AANP FNP EXAM TEST (QUESTIONS AND ANSWERS) 2023/2024

AANP FNP EXAM TEST (QUESTIONS AND ANSWERS) 2023/2024 Basal Cell Carcinoma - CORRECT ANSWER--painless, pearly, ulcerated nodule with overlying telangiectasis -found on sun areas Actinic Keratoses - CORRECT ANSWER--slightly rough, pink or flesh-colored lesion in sun-exposed area -pharmacological treatment: 5-fluorouracil (topical chemotherapy) -non-pharmacological treatment: chemical peel, cryotherapy, laser resurfacing Tuberculosis - CORRECT ANSWER-I. Transmission A. Mycobacterium tuberculosis carried in airborne droplets B. Active Pulmonary or Laryngeal Tuberculosis transmitted 1. Sneeze, cough, speak, or sing II. Symptoms A. Latent Tuberculosis is asymptomatic B. Active Tuberculosis presentation often mimics cancer presentation 1. Non-specific presentation (most common) a. Fatigue b. Weight loss c. Cachexia d. Night Sweats C. Pulmonary Tuberculosis symptoms 1. Productive cough (typically 2-3 weeks) 2. Hemoptysis (uncommon) 3. Pleuritic Chest Pain 4. Dyspnea III. Signs A. Sites of Involvement 1. Primary infection: lung involvement B. Disseminated Disease IV. Management A. Latent Tuberculosis 1. Positive PPD without signs of Active Tb 2. Treatment indicated if risk of Tb Progression from latent to active disease B. Active Tuberculosis Gout - CORRECT ANSWER-I. Pathophysiology A. *Gout occurs when Uric Acid levels exceed solubility limits* 1. Monosodium urate crystals deposit in joints, Kidney, and soft tissues 2. Crystal deposition triggers a inflammatory response from cytokines and Neutrophils 3. Joint space is irreversibly injured with ongoing attacks II. Risk Factors A. Most common 1. Obesity 2. Alcohol use (especially beer) 3. High purine diet (red meats, turkey and wild game, organ meats, seafood) 4. Drinks sweetened with high fructose corn syrup 5. Diuretic therapy including Thiazide Diuretics 6. Other risks a. Diabetes Mellitus b. Hyperlipidemia c. Hypertension d. Atherosclerosis e. Renal Insufficiency f. Myeloproliferative disease III. Symptoms A. Associated Symptoms 1. Chills 2. Fever as high as 104 F (40 C) 3. Severity: Very severe pain a. Unable to bear weight b. Too painful to put on socks c. Intollerant to light touch from blankets B. Regions Lower extremities 1. *First Metatarsophalangeal joint of great toe* (most common) a. Known as *Podagra* i. Affected in 50% of first gout attacks Mid-tarsal joints 2. Ankle Joints 3. Knee Joints C. Regions upper extremities 1. Fingers 2. Wrists 3. Elbows D. Characteristics: Joint Pain 1. Excruciating, crushing type pain 2. Timing: Joint Pain 3. Acute onset of lower extremity Joint Pain 4. Wakens patient from sleep IV. Signs A. Acute 1. Joint Inflammation 2. Erythema, tenderness and swelling at affected joint a. Pain extends well beyond joint b. Entire foot involved in some cases 3. Asymmetric joint involvement a. May only involve one side with the first attack 4. Skin over joint is tense and shiny B. Chronic 1. Gouty Tophi (develop after 10 years) a. Subcutaneous Nodules of monosodium urate crystals and lipids, proteins and mucopolysaccharides C. Chronic Arthritis 1. Chronic deposition occurs with recurrent attacks Dix-Hallpike Maneuver - CORRECT ANSWERCentral Vertigo - CORRECT ANSWER-I. Findings: Suggestive of central causes A. Nystagmus 1. Vertical or torsional Nystagmus (pure Horizontal Nystagmus may occur with either peripheral or central cause) 2. No Nystagmus on Horizontal Head Impulse Test 3. Persists <6 seconds after Dix-Hallpike Maneuver 4. Fixation of eyes on object does not inhibit Nystagmus 5. Requires weeks to months to resolve B. Episodes last hours to days C. Severe imbalance impairs standing and walking D. No Hearing Loss or Tinnitus in most central cases E. Acute Vestibular Syndrome (Posterior Circulation in 25% of cases) 1. Rapid onset (<1 hour) of acute, persistent, continuous Vertigo or Dizziness 2. Associated with Nystagmus, Nausea or Vomiting, head motion intolerance, and gait unsteadiness F. Positive HiNTs Exam Criteria (at least 1 of 3 positive) are suggestive of cerebellar CVA or Brainstem CVA (100% sensitive, 96% specific) 1. Normal Horizontal Head Impulse Test (no saccade/correction on head rotation) OR 2. Nystagmus that changes direction (or Vertical Nystagmus or torsional Nystagmus) OR 3. Skew Deviation on Alternate Eye Cover Test in which uncovered eye demonstrates quick vertical gaze corrections III. Causes: Central Vertigo A. Non-Vascular Central Causes of Vertigo (CN 8 or CNS) 1. Tumor a. Acoustic Neuroma (Vestibular Schwannoma) b. Infratentorial ependymoma c. Brainstem glioma d. Medulloblastoma e. Neurofibromatosis 2. Migraine Headache 3. Multiple Sclerosis B. Vascular disease related transient cerebral anoxia 1. Specific anoxia to vertebrobasilar system a. Vessel specific i. Brainstem Infarct (associated with Hearing Loss) 1. Anterior Inferior Cerebellar Artery Infarction 2. Anterior Vestibular Artery Infarction ii. Brainstem Infarct (no Hearing Loss) 1. Posterior Inferior Cerebellar Artery infarction 2. Labyrinthine Artery Infarction b. Precipitating conditions i. Arteriosclerosis ii. Hypertension iii. Anemia iv. Atrial Fibrillation C. Other Causes 1. Postural Hypotension 2. Syncope Peripheral Vertigo - CORRECT ANSWER-I. Findings: Suggestive of peripheral causes A. Pathognomonic for peripheral cause 1. Sudden onset with brief episodes often on awakening 2. Rotary Illusion with Nausea, Vomiting B. Nystagmus 1. Combined horizontal and torsional Nystagmus 2. Persists 5-20 seconds after Dix-Hallpike Maneuver 3. Fixation of eyes on object inhibits Nystagmus C. Moderate imbalance D. Nausea or Vomiting E. Associated findings 1. Hearing Loss 2. Tinnitus F. Tullio's Phenomenon 1. Nystagmus and Vertigo provoked by loud sounds II. Causes: Common (Peripheral Vertigo) A. Acute Vestibular Neuronitis B. Benign Paroxysmal Positional Vertigo C. Meniere's Disease III. Causes: Other (Peripheral Vertigo) A. Ear Infections 1. Serous Otitis Media 2. Chronic Otitis Media 3. Otitis Externa 4. Mastoiditis B. Other infections 1. Herpes Zoster Oticus (Ramsay Hunt Syndrome) 2. Acute Labyrinthitis (uncommon) a. Not synonymous with Vestibular Neuritis i. Labyrinthitis is much less common than neuritis ii. Labyrinthitis causes permanent Hearing Loss b. Types i. Viral Labyrinthitis ii. Bacterial Labyrinthitis (Rare) C. Structural disorder 1. Cholesteatoma 2. Perilymphatic Fistula 3. Otosclerosis D. Trauma 1. Temporal Bone Fracture 2. Labyrinthine Concussion Reiter's Syndrome - CORRECT ANSWERPerihepatitis - CORRECT ANSWERSpontaneous Abortions - CORRECT ANSWER-When there is vaginal bleeding and cramping but the cervix remains closed it is a threatened abortion. It is possible in this case that the pregnancy can be salvaged. In an inevitable abortion the cervix is dilated. In a complete abortion the placenta and fetus are expelled completely. In an incomplete abortion placental products remain in the uterus and the cervix remains dilated. Addison's Disease - CORRECT ANSWERCushing's Disease - CORRECT ANSWERMyocardial Infarction - CORRECT ANSWERFosamax - CORRECT ANSWER-Patients taking aledronate are instructed to take the medication when they get up in the morning, 30 minutes before eating and with a full glass of water. They should be instructed to remain upright to avoid esophageal irritation. If they take this medication with food, it will reduce the bioavailability by 40%. Taking alendronate with coffee or orange juice will reduce bioavailabiliy by 60%. Hyperlipidemia Medications - CORRECT ANSWER-The expected outcomes of the preceding medications are as follows: Lipitor: LDL: 20-60% decrease HDL: 5-15% increase Triglyceride: 10-40% decrease Gemfibrozil: LDL: 5-15% decrease HDL: 14- 20% increase Triglyceride: 20-50% decrease Nicotinic acid: LDL: 10-25% decrease HDL: 15-35% increase Triglyceride: 20-50% decrease Colestipol: LDL: 10-20% decrease HDL: 3-5% increase Triglyceride: May increase Trochanteric Bursitis - CORRECT ANSWER-I. Definition A. Inflammation of bursa overlying hip greater trochanter II. Symptoms A. Pain overlying greater trochanter B. May radiate into knee or ankle or into buttock C. Night pain occurs if lying on affected side D. Palliative and provocative factors 1. Worse when standing from seated or lying position 2. Improves initially on walking 3. Worse again after walking for >30 minutes III. Signs A. Point tenderness over lateral greater trochanter of hip B. Symptoms reproduced on hip adduction C. Adduction and internal rotation may also provoke IV. Management A. NSAIDs B. Modify activity C. Trochanteric Bursa Injection Marfan Syndrome - CORRECT ANSWER-I. Etiology A. Defect in gene coding for fibrillin structure B. Connective tissue defect affecting multiple systems 1. Musculoskeletal disease 2. Ocular disease 3. Cardiac disease II. Signs A. Body habitus 1. *Tall (Height exceeds 95th percentile for age)* 2. *Extremely slender build* B. Cardiovascular signs and conditions 1. Mitral Valve Prolapse 2. Aortic root dilatation 3. Myocardial Infarction 4. Aortic Insufficiency