Family Nurse Practitioner (FNP) Study Guide

Cough for 4 weeks
No fever
No wheeze
No sputum

Dx & tx
Bronchitis

SABA

Paroxysmal cough
Pertussis

Send to ED

Macrolide

Burning, dry cough
Sour taste

Dx & tx
GERD

H2 or PPI

Barrett's esophagus
Increased risk with Long-standing GERD

Worst case, leads to CA

Most worrisome GERD s/s
Dysphagia

Mailman with fever, chills, n/v
Encountered an odd substance at work
Anthrax - bioterrorism

Cipro 60 days

Male infant with scrotum that transluminates
Hydro electric

Refers by 1 yo or refer to GU

High fever 5 days
Skin peeling from hands and feed
No ulceration

Dx & tx
Kawasaki

ASA or IV IgG

Youngest age for flu vaccine
6 mos

Youngest age for MMR & varicella vaccines
12mos

Tdap age
7yo and up

T=teen

HPV youngest age
9yo

Birth weight doubles by ________

6mos

Birth weight triples by __________

12 mos

Screen autism at what age?
18-24 mos

RhoGam given when?
28weeks and 72hr postpartum

Swab GBS when?
36 weeks

Hand-foot-mouth disease
Coxsackie virus

Fifth disease
erythema infectiosum

Parvovirus B19

Slapped cheek, lacy rash

Roseola
Exanthem subitum

Herpes virus 6

Appears after fever resolves
Maculopapular on body

Rubella
German measles

Lymphadenopathy
Maculopapular

Macular on soft palate (Forcheimer)

scarlatina
Scarlet fever, Group A Strep

Sandpaper rash
Desquamation

Rubeola
Measles

Cough, Coryza, conjunctivitis

Koplik spots on buccaneers mucosa

actinic keratosis
Dry, rough Horn
Slow growing
Non-healing

Sun damage
Older people

Increased risk of squamous cell ca

seborrheic keratosis
Waxy, stuck on appearance
Light tan to black
Wart like

 

basal cell carcinoma
Round
Light
Pearly

Treatment: 5FU cream or cryotherapy

Common abx to treat skin infection
Penicillin and keflex

Skin lesion - round with central clearing, itches
Tinea corporis

Melanoma
Irregular border
Dark
Uneven texture
>6mm

strabismus

s/s and test
Uneven gaze
Cross eyed

Test with cover, uncover (Hirschberg)

Refer if not resolved by 6mos

Lab to test for Rh antibodies
Coombs test

What test is done before changing treatment for asthma?
Spirometry (PFTs)

Migraine s/s
Unilateral
behind eye
Photophobia
n/v

Migraine abortive tx
Triptan

Migraine preventive treatment
Propranolol

Cluster HA
same time
same location
Unilateral
Tearing and rhinorrhea

Cluster HA tx
High flow O2

Abortive tx- triptan
Prophylactic to- VERApamil
CCB to vasodilate

Tension HA
Bilateral
Band like
Squeezing

Tx- bNSAID

Patient fell and is woozy
Neuro exam is negative
Concussion

Someone fell & is slurring words
Subdural hematoma

Slow, progressive bleed

Send to ED

Cranial nerve of Bell's Palsy
7

Cranial nerves of EOM

3.4.6

Crania nerve of trigeminal neuralgia
5

trigeminal neuralgia
aka tic douloureux
severe, burning pain
Shock, lightning, electric

Unpredictable, intermittent

trigeminal neuralgia tx
Carbamazepine (tegretol)

UTI in pregnancy
Nitrofurantoin in 1st & 2nd trimester

Keflex in 3rd trimester
Kick the baby out

C.diff treatment
Flagyl or vancomycin

If PCN ax, give
Macrolide (azithromycin)

If ax to macrolide, go to doxy

Chlamydia tx
Azithromycin 1G

If ax, give doxy

#1 cause of adolescent deaths
auto accidents

#1 cancer killer of men and women
Lung cancer

#1 killer of men and women
heart disease

Eczema special instructions
No hot water when bathing
Moisturize

Special instruction with flagyl
No ETOH
antabuse

Corneal abrasion
Linear
Round and irregular if several

Weber test in conductive hearing loss
sound lateralizes to impaired ear

Rinne: Normal Hearing
AC>BC

Rinne conductive hearing loss
BC > AC

Rinne sensorineural hearing loss
AC>BC

Malaria prophylaxis
Doxycycline

INR for anticoagulation
2-3

Diet when on warfarin
Limit green, leafy vegetables
Avoid grapefruit juice
Avoid bactrim

DM2 diagnosis

A1C
Fasting BG
>= 6.5

>= 126

New DM first medication
Metformin

s/e GI upset
Max dose 2000mg/day

PreDM diagnosis

A1C
Fasting BG

5.7-6.4
100-125

Tx A1C >= 10
Basal insulin
Lantus or levimir

metformin risk
lactic acidosis
Hold 24hrs before and 48hrs after contrast

Need to check BG average, but it's not time for A1C
Frustosamine
Trend of 2-3weeks

Dawn phenomenon
AM hyperglycemia
Increases al night long

Give more night time insulin

Somogyi effect
hypoglycemia followed by rebound hyperglycemia

Give less night time insulin or snack at bedtime

A1C goal for diabetics
7%
8% Medicare age

Elderly on dig with elevated creatinine
Decrease dose to prevent toxicity

Check dig level

plantar fasciitis
Pes planus

Tx RICE & NSAIDS

Twisted knee with no instability
RICE

DeQuervain's Tenosynovitis
tendonitis originating in the base of the thumb

Positive Finkelstein

RICE

Gold standard test for back pain
MRI

Lupud definitive lab test
ANA

chloasma
Mask of hyperpigmentation

Melasma

No period by 16yo
Primary amenorrhea
Refer

secondary amenorrhea
no menses for 3 months

UPT, Hcg

Galactorrhea- labs
Prolactin

Med that causes gynecomastia in men and women
Spironolactone

Acute burn first aid
Remove clothes before they burn into skin

Scrotum like bag of worms
Varicocele

Refer

Atypical pneumonia
Mycoplasma pneumoniae

Sore throat
Cough
HA
Fever

Atypical pneumonia tx
Macrolide
Azithromycin

cough and rust colored sputum
Strep pneumonia

Tx with Levaquin

If peds- treat with high dose amox

Oseoarthritis nodes
Heberden and Bouchards

Osteoarthritis first line med
Tylenol

OA exercises
Low impact, isometric
Water exercises

Osteoporosis exercises
Weight bearing to stimulate bone production

Osteoporosis tx
Bosphosphonates

Full glass water
Empty stomach 30mins
Sit upright

Osteoporosis screening
 DEXA
 women 65+
 every 2 yrs

Fall risk assessment
Get up and go
>12sec - fall risk
12sec or less -passed

calcium requirements
1200mg/day

Vit D requirements
600 -800 units/day

Inner elbow pain
Medial epicondylitis

Golfers elbow
Tx RICE

Outer elbow pain with twist and grasp
Lateral epicondylitis
Tennis elbow
Tx RICE & NSAID

Numbness and burning between 3rd & 4th metatarsal
Morton's neuroma

RA s/s
Joint pain lasts >1hr in AM
Bouchard nodes (proximal -PIP)
Boutonnières- bent knuckles
Swan neck deformity (fingers point out)

May have low grade temp

RA first line treatment
NSAIDS

ankylosing spondylitis
Chronic inflammatory process

back pain, sacroiliac pain

Bamboo spine on imaging

Worse with lying still

Microcytic anemias
IDA
Thalassemia
Lead Toxicity

macrocytic anemia
B12 deficiency
Folate deficiency

RDW in iron deficiency anemia?
increased

Ferritin in iron deficiency?
Decreased

Diet with iron supplement
Take with OJ, vitamin C
Best on empty stomach

TIBC in iron deficiency anemia
increased

If Fe level unchanged after months of supplement, what dx?
Thalassemia

Check reticulocyte

Gold standard to dx Thalassemia
Hemoglobin electrophoresis

Beefy, red tongue
Glossitis
B12 deficiency

Anemia with
Ataxia & paresthesia
B12 deficiency

PICA, spoon shaped nails
IDA

vaccines for sickle cell
Must be on time

sickle cell crisis first line tx
Hydration

Cows milk before 9mo is risk factor for
iron deficiency anemia
Can't breakdown enzymes and causes GI bleed

Gout prophylaxis
Allopurinol

gout flare treatment
NSAIDS- indomethacin & colchecine

Gout diet
Avoid purines
anchovies, organ meats, fish/sea food, yeast, & beer

Gout affect what joints?
Peripheral joints

Fingers. Knees. Toes.

Herb for BPH
Saw palmetto

Herb for migraines
Feverfew
Butterbur

Herb for memory
Ginko

Herb for estrogen
Black cohosh
Isoflavones
Soybeans

Herb for anxiety
Kava kava

Herb for insomnia
Kava kava

Herbs to avoid if on Coumadin
The G's

Garlic, ginko, ginseng

Apprehension Test
Drop arm test

Rotator cuff tear or impingement

Blue, swollen turbinates
Allergic rhinitis

First line tx- intranasal steroid

Most vascular area of nose
Most nosebleeds
Anterior kiesselbachs plexus

BPH
Enlarged but no pain

Dog bite tx
Augmentin

And cramping that improves with release of blood and mucus in stool
IBD

If conjunctivitis doesn't improve after treatment,
Obtain culture

Redness & swelling around eye
Periorbital cellulitis

Refer to ED

Mono back to activities
When spleen back to normal size

If feel bad 3 mos after mono dx, is it mono again?
No. Can only get it once. Pt is probably immunocpromised due to splenomegaly.

Elderly with low bp, worry about...
Falls

Acute pressure on sacral nerve root
Cauda equina

Incontinence. Numbness
Refer

Sciatica worse with
Sitting.

Spinal stenosis worse with standing.

Acute prostatis work up
Urine culture
STI if <30yo

Acute prostatitis s/s
Fever, chills
n/v
Suprapubic pain
Perineal pain

Acute prostatitis tx
Bactrim, Levaquin, cipro 4-6 weeks

effusion of ear can last how long?
8 weeks

Shiny, bulging

Acute sinusitis tx
1- amoxicillin
2- augmentin

Acute sinusitis s/s
Pain radiates to teeth, jaw, maxilla

Virus that causes diarrhea and GI upset
Rotavirus

Zollinger-Ellison syndrome
Gastrin-secreting tumor associated with ulcers
Not H pylori

Lab- fasting serum gastrin

Ulceration in mouth with red base
Stomatitis

Trichomoniasis lab
Wet prep
Flagellated trichomonads

COPD #1 education
Smoking cessation

Redness with papules and pustules around mouth
Acne rosacea

Tx- metrogel
if ax to flagyl, aslex acid

West Nile Disease
No labs. Treat symptoms

Fever
Vomiting
Urticaria
Fatigue
Muscle weakness

Birth control if hx migraine with aura
Avoid estrogen!
IUD, minipill, depo - progestin only

HBsAg
hepatitis B surface antigen
If positive, infection

Anti-HBs
Antibody
Positive = immunity to hepatitis B

AntiHBc
Positive = current infection

mild asthma
SABA, Low ICS

Symptoms >2x/week but not daily
FEV >80% of best

severe asthma
Med ICS + LABA or LAAC

Symptoms daily and nightly
PEFR <60

moderate asthma
Low ICS +LABA or Med-ICS

Symptoms daily but not nightly
FEV >60-80%

Fitz-Hugh-Curtis syndrome
Inflammation of hepatic capsule due to prior PID
Chlamydia or gonorrhea

Sub clinical HPV lesion
Apply acetic acid to lesion
Acetowhite changes

Thayer-Martin culture
To diagnose gonorrheal pharyngitis or proctitis

Legg-Calve-Perthes Disease
avascular necrosis of the femoral head

Refer at 6yo
Positive trendelenburg

Usually in young children
Legg=Little

Slipped Capital Femoral Epiphysis (SCFE)
Slippage of end of femur
Common in overweight teens

No walking. Refer.

Positive trendelenburg

Med for croup
Single dose dexamethasone

Croup X-ray
Steeple sign

rotator cuff injury s/s
Dull ache
Arm weakness

polymyalgia rheumatica s/s
Bilateral morning stiffness and aching >30 min to
shoulders, neck, hip, torso
Difficulty dressing
High risk temporal arteritis

Mostly females over 50yo

Tx oral steroids

Triple therapy for H. pylori
amoxicillin, clarithromycin, PPI