AANP FNP Certification With Complete Solution

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 - Answer III first time audible, IV first time thrill Fundal height 12 weeks - Answer 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? - Answer Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - Answer Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - Answer Mini mental exam 4 month old with strabismus, mom is worried...... - Answer tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - Answer Growth chart 6 month old closed anterior fontanel. - Answer XRAY Abnormal cells on PAP, what do you do next? - Answer Refer for Colposcopy CAGE ACRONYM - Answer Cut down Annoyed by criticism Guilty about drinking Eye opener drink Causes of tachycardia - Answer Fever Anemia Hypotension Cranial nerves responsible for extraocular eye movements - Answer CN 3,4,6 Definition of metabolic syndrome - Answer cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - Answer wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - Answer Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - Answer Anterior septum Definitive diagnosis of acute bacterial prostatitis - Answer urinalysis and culture GERD treatment - Answer H2 is first line, give hs Grade 3 cells on Pap, treatment? - Answer LEEP excision Fingernail hematoma treatment? - Answer drill hole and drain blood? Increased risk of ectopic pregnancy - Answer Salpingitis, or history of abortion, PID, Koplick spots - Answer Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - Answer Measles (rubeola). Grains of salt lesions inside mouth in Measles Legg-Calve-Perthes Disease - Answer Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - Answer Pancreatitis Low HGB, Low HCT, High MCV indicates what? - Answer Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - Answer Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - Answer Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - Answer Meniscus tears Lachman's Test - Answer pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - Answer refer to orthopedist Osgood-Schlatter disease - Answer 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? - Answer 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? - Answer Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - Answer Tinea Corporis Pt presents with "bag of worms:, indicates? - Answer Varicocele Pt with atopic dermatitis, look for what other diseases? - Answer Asthma Pt with bleeding after menopause - Answer endometrial biopsy, need to screen for cancer Pt with hx of PID, increased rick for? - Answer Infertility Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? - Answer This is good. Want higher than 350 Pt with hx of htn and stroke, now having memory loss. What does this indicate? - Answer Vascular dementia Pregnant teacher with exposure to 5ths disease (SLAP CHEEK), what risk is there to the fetus? - Answer slap cheek, PVB19, rash hands / feet Fetal death and birth defects Quick assessment of patients fall risk? Timed Get up and Go - Answer Timed Get up and Go Red beefy tongue? - Answer pernicious anemia Rotator cuff injury presentation - Answer disturbs sleep, arm weakness, dull ache Shingles near eye - Answer immediate referral to ophthalmology Signs and symptoms of Roseola (6ths disease) ? - Answer Viral infection Can result in a maculopapular rash, but up to 70% of cases proceed without the rash stage -Usually accompanied by a high fever (41°C or 105°F) that comes on quickly and lasts up to 3 days followed by rash -Seizures may occur during this period. -On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs. -High fever, pink flat or raised rash Treatment for chronic alcoholism: - Answer 12 step program Treatment for Gonorrhea? - Answer Rocephin 250mg IMx1 plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - Answer IUD Basal cell cancer - Answer Waxy, pearly, telangiectasia, ulcer center lesion -most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - Answer Scaly red to yellow located in sun exposed area -a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - Answer Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area -a pre squamous cell carcinoma occurs on sun-damaged skin biopsy cryo or 5fu cream subungual hematoma tx - Answer Make a hole and drain the blood Moderate acne treatment - Answer 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 - Answer MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta - Answer 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 - Answer Loud murmur easily heard JVD caused by - Answer -tension pneumothorax, -Rt. sided heart failure, -cardiac tamponade, -traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - Answer endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles. Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency or PVD. There was question about PAD. - Answer PAD: Absence of pulse, decrease blow flowing down, PAIN, Dx doppler or ABI<0.9, TX exercise by walking or antiplatelet, PVD: Volume, edema, discoloration, decrease blood going up, Chronic Bronchitis Treatment - Answer Smoking cessation Pulmonary rehabilitation Pharmacologic therapy Supplemental oxygen TB... PPD is positive if area of induration is: - Answer >5 mm in an immunocompromised patient or close contact >10 mm in immigrant, health care workers, drug user >15 mm in a patient who lives in an area where TB is very rare. what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck. - Answer Croup/Epiglottitis AV nicking (Arterioles pressing on vein of the eye) - Answer HTN retinopathy intraocular pressure (IOP) - Answer Fluid pressure inside the eye; measured with tonometry Rovsing sign - Answer pain in the RLQ when the LLQ is palpated (indicative of appendicitis) Pencil-like stools occur in an obstruction of what - Answer Sigmoid descending colon It's a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy headache after trauma - Answer SDH migraine headache - Answer -paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4-12 hours, abortive triptans prophylaxis propranolol, TCA amitriptyline, anticonvulsants topiramate Vitamin B12 - Answer Folate shares a close relationship with this other B Vitamin. Vitamin B12 - Answer 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. - Answer be changed to NSAID, SED rate is a sign of inflammation Which medication causes low sperm count for a patient - Answer SSRI grandiosity - Answer Exaggerated belief in or claims about one's importance or identity. Bipolor