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A middle-age female patient presents to the clinic with a recurrence of mild
hidradenitis suppurativa after topical therapies failed. Which first-line treatment
is recommended?
Tetracycline
Twelve weeks of oral tetracycline (Sumycin) is the recommended first-line
treatment for hidradenitis suppurativa.
__________________________________________________
Hidradenitis suppurativa is a disorder of the terminal follicular epithelium in
apocrine gland-bearing skin. It is a chronic, disabling disorder that progresses,
often causing keloids, contractures, and immobility. It is characterized by
comedone-like follicular occlusion, chronic and relapsing inflammation,
mucopurulent discharge, and progressive scarring.
Arthropathy associated with hidradenitis may be present. Typical presentation
includes nodules and sinus tracts (inflamed or noninflamed), abscesses, and scarring
found in the axilla, genitofemoral area, perineum, gluteal area, and inframammary
area in women.
Recommended treatments include antibiotics, steroids, retinoids, dapsone, and
anti- tumor necrosis factor agents. A dermatology consultation should also be
considered. First-line treatment is a 12‑week course of an oral tetracycline
(Sumycin) such as doxycycline. For patients who do not respond to doxycycline,
the next recommended step is a combination of twice-daily clindamycin (Cleocin)
and rifampicin (Rifadin) for 10- 12 weeks. If treatment fails, acitretin (Soriatane,
for males and nonfertile females) or dapsone (Aczone) may be considered by a
dermatologist. In patients with moderate to severe hidradenitis suppurativa,
adalimumab (Humira) may possibly be considered.
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When providing culturally competent health care services to an American
Indian elder, the nurse practitioner understands which is traditionally true?
The "Medicine Wheel" is used by many for the purpose of health and healing
The "Medicine Wheel" is traditionally used and contains four directions; north,
south, east, and west. Traditionally each tribe has different meanings for each
direction and they may represent the season of the year or stage of life. It is
aimed at providing a holistic view of life.
________________________________________
An understanding of different cultural preferences leads to cultural
competence in healthcare. Some patients may value traditional culture and
preferences as it relates to healthcare. These individual preferences should be
included in the interview and treatment plan for patients.
Traditionally, the American Indian culture values a holistic approach to health
care integrating the person, lifestyle, environment, family, and religion.
Patients adhering to these traditional cultural practices often feel that illness is
due to a lack of harmony with the physical body, mind, spirit, and emotions.
Patients may seek care from western medicine for specific ailments while also
consulting with traditional healers for spiritual guidance.
Healthcare providers should seek to understand relevant cultural factors and
assess each individual's healthcare literacy in order to provide culturally
competent care.
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The nurse practitioner sees an older adult patient in the clinic with the primary
report of hearing loss and a sensation of fullness in the right ear. The nurse
practitioner suspects conductive hearing loss. Which could contribute to this?
Cerumen, commonly called earwax, is a combination of secretions and
sloughed epithelial cells that protects the ears from infection, water, and
insects. It is normally expelled from the ear canal through natural jaw
movement. When this self-cleaning process fails, cerumen can become
impacted. Cerumen impaction occludes the ear canal and can press against
the tympanic membrane, resulting in conductive hearing loss.
_________________________________________
Conductive hearing is the transition of sound from the external and middle ear
to the inner ear. Conductive hearing loss is caused by problems in the external
and middle ear that interfere with the transmission of sound and its conversion
to mechanical vibration. Causes of conductive hearing loss include obstruction
of the external auditory canal by cerumen, foreign bodies, debris from otitis
externa, and large exocytosis and osteomas. Sensorineural hearing loss
involves difficulty converting mechanical vibrations to electrical potential in
the cochlea or in auditory nerve transmission to the brain. It is mostly caused
by permanent damage in the organ of Corti. It can be caused by age- related
hearing loss, noise trauma, medications, autoimmune diseases, mechanical
trauma, Meniere disease, infection, and neoplasm (acoustic neuroma).
Approximately one-third of older adults between the ages of 61 and 70 years
have hearing loss. More than 90% of adults older than 85 years of age have
hearing loss. The most common type of hearing loss is age-related and
sensorineural. All adults older than 60 years of age should be screened for
hearing loss at periodic health examinations.
Which of the following cranial nerves would be responsible for the sense of
smell?
CN I
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Which of the following rash-producing febrile illnesses is caused by the human
parvovirus B19?
Fifth disease
Which of the following parts of the eye is for color perception?
cones
Which of the following tests would you most likely order for a patient whom you
suspect has iron deficiency anemia?
-CBC with differential or smear
-TIBC
-ferritin
****all of the above
If heat is applied to the site of an insulin injection, which of the following can
happen?
hypoglycemia
You have a 62-year-old male patient who has just recovered from an acute
attack of gout. You want to prescribe a maintenance medication for this
patient. Which of the following gout medications would you prescribe?
Allopurinol
Which of the following is NOT an incomplete spinal cord injury syndrome?
Miller Fisher syndrome
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