Description

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