Download AANP FNP review - GI & Endo Latest Exam 2025 2026 With Correct Verified Answers and more Exams Nursing in PDF only on Docsity!
AANP FNP review - GI & Endo Latest Exam 2025-
2026 With Correct Verified Answers
Random episodes of headache (mild to severe) diaphoresis, tachycardia, HTN. Episodes resolve spontaneously with normal VS in between attacks. - correct answer>>Pheochromocytoma An autoimmune disorder causing hyperfunction and production of excess thyroid hormones T3 T4 TSH. Tachycardia, rapid weight loss, irritability, anxious, hyperactivity, & insomnia. May have palpitations, HTN, a fib or PAC, sweaty, exophthalmos, skin smooth silky, diarrhea, amenorrhea, heat intolerance, fine tremors, brisk deep tendon reflexes, & CHF. May also note ophthalmopathy, lid lag, goiter, &/or thyroid nodules. Grave's most common in US, higher in women. Higher risk for pernicious anemia, osteoporosis/osteopenia, & other autoimmune d/o (rheumatoid arthritis RA). - correct answer>>Hyperthyroidism Life-threatening s/s during thyroid storm: tachycardia, HTN, high temp, LOC mental status changes, abdominal pain. Start beta blocker, propranolol or nadolol, to counteract tachycardia & tremors. Refer to Endo for RAIU Propylthiouracil (PTU) & Methimazole (Tapazole) shrinks gland/↓ hormone production (side effects - rash, anemia, thrombocytopenia, hepatic necrosis) Radioactive iodine (ablation - then need levothyroxine) Supplement with calcium and vitamin D 1200mg plus weight-bearing exercise. - correct answer>>Hyperthyroidism - thyrotoxicosis & tx Screen: Annual for BMI >25yr with 1+ risk factor, and everyone >45y every 3 years if normal Diagnostics: A1c > 6.5%, IFG >26, Random glucose >200 with polydipsia, polyphagia, polyuria & unexplained weight loss,OGTT > Prediabetes: A1C 5.7-6.4%, IFG 100-125, IGT= 140-199 (check A1C 2x/yr if meeting goal or every 3mo if not meeting goal After dx established: Check A1c q3mo until well-controlled, annual lipid profile, & annual urine for microalbuminuria - correct answer>>Diabetes Mellitus 2 - screen & dx Risk factors: age >45y, overweight or obese, abdominal obesity, sedentary lifestyle, family hx 1st degree relative, HTN, HLD at age <35y, PCOS, hx vascular disease, metabolic syndrome, or ethnic (Hispanic, African American, Asian or American Indian). Meds that can ↑ risk of Type 2 DM - glucocorticoids, HCTZ, atypical antipsychotics, statins - correct answer>>Diabetes Mellitus 2 - risk
DM 1: Unexplained weight loss despite eating a lot of food, ketonuria, polydipsia, polyphagia, polyuria, blurred vision, breath has "fruity odor" & ketones in urine. Usually dx in the acutely ill child or younger adult (4-6 or 10-14). DKA - drowsiness, lethargy DM 2: Acanthosis nigricans (cutaneous manifestation of hyperinsulinemia) commonly seen on groin folds, over knuckles, & elbows (will regress with weight loss and physical activity). Usually dx during routine screen. - correct answer>>Diabetes Mellitus - manifests Set A1c goal: <7% for most, 6% with low risk, <8% for elderly (varies with pt. attitude, risk for hypoglycemia, life expectancy, shorter duration with tighter control, comorbidities) Glucose goal: Pre-prandial 80-130; Peak postprandial< 180; Bedtime 90- 150 Start with Metformin (always prescribe with largest meal of day 500mg → 1000mg → 1500mg → 2000mg). ACEI or ARB for HTN (helps renal system) Multi-drug combo (order patient specific): metformin, sulfonylurea (improve fasting), & DPP4 (post meal insulin release) - correct answer>>Diabetes Mellitus - treatment Every visit: BP, feet, lifestyle (healthy eating, weight control, ↑ physical activity 150 min. week; BP <140/90 (ADA prefers <130/80). Yearly: flu shots, aspirin 81mg daily, eye exam/dental exam, thyroid, lipid profile, urine microalbuminuria (kidney function - eGFR, Cr) Vaccines: Tdap, annual flu, Hep B, zoster, & pneumococcal Prevent complications (Microvascular, small arteries) retinopathy (cotton wool spots & microaneurysms), nephropathy, & neuropathy; and (Macrovascular, large arteries) atherosclerosis PAD, CAD, MI, stroke. - correct answer>>Diabetes Mellitus - prevent complications Long acting (basal) give once a day at the same time (Ex lantus toujeo levemir. Titration, 2U every 2 - 3d until goal reached. Short acting (bolus) give before meal (Ex Aspart Novolog Humalog). Titration 1-2U every 2 - 3d until Intermediate (usually BID) Ex NPH Mixed (rapid acting mixed with NPH) should be given 15min before a meal (Humulin 70/30 NPH/reg) Insulin adjustment based on postprandial or fasting blood glucose levels are higher: if postprandial higher then increase bolus insulin; or if fasting blood glucose higher then increase long acting or intermediate acting insulin - correct answer>>Diabetes Mellitus - insulin types
DDP4 inhibitor (reduced A1c 0.6-1.4%) ↑ insulin release (largely in response to ↑blood glucose post meal) acts largely on postprandial (minimal to NO hypoglycemia) expensive (weight neutral). Risk: pancreatitis & unexplained joint aches - correct answer>>Diabetes Mellitus - drug class "gliptin" (ex: Sitagliptin/Januvia or linagliptin/Tradjenta) GLP1 agonist (reduced A1c 1-1.5%) ↑ insulin release (largely in response to ↑blood glucose post meal) acts largely on postprandial (minimal hypoglycemia) expensive (slows gastric emptying, leading to appetite suppression & possible weight loss) Injection only. Contraindication: avoid in gastroparesis, & severe renal impairment or ESRD Risk: rare pancreatitis - correct answer>>Diabetes Mellitus - drug class "tide" (ex: liraglutide/Trulicity) SGLT2 inhibitor (reduced A1c 0.7-1%) lower plasma glucose by ↑ amount of glucose excreted in urine (primarily postprandial effect) lowers BP (HYPOGLYCEMIA RISK when used with insulin and insulin secretagogues, insulin secreters/releasers, such as sulfonylurea, DPP-4 inhibitor, & GLP-1 agonist) weight loss. Risk: ↑ GU infection, DKA, & urosepsis (adjust dose in renal impairment) - correct answer>>Diabetes Mellitus - drug class "flozin" (ex: empagliflozin/Jardiance) ABCDEFG: A - aspirin (81-162 mg QD) for diabetes plus 1 CVD risk (smoking, HTN, & fam hx) esp. men >50y, & women >60y. B - BP controlled >2 agents including ACEI/ARB, & thiazide C - cholesterol: statin therapy >40 or hx ACS. Goal Lipids <100 & annual renal (Cr, GFR, & urine microalbumin) D - Diet (limit trans & saturated fat, order dietician if needed) & dental E - Exercise: > 150 min/week (walking) + resistance exercise 3x week; & Eye exam annually F- foot exam (visual exam, every visit, & monofiliment at least annual) G - goals of care - correct answer>>Diabetes Mellitus - ABCDEFG Eye exam changes: neovascularization (new growth of fragile arterioles in retina), microaneurysms, cotton wool spots, soft/hard exudates. Somogyi: severe nocturnal hypoglycemia stimulating glucagon to be released from the liver; high fasting BG by 7am most often r/t over-treating evening/bedtime insulin (more common DMI).
Dawn phenomenon: elevation in FBG daily, early in morning, d/t increase in insulin resistance between 4 - 8AM, caused by spike in GH & glucagon. - correct answer>>Diabetes Mellitus - recognize ↑ levels of cortisol for extended period (long term steroid use) or overproduction of ACTH; or pituitary tumor Common s/s: progressive weight gain, striae on abdomen, thinning fragile skin that bruises easily, slow healing, and fatty tissue deposits, particularly around midsection & upper back, in the face (moon face) and between shoulders (buffalo hump), Striae on abdomen, thinning fragile skin that bruises easily, slow healing. May have fatigue, muscle weakness, & hirsutism. - correct answer>>Cushing's Endocrine works as negative feedback system: low level of active hormone stimulates production; and high level of hormone stops (blocks) hormone production. Hypothalamus stimulates anterior pituitary gland into producing stimulating hormones (FSH, LH, TSH) - these hormones tell organs to produce hormones (these are on & off switch hormones). Hypothalamus: coordinates nervous & endocrine system by sending signals, produces neurohormones that stimulate or stop production. - correct answer>>Endocrine - hypothalamus Posterior pituitary gland: secretes antidiuretic hormone ADH & oxytocin which are made by hypothalamus, and stored & secreted by posterior pituitary. Thyroid glands: uses iodine to produce T3 (huge impact on metabolism - 5x) & T4 (small changes affect TSH). Parathyroid glands: produce PTH which is responsible for calcium balance of body by regulating calcium loss or gain from bones, kidneys, & GI tract. Pineal gland: pea-sized gland in brain that produces melatonin. - correct answer>>Endocrine glands Hypothalamus: TRH, GnRH, CRH, GHRH, Somatostatin Posterior pituitary (on/off switch hormones): TSH, FSH, LH, GH, ACTH, MSH, Prolactin, Vasopressin, and Oxytocin. Target organs (on/off hormones from posterior pituitary: Thyroid (TSH): T3 & T4 (thyroxine) - free or bound (no impact on metabolism) Ovaries/Testes (FSH/LH) - estrogen, progesterone, androgens, testosterone Adrenal Cortex (ACTH) - glucocorticoids, mineralocorticoids Body (GH): somatic growth Uterus (oxytocin) - uterine contractions, bonding Kidneys (vasopressin) - blood volume
Periodic screen recommended with Down syndrome (↑ risk) - correct answer>>Hypothyroidism Levothyroxine (use ideal body weight if pt obese) Adults (1.6mcg/kg/d); Elderly (start 25mcg); Child (4mcg/kg/d); and Pregnancy (↑ by 33%) - Check TSH about 8 weeks after initiation &/or dose changes. Teach to take with water on an empty stomach (avoid taking within 2 hours of calcium, iron, aluminum, magnesium) & to report palpitations, nervousness, &/or tremors. Natural thyroid (armour thyroid) contains fixed doses of T3 & T4, and has different pharmakinetics than levothyroxine (synthetic). Excessive use of levothyroxine = bone thinning Drugs that affect thyroid - Lithium, amiodarone, high doses of iodine, interferon-alfa, & dopamine (lithium can damage thyroid) - correct answer>>Hypothyroidism - management Thyroid panel: ↑ TSH, ↓ free T4 (normal or low T3) Subclinical hypothyroidism has elevated TSH with normal free T4 & T3. TSH: NL 0.4-4.0 (goal 1.2) hypothalamic-pituitary function (anterior pituitary ability to detect circulating free thyroxine) when TSH normal, thyroid disease ruled out. Free T4 (free thyroxine): unbound, metabolically active portion of thyroxine (a f/u test to confirm, support dx of hypo or hyperthyroidism with abnormal TSH) Thyroid peroxidase antibody (TPO Ab): test to help detect autoimmune thyroid disease (measures antibody against peroxidase) Total T4 (total thyroxine): reflects the total of the protein-bound & free thyroxine (useless - altered by medications & clinical conditions) Untreated - hypothyroidism or inadequate thyroxine dose (↓ Free T4 = ↑ TSH) or hyperthyroidism (↑ Free T4 = ↓ TSH) Hypothyroidism associated = ↑ LDL, hyponatremia, ↑ MCV, ↑ CK - correct answer>>Hypothyroidism - thyroid panel Solitary nodule: palpable thyroid mass >1 cm in diameter (5% chance of malignancy) Malignant nodule: firm, non-tender with palpation, relatively fixed (non-mobile), size
4cm, persistent non-tender cervical lymphadenopathy, dysphonia, hemoptysis ↓TSH - metabolically active (HOT) Nuclear med thyroid scan (radioactive ablation or surgery) ↑TSH - metabolically inactive (most common) NOT HOT (cold, usually a cyst). Fine needle aspiration biopsy (refer) most cost effective. - correct answer>>Thyroid nodule
Single thyroid nodule usually in upper half of one lobe, may be accompanied by enlarged cervical nodes. May complain of hoarseness & dysphagia. More common women (3:1) than men, & age 20-55y. ↑ risk with radiation therapy from childhood cancer (Wilms tumor, lymphoma, neuroblastoma); low-iodine diet; or family hx of thyroid cancer. - correct answer>>Thyroid cancer Benign, metabolically active thyroid nodule. Autonomously functioning adenoma Painless thyroid nodule with undetectable TSH - correct answer>>Toxic adenoma Sign of pituitary adenoma. Slow onset. Women may present with amenorrhea. Galactorrhea in both males and females. When tumor is large enough, pt. will complain of headaches and vision changes. Serum Prolactin ↑ Check prolactin if galactorrhea or gynecomastia - big boobs or lactating = prolactin - correct answer>>Hyperprolactinemia Acute onset periumbilical pain steadily worsening over 12-24h. Pain localizes at McBurney's point (RLQ) with rebound & guarding, anorexia. Positive psoas & obturator signs. If ruptures, guarding, rebound, & board-like abdomen. Peak age 10-30y. CT with contrast (Abd US used for younger &/or thinner) Left shift: ↑ WBC, ↑ neutrophils, ↑ Bands (myelocytes or metamyelocytes are immature neutrophils, which can be marker of life-threatening infx found with appendiceal rupture). - correct answer>>Appendicitis Psoas/iliopsoas sign - position supine, flex hip 90° (ask pt push against resistance, trying to straighten leg). Obturator sign - position supine, internal rotate full ROM of right hip (causes pain with movement, flexion of the hip). Rosving's sign - deep palpation of LLQ = pain RLQ McBurney's point - area between superior iliac crest and umbilicus in RLQ - correct answer>>Appendicitis - abdominal maneuvers Markle test (heel jar) - raise heels then drop suddenly or jump (causes pain or pt refuses d/t pain). Involuntary guarding- abdominal muscles reflexively become tense when palpated.
Serum - CBC (leukocytosis, anemia), ↑ CRP & ESR. (May have anemia of chronic disease or Vit B12 deficiency). Stool - WBCs in stool Endoscopy cobblestone mucosal pattern (skin lesions). Lactulose intolerance is common. Stop smoking. Gut rest. Tx: oral aminosalicylates sulfasalazine & mesalamine (better tolerated); Flagyl & Cipro; immune modulators. Risk of development of lymphoma, especially when treated with azathioprine. - correct answer>>Crohn's disease - dx & plan Infected diverticula (diverticulosis most common in sigmoid colon). Fever, anorexia, nausea, cramping, LLQ pain (Blumberg's sign). Acute abdomen with rebound (Rovsing +, board like abdomen). - correct answer>>Diverticulitis Risk factors: ↑ age, constipation, low dietary fiber intake, obesity, lack of exercise, NSAIDs, family hx, connective tissue disorder. Complications: Sepsis, ileus, SBO, hemorrhage, perforation, fistula, death. Diverticulosis - exam normal, 33% of population will develop diverticulosis by age 50. - correct answer>>Diverticulitis - risk & complications CBC shows leukocytosis with neutrophilia (bands signal severe bacterial infection); FOBT positive if there's bleeding CT scan (definitive test). Ciprofloxacin & Metronidazole 10-14d (alternate Levaquin & Flagyl). Teach to ensure a high fiber diet & f/up in 48-72h (if worsens, refer to ER). - correct answer>>Diverticulitis - dx & plan Asymptomatic until advanced disease. Vague GI symptoms, changes in bowel habits, stool or bloody stool. Heme-positive stool, dark tarry stool, mass on abdominal palpation. May have hx of polyps. Adenocarcinomas 3rd leading cause of cancer deaths in US. Risk factors: ↑ risk 50 yrs.; multiple polyps or inflammatory bowel disease; & diet (high fat, red meat, & low calcium). - correct answer>>Colon cancer Screen: colonoscopy age 50y (repeat Q10 yr, unless polyps); <40y assess cancer risk; FOBT annually ever year; Cologuard Q3yr.
Ask these questions: Have you ever had colorectal cancer (CRC) or adenomatous polyp (AP)? Inflammatory bowel disease? Family member with CRC or AP? If CRC - Surgery, chemo, & radiation. - correct answer>>Colon cancer Severe watery diarrhea 10-15 stools a day with lower abd pain, cramping, & fever. Symptoms appear 5-10d after antibiotic initiation (clindamycin, quinolones, cephalosporins and PCNs). CBC (leukocytosis >15,000) & stool assay for C-diff Tx: metronidazole/Flagyl (avoid anti-motility agents & opiates, increase fluid intake). - correct answer>>Clostridium difficile colitis (C-diff) Acute onset fever, N/V; associated with rapid onset severe abd pain radiating to mid- back with bloating; guarding & tenderness over epigastric region on exam; rocks back and forth to relieve pain. Classic sign - severe midepigastric pain that radiates to midback Positive Cullen's sign & Grey-Turner's sign. Common causes = Drug use, Alcohol abuse, gallstones, elevated triglycerides, infections.
- correct answer>>Pancreatitis Serum: ↑ amylase, lipase, & trypsin ↑ AST, ALT, GGT, bilirubin, CBC (leukocytosis) Abdominal ultrasound & CT ↑ risk if triglycerides > Amylase & lipase are sensitive tests used for pancreatic inflammation (pancreatitis). Complications: ileus, sepsis, shock, multi-organ failure Risk factors for pancreatic cancer include chronic pancreatitis, tobacco use, & DM - correct answer>>Pancreatitis - dx Gastric contents regurgitate from stomach to esophagus due to reduction in LES tone, irritation of esophageal mucosa, ↑ gastric secretion. Chronic heartburn over time (large/fatty meals & supine worsen s/s). Recurrent dry cough, chronic pharyngitis, & hoarseness. Self-tx OTC antacids & H2 blockers (failed self tx) May be due to chronic NSAID use, aspirin, alcohol, or calcium channel blocker (blocks calcium and ↓ electoral conductivity - smooth muscle relaxer which ↓ LES and increases GERD) ***Anyone with GERD x 10y should be referred to GI for r/o Barrett's. - correct answer>>GERD Clinical diagnosis per HPI.
Intermittent epigastric pain, burning/gnawing pain. Pain worse with eating, tender at epigastrium. Worrisome symptoms: dysphagia, early satiety, & weight loss Common causes = H. pylori; excessive stress, alcohol, or NSAIDs. H. pylori test (stool antigen test or urea breath test) but NEVER serological H. pylori test (NOT reliable, will test positive if pt was ever infected & does not detect current infx). - correct answer>>Erosive Gastritis (Gastric Ulcer) Episodic epigastric pain & burning/gnawing pain; pain is relieved by food or antacids (recurrent pain 2-3h after meals); awakens at 1-2am with s/s. H. pylori (more common cause) is transmitted oral/fecal & oral/oral. H. pylori test (stool antigen test or urea breath test) NEVER serum. - correct answer>>Duodenal Ulcer H. PYLORI NEGATIVE: stop NSAIDs (if needed, add PPI or misopristol); stop alcohol; stop smoking; stress management; lifestyle changes plus H2 blockers (the step up to PPI). H. PYLORI POSITIVE: triple therapy Clarithromycin, Amoxicillin, & omeprazole X14d (Flagyl if allergic to Amoxicillin). - correct answer>>Gastric or duodenal ulcer - plan AST Aspartate Aminotransferase (AKA SGOT) present in liver, heart, muscle, kidney and lung. ALT Alanine Aminotransferase (AKA SGPT) found mainly in liver; detects liver inflammation (more specific for liver). If both AST and ALT elevated (compare): ALT >AST - (liver) think "L" liver for hepatitis or AST >ALT - think AST (acetaminophen, statins, tequila) for hepatic inflammation AST/ALT ratio: 2.0+ (alcohol abuse) 1-2 (alcohol, liver disease) <1 (fatty liver disease) - correct answer>>Liver function tests (LFTs) - AST ALT GGT (sensitive for alcohol abuse) elevated in liver abuse & acute pancreatitis ALP (alkaline phosphatase) enzyme derived from bone, liver, gallbladder, kidneys, GI, & placenta. ↑ levels seen during growth spurts; healing fractures, osteomalacia, bone malignancy, vitamin D deficiency, Paget's, bone cancer (expect elevation in pregnancy & kids r/t growth) Albumin - liver makes albumin - correct answer>>Liver function tests (LFTs) - GGT ALP albumin Abdominal pain associated with dilated loop of bowel & tinkling bowel sounds. KUB (abd XR) - ileus. REFER (GI surgery). Common s/s cramping pain, N/V, bloating, decreased appetite, constipation
Ileus = absent bowel sounds - KUB (abd XR). Partial obstruction plus chronic low volume bleed, consider & r/o: esophageal stricture, esophagitis, esophageal cancer (order endoscopy) Random pearl - acute LUQ abdominal pain for 60min, order an EKG. - correct answer>>Bowel obstruction ↑ Bilirubin only (dx exclusion) isolated asymptomatic unconjugated hyperbilirubinemia; hepatic enzymes WNL (ALT, AST, ALP, GGT); no overt s/s hemolysis (retic count <1.5% & negative coombs) - correct answer>>Gilbert's syndrome Ulcer or tear of anus, most often posteriorly Severe anal pain (razor blades) with bowel movements lasting hours after the BM (pain leads to constipation & drops of blood when wiping). Risk factors include constipation, diarrhea, childbirth, anal sex Primary treatment is to prevent constipation - ↑ dietary fiber, laxative (mineral oil - avoid long term use due to inability to absorb A, D, E, K vitamins), sitz bath, cool compresses. If these measures fail nitroglycerin, Botox, surgical sphincterotomy - correct answer>>Anal fissure Idiopathic & functional causes. Lifestyle factors: immobility, low fiber diet, dehydration, milk intake, ignoring the urge to have BM. Drugs with constipation side effect: iron supplements, beta blockers, calcium channel blockers CCBs, antihistamines, anticholinergics, antipsychotics, opiates, & calcium based antacids Treatments: dietary changes, bowel retraining, intake bulk forming fiber (25-35g/d), increase physical activity, increase fluid intake (8-10 glasses), & consider laxatives - correct answer>>Constipation Classification: Grade I (no prolapse), Grade II (prolapse upon defecation but reduce spontaneously), Grade III (hemorrhoids prolapse upon defecation & must be reduced manually), Grade IV (hemorrhoids are prolapsed & cannot be reduced manually). Risks: ↑ risk with excessive alcohol, chronic diarrhea or constipation, obesity, high fat, low fiber diet, prolonged sitting, sedentary lifestyle, anal intercourse, & loss of pelvic floor muscle tone. - correct answer>>Hemorrhoids Fatigue, nausea, anorexia, malaise, abdominal pain, dark colored urine, clay stools, & joint pain for several days. Skin & sclera have a yellow tinge. Tenderness over liver with percussion & deep palpation. LFTs (↑ ALT/AST up to 10x normal). Remove & treat cause. Avoid hepatotoxic agents such as Tylenol, alcohol, & statins.
Anti-HAV IgM & IgG negative - detects no immunity & needs vaccine - correct answer>>Hep A serology HBsAg (surface antigen) screens for Hep B. Positive detects virus (not immune). Anti-HBs (surface antibody) positive, means antibodies present (immune). Anti-HBc (totally Hep B core antibody) think "rotten to the core" IGM anti-HBc - correct answer>>Hep B serology Anti-HCV screens for Hep C. If Anti-HCV negative, but there's hx of exposure, order HCV RNA. For Anti-HCV positive - order HCV RNA or PCR (r/o chronic infection). For HCV RNA or PCR positive, this means active Hep C infx (refer to GI). - correct answer>>Hep C serology Example 1 case serum results: HBsAg (negative), Anti-HBs (positive), Hepatitis B "e" antigen HBeAg (negative). Results support immunity to Hep B (presence of Hep B surface antibodies can be either d/t vaccine or native infx), NOT a carrier of Hep B (HBeAg negative, HBsAg negative). Example 2 case serum results: HBsAg (positive), HBeAg (positive), Anti-HBs (negative), Anti-HAV (positive), Anti-HCV (negative). Results support active Hep B infx (presence of B surface antigen), chronic Hep B infx (presence of e, so carrier of Hep B, & highly reactive, so highly contagious), immunity to Hep A (presence of Hep A antibodies), & no Hep C infx (Hep C antibody not detected). - correct answer>>Hepatitis serology examples
