EXAM 2023/2024 AANP STUDY GUDE TEST EXAM

EXAM 2023/2024 AANP STUDY GUDE TEST EXAM Migranes - CORRECT ANSWER-- Symptoms: Throbbing pain behind one eye Photophobia, phonophobia, N/V - At-Risk Patients: Adult females - Aggravating Factors: Red wine, MSG, aspartame, menstruation, stress Trigeminal neuralgia - CORRECT ANSWER-- Symptoms: Type 1: Intense, sharp, shock-like, stabbing pain; Type 2: constant, aching, burning pain - At-Risk Patients: Older adults and elderly - Aggravating Factors: Cold food, cold hair, chewing, talking, touch Cluster HA - CORRECT ANSWER-- Symptoms: "Icepick" piercing pain behind one eye/temple Tearing, rhinorrhea, ptosis, miosis Homer's syndrome - At-Risk Patients: Middle-aged females - Aggravating Factors: Occurs at same time, daily, in clusters Weeks to months Tension HA - CORRECT ANSWER-- Symptoms: b/1 "band-like" pain; dull, may last a day; may have spasms of trapezius muscles - At-Risk Patients: Adults - Aggravating Factors: Stress Migrane - CORRECT ANSWER-- Acute tx: Ice pack, rest, dark room Sumatriptan or Toradol Prochlorperazine for - Prophylaxis/Other: TCA, BBs, Effexor, Topamax {not if hx of kidney stones) Pharmacokinetics - CORRECT ANSWER-Movement of drugs through body Pharmacodynamics - CORRECT ANSWER-Physiologic and biochemical effects of drugs Pharmacogenomics - CORRECT ANSWER-Study of how genes affect response to meds Half-life - CORRECT ANSWER-Amount of time it takes for drug concentration to decrease 50% First-Pass Effect - CORRECT ANSWER-Oral drug enters portal circulation - in liver, CYP450 metabolizes drug, then it is released to body; can bypass first-pass effect via IV, gels/creams/patches, buccal When asked about drug interactions, think of these - CORRECT ANSWER-· Macrolides · Antifungals · Cimetidine · Citalopram · Protease inhibitors · Grapefruit juice (Interacts with statins, erythromycin, CCBs, antivirals, amiodarone, benzos, cisapride, carbamazepine, buspirone) Safety Issues with Common Meds Drug: Thiazolidinediones e.g. pioglitazone - CORRECT ANSWER-Safety Issue: Black box: exacerbate CHF, do not use if NYHA Class Ill or IV HF Contraindications: Ml, stroke, bladder CA, TlDM, eye/liver Safety Issues with Common Meds Drug: H2 antagonists e.g. ranitidine, famotidine - CORRECT ANSWER-Safety Issue: Mental status changes w/ kidney disease Avoid if creatinine clearance< 50 ml/min Safety Issues with Common Meds Drug: PPls e.g. omeprazole, pantoprazole - CORRECT ANSWER-Safety Issue: Risk of fractures, PNA, CDiff, hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, kidney disease Interactions: warfarin, diazepam, carbamazepine, phenytoin, ketoconazole Safety Issues with Common Meds Drug: Warfarin - CORRECT ANSWER-Safety Issue: Interacts with "G" herbs - garlic, ginger, ginkgo, ginseng D/C 7 days before surgery Aortic regurgitation presentation - CORRECT ANSWER-Long asymptomatic period followed by exercise intolerance then dyspnea at rest. The left ventricle fails unless the aortic valve is replaced AV nicking is most commonly seen? - CORRECT ANSWER-Retinal exam of patients with hypertension Carotid artery bruits can indicate? - CORRECT ANSWER-Generalized atherosclerosis The USPSTF recommends a 1-time abdominal aortic aneurysm screening with ultrasonography is done in men - CORRECT ANSWER-Age 65 to 75 who have ever smoked Hypertension is the most common cause of? - CORRECT ANSWER-Hemorrhagic stroke Patients with acute coronary syndrome typically have? - CORRECT ANSWER-Plaque erosion caused by accumulation of hyaluronan and neutrophils The ductus arteriosus is a blood vessel that connects? - CORRECT ANSWER-The aorta and the pulmonary artery in fetus so that blood flow skips the lungs In patients with ductus arteriosus, the murmur is best heard where? - CORRECT ANSWER-At the left clavicle and is both systolic and diastolic Cardiovascular: Diabetics, females and elderly The tricuspid valve separates what? - CORRECT ANSWER-The right atrium and right ventricle Pulmonic stenosis - CORRECT ANSWER-A mid to late systolic murmur How many licks does it take to get to the Tootsie Roll center of a Tootsie Pop? - CORRECT ANSWER-No idea. Aortic regurgitation and mitral valve stenosis are? - CORRECT ANSWER-Diastole only murmurs EKG shows ST elevation, T wave changes (such as inversion), ST depressional and Q waves during episodes of angina. - CORRECT ANSWER-Diastole is the minimum arterial pressure exerted during relaxation and dilation of the ventricle. The 4 heart defects of Tetralogy of Fallot are? - CORRECT ANSWER-- Ventricular Septal Defect - Right Ventricular Hypertrophy - Overriding Aorta - Pulmonary Stenosis Audible S3 in an older adult patient is usually a sign of? - CORRECT ANSWER-Left ventricular hypertrophy from heart failure or cardiomyopathy Atherosclerotic peripheral arterial disease presents with symptomatic limb ischernia upon exertion. - CORRECT ANSWER-Mitral regurgitation is a harsh murmur heard loudest at the apex with radiation toward the left axilla. A widened pulse pressure greater than or equal to 60 in an older adult is a risk factor for? - CORRECT ANSWER-Cardiovascular disease, stroke, or renal disease The atrium forcefully contracting against a stiffened ventricle causes S4. - CORRECT ANSWER-Pericarditis often causes sharp chest pain. In coarctation of the aorta, blood pressure is higher in the arms than in the legs due to? - CORRECT ANSWER-Narrowing in the aorta. It is common to hear a split S2 heart sound over the pulmonic area of the heart with inspiration. As long as it disappears with expiration, with no other abnormal symptoms, this is a normal finding. - CORRECT ANSWER-Go Brandy! Go Brandy! Go Brandy GO! Common side effects of NSAIDs are? - CORRECT ANSWER-- Renal impairment - Acute renal failure - Gastritis Oral Iron should be taken on empty stomach with something acidic and high in calcium such as orange juice. - CORRECT ANSWER-Skin manifestations of a Penicillin allergy is hives. Headache, nausea, insomnia, restlessness and agitation are symptoms that a patient may experience when they are started on SSRI but these symptoms usually resolve in 2 weeks. - CORRECT ANSWER-ACEI induced cough usually begins around 2 weeks after starting medication The drug of choice for male patients with a UTI is? - CORRECT ANSWER-Bactrim for 7-10 days If no response to SSRis another antidepressant can be tried in 8-12 weeks. - CORRECT ANSWER-NSAIDs should be used cautiously in patients with hypertension because they cause sodium retention and increase blood pressure. Side effects of ADHD medication (Strattera) include? - CORRECT ANSWERHypertension and tachycardia Theophylline is a methylxanthines medication that causes bronchodilation. It is used to treat wheezing, sob, asthma, bronchitis, emphysema and lung disease. - CORRECT ANSWER-Beta blockers are contraindicated in patients with Variant (prinzmetal) angina because they may induce coronary vasospasm. Ropinirole (Requip) is a dopamine agonist used to treat? - CORRECT ANSWERParkinson's disease and restless leg syndrome Medications known to cause urinary retention are? - CORRECT ANSWER-- Antihistamines - TCAs - Antispasmodics - Bronchodilators - Antipsychotics - Carbidopa/levodopa The biggest side effect of colchicine is? - CORRECT ANSWER-Diarrhea PDE5 inhibitors (sildenafil and tadalafil) are contraindicated in patients who are on nitrates or triptans because of the risk of hypotension. - CORRECT ANSWER-ACEIs can cause hyperkalemia. Diphenhydramine has anticholinergic properties and is contraindicated in elderly patient and in patients with glaucoma. - CORRECT ANSWER-Statins and CCBs interact with grapefruit juice. CYP450 inhibitors slow down drug clearance which causes an increase in drug concentration. Examples are Macrolides (erythromycin, clarithromycin), Antifungals (ketoconazole, fluconazole), Cimetidine (Tagamet), Ritonavir, and Citalopram (Celexa). - CORRECT ANSWER-CYP450 Inducers speed up drug clearance and causes a decrease in drug concentration. Examples are Rifampin, Rifabutin, Carbamazepine, Phenobarbital and Phenytoin. LABA medications - CORRECT ANSWER-- Arformoterol (Brovana) - Salmeterol (Serevent) - Formoterol (Foradil) - Salmeterol/Fluticasone (Advair) - Formoterol/Budesonide (Symbicort) Anxiety and depression are sequelae associated with? - CORRECT ANSWER-COPD Intermittent Asthma symptoms occur? - CORRECT ANSWER-Less than 2 times a week, nighttime awakening less than two times per month Making love to you is INCREDIBLE!! - CORRECT ANSWER-Truth. Mild Persistent Asthma symptoms occur? - CORRECT ANSWER-More than 2 times a week (but not daily), nighttime awakening 3-4 times a month Moderate Persistent Asthma symptoms occur? - CORRECT ANSWER-Daily, nighttime awakening more than once a week (but not nightly) Severe Persistent Asthma symptoms occur? - CORRECT ANSWER-Continuously throughout the day, nighttime awakening nightly The most common cause of pneumonia in all ages is? - CORRECT ANSWER-Strep pneumo Most common cause of croup is? - CORRECT ANSWER-Parainfluenza virus