Download Fitzgerald Prep part 2 Question and answers correctly solved 2025 and more Exams Nursing in PDF only on Docsity!
Fitzgerald Prep part 2 Question and
answers correctly solved 2025
Too much estrogen s/s - correct answer ✔Nausea, bloating, breast tenderness, increased blood pressure, melasma, headache Too little estrogen s/s - correct answer ✔Early or mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea Too much progestin s/s - correct answer ✔Breast tenderness, headache, fatigue, changes in mood Too little progestin s/s - correct answer ✔Late breakthrough bleeding Too much androgen s/s - correct answer ✔increased appetite, weight gain, acne, oily skin, hirsutism, decreased libido, increased breast size, breast tenderness, increased LDL cholesterol, decreased HDL cholesterol Latent tuberculosis infection: definition and scope of problem - correct answer ✔Found in a person who has acquired the TB bacillus but is without s/s of active TB and is unable to spread the disease to others. Usually, the person has a positive tuberculin skin or serological test result. Subsequent chest x- ray is usually normal but occasionally shows abnormalities suggestive of prior TB. The lifetime risk of active tuberculosis among patients with a history of a positive tuberculin skin test result is between 5% and 10% Candidates for TB testing: - correct answer ✔- People who have spent time with a person known to have or suspected of having active TB disease
- People who have HIV infection or another condition that weakens the immune system, creating a high risk for active TB disease
- People who have symptoms of active TB disease
- People from a country where active TB disease is common (most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia)
- People who live somewhere in the United States where active TB disease is more common, such as a homeless shelter, migrant farm camp, prison or jail, or some nursing homes
- People who inject illegal drugs Reactive Mantoux Tuberculin Skin Test (TST):
/= 5 mm, risk factors that support a positive result: - correct answer ✔HIV, recent contact with a person with TB disease, fibrotic changes on CXR c/w previous TB infection, organ transplant, immunosuppression from other causes (e.g., taking equivalent of > 15 mg/day of prednisone for >/= 1 month or taking TNF-alpha antagonists Reactive Mantoux Tuberculin Skin Test (TST): /= 10 mm risk factors that support a positive result: - correct answer ✔Immigration from high-prevalence countries in the last 5 years, IV drug use, employment or residence in high-risk congregate settings, employment in mycobacteriology lab, high-risk clinical conditions, < 4 years, childhood (including adolescent) exposure to adults in high-risk categories Reactive Mantoux Tuberculin Skin Test (TST): /= 15 mm, risk factors that support a positive results: - correct answer ✔none required
Normocytic, normochromic anemia with NL RDW - correct answer ✔MCV = NL (80-96); MCHC= NL (31-37); RDW = NL (37-55) Most common etiology: acute blood loss or anemia of chronic disease (ACD). Cells made under ordinary conditions with sufficient hemoglobin. This yields cells that are normal size (normocytic), normal color (normochromic), and about the same size (NL RDW). Ex: 72 yr old man with an acute GI bleed (acute blood loss). 32 yr old woman with newly-diagnosed systemic lupus erythematosus (ACD). Hb = 10.1 g/L (12-14g/L) DOWN (101 g/L [120-140 g/L]) Hct = 32% (36-43%) DOWN (0.32 proportion [0.36-0.43 proportion]) RBC = 3.2 million/mm3 (4.2-5.4 mil) DOWN MCV = 82 fL (81-96) NL MCHC = 34.8 g/dL (31-37 g/dL) NL RDW = 12.1% (11.5-15%) NL Microcytic, hypochromic anemia with elevated RDW - correct answer ✔MCV down (<81); MCHC down (<31); RDW up (>15%) Most common etiology: iron deficiency anemia (IDA). Small cells (microcytic) due to insufficient hemoglobin (hypochromic), with new cells smaller than old cells (elevated RDW). [Next step test: Ferritin for estimate of iron stores.] Ex: 68 yr old man with erosive gastritis 48 yr old woman with menorrhagia Hb = 10.1 (12-14) down Hct = 32% (36-43%) down RBC = 3.2 (4.2-5.4) down MCV = 72 (81-96) down = microcytic
MCHC = 26.8 (31-37) down = hypochromic RDW = 18.1% (11.5-15) up = new cells different from old cells Microcytic, hypochromic anemia with NL RDW - correct answer ✔MCV down (<81); MCHC down (31); RDW NL (11.5-15) Most common etiology: Alpha or beta thalassemia minor (also known as thalassemia trait) [At risk ethnic groups for alpha thalassemia minor: AAA: Asian, African ancestry. For beta thalassemia minor: BAMME: African, Mediterranean, Middle Eastern ancestry] Through inherited genetic variation (not considered a disease state), small (microcytic), pale (hypochromic) cells that are all around the same size (NL RDW). [Next step test = hemoglobin electrophoresis for evaluation of hemoglobin variants] Ex: 27 yr old man of African ancestry with beta thalassemia minor. Hb = 11.6 (14-16) down Hct = 36.7% (42-48) down RBC = 6.38 (4.7-6.10) up MCV = 69.5 (81-99) down MCH = 22 (27-33) down RDW = 13.8% (11.5-15) NL Interpretation: lots of small pale cells, old same size as new Macrocytic, normochromic anemia with elevated RDW - correct answer ✔MCV up (>96); MCHC NL (27-33); RDW up (>15) Most common etiologies: pernicious anemia, dietary-induced vitamin B deficiency (uncommon), folate deficiency anemia (uncommon) Abnormally large (macrocytic) cells due to altered RNA:DNA ratio, hemoglobin content NL (normochromic), new cells larger than old cells (elevated RDW) Next step test = Vitamin B12 and folate
- Replace needed micronutrients, such as iron and select vitamins (i.e. B vitamins and folate). Micronutrient requirements increase in reticulocytosis.
- Epoetin alfa (EPO, Protcrit) as indicated. Biologically identical to endogenous erythropoietin induces erythropoiesis. Helpful in severe anemia, particularly presence of advancing renal failure. Erythropoietin supply is diminished in advancing renal failure, usually beginning when glomerular filtration rate (GFR) <49 mL/min (normal GRF = 90-120) What is the most common type of anemia in childhood? - correct answer ✔IDA - iron deficiency anemia What is the most common type of anemia during pregnancy? - correct answer ✔IDA - iron deficiency anemia What is the most common type of anemia in women during reproductive years? - correct answer ✔IDA What is the most common type of anemia in the elderly? - correct answer ✔ACD - anemia of chronic disease What is the most important source of the body's iron supply? - correct answer ✔Recycled iron content from aged red blood cells (85%) A 78-yr old woman presents with fatigue, spoon-shaped nails and the following lab results: Hb = 9 (11.8-14) Hct = 28.1% (35.4-42%) RBC = 2.4 (3.2-4.3) MCV = 70 (80-96)
MCHC = 24.2 (31-37)
RDW = 19% (11-15%)
A critical causative diagnosis to consider as origin of her anemia is: - correct answer ✔GI bleed (iron deficiency anemia on labs: microcytic, hypochromic, new cells different from old cells) Next step: Ferritin, occult blood, GI consult What is the optimal advice to a patient who is taking oral iron therapy to maximize the medication's effectiveness? - correct answer ✔Take your medication on an empty stomach A 68 yr old woman presents with 6 month history of increasingly severe peripheral numbness and oral irritation. Hemogram results are as follows: Hb = 6.2 (12-14) Hct= 20% (36-42%) RBC = 2.1 (4.2-5.4) MCV = 132 (80-90) MCHC = 32.4 (31-37) RDW = 19% (11-15%) WBC morphology = hypersegmented neutrophils Physical exam reveals pale conjunctiva, a grade 2/6 systolic ejective murmur over the precordium without radiation, and a smooth, red tongue. The most likely cause of this anemia is: - correct answer ✔Vitamin B12 deficiency (macrocytic and neuro complaints) A 68 yr old woman presents with 6 month history of increasingly severe peripheral numbness and oral irritation. Hemogram results are as follows: Hb = 6.2 (12-14) Hct= 20% (36-42%)
by allergens, environmental irritants, and/or infection (viruses [MAJORITY], bacterial and fungi). Acute bacterial rhinosinusitis (ABRS or ABS) - correct answer ✔Secondary bacterial infection of paranasal sinuses, usually following viral URI; relatively uncommon in adults and children. LESS THAN 2% OF VIRAL URIs ARE COMPLICATED BY ABRS. IN THE MAJORITY, ABRS WILL RESOLVE WITHOUT ANTIMICROBIAL THERAPY (NNT = 13) Empiric antimicrobial therapy - correct answer ✔The decision making process in which the clinician chooses the agent based on patient characteristics and site of infection Questions to ask prior to choosing an antimicrobial - correct answer ✔What is/are the most likely pathogen(s) causing this infection? What is the spectrum of a given antimicrobial's activity? What is the likelihood of a resistant pathogen? What is the danger if there is treatment failure? S. pneumonia (#1 MOST COMMON CAUSATIVE PATHOGEN IN ABRS, AOM, CAP) - correct answer ✔Gram-positive diplococci, ABRS causative organism in adults = 38%, children = 21-33%.
/= 25% drug-resistant (DRSP) via altered protein-binding sites that limit certain antibiotic's ability to bind to the pathogen H. influenzae (#2 MOST COMMON CAUSATIVE PATHOGEN IN ABRS, AOM, CAP, PARTICULARLYWITH RECURRENT INFECTION, TOBACCO USE) - correct answer ✔Gram-negative bacillus, ABRS causative organism in adults = 36%, children = 31-32%.
/= 30% penicillin-resistant via production of beta-lactamase that cleaves beta-lactam ring in most penicillins including amoxicillin, ampicillin. Most cephalosporins are stable in the presence of beta-lactamase. Cephalosporins - correct answer ✔Beta-lactam antibiotics First generation: cefazolin Second generation:
- subgroup with activity against Haemophilus influenzae (cefuroxime)
- Cephamycin subgroup with activity against Bacteroides spp (cefoxitin and cefotetan) Third generation:
- Subgroup with broad gram negative acitivity but poor activity against Pseudomonas aeruginosa (cefotazime and ceftriaxone)
- Subgroup with broad negative activity including good activity against Pseudomonas aeruginosa (ceftazidime) Fourth generation: cefepime Fifth generation: ceftraroline M. catarrhalis (LEAST COMMON PATHOGEN IN ABRS, AOM, UNCOMMON CAUSE OF CAP) - correct answer ✔Gram-negative coccus, ABRS causative organism in adults = 16%, children = 8-11%.
/= 90% penicillin-resistant via beta-lactamase production In treating ABRS, what types of bacteria should you generally cover for? - correct answer ✔Chose an antimicrobial with acitivity against gram-positive (S. penumoniae, consider DRSP risk) and gram-negative (H. influenzae, M. catarrhalis, consider beta-lactamase production rates) Risk for antibiotic resistance - correct answer ✔- age <2 or >
- Symptomatic treatment (saline nasal irrigations, intranasal corticosteroids when accompanied by allergic rhinitis (Flonase), topical or systemic decongestants for pts sense of congestion relief (pseudoephedrine - do not use with HTN)
- Improvement after 3-5 days: complete 5-7 days of antimicrobial therapy
- Worsening or no improvement after 3-5 days: broaden coverage or switch to different antimicrobial class; improvement, complete 5-7 or 7-10 days therapy; worsening or no improvement in 3-5 days, CT or MRI to investigate noninfectious causes of suppurative complications, sinus or meatal cultures for pathogen-specific therapy and refer to specialist Symptomatic treatment of ABRS - correct answer ✔- Saline nasal irrigations
- Intranasal corticosteroids when ABRS is accompanied by allergic rhinitis (Flonase)
- Topical or systemic decongestants for patient sense of congestion relief (i.e. pseudoephedrine) Initial empiric therapy for ABRS - correct answer ✔First-line (no DRSP risk): Amoxicillin-clavulanate 500 / 125 mg PO TID, or 875 mg/125mg PO BID Second line (DRSP risk): Amoxicillin-clavulanate 2000 mg/126 mg PO BID or Doxycicline 100 mg PO BID or 200 mg PO daily. High-dose amoxicillin needed against drug-resistant Streptococcus pneumonia (DRSP). Clavulanate as a beta-lactamase inhibitor, allows amoxicillin to have activity against beta-lactamase producing organisms, such as H. influenzae, M. catarrhalis. Doxycycline: DRSP tx failure risk, acivity against Gram-negative organisms, stable in the presence of beta-lactamase. Doxycycline = PREGANANCY RISK D
Antimicrobial therapy for ABRS in beta-lactam allergy (i.e. PCN, cephalosporins) - correct answer ✔Doxycycline 100 mg PO BID or 200 mg PO daily ( DRSP tx failure risk, PREGNANCY RISK D) or Levofloxacin 500 mg PO daily or Moxifloxican 400 mg PO daily. Respiratory flouroquinolones (FQ) (Levofloxacin and Moxifloxican): activity against DRSP, gram-negative organisms, stable in presence of beta- lactamase. Major rationale the use of respiratory FQ is the presence of DRSP risk. Antimicrobial therapy for ABRS with risk for antibiotic resistance (DRSP) or failed initial therapy - correct answer ✔Amoxicillin-clabulanate 2000 mg/ mg PO BID or Levofloxacin 500 mg PO daily or Moxifloxacin 400 mg PO daily. All options with activity against DRSP, Gram-negative organisms, stable in presence of and/or active against beta-lactamase CYP450 3A4 substrate common examples - correct answer ✔Sildenafil (Viagra), atorvastatin, simvastatin, venlafaxine (Effexor), alprazolam (Xanax), many others. About 50% of all prescription meds are CYP450 3A4 substrates **** A substrate utilizes a specific enzymatic pathway. A medication or substance that is metabolized by the isoenzyme, utilizing this enzyme in order to be modified so it can reach drug site of action and/or be eliminated.
AR issue: Controller therapy to prevent symptoms - correct answer ✔Intranasal corticosteroids as first-line controller therapy (block 8 receptors)
- Ex: Fluticasone propionate (Flonase), triamcinolone (Nasocort AQ). Leukotriene receptor antagonists (LTRAs) SHOULD NOT BE OFFERED AS FIRST-LINE CONTROLLER THERAPY
- Ex: Montelukast (Singulair) - blocks only 1 receptor. Mechanism of action: prevention of inflammatory mediators. Intranasal corticosteroids significantly more effective when compared to LTRA due to suppression of more inflammatory mediators (8:1), onset of action within 2-7 days of use. LTRA - best as add-on therapy if symptoms are not adequately controlled with intranasal corticosteroids. AR issue: Reliever therapy to relieve acute symptoms - correct answer ✔2nd generation oral antihistamines preferred over first-generation antihistamines (i.e. Benadryl) due to less unfavorable adverse affect profile
- Ex: Cetirizine (Zyrtec) - most effective; and loratadine (Claritin) less effective Intranasal antihistamine - an option for nasal symptom relief.
- Intranasal antihistamine ex: Azelastine (Astelin, Astepro) Ocular antihistamine: helpful in managing allergic conjunctivitis s/s
- Ex: Olopatadine (Patanol, Pataday), azelastine (Optivar), bepotastine (Bepreve). Mechanism of action: block histamine-1 receptor sites. Limited benefit with nasal congestion. Oral first-generation antihistamines (diphenhydramine [Benadryl], chlorpherniramine [Chlor-trimeton], others) clinically effective but not favored over 2nd generation oral antihistamines. Significant potential to cause sedation, impair performance, and exert anticholinergic effects. Due to adverse effects, not first-line therapy. Adverse effects particularly problematic in the older adult. Found in OTC URI and AR medications labeled to "dry runny nose" and in most OTC sleep aids.
AR issue: Immunotherapy - correct answer ✔Immunotherapy (sublingual or subcutaneous) for pts with allergic rhinitis who have inadequate response to symptoms with pharmacologic therapy with or without environmental controls. Usually requires specialty referral. Mechanism of action: restore tolerance to allergen by reducing its tendency to induce IgE production AR issue: Acupunture - correct answer ✔Provide or refer to a clinician who can offer acupuncture, for pts with allergic rhinitis who are interested in nonpharmacologic therapy. No current evidence to support herbal therapy. On Old Olympus Towering Tops A Finn And German Viewed Some Hops - correct answer ✔Olfactory - I - smell (one nose) Optic - II - vision (two eyes) Oculomotor - III - eyelid and eyeball movement (up, down and all around) Trochlear - IV (4) - innervates superior oblique, turns eye downward and laterally (4 eyes) Trigeminal - V (5) - chewing, face and mouth, touch and pain Abducens - VI (6) - turns eye laterally (6 to 6, tick tock) Facial - VII (7) - controls most facial expressions, secretion of tears and saliva, taste Acoustic - VIII (8) - hearing, equilibrium, sensation (number 8 looks like and ear) Glossopharyngeal - IX (9) - taste, senses carotid blood pressure Vagus - X (10) - Senses aortic blood pressure, slows heart rate, stimulates digestive organs, taste Spinal accessory - XI (11) - Controls trapezius and sternocleidomastoid, controls swallowing movements (11 to shrug your shoulders and swallow)
Myopia - correct answer ✔Near-sightedness Sharp disk margins in a eye exam are: - correct answer ✔a normal finding Retinal arteries wider than veins in an eye exam is: - correct answer ✔an abnormal finding Lid ectropion - correct answer ✔Aversion of eyelid away from the globe Bells palsy - correct answer ✔Sudden onset of inability to raise eyebrow or smile on one side of the face; decreased lacrmation of same side and difficulty closing same side eyelid. Tx: oral corticosteroids, heavy, short dose 90% of oral cancers - correct answer ✔Squamous cell carcinoma Aphthous stomatitis - correct answer ✔aka canker sore in the mouth, very painful Oral candidiasis - correct answer ✔coated tongue that scrapes off Syphilitic chancre of the mouth - correct answer ✔goes away in 3 wks without tx What is most likely to be found on the fundoscopic exam in the person with angle-closure glaucoma? - correct answer ✔A deeply-cupped optic disc
Arteriovenous nicking = - correct answer ✔atherosclerotic change in the eye Papilledema = - correct answer ✔too much pressure in the brain (intracranial pressure) Hemorrhagic lesions in the eye = - correct answer ✔trauma, HTN, DM retinopathy Peripheral vision los most common etiology - correct answer ✔untreated open-angle glaucoma (ie tunnel vision); insidious Need for increased illumination vision alteration most common etiology: - correct answer ✔normative aging Central vision loss most common etiology - correct answer ✔Macular degeneration MOST COMMON VISION LOSS IN OLDER ADULTS Women>men (estrogen a factor) What is used as a screening test for macular problems? - correct answer ✔Amsler grid test Slit-lamp examination - correct answer ✔The slit lamp allows the eye to be examined with a beam or "slit" of light (versus diffuse light) whose height and width can be adjusted. The slit of light, when directed at an angle, accentuates the anatomic structures of the eye, allowing close inspection. The slit lamp provides greater magnification (10 to 25 times) and illumination than most handheld devices (eg, Wood's lamp), which is necessary to diagnose a number of traumatic and nontraumatic disorders.
