> transmitted to bladder -> overcomes sphincteric and urethral pressure causing leaking of urine
Ex: coughing increases pressure
young woman
after delivering a baby
Lifestyle changes: Kegel exercises, vagin

Intrinsic sphincter deficiency

open bladder neck
at rest
-type of stress incontinence

Anatomic stress urinary incontinence

Bladder neck
isn't able to hold pressure, hypermobility of bladder neck

Urge incontinence

Detrusor muscle instability (bladder wall muscle)
during bladder filling (idiopathic or neurogenic)
-more common in
elderly female
patient (possible uterine prolapse)
Treatment: Bladder training
First line: (antimuscarinics): oxybutynin

Different types if incontinence

Stress, urge, mixed, overflow, functional or transient

What different types of tinea exist

Capitis (head or scalp)
Corporis (body)
Manuus (hand)
Pedis (athlete's foot)
Cruris (jock itch / groin)
Unguium (nail) aka onychomycosis

Peritonsillar abscess (PTA) presentation

Severe sore throat
(usually unilateral), fever, and a "hot potato" or muffled voice.
Pooling of saliva or drooling
may be present.
, Neck swelling and pain, may have ipsilateral ear pain. Fatigue, irritability, and decreased oral intake may o

Measles (rubeola) presentation

fever, myalgias, cough, coryza, and conjunctivitis.
Koplik spots predates exanthem by 1-2 days and lasts 2-4 days
Exanthem: onset 2-4 days after fever; erythematous,
maculopapular blanching rash
. Initially in the hairline, forehead and behind

Varicella presentation (chickenpox)

S/S: Symptoms generally develop within 15 days after the exposure and typically include a prodrome of fever, malaise, or pharyngitis, loss of appetite, followed by the development of a generalized vesicular rash, usually within 24 hours.
-Lesions in diffe

Mononucleosis (mono) presentation

-Epstein-Barr virus (EBV)
fever, pharyngitis, adenopathy, fatigue, and atypical lymphocytosis
. Fatigue may be persistent and severe for months. A history of sore throat is often accompanied by pharyngeal inflammation and tonsillar exudates

Bacterial Pharyngitis presentation

Sore throat that worsens when swallowing. Neck pain or swelling due to regional lymphadenopathy. Fever, headache, fatigue, and malaise are variably present.

Green Peak flow zone

(80 to 100 percent of personal best)
signals "all clear." When readings are within this range and symptoms are not present, the patient is advised to adhere to his or her regular maintenance regimen.
Tx: Daily control meds
Ex: inhaled glucocorticoid and L

Yellow Peak flow zone

(50 to 80 percent of personal best)
signals "caution," since the airways are somewhat obstructed. The patient should implement the treatment plan decided upon with the clinician to reverse airway narrowing and regain control
Tx: SABA as needed for relief

Red Peak flow zone

(below 50 percent of personal best)
signals "medical alert." Bronchodilator therapy should be started immediately, and the clinician should be contacted if PEF measures do not return immediately to the yellow or green zones. To ED if no improvement.
Tx: o

Benign vs. precancerous skin lesions (moles)

Benign moles rarely up to 1 mm, cancerous often > 1 mm

Odd behaviors of skin lesions (determine if precancerous)

pruritus, tenderness, growing or changing.

ABCDE of moles

Asymmetry (one half of the mole doesn't match the other)
Border irregularity
Color that is not uniform
Diameter greater than 6 mm (about the size of a pencil eraser)
Evolving size, shape or color

Primary prevention examples

-Goal is to prevent a disease from ever occurring and its target population is healthy individuals.
immunizations, healthy diet, exercise

Secondary prevention examples

-Emphasizes early disease detection, and its target is a healthy appearing individual with subclinical forms of the disease.
blood pressure screenings, etc.

tertiary prevention examples

-targets both the clinical and outcome stages of a disease. Aims to reduce the effects of the disease once established in an individual
treatment of disease
HTN medication management

First line treatment for allergic rhinosinitus (drug class / name)

S/S: sneezing, rhinorrhea and nasal obstruction, as well as pruritus of the nose and palate. Postnasal drip, cough, irritability, and fatigue, itching, watery eyes.
Treatment: avoidance of known allergens & intranasal corticosteroids should be first-line

Risk factors for antibiotic resistance or poor outcome include:

-Living in geographic regions with rates of penicillin-nonsusceptible Streptococcus pneumoniae exceeding 10%
-Age ?65 years
-Hospitalization in the last five days
-Antibiotic use in the previous month
-Multiple comorbidities (eg, diabete

Gold standard for diagnosis of pneumonia

chest x-ray

Gold standard for diagnosis of asthma

-Done before & after bronchodilation
-Initial Results: FEV1/FVC
<80% of predicted
FEV1 after bronchodilator should show at least 200mL or 12% improvement

Gold standard for diagnosis of bronchitis

-usually diagnosed by PE alone, rule out pneumonia first (no consolidation in lung fields)


This is a pulmonary function test that is used to measure airflow (how much air you exhale and how quickly you exhale it)

Gold standard for diagnosis of COPD

<0.70 post bronchodilator

Generalized abdominal pain differential diagnosis

-rule out vascular / surgical / cardiac first and then move on to less serious GI causes.

Hepatitis A (how it spreads)

-fecal-oral route (either via person-to-person contact or consumption of contaminated food or water).

Hepatitis B (how it spreads)

-blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected.
E.g. Mother-to-child transmission, unprotected sexual intercourse and injection drug use in adults.

Hepatitis C (how it spreads)

-blood from an infected person
Injection drug use is the most important risk factor
, blood transfusion, sex with IV drug user

AAA (what do you do within the exam room and POC diagnostics available?)

-abdominal ultrasound and computed tomography (CT) of the abdomen are the most useful.
-PE: pulsatile abdominal mass,
-AAA <5.5 cm in diameter should be managed conservatively with surveillance

Chest pain characteristics that would concern you of a cardiac issue

-Positional - pain that improves with sitting up suggests
-Ripping/tearing - concern for aortic dissection
-Ischemic pain is often
diffuse and difficult to localize
-Chest pain
increases probably due to MI
-Ischemic pain is often

Candidiasis presentation

CM: pink or red moist patches bordered by a thin fringe of scale. Can cause pruritus.
Topical antifungals first and then oral antifungals
. Vaginal - Fluconazole 150mg

Herpes presentation

CM: Multiple painful, grouped, round, red vesicles that occur at site of infection. May also have fever, tender local lymphadenopathy, dysuria, vaginal discharge (female).
Diagnostics: thorough PE,
viral cultures
(90% sensitivity), polymerase chain reacti

Amylase / Lipase

-common tests obtained as
biochemical markers for acute pancreatitis.
-Elevated results due to increase in pancreatic or extrapancreatic production or a decrease in clearance.
Pancreatitis S/S: persistent, severe, epigastric pain with tenderness on palpat

C-Reactive Protein (CRP)

-Elevations occur in association with acute and chronic
-Elevated levels of CRP are strongly associated with infection & inflammation.

Erythrocyte sedimentation rate (ESR)

-increased in patients with active inflammation, marked elevations are more often due to infection.

Brain natriuretic peptide (BNP)

-Useful as a component of the evaluation of suspected heart failure (HF) when the diagnosis is uncertain.
-elevated in patients with renal failure, HF, CKD
-decreased in obesity

Serum albumin

-reflect the condition of the liver, most important plasma protein
-order for suspected liver or kidney disease
-Low levels - malnutrition, liver disease, inflammatory disease.
-Elevated - cute infections, burns, and stress from surgery or a heart attack,

Stages of heart failure

Stage A:
At risk for HF
without structural or functional abnormalities;
no signs or symptoms
Stage B:
with structural heart disease that is strongly associated with the development of HF but
without signs or symptoms
(cardiomyopathy, amyloidosis, cardiac

Etiology of ED

-Low intracavernosal nitric oxide synthase levels found in cigarette smokers and patients with diabetes
-Testosterone deficiency
-Age, decreased libido, health status

CHADS2 risk score - what is the pneumonic

C: Congestive Heart Failure
H: Hypertension
A: Age >75 years
D: Diabetes
S: Stroke / TIA / TE
Maximum score 6,
risk score used in A. Fib for predicting risk of stroke

A. Fib - treatment / patient education

most common cardiac arrhythmia in clinic
Risk factors: CAD, HTN, heart failure, valvular disease, diabetes, thyroid, COPD, sleep apnea, advanced age, heavy alcohol intake.
CM: fatigue, palpitations, chest pain, syncope.
seen on EKG
Diagnostics: CBC, CMP,

How to diagnose a swallowing DO

barium contrast esophagram (barium swallow) as the initial test
-upper endoscopy

How to diagnose nephrotic syndrome

protein excretion > 3.5g/24hrs, peripheral edema, & hypoalbuminemia.
Diagnostics: UA w/ microscopy to look for proteinuria, urine protein-to-creatinine ratio (spot urine at first, then 24 hour collection)
, CMP (BUN, creatinine, albumin, GFR), Lipid p

How to diagnose AKI

-CMP - acutely elevated serum creatinine, high serum potassium, metabolic acidosis
-20:1 serum BUN to creatinine ratio (prerenal azotemia)
-CBC with diff - anemia, leukocytosis, thrombocytopenia
-UA - RBCs, WBCs, cellular casts, proteinuria, bacteria, pos

How to diagnose CKI

-Elevated serum creatinine
-Estimated GFR (<60)
-First morning or random urine sample (urine microalbuminuria)
-UA - hematuria and/or proteinuria
-HgbA1C - need to treat DM aggressively
-Lipid profile - risk factor for worsening disease.
-CBC with di

Shingles (Herpes zoster) Overview

a dermatologic eruption caused by reactivation of the VZV.
A prodrome of pain or dysesthesia (tingling/pain)
usually precedes by several days
CM: pain, erythematous, maculopapular rash in a unilateral, dermatomal distribution and
does not cross midline

Common etiologies of prostatitis or epididymitis (young vs. older males)

Young: STIs
Older: E. Coli, BPH

Atopic dermatitis presentation

Dry skin and severe pruritus are the cardinal signs.
Pruritic, erythematous, dry patches of skin, often with cale and linear excoriations, borders not well defined, crusting and oozing common. Thickened skin and lichenification may develop.

Atopic dermatitis diagnostics

-clinical, based upon history, morphology and distribution of skin lesions, and associated clinical signs

Atopic dermatitis treatment

Multipronged approach that involves the elimination of exacerbating factors, restoration of the skin barrier function and hydration, patient education, and pharmacologic treatment of skin inflammation.
Topically applied corticosteroids and emollients are

Common pathogens that cause bacterial skin infections

Most likely to be staph aureus
, less likely to be strep or MRSA.


Use topical first for skin (ointment more potent than cream, covering <20% of body).
Oral - taper off over two weeks
due to length of time on meds.
Adrenal crisis if stopped abruptly. No NSAIDS. Take in the morning. Warn of "roid rage

Topical corticosteroid options (least potent to superpotent) for atopic dermatitis

Least: Desonide 0.05%, hydrocortisone 2.5%, Betamethasone
Moderate: Fluocinolone 0.025%, triamcinolone 0.1%, betamethasone dipropionate 0.05%
Superpotent: Betamethasone dipropionate, augmented,Clobetasol propionate, Fluocinonide, Flurandrenolide, Halobeta

Risk factors for PUD

H. pylori, NSAIDs, smoking, stress, alcohol

Pathophysiology of atopic dermatitis

Poorly understood. IgE sensitization and/or a primary defect in the epithelial barrier.

Pityriasis rosea (presentation, diagnostics, treatment)

Prodrome: Headache, malaise, pharyngitis, and itching but generally asymptomatic
Initial herald patch; a single, oval, sharp, pink or salmon colored lesion on chest, neck, or back
. more eruptions up to 1-2 weeks later, on trunk morphing into Ch

Varicella (chicken pox) (presentation, diagnostics, treatment)

Prodrome: Malaise with low-grade fever
Tear-drop vesicles (dew on a rose petal)
, presenting with multiple stages at the same time.
Transmission: Respiratory droplets.
Diagnostics: real-time polymerase chain reaction (PCR) assays
Treatment: Alcy

Rubella (presentation, diagnostics, treatment)

Prodrome: malaise, low-grade fever, coryza, mild conjunctivitis, and
upper respiratory symptoms
. Suboccipital and post auricular glands lymphadenopathy.
Exanthem: Pink macules and papules
on the face that spread to the trunk and extremities
lasting 1-3 d

Fifths Disease (presentation, diagnostics, treatment)

Prodrome: Arthritis in hands, wrists, knees, and ankles; along with
papular purpuric gloves and socks syndrome.
Exanthem: May appear 7-10 days after prodrome period.
Bright red erythema appears abruptly over cheeks
at 1-4 days. An erythematous, morbillifo

Cholesteatoma (presentation, TM, patient education, treatment)

-keratinized, desquamated epithelial collection in the middle ear or mastoid. Can be primary or secondary (r/t TM perforation)
S/S: hearing loss, dizziness, and/or otorrhea.
TM: retracted area of the tympanic membrane, may be obstructive polyp

Otitis externa (presentation, TM, patient education, treatment)

S/S: ear pain, itching, fullness with or without hearing loss or jaw pain AND signs of ear canal inflammation: tenderness of tragus/pinna or ear canal edema/erythema
TM: erythema
Treatment: lAntimicrobial options: Ciprodex , Neomycin/polymyxin B/hydrocort

TM perforation (presentation, TM, patient education, treatment)

S/S: Ear pain, hearing loss, tinnitus, vertigo, n/v, mucuslike drainage,
TM: visualized perforation in TM upon exam
Treatment: Most heal without treatment need, otherwise can start an antibiotic ear drop (e.g. ofloxacin otic)
Education: keep ear dry, refr

Serous otitis media (aka OME) (presentation, TM, patient education, treatment)

-fluid in middle ear that is not infected in absence of acute symptoms
-S/S: conductive hearing loss, increased pressure sensation in the ears, ear pain, fullness in the ears
TM: often retracted or in the neutral position
Monitoring is mainstay

Diverticulitis (risk factors, treatment)

Mild to moderate, colicky to steady, aching abd pain in the LLQ, Fever, Leukocytosis, Possible change in bowel pattern (constipation/loose stools), Possible n/v, mild abd distension, normal BS, LLQ tenderness, mass may be palpated, tenderness to the p

Hordeolum (causes, presentation, treatment options)

Erythema, edema of eyelids
, localized tenderness
eyelid hygiene is mainstay tx Warm compresses, lid scrubs
for recurrent lesions. Antibiotics on eyelid margins not recommended.

Gold standard test for myocarditis

-definitively established in patients who have
diagnostic findings on Endomyocardial biopsy (EMB)

Crohns vs. UC

Affects any portion from anus to mouth
-Skip lesions
-Usually rectal sparring and terminal ileum affecting
-Transmural IF -->
Cobble stone mucosa
-Fissures, abscess
-Noncaseating granuloma
non-bloody diarrhea
Only affects

Blepharitis CM/Mangement/Education

-inflammation of the eyelids
S/S: burning, foreign body sensation, tearing, photophobia, itching, redness, DC, swollen erythematous eyelids worse in the morning.
eyelid hygiene is mainstay tx
Daily warm compress, cleanse w/ mild soap, gentle lid massa

Common bacteria associated with rhinosinitus

Streptococcus pneumoniae, H. influenzae, and Moraxella catarrhalis

Common bacteria associated with acute otitis media

Streptococcus pneumoniae and H. influenzae

Common bacteria associated with bacterial infection of the throat

group A Streptococcus

How to apply CENTOR score

-determines patients with Group A Strep (GAS)
1 point added for the criteria; tonsillar exudates, tender anterior cervical lymphadenopathy, fever and absence of cough
-likelihood of GAS increases as total points rise;
patients w/ <3 on score are unlikely

Nephrolithiasis (kidney stones) patient education and treatment

Patient education: If staying home to pass stone, drink a lot of fluids, can take NSAIDS to aid pain, strain urine to recover stone.
Tamsulosion / Flomax can be prescribed for home pass.
Stone removal is indicated for pain or obstruction or for

PSA sensitivity and specificity

-Low sensitivity means that some men with PSA levels <4 ng/mL will have prostate cancer
-Often elevated in men with prostate cancer

Blunt force trauma to eye (step by step)

-eyes are located near the intracranial space, the cervical spine, and the airway, life-threatening injuries involving these structures need to be considered prior to assessing periocular and ocular damage.
-identify threats to vision
-In open globe injur

Cervical (carotid) bruit

-An important sign of carotid stenosis
in a pt. younger than 50 years of age
suggestive of blunt cerebrovascular injury in the trauma patient and should prompt emergent evaluation and interventions directed at hemorrhage control or stroke management.

How to treat a COPD exacerbation

increased dyspnea is key symptom
, increased cough, sputum, and wheeze.
treated with SAB (albuterol, levalbuterol, impratroprium)
treated with SABDs + antibiotics and/or oral corticosteroids
SABD: albuterol, ipratroprium

Mitral valve prolapse vs. mitral regurgitation murmur (what it sounds like, what if it is together)

Prolapse: late, systolic murmur.
Best heard with the diaphragm of the stethoscope, over or just medial to the cardiac apex. It is usually preceded by single or multiple clicks
Regurgitation: early, systolic murmur.
High pitched and best heard with the dia