NR 667 VISE Assignment Latest Update 2023-2024 272 Questions and Verified Correct Answers Guaranteed A+ -Assessment findings: Eczema - ANSWER: -Pruritus, erythema, dry skin, erythema of infraorbital folds, antecubital fossa, posterior patella, scalp -Flexural surfaces i.e. doors of hands, feet -Often reappears in adulthood after absence since childhood -Lichenification and scaling typical
-Diagnostic studies: Depressive disorder - ANSWER: -Structured interviews/questionnaire
-DSM-5
-PROMIS (ages 6-17)
-PHQ-9
-Zung- self-rating depression scale -Laboratory studies to rule out other conditions: TSH, urine drug screen, ECG, Vit D, genetic testing to help with medication selection
-Diagnostic studies: Eczema - ANSWER: -Usually none needed -80% of patients have eosinophilia during exacerbations -Serum allergy testing
-Differential diagnosis: Depressive disorder - ANSWER: -Bipolar disorder -ADD -Chronic physical illness -Physical/sexual abuse -PTSD -Substance abuse -Grief reaction -Hypothyroidism/B12 deficiency -Dementia
-Expected course: Eczema - ANSWER: -Exacerbations and remission -Expect flare-ups
-Risk factors: Tinea unguium - ANSWER: -Excessive exposure to water, soap, detergent -Distortion of nails from chronic inflammation -Commonly associated with tinea pedis
-Risk factors: Transient Synovitis of the Hip - ANSWER: -History of URI 7-14 days before symptom onset in 70% of affected children -History of trauma 1 / 4
Assessment findings: ACL Injury - ANSWER: -Timing -Mechanism -Popping sound at the time of injury -Acute pain -Inability to weight bear after injury -Acute swelling/hemarthrosis with rapid onset -Joint instability, "giving out" -Positive lachman test -Positive pivot shift "clunk" -Positiv anterior drawer test -Medial/lateral laxity
Assessment findings: Allergic rhinitis - ANSWER: -DX is based on h+p findings consistent with allergy-related cause; presence of one or more of these symptoms: nasal congestion, rhinorrhea, itchy nose, sneezing -Conjunctival injection, watery eyes -Pale, boggy nasal mucosa with congestion and clear rhinorrhea -Transverse crease on tip of nose due to allergic salute-repeated wiping of nose in an upward direction -Mouth breathing, dry lips -Sore throat, dry mouth upon waking -Palpable lymph nodes -Enlarged tonsils and adenoids
-Presence of associated conditions: sleep-disordered breathing, otitis media,
rhinosinusitis, conjunctivitis, asthma, atopic dermatitis
Assessment findings: Anxiety - ANSWER: -Children: separation anxiety after age 3-4 years (can be present in adulthood); unrealistic worry about harm to self or family; persistent worry about past behavior, competence, or future events
-Adults: apprehension, restlessness, edginess, distractibility, insomnia
-Somatic complaints: fatigue, headaches, paresthesia, near syncope, derealization, dizziness, diaphoresis, palpitations, tachycardia, chest pain/tightness, dyspnea, hyperventilation, N/V/D, excessive rumination
Assessment findings: Asthma - ANSWER: -Free of symptoms between attacks -Airway constriction causing expiratory wheezing -SOB -Tachypnea, tachycardia -Nonproductive cough -Chest tightness -Hyper-resonance -Prolonged expiration -Accessory muscle use in severe attack -Sudden nocturnal dyspnea -Decreased exercise tolerance 2 / 4
Assessment findings: Back pain - ANSWER: -Cauda equina is a surgical emergency that presents with back pain + 1. perineal anesthesia, 2. loss of bladder/bowel control,
- loss of rectal sphincter tones with digital exam, 4. bilateral radicular pain, numbness
and weakness -Back, but, and thighs may be aggravated by movement, rising from seated position, standing, and flexion; may be relieved by rest, repositioning, or reclining -Muscle spasm may be present over lumbosacral area due to ligament or muscle involvement -Pain may radiate down leg below knee with with spinal nerve irritation and radiculopathy -Motor, sensory, and reflex exams are essential; note asymmetry of findings -Observe gait, lower extremity strength, and muscle bulk
Assessment findings: BPH - ANSWER: -Obstructive: incomplete bladder emptying, hesitancy and post-void dribbling, straining to void, weak urine stream
-Irritative: nocturia, frequency, urgency, dysuria
-Urinary incontinence -Urinary retention
-Hematuria: gross or microscopic
-Firm, smooth, symmetrically enlarged prostate
Assessment findings: Bronchitis - ANSWER: -Cough: dry and non-productive, then productive, may be purulent -URI symptoms -Fatigue -Fever due to bacterial infection; more common in smokers and those with COPD -Fever due to virus; unusual after the first few days -Burning sensation in chest -Crackles, wheezes -Chest wall pain
Assessment findings: Depressive disorder - ANSWER: -Depressed mood for 2 weeks or longer and/or anhedonia (inability to feel pleasure) -Increased/decreased appetite -Weight loss or gain -Sleep disorder -Psychomotor agitation or retardation -Fatigue, loss of energy -Feelings of worthlessness, inappropriate guilt -Recurrent thoughts of death -Difficulty thinking/concentrating, indecisiveness
Assessment findings: DM II - ANSWER: -Usually discovered on routine exam
-CMP and urinalysis: glycosuria, proteinuria, hyperglycemia
-Obesity 3 / 4
-Acanthosis nigricans -Polydipsia, polyuria, polyphagia -Fatigue -Blurred vision -Chronic skin infections -Balanitis in men > 65 years -Chronic candidiasis vulvovaginitis -Hyperosmolar state or coma
Assessment findings: Fibromyalgia - ANSWER: -Multisite pain defines as 6 or more pain sites from 9 possible sites -Moderate to severe sleep problems or fatigue -Both for at least 3 months -Tenderness of soft tissue and muscles -Musculoskeletal stiffness -Headache, TMJ pain, GI symptoms, back/neck pain
Assessment findings: GERD - ANSWER: -Chest pain (requires cardiac workup) -Chronic sore throat/hoarseness -Dysphagia -Erosion of tooth enamel -Esophageal pain referred to neck, midback, upper abdomen
-Extra-esophageal presentation: asthma, chronic cough, laryngitis
-Post-nasal drip, throat clearing -Pyrosis (heartburn) -Regurgitation -Sensation of lump in throat
-Ulceration: hematemesis, fatigue, anemia
Assessment findings: Hyperlipidemia - ANSWER: -Few physical findings; xanthomata (fat deposits in the skin), xanthelasma (yellow plaques on the eyelid), corneal arcus prior to age 50 (arc of cholesterol around the iris), bruits, angina pectoris, MI, stroke
Assessment findings: Hypothyroidism - ANSWER: -Clinical symptoms range from asymptomatic to myxedema coma -Lethargy, delayed DTRs -Mild weight gain, swelling of hands/feet, macroglossia (large tongue), periorbital edema -Cold intolerance -Constipation -Menstrual irregularities, decreased libido, infertility -Memory loss, depression -Course dry skin; body and scalp hair loss, brittle nails -Bradycardia, enlarged heart -Anemia *Expect lipid levels to be elevated
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