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2023 NR507 MIDTERM CHAMBERLAIN Verified
Answers (Graded A+ )
1
...
What is the most common cause of nausea and vomiting? –
CORRECT ANSWERS Acute Gastroenteritis (AGE)
3
...

May also include fatigue, malaise, anorexia, tenesmus and borborygmus
...
How is the severity of AGE gauged? - CORRECT ANSWERS Dehydration
secondary to profuse watery diarrhea, fever greater than 101ºF (38
...

5
...

6
...

7
...

8
...
may also help protect against a future attack by the
same pathogen
...
Onset of N/V begin within 6 hours after exposure
...

10
...


11
...

12
...

13
...
What is the reason? - CORRECT ANSWERS Hypoalbuminemia
14
...
- CORRECT
ANSWERS True
15
...
What is the most common viral pathogen causing AGE in adults? - CORRECT
ANSWERS Norovirus
17
...
This has been greatly reduced since the
introduction of the rotavirus vaccine
...
T or F: Stool studies are indicated in the absence of bloody diarrhea or systemic
disease - CORRECT ANSWERS False
19
...
When are stool studies warranted? - CORRECT ANSWERS Severe or
prolonged diarrhea, a fever > 38
...

21
...
coli
...
What should the clinician do if the patient develops diarrhea after initiation of
completion of antibiotic therapy? - CORRECT ANSWERS Test for C
...

23
...

24
...

25
...

26
...
Sports drinks aren't as effective as
specific electrolyte replenishing drinks
...
At what point should a patient be referred to the hospital for dehydration? CORRECT ANSWERS Signs of hypovolemia such as hypotension, tachycardia,
pallor, and poor skin turgor
...
T of F: Empiric antimicrobial therapy is recommended for patients with severe
diarrhea suspected form traveling
...
Bactrim,
Ciprofloxacin, Norfloxacin, Floxacin
...
T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is
appropriate
...
How effective is antibiotic prophylaxis for patients traveling to high-risk areas? CORRECT ANSWERS 90% effective
31
...

32
...
What is an appropriate symptomatic treatment for patients < 65 years or age with
significant vomiting? - CORRECT ANSWERS Two-day course of Zofran or
Phenergan
...
What is the best way to prevent AGE? - CORRECT ANSWERS Hand washing
...
T or F: Kids can attend daycare with infectious diarrhea as long as they're
separated from other children
...

36
...
If pain is present in the left lower quadrant, what might be the etiology related to
bowel disorders? - CORRECT ANSWERS Diverticulitis, IBS, IBD, Constipation,
and Infectious Colitis
...
If pain is present in the left upper quadrant, what might be the etiology related to
bowel disorders? - CORRECT ANSWERS Stomach ulcers, pancreatitis, and
gastritis
...
If pain is present in the right upper quadrant, what might be the etiology related to
bowel disorders? - CORRECT ANSWERS Gall bladder, hepatitis, and
pancreatitis
...
T or F: IBS is a disorder of bowel function in the absence of an atomic
abnormality
...
What are common symptoms of IBS? - CORRECT ANSWERS Changes in
bowel habits such as diarrhea (IBS-D), constipation (IBS-C), abdominal pain,
bloating, rectal urgency with diarrhea
...
What are some extra-intestinal (outside the intestines) symptoms of IBS? CORRECT ANSWERS Sexual dysfunction, loss of libido, dyspareunia, muscle
aches and pains, fatigue, fibromyalgia, headaches, back pain, urinary urgency,
urinary hesitation, or bladder spasms
...
T or F: IBS results in serious medical consequences - CORRECT ANSWERS
False, prognosis for IBS is excellent
...
T or F: IBS is a risk factor for IBD (Crohn's and UC) and colon cancer
...
What are the two most common types of bowel disorders under the Inflammatory
Bowel Disease (IBD) umbrella? - CORRECT ANSWERS Ulcerative Colitis (UC)
and Crohn's Disease
46
...
T or F: UC extends into the small intestine
...

48
...
CORRECT ANSWERS True

49
...
What are these areas
referred to as? - CORRECT ANSWERS Skipped lesions
50
...

51
...
Subsequently, those with a certain genetic predisposition may
produce antibodies that chronically attack the intestine (autoimmune)
...

52
...
- CORRECT ANSWERS
Disordered sensation or abnormal function of the small or large intestine
...
What is the most consistent characteristics of IBS? - CORRECT ANSWERS
Alteration in bowel habits alternating
...
Painless
diarrhea may occur
...
What are the three most common areas of abdominal tenderness for patients
with suspected IBS? - CORRECT ANSWERS LLQ, umbilicus, or epigastrium
...
T or F: The physical exam for patients with suspected IBS is usually abnormal CORRECT ANSWERS False: It's usually normal because there is no anatomical
abnormality behind this condition
...
T or F: Digital rectal exams are usually normal in patients with suspected IBS but
may exacerbate symptoms
...
T or F: Extensive testing such as thyroid testing, abdominal imaging, and stool
studies are indicated in patients with suspected IBS - CORRECT ANSWERS
False: Start with basic labs such as CBC and ESR, although elevated ESR and
leukocytosis is typically seen with IBD, not IBS
...
T or F: Colonoscopy and barium enema are abnormal in a patient with suspected
IBS - CORRECT ANSWERS False: Those tests would be normal because there
is no anatomical abnormality behind this condition
...
What are 4 main points of diagnosis for patients with suspected IBS? CORRECT ANSWERS 1
...

2
...
Heightened sensation in bowel activity

4
...
- CORRECT
ANSWERS False
What is the first step to treating a newly diagnosed IBS patient? - CORRECT
ANSWERS Determine whether they are IBS-D, IBS-C, or IBS-M
What are the 4 main points of IBS treatment? - CORRECT ANSWERS 1
...
Education
3
...
Supportive interventions: i
...
reduce stress
T of F: There is proven treatment for IBS - CORRECT ANSWERS False
At what severity are pharmacological measures taken in patients with IBS? Mild,
moderate, or severe? - CORRECT ANSWERS Moderate to severe
What is the first-line treatment for IBS-C? - CORRECT ANSWERS 1
...
Exercise
3
...
- CORRECT ANSWERS False
...

What stimulant laxatives can be used for IBD-D on a short-term basis? And if these fail?
- CORRECT ANSWERS 1
...

2
...
- CORRECT ANSWERS True
T or F: Tricyclics antidepressants and SSRIs have shown to have favorable outcomes in
patients with IBS - CORRECT ANSWERS True
T or F: APRNs should not be managing patients with IBS and should immediately refer
to a gastroenterologist - CORRECT ANSWERS False
...
If these fail, they should then be referred
...
Fever
2
...
Leukocytosis
4
...
CORRECT ANSWERS True
Crohn's Disease represents an abnormality in intestinal immune response
...
Causes fibrosis which thickens the bowel wall
2
...

T or F: Patients with Crohn's are at higher risk than the general population for
developing colon cancer
...

What type of tissue damage occurs ulcerative colitis (UC)? - CORRECT ANSWERS 1
...

2
...

What happens to the mucosa in ulcerative colitis (UC)? - CORRECT ANSWERS It
becomes edematous and thickened, narrowing the lumen of the colon
...
Abdominal cramping
2
...
Anorexia and weight loss
4
...
RLQ pain or mass
What are the possible components of the stool that show up in patients with Crohn's? CORRECT ANSWERS 1
...
Mucus
3
...


T of R: Crohn's is characterized by periods of acute exacerbation alternating with
complete remission
...

What are the most common presenting symptoms of ulcerative colitis (UC)? CORRECT ANSWERS 1
...
Abdominal cramping
3
...

- CORRECT ANSWERS True
How many bowel movements do patients with mild UC report on a daily basis? CORRECT ANSWERS Up to 4 loose BMs associated with abdominal cramps that are
relieved with defecation
...

How many bowel movements do patients with severe UC report on a daily basis? CORRECT ANSWERS 6-10 loose BMs per day, abdominal tenderness, and symptoms
of anemia, hypovolemia, and impaired nutrition
...

What is the severity of Crohn's based on? - CORRECT ANSWERS Level of
inflammation and intestinal lumen obstruction caused by fibrosis
...
Tenderness in the LLQ or across the entire abdomen
2
...
Abdominal distention
4
...

What is an important first step when considering ulcerative colitis as a diagnosis? CORRECT ANSWERS Excluding an infectious cause for the colitis

What tests are used to differentiate UC from CD? - CORRECT ANSWERS 1
...
Colonoscopy
3
...
CT
T or F: IBD treatment can be very complex and in generally managed by a
gastroenterologist
...

T or F: Antidiarrheals should be used for acute UC and toxic megacolon
...

If 5-ASA drugs fail to help treat IBD, what is the next line of drug therapy? - CORRECT
ANSWERS Corticosteroid therapies such as prednisone or hydrocortisone and are very
effective in reducing inflammation
...
Note: These drugs cause bone marrow suppression which
increased the risk of infection
...

What disease is present when inflammatory changes within diverticula mucosa of the
intestines arises? - CORRECT ANSWERS Diverticular Disease
What does diverticular disease, or diverticulosis, look like upon examination of the
bowels? - CORRECT ANSWERS Small outpouchings or sacs in the wall of the colon
are present, usually at the location of weakened areas of the bowel wall where arterial
vessels perforate the colon
...
- CORRECT ANSWERS True
Although diverticula con occur anywhere in the intestines, where is the most common
place for them to arise? - CORRECT ANSWERS Descending and sigmoid colon

How does diverticulosis differ from diverticulitis? - CORRECT ANSWERS The latter
occurs when the former becomes inflamed and subsequently has the potential to
rupture
Where does acute diverticulitis usually show up during an abdominal exam? CORRECT ANSWERS LLQ abdominal pain and tenderness
If a perforation of a diverticula occurs and is not isolated, signs and symptoms of
_________________ may be present
...
think
rebound tenderness!
What are common signs and symptoms of diverticulitis? - CORRECT ANSWERS 1
...
Fever
3
...
N/V
T or F: Occult blood can usually be found in the presence of diverticulitis
...
CBC: can show mild to moderate leukocytosis
2
...

T or F: Abdominal x-rays should be obtained on all patients with suspected diverticulitis
...

Which clinical test is very sensitive and accurate for definitive diagnosis of diverticulitis?
- CORRECT ANSWERS CT scan with oral and IV contrast
If evidence of diverticulitis is found on x-ray, what would be the next step? - CORRECT
ANSWERS Treat empirically, do NOT wait for confirmation with CT
...
Idiopathic
2
...
Tricyclics antidepressants
4
...
Anticholinergics
6
...
Antipsychotics
8
...
Can be a symptom of colorectal cancer
How is constipation treated? - CORRECT ANSWERS 1
...
Bulking agents: psyllium and methylcellulose
...
They're softer and easier to pass
...
Laxatives & stool softeners if diet changes aren't sufficient
4
...

Personal history of CC or adenomatous polyps
2
...

3
...
A known family history of hereditary colorectal cancer syndromes such as familial
adenomatous polyposis or Lynch Syndrome (hereditary nonpolyposis colorectal
cancer)
...
- CORRECT ANSWERS True
What are some red flag symptoms of colorectal cancer? - CORRECT ANSWERS 1
...
Rectal bleeding
3
...
New onset of severe diarrhea or constipation
5
...
Loss of appetite
What are two possible functions of the appendix? - CORRECT ANSWERS 1
...
Immune system role
What percentage of the populations experiences appendicitis at some point in their life?
- CORRECT ANSWERS 10%

T or F: Appendectomy is the most common surgery of the abdomen
...
Fecalith or "poop rock"
2
...
Pinworm infection
4
...

How does the appendix become inflamed and what nerves does it affect? - CORRECT
ANSWERS Mucus is continually produced by intestinal tissue
...
As it inflames, it pushes on the visceral nerve fibers causing abdominal
pain
...
coli and Bacteroids fragilis multiply and
causes the immune system to respond
...
RLQ pain --> McBurney's Point
2
...
N/V
What is the pathology of appendicitis from onset to peritonitis? - CORRECT ANSWERS
Increasing inflammation causes blood vessels to become compressed --> ischemia of
the appendiceal tissue --> tissues necrosis --> bacterial invasion of appendiceal tissue
and pus formation--> appendiceal tissue rupture --> peritonitis with rebound tenderness
What are two possible complications of a ruptured appendix beyond peritonitis? CORRECT ANSWERS 1
...
Subphrenic abcess
What treatment is usually performed when appendicitis is present? - CORRECT
ANSWERS Appendectomy + Antibiotics
Describe acute pancreatitis in one sentence
...

What are the main endocrine functions of the pancreas? - CORRECT ANSWERS
Alpha and beta cells secret hormones into the bloodstream, namely glucagon and
insulin, respectively
...

How does the pancreas protect itself from its own enzymes? - CORRECT ANSWERS
By producing inactive forms of enzymes called proenzymes, known more specifically as
zymogens
...

Where is zymogen stored to keep it away from sensitive tissues? - CORRECT
ANSWERS In vesicles called zymogen granules
...

How are zymogens used to digest food? - CORRECT ANSWERS They are secreted
into the pancreatic duct and enter the duodenum where they are activated by the
protease trypsin
...
It is activated by enteropepidase
which is produced in the duodenum
...

What is the results of trypsinogen and other zymogens becoming active prematurely? CORRECT ANSWERS Acute Pancreatitis
Acute pancreatitis may be a result from what two physical circumstances? - CORRECT
ANSWERS 1
...
Impaired secretion of proenzymes
What are the leading causes of impaired secretion of proenzymes from the pancreas? CORRECT ANSWERS 1
...
Gallstones
How does alcohol induce acute pancreatitis? - CORRECT ANSWERS 1
...
Simultaneously, it decreases fluid and
bicarbonate in the ducts of the pancreas
...

2
...
Membrane
trafficking* becomes chaotic
...
This brings
trypsinogen into contact with lysosomal digestive enzymes
...

3
...

Neutrophils arrive and release superoxide and proteases which contributes to the
problem
...
High alcohol consumption and oxidative metabolism of alcohol produces reactive
oxygen species which may overwhelm cellular defenses
...
Membrane trafficking uses membrane-bound vesicles as transport
intermediaries
...
This results in much the same results as alcohol induced acute
pancreatitis (because of the plug)
Fill out the acronym "I GET SMASHED" in order to show the varied causes of acute
pancreatitis
...
e
...

D: drugs --> sulfa, reverse transcriptase inhibitors and protease inhibitors
...

What happens when lipases are activated in the pancreas as a result of the
inflammatory process? - CORRECT ANSWERS They can destroy the fat surrounding
the pancreas known as the peripancreatic fat
...

One complication of acute pancreatitis is a pseudocyst
...
Symptoms: abdominal pain, loss of appetite, palpable
mass, serum amylase/lipase/bilirubin elevation
...
They can become infected, often by E
...

How is a pancreatic pseudocyst distinguished from a pancreatic abscess since they
present similarly in symptoms and imaging? - CORRECT ANSWERS 1
...

How does acute pancreatitis affect the body's respiratory system? - CORRECT
ANSWERS May lead to acute respiratory distress syndrome (ARDS) where massive
pancreatic inflammation leads to leaky blood vessels throughout the body making it
harder to breath
...

What are some general symptoms of acute pancreatitis? What about distinctive signs? CORRECT ANSWERS 1
...
Hypocalcemia as a result of fat necrosis
3
...
Bruising along the flanks (Grey Turner's sign)
3 & 4 happen as a result of necrosis induced hemorrhaging spreads to the soft tissues
of those body areas
What are the diagnostic features of acute pancreatitis? - CORRECT ANSWERS 1
...
Labs: Amylase and lipase, the latter being more specific to the pancreas
...
CT scan: inflammation, necrosis, pseudocyst
4
...

How is acute pancreatitis treated? - CORRECT ANSWERS It can't be cured, per se
...

Treat complications with oxygen (ischemia of tissue) and antibiotics for infection such as
in an abscess
...


The small intestine secretes ________________ into the blood when food is present in
order to instruct the ___________ to secrete ________ to help digest food
...
cholecystokinin
2
...
bile
Pain resulting from acute cholecystitis usually starts in the ____________ region and
shifts to the ____________ as the gallbladder becomes ____________
...
midepigastric
2
...
infection
What is the main subjective s/s of acute cholecystitis? - CORRECT ANSWERS Nausea
& vomiting which can last a long time
...
The bile
becomes an irritant to the gallbladder mucosa which in turn secretes mucus and
enzymes
...

Where does pain caused from cholecystitis radiate? - CORRECT ANSWERS Right
scapula, shoulders
Bacteria eventually make their way through the gall bladder wall and into the
_____________ causing _____________
...
CORRECT ANSWERS 1
...
peritonitis
3
...
CORRECT ANSWERS Murphy's
What would blood work show in a patient with cholecystitis? What is the condition
called? - CORRECT ANSWERS 1
...
Neutrophilic leukocytosis
What is the most common resolution of cholecystitis? - CORRECT ANSWERS The
gallstone leaves the cystic duct falling back into the gallbladder
...
This causes ischemia to the organ which leads to gangrenous cell death
...


What complications might arise upon gallbladder rupture? - CORRECT ANSWERS
Bacteria from the gallbladder can be expelled and infect the circulatory system leading
to sepsis
...

What complications arise if a gallstone becomes lodged in the common bile duct? CORRECT ANSWERS Bile backs up into the gallbladder and the liver
...

What markers in the blood can be used to assist in the diagnosis of cholecystitis? CORRECT ANSWERS ALT or alkaline phosphatase
...
The increased pressure of the bile in
the ducts can cause the cells to rupture, releasing their ALP into the blood
...
Ultrasound
2
...

*This test can also elicit the Sonographic Murphy's Sign
...
Cholescintigraphy (HIDA scan) - radio-labeled marker
...

2
...

3
...
Intravenous fluids
2
...
Antibiotics
Surgery: cholecystectomy or Lap Chole (laparoscopic approach)
What are some ototoxic drugs? - CORRECT ANSWERS Aminoglycosides, antibiotics,
aspirin, and quinine
...

_____________ is age related hearing loss and is a form of sensorineural hearing loss
...
- CORRECT ANSWERS True
T or F: Conductive hearing is often reversible
...

- CORRECT ANSWERS False, it's high-frequency loss
...
- CORRECT ANSWERS True
The _______ test used a vibrating 512-Hz (or higher) turning fork placed midline on the
patient's skull
...
- CORRECT ANSWERS unaffected (or less affected) ear
Using the Weber test, in conductive loss, the sound is ________ in the affected ear
...
When the
sound ______ ______ , the fork is promptly placed over the external auditory meatus
...
Rinne
2
...
- CORRECT ANSWERS two
Using the Rinne test, in _________________ loss, the ratio of air conduction to bone
conduction remains the same or normal (2:1)
...
- CORRECT ANSWERS 1
...
reversed
In __________ test, a vibrating tuning fork is placed over the mastoid process of the
patient and then the examiner and the results are compared
...
- CORRECT ANSWERS
sensorineural

Using the Schwaback test, in _________________ loss, the patient's bone conduction
persists for al longer time than the examiner's
...
- CORRECT ANSWERS 1
...
Exposure to loud noises
3
...
Acoustic neuroma
5
...
- CORRECT ANSWERS 1
...
Foreign body in the external canal
3
...
Chroic otitis media
5
...
Otosclerosis
7
...
Cholesteatoma
____________ hearing loss is gradual and progressive, high frequency loss, and
deterioration of the cochlea
...

How is sensorineural hearing loss treated? - CORRECT ANSWERS There's no proven
treatment, but hearing aids and cochlear implants (for profound loss) can aide
...
- CORRECT ANSWERS
False, most are reversible
...

Acute infection of the middle ear may cause a relative ischemia in drum concurrent with
increased pressure in the middle ear space
...

What are the signs and symptoms of a perforated tympanic membrane? - CORRECT
ANSWERS 1
...
Drainage from the canal, tinnitus, possible hearing loss

3
...

_______________ is scarring after the tympanic membrane has ruptured and healed
...
AOM
or tympanovstomy tubes that are expelled
...
CORRECT ANSWERS Otitis externa
What is a medical emergency that can result from otitis externa? - CORRECT
ANSWERS Osteomyelitis of the skull
What are the most common causative agents of otitis externa? - CORRECT ANSWERS
Gram-negative rods such as pseudomonas as well as fungi
...
Painful and itchy
2
...
Red, swollen and purulent discharge
...
Painful auricle
5
...
No class is better than another
...

If the TM cannot be visualized in otitis externa _______________ drops much be used
when treating
...
- CORRECT
ANSWERS 1
...
Fluoroquinolone
Uncomplicated acute otitis externa common resolves after ________ days of topical
treatment
...
With refractory cases or
auricle cellulitis
2
...
aureus
...
Connects the
middle ear to the nasopharynx
2
...
Equalizes pressure
4
...

Allergic rhinitis
2
...
URI
4
...
Pregnancy
6
...
Decreased or muffled hearing
2
...
Inability to "pop" ears with barometric pressure changes
4
...
Concern for ear infection or cerumen impaction
What is the differential diagnosis for eustachian tube disorder (ETD)? - CORRECT
ANSWERS 1
...
Otitis externa
3
...
Viral myringitis
5
...
Otosclerosis
What may be encountered on physical exam of patient with eustachian tube disorder
(ETD)? - CORRECT ANSWERS 1
...

2
...
Immobile tympanic membrane
Weber and Rinne tests in patients with eustachian tube disorder (ETD) will show
___________ hearing loss on the affected side
...
cold, AOM, AR,
T o F: Holding nose and blowing out is an effective way to help clear and equalize the
eustachian tube
...
Sometimes tympanostomy tubes are placed to relieve pressure
...
What
causes this sensation? - CORRECT ANSWERS 1
...
Poorly understood, might be from chronic noise exposure that may damage the cilia
and auditory hair cells or spontaneous activity in individual auditory nerve fibers
...
Age and
hearing loss
2
...
Metabolic disorders
4
...
Trauma
6
...
Vascular and neurogenic causes
What is the differential diagnosis for tinnitus? - CORRECT ANSWERS 1
...
Acoustic neuroma
3
...
Otosclerosis
5
...
Salicylate overdose
What should be included in the physical exam and what tests should be used when a
patient presents with tinnitus? - CORRECT ANSWERS 1
...
Weber
3
...
Pneumatic otoscopy
What labs should be drawn when a patient presents with idiopathic tinnitus? CORRECT ANSWERS TSH, CBC, B12, Lipids
Ménière's disease is a sensory disorder of the _____________ and _____________
and is idiopathic
...

Genetics may play a role
...

What is the differential diagnosis for Ménière's disease? - CORRECT ANSWERS 1
...
Vesibular neuritis
3
...
Acoustic neuroma
5
...
Acute vestibular labyrinthitis
...
Diuretics often used to reduce lymphatic pressure and
volume
...
- CORRECT ANSWERS False, but there is a
vaccination
...
Starts on head/face or behind the ears and then
spreads
...
drug reaction
2
...
other viral exanthem
What bloodwork should be drawn for suspected rubeola? - CORRECT ANSWERS IgG,
IgM, RT-PCR
T or F: Rubeola is not a reportable disease - CORRECT ANSWERS False, must be
reported to the CDC
...

When is a person with rubeola contagious? - CORRECT ANSWERS 4 days before
onset and 4 days after
...
- CORRECT ANSWERS 2
What are the s/s of rubella infection? - CORRECT ANSWERS Low grade fever,
headache, ST, rhinorrhea, malaise, eye pain and myalgia for 2-5 days prior to rash
(prodrome)
...

How long does a rubella rash linger? How long do myalgia linger? - CORRECT
ANSWERS 1-2 days, weeks
What is the differential diagnosis for rubella? - CORRECT ANSWERS 1
...
Contact dermatitis
3
...
Other exanthems
How is rubella diagnosed? - CORRECT ANSWERS Clinically
How is rubella treated? - CORRECT ANSWERS Symptomatic care with pain relief
When is a person with rubella contagious? - CORRECT ANSWERS 1-2 days before
onset of rash
What are the other names for Fifth's Disease? - CORRECT ANSWERS Erythema
Infectiosum (Human Parvovirus)
How is Fifth's Disease spread? - CORRECT ANSWERS Droplet and blood products
What is the prodrome of symptoms for Fifth's Disease? - CORRECT ANSWERS Fever,
chills, headache
...

How does the first stage of Fifth's Disease manifest? - CORRECT ANSWERS As a
"slapped cheek" bilateral rash, sparing the forehead, bridge of nose and perioral region
...
Spares the palms of hands and soles of feet
...

What is the differential diagnosis for Fifth's Disease? - CORRECT ANSWERS 1
...
Systemic lupus

3
...
Other viral exanthems
T of F: bloodwork is a good option for Fifth's disease diagnosis because IgG and
parvovirus are readily detectable
...
Virus can't be
detected until 3 weeks after rash eruption
...
Avoid heat
which can exacerbate rash
...

Phototoxic reaction
2
...
Drug eruption
4
...

T or F: Pityriasis Rosea is an easily identified virus - CORRECT ANSWERS False
What population is affected and what is the timing for Pityriasis Rosea? - CORRECT
ANSWERS 1
...
Females > Males
3
...
This is called a
Harold Patch
...

What parts of the body are spared in Pityriasis Rosea? - CORRECT ANSWERS Face,
palms of hands and soles of feet
What are the s/s of Pityriasis Rosea? - CORRECT ANSWERS Low grade fever,
headache, and fatigue
...
- CORRECT
ANSWERS True

What is the differential diagnosis for Pityriasis Rosea? - CORRECT ANSWERS 1
...
Drug eruption
3
...
Topical steroids, systemic
if intractable
...
Acyclovir for 1 week may decreased severity
3
...
Avoid trauma and harsh chemicals on skin
5
...

What viruses are responsible for Hand, Foot, and Mouth Disease (HFMD)? - CORRECT
ANSWERS Coxsackie Virus A16 and Enterovirus 71
What is the prodrome of Hand, Foot, and Mouth Disease? - CORRECT ANSWERS 1
...
Fatigue
3
...

Lesions are often vesicles with erythematous halos
...
CORRECT ANSWERS False, 7 days
...
Varicella
2
...
History
and clinical diagnosis
How is Hand, Foot, and Mouth Disease treated? - CORRECT ANSWERS
Symptomatically, this is a self-limiting disease
...


When is a patient with Hand, Foot, and Mouth Disease contagious? - CORRECT
ANSWERS 4-6 days before rash begins
...

What virus is responsible for molluscum contagiosum and who can it affect? CORRECT ANSWERS Poxviridae, affects both children and adults
...
2-5mm
pustules with a depression in the center
...
Single or multiple lesions may occur
3
...
ALWAYS
How long do papules of molluscum contagiosum last? How about the virus that causes
it? - CORRECT ANSWERS 1
...
8+ months
What is the differential diagnosis for molluscum contagiosum? - CORRECT ANSWERS
1
...
Hypersensitivity reaction
3
...
Often
misdiagnosed as genital warts
...
OTC
creams such as Zymaderm
2
...
Oral cimetidine 40mg/kg/day x 2 months
4
...

When can a person infected with molluscum contagiosum return to activity? CORRECT ANSWERS Once they are symptom-free
...

T or F: the most common cause of folliculitis is gram - bacteria
...
aureas

How does folliculitis present? - CORRECT ANSWERS Pustules and erythema around
hair follicle
...

T or F: KOH is used to determine if folliculitis fungal or yeast-related
...
Acne
2
...
Papular eczema
4
...
Topical antibiotic or systemic +
topical if needing to cover larger area
...
Doxycycline 100mg BID x 14 days
3
...
Chlorhexidine wash twice a week to decrease staph on skin
...
aureus
What is a furuncle? - CORRECT ANSWERS Infection that involves the hair follicle and
extends to surrounding tissue (usually axillae, neck and buttock)
What is a carbuncle? - CORRECT ANSWERS Cluster of abscesses that connect
subcutaneously and form one large mass
...

What is the differential diagnosis of abscess? - CORRECT ANSWERS 1
...
Bug bite
3
...
Keep
the area clean
2
...
Cover if draining
When should incision and drainage (I&D) be considered for an abscess? - CORRECT
ANSWERS When the abscess is fluctuant (able to move or compress substance of
mass)
...


How are abscesses treated pharmacologically? - CORRECT ANSWERS 1
...

2
...

T or F: Scarlet fever is caused by Group-A beta-hemolytic streptococcus (GABHS) CORRECT ANSWERS True
How does Scarlet Fever present? - CORRECT ANSWERS 1
...
Fever, bright red sore throat, lymphadenopathy, bright red skin especially in the
elbow, axillae, and groin
...
Viral
rash
2
...
Contact dermatitis
How is Scarlet Fever diagnosed? - CORRECT ANSWERS 1
...
If rapid strep is negative, culture the throat
...
PCN VK drug of choice
2
...
Erythromycin or later generation macrolide for patients allergic to PCN
...
- CORRECT ANSWERS False, it is
manageable but NOT curable
...
Mild
2
...
Severe
How is mild acne defined? - CORRECT ANSWERS A patient with mild acne that has a
few papules and pustules
...

How is severe acne defined? - CORRECT ANSWERS A patient with moderate acne
that has a few papules, multiple pustules, and many multiple and are painful
...
Rosacea
2
...
Perioral Dematitis
T or F: Chocolate and greasy food causes acne
...


T of F: There is a possible correlation between low fat milk (particularly skim) and acne
...
Good facial cleanser with benzoyl
peroxide or salicylic acid
...
Mild: cleaner, topical antibiotic, possible low-potency retinoid (Adapalene)
3
...
Severe: cleaner, medium to high potency retinoid, topical and oral antibiotic
What is another name for Accutane? - CORRECT ANSWERS Isotretinoin
When is Accutane an appropriate treatment? - CORRECT ANSWERS When multiple
other treatments have failed and in whom scarring is a concern
...

What are two risks associated with Accutane? - CORRECT ANSWERS IBD and
depression
What are common side-effects of Accutane? - CORRECT ANSWERS Chapped lips
and dry skin
...
Athlete's Foot
How does tine pedis present? - CORRECT ANSWERS Erythematous, scaly, possible
inflammation and itching
...
Ketoconazole cream x 4 weeks
2
...
Oral abx may be needed if severe
What part of the body does tinea cruris affect? - CORRECT ANSWERS The groin,
buttocks, or inner thighs
...

How is tinea cruris treated? - CORRECT ANSWERS Topical anti fungal x 4 weeks,
Zeabsorb powder to prevent another occurrence
...
Can be large or small
...
4 weeks of treatment
...
Yellow, green, black, or white in color
...

How is tinea unguium (onychomycosis) treated? - CORRECT ANSWERS 1
...

2
...
- CORRECT ANSWERS True
T of F: The hands, feet, and genitalia are the hardest to treat for warts
...
They interrupt skin lines
...

How are warts treated? - CORRECT ANSWERS 1
...
Paring the skin and using liquid nitrogen
...
Usually takes 6-8
treatments 4 weeks apart
...
Duct tape occlusion: 4-6 days, remove, pare, repeat until resolved
...
Cantharidin-blistering agent (not for face or genitals), bandage over the top, patent
washes it off 4-6 hours after treatment
...

5
...

How does scabies present? - CORRECT ANSWERS Patient will report intense itching
that is worse at night
...
Common places: finger and toe webbing
...
Medicate patient and treat
environment
2
...

Every crease and crevice!
3
...

4
...

5
...

*Caution in patients with asthma
...
25% become squamous cell carcinoma
...

- CORRECT ANSWERS True
How do actinic keratoses present? - CORRECT ANSWERS Rough, textured skin
...

What might patients complain of when they rub their hands over an AK? - CORRECT
ANSWERS Stinging sensation
What is the differential diagnosis for AKs? - CORRECT ANSWERS 1
...
Eczema
3
...
Squamous Cell Carcinoma (SCC)
How are AKs treated? - CORRECT ANSWERS 1
...
Educated about
possibility of hypopigmentation
...
Immunotherapy: (Imiquimod and 5-fluorouracil)
What is Vitiligo? - CORRECT ANSWERS When the melanocytes in the skin
malfunction resulting in depigmented areas of skin
...


What are some possible etiologies of Vitiligo? - CORRECT ANSWERS Hereditary
factor or autoimmune disorder
How does Vitiligo present? - CORRECT ANSWERS Well-demarcated, depigmented
white macule or patches surrounded by normal skin
...

How is Vitiligo treated? - CORRECT ANSWERS 1
...
Phototherapy: large areas
...
Use sun protection
What is contact dermatitis? - CORRECT ANSWERS Allergic reaction to substance
which produces an immune reaction
...
It is not
contagious
...

What are common causes of contact dermatitis? - CORRECT ANSWERS Poison ivy,
nickel, antibiotic creams, soaps, fragrances, jewelry, other plants, etc
...

1
...
Oral antihistamines for itching
3
...
These should be
tapered
...
Disorder
that is the result in a gene variation that affects the skins ability to retain moisture
...
CORRECT ANSWERS True
What can cause a flare-up of atopic dermatitis? - CORRECT ANSWERS Food or
environmental exposures
How does atopic dermatitis present? - CORRECT ANSWERS Patchy, dry, itchy skin;
reddish-brown; vesicles that leak
How is atopic dermatitis treated? - CORRECT ANSWERS 1
...
Avoidance of causative factors
...
Short of breath of difficulty breathing
2
...
Suffocation or smothering
4
...
Winded
T of F: The most common cause of dyspnea is pulmonary or cardiac decompensation CORRECT ANSWERS True
What are some etiologies other than pulmonary or cardiac decompensation that may be
the cause of dyspnea? - CORRECT ANSWERS 1
...
Neuromuscular disease
3
...
Pain
5
...
- CORRECT ANSWERS True
Define acute dyspnea
...

Define chronic dyspnea
...
- CORRECT ANSWERS True
T of F: 2/3 of chronically symptomatic patients have a cardiopulmonary etiology
...
The other 1/3 of patients have multi-factorial causes
...
Asthma
2
...
Malignancy
4
...
Interstitial lung disease
6
...
Valvular heart disease
8
...
Arrhythmias
10
...
Myocardial ischemia
What are come common non-cardiopulmonary conditions that lead to chronic dyspnea?
- CORRECT ANSWERS 1
...
Physical deconditioning
3
...
Psychogenic disorders
5
...
Kyphoscoliosis
7
...
Upper airway obstruction (tumor, vocal cord paralysis, tracheal stenosis, etc
...
Pharmacological causes of dyspnea
What are the different classifications of dyspnea? - CORRECT ANSWERS 1
...
Volume
These two classes can be either extra-thorax or intra-thorax
...
- CORRECT ANSWERS Obstruction of
distal/smaller airway: cause expiratory effort in infants and also in children less than five
years of age
...
Asthma
2
...
Vascular ring
4
...
Lymph node enlargement pressure
Define extra-thorax flow disorder
...

1
...
Cranio-facial malformaiton
3
...
Tonsil-adenoid hypertrophy
5
...
Larynx papilloma
7
...
Croup, epiglottitis
9
...
- CORRECT ANSWERS Lung parenchyma
disorders: these disorders affect inspiratory effort
1
...
Atelectasis
3
...
Near drowning
5
...
- CORRECT ANSWERS Lung compliance
disorders: these disorders affect inspiratory effort
1
...
Cardiomegaly, heart failure (perfusion)
3
...
Hernia diaphragmatic
5
...
Intra-thorax mass (non-pulmonary)
7
...
Thorax deformity (picture excavated, scoliosis)
Lung compliance issues: inspiratory constraint
1
...
Gastritis, peptic ulcer
3
...
Peritonitis, appendicitis, acute abdomen
5
...
Ascites
7
...
Abdominal solid tumor
Respiratory center disorders
...
Anemia
2
...
CNS infections: meningitis, encephalitis
4
...
Poisoning: salicylate, alcohol
6
...
CNS disease sequelae
How is the clinical diagnosis of dyspnea approached? - CORRECT ANSWERS 1
...

2
...

-Cardiac: 3rd and 4th heart sounds, murmurs, friction rubs, JVD, pedal edema, calf
tenderness
3
...

*80% of dyspnea cases can be initially diagnosed through history
...
Meibomian glands are
dysfunctional
...

How does blepharitis present? - CORRECT ANSWERS Irritation, burning, itching,
scales, and redness
...

What complications can occur from blepharitis? - CORRECT ANSWERS Conjunctivitis,
cellulitis, keratitis
How is blepharitis treated? - CORRECT ANSWERS 1
...
Erythromycin topical ointment to lids at night
T or F: Lice can also be the causes of blepharitis - CORRECT ANSWERS True, and it's
usually pubic lice
...
These represent
the feces of the lice
...
Onset
is acute
...


How is a chalazion treated? - CORRECT ANSWERS 1
...
Requires time
and patience, can take weeks to months to resolve
...

3
...

4
...

5
...
Acute and very painful onset associated with redness and swelling and are
usually on the outside of the lid
...

What is bacterial conjunctivas (pink eye)? - CORRECT ANSWERS Direct hand to eye
contact with infected person, spread of one's own nasal sinus bacterial during illness
...
Reddened conductive, led swelling
...

How is bacterial conjunctivitis treated? - CORRECT ANSWERS May resolve without
treatment, but abx drops can help eradicate quicker
...
Choice of
abx is based on patient's allergies, preference, cost, and availability
...
Throw away all makeup related items that are likely contaminated
...
24hours of treatment before returning to work/school
...
Sight-threatening
...
Hyper-purulent discharge
...
Others: herpes simplex or zoster virus, molluscum contagiosum
...
Exam: mild to intense hyperemia, water
or mucous drainage but NOT purulent
...
Test:
rapid-test available office but its expensive and not normally done
...
Days to
weeks
...
No firm guidelines about school/work, but AAO
recommends absence until redness or tearing are gone
...

What is allergic conjunctivitis? - CORRECT ANSWERS Usually caused by
environmental allergen such as pollen, grass, trees
...

HALLMARK: Itching
How does allergic conjunctivitis present? - CORRECT ANSWERS HALLMARK: Itching
...
May find
"follicles" on the internal side of the eyelid, considered another hallmark of allergy
...
No
scratching
...
OTC anti-allergy drops
...

What is toxic conjunctivitis? - CORRECT ANSWERS Overuse of topical ocular
medications such as Visine and antibiotic drops (most common)
...

How does toxic conjunctivitis present? How is it treated? - CORRECT ANSWERS 1
...
gathered from history
...
STOP THE DROPS
What are some traumatic injuries of the eye commonly seen? - CORRECT ANSWERS
1
...
Guaze over eye and send to
ER
...
Subconjunctival hemorrhage: directed trauma, sudden increase of pressure
(sneezing, coughing, straining, vomiting, strangling)
...

-Mild: benign, self-resolving
...
Check visual acuity! If normal, reassure
...

3
...
Trauma, FB
...
Test: Fluorescein staining, topical
anesthetic
...
REFER
4
...
REFER
...
Hyphema: blood trapped between Iris and Cornea
...
REFER
...
Ruptured globe: blunt or penetrating trauma, will require surgical repair
...
REFER
...
Chemical injuries: Severity depends on pH, volume, and duration
...
Liquids, solids, powder, mist for vapor
...

-Common alkaline: ammonia, drain cleaner (lye), cement (lime), plaster mortar
(sodium), airbags and fireworks (magnesium hydroxide)
...
REFER!
•Acid burns: conjunctival and corneal abrasion, mild corneal haze, prognosis is good for
full recovery
...
Poor prognosis
...
Localized infection
(sinus, tooth) or skin disruption
...
Common pathogens: Steph, GABHS, Strep Pneumo
How does periorbital cellulitis present? - CORRECT ANSWERS Minimal pain, fever,
redness, lid edema, doesn't look too sick
...

How does orbital cellulitis present? - CORRECT ANSWERS 1
...
Hallmark: Pain with eye movement
...

2
...

3
...
influenzae
4

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