AANP FNP Certification Exam Prep 2026–2027: Complete Study Guide, 400 Practice Questions & Rationales

AANP FNP Certification Exam Prep 2026–2027: Complete Study Guide, 400 Practice Questions & Rationales 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 III first time audible, IV first time thrill Fundal height 12 weeks 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? Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss Mini mental exam 4 month old with strabismus, mom is worried...... tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? Growth chart 6 month old closed anterior fontanel. XRAY Abnormal cells on PAP, what do you do next? Refer for Colposcopy CAGE ACRONYM Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements CN 3,4,6 Definition of metabolic syndrome cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? Anterior septum Definitive diagnosis of acute bacterial prostatitis urinalysis and culture GERD treatment H2 is first line, give hs Grade 3 cells on Pap, treatment? LEEP excision Fingernail hematoma treatment? drill hole and drain blood? Increased risk of ectopic pregnancy Salpingitis, or history of abortion, PID, Koplick spots Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots Measles (rubeola). Grains of salt lesions inside mouth in Measles Legg-Calve-Perthes Disease Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? Pancreatitis Low HGB, Low HCT, High MCV indicates what? Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress Meniscus tears Lachman's Test pivot shift test (ACL tear) Newborn with foot turned in, what do you do? refer to orthopedist Osgood-Schlatter disease Knee pain. inflammation or irritation of the tibia at its point of attachment with the patellar tendon Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? Alzheimer's Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? Tinea Corporis Pt presents with "bag of worms:, indicates? Varicocele Pt with atopic dermatitis, look for what other diseases? Asthma Pt with bleeding after menopause endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? Infertility Pt with HIV took high potency anti viral treatments and CD4 is 400, what does this indicate? This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go Timed Get up and Go Red beefy tongue? pernicious anemia Rotator cuff injury presentation disturbs sleep, arm weakness, dull ache Shingles near eye immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease) ? 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: 12 step program Treatment for Gonorrhea? 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: IUD Basal cell cancer Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis 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 cryo or 5fu cream subungual hematoma tx Make a hole and drain the blood Moderate acne treatment Without inflammation: Topical retinoid Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered) PLUS ADD Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone heart murmur with holosystolic or pan systolic Heart mumur with mid systolic MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs. -congenital cardiac condition characterized by a narrowing of the aorta - Murmur Grade III - VI Loud murmur easily heard JVD caused by -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 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. PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: 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. Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) HTN retinopathy intraocular pressure (IOP) Fluid pressure inside the eye; measured with tonometry Rovsing sign pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma SDH migraine headache -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 Folate shares a close relationship with this other B Vitamin. Vitamin B12 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 something to 25. How would you treat the pt. be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient SSRI grandiosity Exaggerated belief in or claims about one's importance or identity. Bipolor ADHD A behavioral problem characterized by short attention span, restless movement, and impaired learning capacity. pt. pap's smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? HPV test if not done. Refer for colposcopy Chlamydia trachomatis Doxycycline (+ ceftriaxone for gonorrhea coinfection) Genital warts treatment Cryotherapy OR Podophyllotoxin cream - OR Imiquimod (Aldara cream) HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. tell the pt. that he is qualified to be diagnosed with AIDS according to CDC Most common cause of death in children motor vehicle Tanner 2 Tanner 2- female breast bud areola develops Male testes scrotum start to enlarge, scrotum gets darker Tanner 4 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. vascular dementia presbycusis 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 Ultrasound Romberg test 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 r/o bilirubin preeclampsia treatment bed rest, laying on her side Molluscum contagiosum treatment Currettage, liquid nitrogen pyloric stenosis 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 Ménière's disease ? Nystagmus test the involuntary jerking of the eyes as a person gazes to the side eating, painful lump noted on the jaw that comes and go. sialolithiasis). Etopic Pregnancy: Risk Factors 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 Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration hypercapnia Osteoporosis Risk Factors (ACCESS) 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 VITAMIN D 600-800, CALCIUM . OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION. LOW TSH= Hyperthyroidism- BONE DEMINERALIZATION. NEED CALCIUM for BONE GROWTH Carotid bruit abnormal flow of blood through the carotid artery Carotid bruit abnormal flow of blood through the carotid artery due to atherosclerotic disease Common causes of GERD risk factors- alcohol, anticholinergic, CCB, chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline, exacerbated by CCB verapamil Common causes of GERD risk factors- alcohol, anticholinergic, CCB, BB chocolate peppermint, fatty, spicy, citrus foods, hormones, obesity, pregnancy, smoking, theophylline Zeprexa. What lab and intervention to put in place CAUSES ELEVATED LIPDS, GLUCOSE, WEIGHT monitor CBC for low WBC weight- BMI q 3m b/p, mental status, lips, prolactin, glucose Weber test 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 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 Dullness Assessment on patient with ascites Dullness to percussion Varus Stress Test 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 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) 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 patient with IOP of 32mmHg, what do you expect during fundoscopic exam increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence 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 TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception 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 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) An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) 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 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 Natural progesterone cream prompts new bone growth Statins increase bone mineral density Osteoporosis treatment TX BIOPHOSPHATES alendronate, Fosamax, CALCIUM 500 mg, vitamin D food and supplementation, testosterone, WT BEARING EXERCISE CAUCASIAN and ASIAN affected most RISK PPI, STATIN, STEROIDS, THYROID, Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss Natural progesterone cream prompts new bone growth BONE DENSITY 2.5 Retinoblastoma white reflection in child's pupil for staph aureus infection (skin) with pus MRSA- TX Bactrim or tetracyclines? hyperparathyroidism high calcium Hyperthyroidism treatment methimazole, PTU-propylthiouracil (preferred in pregnancy) Radioactive iodine, Beta blockers Mammography Screening -Age 45 - 54 yearly mammogram -55 and older every 2 years Fifth's Disease (Erythema Infectiosum) 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 TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema optic disc swollen w/ blurred edges due to increased ICP EXAM actinic keratoses 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 "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD 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 - Shoulder shrug/ ROMBERG test EXAM CN V Trigeminal Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear ears 8 EXAM CN VII Facial BELLS EXAM ACEI contraindicated pregnancy Safe to give varicella/MMR Do not give 12 mo. EXAM QUESTION Acne Vulgaris 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 - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts is on EXAM in elderly night vision issues. Opaque Kawasaki disease - 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 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 Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT doxycycline. EXAM Addison's 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 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 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 OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM Fibromyalgia polymyalgia 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 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 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 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 Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents. Acne Rosacea Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT Metrogel, Azelex. Low dose tetracycline. EXAM Parathyroid hormone PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM Diabetic Retinopathy Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED HTN Retinopathy Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM Wilms Tumor 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 Primary Amenorrhea Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics. Aphthous stomatitis Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash. Temporal arteritis 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) 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 ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending Cellulitis Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS. Erysipelas 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 "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, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM Impetigo Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM Scarlet fever- scarlantina "sandpaper textured-pink rash with sore throat" strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM Lichen planus LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM Spider bite fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam Pityoris rosea Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM Corneal abrasion Corneal Abrasions- Round/Irregular. Was on EXAM. Acute Angle Closure Glaucoma acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM Conductive Conductive: Lateralization to bad ear. Rinne- BC AC. Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM Koplik spots Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM Sensorineural Sensorineural: Lateralization to good ear. Rinne- AC BC. OME Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM Presbycusis sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM OE Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM Sinusitis TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE Meiniers disease VERTIGO TINNITUS, HEARING LOSS. nystagmas Mono test heterophile antibody test. ON EXAM MR. ASS (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam. Mitral Regurg (Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL. Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb. All diastolic murmurs are pathological. Grades Murmurs I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM MVP MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC. S3- HF, S4-LVH stiffening, S3- HF, Kentucky, early diastole. Abn 35. Bell EXAM S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM Isolated Systolic HTN CCB PAD/ PVD PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM CVI CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM blood pressure BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is 120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM. Thiazide diuretics no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM Statin Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM Pulses paradoxus Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM Emphysema Emphysema Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM Acute Bacterial Pneumonia- CXR middle lobe. ON EXAM OSA does not include Microglossia which is an absent tongue congenital. EXAM TB fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes. TPO TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM hyperthyroid Hyperthyroid- Low TSH, high "FREE" T4/T3. ALWAYS DO FREEs. Graves disease autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then. A1C 9 If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM Parathyroid For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM cushings Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must draw cortisol levels in the morning. Fructosamine test checks sugar for past 2-4 weeks. triglycerides causes pancreatitis 500. If 500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM Pancreatitis diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring" epigastric pain. Fever, n/v. EXAM TOPICS Metformin Metformin - monitor BUN, Creatinine. contraindicated renal and liver disease ARF creatinine up and GFR down. affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea flatulence CT: hold 24 hr before and 48hr after Polycythemia vera slow growing blood cancer. blood too thick, clots. bone marrow to many RBC. risk bleed , anemia, CBC CCB BLE edema- walk around Kava Kava anxiety and insomnia, don't mix w sedating benzos. Bipolar med lithium- monitor TSH, toxicity bind to TH cause hypothyroidism. Depression med acute Anxiety/ panic med GAD med depression SSRI panic benzo, Xanax, ativan GAD SSRI SNRI- Buspar, Effexor, Cymbalta- Taper OFF SNRI/ Benzo Discontinuation Buspar, Effexor, Cymbalta and Benzo Taper OFF Thiazide GLUT Glyceridemia Lipidemia Uricacidemia Triglyceridemia HYPO-Kalemia ACE/ARB contraindications pregnancy Renal failure Renal Stenosis METABOLIC SYNDROME METABOLIC SYNDROME NO THIAZIDES,CCB (HF) NO TZD ACTOS (Pioglitazone) GIVE Metformin, ACE or ARB- kidney protective, BB- causes hypoglycemia, Triglyceride 300 what do we do first? Triglyceride in 300 plus risk for what do we do? Lifestyle modification Pancreatitis, Niacin then add, fenofibrates Serotonin syndrome ss hyper rigidity, fever, myoclonus, dilated pupils, AMS, hyper reflexes, from SSRI or mix w MAOI and TCA NSAID contraindicated in HF and ARF increase BP impair renal prostaglandin and sodium retention strabismus misalignment of eyes, abnormal after 6 months macular degeneration loss of central vision retinal detachment floaters, curtain, flashes Xanthelasmas sharply demarcated yellowish deposit of cholesterol underneath the eye Red reflex absent retinoblastoma (leukorrhea) , cataracts, glaucoma. Will have white reflex Mono, return to play and Dx 4-6 weeks when spleenolmegaly resolves Mono spot/ Heterophile Viral stomatitis ulcer on cheek (Aphthous)- viral canker sore cholesteatoma chronic sinusitis or OM. cauliflower, foul-smell, hearing loss. erodes bones in face affects facial CN 7. Benign- risk hearing loss refer SURGERY Acute Closed Angle Glaucoma Vs Open Angle Acute: Sudden pain, halos, cupping, dilated, cloudy , IOP, HA, refer ED Open (primary) : CN 2, gradual loss peripheral vision first Papilledema Swollen, optic disc, increase cup to disc ratio, HA, ICP, HTN, Acyclovir (cheapest) 200mg 5 x day Pt on PPI, has osteoporosis has a cough, refer for EGD r/o Barrett's. allergic rhinitis blue pale turbinate clear drainage. Tx inhaled corticosteroids hordeolum Vs chalazion blepharitis hordeolum: painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin. chalazion does not hurt Blepharitis always unilateral, Tx baby shampoo warm compress Sialolithiaisis painful lump, calculi or salivary stones. sub mandibular gland whartons; duct. Roseola infantum- Sixth disease viral, young children, high Fever 3-4 days followed by maculopapular rash Herpetic keratitis ocular herpes - blurr vision, inflammation of eye; gritty feeling, conjunctivitis, sharp pain, and photophobia- AVOID SUN REFER OPTHO Tx acyclovir