2022/2023 AANP review Questions and ANSWERS

AANP review Questions and ANSWERS for 2022/2023 Classic ECG finding in atrial flutter. Correct Answer: "Sawtooth" P waves Definition of unstable angina. Correct Answer: Angina is new, is worsening, or occurs at rest Antihypertensive for a diabetic patient with proteinuria. Correct Answer: ACEI Beck's triad for cardiac tamponade. Correct Answer: Hypotension, distant heart sounds, and JVD Drugs that slow AV node transmission. Correct Answer: β-blockers, digoxin, calcium channel blockers Hypercholesterolemia treatment that → flushing and pruritus. Correct Answer: Niacin Treatment for atrial fibrillation. Correct Answer: Anticoagulation, rate control, cardioversion Treatment for ventricular fibrillation. Correct Answer: Immediate cardioversion Autoimmune complication occurring 2-4 weeks post-MI. Correct Answer: Dressler's syndrome: fever, pericarditis, ↑ ESR Diagnostic test for hypertrophic cardiomyopathy. Correct Answer: Echocardiogram (showing thickened left ventricular wall and outflow obstruction) A fall in systolic BP of 10 mmHg with inspiration. Correct Answer: Pulsus paradoxus (seen in cardiac tamponade) Classic ECG findings in pericarditis. Correct Answer: Low-voltage, diffuse ST-segment elevation Definition of hypertension. Correct Answer: BP 140/90 on three separate occasions two weeks apart Eight surgically correctable causes of hypertension. Correct Answer: Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn's syndrome, Cushing's syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism Evaluation of a pulsatile abdominal mass and bruit. Correct Answer: Abdominal ultrasound and CT Indications for surgical repair of abdominal aortic aneurysm. Correct Answer: 5.5 cm, rapidly enlarging, symptomatic, or ruptured Treatment for acute coronary syndrome. Correct Answer: Morphine, O2, sublingual nitroglycerin, ASA, IV β-blockers, heparin What is the metabolic syndrome? Correct Answer: Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states Appropriate diagnostic test? ■ A 50-year-old male with angina can exercise to 85% of maximum predicted heart rate. Correct Answer: Exercise stress treadmill with ECG Appropriate diagnostic test? ■ A 65-year-old woman with left bundle branch block and severe osteoarthritis has unstable angina. Correct Answer: Pharmacologic stress test (e.g., dobutamine echo) Signs of active ischemia during stress testing. Correct Answer: -Angina -ST-segment changes on ECG -↓ BP ECG findings suggesting MI. Correct Answer: -ST-segment elev (depression = ischemia), -flattened T waves -Q waves A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal. Correct Answer: Prinzmetal's angina The diagnostic test for pulmonary embolism. Correct Answer: V/Q scan An agent that reverses the effects of heparin. Correct Answer: Protamine The coagulation parameter affected by warfarin. Correct Answer: PT A young patient with a family history of sudden death collapses and dies while exercising. Correct Answer: Hypertrophic cardiomyopathy Endocarditis prophylaxis regimens. Correct Answer: -Oral surgery—amoxicillin; -GI or GU procedures—ampicillin and gentamicin before and amoxicillin after The 6 P's of ischemia due to peripheral vascular disease. Correct Answer: Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia Virchow's triad. Correct Answer: Stasis, hypercoagulability, endothelial damage The most common cause of hypertension in young women. Correct Answer: OCPs The most common cause of hypertension in young men. Correct Answer: Excessive EtOH "Stuck-on" appearance. Correct Answer: Seborrheic keratosis Red plaques with silvery-white scales and sharp margins. Correct Answer: Psoriasis The most common type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias. Correct Answer: Basal cell carcinoma Honey-crusted lesions. Correct Answer: Impetigo A febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity. Correct Answer: Cellulitis A 55-year-old obese patient presents with dirty, velvety patches on the back of the neck. Correct Answer: Acanthosis nigricans. Check fasting blood sugar to rule out diabetes Dermatomal distribution. Correct Answer: Varicella zoster Flat-topped papules. Correct Answer: Lichen planus Iris-like target lesions. Correct Answer: Erythema multiforme A lesion characteristically occurring in a linear pattern in areas where skin comes into contact with clothing or jewelry. Correct Answer: Contact dermatitis Presents with a herald patch, Christmas-tree pattern. Correct Answer: Pityriasis rosea A 16-year-old presents with an annular patch of alopecia with broken-off, stubby hairs. Correct Answer: Alopecia areata (autoimmune process) Pinkish, scaling, flat lesions on the chest and back. KOH prep has a "spaghetti-and-meatballs" appearance. Correct Answer: Pityriasis versicolor Four characteristics of a nevus suggestive of melanoma. Correct Answer: Asymmetry, border irregularity, color variation, large diameter Premalignant lesion from sun exposure that can → squamous cell carcinoma. Correct Answer: Actinic keratosis "Dewdrop on a rose petal." Correct Answer: Lesions of 1° varicella "Cradle cap." Correct Answer: Seborrheic dermatitis. Treat with antifungals Associated with Propionibacterium acnes and changes in androgen levels. Correct Answer: Acne vulgaris A painful, recurrent vesicular eruption of mucocutaneous surfaces. Correct Answer: Herpes simplex Inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women. Correct Answer: Lichen sclerosus nodular opaque sun-exposed area ulcerating non-distinct borders *associated with a risk of metastasis* Correct Answer: Squamous cell carcinoma The most common cause of hypothyroidism. Correct Answer: Hashimoto's thyroiditis Lab findings in Hashimoto's thyroiditis. Correct Answer: High TSH, low T4, antimicrosomal antibodies Exophthalmos, pretibial myxedema, and ↓ TSH. Correct Answer: Graves' disease The most common cause of Cushing's syndrome. Correct Answer: Iatrogenic steroid administration. The second most common cause is Cushing's disease A patient presents with signs of hypocalcemia, high phosphorus, and low PTH. Correct Answer: Hypoparathyroidism "Stones, bones, groans, psychiatric overtones." Correct Answer: Signs and symptoms of hypercalcemia A patient complains of headache, weakness, and polyuria; exam reveals hypertension and tetany. Labs reveals hypernatremia, hypokalemia, and metabolic alkalosis. Correct Answer: 1° hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia) A patient presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic. Correct Answer: Pheochromocytoma Should α- or β-antagonists be used first in treating pheochromocytoma? Correct Answer: α-antagonists (phentolamine and phenoxybenzamine) A patient with a history of lithium use presents with copious amounts of dilute urine. Correct Answer: Nephrogenic diabetes insipidus (DI) An antidiabetic agent associated with lactic acidosis. Correct Answer: Metformin A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment? Correct Answer: 1° adrenal insufficiency (Addison's disease). Treat with replacement glucocorticoids, mineralocorticoids, and IV fluids Goal hemoglobin A1c for a patient with DM. Correct Answer: 7.0 Treatment of DKA. Correct Answer: Fluids, insulin, and aggressive replacement of electrolytes (e.g., K+) Why are β-blockers contraindicated in diabetics? Correct Answer: They can mask symptoms of hypoglycemia Sensitive tests have few false negatives and are used to rule _____ a disease. Correct Answer: Out PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a +PPD. Highly sensitive or specific? Correct Answer: Highly sensitive for TB Describe a test that consistently gives identical results, but the results are wrong. Correct Answer: High reliability, low validity indications for early colorectal cancer screening? Correct Answer: -IBD -familial adenomatous polyposis (FAP)/hereditary nonpolyposis colorectal cancer (HNPCC) -first-degree relatives with adenomatous polyps ( 60 years of age) or colorectal cancer The most common cancer in men and the most common cause of death from cancer in men. Correct Answer: Prostate cancer is the most common cancer in men, but LUNG cancer causes more deaths A 15-year-old pregnant girl requires hospitalization for preeclampsia. Should her parents be informed? Correct Answer: No. Parental consent is not necessary for the medical treatment of pregnant minors Involuntary psychiatric hospitalization can be undertaken for which three reasons? Correct Answer: The patient is a danger to self, a danger to others, or gravely disabled (unable to provide for basic needs) When can a physician refuse to continue treating a patient on the grounds of futility? Correct Answer: When there is no rationale for treatment, maximal intervention is failing, a given intervention has already failed, and treatment will not achieve the goals of care An eight-year-old child is in a serious accident. She requires emergent transfusion, but her parents are not present. Correct Answer: Treat immediately. Consent is implied in emergency situations Conditions in which confidentiality must be overridden. Correct Answer: Real threat of harm to third parties; suicidal intentions; certain contagious diseases; elder and child abuse Involuntary commitment or isolation for medical treatment may be undertaken for what reason? Correct Answer: When treatment noncompliance represents a serious danger to public health (e.g., active TB) The most likely cause of acute lower GI bleed in patients 40 years old. Correct Answer: Diverticulosis Diagnostic modality used when ultrasound is equivocal for cholecystitis. Correct Answer: HIDA scan Risk factors for cholelithiasis. Correct Answer: Fat, female, fertile, forty, flatulent Inspiratory arrest during palpation of the RUQ. Correct Answer: Murphy's sign, seen in acute cholecystitis Identify key organisms causing diarrhea: ■ Most common organism Correct Answer: Campylobacter Identify key organisms causing diarrhea: ■ Recent antibiotic use Correct Answer: Clostridium difficile Identify key organisms causing diarrhea: ■ Camping Correct Answer: Giardia Identify key organisms causing diarrhea: ■ Traveler's diarrhea Correct Answer: ETEC Identify key organisms causing diarrhea: ■ Uncooked hamburgers Correct Answer: E. coli O157:H7 Identify key organisms causing diarrhea: ■ Fried rice Correct Answer: Bacillus cereus Identify key organisms causing diarrhea: ■ Poultry/eggs Correct Answer: Salmonella Identify key organisms causing diarrhea: ■ Raw seafood Correct Answer: Vibrio, HAV Identify key organisms causing diarrhea: ■ AIDS Correct Answer: Isospora, Cryptosporidium, Mycobacterium avium complex (MAC) A 25-year-old Jewish male presents with pain and watery diarrhea after meals. Exam shows fistulas between the bowel and skin and nodular lesions on his tibias. Correct Answer: Crohn's disease Inflammatory disease of the colon with ↑ risk of colon cancer. Correct Answer: Ulcerative colitis Extraintestinal manifestations of IBD. Correct Answer: Uveitis, ankylosing spondylitis, pyoderma gangrenosum, erythema nodosum, 1° sclerosing cholangitis Medical treatment for IBD. Correct Answer: 5-aminosalicylic acid +/− sulfasalazine and steroids during acute exacerbations Charcot's triad. Correct Answer: RUQ pain, jaundice, and fever/chills in the setting of ascending cholangitis Medical treatment for hepatic encephalopathy. Correct Answer: ↓ protein intake, lactulose, neomycin First step in the management of a patient with acute GI bleed. Correct Answer: Establish the ABCs A four-year-old child presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely diagnosis and cause? Correct Answer: Hemolytic-uremic syndrome (HUS) due to E. coli O157:H7 Classic causes of drug-induced hepatitis. Correct Answer: TB medications (INH, rifampin, pyrazinamide), acetaminophen, and tetracycline A 40-year-old obese female with elevated alkaline phosphatase, elevated bilirubin, pruritus, dark urine, and clay-colored stools. Correct Answer: Biliary tract obstruction A 50-year-old man with a history of alcohol abuse presents with boring epigastric pain that radiates to the back and is relieved by sitting forward. Management? Correct Answer: Confirm the diagnosis of acute pancreatitis with elevated amylase and lipase. Make patient NPO and give IV fluids, O2, analgesia, and "tincture of time" Four causes of microcytic anemia. Correct Answer: TICS—Thalassemia, Iron deficiency, anemia of Chronic disease, and Sideroblastic anemia An elderly male with hypochromic, microcytic anemia is asymptomatic. Diagnostic tests? Correct Answer: Fecal occult blood test and sigmoidoscopy; suspect colorectal cancer Precipitants of hemolytic crisis in patients with G6PD deficiency. Correct Answer: Sulfonamides, antimalarial drugs, fava beans The most common inherited cause of hypercoagulability. Correct Answer: Factor V Leiden mutation The most common inherited hemolytic anemia. Correct Answer: Hereditary spherocytosis Medications and viruses that → aplastic anemia. Correct Answer: Chloramphenicol, sulfonamides, radiation, HIV, chemotherapeutic agents, hepatitis, parvovirus B19, EBV How to distinguish polycythemia vera from 2° polycythemia. Correct Answer: Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low epo levels Treatment for idiopathic thrombocytopenic purpura (ITP) in children. Correct Answer: Usually resolves spontaneously; may require IVIG and/or corticosteroids An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment? Correct Answer: Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment? Correct Answer: von Willebrand's disease; treat with desmopressin, FFP, or cryoprecipitate A 60-year-old African-American male presents with bone pain. Workup for multiple myeloma might reveal? Correct Answer: Monoclonal gammopathy, Bence Jones proteinuria, "punched-out" lesions on x-ray of the skull and long bones Reed-Sternberg cells Correct Answer: Hodgkin's lymphoma A 10-year-old boy presents with fever, weight loss, and night sweats. Examination shows anterior mediastinal mass. Suspected diagnosis? Correct Answer: Non-Hodgkin's lymphoma Microcytic anemia with ↓ serum iron, ↓ total iron-binding capacity (TIBC), and normal or ↑ ferritin. Correct Answer: Anemia of chronic disease Anemia: Microcytic with ↓ serum iron, ↓ ferritin, and ↑ TIBC. Correct Answer: Iron deficiency anemia An 80-year-old man presents with fatigue, lymphadenopathy, splenomegaly, and isolated lymphocytosis. Suspected diagnosis? Correct Answer: Chronic lymphocytic leukemia (CLL) A late, life-threatening complication of chronic myelogenous leukemia (CML). Correct Answer: Blast crisis (fever, bone pain, splenomegaly, pancytopenia) Auer rods on blood smear. Correct Answer: Acute myelogenous leukemia (AML) AML subtype associated with DIC. Correct Answer: M3 A 50-year-old male presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis? Correct Answer: CML Heinz bodies? Correct Answer: Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy Virus associated with aplastic anemia in patients with sickle cell anemia. Correct Answer: Parvovirus B19 A 25-year-old African-American male with sickle cell anemia has sudden onset of bone pain. Management of pain crisis? Correct Answer: O2, analgesia, hydration, and, if severe, transfusion A significant cause of morbidity in thalassemia patients. Treatment? Correct Answer: Iron overload; use deferoxamine The three most common causes of fever of unknown origin (FUO). Correct Answer: Infection, cancer, and autoimmune disease Four signs and symptoms of streptococcal pharyngitis. Correct Answer: Fever, pharyngeal erythema, tonsillar exudate, lack of cough A nonsuppurative complication of streptococcal infection that is not altered by treatment of 1° infection. Correct Answer: Postinfectious glomerulonephritis Asplenic patients are particularly susceptible to these organisms. Correct Answer: Encapsulated organisms--pneumococcus, meningococcus, Haemophilus influenzae, Klebsiella Which healthy population is susceptible to UTIs? Correct Answer: Pregnant women. Treat this group aggressively because of potential complications Nonpainful chancre. Correct Answer: 1° syphilis A "blueberry muffin" rash is characteristic of what congenital infection? Correct Answer: Rubella Meningitis in infants. Causes? Treatment? Correct Answer: Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin CSF findings: ■ Low glucose, PMN predominance Correct Answer: Bacterial meningitis CSF findings: ■ Normal glucose, lymphocytic predominance Correct Answer: Aseptic (viral) meningitis CSF findings: ■ Numerous RBCs in serial CSF samples Correct Answer: Subarachnoid hemorrhage (SAH) CSF findings: ■ ↑ gamma globulins Correct Answer: MS Initially presents with a pruritic papule with regional lymphadenopathy and evolves into a black eschar after 7-10 days. Treatment? Correct Answer: Cutaneous anthrax. Treat with penicillin G or ciprofloxacin Findings in 3° syphilis. Correct Answer: Tabes dorsalis, general paresis, gummas, Argyll Robertson pupil, aortitis, aortic root aneurysms Characteristics of 2° Lyme disease. Correct Answer: Arthralgias, migratory polyarthropathies, Bell's palsy, myocarditis A 24-year-old male presents with soft white plaques on his tongue and the back of his throat. Diagnosis? Workup? Treatment? Correct Answer: Candidal thrush. Workup should include an HIV test. Treat with nystatin oral suspension Begin Pneumocystis carinii pneumonia (PCP) prophylaxis in an HIV + pt? Correct Answer: ≤ 200 Tx with TMP Risk factors for pyelonephritis. Correct Answer: Pregnancy, vesicoureteral reflux, anatomic anomalies, indwelling catheters, kidney stones Neutropenic nadir postchemotherapy. Correct Answer: 7-10 days Erythema migrans. Correct Answer: Lesion of 1° Lyme disease Classic physical findings for endocarditis. Correct Answer: Fever, heart murmur, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth's spots Aplastic crisis in sickle cell disease. Correct Answer: Parvovirus B19 Ring-enhancing brain lesion on CT with seizures Correct Answer: Taenia solium (cysticercosis) Name the organism: ■ Painful chancroid. Correct Answer: Haemophilus ducreyi Name the organism: ■ Dog or cat bite. Correct Answer: Pasteurella multocida Name the organism: ■ Gardener. Correct Answer: Sporothrix schenckii Name the organism: ■ Pregnant women with pets. Correct Answer: Toxoplasma gondii Name the organism: ■ Meningitis in adults. Correct Answer: Neisseria meningitidis Name the organism: ■ Meningitis in elderly. Correct Answer: Streptococcus pneumoniae Name the organism: ■ Alcoholic with pneumonia. Correct Answer: Klebsiella Name the organism: ■ "Currant jelly" sputum. Correct Answer: Klebsiella Name the organism: ■ Infection in burn victims. Correct Answer: Pseudomonas Name the organism: ■ Osteomyelitis from foot wound puncture. Correct Answer: Pseudomonas Name the organism: ■ Osteomyelitis in a sickle cell patient. Correct Answer: Salmonella A 55-year-old man who is a smoker and a heavy drinker presents with a new cough and flulike symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis? Correct Answer: Legionella pneumonia