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What |are |the |signs |and |symptoms |of |acute |HIV |infection |and |how |long |does |it |last? |- |correct |answer |✔Generalized |flu |or |mono-like |symptoms |that |last |for |weeks |to |months. |Labs |reveal |a |dramatic |rise |and |drop |in |viral |load |and |drop |and |rise |in |CD4 |count.
What |symptoms |may |occur |during |the |chronic |latent |or |asymptomatic |phase |of |HIV |infection, |how |long |does |it |last, |and |what |is |the |CD4 |count? |- |correct |answer |✔Fatigue, |low-grade |fever, |night |sweats, |lymphadenopathy |lasting | 2 |to | 10 |years |with |a |slow |rise |in |viral |load |and |decline |CD4 |count |> | 500
What |opportunistic |infections |are |common |when |CD4 |count |is |above |200? |- |correct |answer |✔Bacterial |infections
TB
Herpes |simplex
Herpes |zoster
Vaginal |candidiasis
Hairy |leukoplakia
Kaposi |sarcoma
What |opportunistic |infections |are |common |when |CD4 |count |is |between |50- 200? |- |correct |answer |✔Pneumocystocis
Toxoplasmosis
Cryptococcosis
Coccidioidomycosis
Cryptosporidiosis
What |opportunistic |infections |are |common |when |CD4 |count |is |below |50? |- |correct |answer |✔MAC
Histoplasmosis
CMV |retinitis
CNS |lymphoma
How |is |HIV |diagnosed? |- |correct |answer |✔1. |HIV |rapid |antibody |test, |99% |sensitivity |and |specificity
- |HIV |1/2 |Ag/Ab |immunoassay
- |Both |must |be |confirmed |using |the |HIV |1/2 |Ab |differentiation |immunoassay
The |treatment |for |MRSA |includes: |- |correct |answer |✔I&D |of |the |abscess |and |antibiotics |for |more |complicated |cutaneous |infections
A |CD4 |count |less |that | 500 |can |increase |the |risk |of |which |of |the |following?
- |Erythema |multiforme
- |Primary |HIV |infection
- |Opportunistic |infections
- |Lupus |- |correct |answer |✔Opportunistic |infections
- |flu-like |symptoms
- |opportunistic |infections
- |pneumonia |- |correct |answer |✔Flu-like |symptoms
For |the |diagnosis |of |AIDS, |the |CD4 |count |would |be |less |than:
- | 400
- | 200
- | 10
- | 20 |- |correct |answer |✔ 200
In |HIV, |which |of |the |following |stages |is |best |described |as |by |occurring |within | 3 |weeks |and |exhibiting |flu-like |symptoms?
- |tertiary
- |transition
- |primary |infection
- |asymptomatic |- |correct |answer |✔Primary |infection
Which |causes |fits |of |coughing |so |violent |that |the |patient's |ribs |can |break?
- |Zika
- |AIDS
- |SARS |CoV
- |Pertussis |- |correct |answer |✔Pertussis
Which |candida |is |a |worrisome |emerging |fungal |infection?
- |Candida |krusei
- |Candida |auris
- |Candida |glabata
- |Candida |albicans |- |correct |answer |✔Candida |auris
Which |of |the |following |is |most |likely |associated |with |an |HIV |infection |and |CD |count |above |500?
- |asymptomatic |stage
- |symptomatic |stage
- |opportunistic |infections
- |AIDS |- |correct |answer |✔Asymptomatic |stage
What |are |some |AIDS |defining |conditions? |- |correct |answer |✔Recurrent |bacterial |pneumonia
PJP
CMV
Fingal |infections
Candidiasis |of |the |esophagus
Tumors: |Kaposi |sarcoma, |primary |lymphoma
What |is |the |goal |of |ART |therapy |in |HIV? |- |correct |answer |✔Suppression |of |viral |replication |as |measured |by |viral |load, |start |as |soon |as |possible
Other |goals |include |prophylaxis |and |treatment |for |opportunistic |infections, |malignancies, |and |other |complications
All |of |these |signs |and |symptoms |are |characteristic |of |asthma |except:
- |unilateral |lower |extremity |edema
- |cough
- |nasal |mucosal |swelling
- |eczema |- |correct |answer |✔Unilateral |lower |extremity |edema
A |patient |who |has |an |initial |peak |expiratory |flow |of | 300 |L/min |now |has |a |PEF |of | 420 |L/min |after |one |duoneb |and |three |albuterol |treatments. |What |does |this |indicate?
- |The |patient |is |not |responding |well |and |she |should |be |discharged |with |a |corticosteroid |for |five |days
- |The |patient |is |responding |well |and |will |likely |be |discharged |to |follow |up |with |their |primary
- |The |patient |is |responding |well |but |will |likely |need |to |be |admitted |for |pulmonary |toileting
- |The |patient |is |doing |poorly |and |will |likely |be |intubated |and |sent |to |the |ICU |for |further |management |- |correct |answer |✔The |patient |is |responding |well |and |will |likely |be |discharged |to |follow |up |with |their |primary
Patient's |PEF |improved |by |30%
A |patient |present |to |the |ED |with |HR |121, |RR |32, |SaO2 |82% |on |6L |O2, |and |PEG |is |50% |of |predicted |value. |After |IV |corticosteroids, |one |dose |of |duoneb, |and |three |doses |of |albuterol |nebulizers, |the |patient |continues |to |deteriorate. |What |is |your |next |plan |of |action?
- |Give |IV |magnesium |and |continue |to |monitor
- |Start |the |patient |on |hi-flow |nasal |cannula
- |Start |IV |antibiotics |and |admit
- |Prepare |for |intubation |- |correct |answer |✔Prepare |for |intubation
Two |of |the |following |tests |on |different |days |performed |in |an |experienced |laboratory |is |needed |for |accurate |diagnosis |of |CF:
- |Quantitative |pilocarpine |iontophoresis |sweat |test
- |nasal |membrane |potential |difference
- |thin |section |CT |scan
- |CFTR |genotyping |- |correct |answer |✔Quantitative |pilocarpine |iontophoresis |sweat |test
This |procedure |is |the |only |definitive |treatment |for |advanced |cystic |fibrosis:
- |Genetic |counseling
- |Lung |transplant
- |Long |term |antibiotics
- |CFTR |modulators |- |correct |answer |✔Lung |transplant
Chronic |bronchitis |is |defined |as |chronic |productive |cough |for:
- | 3 |months
- | 2 |months
- | 6 |months
- | 2 |weeks |- |correct |answer |✔ 3 |month
All |of |the |following |are |characteristics |of |Type |A |COPD, |pink |puffers, |except:
Results |in |bronchodilation, |anti-inflammatory |properties, |and |extrapulmonary |effects |on |diaphragm |strength, |myocardial |contractility, |and |kidney |function, |but |is |a |last |resort |because |of |the |narrow |therapeutic |window
What |kind |of |pleural |effusion |is |due |to |injury |to |the |thoracic |ducts?
- |exudative
- |empyema
- |parapneumonic
- |chylothorax |- |correct |answer |✔Chylothorax
Which |pleural |effusion |is |associated |with |fever?
- |empyema
- |hemothorax
- |exudative
- |chylothorax |- |correct |answer |✔Empyema
Which |of |the |following |is |not |a |special |consideration |for |gerontological |patients?
- |The |chest |wall |muscle |compliance |decreases
- |Respiratory |muscle |strength |and |induration |decreases
- |Incidence |of |lung |cancer |decreases
- |Antibiotic |doses |may |need |to |be |reduced |- |correct |answer |✔Incidence |of |lung |cancer |decreases
What |is |not |an |essential |criteria |for |the |diagnosis |of |ARDS?
- |Onset |of |respiratory |distress |within | 7 |days |of |known |clinical |insult
- |New |bilateral |pulmonary |opacities
- |Respiratory |failure |not |fully |explained |by |heart |failure |or |volume |overload
- |Unimpaired |oxygenation |- |correct |answer |✔Unimpaired |oxygenation
A |patient |with |emphysema |is |referred |for |PFT. |Due |to |the |changes |in |the |lungs |of |a |patient |with |emphysema |with |the |loss |of |recoil |and |the |general |enlargement, |the |NP |would |expect |what |abnormalities |in |the |PFT |results?
- |Normal |FEV
- |Reduced |FEV1 |and |increased |TLC |and |RV
- |Normal |FVC
- |Reduced |TLC |and |RV |- |correct |answer |✔Reduced |FEV1 |and |increased |TLC |and |RV
A |patient |is |admitted |to |MICU |for |respiratory |failure. |She |is |on |high |ventilator |setting |and |her |oxygenation |is |not |improving |despite |80% |FiO2 |and |a |PEEP |of |16. |Her |CXR |reveals |bilateral |alveolar |infiltrates. |What |is |the |most |likely |cause?
- |CHF |w |pulmonary |edema
- |Aspiration |pneumonia
- |TRALI
- |ARDS |- |correct |answer |✔ARDS
The |NP |is |evaluating |a | 67 |year |old |patient |with |a | 50 |ppy |history |of |smoking. |The |patient |presents |with |complaints |of |becoming |easily |short |of |breath |and |fatigue. |Exam |reveals |diminished |breath |sounds, |hyperresonance, |and |hypertrophied |respiratory |accessory |muscles. |A |CBC |reveal |a |slightly |elevated
- |restrictive
- |normal |- |correct |answer |✔Obstructive
The |most |likely |disease |process |to |produce |transudative |pleural |effusion |is |which |one |of |the |following?
- |Malignancy
- |CHF
- |Pneumonia
- |Cirrhosis
- |Nephrotic |syndrome |- |correct |answer |✔CHF
The |NP |is |evaluating |a |patient |with |acute |bronchitis. |The |patient |has |a |moderately |productive |cough, |wheezing, |low |grade |fever, |and |fatigue. |When |prescribing |the |medication |regime, |the |NP |should |be |cautious |with |the:
- |antitussive |agent
- |antibiotic
- |bronchodilator
- |expectorant |- |correct |answer |✔Antitussive |agent
The |cornerstone |of |moderate |persistent |asthma |drug |therapy |is |the |use |of:
- |SABA
- |inhaled |corticosteroids
- |oral |theophylline
- |mast |cell |stabilizers |- |correct |answer |✔ICS
When |reviewing |lung |volumes |from |a |pulmonary |function |test, |the |volume |of |air |that |is |normally |breathed |with |each |breath |is |the:
- |TLC
- |TV
- |VC
- |IRV |- |correct |answer |✔TV
The |NP |is |seeing |a |fairly |healthy |patient |in |her |mid-30s |who |complaints |of |breathlessness |occurring |no |more |than |twice |a |week. |On |exam, |she |can |answer |questions |using |complete |sentences |without |use |of |accessory |muscles |and |without |significant |shortness |of |breath. |Her |heart |rate |is | 102 |and |she |has |a |mild |end |expiratory |wheezes. |What |should |be |the |treatment |regime |at |this |time |for |this |patient?
- |Once |daily |inhaled |corticosteroid |and |inhaled |beta |agonist |for |quick |relief
- |Anti-inflammatory |high |dose |corticosteroid |and |long |acting |bronchodilator |or |sustained |release |theophylline |plus |inhaled |beta |agonist |for |quick |relief
- |Anti-inflammatory |medium |dose |inhaled |steroid |or |inhaled |steroid |and |long |acting |bronchodilator |plus |inhaled |beta |agonist |for |quick |relief
- |No |daily |medication |but |short |acting |B2 |agonist |as |needed |- |correct |answer |✔No |daily |medication |but |short |acting |B2 |agonist |as |needed
A |45yo |construction |worker |presents |with |a | 2 |day |cough |with |yellow-green |sputum. |He |smokes |a |pack |per |day |and |has |no |other |medical |problems. |He |has |chills |and |chest |discomfort |when |he |coughs. |WBC |is |20k |and |temp |is |101.4. |A |CXR |is |ordered.
- |Left |PTX
- |RML |consolidation, |likely |PNA
- |COPD
- |Admit |and |start |vanc
- |Discharge |home |on |oral |levofloxacin
- |Admit |for |IV |steroids
- |Discharge |home |on |oral |azithromycin |- |correct |answer |✔Discharge |home |on |oral |azithromycin
A |patient |is |admitted |for |suspected |CAP. |Which |antibiotic |would |they |question |for |this |patient?
- |Metronidazole
- |Levofloxacin
- |Azithromycin
- |Ceftriaxone |- |correct |answer |✔Metronidazole
VAP |is |pneumonia |that |develops
- |between |10-20 |hours |after |intubation
- |exactly | 20 |hours |after |intubation
- |> | 48 |hours |after |intubation
- |< | 20 |hours |after |intubation |- |correct |answer |✔> | 48 |hours |after |intubation
A |50yo |man |s/p |lap-chole |develops |a |fever |and |cough |on |post-op |day |4. |HAP |is |suspected. |He |is |allergic |to |PCN. |Which |of |these |antibiotics |would |you |order?
- |Zosyn
- |Levaquin
- |Vancomycin
- |Linezolid |- |correct |answer |✔Levofloxacin
Vanc/Linezolid |are |for |MRSA
Zosyn |is |a |penicillin
A |55yo |male |patient |POD#3 |s/p |left |TKR |develops |a |fever |and |cough. |He |is |otherwise |healthy |and |does |not |have |any |PMHx |or |allergies. |Which |antibiotic |for |PNA |is |most |appropriate?
- |azithromycin
- |metronidazole
- |piperacillin-tazobactam
- |gentamicin |- |correct |answer |✔Piperacillin-tazobactam
A |60yo |patient |on |day | 6 |of |mechanical |ventilation |after |failed |extubation |post |CABG |develops |a |WBC |of |20k |and |temp |of |102. |He |has |no |medication |allergies. |Which |of |these |antibiotic |choices |shows |and |understanding |of |antibiotic |management |for |this |patient?
- |Azithromycin |+ |ceftriaxone
- |Piperacillin-tazobactam |+ |cipro |+ |vanco
- |Meropenem |+ |metronidazole
- |Metronidazole |+ |Levaquin |- |correct |answer |✔Piperacillin-tazobactam |+ |cipro |+ |vanco
A |50yo |female |with |PMH |of |DM, |HTN, |HIV |presents |with |cough |and |hemoptysis |and |night |sweats. |She |says |she |has |not |been |able |to |afford |her |meds. |She |appears |to |be |in |distress |and |her |O2 |sat |is |88%. |You |suspect |TB |and |order |a |CXR |which |showing |focal |infiltration |and |hilar |enlargement. |What |is |the |most |appropriate |intervention?
- |Do |not |stop |medication |without |talking |to |your |provider |- |correct |answer |✔If |you |develop |diarrhea |while |on |the |medication |you |should |stop |it
All |of |the |following |are |treatment |choices |for |patients |with |pulmonary |fibrosis |except:
- |Oxygen
- |Pulmonary |rehab
- |Long |term |antibiotics
- |Lung |transplant |- |correct |answer |✔Long |term |antibiotics
The |NP |shows |understanding |of |PH |when |they |explain |to |their |patient |that |the |cause |of |her |shortness |of |breath |when |they |state:
- |Your |shortness |of |breath |is |because |of |lack |of |exercise
- |The |shortness |of |breath |is |because |of |failure |in |the |right |ventricle |of |your |heart
- |Your |shortness |of |breath |is |because |of |associated |COPD
- |Your |PH |won't |cause |you |to |be |short |of |breath |- |correct |answer |✔The |shortness |of |breath |is |because |of |failure |in |the |right |ventricle |of |your |heart
Which |is |the |definitive |diagnostic |test |for |PH?
- |Right |heart |cath
- |TEE
- |TTE
- |PFTs |- |correct |answer |✔Right |heart |cath
Treatment |choices |for |a |patient |with |PH |secondary |to |left |heart |failure |will |include
- |Sildenafil
- |Rivaroxaban
- |Furosemide
- |Tadalafil |- |correct |answer |✔Furosemide
Your |patient's |ABG |is |7.28/80/50/30. |What |is |the |most |appropriate |intervention?
- |Place |on |O2 |at |2L |per |NC
- |Place |on |high |flow |at |50%
- |Place |on |BiPAP
- |Continue |to |monitor |- |correct |answer |✔Place |on |BiPAP
A |patient |has |newly |diagnosed |DM |and |presents |with |signs |of |DKA. |What |ABG |values |are |consistent |with |DKA?
- |7.3/30/90/
- |7.4/45/80/
- |7.6/60/70/
- |6.9/80/50/14 |- |correct |answer |✔7.3/30/90/
Causes |of |metabolic |alkalosis |include |all |of |the |following |except:
- |Loop |and |thiazide |diuretics
- |NGT |suctioning
- |Vomiting
