SARAH MICHELLE CRASH FINAL EXAM UPDATED
QUESTIONS AND ANSWERS SURE A+
✔Conjunctivitis - ✔✔-bacterial, viral, allergic
-bilaterally= allergic
-starts unilaterally than spreads to other eye= viral
-allergic drainage- stringy and ropey
-viral conjunctivitis- preauricular or submandibular enlarged lymph nodes.
-allergic= cervical enlarged lymph nodes.
-bacterial- no lymphadenopathy
-medical term for pink eye= adenoviral conjunctivitis.
✔✔Cataracts - ✔✔- symptoms driving at night
-bilateral leukocoria noted on exam (white reflex)
✔✔Macular degeneration - ✔✔-central vision loss
-put things in larger print to read
✔✔Presbyopia - ✔✔-middle age range
-arms "too short", short arm syndrome
-reading glasses
✔✔corneal abrasion - ✔✔-eye irritation after bell's palsy episode
-keep eyes lubricated
-Diagnostic tool: fluorescein staining
-tonometry when to measure IOP.
✔✔Keratitis (caused by bacterial infection) - ✔✔-wears contacts
-inflamed and reddened cornea
-inability to hold eye open
-cloudiness and blurred vision
-no recent trauma/injury
-refer to ophthalmologist immediately
✔✔Iritis - ✔✔-eye pain
-sensitivity to light
-not able to see normal
-entire eye red, swelling of the iris
-refer to ophthalmology
✔✔Subconjunctivae hemorrhage - ✔✔-broken blood vessels on sclera
-typically, asymptomatic
-may use eye drops for lubrication
✔✔Brain tumor headache - ✔✔-behavioral changes
,-vision changes
-nausea/vomiting
-dull, always in the same spot
-diagnostic tests: CT scan (rule out CVA)
-worse headache of their life
✔✔Ischemic vs hemorrhagic stroke - ✔✔-unilateral weakness
-facial drooping
-slurred speech
-Afib= increased risk of ischemic stroke
-HTN=increased risk of hemorrhagic CVA
-TIA- symptoms resolved within 1-24 hours
-BE FAST (balance, eyes, face, arm, speech, time).
✔✔Aphasia - ✔✔-pt's inability to understand or produce speech
-boils down to residual effects r/t Wernicke's or Broca's area.
✔✔Wernicke's area affected - ✔✔-receptive aphasia (not understanding what is said to
them)
-W&R are close together in the alphabet
✔✔Broca's area affected - ✔✔-expressive aphasia
-B and E are close together in the alphabet.
✔✔Cluster headache - ✔✔-unilateral
-tearing/runny nose
-occurs at the same time every day.
-Treatment: CCB's and 100% oxygen
✔✔Giant cell temporitis - ✔✔-unilateral
-possible visual impairment
-temple pain/pulsating
-increased ESR and inflammatory markers
-can lead to permeant blindness
-Treatment: long-term, high dose steroids.
-Diagnostic testing: temporal artery biopsy.
✔✔Wernicke-Korsakoff syndrome - ✔✔chronic alcohol use, vitamin B1 deficiency
(thiamine).
✔✔Hypertension headache - ✔✔-occipital headache
-typically, upon awakening
✔✔Migraine - ✔✔-sensitive to lights or noise
-throbbing, pulsating
,-possible n/v
-aura
-prophylaxis: avoid triggers
-Treatment: BB, TCA's, abortive treatment "triptans".
-No triptans for uncontrolled HTN and SSRIs (increases risk of serotonin syndrome).
✔✔Tension headaches - ✔✔-bilaterally
-pressure/tight band
✔✔Polymyalgia rheumatica - ✔✔-inflammatory disorder
-muscle pain
-temporal arteritis can go hand and hand
✔✔Parkinson's disease - ✔✔-depletion of dopamine
-Sinemet long term can stop working for symptoms
-symptoms: bradykinesia, resting tremor, rigidity, postural instability.
✔✔Meningitis - ✔✔-characterized by demyelinated lesions in the brain
-affects communication to the peripheral nerves
-sx: weakness, sensory loss, fatigue.
-Tx is geared toward slowing disease progression.
✔✔Alzheimer's disease - ✔✔-3 A's (apraxia, agnosia, aphasia)
-MMSE
agonisa- not recognizing familiar objects
apraxia- inability to carry out movements or gestures
aphasia-difficulty understanding
✔✔Cranial nerves - ✔✔"oh oh oh to touch and feel a great vein ah heaven"
CN 1: olfactory
CN II: optic
CN III: Oculomotor
CN IV: Trochlear
CN V: Trigeminal
CN VI: Abducens
CN VII: Facial
CN VIII: Acoustic
CN IX: Glossopharyngeal
CN X: Vagus
CN XI: Accessory
CN XII: Hypoglossal
some say marry money, but my brother says big brains matter more
(Mnemonic to remember sensory, motor, or both).
, ✔✔Trigeminal neuralgia - ✔✔-severe, stabbing pain in the face
-cranial nerve V affected
-Treatment is Tegretol
-increased risk for suicide risk if pain is not controlled.
✔✔Bells palsy - ✔✔-CN VII (facial nerves)
-eye lubricant to prevent corneal abrasions
✔✔Rinne and weber - ✔✔- CN VIII (acoustic nerve)
-vesticular cochlear
Rinne test
-Rinne test (Rinne under the pinne), normal= AC > BC.
-Weber test- normal finding=sound will be heard equally by both ears (there is no
lateralization). Tuning fork on top of head.
-results= laterize to the bad or affected ear, lateralize to the unaffected ear or there will
be no laterization.
-Normal finding= does not lateralize to one ear or the other and can be hear equally in
both ears.
Weber test
-conductive
-can see (C) the issue
-sound will laterize to the affected side.
-ex: cerumen impaction
-Sensorineural
-cannot physically see the area/issue
-sound will laterize to the unaffected ear.
✔✔Meniere's disease - ✔✔Sx: vertigo, tinnitus, ear pressure, nystagmus.
-potential permeant hearing loss.
✔✔Depression - ✔✔-PHQ 2 > + > PHQ 9
-first line is SSRI and SNRI's.
-ASE: sexual dysfunction and weight gain
-Fluoxetine: first line in pediatrics when psychotherapy is not effective.
-St. John's wort may not take any serotonin meds (together increased risk of serotonin
syndrome). S/sx: shivering, shaking, tachycardia, and agitation, prompt referral to ED.
-4-6 weeks to begin working
-> 6 weeks, may increase dosage
-GI effects usually go away 2-3 weeks
-effective dose- keep on for 6 months, try tapering off.
-suicide risk (risks: male sex, hx psych disorder, access to firearms, etc).
-Avoid fluoxetine in older adults (increased 1/2 life)
-TCA- do not give to older adults (anticholinergic effects).
-Lexapro and sertraline are first line for older adults.
QUESTIONS AND ANSWERS SURE A+
✔Conjunctivitis - ✔✔-bacterial, viral, allergic
-bilaterally= allergic
-starts unilaterally than spreads to other eye= viral
-allergic drainage- stringy and ropey
-viral conjunctivitis- preauricular or submandibular enlarged lymph nodes.
-allergic= cervical enlarged lymph nodes.
-bacterial- no lymphadenopathy
-medical term for pink eye= adenoviral conjunctivitis.
✔✔Cataracts - ✔✔- symptoms driving at night
-bilateral leukocoria noted on exam (white reflex)
✔✔Macular degeneration - ✔✔-central vision loss
-put things in larger print to read
✔✔Presbyopia - ✔✔-middle age range
-arms "too short", short arm syndrome
-reading glasses
✔✔corneal abrasion - ✔✔-eye irritation after bell's palsy episode
-keep eyes lubricated
-Diagnostic tool: fluorescein staining
-tonometry when to measure IOP.
✔✔Keratitis (caused by bacterial infection) - ✔✔-wears contacts
-inflamed and reddened cornea
-inability to hold eye open
-cloudiness and blurred vision
-no recent trauma/injury
-refer to ophthalmologist immediately
✔✔Iritis - ✔✔-eye pain
-sensitivity to light
-not able to see normal
-entire eye red, swelling of the iris
-refer to ophthalmology
✔✔Subconjunctivae hemorrhage - ✔✔-broken blood vessels on sclera
-typically, asymptomatic
-may use eye drops for lubrication
✔✔Brain tumor headache - ✔✔-behavioral changes
,-vision changes
-nausea/vomiting
-dull, always in the same spot
-diagnostic tests: CT scan (rule out CVA)
-worse headache of their life
✔✔Ischemic vs hemorrhagic stroke - ✔✔-unilateral weakness
-facial drooping
-slurred speech
-Afib= increased risk of ischemic stroke
-HTN=increased risk of hemorrhagic CVA
-TIA- symptoms resolved within 1-24 hours
-BE FAST (balance, eyes, face, arm, speech, time).
✔✔Aphasia - ✔✔-pt's inability to understand or produce speech
-boils down to residual effects r/t Wernicke's or Broca's area.
✔✔Wernicke's area affected - ✔✔-receptive aphasia (not understanding what is said to
them)
-W&R are close together in the alphabet
✔✔Broca's area affected - ✔✔-expressive aphasia
-B and E are close together in the alphabet.
✔✔Cluster headache - ✔✔-unilateral
-tearing/runny nose
-occurs at the same time every day.
-Treatment: CCB's and 100% oxygen
✔✔Giant cell temporitis - ✔✔-unilateral
-possible visual impairment
-temple pain/pulsating
-increased ESR and inflammatory markers
-can lead to permeant blindness
-Treatment: long-term, high dose steroids.
-Diagnostic testing: temporal artery biopsy.
✔✔Wernicke-Korsakoff syndrome - ✔✔chronic alcohol use, vitamin B1 deficiency
(thiamine).
✔✔Hypertension headache - ✔✔-occipital headache
-typically, upon awakening
✔✔Migraine - ✔✔-sensitive to lights or noise
-throbbing, pulsating
,-possible n/v
-aura
-prophylaxis: avoid triggers
-Treatment: BB, TCA's, abortive treatment "triptans".
-No triptans for uncontrolled HTN and SSRIs (increases risk of serotonin syndrome).
✔✔Tension headaches - ✔✔-bilaterally
-pressure/tight band
✔✔Polymyalgia rheumatica - ✔✔-inflammatory disorder
-muscle pain
-temporal arteritis can go hand and hand
✔✔Parkinson's disease - ✔✔-depletion of dopamine
-Sinemet long term can stop working for symptoms
-symptoms: bradykinesia, resting tremor, rigidity, postural instability.
✔✔Meningitis - ✔✔-characterized by demyelinated lesions in the brain
-affects communication to the peripheral nerves
-sx: weakness, sensory loss, fatigue.
-Tx is geared toward slowing disease progression.
✔✔Alzheimer's disease - ✔✔-3 A's (apraxia, agnosia, aphasia)
-MMSE
agonisa- not recognizing familiar objects
apraxia- inability to carry out movements or gestures
aphasia-difficulty understanding
✔✔Cranial nerves - ✔✔"oh oh oh to touch and feel a great vein ah heaven"
CN 1: olfactory
CN II: optic
CN III: Oculomotor
CN IV: Trochlear
CN V: Trigeminal
CN VI: Abducens
CN VII: Facial
CN VIII: Acoustic
CN IX: Glossopharyngeal
CN X: Vagus
CN XI: Accessory
CN XII: Hypoglossal
some say marry money, but my brother says big brains matter more
(Mnemonic to remember sensory, motor, or both).
, ✔✔Trigeminal neuralgia - ✔✔-severe, stabbing pain in the face
-cranial nerve V affected
-Treatment is Tegretol
-increased risk for suicide risk if pain is not controlled.
✔✔Bells palsy - ✔✔-CN VII (facial nerves)
-eye lubricant to prevent corneal abrasions
✔✔Rinne and weber - ✔✔- CN VIII (acoustic nerve)
-vesticular cochlear
Rinne test
-Rinne test (Rinne under the pinne), normal= AC > BC.
-Weber test- normal finding=sound will be heard equally by both ears (there is no
lateralization). Tuning fork on top of head.
-results= laterize to the bad or affected ear, lateralize to the unaffected ear or there will
be no laterization.
-Normal finding= does not lateralize to one ear or the other and can be hear equally in
both ears.
Weber test
-conductive
-can see (C) the issue
-sound will laterize to the affected side.
-ex: cerumen impaction
-Sensorineural
-cannot physically see the area/issue
-sound will laterize to the unaffected ear.
✔✔Meniere's disease - ✔✔Sx: vertigo, tinnitus, ear pressure, nystagmus.
-potential permeant hearing loss.
✔✔Depression - ✔✔-PHQ 2 > + > PHQ 9
-first line is SSRI and SNRI's.
-ASE: sexual dysfunction and weight gain
-Fluoxetine: first line in pediatrics when psychotherapy is not effective.
-St. John's wort may not take any serotonin meds (together increased risk of serotonin
syndrome). S/sx: shivering, shaking, tachycardia, and agitation, prompt referral to ED.
-4-6 weeks to begin working
-> 6 weeks, may increase dosage
-GI effects usually go away 2-3 weeks
-effective dose- keep on for 6 months, try tapering off.
-suicide risk (risks: male sex, hx psych disorder, access to firearms, etc).
-Avoid fluoxetine in older adults (increased 1/2 life)
-TCA- do not give to older adults (anticholinergic effects).
-Lexapro and sertraline are first line for older adults.
