NR 603 Week 4 APEA Predictor Exam; (Board Examination Review)

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Question that I was able to remember · Basal Cell Cancer: Question description and the fact that it doesn’t have any tx (Hints: Waxy, pearly, telangiectasia, ulcer center lesion ... Basal cell- most prevalentskin cancer, pearly domed nodule with overlying telangiectatic vessels, maybe plaque, maybe papule, may see central ulceration and crusting, deepest layer of the epidermis,Dx gold standard biopsy,TX chemo or immunotherapy · Actinic Keratosis: Question about description (Scaly red to yellow located in sun exposed area: precancerous Actinic keratosis- rough flat, dry, crusty, erythematous papules or plaques, scaly patch of red or brown skin caused by years of sun exposure, evolving carcinoma, precursor to squamous cell carcinoma, Dx biopsy, refer to dermatology, TX topical 5 fluoracil 5-FU, cryotherapy, · Melanoma question: Know ABCDE ABCDE- asymmetry, border is irregular, color variegation, diameter .6mm size greater than pencil eraser, elevation above skin level · Squamous cell- skin cancer develops in the outer layer of the skin, lower lip common location, nodule, indistinct margins, surface is firm, scaly, irregular, and may bleed easily, may metastasize · Postherpetic neuralgia PHN- prophylaxis is TCA-Elavil Shingles · Cellulitis- deep tissue, gram positive, gradual course over days, TX PCN, macrolide · Erysipelas-(strept infection)- acute onset, well demarcated and above the skin, TX pcn or macrolide · MRSA- TX Bactrim or tetracyclines · Papule – solid elevated mass up to 1 cm · Macule- flat small like a freckle · Vesicle – filled with serous fluid and less than 1 cm · Bullae- fluid filled and larger than 1 cm, can be found with 2nd degreeburns · Xerosis- dry skin, use petroleum-based product, not lotions · Psoriasis- pruritic erythematous plaque covered with fine silvery white scales, scalp and elbows TX topical steroids · Shingles- chicken pox, reactivation of varicella zoster virus involves single dermatome, less likely several dermatomes, finding prodrome- itching burning photophobia fever headache malaise, acute phase dermatomal rash 3-4 days, unilateral, pain, possible severe, macupapular rash progresses to vesicles then pustules 3-4 days, may appear for a week, convalescent phase- 2-3 week rash resolves, pain Dx viral culture, polymerase chain reaction PCR, TX acyclovir, zostrix cream, gabapentin amitriptyline · Varicella: Chicken pox, starts on the FACE, spreads to trunk, arms and scalp. Prodrome of fever, pharyngitis, malaise., followed by 24, eruption of puritic vesicular lesions. Exanthem, erthematous puritic maculars develop to papules and fluid filled vesicles”drewdrops on a rose petal” Hairline and spread · Shingles: herpes zoster: varicella virus infection: elderly. One dermatone · Spider bite- TX abx on wound, cold packs nsaids · Dog bite- treat with analgesia (Tylenol, nsaids, Demerol), Augmentin/doxycycline/Bactrim, wound cleaning with soap and water, betadine, local anesthesia (lidocaine), irrigated with 2000ml normal saline, betadine, wound debridement, facial bites should be closed with sutures only, pack wound, tetanus immunization, antibiotic therapy, · Lyme disease- erythema migrans, (Borrelia burgdorferi) bulls eye rash, start within 72 hours of exposure, TX with doxycycline or amoxicillin, or azithromycin Dx two step test EIA and then western blot · Lupus- multisystem autoimmune disease, characterized by remission and exacerbations, affects organs, skin kidney, heart, and blood vessels, face butterfly rash, avoid sunlight exposure, photosensitivity TX refer to rheumatologist, topical and oral steroids, avoid sun and cover skin Less seen in Caucasians · Pityriasis rosea- exanthem, Christmas tree pattern rash, herald patch, normally on trunk, and limbs, oval erythematous-squamous scaly lesion. Pityriasis=bran, rosea=pink, last 5weeks · Anthrax-bacterial infection, from animals, spores inhaled, caused dark scabs difficult to breath. TX doxycycline/ fluoroquinolones (Cipro) · Tinea versicolor- trunk and extremities sun spots, lighten areas over darker skin · Tinea corporis-(ringworm) arms/legs or body, fungal, Tx: mupirocin ointment · Tinea cruris- jock itch · Tinea capitas- skin or scalp · Tinea pedis-athletes foot · Psoriasis- cause pitting in finger nails · Erthema Multiforme- Bulls Eye Rash.Infection. erythematous macule evolves into a papuleSX: skin, mouth lesions that ave pink-red center surrounded by pale ring border, can be painful and puritic. Hands. Bulla on lips vesicle filled large lesions, Causes:herpes simplex, or sulfa drugs.seborrhe · Subungal Hematoma tx: Make a hole and drain the blood · A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail (black toenail). It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition. TX make hole and drain the blood (trephination) · Tx for moderate acne Moderate acne- TXoral abx + topical retinoid +/- benzoyl peroxide (tetracycline + tazarotene +/- Benz Pero Retin topical, oral tetracycline then Accutane (isotretinoin) · Left Ventricle Failure: SX; crackles bibasilar rales, cough, dyspnea, orthopnea, · Right Ventricle Failure: Jugular Vein Distention JVD) enlarged spleen, and liver, anorexia, nausea, abdominal px., lower extremity edema and cool. S3 gallop. · Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS question was asked about heart murmur with high pitch holosystolic and the other one is mid systolic. · Systolic murmurs (audible between 1st and 2nd heart sound) MR/mitral regurg (high pitch), heard at mitral area- radiates to left axilla AS/aortic stenosis (medium pitch) heard at AORTA area- radiates to neck MVP/mitral valve prolapse (midsystolic click) heard at mitral area · Diastolic murmurs—ABNORMAL ASSOC WITH AORTIC/PULMONIC VALVES (audible between 2nd and 1st heart sound) AR/aortic regurg (high pitch) heard at AORTA area MS/mitral stenosis (low pitch with bell) heard at mitral area · Mitral area- 5th ICS midclavicular, apex, apical area, PMI, apical pulse · Aorta area- 2nd ICS to the right side of upper border of sternum, · Grade of murmurs 1. Barely audible, 2 faints but audible, 3 Moderately loud no thrill palpable, 4 LOUD WITH PALPABLE THRILL, 5 very loud stethoscopes off chest, thrill palpable, 6 audible without stethoscope thrill palpable · S1- closure of atrioventricular valves , state of systole · S2- closure of semilunar valves · S3- heard in pulmonic, sign of CHF, S3 gallop heard in pregnancy and thyrotoxicosis · S4 – heard in elderly not associated with heart disease, normal · Pulse deficit- apical/radial pulse taken at same time, find difference · Hypertrophic cardiomyopathy- causes sudden death in young athletes · Question about Grade III/VI Murmur: (Loud murmur easily heard) Mitral regurgitation: holosystolic murmur-apex radiates to left axilla, loud, does not increase in inspirations, S3, Pansystolic, pathologic · Coarctation of Aorta: Know that systolic BP on lower extremities is supposed to be higher compare to upper extremities. In COA case its vise versa. Look for weak radial and bounding femoral pulse · Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency. There was question about PAD and the answer was exercise by walking (Tx) Peripheral arterial disease-impedance of arterial blood flow in lower extremities ankle brachial index <.90, plaque develops in in vessels due to atherosclerosis, pain with exercise, relief with rest, lack of hair growth on lower extremities, gangrene toes TX check pedal pulses, ABI test, exercise by walking, lifestyle modifications -smoking cessation, antiplatelet, cool to touch. Chronic venous insufficiency- and varicose veins result from venous incompetence secondary to valvular dysfunction, low extremity edema, skin discoloration, ulceration, DVT/PE are complications warm to touch, TX light exercise, stockings, weight loss, elevate legs [Show More]

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