SOAP/Legal terms
Subjective or Objective-
1. Pitting edema
2. B/P done in office
3.Divorced
4. Dysuria
2. Objective
3.Subjective
4. Subjective
The most common side effect to metformin (glucophage) therapy is:
GI pain, diarrhea, nausea and flatulence.
Patient presents to office with complaints of RUQ abdominal pain. They are not able to recall information of what makes it better or worse. What imaging do you initially order?
Abdominal US – Can find cholecystitis or even dx NAFLD
Name 2 symptoms that may be associated with Vitamin B12 deficiency anemia.
S3 heart sound would may be indicative of what dx?
CHF
Educating a patient about their new prescription is an example of what legal term?
Beneficence - the obligation to help the patient "Do no harm"
A 10 y/o boy who recently started to play soccer at school has a hx of exercise-induced asthma. You are seeing him for his physical and he asks you when he should use his albuterol inhaler. You advise which?
You would use a (CT/MRI) for imaging of a tumor?
MRI
Identify three conditions related to the metabolic syndrome that are associated with Non-Alcoholic Fatty Liver Disease.
- Waist circumferences (35 inches in female and 40 inches in male)
- Diabetes
- Dyslipidemia
- HTN
What is depolarization and repolarization?
Depolarization: contraction
Repolarization: Rest
What does SOAP stand for and what kind of information goes in each section?
Subjective- HPI, Hx, ROS
Objective- PE
Assessment - Tests/labs, differentials
Plan- what the plan is for the patient
All of the medications are used to treat inflammation in the lungs of asthmatic patients except:
47 y/o female with hx of Migraines presents to office with complaints of recently having headaches “that feel different” than usual. While interviewing you find out 2 weeks ago she fell while skiing and hit her head. Denies blurry vision or nausea/vomiting. What imaging do you order?
MRI – In this case the past has post trauma to the head, it was 2 weeks ago and now headaches have changed. MRI of the head is more sensitive than CT for most secondary causes of headache and does not result in radiation exposure
What is the gold standard diagnostic test for thalassemia?
2, Hemoglobin Electrophoresis- Also is the gold standard to dx of sickle cell anemia
What tool can de used when deciding anticoagulation therapy for Afib?
CHADS2 (congestive heart failure; hypertension; age 75 years or older; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism)
0-1- Aspirin
1-2- Aspirin + plavix
3 or >- coumadin vs direct anticoagulant
What factors does the primary care nurse practitioner need to consider when discussing advanced care planning with a patient?
1. Autonomy and patient safety are rarely competitive considerations.
2. Decisions regarding a health care representative are a family group decision.
3. Family members are not integral components in care planning.
4. Trust and rapport with patients are key to patient satisfaction in decisions for care.
4. Trust and rapport with patients are key to patient satisfaction in decisions for care.
A 55 y/o male patient with a BMI of 30 with hx of angina and type 2 diabetes presents to office for follow up. His lipid panel results total cholesterol 280, LDL 195, HDL 25. You diagnose him with HLD. What intensity tx is recommended for this patient?
3. High-intensity statin
Atorvastatin 40-80mg daily
Rosuvastatin 20-40 mg daily
A chest radiograph shows an area or consolidation on the lower lobe. What medication can you expect to prescribe this person?
-Consolidation on the lower lobe would indicate Bacterial Pneumonia. So you would expect to prescribe an abx. Perhaps Azithromycin, Levaquin, Amoxicillin, Cephalosporin
Based on the recommendations from US preventative services task force, Which imaging test do you order for screening of Lung CA in your patient who is 60 Y/O current every day smoker with 30 pack year hx?
CT scan- This screening is annual for patients 55-80 y/o with 30-pack-year hx or currently smoke (or quit within the past 15 years). D/C annual screening if the person has not smoked in >15 yrs or develops a problem that substantially limits life expectancy or willingness to have curative lung surgery.
T wave inversion is indicative of?
Ischemia
Define one of the following:
Nonmaleficence
Justice
Fidelity
1. Nonmaleficence-
•Obligation to avoid harm
•Protecting the patient from harm
2. Justice-
•The quality of being fair and acting with a lack of bias.
•Fair and equitable distribution of society resources
3. Fidelity-
•Obligation to maintain trust in relationships.
•Dedication and loyalty to your patients, keeping one’s promise
60 y/o male presents to office for routine well visit. Upon reading his Bloodwork you see his LDL is 150, HDL- 80 Total cholesterol 200. His 10-year CVD risk is high. What medication would you start?
Moderate dose statin. Because his LDL <190 but his 10-year CVD risk is elevated
Example: ●Lovastatin 40 to 80 mg
●Pravastatin 40 to 80 mg
●Simvastatin 20 to 40 mg
●Atorvastatin 10 to 20 mg
●Rosuvastatin 5 to 10 mg
You are seeing a 70 y/o female who complains of vaginal bleeding that has been intermittent since last week. What imaging study are you going to order?
Complete pelvic US including transvaginal
The red blood cells with pernicious anemia will show what?
Macrocytic and Normochromic cells
Define the ECG characteristics of the 4 different heart blocks.
1st degree- Prolongation of PR interval >0.2 sec
2nd type 1- progressively lengthening PR interval from cycle to cycle prior to a dropped QRS complex
2nd type 2 - Punctual P wave that is not followed by a QRS
3rd degree- dissociation of P wave and QRS complex