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AANP FNP certification Exam
2024 Questions and Answer
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All diastolic murmurs are pathological. Murmurs Grades I-barely II- audible III- clearly audible. IV- first time thrill V-Steth edge VI- entire steth. EXAM - SOLUTION III first time audible, IV first time thrill Fundal height 12 weeks - SOLUTION Fundal Height 12 weeks above symphysis pubis. EXAM Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - SOLUTION Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - SOLUTION Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - SOLUTION Mini mental exam 4 month old with strabismus, mom is worried...... - SOLUTION tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - SOLUTION Growth chart 6 month old closed anterior fontanel. - SOLUTION XRAY
Abnormal cells on PAP, what do you do next? - SOLUTION Refer for Colposcopy CAGE ACRONYM - SOLUTION Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - SOLUTION Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - SOLUTION CN 3,4, Definition of metabolic syndrome - SOLUTION cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - SOLUTION wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - SOLUTION Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - SOLUTION Anterior septum Definitive diagnosis of acute bacterial prostatitis - SOLUTION urinalysis and culture GERD treatment - SOLUTION H2 is first line, give hs Grade 3 cells on Pap, treatment? - SOLUTION LEEP excision Fingernail hematoma treatment? - SOLUTION drill hole and drain blood?
Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - SOLUTION Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - SOLUTION Tinea Corporis Pt presents with "bag of worms:, indicates? - SOLUTION Varicocele Pt with atopic dermatitis, look for what other diseases? - SOLUTION Asthma Pt with bleeding after menopause - SOLUTION endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? - SOLUTION Infertility Pt with HIV took high potency anti viral treatments and CD4 is
400, what does this indicate? - SOLUTION This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? - SOLUTION Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - SOLUTION slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go - SOLUTION Timed Get up and Go Red beefy tongue? - SOLUTION pernicious anemia Rotator cuff injury presentation - SOLUTION disturbs sleep, arm weakness, dull ache
Shingles near eye - SOLUTION immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease)? - SOLUTION Viral infection Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage -Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash -Seizures may occur during this period. -On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs. -High fever, pink flat or raised rash Treatment for chronic alcoholism: - SOLUTION 12 step program Treatment for Gonorrhea? - SOLUTION Rocephin 250mg IMx plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - SOLUTION IUD Basal cell cancer - SOLUTION Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - SOLUTION Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - SOLUTION Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area -a pre squamous cell carcinoma occurs on sun-damaged skin biopsy
Murmur Grade III - VI - SOLUTION Loud murmur easily heard JVD caused by - SOLUTION -tension pneumothorax, -Rt. sided heart failure, -cardiac tamponade, -traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - SOLUTION endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles. Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - SOLUTION PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - SOLUTION Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - SOLUTION >5 mm in an immunocompromised patient or close contact
10 mm in immigrant, health care workers, drug user 15 mm in a patient who lives in an area where TB is very rare. what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - SOLUTION Croup/Epiglottitis
AV nicking (Arterioles pressing on vein of the eye) - SOLUTION HTN retinopathy intraocular pressure (IOP) - SOLUTION Fluid pressure inside the eye; measured with tonometry Rovsing sign - SOLUTION pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - SOLUTION Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - SOLUTION SDH migraine headache - SOLUTION -paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate Vitamin B12 - SOLUTION Folate shares a close relationship with this other B Vitamin. Vitamin B12 - SOLUTION Cognitive deficits, glossitis, pernicious anemia, Folate shares a close relationship with this other B Vitamin. 88/yr. old patient in for follow up secondary. She's been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from
Tanner 4 - SOLUTION Tanner 4- female nipples and areola become elevated from breast, secondary mound Male penis grows wider grows in length, darker scrotum pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. - SOLUTION vascular dementia presbycusis - SOLUTION a gradual loss of sensorineural hearing that occurs as the body ages a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical). What should be done - SOLUTION Ultrasound Romberg test - SOLUTION cerebellar -ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed -expected finding: client should be able to stand with minimal swaying for at least 5 seconds Direct Coombs test - SOLUTION r/o bilirubin preeclampsia treatment - SOLUTION bed rest, laying on her side Molluscum contagiosum treatment - SOLUTION Currettage, liquid nitrogen pyloric stenosis - SOLUTION non bilious vomiting, olive like firm mass palpated on right upper quadrant horizontal nystagmus that stops when eye is close to midline in a college student - SOLUTION Ménière's disease? Nystagmus test - SOLUTION the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. - SOLUTION sialolithiasis).
Etopic Pregnancy: Risk Factors - SOLUTION Previous ectopic pregnancy Prior fallopian tube surgery Previous pelvic or abdominal surgery Certain sexually transmitted infections (STIs) Pelvic inflammatory disease Endometriosis cigarette smoking age older than 35 years history of infertility use of assisted reproductive technology, such as in vitro fertilization (IVF) Which among the list can cause increase in respiration - SOLUTION Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - SOLUTION hypercapnia Osteoporosis Risk Factors (ACCESS) - SOLUTION A-lcohol Use C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - SOLUTION VITAMIN D 600-800, CALCIUM 1000-
OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH
Assessment on patient with ascites - SOLUTION Dullness Assessment on patient with ascites - SOLUTION Dullness to percussion Varus Stress Test - SOLUTION application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL Varus Stress Test - SOLUTION TEST LCL (lateral-vaRus) McMurrays- Meniscus CLICK application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL German Measles (Rubella) - SOLUTION Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots. patient with IOP of 32mmHg, what do you expect during fundoscopic exam - SOLUTION patient with IOP of 32mmHg, what do you expect during fundoscopic exam - SOLUTION increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - SOLUTION anticholinergics/oxybutynin, impamine/tricyclic/antidepressant Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH
BPH and urge incontinence - SOLUTION TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - SOLUTION a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - SOLUTION telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS intussusception - SOLUTION telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL IBS (irritable bowel syndrome) - SOLUTION An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) - SOLUTION SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress Osteoporosis treatment - SOLUTION TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss
Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy - SOLUTION Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema - SOLUTION optic disc swollen w/ blurred edges due to increased ICP EXAM actinic keratoses - SOLUTION Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM Allergic Conjunctivitis - SOLUTION "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - SOLUTION COPD- Gold 1-2- SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN CN IX Glossopharyngeal - SOLUTION - Shoulder shrug/ ROMBERG test EXAM
CN V Trigeminal - SOLUTION Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - SOLUTION ears 8 EXAM CN VII Facial - SOLUTION BELLS EXAM ACEI contraindicated - SOLUTION pregnancy Safe to give varicella/MMR - SOLUTION Do not give <12 mo. EXAM QUESTION Acne Vulgaris - SOLUTION common acne. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide. Acne Rosacea - SOLUTION - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts - SOLUTION is on EXAM in elderly night vision issues. Opaque Kawasaki disease - SOLUTION - acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM Erythema migrans - SOLUTION Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM Rocky Mountain Spotted Fever - SOLUTION Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you
2 cm more of less from # of wk gestation is normal if more or less order US. Psoriasis - SOLUTION Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds. (Koebner phenomenon- new psoriatic plaques form over skin trauma) (Auspitz sign- pinpoint bleeding when plaques are removed). TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic. D Dacrocystitis - SOLUTION Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents. Acne Rosacea - SOLUTION Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM Parathyroid hormone - SOLUTION PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM Diabetic Retinopathy - SOLUTION Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED HTN Retinopathy - SOLUTION Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM Wilms Tumor - SOLUTION Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2- y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM
Primary Amenorrhea - SOLUTION Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics. Aphthous stomatitis - SOLUTION Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash. Temporal arteritis - SOLUTION Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids. Atopic Dermatitis (eczema) - SOLUTION Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy lesions" they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM Tinea Corporis - SOLUTION ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending Cellulitis - SOLUTION Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS. Erysipelas - SOLUTION Group A strep, painful, Upper dermis, clear demarcated, cheeks, shins. TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d. MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim. Varicella Zoster - SOLUTION "contagious 48 h. before, until all lesions crusted over" low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. "initially on trunk, then scalp and face" TREATMENT supportive,
