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2024 NR511 MIDTERM EXAM WITH CORRECT ANSWERS
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2024 NR511 MIDTERM EXAM WITH CORRECT ANSWERS
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2024 NR511 MIDTERM EXAM WITHCORRECT ANSWERS
Define diagnostic reasoning - CORRECT-ANSWERSReflective thinking
because the process involves questioning one's thinking to determine if all
possible avenues have been explored and if the conclusions that are being
drawn are based on evidence.
Seen as a kind of critical thinking.
What are some common meds used to treat TB? - CORRECT-
ANSWERSIsoniazid
Rifampin
Pyrazinamide
Ethambutol
What is the MOA and common SE's of Isoniazid? - CORRECT-ANSWERSMOA:
Isoniazid is a prodrug and must be activated by M. tuberculosis catalase-
peroxidase enzyme KatG.
Activation produces oxygen-derived free radicals (super oxide, hydrogen
peroxide, peroxynitrite) and organic free radicals that inhibit formation of
mycolic acids of bacterial cell wall, causing DNA damage, and death of
bacillus.
Most common mechanism of resistance consists of KatG mutations, which
decrease activity of isoniazid and prevent prodrug from being converted into
its active metabolite.
SE:
N/V
Epigastric pain
Transitory and asymptomatic increase in hepatic enzyme levels
Arthralgia
Changes in behavior: HA, insomnia, euphoria, agitation, anxiety, somnolence
Acne
Cutaneous pruritis or fever
What is the MOA and common SE's of Rifampin? - CORRECT-ANSWERSMOA:
Inhibits gene transcription of mycobacteria by blocking DNA-dependent RNA
polymerase, which prevents bacillus from synthesizing messenger RNA and
protein, causing cell death.
,SE:
Nausea
Anorexia
Abd pain
Orange colored tears/sweat/urine
Pruritis with or without erythema (6% of pts)
Flulike syndrome
Fatigue
Dizziness
HA
Dyspnea
Ataxia
What is the MOA and common SE's of Pyrazinamide? - CORRECT-
ANSWERSMOA:
Prodrug that needs to be converted to active form, pyrazinoic acid, by
bacterial enzymes.
MOA not fully understood
Possibly enters bacillus passively, converts to pyrazinoic acid by
pyrazinamidase, reaches high concentrations in bacterial cytoplasm due to
inefficient efflux system.
Accumulation of pyrazinoic acid decreases intracellular pH to levels that
cause inactivation of enzymes.
SE:
N/V
Anorexia
Hyperuricemia
Arthralgia
Exanthema
Pruritis
Dermatitis (photosensitivity)
What is the MOA and common SE's of Ethambutol? - CORRECT-
ANSWERSMOA:
Interferes with biosynthesis with arabinogalactan enzyme, which mediates
polymerization of arabinose into arabinogalactan.
SE:
Retrobulbar neuritis (usually reversible, depending on dose and length of
therapy)
N/V
Abd pain
Hepatotoxicity
Eosinophilia
Neutropenia
,Thrombocytopenia
Myocarditis
Pericarditis
HA
Dizziness
Confusion
Hyperuricemia/gout
Skin rash
Arthralgia
Fever
Occasionally pulmonary infiltrates
What are the different strengths of tretinoin and when is each appropriate? -
CORRECT-ANSWERSGel:
0.025% and 0.01%
Cream:
0.1%, 0.05%, and 0.025%
Caps:
10mg
Topical used for acne
Oral used for induction of remission in acute promyelocytic leukemia
Identify various types of lesions based on their characteristics: - CORRECT-
ANSWERSRubeola:
Pt looks ill
High fever
Red mucus membranes
Conjunctivitis
Nasal congestion
Reddish/purple generalized macular/papular rash
Lesions start on head (face/behind ears), spread over rest of body in 1-2
days
Rubella:
Low-grade fever
HA
Sore throat
Rhinorrhea
Malaise
Eye pain
Myalgia 2-5 days before rash
Rose-pink macules/papules
, Lesions start on head, travel down body
Rash disappears in 1-2 days in same order it appeared
Varicella:
Malaise
Fever
Chills
HA
Arthralgia
1-2 days later, urticarial erythematous macules/papules appear, quickly
turning to vesicles/pustules
Rash starts on face/chest, spreads quickly over entire body, dry up in 1 week
Roseola:
High fever
Irritability
Diarrhea
Cough
Cervical lymphadenopathy
Light pink erythematous macules/papules on face, neck, extremities,
resolves in 1-3 days
Fifth's Disease:
Starts with HA, fever, chills, maybe cough
Stage 1: "Slapped cheek" rash
Stage 2: Pink lacy erythematous macules on extremities/trunk, spares palms
and soles. May be itchy.
Stage 3: 2-3 weeks of body rash
Pytiriasis rosea:
2-4 patches or plaques on trunk that starts 2-3wks before general rash, aka
"herald patch"
Rash pink to erythematous, round to oval plaques and papules with possibly
scaly borders
Rash resembles shape of Christmas tree
Rash can be itchy
Low-grade fever
HA
Fatigue
Can last 1-2mo or longer
Hand, foot, and mouth:
Mouth sores usually first to appear
Hand vesicles are erythematous halos, mostly soles and palms
Sometimes are on legs, butt, face
Usually resolve in 7 days
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