NRNP 6550 MIDTERM EXAM
Vaccinations and immunosuppression. 2 keypoints
- give inactive agents instead of live agents
- might not work as effectively
Live virus vaccine types
- Virus:
- measles
- mumps
- polio (oral)
- rubella
- varicella
- yellow fever
- herpes zoster
Bacteria:
- typhoid
Inactive vaccine virus
- Virus:
- Hep A and B
- HPV
- influenza
- polio (subq)
- rabies
Bacteria:
- anthrax
- cholera
- diphteria
- Lyme
- meningococcus
- pertussis
- plague
,- pneumococcus
- tetanus
Immunization recommendation influenza
- all ages, all types (pregnant, diabetes, immunocompromised, etc)
Immunization recommendation pregnancy and weakened immune system
- 1 dose Tdap
- no varicella, zoster, MMR
HIV and vaccinations
- Give inactive agents when CD4 count is greater than 200 cells/ mm3
Health screening 18 - 45 years
- BMI
- BP (q2years)
- at age 20: fasting lipid profile: total cholesterol, LDL, HDL, triglycerides (cardiac testing if LDL
greater than 200 or HDL lower than 40)
- annual breast exam, females
- Pap-smear annually
Health screening 45 and up
- blood glucose q3years
- 50 and up: colorectal screening (digital exam annually, sigmoidscopy q5years, colonoscopy
q10yrs)
- PSA with digital exam annually for males
- mammography q1 -2 yrs
- women 65 and up: screen for osteoporosis
Top 5 leading causes of death
,- 1. heart disease
2. cancer
3. respiratory disease
4. stroke
5. accidents
Conjunctivitis; definition
-Pink eyey
- Inflammation of conjuctiva (outer layer of eye)
Conjunctivitis: causes
- Chemical, bacterial, viral, allergic, herpetic. Adenovirus is the most common cause, but
bacteria (Haemophilus influenzae and Streptococcus pneumoniae) are also common causes in
children.
Conjunctivitis: findings
- redness
- itching
- discharge
- edema eyelid
- may find gonorrhea or chlamydia in eye discharge
Conjunctivitis: management
- cooling
- rule out corneal abrasion
- bacteria: antibiotic solution (gentamicin, neomycin)
- chlamydia: oral tetracycline or erythromycin
- gonorrhea: single dose ceftriaxone
- herpes: refer to opthalmologist
Corneal abrasion: definition, cause, findings, treatment
, - disruption of cornea (clear covering of eye)
- foreign body/ trauma
- pain, redness, photophobia, decreased visual acuity
- ab ointment: gentamicin, sulfacetamide, eye-patch, ophthalmologist
Diabetic retinopathy: definition, cause, findings, treatment
- ocular retinal disease due to DM
- DM, exac by smoking and HTN (macular edema)
- flashing lights in vision, blurred vision, black spots, loss of vision, sustained glucose greater
than 130
- Laser therapy for macular edema, smoking cessation, glucose control, BP control
Retinal detachment: definition, cause, findings, treatment
- separation of retina and choroid
- trauma, intraocular mass, iris inflammation, cataract surgery, DM, sickle cell
- painless vision changes, blurred vision, light flashes, "curtain" over visual field, bullous
elevation without tears
- ophthalmologist for cryotherapy, laser therapy, vitrectomy. If from trauma: eye patch
Central & Branch Retinal Artery Occlusion: definition, cause, findings, treatment
- abrupt blockage of retinal artery causing sudden vision loss> will become permanent
without intervention
- thrombosis/ embolism, arteritis (migraine, older age, afib, DM, HTN, coagulopathies)
- sudden, painless vision loss, sluggish pupil, cherry-red spot at fovea
- EMERGENCY. Put pressure on eyelid, heparin, immediate consult opthalmolohgist. check
coagulopathies, check labs for artherosclerotic disease, blood cultures (endocarditis?),
Glaucoma: definition, cause, findings, treatment
- progressive visual loss, first peripherally then centrally: chronic open angle or actute closed
angle. Optic neuropathy.
- open: too much intraocular fluid production without removal. Secondary from trauma,
tumor, or cataracts. Causes: age, steroids, trauma, family history
Vaccinations and immunosuppression. 2 keypoints
- give inactive agents instead of live agents
- might not work as effectively
Live virus vaccine types
- Virus:
- measles
- mumps
- polio (oral)
- rubella
- varicella
- yellow fever
- herpes zoster
Bacteria:
- typhoid
Inactive vaccine virus
- Virus:
- Hep A and B
- HPV
- influenza
- polio (subq)
- rabies
Bacteria:
- anthrax
- cholera
- diphteria
- Lyme
- meningococcus
- pertussis
- plague
,- pneumococcus
- tetanus
Immunization recommendation influenza
- all ages, all types (pregnant, diabetes, immunocompromised, etc)
Immunization recommendation pregnancy and weakened immune system
- 1 dose Tdap
- no varicella, zoster, MMR
HIV and vaccinations
- Give inactive agents when CD4 count is greater than 200 cells/ mm3
Health screening 18 - 45 years
- BMI
- BP (q2years)
- at age 20: fasting lipid profile: total cholesterol, LDL, HDL, triglycerides (cardiac testing if LDL
greater than 200 or HDL lower than 40)
- annual breast exam, females
- Pap-smear annually
Health screening 45 and up
- blood glucose q3years
- 50 and up: colorectal screening (digital exam annually, sigmoidscopy q5years, colonoscopy
q10yrs)
- PSA with digital exam annually for males
- mammography q1 -2 yrs
- women 65 and up: screen for osteoporosis
Top 5 leading causes of death
,- 1. heart disease
2. cancer
3. respiratory disease
4. stroke
5. accidents
Conjunctivitis; definition
-Pink eyey
- Inflammation of conjuctiva (outer layer of eye)
Conjunctivitis: causes
- Chemical, bacterial, viral, allergic, herpetic. Adenovirus is the most common cause, but
bacteria (Haemophilus influenzae and Streptococcus pneumoniae) are also common causes in
children.
Conjunctivitis: findings
- redness
- itching
- discharge
- edema eyelid
- may find gonorrhea or chlamydia in eye discharge
Conjunctivitis: management
- cooling
- rule out corneal abrasion
- bacteria: antibiotic solution (gentamicin, neomycin)
- chlamydia: oral tetracycline or erythromycin
- gonorrhea: single dose ceftriaxone
- herpes: refer to opthalmologist
Corneal abrasion: definition, cause, findings, treatment
, - disruption of cornea (clear covering of eye)
- foreign body/ trauma
- pain, redness, photophobia, decreased visual acuity
- ab ointment: gentamicin, sulfacetamide, eye-patch, ophthalmologist
Diabetic retinopathy: definition, cause, findings, treatment
- ocular retinal disease due to DM
- DM, exac by smoking and HTN (macular edema)
- flashing lights in vision, blurred vision, black spots, loss of vision, sustained glucose greater
than 130
- Laser therapy for macular edema, smoking cessation, glucose control, BP control
Retinal detachment: definition, cause, findings, treatment
- separation of retina and choroid
- trauma, intraocular mass, iris inflammation, cataract surgery, DM, sickle cell
- painless vision changes, blurred vision, light flashes, "curtain" over visual field, bullous
elevation without tears
- ophthalmologist for cryotherapy, laser therapy, vitrectomy. If from trauma: eye patch
Central & Branch Retinal Artery Occlusion: definition, cause, findings, treatment
- abrupt blockage of retinal artery causing sudden vision loss> will become permanent
without intervention
- thrombosis/ embolism, arteritis (migraine, older age, afib, DM, HTN, coagulopathies)
- sudden, painless vision loss, sluggish pupil, cherry-red spot at fovea
- EMERGENCY. Put pressure on eyelid, heparin, immediate consult opthalmolohgist. check
coagulopathies, check labs for artherosclerotic disease, blood cultures (endocarditis?),
Glaucoma: definition, cause, findings, treatment
- progressive visual loss, first peripherally then centrally: chronic open angle or actute closed
angle. Optic neuropathy.
- open: too much intraocular fluid production without removal. Secondary from trauma,
tumor, or cataracts. Causes: age, steroids, trauma, family history
