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Medical Exam Review

Aug 22, 2025

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Overview

This lecture provides a comprehensive review of key topics for the nurse practitioner board exam, covering dermatology, eyes, ears, cardiac, respiratory, endocrine, GI, GU, neuro, and mental health.

Dermatology

  • Keloid: overgrowth of scar tissue.
  • Cherry angioma: bright red/purple, benign blood vessel lesion—no treatment unless cosmetic.
  • Solar lentigo: flat, oval, brown "liver spots."
  • Seborrheic keratosis: warty, scaly, "pasted on" tan-black lesion.
  • Skin tags: painless, benign outgrowths.
  • ABCDE rule for assessing lesions for cancer.
  • Candidiasis: yeast infection with white discharge; treat with hygiene and nystatin.
  • Contact dermatitis: localized skin reaction matching irritant; treat by avoiding triggers.
  • Atopic dermatitis (eczema): crusty yellow lesions, common in flexural areas; treat with topical steroids and antihistamines.
  • Impetigo: honey-colored crust, treat with topical/oral antibiotics, return to school after 48-72h of treatment.
  • Psoriasis: silvery, scaly plaques, elbows/knees; chronic, treat with topical steroids.
  • Scabies: interdigital itching, treat with permethrin cream.
  • Vitiligo: depigmented patches, often autoimmune; affects body image.
  • Basal cell carcinoma: pearly, waxy nodule with ulcerated center.
  • Actinic keratosis: rough, scaly sun-exposed patch; can become squamous cell carcinoma.
  • Animal/human bites: assess, wash, Augmentin, tetanus shot; don't suture cat bites.

Eyes & Ears

  • Refer out for abnormal eye findings; hypertension/diabetes can cause retinopathy.
  • Corneal ulcer: white corneal lesion in contact lens users, refer to ED.
  • Glaucoma: open angle is gradual vision loss; angle closure is sudden, painful, emergent.
  • Retinal detachment: "curtain" vision change, floaters, flashing lights—refer immediately.
  • Blepharitis: eyelid inflammation, treat with lid hygiene and warm compresses.
  • Weber/Rinne tests differentiate hearing loss types.
  • Otitis media: ear infection, treat with antibiotics.
  • Epistaxis: nosebleed, direct pressure, refer if recurrent/posterior bleed.

Neuro & Mental Health

  • Cluster headache: sharp, unilateral, treat with high-flow oxygen.
  • Migraine: aura, photosensitivity, treat with triptans.
  • Bell's Palsy: unilateral facial paralysis (CN VII); corticosteroids.
  • Ischemic vs. hemorrhagic stroke: "worst headache" suggests hemorrhage.
  • Parkinson’s: resting tremor, rigidity; refer to neurology.
  • Depression: screen with PHQ-2/9, first-line SSRI; ask about suicide risk.
  • Alcohol use: screen with CAGE, labs (GGT), withdrawal precautions.
  • Insomnia: emphasize sleep hygiene; meds are short-term.
  • Schizophrenia: reality distortion, hallucinations; managed by psychiatry.

Cardiac & Vascular

  • S3 normal in kids/pregnancy; S4 always abnormal.
  • Systolic murmur: aortic stenosis/mitral regurgitation; diastolic always abnormal.
  • Hypertension: ≥2 readings, treat w/lifestyle, thiazide, CCB, ACE/ARB.
  • Heart failure: left-sided (pulmonary), right-sided (edema/JVD), diagnose w/echo.
  • ACS: unstable angina, NSTEMI (ST depression), STEMI (ST elevation); refer to ED.
  • Atrial fibrillation: palpitations, refer for OAC, EKG, labs.
  • DVT: unilateral leg pain, Homan’s sign; risk of PE.

Respiratory

  • COPD: chronic cough/SOB; group-dependent therapy, encourage smoking cessation.
  • Asthma: stepwise approach, mainly inhaled therapies.
  • Pneumonia: SOB, green sputum, consolidation on CXR; treat with antibiotics.
  • Tuberculosis: night sweats, fever, positive if induration ≥15mm (or ≥5mm for HIV).
  • Obstructive sleep apnea: refer for sleep study.

Endocrine & Diabetes

  • Hypothyroidism: high TSH, low T3/T4, treat with Synthroid.
  • Hyperthyroidism: low TSH, high T3/T4, treat with methimazole/PTU.
  • Diabetes type 2: managed stepwise—lifestyle, metformin, add meds/insulin as needed.
  • DKA: hyperglycemia emergency, refer to ED.
  • Addison's (low cortisol): hyperpigmentation; Cushing's (high cortisol): moon face, striae.

GI & GU

  • GERD: lifestyle, antacids, escalate to PPI.
  • PUD: epigastric pain, H. pylori testing, treat w/PPI.
  • IBD (Crohn’s, UC): inflammation, extraintestinal symptoms, refer for chronic management.
  • UTI: dysuria, frequency, elderly may have confusion; treat based on complication status.
  • Pyelonephritis: fever, flank pain; needs antibiotics.
  • Kidney stones: severe flank pain, treat with hydration, refer if large.

Key Terms & Definitions

  • ABCDE — Asymmetry, Border, Color, Diameter, Evolution (skin cancer screening).
  • Cherry angioma — Benign red vascular skin lesion.
  • Impetigo — Honey-colored crust skin infection.
  • Retinal detachment — Retina separated from underlying tissue; emergency.
  • S3/S4 — Heart sounds indicating normal/abnormal states.
  • NSTEMI/STEMI — Types of myocardial infarction.
  • Atrial fibrillation — Irregular, often rapid heart rate.
  • DKA — Diabetic ketoacidosis, medical emergency.
  • PUD — Peptic ulcer disease.
  • IBD — Inflammatory bowel disease (Crohn’s/UC).
  • UTI — Urinary tract infection.

Action Items / Next Steps

  • Review all key dermatological lesion features and treatments.
  • Memorize ABCDE melanoma criteria and heart/lung sounds.
  • Practice distinguishing murmurs and headache types.
  • Review stepwise treatment approaches for COPD, asthma, and diabetes.
  • Prepare for part two of the board review.
  • Watch associated videos or read further details as instructed.

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