SARAH MICHELLE CRASH LATEST EXAM ACTUAL
QUESTIONS AND ANSWERS SURE A+
✔✔chronic venous insufficiency - ✔✔-involves damage to leg veins
-manifestations: LE edema, varicose veins, hyperpigmentation
-tx: compression therapy, elevate legs, exercise, skin care.
-complications=DVT
✔✔DVT - ✔✔-provoked- cause to identify
-unprovoked- unknown cause
-acute onset of localized swelling, erythema
-Homan sign: pretty unreliable
-doppler US, d-dimer (not diagnostic alone)
-Tx: DOAC, warfarin for severe kidney disease.
✔✔Raynaud's phenomenon - ✔✔-episodes of narrowed blood flow in fingers and toes
-pale phalanges
-triggers are cold and stress
-CCB, avoid triggers.
✔✔Asthma - ✔✔-GINA guidelines
-develops at any age
-most predominant sx: cough, often worse at night
-other common sx: wheezing, SOB, chest tightness
-sx typically triggered by allergens or exercise
-physical exam: wheezing, tachypnea, accessory muscle use.
-dx tool: PFT
-FEV1: amount of air the patient can force out of their lungs in 1 second.
-in asthma, this will demonstrate reversibility after the patient receives a bronchodilator
to open the airways.
-normal FEV1 is > 80% (generally decreases with asthma severity
-cornerstone of treatment- inhaled corticosteroids (provide better control of sx, reduce
risk of exacerbations)
-short acting beta-agonists (SABAs)- albuterol, no longer recommended as the "go to"
rescue inhaler. (don't do well for underlying inflammation or lung preservation).
-never prescribe LABAs as monotherapy (increased risk of asthma-related deaths).
✔✔Asthma step-treatment (12 and older) - ✔✔-step 1 and 2: low dose ICS- formoterol
as needed (ex: budesonide-formoterol (mild asthma, sx < twice a month.
-step 3: low-dose ICS-formoterol daily (moderate asthma)
-step 4: medium-dose ICS daily (severe asthma) (refer)
-step 5: high-dose ICS daily, LAMA, (severe asthma) (refer)
-reliever treatment for all stages- ICS-formoterol as needed.
✔✔Asthma follow-up - ✔✔-peak flow reads at home
,-three things that impact flow readings: height, weight, sex (HAS), in this order.
✔✔COPD - ✔✔-damage to airways
-risk factors: smoking, long-term exposures to pollution, chemicals, or other lung
irritants.
-chronic bronchitis and emphysema
-chronic bronchitis leads to Cilla destruction and mucus buildup causing that chronic
productive cough.
-emphysema destroys the alveoli in the lungs leading to the classic wheezing and
dyspnea.
-dyspnea, chest tightness, generalized and symmetrical hyperresonance abnormal
breath sounds/crackles, increased AP diameter of the chest (barrel chest).
-gold-standard test is spirometry
-FEV1/FVC ratio- indicates air flow limitation, < 0.7
-A: Bronchodilator
-B: LABA
-C: LAMA
-D: LAMA or LAMA + LABA or ICS + LABA
✔✔2023 COPD Gold guidelines - ✔✔-Group A: 0-1 moderate exacerbations (without
hospitalization), CAT < 10. Tx with bronchodilator (typically LABA).
-Group B: 0-1 moderate exacerbations (without hospitalization), CAT > 10. Tx with
LABA + LAMA
-Group E: > 2 moderate exacerbations or > 1 exacerbation leading to hospitalization. Tx
with LABA + LAMA + ICS. Refer.
-all patients should have a SABA for episodes of dyspnea.
✔✔LLL pneumonia - ✔✔-cough, increased RR, chest pain, SOB, fatigue, fever.
-crackles, rhonchi, tactile fremitus.
-Treatment: macrolide, amoxicillin, doxycycline, usually strep pneumoniae. Atypical
pneumonia: mycoplasma pneumonia. Treat with macrolides.
✔✔Pneumonia treatment - ✔✔-antibiotics for healthy outpatient patients
-Macrolides (-mycin)
-Amoxicillin
-Doxycycline
-antibiotics for adults with comorbidities or who have had ABX within 90 days=
levofloxacin.
-Augmentin + macrolide or doxycycline
-ciprofloxacin is not a respiratory fluoroquinolone.
✔✔CURB-65 criteria (Hospital admission) - ✔✔-confusion
-urea (measured with a BUN > 19)
-respiratory rate > 20-30
-blood pressure < 90/60
-2 points= may need to be admitted
, ->3 points= have to be admitted
✔✔Tuberculosis - ✔✔-upper lobes
-requires long treatment (usually 3 meds together)
->5 mm = positive for pts with HIV and immunocompromised
->15mm= general public
->10mm=immigrated from high-risk areas
->5mm= health care worker with recent exposure.
✔✔HIV turns over to AIDs - ✔✔-CD4 count gets less than 200
-confirm TB through sputum cultures
✔✔Strep vs Mono - ✔✔-both may have sore throat
-strep: exudate on tonsils (but also can be seen with mono)
-splenomegaly=mono
-palatine petechiae=step
-headache-strep
-Tx: PCN, Mono- Tx symptomatically
-Mono patients can return to sports when spleen is no longer enlarged, order a spleen
ultrasound.
✔✔Scarlatina or scarlet fever - ✔✔-sand paper- esque rash, terrible looking throat.
-results from untreated strep
-untreated strep can lead to rheumatic fever and glomerulonephritis
-if patient has both strep and mono- Tx with macrolide or cephalosporin. (giving PCN to
pt with mono will cause a more biliform rash). PCN VK may be given (won't cause rash).
✔✔Peritonsillar abscess - ✔✔-sore throat not resolving, large erythematous tonsil with
pus
-deviated uvula
-pesky strep is the most common cause
-referral to ENT or ER
✔✔Acute bronchitis - ✔✔-nagging cough (may be productive)
-95% of cases are viral
-only Tx with ABX if pertussis
-pertussis- cough that last > 3 weeks
-Tx: macrolides
-TDAP or DTAP can prevent
✔✔Sinusitis - ✔✔-acute URI recently, 7-10 days later sx return.
-pain bending over
-unilateral all tooth ache
-Tx with amoxicillin or Augmentin
-prevent periorbital cellulitis
QUESTIONS AND ANSWERS SURE A+
✔✔chronic venous insufficiency - ✔✔-involves damage to leg veins
-manifestations: LE edema, varicose veins, hyperpigmentation
-tx: compression therapy, elevate legs, exercise, skin care.
-complications=DVT
✔✔DVT - ✔✔-provoked- cause to identify
-unprovoked- unknown cause
-acute onset of localized swelling, erythema
-Homan sign: pretty unreliable
-doppler US, d-dimer (not diagnostic alone)
-Tx: DOAC, warfarin for severe kidney disease.
✔✔Raynaud's phenomenon - ✔✔-episodes of narrowed blood flow in fingers and toes
-pale phalanges
-triggers are cold and stress
-CCB, avoid triggers.
✔✔Asthma - ✔✔-GINA guidelines
-develops at any age
-most predominant sx: cough, often worse at night
-other common sx: wheezing, SOB, chest tightness
-sx typically triggered by allergens or exercise
-physical exam: wheezing, tachypnea, accessory muscle use.
-dx tool: PFT
-FEV1: amount of air the patient can force out of their lungs in 1 second.
-in asthma, this will demonstrate reversibility after the patient receives a bronchodilator
to open the airways.
-normal FEV1 is > 80% (generally decreases with asthma severity
-cornerstone of treatment- inhaled corticosteroids (provide better control of sx, reduce
risk of exacerbations)
-short acting beta-agonists (SABAs)- albuterol, no longer recommended as the "go to"
rescue inhaler. (don't do well for underlying inflammation or lung preservation).
-never prescribe LABAs as monotherapy (increased risk of asthma-related deaths).
✔✔Asthma step-treatment (12 and older) - ✔✔-step 1 and 2: low dose ICS- formoterol
as needed (ex: budesonide-formoterol (mild asthma, sx < twice a month.
-step 3: low-dose ICS-formoterol daily (moderate asthma)
-step 4: medium-dose ICS daily (severe asthma) (refer)
-step 5: high-dose ICS daily, LAMA, (severe asthma) (refer)
-reliever treatment for all stages- ICS-formoterol as needed.
✔✔Asthma follow-up - ✔✔-peak flow reads at home
,-three things that impact flow readings: height, weight, sex (HAS), in this order.
✔✔COPD - ✔✔-damage to airways
-risk factors: smoking, long-term exposures to pollution, chemicals, or other lung
irritants.
-chronic bronchitis and emphysema
-chronic bronchitis leads to Cilla destruction and mucus buildup causing that chronic
productive cough.
-emphysema destroys the alveoli in the lungs leading to the classic wheezing and
dyspnea.
-dyspnea, chest tightness, generalized and symmetrical hyperresonance abnormal
breath sounds/crackles, increased AP diameter of the chest (barrel chest).
-gold-standard test is spirometry
-FEV1/FVC ratio- indicates air flow limitation, < 0.7
-A: Bronchodilator
-B: LABA
-C: LAMA
-D: LAMA or LAMA + LABA or ICS + LABA
✔✔2023 COPD Gold guidelines - ✔✔-Group A: 0-1 moderate exacerbations (without
hospitalization), CAT < 10. Tx with bronchodilator (typically LABA).
-Group B: 0-1 moderate exacerbations (without hospitalization), CAT > 10. Tx with
LABA + LAMA
-Group E: > 2 moderate exacerbations or > 1 exacerbation leading to hospitalization. Tx
with LABA + LAMA + ICS. Refer.
-all patients should have a SABA for episodes of dyspnea.
✔✔LLL pneumonia - ✔✔-cough, increased RR, chest pain, SOB, fatigue, fever.
-crackles, rhonchi, tactile fremitus.
-Treatment: macrolide, amoxicillin, doxycycline, usually strep pneumoniae. Atypical
pneumonia: mycoplasma pneumonia. Treat with macrolides.
✔✔Pneumonia treatment - ✔✔-antibiotics for healthy outpatient patients
-Macrolides (-mycin)
-Amoxicillin
-Doxycycline
-antibiotics for adults with comorbidities or who have had ABX within 90 days=
levofloxacin.
-Augmentin + macrolide or doxycycline
-ciprofloxacin is not a respiratory fluoroquinolone.
✔✔CURB-65 criteria (Hospital admission) - ✔✔-confusion
-urea (measured with a BUN > 19)
-respiratory rate > 20-30
-blood pressure < 90/60
-2 points= may need to be admitted
, ->3 points= have to be admitted
✔✔Tuberculosis - ✔✔-upper lobes
-requires long treatment (usually 3 meds together)
->5 mm = positive for pts with HIV and immunocompromised
->15mm= general public
->10mm=immigrated from high-risk areas
->5mm= health care worker with recent exposure.
✔✔HIV turns over to AIDs - ✔✔-CD4 count gets less than 200
-confirm TB through sputum cultures
✔✔Strep vs Mono - ✔✔-both may have sore throat
-strep: exudate on tonsils (but also can be seen with mono)
-splenomegaly=mono
-palatine petechiae=step
-headache-strep
-Tx: PCN, Mono- Tx symptomatically
-Mono patients can return to sports when spleen is no longer enlarged, order a spleen
ultrasound.
✔✔Scarlatina or scarlet fever - ✔✔-sand paper- esque rash, terrible looking throat.
-results from untreated strep
-untreated strep can lead to rheumatic fever and glomerulonephritis
-if patient has both strep and mono- Tx with macrolide or cephalosporin. (giving PCN to
pt with mono will cause a more biliform rash). PCN VK may be given (won't cause rash).
✔✔Peritonsillar abscess - ✔✔-sore throat not resolving, large erythematous tonsil with
pus
-deviated uvula
-pesky strep is the most common cause
-referral to ENT or ER
✔✔Acute bronchitis - ✔✔-nagging cough (may be productive)
-95% of cases are viral
-only Tx with ABX if pertussis
-pertussis- cough that last > 3 weeks
-Tx: macrolides
-TDAP or DTAP can prevent
✔✔Sinusitis - ✔✔-acute URI recently, 7-10 days later sx return.
-pain bending over
-unilateral all tooth ache
-Tx with amoxicillin or Augmentin
-prevent periorbital cellulitis
