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NUR 932 Exam 1

What can steroids do to a person's WBC? Increase it
A protein that has activity similar to a hormone and a cytokine. It is produced by several cell types and many organs in response to a proinflammatory stimuli, particularly due to bacteria Procalcitonin (Pro-CT)
Measure of inflammation that reflects the observation that RBCs settle more rapidly when acute phase proteins are present in serum than when they are not ESR (Sed rate)
What is an ESR considered a useful marker for To evaluate the effectiveness of therapy when long term antibiotics are needed (i.e. osteomyelitis)
Epitrochlear lymphadenopathy is highly suggestive of what disease? Mononucleosis
What are the 3 C's of measles? cough, coryza, conjuntivitis
What is the most common complication of recurrent Otitis Media? Hearling loss
A strong history of autoimmune disease in the family may suggest what? rheumatologic diagnosis
A new heart murmur could indicate what? endocarditis or rheumatic fever
A bacterial infection will often increase what? neutrophil
A history of any first or second degree relative with numerous infections, difficulty recovering from an infection, or a hx of recurrent miscarriages is a risk factor for what? immune deficiency
What two sinuses are most involved in sinusitis? Maxillary and ethmoid
Sinusitis is termed "chronic" if lasting longer than? 30 days
With sinusitis the patient's cough is worse when? night
Transillumination of the sinuses will reveal what if sinusitis is present? opacification of the sinuses
A patient has red/swollen nasal mucosa, periorbital edema, and a cough that is worse at night. What is the diagnosis? sinisitis
A patient has 2 week hx of red/swollen nasal mucosa, periorbital edema, and a cough that is worse at night. The dx is sinusitis. You write a script for Amoxicillin. How long would you prescribe this antibiotic for? 10-21 days
How long do you prescribe antibiotic for in chronic sinusitis? 6 weeks
A child comes in with persistent unilateral purulent nasal discharge. This is common with what finding? Foreign body in nose
What is a main difference between viral and bacterial pharyngitis? Viral pharyngitis has a gradual onset with nasal symptoms, bacterial pharyngitis has a rapid onset w/out nasal symptoms
The oropharynx of a patient with viral pharyngitis caused by the EBV will have what appearance? Possible exudate with petechiae noted on the soft palate
The oropharynx of a patient with viral pharyngitis caused by an enterovirus will have what appearance? vesicles or ulcers on the pillars and posterior faucets
Viral pharyngitis has what type of onset? gradual
Bacterial pharyngitis typically has what type of onset? rapid
What is the treatment for bacterial pharyngitis Penicillin
What type of rash is sometimes noted with bacterial pharyngitis? scarlitiniform rash
What are 2 other treatments for bacterial pharyngitis besides Penicillin Zithromax and erythromycin
What is the most common site for epistaxis? Kiesselbach's triangle found on the anterior portion of the septum
What lab test would you possibly order for a pt with epistaxis? Hgb/Hct
What two differential diagnosis must a practitioner rule out when evaluating epistaxis bleeding disorder and nasal tumors
What is the most frequent infection in humans? rhinitis
A person with allergic rhinitis will have nasal turbinates that appear? pale, boggy, bluish
A person with viral rhinitis will have nasal turbinates that appear? red, inflammed
What is an example of a prescription antihistamine nasal spray that may be prescribed for rhinitis? Astelin
When should a patient with rhinitis be referred? A patient who is worse or has not improved after 4 or more weeks on antihistamine
Oral candidiasis is common in individuals who use what type of medication? inhaled steroids
A patient who presents with white plaques on their tongue and buccal mucosa have a diagnosis of what? Thrush
What instructions should a breastfeeding mother be given when her infant is diagnosed with thrush? clean nipples, apply Nystatin to nipples
What is a common cause of peridontal disease? poor hygiene
Bad breath, bleeding gums, and tooth mobility are all signs of what? peridontal disease
What disease is characterized by inflammation of the gums and sometimes the bony structures of the mouth. peridontal disease
Another name for apthous stomatitis? canker sores
What is the difference in minor and major apthous stomatitis? Ulcers are <1cm in minor, Ulcers are >1cm in major
What are two treatments for apthous stomatitis? topical antacids and topical corticosteroids
What type of apothous stomatitis is described as: up to 100 1-2mm yellow vesicles that may produce ulcers? herpetiform
What are the s/s of TMJ? otalgia (ear pain), HA, tinnitus
What is the treatment for TMJ? NSAIDS, muscle relaxer at bedtime
Bilateral involvement in TMJ is common in patients with what disease Rheumatoid arthritis
What often comes prior to myofascial pain in TMJ? emotional stress
What is cervical adenitis? inflammation of one or more lymph nodes of the neck
Cervical adenitis is commonly caused by what? viral infection
A peritonsilar abscess is most commonly caused by what organism? Streptococcus
A patient presents with a muffled voice and throat pain. On exam, you observe the uvula is deviated to one side. What is your diagnosis? peritonsilar abscess
What spirochete is responsible for Lyme's Disease? borrelia burgdorferi
In lyme's disease, the tick must feed for how long? 36-48 hours
What is erythema chronicum migrans the skin lesion that appears days-4 weeks after tick bite associated with lyme's disease
What is the treatment for lyme disease? Doxycycline or Amoxicillin x28 days
If the first 28 days of treatment fails in a pt with lyme's what is the next step? an additional 28 days of oral therapy or 2-4 weeks of IV therapy
The target lesion associated with lyme disease is what size? 5-30cm
What symptoms often accompany the target lesion associated with lyme disease? fever, malaise, lymphadenopathy
Stage 2 of lyme disease occurs when? days to 10 months after bite
Stage three of lyme disease is characterized by what? progressive arthritis
Rheumatic fever is an autoimmune disorder that follows what type of infection? GABHS
Rheumatic fever is also described as what? systemic connective tissue disorder
A person that has been affected by rheumatic fever has to have prophylaxis prior to what type of appt? Dental
What is the rx for dental prophylaxis for a patient with a murmur who has been affected by rheumatic fever? Amoxicillin 3 grams 1 hour PTA, and 1.5 grams six hours after first dose
Minor criteria of Rheumatic fever includes an elevation of what 2 lab results? ESR, CRP
What EKG change is a minor criteria of rheumatic fever? Prolonged PR interval
The slow growing gram-negative bacillus B. henselae is responsible for what disease? Cat Scratch Disease
What are 3 common antibiotics prescribed for cat scratch disease? Augmentin, Cipro, Keflex
How long do the lesions stay with cat scratch disease? 1 week to months
What pattern might the lesions associated with cat scratch disease follow? linear
Are the lesions possible with cat scratch disease pruritic? NO
When dose node swelling start in cat scratch disease? typically 4 weeks after the scratch occurs
What node swells with cat scratch disease? The node closest to the injury
How large can the affected lymph node swell in cat scratch disease? 1-5cm
The affected lymph node can stay enlarged anywhere from 1-2 months to a year in what disease? Cat scratch disease
What day does the rash occur in Rocky Mountain Spotted Fever? day 4
Rickettsia ricketsii is responsible for what disease? Rocky Mountain Spotted Fever
The 2-3 day prodome associated with Rocky Mountain Spotted Fever consists of what symptoms? photophobia, low grade fever, HA, N/V
The 2-3 day prodome associated with Rocky Mountain Spotted Fever is followed by what symptoms? higher feer, mental confusion, lethargy
The rash associated with Rocky Mountain Spotted Fever starts where? peripherally on wrists, ankles, hands, and feet and spreads centrally
Over time, the rash associated with Rocky Mountain Spotted Fever does what in color? deepens in color and progresses to petechiae
What is an important characteristic of the rash of Rocky Mountain Spotted Fever it starts peripherally
Mononucleosis is caused by what virus? Epstein Barr
What are two complications of Mononucleosis in developing countries? nasopharyngeal cancer and Burkitt's lymphoma
Mononucleosis is transmitted how? saliva
What is a possible rx given to a person with monomucleosis Short course of prednisone
A rash occurs in the majority of patients that have mononucleosis and are treated with what antibiotics Amoxicillin and ampicillin
The CBC differential of a patient with mononucleosis will demonstrate what? lymphocytosis with numerous atypical lymphocytes and monocytes
Nontender lymphadenopathy in a person with mononucleosis affects what node? posterior cervical chair and epitrochlear
A child with mono should be kept out of contact sports if what objective finding is noted? hepatosplenomegaly
Tamiflu or amantadine are most effective when? within 24-72 hours of influenza symptoms
A 5 month old infant presents with irritability x 3 days, temp 101. Left TM is noted to be red and bulging. Would you prescribe antibiotcs ? Yes, child is <6 months, and has a red and bulging ear drum
3 year old child is brought to the ear with temp 103, bilateral severe ear pain. There is decreased movement with pneumatic otoscopy. Would you prescribe antibiotic? Yes, child may be older than 2 but temp is >102.2 and otalgia is severe
What is the recommended duration of antibiotic therapy for AOM in a child that has severe symptoms? 10 days
What is the recommended duration of antibiotics for AOM in a child 3 years of age or older that has nonsevere symptoms of AOM? ages 2-6= 7 days
What is the recommended duration of antibiotics for AOM in a child 7 years of age or older that has nonsevere symptoms of AOM? ages >6= 5-7 days
Scarlet fever is caused by what? GABHS, erythrogenic toxin
A person with scarlet fever is contagious when? 24 hours before symptoms until 48 hours after PCN started
The Schultz-Charlton test is what? test on scarlitinin rash associated with scarlet fever. Test skin to see if it blanches. Positive if skin blanches
Describe the rash associated with Scarlet fever red, fine, papular, blanches
When does the rash associated with scarlet fever begin? 12-48 days after symptoms begin
Where does the rash associated with scarlet fever begin? axila, neck, groin and spreads centripetally
Fifth's disease is caused by what? parvovirus B19
When does the characteristic rash of Fifths disease appear? 7-10 after prodrome of mild fever, myalgia, HA, URI
Describe the first stage of the Fifths disease rash "slapped cheeks look" bright red cheeks
How long does the first stage of the fifths disease rash last before progressing to stage 2? 1-4 days
Who should children with the fifths disease stay away from? pregnant women
How long can the stage 2 rash of fifths disease last? up to 1 month
Describe the rash associated with the 2 stage of fifths disease lacy, maculopapular eruptions starting on the trunk and spreading to thighs, arms and buttocks
Describe the 3rd stage of fifths disease Rash subsides but may reoccur
Can children go to school when the have the fifths disease rash? yes
Otitis externa is an infection of what? External auditory canal
Pain with pressure on the tragus is indicative of what? Otitis externa
Black spots in the External ear canal are indicative of what? otitis externa caused by a fungal infection
What is the most common symptom of otitis externa? itching
what must be ruled out with when a person presents with c/o otitis externa? foreign body in ear
What is the treatment for otitis externa? clean ear canal and cortisporin drops
When are Oral antibiotics indicated for otitis externa? Diffuse infection (i.e. cellulitis)
True or False. A person with shingles can cause chicken pox in another individual? True
What is an important part of treatment in a person with shingles affecting the eye or bridge of nose? Ophthalmology consult
What is the treatment for post herpetic neuralgia? amitriptyline (Elavil), Lyrica, gabapentin (Neurontin)
What is a side effect of Lyrica and Neurontin? sedation and edema
Shingles is characterized by what? unilateral involvement that follows dermatome
What is a symptom of shingles? pain at the site before rash erupts
Shingles is the reactivation of what virus? varicella
What is the primary illness of varicella? chicken pox
A person that has received immunoglobulin may have a prolonged incubation period lasting how many days? 14-28 days
The prodrome of chicken pox is fever and malaise. How many days until the rash appears? 2 days
Where does the chicken pox rash begin? scalp, face, or trunk
Describe the progression of the chicken pox rash. vesicle to crusty and scab
When can children return to school that are affected by the chicken pox? when the lesions dry
the white blood cell count in a child with chicken pox is ___________? normal
The more severe the rash, the higher the _______? fever
How long can the scabs last with chicken pox? 5-20 days
Acyclovir must be started when with chicken pox to be affective? within 24 hours of onset
Who must children with chicken pox particularly stay away from pregnant women
The chicken pox rash spreads _______________ centripetal
Rubeola (measles) is caused by what virus? morbilivirus
What are koplik spots? small, irregular, bluish-white granules on red background that are found on the inner lower cheeks
How long do koplik spots last? 12-15 hours
Koplik spots are related to the 4-5 prodrome phase of what disease? Rubeola (measles)
The rash associated with rubeola (measles) appears when? 3rd or 4th day of illness
Where does the rash of rubeloa (measles) start? behind the ears and on the forehead and moves down
With rubeola (measles), The worse the rash _______ The worse the disease
Prodromal stage of rubeola (measles) lasts how long? What are the symptoms? 4-5 days of cough, coryza, and conjunctivitis
In rubeola (measles) when does the fever increase? when the rash appears
The rash of rubeola (measles) is described how? maculopapular
When do the respiratory symptoms of rubeola (measles) worsen? Day 3 of rash
What is a complication of rubeola (measles) hemorrhage, DIC
What supplement is sometimes given to people with rubeola (measles)? Vitamin A
When is a person with rubeola (measles) contagious? 3-5 days before rash and 4 days after rash
Roseola is also known as what two names? exanthem subitum and sixth disease
Roseola is caused by what virus human herpes virus 6 (HHV-6)
Does the child with roseola seem ill during the fever period? not always
The CBC of a patient with roseola demonstrates what? leukopenia
Where does the rash of roseola start? trunk
Describe the fever of a patient with roseola Sudden onset of fever greater than 101 degrees that lasts for 3-7 days and then breaks.
When does the rash occur in a patient with roseola? when the fever breaks
How long does the rash last in roseola? hours to 2-3 days
Describe the roseola rash. diffuse, rose color, maculopapular, 2-3mm
Does the roseola rash itch? NO
What is the peak age of roseola? 15 months
What age range is most commonly affected by roseola? 6 months to 24 months
A child with congenital rubella (3 day/german measles) may shed the virus in their nasopharyngeal secretions and urine for how long? up to 1 year
What are 3 complications associated with rubella (3 day/German measles)? ITP,neuritis, encephalitis
What are the 3 stages of rubella (3 day/German measles)? 1-Prodrome, 2-Lymphadenopathy, 3-Rash
What are Forchheimer spots? small, rosey red spots on soft palate of person with rubella (3 day/German measles)
The prodrome stage of rubella (3 day/German measles) occurs how many days before the rash 1-5 days
The lymphadenopathy stage of rubella (3 day/German measles) occurs how many days before the rash 1-7 days
what 3 nodes are most affected by lymphadenopathy in rubella (3 day/German measles) post auricular cervical posterior occiptial
Lymphadenopathy associated with rubella (3 day/German measles) can last how long longer than 1 week
The rash associated with rubella (3 day/German measles) starts where? Face to chest
The rash associated with rubella (3 day/German measles) spreads how? caudally
Describe the rash associated with rubella (3 day/German measles) discrete, maculopapules
Mucocutaneous lymph node syndrome is a description of what disease? Kawasaki disease
What is the peak age of Kawasaki disease? 1-2 years
A symptom of Kawasaki disease is a fever >102 for ___ days 5
Cardiac complications associated with Kawasaki disease are what? tachycardia, persistent gallop, signs of CHF
A child with Kawasaki disease may demonstrate what cardiac complication on an ECHO? coronary artery dilation
Acute febrile vasculitis of small and medium blood vessels describes what disease? Kawasaki disease
What are the 5 criteria describing Kawasaki disease? 4 must be present for diagnosis. 1-Changes in extremities 2-polymorphous rash 3-bilateral conjunctivitis 4-changes in lips and oral cavity 5-cervical lymphadenopathy
What is the initial tx for Kawasaki disease IV immunoglobulin, high dose aspirin
What is the mid term tx for Kawasaki disease? low dose aspirin
What is the long term tx for Kawasaki disease exercise, diet, tobacco prevention
The platelet count of a child with Kawasaki disease might be_____? elevated
What lab test might be abnormal with Kawasaki disease liver enzymes
The ESR and CRP of a child with Kawasaki disease might be_____? elevated
What will the CBC differential show if a child has Kawasaki disease increased WBC with neutrophil predominance
What type of anemia is possible with Kawasaki disease? normochromic normal hemoglobin, low RBC
Amoxicillin is not given to a patient who has otitis media and ____________? conjunctivitis
Amoxicillin is not given to a patient who has otitis media who has had Amoxicillin in the past ___ days? 30
If a pt has no response to OM treatment in 48-72 hours what should the provider do? Reevaluate, change antibiotic
Residual otitis media is? continued MEE after 3-6 wks of treatment
Persistent otitis media is ? MEE after 6-12 weeks of treatment
Unresponsive otitis media is? MEE with inflammation or symptoms after initial treatment
Recurrent OM is? 3 seperate episodes in months
visibility of inner ear landmarks will be ________ in OM decreased
Otitis media is characterized by what type of otalgia rapid onset
the tympanic membrane of a child with otitis media is what color red or yellow
mobility of the tympanic membrane in someone with OM is ____? decreased
What diagnostic tool is used to identify mobility of tympanic membrane? pneumatic otoscopy
Created by: vpadgett
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