FNP Leik System Review Chapter 4 (Preventive Health) - ✔✔ Sensitivity - ✔✔(SNOUT) Negative results rules out the disease. Sensitivity test are good at identifying the positive markers of disease. So good that it is more prone to report false positives. So a negative result is more definitive Specificity - ✔✔(SPIN) Positive results rules in the disease. Spec ificity tests are good at identifying the negative marker of a disease. So good that is more prone to report false negatives. So a positive result is more definitive. Primary Prevention - ✔✔Prevent the disease in its entirety. Examples include healthy die t, exercise, safety (helmets/seatbelts), immunizations, and job safety Secondary Prevention - ✔✔Early detection of a disease. Examples include screening tests Tertiary Prevention - ✔✔Rehabilitation of a disease. Examples include support groups, education for pts with pre -existing disease, drug side effect safety, medical equipment safety, any type of rehab like PT or OT Breast Cancer Screening Guidelines (USPSTF) - ✔✔Onset = 50yo. Biannual. Stop at age 74yo. No SBE. Breast Cancer Screening Guidelines (A CA) - ✔✔Onset = 40yo. Annual. No stop age. Cervical cancer screening guidelines - ✔✔Onset=21yo (immunocompromised individuals start at onset of sexual activity). Every 3 years Pap w/ no HPV test until 30yo. Pap and HPV test after 30 yo and can begin scree ning every 5 years. Stop at age 65yo. Complete hysterectomy means no Pap unless pt has history of cervical cancer or high grade lesion. Colorectal cancer - ✔✔Onset 50yo. 1) colonoscopy q 10 years if wnl, 2) sigmoidoscopy q 5 years if wnl, 3) annual FOBT w ith 3 stool samples. Stop age 75 yo. Prostate cancer - ✔✔USPSTF does not recommend screening with PSA but it based on individual pt. Lipid screening - ✔✔Onset 18 -35/45yo screen if at increased risk of heart disease. Males >35yo and Females >45yo Flu vac cine - ✔✔LAIV - Live virus can only be given to healthy non -pregnant 2 -49 yo w/o recent hx of asthma (Peds). Cautioned or C/I in pts with egg, gentamicin or gelatin allergy and kids receiving aspirin therapy (Reye's syndrome). TIV (trivalent inactivated v accine) is approved for >6months. Tetanus vaccine - ✔✔Q 10 years. Booster for dirty wounds if last TDAP/Td is > 5 years old. >7yo receive Td/TDAP . Avoid in egg allergy and Gullian Barre. 5 doses of DTAP aka Pediarix (2,4,6,15 months and 5 yo) First TDAP is at age 11 -12yo. Td is the booster every 10 years or if someone has never had TDAP (came out in 2005) then they should have a one time dose of TDAP and then continue with Td boosters. Pneumococcal vaccine - ✔✔PCV 23 given one time at age 65 yo in healthy adults and for persons who are 2 y ears and older and at high risk for pneumococcal disease (e.g., those with sickle cell disease, HIV infection, or other immunocompromising conditions). PPSV23 is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma. One time booster given 5 years after first dose (So non -healthy pts will receive 2 doses of PSV23 over their lifetime). PCV 13 is for <5 yo. When both PCV13 and PPSV23 are indicated, PCV13 should be administered first; PCV13 and PPSV23 should not be administered during the same visit. When indicated, PCV13 and PPSV23 should be administered to adults whose pneumococcal vaccination history is incomplete or unknown. Varicella Vaccine - ✔✔60 yo. May be given to pts who have previously had shingles. Ma y be given earlier at age 50yo. Live virus so c/I include pregnancy and immunocompromised. Chapter 5 (EENT) - ✔✔ Herpes Keratitis - ✔✔Inflammation of the cornea. C/O abrupt severe eye pain, photophobia and blurred vision. Diagnose with fluorescein dye an d black lamp. Look for fernlike lines (corneal abrasions appear more linear). Infection permanently damages corneal epithelium which may result in blindness. Acute angle closure - ✔✔Glaucoma (Increased ICP r/t blocked drainage duct). Elderly pt c/o abrupt onset of severe eye pain, HA, N/V, halos around eyes, and decreased vision. Exam reveals mid -dilated pupil that is oval shaped, cloudy cornea, and fundoscopic exam shows cupping of the optic nerve. Tx = keep pt supine, trx to ED for acetazolamide, B block ers, and topical steroids. Sx may be required Cholesteatoma - ✔✔Cauliflower like growth in the middle ear. Pt c/o foul smelling discharge and hearing loss. On exam, no TM or ossicles visible. PMhx of chronic OM. The mass is not cancerous but it can erode in to the bones of the face and damage CN7. Tx = ENT referral for sx, abx. Mass is usually made of epithelium and cholesterol. AKA pearl tumor. Battle's sign - ✔✔Bruise behind the ear over the mastoid process. Hx of trauma, and indicates a fracture of the basilar skull. Golden serous discharge from ear or nose. Refer to ED for abx and imaging (CSF will be + for glucose. Mucous will be - for glucose). Cavernous sinus thrombosis - ✔✔Blood clot in w/I cavernous sinus. This cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema, photophobia, proptosis and inability to move eye appropriately. Peritonsillar abcess - ✔✔Pt c/o severe sore throat, difficult and painful swallowing (odonophagia) and LOCKJAW (trimus), and a hot potato voice. Unilateral swelling peritonsillar area and soft palate with displaced uvula. Tx = I&D in ED or needle aspiration Diptheria - ✔✔Bull neck, dysphagia, and gray/yel low psuedomembrane that is not to displace (stuff is like concrete) and may obstruct airway Geographic tongue - ✔✔Benign finding Torus Palatinus - ✔✔Painless bony protuberance on hard palate that is benign Fishtail uvula - ✔✔Split uvula is usually benig n (rarely a sign of cleft palate) Nystagmus - ✔✔Vertical nystagmus is always abnormal. Horizontal nystagmus that occurs on prolonged lateral gaze and resolves when eye moves toward midline is benign Papilledema - ✔✔Optic disc swollen w blurred edges r/t increased ICP (most commonly from b leeding, brain tumor, abscess or pseudo tumor cerebri). HTN Retinopathy includes - ✔✔result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure such as Copper/silver arterioles, av nicking, bl ot/flame hemorrhages, cotton wool spots, hard exudates and papilledema Copper/silver arterioles - ✔✔Indicates sclerosis and hyalinization of the arterioles. Silver is worse than copper. Diabetic Retinopathy - ✔✔Microaneurysms caused by new fragile arteri es in the retina. Examples see cotton wool spots, flame hemorrhages and dot -blot hemorrhages. Cataracts - ✔✔Opacity of cornea Koplik's spots - ✔✔Small sized red papules w/ blue white centers inside the cheeks by the lower molars. They are the prodromic v iral enathem of measles (Rubeola) Hairy Leukoplakia - ✔✔Pathognomic for Epstein barr virus in immunocompromised pts Sjogren's syndrome - ✔✔Chronic autoimmune disorder characterized by decreased function of lacrimal and salivary glands. Pt c/o dry eyes/mo uth for > 3 months and/or gritty eyes. OTC eye drops and refer to ophthalmology and rheumatologist Blepharitis - ✔✔Chronic condition. Base of eyelids are inflamed. Ithcy/irritation with some crusting. Tx is johnson's baby shampoo and may need erythromycin optho ointment Epitaxis - ✔✔Posterior nasal bleeds can result in severe hemorrhage. Tx for anterior bleeds is tilt head forward and apply pressure over nasal bridge. Afrin nasal spray can be helpful.
