ACNP ANCC Chels- Questions and
Answers
What are the characteristics of CML? Correct Ans--Occurs most often in persons > 40
-Median survival is 3-4 yrs
Hallmark sign: Philadelphia chromosome seen in leukemic cells
Symptoms, labs, and treatment of leukemia? Correct Ans-S/S: fatigue, weakness, weight loss,
generalized lymphadenopathy
Labs: CBC with subnormal RBCs and neutrophils. Elevated ESR. Peripheral smear distinguishes
between acute and chronic. Bone marrow aspiration is require to confirm diagnosis.
Tx: Chemo. Bone marrow transplantation. Symptom control.
Staging of lymphomas Correct Ans-Diagnosed by biopsy of enlarged lymph nodes
Stage I: Disease localized to single lymph node or group
Stage II: More than one lymph node group involved; confined to one side of the diaphragm.
Stage III: Lymph nodes or the spleen involved; occurs on both sides of the diaphragm.
Stage IV: Liver or bone marrow involved.
,Management of lymphomas? Correct Ans-Radiation
Chemotherapy
Bone marrow transplantation
Characteristics of non-hodgkin's lymphoma Correct Ans--Often presents as
lymphadenopathy--usually advanced stage
-Most common neoplasms between 20-40 yrs
-Less predictable pattern of spread than Hodgkin's disease
Characteristics of hodgkin's lymphoma Correct Ans--More common in males-- average age
32
-Usually presents with cervical adenopathy and spreads in a predictable fashion
-Reed-Sternberg cells differentiate from non-hodgkin's
What are the hallmark signs of Idiopathic Thrombocytopenia Purpura (ITP) and management?
Correct Ans-S/S: Bone marrow analysis. Low plt count with other causes ruled out. hx of
bruising or bleeding.
Tx: when <20K: high dose corticosteroids, IV gamma globulin, Plt transfusion.
What are thrombocytopenic precautions? Correct Ans-Avoid constipation (increase fiber,
laxatives, etc.), No flossing, No shaving, Hold pressure for 5 min or more for cuts, line insertion,
etc.
,What are the labs values that indicate DIC? Correct Ans--plts < 150k
-fibrinogen <170
-decreased RBCs
-Increased FDPs (>45)
-Prolonged PT/PTT
-D-dimer +
Treatment of DIC? Correct Ans-Goal: treat underlying condition and control bleeding
Plst, FFP, and cryoprecipitate for severe bleeding
Therapy is aimed at cessation of bleeding, increasing fibrinogen/plt count, and decreasing FDPs.
What are the hallmark signs of Gonorrhea and management? Correct Ans-S/S:
Females: dysuria, green mucopurulent vaginal discharge, labial pain/swelling, fever, abnormal
menstrual periods
Males: dysuria, white/yellow-green penile discharge, testicular pain.
Tx: Ceftriaxone IM x 1 dose + azithromycin PO x 1 dose (to treat for chlamydia). Report to
health department.
What are the hallmark signs of Syphilis and management? Correct Ans-S/S:
, Primary: chancre is painless, indurated ulcer
Secondary: flu-like, palm/plantar rash, lymphadenopathy, alopecia
Latent: seropositive, but asymptomatic
Tertiary: Leukoplakia, cardiac insufficiency, Aortic aneurysm, meningitis, hemiparesis,
hemiplegia.
Tx: Benzathine Penicillin G 2.4 million units IM (weekly x 3 weeks for latent/tertiary)
What are the hallmark signs of Chlamydia and management? Correct Ans-S/S:
Males: dysuria, thick/cloudy penile discharge, testicular pain
Female: dysuria, postcoital bleeding, painful intercourse
Tx: Azithromycin x 1 dose or doxy BID x 7 days
What are the hallmark signs of Trichomonas and management? Correct Ans-S/S:
Malodorous, frothy yellow-green discharge, "strawberry patches" on cervix and vagina.
Tx: Metronidazole 2 g PO x 1, 500 mg BID x 7 days
What are the hallmark signs of Bacterial vaginosis and management? Correct Ans-S/S:
"fishy" smelling discharge, watery/grey discharge
Answers
What are the characteristics of CML? Correct Ans--Occurs most often in persons > 40
-Median survival is 3-4 yrs
Hallmark sign: Philadelphia chromosome seen in leukemic cells
Symptoms, labs, and treatment of leukemia? Correct Ans-S/S: fatigue, weakness, weight loss,
generalized lymphadenopathy
Labs: CBC with subnormal RBCs and neutrophils. Elevated ESR. Peripheral smear distinguishes
between acute and chronic. Bone marrow aspiration is require to confirm diagnosis.
Tx: Chemo. Bone marrow transplantation. Symptom control.
Staging of lymphomas Correct Ans-Diagnosed by biopsy of enlarged lymph nodes
Stage I: Disease localized to single lymph node or group
Stage II: More than one lymph node group involved; confined to one side of the diaphragm.
Stage III: Lymph nodes or the spleen involved; occurs on both sides of the diaphragm.
Stage IV: Liver or bone marrow involved.
,Management of lymphomas? Correct Ans-Radiation
Chemotherapy
Bone marrow transplantation
Characteristics of non-hodgkin's lymphoma Correct Ans--Often presents as
lymphadenopathy--usually advanced stage
-Most common neoplasms between 20-40 yrs
-Less predictable pattern of spread than Hodgkin's disease
Characteristics of hodgkin's lymphoma Correct Ans--More common in males-- average age
32
-Usually presents with cervical adenopathy and spreads in a predictable fashion
-Reed-Sternberg cells differentiate from non-hodgkin's
What are the hallmark signs of Idiopathic Thrombocytopenia Purpura (ITP) and management?
Correct Ans-S/S: Bone marrow analysis. Low plt count with other causes ruled out. hx of
bruising or bleeding.
Tx: when <20K: high dose corticosteroids, IV gamma globulin, Plt transfusion.
What are thrombocytopenic precautions? Correct Ans-Avoid constipation (increase fiber,
laxatives, etc.), No flossing, No shaving, Hold pressure for 5 min or more for cuts, line insertion,
etc.
,What are the labs values that indicate DIC? Correct Ans--plts < 150k
-fibrinogen <170
-decreased RBCs
-Increased FDPs (>45)
-Prolonged PT/PTT
-D-dimer +
Treatment of DIC? Correct Ans-Goal: treat underlying condition and control bleeding
Plst, FFP, and cryoprecipitate for severe bleeding
Therapy is aimed at cessation of bleeding, increasing fibrinogen/plt count, and decreasing FDPs.
What are the hallmark signs of Gonorrhea and management? Correct Ans-S/S:
Females: dysuria, green mucopurulent vaginal discharge, labial pain/swelling, fever, abnormal
menstrual periods
Males: dysuria, white/yellow-green penile discharge, testicular pain.
Tx: Ceftriaxone IM x 1 dose + azithromycin PO x 1 dose (to treat for chlamydia). Report to
health department.
What are the hallmark signs of Syphilis and management? Correct Ans-S/S:
, Primary: chancre is painless, indurated ulcer
Secondary: flu-like, palm/plantar rash, lymphadenopathy, alopecia
Latent: seropositive, but asymptomatic
Tertiary: Leukoplakia, cardiac insufficiency, Aortic aneurysm, meningitis, hemiparesis,
hemiplegia.
Tx: Benzathine Penicillin G 2.4 million units IM (weekly x 3 weeks for latent/tertiary)
What are the hallmark signs of Chlamydia and management? Correct Ans-S/S:
Males: dysuria, thick/cloudy penile discharge, testicular pain
Female: dysuria, postcoital bleeding, painful intercourse
Tx: Azithromycin x 1 dose or doxy BID x 7 days
What are the hallmark signs of Trichomonas and management? Correct Ans-S/S:
Malodorous, frothy yellow-green discharge, "strawberry patches" on cervix and vagina.
Tx: Metronidazole 2 g PO x 1, 500 mg BID x 7 days
What are the hallmark signs of Bacterial vaginosis and management? Correct Ans-S/S:
"fishy" smelling discharge, watery/grey discharge
