AGNP AANP SETS COMPREHENSIVE ANSWERS AND
QUESTIONS SET A+
✔✔GERD - ✔✔sx: retrosternal burning, occurs at night or in recumbent position,
relieved by sitting up, antacids, water or food
dx: EGD to r/o Barrett's esophagus (esophageal cancer d/t wear down of lining from
acid)
tx: antacids prn, H2 blockers, PPIs (if H2 dpn't work)
✔✔gastroenteritis tx - ✔✔antimotility meds NOT rec for mild disease, contraindicated in
patients with bloody stool or fever
traveler's diarrhea prophylaxsis- bsimuth
✔✔hepatitia A - ✔✔acute only, no chronic
oral fecal route from contaminated water and food
2-6wk incubation period
✔✔hepatitis B - ✔✔bloodborne DNA virus in serum, saliva, semen, & vaginal secretions
(blood & bodily fluids)
✔✔hepatitis C - ✔✔bloodborne RNA virus, blood transfusions & IV drug use (vietnam
vets at risk)
✔✔hepatitis s/sx - ✔✔pre ictericl fatigue, malaise, n/v, HA
icteric: clay colored stools, jaundice, RUQ pain, dark urine, weight loss, low grade fever,
hepatosplenomegaly
✔✔hepatitis serology - ✔✔hep A:
,-acute = anti-HAV, IgM
-recovered = anti-HAV, IgG
Hep B:
-active = HBsAg, HBeAg, Anti-HBc, IgM
-chronic = HBsAg, Anti-HBc, Anti-HBe, IgM, IgG
-recovered = anti-HBc, anti-HBs
(HBsAg = antigen = enemy has landed
Anti-HBc = increased viral load
HBeAg = little "e" in middle = middle of fight = active infx
Anti-HBe = e on end = decreased viral load = chronic hep
Anti-HBs = recovered/immunity)
10% pts are nonconverters = won't make antibodies regardless of vaccines
check titers for healthcare workers every 10 yrs)
Hep C:
-PCR differentiates prior exposure from viremia
-acute = anti-HCV, HCV RNA
-chronic = Anti-HCV, HCV RNA
-Recovered = Anti-HCV
✔✔hepatitis management - ✔✔low to no protein diet, rest, fluids, lactulose for elevated
ammonia levels, antivirals
✔✔diverticulitis - ✔✔sx: LLQ pain to palpation
labs: CT to evaluate abscess is gold standard; plain abdominal films to look for free air
(constipation, gas, blockage, kidney stones)
tx: cipro + flagyl or levaquin
✔✔irritable bowel syndrome - ✔✔sx: abd cramping, rectal tenesmus common, pain
releived by defecation, anxiety or depression common
tx: fiber, fluids, exercise, low stress, eliminate gluten, SSRIs for depressed pts
no specific IBS drug
✔✔cholecystitis - ✔✔sx: vomiting provides relief of epigastric pain
findings: murphy's sign, RUQ tender, muscle guarding, fever
labs: US is gold standard
, tx: pain, NGT, IV, GI consult
✔✔bowel obstruction - ✔✔sx: vomiting within minutes of pain = proximal; vomiting
within hours of pain = distal
findings: high pitched tinkling bowel sounds (faucet dripping)
tx: refer
✔✔ulcerative colitis - ✔✔INFLAMMATORY CONDITION involving the rectum and may
extend upward involving the whole colon
sx: bloody diarrhea is hallmark, rectal tenesmus
tx: mesalamine suppositories, hydrocortisone suppositories and enemas
*Crohn's disease is upper bowel*
✔✔colon cancer - ✔✔causes: FMH of colon cancer or ovarian or endometrial cancer;
high fat diet, polyps, IBD
sx: ribbon stools = descending colon cancer, weight loss, change in bowels
dx: colonoscopy gold standard; CEA elevated
✔✔appendicitis - ✔✔sx: vague colicky umbilical pain, then to RLQ, n/v
findings: RLQ guarding w/ rebound tenderness, McBurney's point tender, Psoas sign
(right thigh extension), obturator sign (internal rotation of flexed right thigh), rovsings
sign, low grade fever (high suggests perf or other dx)
labs: WBC 10-20k, CT or US is diagnostic
✔✔Gerontology GI - ✔✔decreased jaw muscles for chewing, decreased thirst and taste
perception, decreased gastric motility w/ delayed emptying, increased intestinal transit
time, impaired defecation signal, decreased liver size & blood flow
risk of poor nutrition, altered drug absorption, decreased/impaired metabolism of drugs,
dysphagia, NSAID induced ulcers, constipation (not a normal finding) d/t lack of fiber
exercise poor dentition laxative abuese
✔✔tanner stages breast development for girls - ✔✔I: preadolescent
2: breast buds with areolar enlargement
3: breasts enlarge without nipple contour
4: areola and nipple project as secondary mound
5: fully developed adult breasts, areola recedes, nipple retracts
QUESTIONS SET A+
✔✔GERD - ✔✔sx: retrosternal burning, occurs at night or in recumbent position,
relieved by sitting up, antacids, water or food
dx: EGD to r/o Barrett's esophagus (esophageal cancer d/t wear down of lining from
acid)
tx: antacids prn, H2 blockers, PPIs (if H2 dpn't work)
✔✔gastroenteritis tx - ✔✔antimotility meds NOT rec for mild disease, contraindicated in
patients with bloody stool or fever
traveler's diarrhea prophylaxsis- bsimuth
✔✔hepatitia A - ✔✔acute only, no chronic
oral fecal route from contaminated water and food
2-6wk incubation period
✔✔hepatitis B - ✔✔bloodborne DNA virus in serum, saliva, semen, & vaginal secretions
(blood & bodily fluids)
✔✔hepatitis C - ✔✔bloodborne RNA virus, blood transfusions & IV drug use (vietnam
vets at risk)
✔✔hepatitis s/sx - ✔✔pre ictericl fatigue, malaise, n/v, HA
icteric: clay colored stools, jaundice, RUQ pain, dark urine, weight loss, low grade fever,
hepatosplenomegaly
✔✔hepatitis serology - ✔✔hep A:
,-acute = anti-HAV, IgM
-recovered = anti-HAV, IgG
Hep B:
-active = HBsAg, HBeAg, Anti-HBc, IgM
-chronic = HBsAg, Anti-HBc, Anti-HBe, IgM, IgG
-recovered = anti-HBc, anti-HBs
(HBsAg = antigen = enemy has landed
Anti-HBc = increased viral load
HBeAg = little "e" in middle = middle of fight = active infx
Anti-HBe = e on end = decreased viral load = chronic hep
Anti-HBs = recovered/immunity)
10% pts are nonconverters = won't make antibodies regardless of vaccines
check titers for healthcare workers every 10 yrs)
Hep C:
-PCR differentiates prior exposure from viremia
-acute = anti-HCV, HCV RNA
-chronic = Anti-HCV, HCV RNA
-Recovered = Anti-HCV
✔✔hepatitis management - ✔✔low to no protein diet, rest, fluids, lactulose for elevated
ammonia levels, antivirals
✔✔diverticulitis - ✔✔sx: LLQ pain to palpation
labs: CT to evaluate abscess is gold standard; plain abdominal films to look for free air
(constipation, gas, blockage, kidney stones)
tx: cipro + flagyl or levaquin
✔✔irritable bowel syndrome - ✔✔sx: abd cramping, rectal tenesmus common, pain
releived by defecation, anxiety or depression common
tx: fiber, fluids, exercise, low stress, eliminate gluten, SSRIs for depressed pts
no specific IBS drug
✔✔cholecystitis - ✔✔sx: vomiting provides relief of epigastric pain
findings: murphy's sign, RUQ tender, muscle guarding, fever
labs: US is gold standard
, tx: pain, NGT, IV, GI consult
✔✔bowel obstruction - ✔✔sx: vomiting within minutes of pain = proximal; vomiting
within hours of pain = distal
findings: high pitched tinkling bowel sounds (faucet dripping)
tx: refer
✔✔ulcerative colitis - ✔✔INFLAMMATORY CONDITION involving the rectum and may
extend upward involving the whole colon
sx: bloody diarrhea is hallmark, rectal tenesmus
tx: mesalamine suppositories, hydrocortisone suppositories and enemas
*Crohn's disease is upper bowel*
✔✔colon cancer - ✔✔causes: FMH of colon cancer or ovarian or endometrial cancer;
high fat diet, polyps, IBD
sx: ribbon stools = descending colon cancer, weight loss, change in bowels
dx: colonoscopy gold standard; CEA elevated
✔✔appendicitis - ✔✔sx: vague colicky umbilical pain, then to RLQ, n/v
findings: RLQ guarding w/ rebound tenderness, McBurney's point tender, Psoas sign
(right thigh extension), obturator sign (internal rotation of flexed right thigh), rovsings
sign, low grade fever (high suggests perf or other dx)
labs: WBC 10-20k, CT or US is diagnostic
✔✔Gerontology GI - ✔✔decreased jaw muscles for chewing, decreased thirst and taste
perception, decreased gastric motility w/ delayed emptying, increased intestinal transit
time, impaired defecation signal, decreased liver size & blood flow
risk of poor nutrition, altered drug absorption, decreased/impaired metabolism of drugs,
dysphagia, NSAID induced ulcers, constipation (not a normal finding) d/t lack of fiber
exercise poor dentition laxative abuese
✔✔tanner stages breast development for girls - ✔✔I: preadolescent
2: breast buds with areolar enlargement
3: breasts enlarge without nipple contour
4: areola and nipple project as secondary mound
5: fully developed adult breasts, areola recedes, nipple retracts
