Maryville NURS 623 Exam
Maryville NURS 623 Exam
Maryville NURS 623 Exam
• Late signs: Untreated months to years after infection: multiple joint arthritis
• Generalize pain
• stiffness large joints (Knee)
• polyneuropathy
84. Lyme disease treatment
Treatment: EM present-Doxycycline 100mg oral bid 10 day or 14 days of Amoxicillin 500 mg
3 times daily for 14 days, or cefuroxime 500 mg twice daily for 14 days (this drug is best to
use if you are unsure of a skin infection versus Lyme as it has coverage for both or if allergic
to amoxicillin)
85. What are the guidelines for initiating antibiotic therapy for Lyme's disease?
Within 72 hours of attachment and EM noted.
86. What are the risk factors for HIV infection?
Anal intercourse, intercourse with an HIV positive partner, oral sex, exchange sex for drugs or
money, IV drug use with needle sharing, blood transfusions, body fluids, hepatitis or TB,
herpes simplex virus and syphilis.
87. What physical findings should prompt consideration of HIV testing?
Flu-like symptoms: 6 days to 6 weeks. Darkish, purple-colored spots on the skin: indicative of
Kaposi's sarcoma. Nonproductive cough, shortness of breath, and fever: present for several
days to weeks. Other constitutional symptoms: weight loss, night sweats, chronic fever,
and/or chronic diarrhea
Evaluating risk of HIV infections
88. What is the significance of the HIV viral load?
Viral load testing can establish the prognosis of a patient with HIV infection. Rising viral loads
indicate disease progression, while falling viral loads indicate a favorable prognostic trend. If
the medication regimen is working full viral suppression should be seen by 8-12 weeks.
89. What is the recommended initial screening for HIV?
HIV ½ Antigen/Antibody test
90. Describe the risk groups you would start HIV pre-exposure prophylaxis (PrEP).
For individuals who are at ongoing high risk for HIV infection, pre-exposure prophylaxis with
an antiretroviral-based regimen is an effective strategy to reduce the risk of infection.
Ongoing relationship with HIV infected partner.
Gay or bisexual man who has anal sex without condoms and is not in a monogamous
relationship, or who has had an STI in last 6 months
Anyone who does not use condoms with partners of unknown status.
Anyone who has injected drugs in the last 6 months.
91. What are the initial and monitoring tests you order prior to PrEP?
• Creatinine clearance is important, less than 60mL/min cannot start treatment. Hepatitis and
liver enzymes. HIV Antibody/antigen, HBV, HCV, serum creatinine, Alanine transaminase
(ALT) and aminotransferase (AST)
• Sexual exposure: Screen for syphilis, chlamydia, gonorrhea, pregnancy
Emtricitabine200mg/tenofovir 300mg, Daily, Follow up every 3 months for HIV testing
92. Describe risk factors of individuals who should be started on post-exposure prophylaxis (PEP).
• An uninfected individual has a recent exposure that has a substantial risk of HIV infection.
• Percutaneous contact
• Exposure of mucosal surfaces
And must be started within 72 hours of exposure
93. tinea capitis
A fungal infection of the scalp characterized by red papules, or spots, at the opening of the
hair follicles.
tinea pedis
fungal infection of the foot; athlete's foot
94. Tinea versicolor
Also known as sun spots; a noncontagious fungal infection which is characterized by white or
varicolored patches on the skin and is often found on arms and legs.
95. Tinea versicolor treatment
selenium sulfide shampoo (Selsun Blue) lathered from neck down and left on for 10 minutes
for 7 days, followed by once a week for a month and then once a month for maintenance.
ketoconazole (Nizoral) shampoo can be used weekly for maintenance,
For more aggressive treatment:
Fluconazole 150-300 mg weekly, for 2-4 weeks is the safest choice for systemic treatment.
96. Tinea pedis treatment
Moisture control is key. drying foot powders; miconazole, tolnaftate are very helpful. Burow's
solution to dry out any weeping. Keep them open to air as much as possible. Change socks
1-2 times a day. Use antiperspirants on feet.
Terbinafine 1% cream (Lamsil AT) BID, for 1 week.
Miconazole 2% cream, BID, 4 weeks
Severe cases can be treated system Terbinafine (Lamisil) caution with Liver and kideyy DX
97. tinea capitis treatment
Systemic therapy is required; topical is not sufficient.
Treatment of choice Griseofulvin V 250-500mg, BID, for 2-4 months.
Alternatively, consider terbinafine for 2 to 4 weeks in children older than 4 years is effective
against Trichophyton
Topical therapy with selenium sulfide shampoo (Selsun Blue) may help increase eradication
rates but alone is not sufficient therapy.
98. Tinea cruris (jock itch)
Topical antifungal therapy is effective for treating jock itch. Terbinafine 1% cream (Lamsil AT)
once daily for 1 week. Short-term treatment with mild corticosteroids, Hydrocortisone 1%
OTC to relieve itch and inflammation. Burrow's solution compression if weeping. OTC
antifungal powders help prevent recurrance.
99. What is the most common cause of relative polycythemia?
Dehydration
Acute: vomiting, fever, burns, crush injuries, decreased oral intake in elderly etc
Chronic- Diuretic use like furosemide
100. What is the clinical presentation with polycythemia? (absolute/relative)
Headache, blurred vision, fatigue, irritability, dizziness, tinnitus and most commonly
epistaxis due to mucosal engorgement.
Splenomegaly, peptic ulcer, new vessel growth on retinae, erythromelalgia (burning
pain in hands and feet), plethoric appearance, ruddy cyanosis fingers and toes
Absolute: cushingoid features are noted along with HTN
Women: Hematocrit greater than 48%
Men: Hematocrit greater than 52%
101. patient education for polycythemia
Patients on average live less than 15 years after their diagnosis due to the risk
of thrombosis. It is important to follow hydration and drug regimens.
Increasing activity can decrease the risk of clot formation. Stressing the
importance of adhering to lab draws and scheduled phlebotomies.