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AANP FNP CERTIFICATION LATEST 2024
EXAM QUESTIONS AND CORRECT
ANSWERS
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? - ANSWER- Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - ANSWER- Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - ANSWER- Mini mental exam 4 month old with strabismus, mom is worried...... - ANSWER- tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - ANSWER- Growth chart 6 month old closed anterior fontanel. - ANSWER- XRAY Abnormal cells on PAP, what do you do next? - ANSWER- Refer for Colposcopy CAGE ACRONYM - ANSWER- Cut down Annoyed by criticism Guilty about drinking Eye opener drink
Causes of tachycardia - ANSWER- Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - ANSWER- CN 3,4, Definition of metabolic syndrome - ANSWER- cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - ANSWER- wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x ovary, what do you do next? - ANSWER- Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - ANSWER- Anterior septum Definitive diagnosis of acute bacterial prostatitis - ANSWER- urinalysis and culture GERD treatment - ANSWER- H2 is first line, give hs Grade 3 cells on Pap, treatment? - ANSWER- LEEP excision Fingernail hematoma treatment? - ANSWER- drill hole and drain blood? Increased risk of ectopic pregnancy - ANSWER- Salpingitis, or history of abortion, PID, Koplick spots - ANSWER- Measles (rubeola). Grains of salt lesions inside mouth in Measles
Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - ANSWER- Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - ANSWER- Tinea Corporis Pt presents with "bag of worms:, indicates? - ANSWER- Varicocele Pt with atopic dermatitis, look for what other diseases? - ANSWER- Asthma Pt with bleeding after menopause - ANSWER- endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? - ANSWER- Infertility Pt with HIV took high potency anti viral treatments and CD4 is
400, what does this indicate? - ANSWER- This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? - ANSWER- Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - ANSWER- slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go - ANSWER- Timed Get up and Go Red beefy tongue? - ANSWER- pernicious anemia Rotator cuff injury presentation - ANSWER- disturbs sleep, arm weakness, dull ache
Shingles near eye - ANSWER- immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease)? - ANSWER- 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: - ANSWER- 12 step program Treatment for Gonorrhea? - ANSWER- Rocephin 250mg IMx1 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: - ANSWER- IUD Basal cell cancer - ANSWER- Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - ANSWER- Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - ANSWER- Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area
-congenital cardiac condition characterized by a narrowing of the aorta
Murmur Grade III - VI - ANSWER- Loud murmur easily heard JVD caused by - ANSWER- -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 - ANSWER- 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. - ANSWER- 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 - ANSWER- Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - ANSWER- >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. - ANSWER- Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - ANSWER- HTN retinopathy intraocular pressure (IOP) - ANSWER- Fluid pressure inside the eye; measured with tonometry Rovsing sign - ANSWER- pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - ANSWER- Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - ANSWER- SDH migraine headache - ANSWER- -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 - ANSWER- Folate shares a close relationship with this other B Vitamin.
HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. - ANSWER- tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children - ANSWER- motor vehicle Tanner 2 - ANSWER- Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 - ANSWER- 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. - ANSWER- vascular dementia presbycusis - ANSWER- 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 - ANSWER- Ultrasound Romberg test - ANSWER- 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 - ANSWER- r/o bilirubin preeclampsia treatment - ANSWER- bed rest, laying on her side
Molluscum contagiosum treatment - ANSWER- Currettage, liquid nitrogen pyloric stenosis - ANSWER- 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 - ANSWER- Ménière's disease? Nystagmus test - ANSWER- the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. - ANSWER- sialolithiasis). Etopic Pregnancy: Risk Factors - ANSWER- 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 - ANSWER- Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - ANSWER- hypercapnia
pregnancy, smoking, theophylline Zeprexa. What lab and intervention to put in place - ANSWER- CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose Weber test - ANSWER- Sensorineural loss Weber test(top of head) no laterization, normal finding, does not lateralize to either ear, bilateral hearing loss, if hear better in left ear, right sensorineural loss Weber test - ANSWER- Sensorineural loss Weber test (top of head) no laterization- normal, does not lateralize to either ear- bilateral hearing loss, if hear better in left ear, right sensorineural loss. SUN- sensorial lateralize unaffected ear CAFFE- Conductive lateralize to affected ear Assessment on patient with ascites - ANSWER- Dullness Assessment on patient with ascites - ANSWER- Dullness to percussion Varus Stress Test - ANSWER- 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 - ANSWER- 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) - ANSWER- 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 - ANSWER- patient with IOP of 32mmHg, what do you expect during fundoscopic exam - ANSWER- increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - ANSWER- 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 - ANSWER- TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - ANSWER- a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - ANSWER- telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS
Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY >2. Retinoblastoma - ANSWER- white reflection in child's pupil for staph aureus infection (skin) with pus - ANSWER- MRSA- TX Bactrim or tetracyclines? hyperparathyroidism - ANSWER- high calcium Hyperthyroidism treatment - ANSWER- methimazole, PTU- propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers Mammography Screening - ANSWER- -Age 45 - 54 yearly mammogram -55 and older every 2 years Fifth's Disease (Erythema Infectiosum) - ANSWER- B19: lytic infection, respiratory transmission Sx: flushed rash/fever in kids Px: fever, get better in a week pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - ANSWER- TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy - ANSWER- Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema - ANSWER- optic disc swollen w/ blurred edges due to increased ICP EXAM
actinic keratoses - ANSWER- 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 - ANSWER- "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - ANSWER- 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 - ANSWER- - Shoulder shrug/ ROMBERG test EXAM CN V Trigeminal - ANSWER- Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - ANSWER- ears 8 EXAM CN VII Facial - ANSWER- BELLS EXAM
becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. EXAM Addison's - ANSWER- Addison's- deficient in cortisol (think low sodium, blood sugar, but Increase K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM rheumatoid arthritis - ANSWER- Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM Osteoarthritis - ANSWER- Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM Osteoporosis - ANSWER- OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM Fibromyalgia polymyalgia - ANSWER- Fibro- 11/18 points. Widespread pain for at least three months. EXAM. polymyalgia Tx prednisone 12 months. Must taper off. RISK for Temporal arteritis, DX BX, elevated ESR Serotonin syndrome - ANSWER- Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM Fundal Height - ANSWER- Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS 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. Psoriasis - ANSWER- 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 - ANSWER- Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents. Acne Rosacea - ANSWER- Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM Parathyroid hormone - ANSWER- PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM Diabetic Retinopathy - ANSWER- Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED HTN Retinopathy - ANSWER- Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM Wilms Tumor - ANSWER- Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM
