Test Bank For Primary Care of Women
Chapter 1-26 Complete Guide
pain elicited with pressure is applied halfway between the umbilicus and the anterior
spine of the ilium - answersMcBurney's Sign
deep palpation over LLQ with sudden, unexpected release of pressure (also called
referred rebound tenderness - answersRovsing's sign
pain when the patient is instructed to try to lift the right leg against gentle pressure
applied by the examination - answersPsoas sign
Temporary paralysis of CN 7/Facial nerve - answersBell's Palsy
Lipid bound drugs - answersWhich drugs cross the placenta more readily?
2-7 weeks - answersWhat is the incubation period for Hepatitis A?
LFTs and a hepatitis panel - answersIF you suspect a patient has hepatitis, what is the
first test you will order?
2-6 months - answersWhat is the incubation period for hepatitis B?
Enzyme immunoassay (EIA) - answersWhat is the screening test for hepatitis C?
Inflammation of skin folds caused by friction between surfaces. May be worse with
obesity or diabetes - answersIntertrigo
Noncontagious inflammation of the connective tissue of the skin caused by bacteria -
answerscellulitis
erythmatous lesion with silvery scales; nail pitting - answerspsoriasis
If 60 years or older, treat BP greater than or equal to 160/90
If <60 years old, treat to lower DBP <90 and or SBP <140
Anyone age 18 or greater with CKD or diabetes, treat to lower BP to 140/90 -
answersJNC BP guidelines
In the general nonblack population, including those with diabetes, initial
antihypertensive treatment should include a thiazide-type diuretic, calcium channel
blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor
blocker (ARB). - answersIn non-black population, what is the initial treatment of choice
when starting BP medication?
,In the general black population, including those with diabetes, initial antihypertensive
treatment should include a thiazide-type diuretic or CCB - answersWhat is the initial
treatment of choice in the black population?
In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive
treatment should include an ACEI or ARB to improve kidney outcomes. This applies to
all CKD patients with hypertension regardless of race or diabetes status. - answersIf 18
or older with CKD, what is the treatment for HTN?
When the pt has been sitting for 5 minutes. The pt should not smoke or drink coffee
prior to BP measurement. Be aware of white coat. - answersWhen should BP
measurements be taken?
140 or 90 on two separate occasions . Baseline labs should be done - ECG, lipid panel,
UA, glucose, HCT, potassium, creatinine, GFR, calcium, - answersWhen can HTN be
diagnosed.
1. DASH diet
2. Exercise - daily walking
3. Lifestyle changes
4. Next step is thiazide diuretic - answersTreatment of HTN
ACE inhibitors, because they help the kidneys. - answersWhat type of HTN meds will
help a diabetic?
more common in young women, may be autosomal dominant, most common valve
disorder in U.S. - answersMitral valve prolapse (MVP)
Regurgitation murmur or mid-systolic click upon auscultation. Symptoms - palpitations,
dysrhythmia, tachycardia, syncope, fatigue, lethargy, dyspnea, chest tightness, panic
attacks, depression, atypical chest pain. Refer if symptomatic. - answersMVP findings
anemia caused by b12/folate deficiency due to alcoholism, pernicious anemia, or poor
nutrition. - answersmacrocytic, normochromic anemia
IDA most likely, but can be thalessemia or blood loss - answersmicrocytic anemia
blood loss, hemolytic reaction, anemia of chronic disease - answersnormocytic
normochromic
impaired fasting glucose, central obesity, elevated triglycerides and BP, reduced HDL.
Treated with lifestyle modifications, medications, and referral for bariatric surgery -
answersmetabolic syndrome
,Graves - most common, caused from stimulation of thyroid by antibodies against TSH
receptors. Target is not destroyed but malfunctions. When autoantibodies bind with
receptors for TSH, it messes up the feedback look and stimulates T4 production
S/S are tachycardia, nervousness, tremor, elevated BP, lid lag, weight loss -
answershyperthyroid
PTU - drug of choice for pregnant women
methimazole is other option for tx, but not during pregnancy
Treatment for 6-12 months, then stopped - answerstreatment for hyperthyroid
Heartburn sensation; tx with diet, weight loss, stop smoking, elevation of HOB, small
meals, H2 blocker, PPI - answersGERD
duodenal most common; caused by h Pylori, NSAIDS,
Sx: pain when stomach is empty; weight gain because pt is eating for relief. Ask about
signs of bleeding (black tarry stools). Refer if bleeding or not responding to tx. ABX for h
pylori and PPI to promote healing of ulcer. Stop taking NSAIDS if they are contributing
factor and replace with misoprostol. - answersPUD
IBS is chronic, usually starting in adolescence and correlate with life stressors. IBS has
2/3 features - relief with defecation, frequent or infrequent stools, a change in
appearance of stool, and present for 12 weeks of past 12 months. Does not interrupt
sleep. PE shows no abnormalities. Do CBC, TSH, sed rate, lytes, BUN creatinine,
glucose to rule out infection, stool for occult blood and fecal leukocytes (would indicate
bacterial). Treatment is lifestyle modifications. Avoid trigger foods. Increase fluids and
increase exercise. - answersIBS vs constipation
Caused from e coli or shingella, etc. - answersTravelers diarrhea
burning sensation in chest; accompanied by cough, URI. Nose and throat symptoms go
away but cough can persist with wheezes, rhonchi, rales. Tx with rest, fluids, cough
meds at night, and bronchodilator - answersacute bronchitis
band-like, tightening, bilateral, not aggrivated by exercise. TX with tylenol or NSAIDS -
answerstension headache
unilateral, pulsating, moderate to severe in intensity, aggrivated by physical activity,
nausea and vomiting, photophobia/phonophobia. Tx with lifestyle changes, avoid certain
foods, biofeedback, medications. Prophylaxis - beta blocker or tricyclic antidepressant,
SSRIs, anticonvulsants, NSAIDS - answersCommon migraine
Above symptoms, and also aura that develops in <60 minutes; HA lasts 4-72 hours -
answersClassic migraine
, severe, unilateral, orbital, or temporal pain; lasts 15 min-3 hours; occurs 1-8 times/daily.
At least 5 attacks in history to be called a cluster HA. May be years before attack. More
likely to happen in males. - answersCluster headache
unilateral facial paralysis of facial nerve/CN 7. Treatment: protect eye, massage facial
muscle, prednisone in tapering dosage, and Valtrex x 7 days. Usually self-limiting. -
answersBells palsy
Pain in hand caused by compression of median nerve. Decreased grip. +Tinel and
Phalen sign. Dx with xray and clinical presentation. Tx: NSAIDS, splints, ice, and
modifications to decrease repetitive motion. Referral with no improvement in 3 weeks. -
answersCarpal tunnel syndrome
Smoking, obesity, physical inactivity, dyslipidemia, DM, microalbuminuria or GFR less
than 60, age 55M/65W, fhx of premature cardiovascular disease - answersMajor
cardiovascular risk factors
Primary aldosteronism (weakness is a sign)
Cushing syndrome (truncal obesity/striae)
Phenochromocytoma (palpitations, sweating, tremor)
renal disease, thyroid disease, sleep apnea, drug-induced (cocaine, alcohol, COCs,
OTC cold meds) - answersCauses of secondary HTN
No physical findings, except audible murmur
Soft grade 1/2, medium pitch, systolic
heard best when supine
disappears when standing or straining
Increases with increased cardiac output (fever, exercise) - answersInnocent murmur
findings
Diastolic or pansystolic or any murmur above grade 3
Intensifies with exercise of Valsalva maneuver
Mid to late systolic click, associated with MVP
cyanosis
Jugular vein distension
hepatomegaly
pedal edema or diminished femoral pulses or unequal blood pressure in left and right
arms - answersPathologic murmur findings
Echo, CXR, CBC, Thyroid tests - answersWhat tests should be performed if pathologic
murmur is suspected?
Valvular heart disease, prosthetic heart valves, or other structural cardiac anomolies.
Procedures are dental, upper respiatory, GI, and GU procedures
Amoxicillin PO 2 G one hour prior to procedure - answersWhich patients need bacterial
endocarditis prophylaxis?
Chapter 1-26 Complete Guide
pain elicited with pressure is applied halfway between the umbilicus and the anterior
spine of the ilium - answersMcBurney's Sign
deep palpation over LLQ with sudden, unexpected release of pressure (also called
referred rebound tenderness - answersRovsing's sign
pain when the patient is instructed to try to lift the right leg against gentle pressure
applied by the examination - answersPsoas sign
Temporary paralysis of CN 7/Facial nerve - answersBell's Palsy
Lipid bound drugs - answersWhich drugs cross the placenta more readily?
2-7 weeks - answersWhat is the incubation period for Hepatitis A?
LFTs and a hepatitis panel - answersIF you suspect a patient has hepatitis, what is the
first test you will order?
2-6 months - answersWhat is the incubation period for hepatitis B?
Enzyme immunoassay (EIA) - answersWhat is the screening test for hepatitis C?
Inflammation of skin folds caused by friction between surfaces. May be worse with
obesity or diabetes - answersIntertrigo
Noncontagious inflammation of the connective tissue of the skin caused by bacteria -
answerscellulitis
erythmatous lesion with silvery scales; nail pitting - answerspsoriasis
If 60 years or older, treat BP greater than or equal to 160/90
If <60 years old, treat to lower DBP <90 and or SBP <140
Anyone age 18 or greater with CKD or diabetes, treat to lower BP to 140/90 -
answersJNC BP guidelines
In the general nonblack population, including those with diabetes, initial
antihypertensive treatment should include a thiazide-type diuretic, calcium channel
blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor
blocker (ARB). - answersIn non-black population, what is the initial treatment of choice
when starting BP medication?
,In the general black population, including those with diabetes, initial antihypertensive
treatment should include a thiazide-type diuretic or CCB - answersWhat is the initial
treatment of choice in the black population?
In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive
treatment should include an ACEI or ARB to improve kidney outcomes. This applies to
all CKD patients with hypertension regardless of race or diabetes status. - answersIf 18
or older with CKD, what is the treatment for HTN?
When the pt has been sitting for 5 minutes. The pt should not smoke or drink coffee
prior to BP measurement. Be aware of white coat. - answersWhen should BP
measurements be taken?
140 or 90 on two separate occasions . Baseline labs should be done - ECG, lipid panel,
UA, glucose, HCT, potassium, creatinine, GFR, calcium, - answersWhen can HTN be
diagnosed.
1. DASH diet
2. Exercise - daily walking
3. Lifestyle changes
4. Next step is thiazide diuretic - answersTreatment of HTN
ACE inhibitors, because they help the kidneys. - answersWhat type of HTN meds will
help a diabetic?
more common in young women, may be autosomal dominant, most common valve
disorder in U.S. - answersMitral valve prolapse (MVP)
Regurgitation murmur or mid-systolic click upon auscultation. Symptoms - palpitations,
dysrhythmia, tachycardia, syncope, fatigue, lethargy, dyspnea, chest tightness, panic
attacks, depression, atypical chest pain. Refer if symptomatic. - answersMVP findings
anemia caused by b12/folate deficiency due to alcoholism, pernicious anemia, or poor
nutrition. - answersmacrocytic, normochromic anemia
IDA most likely, but can be thalessemia or blood loss - answersmicrocytic anemia
blood loss, hemolytic reaction, anemia of chronic disease - answersnormocytic
normochromic
impaired fasting glucose, central obesity, elevated triglycerides and BP, reduced HDL.
Treated with lifestyle modifications, medications, and referral for bariatric surgery -
answersmetabolic syndrome
,Graves - most common, caused from stimulation of thyroid by antibodies against TSH
receptors. Target is not destroyed but malfunctions. When autoantibodies bind with
receptors for TSH, it messes up the feedback look and stimulates T4 production
S/S are tachycardia, nervousness, tremor, elevated BP, lid lag, weight loss -
answershyperthyroid
PTU - drug of choice for pregnant women
methimazole is other option for tx, but not during pregnancy
Treatment for 6-12 months, then stopped - answerstreatment for hyperthyroid
Heartburn sensation; tx with diet, weight loss, stop smoking, elevation of HOB, small
meals, H2 blocker, PPI - answersGERD
duodenal most common; caused by h Pylori, NSAIDS,
Sx: pain when stomach is empty; weight gain because pt is eating for relief. Ask about
signs of bleeding (black tarry stools). Refer if bleeding or not responding to tx. ABX for h
pylori and PPI to promote healing of ulcer. Stop taking NSAIDS if they are contributing
factor and replace with misoprostol. - answersPUD
IBS is chronic, usually starting in adolescence and correlate with life stressors. IBS has
2/3 features - relief with defecation, frequent or infrequent stools, a change in
appearance of stool, and present for 12 weeks of past 12 months. Does not interrupt
sleep. PE shows no abnormalities. Do CBC, TSH, sed rate, lytes, BUN creatinine,
glucose to rule out infection, stool for occult blood and fecal leukocytes (would indicate
bacterial). Treatment is lifestyle modifications. Avoid trigger foods. Increase fluids and
increase exercise. - answersIBS vs constipation
Caused from e coli or shingella, etc. - answersTravelers diarrhea
burning sensation in chest; accompanied by cough, URI. Nose and throat symptoms go
away but cough can persist with wheezes, rhonchi, rales. Tx with rest, fluids, cough
meds at night, and bronchodilator - answersacute bronchitis
band-like, tightening, bilateral, not aggrivated by exercise. TX with tylenol or NSAIDS -
answerstension headache
unilateral, pulsating, moderate to severe in intensity, aggrivated by physical activity,
nausea and vomiting, photophobia/phonophobia. Tx with lifestyle changes, avoid certain
foods, biofeedback, medications. Prophylaxis - beta blocker or tricyclic antidepressant,
SSRIs, anticonvulsants, NSAIDS - answersCommon migraine
Above symptoms, and also aura that develops in <60 minutes; HA lasts 4-72 hours -
answersClassic migraine
, severe, unilateral, orbital, or temporal pain; lasts 15 min-3 hours; occurs 1-8 times/daily.
At least 5 attacks in history to be called a cluster HA. May be years before attack. More
likely to happen in males. - answersCluster headache
unilateral facial paralysis of facial nerve/CN 7. Treatment: protect eye, massage facial
muscle, prednisone in tapering dosage, and Valtrex x 7 days. Usually self-limiting. -
answersBells palsy
Pain in hand caused by compression of median nerve. Decreased grip. +Tinel and
Phalen sign. Dx with xray and clinical presentation. Tx: NSAIDS, splints, ice, and
modifications to decrease repetitive motion. Referral with no improvement in 3 weeks. -
answersCarpal tunnel syndrome
Smoking, obesity, physical inactivity, dyslipidemia, DM, microalbuminuria or GFR less
than 60, age 55M/65W, fhx of premature cardiovascular disease - answersMajor
cardiovascular risk factors
Primary aldosteronism (weakness is a sign)
Cushing syndrome (truncal obesity/striae)
Phenochromocytoma (palpitations, sweating, tremor)
renal disease, thyroid disease, sleep apnea, drug-induced (cocaine, alcohol, COCs,
OTC cold meds) - answersCauses of secondary HTN
No physical findings, except audible murmur
Soft grade 1/2, medium pitch, systolic
heard best when supine
disappears when standing or straining
Increases with increased cardiac output (fever, exercise) - answersInnocent murmur
findings
Diastolic or pansystolic or any murmur above grade 3
Intensifies with exercise of Valsalva maneuver
Mid to late systolic click, associated with MVP
cyanosis
Jugular vein distension
hepatomegaly
pedal edema or diminished femoral pulses or unequal blood pressure in left and right
arms - answersPathologic murmur findings
Echo, CXR, CBC, Thyroid tests - answersWhat tests should be performed if pathologic
murmur is suspected?
Valvular heart disease, prosthetic heart valves, or other structural cardiac anomolies.
Procedures are dental, upper respiatory, GI, and GU procedures
Amoxicillin PO 2 G one hour prior to procedure - answersWhich patients need bacterial
endocarditis prophylaxis?
