NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]., Exams of Nursing

Download NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. and more Exams Nursing in PDF only on Docsity! NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 1. Hypertension Presentation: Most are not symptomatic, Occipital Headaches, headache on awakening in am, burry vision. Look for these clinical findings to rule out organ damage: Microvascular • Eyes (HTN retinopathy): AV nicking (causes when arteriole crosses on top of vein), papilledema • Kidneys: microalbuminuria and proteinuria, elevated serum creatinine and abnormal eGFR, peripheral or generalized edema Macrovascular • Heart: S3 (CHF), S4 (LVH), carotid bruits, decreased or absent peripheral pulses • Brain: TIA or hemorrhagic stroke Assessment/Exam: • Asymptomatic • Occipital headache • Blurry vision • Headache upon wakening • Exam of optic fundi: Look for AV nicking, hemorrhage, papilledema • LVH (long standing HTN) • Perform exam of symmetrical pulses • Auscultate for Carotid bruits, abdominal bruits, and kidney bruits Diagnostic studies: EKG, fasting lipid profile, fasting blood glucose, TSH, CXR to R/O cardiomegaly. CBC, CMP, and urinalysis. Measure BP 5 minutes apart. Assess the patients 10- year risk for heart disease (ASCVD) Diagnosis: > 140/90 mm Hg start on B/P medication. Pharmacologic Management: • FIRST LINE DIURETIC: Hydrochlorothiazide (HCTZ) 25 mg/day (max 50mg/day) *May worsen gout and elevate lipids and glucose • ALTERNATIVE CCB: Amlodipine besylate 5 mg /day. (Watch for lower extremity edema) • ACE: lisinopril 10mg/day complicated HTN first line • Consider ACE/ARB in patient with DM, proteinuria, HF. CONTRAINDICATED IN PREGNANCY • If stage 2, initiate 2 drug classes (Diuretic & CCB most effective in African American) Follow up: • 2-4weeks Referral: • Cardiology if EKG is abnormal Secondary HTN causes to consider: • CKD, renal artery stenosis, hyperthyroidism, phenochromocytoma, OSA, coartication of the heart (SBP higher in the legs), oral contraceptives, corticosteroids, cocaine, NSAID, decongestants Differential: • Secondary hypertension • White coat syndrome • Pregnant • Pregnancy induced hypertension NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Education: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. c) High Intensity (lowers LDL on average by >50%): Atorvastatin 40-80mg daily. (Never start on 80mg, always titrate up). Rosuvastatin 20-40mg. • AVOID GRAPEFRUIT JUICE! Watch for rhabdomylosis • INTOLERANCE TO STATIN: Alternative Welchol (Bile Acid Sequestrants) 625 mg tab daily once a day. • Age 21-75 high intensity therapy Follow up: q6-8 weeks re-check lipids until goal is achieved, then q 6-12 months to evaluate compliance Risk Factors: DM, FH of HD, HTN, low HDL, age (men older than 45 and women older than 55), smoking, obesity, CAD, PVD, microalbuminuria Refer: Nutritionist Differentials: • Hypothyroidism • Pregnancy • Diabetes Liek: 1 Hollier: 29, 1 3. Diabetes type 2 - Presentation (assessment): insulin resistance in target tissues, abnormal insulin secretion, or decrease in insulin receptors. **Usually discovered on routine exam! • Polydipsia, Polyuria, Polyphagia, (showing symptoms) • agitation, • nervousness, • obesity, • fatigue • Chronic skin infections • Women: chronic yeast infection • blurry vision • Exam feet, pulses, nail thickness, odor, swelling, mobility • Thyroid palpitation • Skin exam Diagnostics: EKG, CBC, CMP, LIPIDS, Microalbuminuria, TSH, A1C Diagnosis: Hgb A1C >or equal to 6.5% Fasting glucose>126mg/dl and confirmed on a different day Fasting between 100-126 = impaired glucose Nonfasting less than 126 = normal values Recurrent yeast infections Non-pharmacologic Management: • Monitor Blood glucose at home and diary (daily) • Lifestyle modification: diet and Exercise • avoid alcohol • avoid smoking • • • • • NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • Routine oral exams Pharmacologic Management: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • First Line: Begin Metformin (Biguanide) 500mg twice a day (Max: 2000 mg a day in 2 doses). • Additional 1st line or combo therapy: (Sulfonylureas, thiazolidinediones, GLP-1, DDP-4 • Second Line: Insulin, SGLT2, meglitinides, diphenylamine derivatives, bile sequestrants, alpha-glucosidase inhibitors • Actos 15 mg daily • Levemir 10 units once a day Follow up: • 2-4 weeks Referral: • Ophthalmologist at time of diagnosis and then yearly or bi-annualy if no problems • Fundoscopic exam • Diabetic educator/ specialist • Nutritionist • Podiatry Education: • Carbs 50% • Protein 30% • Fat 20% • Good glycemic control – no low sugars • 10-15 years develop complications • Foot care: a. Avoid going barefoot, test water temperature before stepping into a bath. b. Trim toenails to shape of the toe; remove sharp edges. Do not cut cuticles. c. Wash and check feet daily. d. Shoes should be snug but not tight. e. Socks should fit and be changed daily. • Immunization: Once a year influenza vaccine. Pneumococcal vaccine, revaccination for individuals >64 years of age previously immunized. • Increase awareness and screen for social determinant of health: a. Financial ability to afford medications b. Access to healthy foods c. Community support d. Food insecurity Complications: • Peripheral Neuropathy • Nephropathy • CKD • Glaucoma = blindness • Cataracts • Delayed wound healing • CAD/PVD Differentials: • Gestational diabetes • Cushing’s syndrome • Corticosteroid use Liek: 1 NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • If not resolved or improving in 4-6 weeks NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • X-ray/ct after 4 weeks unresolved Differentials: • Muscle strain • Herniated disc • Compression fracture • Cauda equina • Osteoarthritis • Spinal stenosis Liek: 301-302 Hollier: 502, 1 5. Anxiety Presentation: complaints of apprehension, restlessness, edginess, distractibility insomnia; Somatic complaints like fatigue, paresthesia, near syncope, dizziness, palpitation, tachycardia chest pain/tightness, dyspnea, hyperventilation, nausea vomiting diarrhea. Etc Diagnostic: TSH, CBC, CMP, UA, Urine drug screen, Glucose, EKG (rule out cardia issues), Hamilton Anxiety scale Diagnosis: Assess tools like i. Hamilton Anxiety scale : Positive Greater than 18 The GAD-7 (Table 27) has been validated as a diagnostic tool and a severity assessment scale, with a score of 10 or more having good diagnostic sensitivity and specificity (Total score for the 7 items ranges from 0 to 21. Scores of 5, 10, and 15 represent cutoffs for mild, moderate, and severe anxiety) Non-pharmacological: • Psychotherapy/Counseling (CBT) • healthy diet • Avoid stressors as much as possible. • Relaxation • Regular exercise • Avoid caffeine intake • Avoid alcohol (rebound anxiety) Pharmacological: SSRI may not achieve therapeutic response for 2-4 weeks with full response might take 12 weeks or more. ***Use of Benzodiazepines until therapeutic response reached is a short term strategy-up to 1-3 months with planned taper. (ADDICTIVE) • Buspar 7.5mg twice a day and • SSRI – Escitalopram (Lexapro) 10mg PO once daily. May increase in 1-2 weeks. Or Zoloft 50 mg • Klonopin 0.25mg PO PRN twice a day for short-term use and titrate down because benzodiazepines have abuse potential. (Use in caution during the 2-4 weeks that the SSRI will take to meet partial therapeutic response) Only to be used PRN not daily Follow up: • 2-4 weeks Referral: • Psychologist/Psychiatrist NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Differentials: • Depression NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • Bipolar • substance abuse • medication abuse • medication withdrawal • hypothyroidism • B12/Folate deficiency • Dementia Hollier 628; Leik 363 7. Obesity Presentation: Chronic disease due to abnormal/excessive fats accumulate which impairs health Increased morbidity and morality Defined as 20% more than ideal body mass index Parental obesity, hypothyroidism, cushing syndrome, diabetes, Diagnostics: TSH, Lipid panel, glucose/A1c, CBC, CMP, Lipase, EKG, associated with PCOS Diagnosis: BMI >30 Non-Pharmacological: • Lifestyle modification: exercise and diet • Dietary intake and eating habits • Modify times of eating • Less calories consistently Pharmacological: • Adipex-P 37.5mg daily x12weeks Follow up: 2-4 weeks Referral: Nutritionist/dietitian Liek:196-197,1 Hollier:319, 8.GERD: movement of GI contents into esophogaus d/t decreased LES tone. Subjective findings: Heartburn, burning beneath the sternum, postprandial and nocturnal, regurgitation, chest pain, neck pain, chronic cough. Dysphagia, sour taste in mouth, lump in throat, post nasal drip, erosion of teeth by acid Diagnosis: Based on symptoms of heartburn and regurgitation. Empiric PPI treatment should be started for 8 weeks. Diagnostic: Endoscopy after 8 week trial of PPI and unresolved. Non-pharmacological: • First line treatment! Removing or modifying risk factors like coffee, spicy food, chocolate • small more frequent meals • sit up for 2 hours after meals • don’t eat 3-4 hours before going to bed. • Smoking cessation • Avoid alcohol Pharmacological: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Omeprazole 20mg daily before breakfast/ PPI Follow up: 4-8 weeks for re-evaluation, if no relief high risk for Barrets Esophagus. NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Referral: None. GI after 8 weeks of PPI treatment with no relief, worsening of symptoms, or dysphagia. Differentials: • Cardiac disease • Esophageal spasm • Peptic ulcer disease • Asthma • Pulmonary edema Leik 267 Hollier:260 9. Allergic Rhinitis Presentation: S&S: intermittent allergies, Seasonal allergies. Pale boggy turbinates’. Red conjunctivitis. Clear nasal discharge sneezing nasal stuffiness and mucosal edema. Cough? Throat click? Allergic shiners – under eyes Allergic salute – crease on nose from rubbing upward Evaluate medication compliance IgE reaction – allergic reaction – elevated eosinophiles Diagnostic: none. May do CBC if acute reaction to check eosinpphilia Diagnosis: Conjunctival injection, pale, boggy turbinates’ with clear nasal secretions, sore throat, palpable lymph nodes Non-pharmacological: • Avoidance/elimination of offending allergen • frequent vacuuming, dusting, remove feather pillows from the bedroom, • change air conditioner filter frequently, • removal house plants, remove carpet Pharmacological: • Flonase 2 sprays in each nostril daily; • Antihistamine - Claritin 10mg once a day/Zyrtec Follow up: 2-6 weeks after initial evaluation and then 3-6 months depending on severity Referral: None unless polyps or deviated septum Differentials: • Common cold • Nasal foreign body • Tumors • Infection • Rhinitis medicametosa Liek:129 Hollier:169 10. URI (common cold) : Acute onset of fever, sore throat, sneezing, nasal congestion, headache. Ranges 4-10 days, most contagious days 2-3 Presentation: Nasal stuffiness, sneezing, scratchy, irritated throat/hoarseness (reddened), red or NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Symptoms > 10 days is a bacterial infection Diagnostics: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • CBC (elevated WBC), • sinus x-rays for recurrent disease • CT scan for recurrent disease Nonpharmacological: • Avoid environmental irritants, • treat otitis media, • sleep with HOB elevated to aid with drainage, • Good hand hygiene • blowing nose. Pharmacological • Augmentin 875 mg/125 mg PO twice a day for 5 days, • Allergic to Penicillin then Doxycycline 100mg twice a day for 5days. • Azithromycin – Zpack - Follow up: • 1 week Referral: • None Liek: Hollier:202-203,1 13. Acute bronchitis Presentation: inflammation of the bronchioles bronchi and trachea usually follows an upper respiratory infection or exposure to chemical irritants. The cause is usually by adenovirus/rhinovirus – viral in etiology Signs and symptoms: Cough, NON-productive, then productive may be purulent. URI symptoms, fatigue, fever (usually COPD pt), crackles/wheezes, chest wall pain. Diagnostics: • Chest x-ray (hypoxia, tachypnea, fever, abnormal lung exam, o high risk pneumonia) Nonpharmacological: • increase fluid intake, • use humidifier, • rest, • Smoking cessation Pharmacological: • Antibiotics not recommended • Cough suppressants - nighttime • Z-Pack 500mg day one and 250 mg for 4 days (positive Pneumonia) • Tessalon pearls 200mg TID PRN • Albuterol inhaler 2 inhalations every 4-6 hours as needed, Follow up • 1 week Referral • None now • pulmonologist if not improved in 4 weeks. Complications: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • chronic cough • secondary infection NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • Foreign body Liek:235 Hollier:662 15. Hypothyroidism (everything slows down): reduction in circulating free thyroid hormone Subjective complaints: Lethargic, mild weight gain, swelling of hands and feet, Intolerance to cold, constipation, menstrual irregularities, decreased libido, infertility, memory loss, depression, muscle cramps, hair loss, brittle cracking nails, parasthesia Objective findings: coarse hair, dry skin, hair loss, brittle nails, bradycardia. Age greater than 40 Hyperlipidemia (common), at risk of osteopenia, decreased TDRs, macroglossia, dull facial expressions, anemia, hyponatremia, hoarseness, reduced SBP and increased DBP, enlarged thyroid Diagnostic testing: TSH, T4, T3, CBC, CMP, Lipid panel, EKG Confirming Diagnosis: TSH (increased), T4(decreased), T3(maybe decreased) **Subclinical Hypothyroidism: slightly elevated TSH with nonspecific complaints. Monitor TSH Q3 months Nonpharmacological: • High fiber diet to prevent constipation • diet for weight loss • Educate regarding the need for lifelong compliance with thyroid replacement medication • need to report signs of toxicity, infection or cardiac symptoms • Annual lipid level assessment Pharmacological: • Levothyroxine Synthroid 12.5-25mcg (if older), 50mcg daily (empty stomach) • Levo helps prevent mental retardation • Reassess every 6-8 weeks, once stable reassess every 6-12 months • Pregnant monitor monthly and adjust accordingly • See improvement within 2 weeks; symptoms resolve in 3-6 months Follow up: • 6 Weeks, recheck and then q 6-8 until goal • GOAL: <5.0 mU; range 0.5-5.0 Referral: • None at this time Education: • Increase vegetables and fruits, • Increase exercise, • Lipid assessment annually, • Compliance need lifetime treatment • Report s/s: palpitations, nervousness, tremors (means Synthroid dose is too high) Differentials: • Depression • Dementia • CHF • Kidney failure Liek: 249 Hollier: 230 NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 16. Osteoarthritis – NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Presentation: Generalized disease with no known cause. Most common joint disease (destruction). Progressive destruction of the articular cartilage and bone due to osteophyte formation. Subjective Complaints: Joint pain, usually asymmetrical, develops insidiously and accompanies or follows physical activity. Assess for Morning stiffness lasting <1 hour. Stiffness resumes towards the day end and after periods of activity. Physical exam: Assess for crepitus and limited range of motion. Assess for bunions (MTP joints) Assess for site warm and redness (rheumatoid) (Bouchards nodes @PIP) Heberden’s nodes @DIP (B before H) or D for DIP Not symmetrical No constitutional symptoms – only related to the joints Cool joints – not warm like RA Based on physical and history Diagnostic: x-ray findings (joint space narrowing,osteophytes, subchrondal sclerosis), CBC, CMP, ESR, Rheumatoid factors, ANA-NEGATIVE Nonpharmacological: • Weight loss • Rest • Orthotic shoes or insoles • Topical creams • Weight bearing exercises (walking, lifting weights, resistant band exercises) • braces to stabilize joints while exercising, • apply heat/cold to affected joints Pharmacological: ONLY when symptoms are present! • Exercise first line treatment • Age older than 75 TOPICAL only • Acetaminophen 325-650mg q6-4 hours (MAX dose 4g q 24 hours) • No relief with Acetaminophen switch to short acting NSAID Naproxen (250-500 mg Q12) or Ibuprofen 400-600mg TID or QID • Voltaren cream on the affected area as needed for pain. • Cytotec for GI protection from NSAIDs • Toradol is limited to 5 days, first dose given IM • LOWEST RISK OF GI COMPLICATIONS IS IBUPROFEN AND CELEBREX • LOWEST RISK OF CV EVENT IS NAPROXEN Follow up: • 2-4 weeks. Referral: Physical therapy and nutritionist for weight loss. Orthopedic if complete joint destruction/ bone on bone. Education: • Exercise 3 days week • Lose weight • Strengthen quadriceps • Report black tarry stools Differentials: • Gout • Infective arthritis • Inflammatory arthritis: RA; psoriatic, SLE NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • Naproxen 250 mg twice a day. • Pain over 5/10 Tramadol 50 mg TID only during acute phase (ACL) • Diagnostic: x-rays to rule out fractures, MRI to diagnose soft tissue injury. Follow up NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • 1 week after RICE protocol Referral: • physical therapy • Orthopedics (ACL) Differentials: • Osteoarthritis • Rheumatoid arthritis • Patellofemoral pain syndrome • Meniscus tear • Tendonitis Liek:?? Hollier:?? 18. Shoulder pain: Differential diagnosis based on location of pain Presentation: Rotator cuff syndrome: Rotator cuff tears, advanced age, repetitive use, occupation- related, a higher risk with obesity and diabetes Pain often at night, deltoid pain, weakness with abduction/ forward flexion, positive impingement signs, limited range of motion. **Anterior Lateral Shoulder Pain: 2 Most Common Orthopedic Etiologies 1. Impingement syndrome (IS): compression of rotator cuff tendons and the subacromial bursa 2. Rotator cuff tendinopathy (RCT): strain, uncomplicated tendinopathy, chronic calcific tendinopathy, tendinopathy with tear • IS, RCT complaint: Shoulder pain with overhead activity Osteoarthritis: pretty common too! NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 17 Extrinsic Shoulder Pain • Extrinsic (outside the shoulder and often poorly localized): o Cervical nerve root compression o Myocardial ischemia o Splenic injury o Ectopic pregnancy o Others Posterior shoulder pain: • Cervical strain • Cervical radiculopathy • Other less common Diagnostics: X-ray results typically normal, MRI to diagnose, empty gas can, apley test, stratch test, positive arm drop test, Nonpharmacological: Acute Shoulder Pain after minor trauma/injury • General: o Ice x 48-72 hours o Heat o Rest from aggravating activity o NSAIDs o Maintain ROM! Pharmacological: • Tylenol 650 Po as needed for pain every 6 hours, • Naproxen 250 mg twice a day. • Pain over 5/10 Tramadol 50 mg once a day Follow up: • 2-4weeks Referral: • Refer to PT, ortho if not better in 2-6 weeks Education: • Avoid overhead lifting or reaching Differentials: • Adhesive capsulitis (frozen shoulder) • Degenerative arthritis • Cervical radiculopathy • Suprascapular nerve impingement/entrapment Liek:?? Hollier:516,1 19. Hip pain (info retrieved from UpToDate) Presentation: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • change socks twice a day, moisture wicking shoes (like dress socks) • keep feet clean and dry, NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 19 • do not share shoes/socks, • Trim dead skin • avoid walking barefoot in gyms/shared spaces Pharmacological: Don't prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection • Terbinafine oral 250mg daily for 6weeks for fingernail and 12-16 weeks for toenail up to one year. DO NOT TAKE WITH OTHER MEDICATIONS AS IT MAY INTERFERE Follow up: every three months for liver function test and progression. Referral: Dermatology if treatment does not work Liek:159,1 Hollier: 158 21. Tinea Corporis (ringworm) - Presentation: fungal infections of the skin. Rash, itching, well-circumscribed red scaly plaque usually on the trunk, may occur in groups of three or more lesions. Has central clearing, red ring on outside Risk factor: close contact with animals, warm climates, obesity, prolonged use of topical steroids, immunocompromised state, wrestling (contact sports) Diagnostic: KOH Prep (potassium hydroxide Preparation) Non-pharmacological: • Good hygiene, • keep dry and expose to air and light • avoid contact with lesions pharmacological: • Ketoconazole 2% cream, apply once daily covering affected and immediate surrounding area. Treat for at least 2 weeks before re-assessing Follow up: • 2 weeks Referral: • None Liek:158,1 Hollier:?? 22. UTI (Cystitis) – Infection and inflammation of the kidney, bladder, or urethra. Presentation: Mostly E-coli, mostly impacts females. Most infections in female are due to ascending infections from the urethra. Subjective complaints: • Urgency, dysuria, and increased frequency • Feeling of incomplete bladder emptying NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • Fever, chills • Hematuria NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • 2-4 weeks o Annual digital rectal exam NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 22 o PSA annually Referral: • Urology- if refractory to treatment, evidence of renal complications, or surgery is indicated Differentials: • Prostatitis • Prostate cancer • Urethral stricture • Neurogenic bladder • Medication side effects • Urinary tract infection • Bladder cancer Liek:384 Hollier:398 24. Eczema (atopic dermatitis) – part of atopic triad (allergies, asthma, allergic rhinitis) Presentation: atopic dermatitis is an inflammatory skin condition and chronic pruritic skin eruption. Dry skin, erythema Eczema is the acute stage of the pruritic irritation Diagnostics: none needed typically. Although, may do a skin biopsy to r/o other causes, CBC to check for eosinophilia, serum allergy testing Located: knees, hands, neck, antecubital and popliteal space, arms, legs, face Assessment: • Pruritus • Erythema • Dry skin • Facial erythema • Infraorbital folds Nonpharmacological: • Prevent dry skin by using ointment/petroleum based • manage stress • avoid wool clothing, • fragrance-free detergents, • keep the environment free of dust as possible • oatmeal bath • products without scents/for sensitive skin. • Avoid sun trauma. • Moisturize. Pharmacological: • Topical Corticosteroids (NOT ON FACE) low potency steroids • Hydrocortisone butyrate 0.1% 15g apply thin film 2-4 times daily. No more than 3 weeks. • Antihistamines (oral and topical) for itching • Oral corticosteroids may be used for severe cases NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. • Eucerin, Lubriderm, cetaphil Education: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 24 HEENT & Respiratory Asthma DD: TYPES: Extrinsic (Allergic triggers); Intrinsic (Irritant triggers); Mixed (Extrinsic and Intrinsic Asthma) Occup. [Toluene diisocyanate, Polyvinylchloride, Phthalic anhydride, Trimellitic anhydride, Plicatic acid (Western Red Cedar trees), Metal salts, Platinum, Nickel]; Aspirin or NSAID induced Asthma; Exercise Induced; Cough Variant Asthma URI Chronic Obstructive Pulmonary Disease (COPD) GERD Bronchiolitis (kid); Congestive heart failure; Chronic Sinusitis; PE; Foreign body aspiration; Sarcoidosis; Bronchiectasis; CF; Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome) Bronchitis DD: Pneumonia; asthma; URI/ cold; Allergic rhinitis; CHF (esp RHF); Reflux esophagitis; Pertussis infection; Lung cancer COPD DD: Chronic asthma (good SABA/LABA response & normal DLCO on PFT); Acute bronchitis; CHF; Bronchiectasis; chronic cough; Bronchiolitis obliterans (young, nonsmoker, collagen-vascular diseases); PE. Cough Differential Dx: URI, bronchitis, rhinitis/sinusitis (upper airway cough syndrome), asthma, GERD, and ACE inhibitors Dx tests: Sputum culture, chest x-ray/CT scan, and pulmonary function tests are useful diagnostic tests Subacute cough 3 to 8 weeks chronic cough > 8 weeks Influenza DD: URI; Adenovirus/ Arenaviruses; Parainfluenza Virus; Legionnaires Disease Acute Respiratory Distress Syndrome; Cytomegalovirus (CMV); Dengue; Hantavirus Pulmonary Syndrome; HIV Infection and AIDS Pneumonia DD: asthma; bronchitis; viral/bacterial URI; COPD; atelectasis; Bacteremia; Legionairres; ASD or PDA (peds); cardiomyopathy; FB aspiration; Pertussis; Empyema; Pneumothorax; URI Differential Diagnoses: Allergic Rhinitis; Asthma Community-Acquired Pneumonia (CAP); GERD Epstein-Barr Virus (EBV) Infectious Mononucleosis (Mono); Obstructive Sleep Apnea (OSA); NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Bronchiectasis Otitis Media; Pediatric Retropharyngeal Abscess; Reflux Laryngitis; Tuberculosis (TB) NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 25 Sinusitis DD: Migraine headache; URI; Allergic Rhinitis; Rhinovirus (RV) Infection (Common Cold); Chemical rhinitis; Nasal foreign body Tracheomalacia DD Adults: laryngomalacia, subglottic stenosis, cysts, vocal cord paralysis, and hypocalcemic tetany Tracheomalacia DD Infants: Asthma; Bronchiolitis; GERD; Bronchogenic Cyst; Double Aortic Arc; Bronchopulmonary Dysplasia; Pulmonary Artery Sling; Right Aortic Arch in Vascular Ring Defects; Sinonasal Manifestations of Cystic Fibrosis Otalgia Differential Diagnosis: AOM AEM AME; temporomandibular joint syndrome, pharyngitis, dental disease, and cervical spine arthritis Nonotogenic otalgia: referred or reflex pain, neuralgia, or to a psychogenic problem, referred also from primary carcinoma of the head and neck Cardiovascular DD: CHF DD: Pneumonia (CAP, bacterial, viral); COPD; Noncardiac pulmonary edema; Emphysema; Acute Kidney Injury; Idiopathic/ interstitial Pulmonary Fibrosis; MI; Respiratory failure Gastrointestinal DD: Acute Abdomen DD: BAD GUT PAINS= Bowel obstruction; Appendicitis, Adenitis (mesenteric); Diverticulitis; DKA; Dysentery/Diarrhea Drug withdrawal; Gastroenteritis; Gall bladder disease/stones/obstruction/infection; Urinary obstruction (stone) infection (pyelonephritis/cystitis); Testicular Torsion; Toxin - Lead, black widow spider bite; Pneumonia/Pleurisy; Pancreatitis; Perforated bowel/ulcer; Porphyria; Abdominal aneurysm; IN - Infarcted bowel; Infarcted myocardium (AMI); Incarcerated hernia; Inflammatory bowel disease; Splenic rupture/infarction; Sickle cell pain crisis; sequestration crisis Gastritis DD: GERD; GE/Viral GE; PUD; Cholelithiasis/Cholecystitis; Crohn Disease; Gastric Cancer Gastroenteritis DD: High fever, bloody diarrhea, or severe diarrhea suggests bacterial GE. Protozoal infections (endemic protozoal areas - Mexico, India, South America, parts of the US), C dif, IBS, food poisoning. GERD: Acute/chronic gastritis; H Pylori; Hiatal hernia; PUD: IBS; Esophagitis; CAD; Esophageal Spasm; Cholelithiasis; Achalasia; Esophageal Cancer. IBS DD: IBS criteria: Bloating, Minimum 1 Manning criteria (pain onset correlates with BM NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Inability to bear weight for 4 steps, both immediately after the injury and in the ED Ottawa foot X-ray rules : NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. 27 Required only if the patient has pain in the midfoot and one or more of the following: Bone tenderness at the base of the fifth metatarsal Bone tenderness at the navicular bone Inability to bear weight for 4 steps, both immediately after the injury and in the emergency department Hematology DD: Anemia DD: Vit B12 or folate (B9) deficiency; CKD; Chronic liver disease; pregnancy; Low LDL Cholesterol (Hypobetalipoproteinemia); Other types of anemias (Alpha/beta Thalassemia; Aplastic Anemia; Hemolytic Anemia; IDA; Megaloblastic Anemia; Myelophthisic Anemia; Pernicious Anemia; Sickle Cell Anemia; Spur Cell Anemia); hepatitis; CMV; myelodysplastic syndrome; leukemias (ALL, AML, CML, HCL) Anemia Normocytic "NORMAL SIZE" Normal Pregnancy; Overhydration; Renal Disease; Myelophthistic; Acute Blood loss; Liver Disease; SI - Systemic Infection/Inflammation; Zero production – Aplastic; Endocrine: Hypothyroid, hypoadrenal, decreased androgen Index Anemia Microcytic "TICS": Thalassemias; Iron Deficiency (GI Bleed, Menses, Diet); Chronic Inflammation; Sideroblastic-lead toxicity Anemia Hemolytic: "HEMATOLOGIST" Hemoglobinopathy (Hb SS, SC, S beta Thal), Hemoglobinuria (Paroxysmal Nocturnal Hemoglobinuria); Enzyme Deficiency ( Inherited Pyruvate Kinase (PK) deficiency and pyrimidine-5'-nucleotidase deficiency); Medication - Drug- induced immune hemolytic anemias; Antibodies, autoimmune; Trauma to the red cells. Fragmentation (Microangiopathic); Ovalocytosis - This is an autosomal dom disorder in pts from SE Asia- min s/s.; Liver disease; Osmotic fragility in Hereditary spherocytosis and in Hereditary Eliptocytosis; Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD); Infection: Intra- erythrocytic parasites (malaria and babesiosis); Splenic destruction in hypersplenism. Splenomegaly; Transfusion-related, Thalassemias Psychological DD: Anxiety DD: Generalized Anxiety Disorder; OCD; hyperthyroid; Panic Disorder; Social Anxiety Disorder Depression Differential Diagnosis: Adjustment disorder with depressed mood; Anxiety disorders; Hypothyroidism Vitamin B12 or D deficiency; Substance/ETOH/ medication- or medical illness-associated (OSA, hypothyroid), other depressive disorders Bipolar disorder; Premenstrual dysphoric disorder (PMDD); Grief reaction Integumentary DD: Contact Dermatitis Differential Diagnoses: NR667 / NR 667 VISE Exam Study Guide (Latest Update 2022 / 2023)GRADED[ A+]. Allergy versus Irritant Contact Dermatitis; Eczema; Contact Urticaria Syndrome; Drug-Induced Bullous Disorders; Drug-Induced Photosensitivity; Seborrheic Dermatitis; Tinea Corporis