NUR 932 Exam 1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| What can steroids do to a person's WBC? | Increase it
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| 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)
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| 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)
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| What is an ESR considered a useful marker for | To evaluate the effectiveness of therapy when long term antibiotics are needed (i.e. osteomyelitis)
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| Epitrochlear lymphadenopathy is highly suggestive of what disease? | Mononucleosis
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| What are the 3 C's of measles? | cough, coryza, conjuntivitis
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| What is the most common complication of recurrent Otitis Media? | Hearling loss
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| A strong history of autoimmune disease in the family may suggest what? | rheumatologic diagnosis
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| A new heart murmur could indicate what? | endocarditis or rheumatic fever
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| A bacterial infection will often increase what? | neutrophil
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| 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
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| What two sinuses are most involved in sinusitis? | Maxillary and ethmoid
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| Sinusitis is termed "chronic" if lasting longer than? | 30 days
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| With sinusitis the patient's cough is worse when? | night
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| Transillumination of the sinuses will reveal what if sinusitis is present? | opacification of the sinuses
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| A patient has red/swollen nasal mucosa, periorbital edema, and a cough that is worse at night. What is the diagnosis? | sinisitis
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| 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
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| How long do you prescribe antibiotic for in chronic sinusitis? | 6 weeks
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| A child comes in with persistent unilateral purulent nasal discharge. This is common with what finding? | Foreign body in nose
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| 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
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| 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
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| 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
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| Viral pharyngitis has what type of onset? | gradual
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| Bacterial pharyngitis typically has what type of onset? | rapid
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| What is the treatment for bacterial pharyngitis | Penicillin
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| What type of rash is sometimes noted with bacterial pharyngitis? | scarlitiniform rash
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| What are 2 other treatments for bacterial pharyngitis besides Penicillin | Zithromax and erythromycin
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| What is the most common site for epistaxis? | Kiesselbach's triangle found on the anterior portion of the septum
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| What lab test would you possibly order for a pt with epistaxis? | Hgb/Hct
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| What two differential diagnosis must a practitioner rule out when evaluating epistaxis | bleeding disorder and nasal tumors
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| What is the most frequent infection in humans? | rhinitis
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| A person with allergic rhinitis will have nasal turbinates that appear? | pale, boggy, bluish
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| A person with viral rhinitis will have nasal turbinates that appear? | red, inflammed
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| What is an example of a prescription antihistamine nasal spray that may be prescribed for rhinitis? | Astelin
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| When should a patient with rhinitis be referred? | A patient who is worse or has not improved after 4 or more weeks on antihistamine
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| Oral candidiasis is common in individuals who use what type of medication? | inhaled steroids
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| A patient who presents with white plaques on their tongue and buccal mucosa have a diagnosis of what? | Thrush
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| What instructions should a breastfeeding mother be given when her infant is diagnosed with thrush? | clean nipples, apply Nystatin to nipples
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| What is a common cause of peridontal disease? | poor hygiene
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| Bad breath, bleeding gums, and tooth mobility are all signs of what? | peridontal disease
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| What disease is characterized by inflammation of the gums and sometimes the bony structures of the mouth. | peridontal disease
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| Another name for apthous stomatitis? | canker sores
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| What is the difference in minor and major apthous stomatitis? | Ulcers are <1cm in minor, Ulcers are >1cm in major
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| What are two treatments for apthous stomatitis? | topical antacids and topical corticosteroids
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| What type of apothous stomatitis is described as: up to 100 1-2mm yellow vesicles that may produce ulcers? | herpetiform
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| What are the s/s of TMJ? | otalgia (ear pain), HA, tinnitus
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| What is the treatment for TMJ? | NSAIDS, muscle relaxer at bedtime
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| Bilateral involvement in TMJ is common in patients with what disease | Rheumatoid arthritis
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| What often comes prior to myofascial pain in TMJ? | emotional stress
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| What is cervical adenitis? | inflammation of one or more lymph nodes of the neck
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| Cervical adenitis is commonly caused by what? | viral infection
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| A peritonsilar abscess is most commonly caused by what organism? | Streptococcus
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| 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
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| What spirochete is responsible for Lyme's Disease? | borrelia burgdorferi
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| In lyme's disease, the tick must feed for how long? | 36-48 hours
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| What is erythema chronicum migrans | the skin lesion that appears days-4 weeks after tick bite associated with lyme's disease
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| What is the treatment for lyme disease? | Doxycycline or Amoxicillin x28 days
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| 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
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| The target lesion associated with lyme disease is what size? | 5-30cm
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| What symptoms often accompany the target lesion associated with lyme disease? | fever, malaise, lymphadenopathy
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| Stage 2 of lyme disease occurs when? | days to 10 months after bite
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| Stage three of lyme disease is characterized by what? | progressive arthritis
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| Rheumatic fever is an autoimmune disorder that follows what type of infection? | GABHS
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| Rheumatic fever is also described as what? | systemic connective tissue disorder
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| A person that has been affected by rheumatic fever has to have prophylaxis prior to what type of appt? | Dental
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| 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
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| Minor criteria of Rheumatic fever includes an elevation of what 2 lab results? | ESR, CRP
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| What EKG change is a minor criteria of rheumatic fever? | Prolonged PR interval
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| The slow growing gram-negative bacillus B. henselae is responsible for what disease? | Cat Scratch Disease
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| What are 3 common antibiotics prescribed for cat scratch disease? | Augmentin, Cipro, Keflex
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| How long do the lesions stay with cat scratch disease? | 1 week to months
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| What pattern might the lesions associated with cat scratch disease follow? | linear
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| Are the lesions possible with cat scratch disease pruritic? | NO
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| When dose node swelling start in cat scratch disease? | typically 4 weeks after the scratch occurs
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| What node swells with cat scratch disease? | The node closest to the injury
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| How large can the affected lymph node swell in cat scratch disease? | 1-5cm
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| The affected lymph node can stay enlarged anywhere from 1-2 months to a year in what disease? | Cat scratch disease
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| What day does the rash occur in Rocky Mountain Spotted Fever? | day 4
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| Rickettsia ricketsii is responsible for what disease? | Rocky Mountain Spotted Fever
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| The 2-3 day prodome associated with Rocky Mountain Spotted Fever consists of what symptoms? | photophobia, low grade fever, HA, N/V
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| The 2-3 day prodome associated with Rocky Mountain Spotted Fever is followed by what symptoms? | higher feer, mental confusion, lethargy
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| The rash associated with Rocky Mountain Spotted Fever starts where? | peripherally on wrists, ankles, hands, and feet and spreads centrally
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| Over time, the rash associated with Rocky Mountain Spotted Fever does what in color? | deepens in color and progresses to petechiae
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| What is an important characteristic of the rash of Rocky Mountain Spotted Fever | it starts peripherally
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| Mononucleosis is caused by what virus? | Epstein Barr
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| What are two complications of Mononucleosis in developing countries? | nasopharyngeal cancer and Burkitt's lymphoma
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| Mononucleosis is transmitted how? | saliva
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| What is a possible rx given to a person with monomucleosis | Short course of prednisone
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| A rash occurs in the majority of patients that have mononucleosis and are treated with what antibiotics | Amoxicillin and ampicillin
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| The CBC differential of a patient with mononucleosis will demonstrate what? | lymphocytosis with numerous atypical lymphocytes and monocytes
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| Nontender lymphadenopathy in a person with mononucleosis affects what node? | posterior cervical chair and epitrochlear
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| A child with mono should be kept out of contact sports if what objective finding is noted? | hepatosplenomegaly
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| Tamiflu or amantadine are most effective when? | within 24-72 hours of influenza symptoms
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| 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
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| 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
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| What is the recommended duration of antibiotic therapy for AOM in a child that has severe symptoms? | 10 days
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| 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
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| 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
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| Scarlet fever is caused by what? | GABHS, erythrogenic toxin
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| A person with scarlet fever is contagious when? | 24 hours before symptoms until 48 hours after PCN started
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| 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
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| Describe the rash associated with Scarlet fever | red, fine, papular, blanches
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| When does the rash associated with scarlet fever begin? | 12-48 days after symptoms begin
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| Where does the rash associated with scarlet fever begin? | axila, neck, groin and spreads centripetally
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| Fifth's disease is caused by what? | parvovirus B19
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| When does the characteristic rash of Fifths disease appear? | 7-10 after prodrome of mild fever, myalgia, HA, URI
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| Describe the first stage of the Fifths disease rash | "slapped cheeks look"
bright red cheeks
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| How long does the first stage of the fifths disease rash last before progressing to stage 2? | 1-4 days
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| Who should children with the fifths disease stay away from? | pregnant women
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| How long can the stage 2 rash of fifths disease last? | up to 1 month
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| 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
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| Describe the 3rd stage of fifths disease | Rash subsides but may reoccur
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| Can children go to school when the have the fifths disease rash? | yes
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| Otitis externa is an infection of what? | External auditory canal
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| Pain with pressure on the tragus is indicative of what? | Otitis externa
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| Black spots in the External ear canal are indicative of what? | otitis externa caused by a fungal infection
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| What is the most common symptom of otitis externa? | itching
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| what must be ruled out with when a person presents with c/o otitis externa? | foreign body in ear
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| What is the treatment for otitis externa? | clean ear canal and cortisporin drops
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| When are Oral antibiotics indicated for otitis externa? | Diffuse infection (i.e. cellulitis)
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| True or False. A person with shingles can cause chicken pox in another individual? | True
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| What is an important part of treatment in a person with shingles affecting the eye or bridge of nose? | Ophthalmology consult
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| What is the treatment for post herpetic neuralgia? | amitriptyline (Elavil), Lyrica, gabapentin (Neurontin)
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| What is a side effect of Lyrica and Neurontin? | sedation and edema
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| Shingles is characterized by what? | unilateral involvement that follows dermatome
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| What is a symptom of shingles? | pain at the site before rash erupts
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| Shingles is the reactivation of what virus? | varicella
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| What is the primary illness of varicella? | chicken pox
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| A person that has received immunoglobulin may have a prolonged incubation period lasting how many days? | 14-28 days
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| The prodrome of chicken pox is fever and malaise. How many days until the rash appears? | 2 days
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| Where does the chicken pox rash begin? | scalp, face, or trunk
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| Describe the progression of the chicken pox rash. | vesicle to crusty and scab
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| When can children return to school that are affected by the chicken pox? | when the lesions dry
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| the white blood cell count in a child with chicken pox is ___________? | normal
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| The more severe the rash, the higher the _______? | fever
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| How long can the scabs last with chicken pox? | 5-20 days
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| Acyclovir must be started when with chicken pox to be affective? | within 24 hours of onset
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| Who must children with chicken pox particularly stay away from | pregnant women
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| The chicken pox rash spreads _______________ | centripetal
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| Rubeola (measles) is caused by what virus? | morbilivirus
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| What are koplik spots? | small, irregular, bluish-white granules on red background that are found on the inner lower cheeks
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| How long do koplik spots last? | 12-15 hours
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| Koplik spots are related to the 4-5 prodrome phase of what disease? | Rubeola (measles)
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| The rash associated with rubeola (measles) appears when? | 3rd or 4th day of illness
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| Where does the rash of rubeloa (measles) start? | behind the ears and on the forehead and moves down
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| With rubeola (measles), The worse the rash _______ | The worse the disease
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| Prodromal stage of rubeola (measles) lasts how long? What are the symptoms? | 4-5 days of cough, coryza, and conjunctivitis
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| In rubeola (measles) when does the fever increase? | when the rash appears
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| The rash of rubeola (measles) is described how? | maculopapular
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| When do the respiratory symptoms of rubeola (measles) worsen? | Day 3 of rash
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| What is a complication of rubeola (measles) | hemorrhage, DIC
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| What supplement is sometimes given to people with rubeola (measles)? | Vitamin A
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| When is a person with rubeola (measles) contagious? | 3-5 days before rash and 4 days after rash
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| Roseola is also known as what two names? | exanthem subitum and sixth disease
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| Roseola is caused by what virus | human herpes virus 6 (HHV-6)
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| Does the child with roseola seem ill during the fever period? | not always
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| The CBC of a patient with roseola demonstrates what? | leukopenia
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| Where does the rash of roseola start? | trunk
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| 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.
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| When does the rash occur in a patient with roseola? | when the fever breaks
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| How long does the rash last in roseola? | hours to 2-3 days
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| Describe the roseola rash. | diffuse, rose color, maculopapular, 2-3mm
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| Does the roseola rash itch? | NO
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| What is the peak age of roseola? | 15 months
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| What age range is most commonly affected by roseola? | 6 months to 24 months
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| 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
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| What are 3 complications associated with rubella (3 day/German measles)? | ITP,neuritis, encephalitis
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| What are the 3 stages of rubella (3 day/German measles)? | 1-Prodrome, 2-Lymphadenopathy, 3-Rash
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| What are Forchheimer spots? | small, rosey red spots on soft palate of person with rubella (3 day/German measles)
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| The prodrome stage of rubella (3 day/German measles) occurs how many days before the rash | 1-5 days
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| The lymphadenopathy stage of rubella (3 day/German measles) occurs how many days before the rash | 1-7 days
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| what 3 nodes are most affected by lymphadenopathy in rubella (3 day/German measles) | post auricular
cervical
posterior occiptial
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| Lymphadenopathy associated with rubella (3 day/German measles) can last how long | longer than 1 week
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| The rash associated with rubella (3 day/German measles) starts where? | Face to chest
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| The rash associated with rubella (3 day/German measles) spreads how? | caudally
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| Describe the rash associated with rubella (3 day/German measles) | discrete, maculopapules
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| Mucocutaneous lymph node syndrome is a description of what disease? | Kawasaki disease
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| What is the peak age of Kawasaki disease? | 1-2 years
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| A symptom of Kawasaki disease is a fever >102 for ___ days | 5
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| Cardiac complications associated with Kawasaki disease are what? | tachycardia, persistent gallop, signs of CHF
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| A child with Kawasaki disease may demonstrate what cardiac complication on an ECHO? | coronary artery dilation
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| Acute febrile vasculitis of small and medium blood vessels describes what disease? | Kawasaki disease
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| 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
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| What is the initial tx for Kawasaki disease | IV immunoglobulin, high dose aspirin
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| What is the mid term tx for Kawasaki disease? | low dose aspirin
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| What is the long term tx for Kawasaki disease | exercise, diet, tobacco prevention
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| The platelet count of a child with Kawasaki disease might be_____? | elevated
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| What lab test might be abnormal with Kawasaki disease | liver enzymes
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| The ESR and CRP of a child with Kawasaki disease might be_____? | elevated
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| What will the CBC differential show if a child has Kawasaki disease | increased WBC with neutrophil predominance
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| What type of anemia is possible with Kawasaki disease? | normochromic
normal hemoglobin, low RBC
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| Amoxicillin is not given to a patient who has otitis media and ____________? | conjunctivitis
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| Amoxicillin is not given to a patient who has otitis media who has had Amoxicillin in the past ___ days? | 30
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| If a pt has no response to OM treatment in 48-72 hours what should the provider do? | Reevaluate, change antibiotic
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| Residual otitis media is? | continued MEE after 3-6 wks of treatment
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| Persistent otitis media is ? | MEE after 6-12 weeks of treatment
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| Unresponsive otitis media is? | MEE with inflammation or symptoms after initial treatment
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| Recurrent OM is? | 3 seperate episodes in months
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| visibility of inner ear landmarks will be ________ in OM | decreased
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| Otitis media is characterized by what type of otalgia | rapid onset
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| the tympanic membrane of a child with otitis media is what color | red or yellow
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| mobility of the tympanic membrane in someone with OM is ____? | decreased
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| What diagnostic tool is used to identify mobility of tympanic membrane? | pneumatic otoscopy
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