Download Medical Facts: Joints, Retinopathy, Medications, Communication, Prevention and more Exams Nursing in PDF only on Docsity!
Family Nurse practitioner exam
with correct marking scheme for
2024 students
Sensitivity - Correct answer defined as the ability of a test to detect a person who has the disease. Specificity - Correct answer defined as the ability of a test to detect a person who is healthy or to detect the person without the disease. Trauma to Kiesselbachs plexus - Correct answer will result in an anterior nosebleed The diagnostic or gold standard test for sickle cell anemia, G6PD anemia, and alpha or beta thalassemia - Correct answer hemoglobin electrophoresis questions asking for "action" - Correct answer the initial action might be to interview and gather subjective data or the history erythromycin "allergy" vs adverse reaction - Correct answer adverse reactio-symptoms of nausea or GI upset allergy -hives, angioedema acute mononucleosis - Correct answer the patient will most likely be a teen presenting with the classic triad of sore throat, prolonged fatigue, and enlarged cervical nodes. Alpha thalassemia - Correct answer more common among Southeast Asians such as filipinos Lupus - Correct answer present with malar rash(butterfly rash)Pts need to avoid or to minimize sunlight exposure(photosensitivity) treatment for polymyalgic rheumatica(PMR) - Correct answer first line treatment for PMR includes long-term steroids. Long term steroids are commonly used to control symptoms(pain, stiffness on shoulders, and hip girdle). PMR pts have higher risk for temporal arteritis.
Gold standard exam for temporal arteritis - Correct answer biopsy of the temporal artery. refer pt to opthalmologist for mgt Finkelstein's test - Correct answer Positive in De Quervains tenosynovitis Anterior Drawer maneuver and Lachman maneuver - Correct answer Positive if anterior cruciate ligament (ACL) of knee damaged. The knee may also be unstable McMurray's sign - Correct answer Positive in meniscus injuries of the knee Damaged Joints - Correct answer order X-ray first, but MRI is the Gold Standard Diabetic retinopathy - Correct answer neovascularization, hard exudates, cotton wool spots, and micoaneurysms Hypertensive retinopathy - Correct answer AV nicking, silver and or copper wire arterioles Checking deep tendon reflexes - Correct answer absent(0), hypoactive (1) normal(2) hyperactive(3) clonus(4) define clonus - Correct answer Clonus is typically seen in patients with stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy. Clonus has also appeared after ingesting potent serotonergic drugs, where ingestion strongly predicts imminent serotonin toxicity (serotonin syndrome). Clonus is a series of involuntary, rhythmic, muscular contractions and relaxations. Clonus is a sign of certain neurological conditions, particularly associated with upper motor neuron lesions involving descending motor pathways, and in many cases is, accompanied by spasticity (another form of hyperexcitability).Unlike small, spontaneous twitches known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex. A rare but serious adverse effect of ACE inhibitors is - Correct answer angioedema
treatment of cutaneous anthrax - Correct answer Ciprofloxacin 500mg orally BID for 60 days or 8 weeks. If pt allergic to ciprofloxacin , use doxycycline 100mg BID Good communication rules - Correct answer Ask open ended questions, do not reassure patients, avoid angering the patient, and respect the patients culture. Eriksons Stages of Psychosocial Development - Correct answer Stage 1: Infancy -- Age 0 to 1 Crisis: Trust vs. Mistrust Stage 2: Toddler -- Age 1 to 2 Crisis: Autonomy (Independence) vs. Doubt (or Shame) Stage 3: Early Childhood -- Age 2 to 6 Crisis: Initiative vs. Guilt Stage 4: Elementary and Middle School Years -- Age 6 to 12 Crisis: Competence (aka. "Industry") vs. Inferiority Stage 5: Adolescence -- Age 12 to 18 Crisis: Identity vs. Role Confusion Stage 6: Young Adulthood -- Age 19 to 40 Crisis: Intimacy vs. Isolation Stage 7: Middle Adulthood -- Age 40 to 65 Crisis: Generativity vs. Stagnation Stage 8: Late Adulthood -- Age 65 to death Crisis: Integrity vs. Despair Important primary vs secondary - Correct answer "Will performing this action prevent the disease or the social condition from happening? If it does, then it is considered as primary prevention(if it doesn, then it is secondary) breast self exam and genital self exam - Correct answer considered secondary prevention tertiary prevention - Correct answer involves not only rehabilitation, but also includes actiivities that will help to prevent complications from disease treatment, such as patient education about medication side effects or the proper use of equipment such as cane. Support groups for a disease /condition are all considered as part of a tertiary prevention activity. Primary prevention - Correct answer (prevent disease.injury/condition)- youth violence prevention, bullying prevention, presonal safety promotion, disease prevention-immunization, using suncreen, healthy lifestyle promotion, promotion of OSHA lawas-workplace safety, EPA laws-clean water, anipollution laws
secondary prevention - Correct answer (Detect disease.condition as Early as Possible) any lab test to screen disease, US preventive Services Task Force- screening rec-mammograms, PSA, PPD, screening for high risk behaviour-suicide, depression, personal action to detect cancer Tertiary prevention - Correct answer (Limiting Further harm and disability) All types of rehabilitation-cardiac, pt/ot, speech therapy , addition/drug rehab, support groups, exercise for an obese person clue cells - Correct answer mature squamous epithelial cells with numerous bacteria noted on the cell borders(bacterial vaginosis) Bacterial Vaginosis - Correct answer has a alkaline pH(vagina normally has an acidic pH of 4.0) BV is the only vaginal condition with the only alkaline pH for the exam. BV is not considered an STD(it is imbalance of vaginal bacteria-sex partner does not need to be treated. The microscopy slide will have very few WBC and large number clue cells. Candida vaginal discharge - Correct answer white in color with a thick and curd like consistency. it frequently causes redness and itching in the vulvovagina due to inflammation microscopy in candidiasis - Correct answer will show a large number of WBC, pseudohyphae, and spores(saghetti and meatballs candida yeast - Correct answer normal flora of gastrointestinal tract and in some womens vaginas trichomonas infection - Correct answer vaginal discharge is copious, bubbly, and green in color. It causes a lot of inflammation resulting in itching and redness of the vulvvagina. It is considered a sexually transmitted infection. The sex partner needs treatment. Gold standard of diagnosis for BV, candida vaginitis, and trichomoniasis for the exam - Correct answer microscopy is the gold standard. treatment for strep throat - Correct answer penicillin VK PO for 10 days. If pt is PCN allergy, macrolides can be used instead. mortality - Correct answer most common cause of death
Stage III-Penis grows longer(length) and testes/scrotum continues to become larger Stage IV-Penis become wider and continues growing in length(testes are larger with darker scrotal skin nd more ruggae) Stage V-Adult pattern scabies - Correct answer classic location of the rashes (finger webs, waist, penis) High risk groups are health care givers, or any erson working with large populations such as schools, nursing homes, group homes, or prisons. Spread skin to skin Rash of Scarletina - Correct answer has sandpaper like texture and is accompanied by a sore throat, strawberry tongue, and skin desquamination(peeling) of the palms and soles. It is not pruritic. Impetigo rashes - Correct answer initially appear as papules that develop into bullae that rupture easily, becoming superficial, bright red weeping rashes with honey-colored exudate that becomes crusted as it dries. The rashes are very pruritic and are located on areas that are easily traumatized, such as the face, arms or legs. Insect bites, acne lesions, and varicella lesion scan also become secondarily infected, resulting in impetigo. Cutaneous larva migrans(creepin eruption) - Correct answer rrashes are shaped like red raised wavy lines(serpinginous or snakelike) that are alone of=r few. appears maculopapular larva migrans - Correct answer the areaas of body that are commonly exposed directly to contaminated soil and sand such as soles of the feet, extremities or buttocks. are most common location treatment for larva migrans - Correct answer systemic treatment with either ivermectin once a day for 1-2 days or albendazole for 3 days first line treatment for AOM and sinusitis - Correct answer Amoxicillin 500mg po TID( for 10 days. Second line of abx is Augmentin BID or cefdinir(omnicef)BID S3 heart sounds - Correct answer indication of heart failure. The best place to listen for the S3 heart sound is the pulmonic area(the pulmonic area is near the ventricles). for pulmonary TB - Correct answer a sputum culture is the gold standard.
incorrect answers - Correct answer are statements that are judgmental, ressuring to the patient, vague, disrespectful, or do not address the issue of suicide(or homicide) in a direct manner. First line treatment for depression - Correct answer SSRI. Second line tx TCAs. TCAs are also used as prophylactic treatment of migraine headaches, chronic pain, and neuropathic pain such as post herpatic neuralgia. Ex: amitriptyline(elavil), nortriptyline(Pamelor) do not give suicidal pt TCAs because of high risk of hoarding and overdosing. Overdose of TCAs can be fatal(cardiac and CNS toxicity) SSRI - Correct answer SSRI are firrst line treatment for OCD, generalized anxiety discorder, panic disorder, social anxiety disorder(extreme shyness) and premenstrual mood disorder(fluoxetine or Prozac) Examples of SSRI: citalopram(Celexa), ecitalopram(lexapro), fluoxetine(Prozac, sertraline (Zoloft), paroxetine (Paxil) CAGE mnemonic - Correct answer is a creening tool used to screen patients for possible alcohol abuse. Scoring two out of 4 is highly suggestive of alcohol abuse. Thizide diuretics - Correct answer prefered for hypertension patients with osteopenia or osteoporosis. The mechanism of action of thiazide on the bone is that it decreases calcium excretion by the kidneys and it stimulates osteoclast activity that helps with bone formation Beta blockers - Correct answer are contraindicated in asthmatics or patients with chronic lung diseases such as astma , COPD, emphysema, or chonic bronchitis. ACute diverticulitis - Correct answer can be treated outpatient with ciprofloxacin 500mg PO BID plus metronidazole PO TID for 10 to 14 days Rocky Mountain Spotted fever - Correct answer South central US, classsic rash (red rash on both wrists and ankles that spread centrally with involvement of the palms and the soles) systemic symptoms-high fever, headache, myalgia, nausea. can cause death if not treated with the first 8 days of symptoms RMSF - Correct answer Dog/wood tick bite, spirochete called Rickettsia rickettsia. Treatment with doxycycline 100mg PO/IV for minimum of 7 days
trough - Correct answer the lowest concentration fo a drug after a dose Potent inhibitors of the cytochrome P450 system. - Correct answer These drugs are respnsible for a large number of drug -drug interactions Macrolides(erythromycin, clarithromycin, pediazole) Antifungals(ketoconazole, fluconazole) Cisapride(Proulsid) Cimetidine(Tagament) Citaprolam(Celexa) coumadin - Correct answer for A fib the target INR is from 2.0 to 3.0. INR values below 2.0 increase stroke risk sixfold vitamin K - Correct answer mayonnaise, canola oil, and soybean oil has Vitamin K Adverse effects of thiazide dieuretics - Correct answer hyperglycemia, elevated triglycerides and LDL, elevattes uric acid, hypokalemia. thiazide diuretics - Correct answer pt with both htn and osteoporosis have an extra benefit from thiazides. thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclasts formation. Patients with serious sulfa allergies should avoid thiazide diuretics. Potassium sparing diuretics can be used as alternative. Potassium sparing diuretics - Correct answer hypertension alternative dieuretics with severe sulfa allergy. loop diuretics. - Correct answer Edema from heart failure, cirrhosis , renal disease, hypertension. Loop diuretics are excreted via loop of Henle of the kidneys and are more motent than Hctz. Ex: Lasix, Gumetanide. Loop diuretics are more potent tha thiazides , but shorter duration of action Adverse effect of loop diuretics - Correct answer Electrolytes imblance, hypocolemia, pancreatitis, juandice, rash. ototoxicity. Aldosterone Antagonists - Correct answer Hirsuitism, htn, sever heart failure. exp spironolactone. Adverse effects are galactorrhea and hyperkalemia. Spironolactone is rarely used to treat htn in primary care due to adverse effects and higher risk of certain cancer. Beta Blockers - Correct answer HTN, post myocardial infarction(first line), angina, arrhythmias, migraine prophylaxis. Adjunct tretment-
hyperthyroidism/thyrotoxicosis (decrease HR, anxiety). Migrain prophylaxis-non-cardioselective(blocks beta 1 and beta 2). Cardio selective(blocks beta 1 only)-atenolol(tenormin), metoprolol (lopressor) Adverse effects of beta blockers - Correct answer bronchospasm, bradycardia, depression, fatigue, erectile dysfunction, blunts hypoglycemic resonse Contraindications of beta blockers - Correct answer asthma(causes bronchospasm) COPD(causes bronchospasm) Chronic bronchitis (causes bronchoconstriction) Emphysema(casues bronchoconstriction) Bradycardia and AV block(second to third degree block Ace inhibitors - Correct answer Lisinopril(Zestril) Captopril(Capoten) Benazepril(lotensin) Combination: lisinopril and HCTZ (Zestoretic) ENalapril(Vasotec) ARBs - Correct answer Valsartan(Diovan) Losartan(Cozar) Irbesartan(Avapro) Potassium sparing diuretics - Correct answer Triamterene(Dyrenium) Triamterne + HCTZ(Dyazide) Amiloride(Midamor) Beta blockers - Correct answer Propranolol(Inderal) atenolol(Tenormin) metoprolol(Lopressor) pindolol(Visken) Due not discontinue beta blockers a Ace inhibitors and ARBS - Correct answer cat C (first trimestor) cat D (second and third trimestor) ACEI blocks conversion of angiotensin I to angiotensin II(potent vasocontrictor). ARBs blocks angiotensin II(less aldonsteron). ACEI suffix "pril" ARBS suffix sartan" Calcium Channel Blockers - Correct answer HTN, Raynauds phenomenon(first line) Amlodipine(Nirvasc) Diltiazem(Cardizem)
3rd gen Ceph Ceftriaxone (Rocephine)IM STD:Gonorrhea cervicitis, urethritis, PID Cefixime (Suprax) daily to BID ENT: AOM in children, acute sinusitis, OM Cefdinir(Omnicef) daily to BID GU: pyelonephritis, CAP Penicillins (CAT B) - Correct answer There is a chance of cross reactivity, especially with firrst gen cephalosporins. Amoxicillin and ampicillin are extended spectrum penicillins. They are effective against gram positive bacteria andsome gram negative bacteria(Haemophilius influenza, Escherichia coli, Proteus mirabilis) Examples: Penicillin V PO QID Amoxicillin PO BID to TID Amoxicillin plus clavulanic acid (Augmentin) PO BID Benzathine PCN G IM Dicloxacillin PO QID Adverse reactions of PCNs - Correct answer diarrhea, c difficile, vaginitis(usualy candida) First line treatment for gonorrheal infection - Correct answer Rocephine(ceftriaxone) IM first line TX for MRSA skin infections(boils , abscesses) - Correct answer do not use cephalosporins. First line tx is either trimethoprim- sulfa(Bactrim DS) BID r clindamycin TID treat for 5 to 10 days. if pt have true allergy to PCN - Correct answer they are more likely to have allergic reaction to cephalosporins(esecially 1st gen) Use PCN VK - Correct answer for mononucleosis, not amoxicillin(causes generalized rash not related to allergy) Dicloxacillin - Correct answer is for pencilinase-producing staph skin infections(mastitis and impetigo) Fluoroquinolones (Quinolones) - Correct answer effective against gram negative bacteria and some atypical bacteria(chlamydia, Mycoplasma, Legionella) Newer generation quinolones (levofloxacin , moxifloxacin, gatifloxacin) are also active against gram positve bacteria.
respiratory quinolones - Correct answer Levoflaxacin and moxifloxacin -due to their excellent activity against strep pneumonia Quinolones - Correct answer Norfloxacin(Noroxin) BID Ciprofloxacin (Cipro) BID Ofloxacin (Floxin) BID Broad spectrum quinolones Moxifloxacin (Levaquin) daily Gemifloxacin (Factive ) daily Black box warning-increased risk of achilles tendon rupture. Avoid strenuous activity while onthe drug) Stop if develops tendon pain/swelling Adverse effects of quinolones - Correct answer QT prolongation, CNS(dizziness, headache, insomnia, mood changes) do not use quinolones on children under 18 due to adverse effects on growing cartilage. Anthrax TX - Correct answer Bioterrorism related inhalation of anthrax is treated with ciprofloxacin 500mg BID x 60 days Pseudomonas aeruoginosa(gram negative) - Correct answer first line tx is ciprofloxacin per cdc - Correct answer stop using quinolones to treat gonorrheal infection Sulfonamides (Cat B) - Correct answer Active against gram negative bacteria(E.Coli, Klebsiella, H. Influenzae) Bacteriostatic- Timethoprim-Sulfamethoxazole(TMP-SMX)Bactrim DS BID Other sulfa-type drugs: -Dieuretics(furosemide, HCTZ) -Sulfonylureas(glyburide, glipizide) -COX-2 inhibito(celecoxib or Celebrex) -Dapsone(for HIV) Contraindications of sulfonamides - Correct answer G6PD anemia(a genetic hemolytic anemia) causes hemolysis Newborns and infants less thn 2 months Pregnancy in late third trimester(increased risk of hyperbilirubinemia/kernicterus) Hypersensstivity to sulfa drugs drug interations -coumadin(increases INR)
Methylprednisolone(Medrol Dose Pack) x 7 days. Does not need to be weaned Topical steroids - Correct answer Classification (class 1 (superpotent) to class 7(least potent) -superpotent(class 1)-clobetasol(Temovate) -Potent-halocinonide (Halog) -Moderate-triamcinolone(Kenalog) -Least potent (Class 7)-hydrocortisone Acutely inflamed joints(knee/hip/shoulders/elbows) - Correct answer cn be treated with intra-articular triamcinolone(Kenolog) injections up to 3 times per year. poison ivy or poison oak - Correct answer severe case of poison ivy case or poison oak rash may require 14 to 21 days of an oral steroid to clear Tapering weaning drugs - Correct answer beta-clockers(rebound htn, or htn crisis)benzodiazepines(severe anxiety, insomnia, seizures, tremors) Oral Steroids Anticonvulstants Antipsychotics Antiarrythmics Paroxetine or Paxil Controled substance act-US FDA DEA - Correct answer Schedule I drugs(heroin, ecstasy/MDMA, PCP, -illegal to prescribe Schedule 2(Demerol, Dilaudid, Oxycontin, cocaine, amphetamines)- only the original prescription with the physicians signature acceptable Schedule 3(Tylenol with codein, Vicodin, nabolic steroids, testosterone, ) Schedule4(benzodiazepines, ambien, lunesta, Soma) Schedule 5(cough medicine with less than 200mg codeine, Lomotil,Lyrica) Schedule 4,5 acn be mailed to the matient. some states allow NPs to prescribe lower level controlled substance For all controlled substance: Must have the prescribers and the supervising physicians name/DEA number with the clinic address on the pad. Some states do not require supervising physician. List of Category X drugs - Correct answer Finasteride(proscar, propecia)-reproductive aged or pregnant women should not handle crushed finasteride tablets Isotretinoin(Accutane) Warfarin sodium(coumadin)
Misoprostol(Cytotec) Androgenic hormones: birth control pills, HRT, testosterone Live virus vaccines(measles, mumps, rubella, varicella, rotavirus, flumist) Thalidomide, DES, methimazole FDA category classification - Correct answer Category A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Category X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Category N FDA has not classified the drug. Prescription pads - Correct answer the NPs prescription pads should contain the following information: NPs name/designation/license number Supervising physician name. clinic address(if multiple sites, the sites where the NP works should be listed on the pad)
Acute angle glaucoma - Correct answer elderly pt with onset of severe eye pain accompanied by headache, nausea/vomiting, halos around lights, and decreased vision examination reveals:mid dilated pupil that is oval shaped, cornea is cloudy, fundoscopics exam reveals cupping of optic nerve. cholesteatoma - Correct answer "cauliflowerlike" groth accompanied by foul smelling ear discharge. Hearing loss on affected ear. refer to ENT MD, can cause face and damage to fcaial nerve VII Battle sign - Correct answer acute onset of bruise behind the ear over the mastoid area after recent hx of trauma. Indicated fracture of the basilar skull Clear golden fluid discharge from the nose/ear - Correct answer indicative of basilar skull fx. CSF slowly leaking through fx Peritonsillar abscess - Correct answer severe sore throat and difficulty swallowing, odonophagia, trsmus, and a "hot potato" voice. refer to ED for incision and drainiage Diptheria - Correct answer sore throat, fever, and swollen neck"bull neck". eyes normal finding - Correct answer fundi:the veins are larger than arteries cones:for color perception, 20/20 vision rods: for detecting light and shadow, depth perception, night vision Macula:the macula is the area responsible for central vision. The fovea which contains large number of cones is set in the middle. This area of the eye determines 20/20 vision. Cobblestoning: inner conjunctiva with mildly elevated lymphoid tissue resembling "cobblestone" may be seen in atopic pt, allergic rhinitis, allergic conjunctivitis Presbyopia:age realted visual change due to a decreaswe ability of the eye to accommodat3e and stiffening of the lense. Usually start at age 40, normal finding ears - Correct answer Tympanic membrame(TM) translucent off white to gray color with the "cone of light" intact Tympanogram:most objects measure for presence of fluid inside middle ear(results in a straight line vs a peaked shape) External portion of ear: has large amount of cartilage. Cartilage: des not regenerate
leukoplakia - Correct answer appear on the surface and under the tongue. may be cancerous. pt with hx of chewing tobacco are high risk of oral cancer apthous stomatitis(canker sores) - Correct answer painful and look like shallow ulcers of soft tissue. avulsed tooth - Correct answer store in cool milk torus palatinus - Correct answer painless bony protuberance midline of the hard palate(roof of mouth). May be asymmetrical. papiledema - Correct answer optic disc swollen with blurred edges due to ICP HTN retinopathy - Correct answer microaneurysm cause by neovascularization cataract - Correct answer opacity of the corneas. Chronic steroid use can cause cataract Allergic rhinitis - Correct answer blue tinged or pale and swollen nasal turbinates kopliks spots - Correct answer small sized red paples with blue white centers inside the cheeks by the lower molars Hairy leukoplakia - Correct answer elongated pailla on the lateral aspects of the tongue that are pathognomic for HIV infection. Caused by epstein barr virus hyperopia - Correct answer farsightedness nystagmus - Correct answer abnormal for color blindness - Correct answer use ishihara chart fluorescein dye strips - Correct answer herpes keratitis appears as fernlike lines. cornial abrasion usually appear more linear hordeolum(stye) - Correct answer a painful acute bacterial infection of a hair follicle on the eyelid treatment:abx drops(sulfa, erythromycin gtts) warm packs BID to TID until pustules drains
