NR 506 LEIK Exam Tips – FNP

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LEIK EXAM TIPS – FNP –NR 506 Chamberlain

Health Screening and Health Promotion

  • US Health Statistics/Mortality Statistics
  • Leading cause of death (all ages/genders):
  • Leading Cause of Cancer Death
  • Leading Cause of Death in Adolescents (^ in males than females)
  • Leading Cause of Death by Age Group
  • Average Life Expectancy: 78.8 years of life

Cancer Statistics

  • Most Common Cancer: skin cancer
  • Most Common type of skin Cancer:
  • Most Common Cancer by Gender
  • Most Common Cancer among all children: Acute Lymphoblastic Leukemia (34% of all cancers in children). 
  • Sensitivity vs. Specificity
  • Top Three Cancers in Children

Health Promotion

  • Aspirin Use to prevent Cardiovascular Disease or Colorectal Cancer
  • Breast Cancer
  • Cervical Cancer
  • Colorectal Cancer
  • Lipid Disorders
  • Lung Cancer
  • Prostate Cancer
  • Ovarian Cancer
  • Skin Cancer Counseling
  • No Routine Screening for the following

Vaccination Facts

  • Hepatitis B Vaccine
  • Influenza Vaccination
  • Tetanus Vaccines (Tdap and/ or Td)
  • Pneumococcal Vaccinations
  • Shingles Vaccination
  • Varicella Vaccination
  • Immunizations for Health Care Workers
  • Vaccination Clinical Pearls

Systems Review

  • Eye Emergency Review
  • Herpes Keratitis
  • Acute Angle-Closure Glaucoma
  • Primary Open-Angle Glaucoma
  • Retinal Detachment

Ear, Nose, and Sinuses Review

  • Cholesteatoma
  • Battle Signs
  • Pharynx Emergency’s
  • Peritonsillar Abscess
  • Diphtheria

Head, Near, Eyes, Nose, and Throat Review (EXAM TIPS ONLY

  • Seasonal Allergic Rhinitis
  • Otitis Externa
  • Ruptured Spleen
  • Beta Blocker eye drops (Timolol)
  • Cholesteatoma
  • Penicillin allergic patients

Learn to recognize Eye descriptions

  • Chalazion:
  • Pinguecula:
  • Pteygium:
  • Cerumenosis
  • Vision
  • Herpes Keratitis
  • Corneal Abrasions or Keratitis
  • Diabetic Retinopathy
  • Cataracts
  • Koplik’s Spots
  • Cheilosis
  • Testing Vision
  • Hearing
  • Exam Tips
  • Types of Hearing Loss

Integumentary Review

  • Integumentary Terminology
  • Secondary Skin Lesions
  • Dermatology Terms
  • Impetigo –
  • Measles- (Rubeola)
  • Scabies
  • Scarlet Fever
  • Tinea Versicolor
  • Pityriasis Rosea
  • Molluscum Contagiosum
  • Erythema Migrans (Lyme Disease)
  • Meningococcemia
  • Rocky Mountain Spotted Fever

Skin and Integumentary System Exam TIPS only

  • Differentiate between contact dermatitis and atopic dermatitis
  • Scabies
  • Human dog/ cat Bite
  • Hydranitis Suppurativa
  • Psoriasis
  • RMSF
  • Meningococcemia
  • Erythema Migrans (Lyme Disease)
  • osacea
  • Acne
  • Pityriassis Rosea
  • Post-Herpectic Neuralgia
  • Differentiate erysipelas vs. other cellulitis

Cardiovascular EXAM tips

  • Advise all HTN Pt’s to DECREASE NA+ intake.
  • How to decrease triglycerides
  • How to increase HDL
  • Dietary Sources
  • ASCVD score of 7.5 or > start on high-intensity statins
  • Murmurs (Only 2-3 questions)
  • Mitral Murmurs:
  • Heart Sounds
  • Cardiac Rhythms – no strips will be on test, just signs and symptoms.
  • JNC Antihypertensive guidelines
  • Eye Findings
  • Isolated systolic HTN: low dose thiazide diuretics or CCB (long acting dihydropyridine).
  • Orthostatic Hypotension – sitting and standing BP
  • ACEI’s or ARB’s- use for DM, CKD, and HF.
  • Thiazide Diuretics
  • Potassium Sparing Diuretics
  • Calcium Channel Blockers
  • Alpha Blockers
  • Statins
  • INR
  • New York Heart Association Class II Heart Disease (Functional Capacity Ratings)
  • Risk Factors for DVT’s
  • Raynaud’s Phenomenon
  • Bacterial Endocarditis
  • Metabolic Syndrome
  • Nonalcoholic Fatty Liver Disease (NAFLD) – usually asymptomatic
  • Overweight

Pulmonary System Exam Tips

  • COPD
  • Rescue Inhalers- Short acting B2 Agonist (Albuterol and Xopenex.
  • Bacterial Pneumonia (Community Acquired Pneumonia)
  • Outpatient CAP- based on S/S and CXR, do not order phlegm for C&S or CBC.
  • Atypical Pneumonia (Walking Pneumonia)
  • Pertussis / Whopping cough
  • Acute Bronchitis
  • TB
  • Peak Expiratory Flow Rate (PEFR or PEF)
  • High dose inhaled corticosteroids
  • Asthmatics
  • Long term Corticosteroids
  • Mucolytic
  • Lung Cancer

Endocrine Exam Tips

  • Subclinical Hypothyroidism
  • Hypothyroidism – Elevated TSH
  • Radioactive Iodine Treatment
  • Hyperthyroidism (Graves Disease)
  • Subclinical Hyperthyroidism
  • Levothyroxine (Synthroid)
  • Alternative Thyroid medications
  • DMII
  • Chronic amenorrhea and hyper metabolism results in osteoporosis
  • Diabetic Retinopathy
  • Hypertensive Retinopathy
  • Pioglitazone (Actos)
  • Insulin Pumps
  • Microvascular Complications of DM
  • Macrovascular Complications of DM
  • Charcot’s Foot – very common in DM
  • DiabeticsAt and increase risk for cataracts and glaucoma

Gastrointestinal Review

  • Gastrointestinal Danger Signs
  • Acute Appendicitis: pain at McBurney’s Point with positive psoas and obutrator signs
  • Acute Cholecystitis: Murphy’s maneuver
  • Acute Diverticulitis: Rovsing’s Sign with board-like abdomen with leukocytosis and neutrophilia and a shift to the left.
  • Acute Pancreatitis: Cullen’s Sign (blue discoloration around umbilicus) & Grey-Turner’s Sign (blue discoloration on the flanks). Also may have ileus and show signs of shock.
  • Clostridium Difficile Colitis: severe watery diarrhea from 10-15 stools a day. Usually appears 5-10 days after the start of antibiotics. Especially common with clindamycin, fluoroquinolones, cephalosporin, and PCN”s.
  • Colon Cancer
  • Crohn’s disease and Ulcerative Colitis.
  • McBurney’s Point:
  • Psoas/Iliopsoas (supine position)
  • Obturator Sign
  • Rovsing’s Sign (supine position)
  • Markle Test (Heel Jar)
  • Involuntary Guarding : With abdominal palpation, the abdominal muscles reflexively become tense or board-like.
  • Barrett’s Esophagus
  • Lifestyle Modifications
  • Cullen’s Sign

Nervous System LEIK EXAM TIPS

  • Danger Signs with headaches
  • Acute Bacterial Meningitis 
  • Temporal Arteritis (Giant cell Arteritis) 
  • Acute/Narrow Angle Glaucoma 

Neurological Testing

  • Cerebellar Testing: Romberg Test (cerebellar testing): tell the patient to stand with arms/hands straight on each side with the feet together, and then instruct the patient to close both eyes while standing in the same position and observe.
  • dem Gait (cerebellar testing): Tell pt to walk a straight line in normal gait, and then instruct the patient to walk a straight line with one foot in front of the other.
  • Kernig’s Sign:Flex the patient’s hip one at a time, then attempt to straighten the leg while keeping the hip flexed at 90 *.
  • Brudzinski: Passively flex/bend the patient’s neck toward the chest.
  • Nuchal Rigidity: Have the pt touch chest with chin.

Neurological Terminology

  • EXAM TIPS
  • Cranial Nerves
  • Mnemonic:On, On, On, They, Traveled, And, Found, Voldemort, Guarding, Very, Special, Horcruxes 
  • Herpes Zoster Infection (Shingles)
  • Acute Bacterial Meningitis
  • Migraine headaches with Aura:

Treatment of Migraines

  • Abortive: Immitrex (see below) and NSAID’s
  • Sumatriptan (Imitrex)
  • NSAID’s, Analgesics, and / or Narcotics
  • Ergotamine/Caffeine (Cafergot
  • Anti-Emetics
  • Prophylactic Treatment
  • Contraindications for Vasoconstriction Drugs
  • Basilar or Hemiplegic Migraines
  • Temporal Arteritis (Giant Cell Arteritis)
  • Polymyalgia Rheumatic (PMR)
  • Trigeminal Neuralgia
  • Bell’s Palsy

Nervous System Exam Tips

  • Carpel Tunnel Syndrome
  • Cluster Headache
  • Alternative Headache Remedy
  • Muscle Tension Headaches
  • TIPS
  • Trigeminal Neuralgia (Tic douloureux) –
  • Temporal Arteritis:

Hematological System Review Tips

  • Acute Hemorrhage
  • Neutropenia
  • Vitamin B 12 Deficiency
  • Hodgkins Lymphoma
  • Non-Hodgkins Lymphoma
  • Multiple Myeloma
  • Thrombocytopenia
  • Exam Tips
  • Total Iron-Binding Capacity (TIBC):
  • Serum Ferritin:

Thalassemia vs. Iron Deficiency Anemia

  • Thalassemia:
  • Iron Deficiency Anemia
  • Taking Iron
  • Medications that lower H/H and/ or worsen anemia.
  • Pernicious Anemia
  • Sickle Cell Anemia
  • Deficient B12

Musculoskeletal Exam Tips

  • MRI:
  • XRAY:
  • Thumb Spica Cast
  • NSAID’s
  • Degenerative Joint Disease (DJD or OA)
  • Medial Tibial Stress Fracture or Syndrome
  • Rheumatoid Arthritis
  • Cauda Equina Syndrome
  • Fracture of the Wrist
  • Baker’s Cyst

Psychosocial Mental Health Exam Tips

  • Minor Depression vs. Major Depression
  • Bipolar
  • Atypical Antipsychotics
  • Typical Antipsychotics
  • Adverse Effects for Antipsychotics
  • Anticonvulsants
  • SSRI’s
  • Atypical Antidepressants
  • SNRI
  • TCA’a
  • Lithium Salt
  • MAOI’s
  • Anticholinergic Side Effects

Alternative Therapies Interaction

  • St. Johns Wort
  • Kava Kava and/ or Valerian Root
  • Folstein MMSE
  • Gamma Flutamyl Transaminase
  • AST/ALT
  • Korsakoff’s Syndrome
  • Nicotine patches
  • Buproprion (Zyban)
  • Alcohol Use
  • Anorexia
  • Abuse
  • Common Findings of Abuse
  • Risk Factors that increase the likelihood of Abuse
  • Physical Exam during Abuse
  • Abuser
  • Exam Tips on Abuse

Men’s Health Review

  • Exam Tips
  • Finasteride (Proscar)
  • Males with hypertension and BPH-
  • Chronic Prostatitis Vs. Acute Prostatitis
  • Acute Prostatitis
  • Priapism
  • Testicular Cancer
  • Prostate Cancer
  • Torsion of the Appendix Testis
  • Testicular Torsion
  • Cremasteric Reflex
  • Pharmacologic Treatment for BPH
  • 5-Alpha-Reductase Inhibitors:
  • Alpha Blockers:

Woman’s Health Review

  • Menopausal Changes
  • Atrophic Vaginitis
  • Normal Findings in the Breast
  • Low-Grade Squamous Intraepithelial Lesions (LSIL)
  • TIPs
  • Cervical Ectropion
  • Contraceptive Tips
  • Bisphosphonates
  • Bone Density
  • Bacterial Vaginitis
  • Candidal Vaginitis
  • Trichomonal Vaginitis

Sexually Transmitted Disease or Infections Review

  • HIV/AIDS
  • Acute HIV Infection (Acute Retroviral Syndrome)
  • Syphilis
  • Gonorrheal
  • Pelvic Inflammatory Disease
  • Proctitis: Occurs from perceptive intercourse
  • Condyloma Acuminata vs. Condyloma Lata
  • Herpes Simplex Virus
  • Fitz-Hugh-Curtis
  • Jarisch-Herxheimer Syndrome
  • Disseminated Gonorrheal Infection (DGI)
  • Tips

Woman’s Health, Pregnancy, and Childbirth Review

  • Presumptive Signs of Pregnancy
  • Probable Signs of Pregnancy
  • Positive Signs of Pregnancy
  • Naegele’s Rule
  • Placenta Previa
  • Placenta Abruptio
  • Fundus Location Correlated to Gestational Age
  • Gestational Diabetes Mellitus (GDM)
  • Rh-Incompatibility Disease
  • Urinary Tract Infections
  • Exam Tips
  • Breast Feeding

Pediatrics

  • Newborn Review
  • Weight Management
  • Caput Succedaneum Vs. Cephalohematoma
  • Breastfeeding
  • Tooth Eruption
  • Genitourinary Anomalies
  • Reflects
  • Immunization Tips
  • Developmental Dysplasia of the Hip (DDH)
  • Exam Tips
  • Coarctation of the Aorta

Toddlers Review (age 2-3)

  • Wilms’ Tumor (Nephroblastoma)
  • Epiglottitis
  • Developmental Tips
  • Autism Spectrum Disorder

School- Aged Children (including preschool)

  • Tips
  • Hand Foot Mouth Disease
  • Scabies
  • Impetigo
  • Varicella
  • Fragile X-Syndrome
  • Molluscum Contagiosum
  • Measles (Rubeola)

Adolescents Review

  • Tips
  • Testicular Torsion
  • Testicular Cancer
  • Hodgkin’s Lymphoma
  • Vaccine Adverse Event Reporting System (VAERS)
  • Puberty
  • Tips
  • Emancipated Minor
  • Right to Consent and Confidentiality
  • Anorexia Nervosa
  • Scoliosis
  • Klinefelter Syndrome
  • Osgood-Schlatter
  • Primary Amenorrhea vs. Secondary Amenorrhea
  • Gynecomastia vs. Pseudogynecomastia
  • Seborrheic Keratosis Vs. Actinic Keratosis
  • Presbycusis
  • Arcus Senilis (Corneal Arcus)               
  • TIPS
  • Macular degeneration
  • Cataracts
  • Anticholinergic Side Effects
  • Pulmonary Changes in Elderly

Common Disorders in Older Adults

  • Retinal Detachment
  • Acute Angle-Closure Glaucoma
  • Hip Fracture
  • Temporal Arteritis
  • Mini Mental Status Exam (MMSE)
  • Korsakoff-Wernicke Dementia
  • Alzheimer’s Disease
  • Parkinson’s Disease
  • Sundowning Phenomenon
  • MAO-B Inhibitors (Selegiline (Elderpryl) or Rasagiline (Azilect)
  • Essential Tremor

Professional Issues Review

  • Ethical Guidelines and Advanced Practice Law
  • Health Insurance Portability and Accountability Act
  • Ombudsman
  • Guardian Ad Litem
  • Hospice
  • Medicare B
  • Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
  • TIPS
  • Quality Improvement Program

Professional Roles and Reimbursement

  • Claims Based Malpractice
  • Occurrence Type Malpractice Insurance
  • TIPS

Culture and Spiritually Related Beliefs

  • Exam Tips

Nursing Research

  • Exam Tips
  • Dependent Variable Vs. Independent Variable
  • Vulnerable Populations
  • Institutional Review Boards (IRB’s)
  • Assent
  • N versus n

Evidence-Based Medicine and Epidemiology

  • Sensitivity vs. Specificity

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