AANP FNP STUDY GUIDE EXAM (QUESTIONS AND ANSWERS) A+ GRADED 2023/2024

AANP FNP STUDY GUIDE EXAM (QUESTIONS AND ANSWERS) A+ GRADED 2023/2024 Tanner Stage 2 - CORRECT ANSWER-Increased rugae of scrotum, testes enlarge. Breast bud. Straight sparse hair. Tanner Stage 3 - CORRECT ANSWER-Penis elongates. Pencil penis. Scrotal color darkens. Breast tissue and areola are one mound. Darkened hair, starts to curl. Tanner 4 - CORRECT ANSWER-Penis thickens and increases in size. Areola/nipple separate for secondary mound. Curly hair, not on medial thigh. When does menarche begin? - CORRECT ANSWER-After Tanner stage 2, within 1-2 years. Delayed puberty if no secondary sexual characteristics by 12-13 in girls and 14 in boys. Trisomy 21 - CORRECT ANSWER-Down Syndrome. Risk with advanced maternal age. Microcephaly, flat nose, hypotonia, simian crease. Marfan's Syndrome - CORRECT ANSWER-Pectus excavatum. Tall, wide arm span. Risk of MVP, aneurysm, aortic regurgitation. Do not clear for sports. Turner's Syndrome - CORRECT ANSWER-FEMALE. Lymphedema in utero, webbed neck, LD, widely spaced nipples, HTN coarctation of aorta. Klienfelter's Syndrome - CORRECT ANSWER-Extra X in males. More feminine. Will see in puberty. Infertile, hypogonadism, low testosterone. Tall, lanky, underdeveloped sexually. Caput succadeum - CORRECT ANSWER-Sutures cross midline, spreads. Caphalohematoma - CORRECT ANSWER-Sutures do not cross midline, more significant. When does anterior fontanelle close? - CORRECT ANSWER-18 months When does posterior fontanelle close? - CORRECT ANSWER-2-3 months Abrnomal red reflex - CORRECT ANSWER-Black or white. Retinoblastoma, cataracts, osteogenesis perfecta. White specks in down syndrome. Edward's Syndrome - CORRECT ANSWER-Trisomy 18. Small mouth. High pitched cry. Newborn screening tests - CORRECT ANSWER-PKU (phenylalanine), can lead to hyperactivity and mental retardation. Hypothyroid. If not treated, mental retardation. Sickle cell. Galactessemia, maple smell to urine, septic. Hordeolum - CORRECT ANSWER-Stye. Pain, edema. Bacitracin ophthalmic ointment. STD conjunctivitis. - CORRECT ANSWER-Emergency. Rocephin for gonorrhea. Gonococcola Ophthamlia Neonatorum - CORRECT ANSWER-2-4 days after birth. Red eye, purulent discharge, swollen eyelids. GC culture, Thayer Martin, ROCEPHIN. Chalmydial Ophthalmia Trachoma - CORRECT ANSWER-4-10 days after birth. Edematous, red, profuse WATERY discharge that becomes purulent. Azithromycin, erythmocycin. Otitis externa - CORRECT ANSWER-Fungal. Odor, black specks. Clotramizole. Pain with tragus/pinna. Corticosporin Sensorineuro hearing loss in PEDS - CORRECT ANSWER-Syphilis, acoustic neuroma, aminoglycoside (gentamycin) Epiglottitis - CORRECT ANSWER-Bacterial. Thumb sign on x-ray. Croup - CORRECT ANSWER-Viral. Steeple sign on x-ray. Bronchioloitis - CORRECT ANSWER-RSV, adenovirus. Under 3. Lower respi. URI, fever, nasal flaring, stridor.If a preemie, synegis. Intermittent Asthma peds - CORRECT ANSWER-SABA, 2 puffs q 4-6 hours. Peak 30 min-2 hours, lasts 4-6. S. pneumonia (CAP) peds - CORRECT ANSWER-Lobar consolidation. Tx with penicillin. H. influenza pneumonia peds - CORRECT ANSWER-Lobar consolidation. Amoxicillin or cephalosporin. M. cataralis or mycoplasma - CORRECT ANSWER-Linear. Azithromycin. Neurofibromatosis - CORRECT ANSWER-Cafe au lait spots. Neurofibromas. Eye nodules. Freckling. Peds IDA - CORRECT ANSWER-Slow GI loss, too much whole milk. PICA. Flat shaped nails. Ferritin low. 6-9 month treatments. 3-6 mg/kg day of iron Thalassemia peds - CORRECT ANSWER-Asymptomatic. Enlarged spleen, tachypnea, tachycardia, prominence in facial bones. TIBC not increased . Electrophoresis. Sickle Cell Peds - CORRECT ANSWER-Vasocclusive crisis. Symptoms in stress, heat, overexerting. Howel Jolly Bodies. Reticulocytosis. Hydrate, oxygenate, pain managemnet. Hemophilia - CORRECT ANSWER-Factor VIII. Mother/daughter carry gene but presents in males. Bleed into joints. Lead Poisoning - CORRECT ANSWER-Over 10 refer. IDA. Butonion line, gingival border. Kelation therapy. Leukemia peds - CORRECT ANSWER-Chronically tired, pale, resp. infections. Blast cells, peripheral smear, WBC HIV testing - CORRECT ANSWER-ELISA in older child. PCR in infant. Western blot confirms. More than 800 CD4 count normal, viral load less than 5000 or 0/undetectable. Cause of fever in less than 2 month old - CORRECT ANSWER-Group B strep, e coli common cause of fever in 2 months and up - CORRECT ANSWER-Strep. pneumoniae, and h. influenza Preoperational phase, preconceptual - CORRECT ANSWER-2-4 years old Causation, intuitive - CORRECT ANSWER-4-7 years old When is vision 20/20? - CORRECT ANSWER-Age 6 Concrete thinking, cognitive tasks, capable - CORRECT ANSWER-School age What can be confused as child abuse in younger children? - CORRECT ANSWEROsteogenesis imperfecta or Mongolian spot VSD - CORRECT ANSWER-Thrill sometimes felt at LL sternal border. Most common heart defect in babies. Opening between septum. Holosystolic murmur. Transposition of great arteries - CORRECT ANSWER-RVH. L. lower sternal border. Egg on a string on x-ray. Tetralogy of fallot - CORRECT ANSWER-VSD. Pulmonary stenosis. Overriding aorta. R. sided hypertrophy. Systolic ejection murmur and thrill. Squat to slow return of blood to heart. Aortic stenosis - CORRECT ANSWER-Systolic thrill. R. upper sternal border. Ejection click heard at apex. LVH. X-ray, severe HF. More common in boys than girls, common to see mild exercise intolerance Coarctation of aorta - CORRECT ANSWER-Ejection murmur heard best at LUSB and L interscapular area. RVH to LVH. Rib notching. Pressures different in upper and lower extremities. OFten seen with mitral regurgitation and Aortic stenosis Still's Murmur - CORRECT ANSWER-1-3/6, early systolic ejection murmur. Musical / vibratory (buzz). Left lower sternal border. Turbulence in left ventricle. Innocents. Softens with standing, Valsalva, sitting. Age 2-6 years Hemic murmur - CORRECT ANSWER-Mild systolic ejection murmur, high-pitched, pulmonic & aortic areas. Only heard in increased cardiac output. Venous hum - CORRECT ANSWER-Heard best while sitting, disappears while supine. R and L upper sternal border, continuous humming murmur. innocent. Disappears in supine position or when jugular vein compressed. > 3yo PDA (patent ductus arteriosus) - CORRECT ANSWER-2-4/6 continuous heard best over LUSB. Full pulses. Most common congenital heart defect. More common in girls MVP - CORRECT ANSWER-1-3/6 mid-systolic click w/ late systolic murmur. Heard best at apex. Louder with standing/squatting. Often seen with pectus excavatum Pulmonic valve stenosis - CORRECT ANSWER-2-5/6 best at LUSB, ejection click @ 2nd L ICS. Radiates to back. May involve wide S2. Usually d/t fusion of valves HTN in peds - CORRECT ANSWER-Organ problem or aldosterone. Cushings. Refer to cards Rheumatic heart disease - CORRECT ANSWER-Joints, CNS, post infectious group a strep. affects mitral valve. Jones criteria (carditis, chorea, erythema marginatum, esr elevated, arthralgia, fever, prolonged PR interval) Kawasaki's - CORRECT ANSWER-Toxic vasculitis. Fever several days, rash, swelling, peeling, strawberry tongue, prolonged PR or QT. ASA, refer. Intusucception - CORRECT ANSWER-Surgical emergency. Lethargy, vomiting, jelly stool, mass in RUQ. Can be from rotavirus ? Neuroblastoma - CORRECT ANSWER-Adrenal gland tumor, before age 5. Mass in abdomen. Catecholamines elevated. Painful, fixed, crosses midline. Fetal alcohol syndrome - CORRECT ANSWER-Small head, shortened palpebral fissures (narrow eyes), flat nasal bridge. Thin upper lip. Port wine stain - CORRECT ANSWER-Trigeminal nerve, refer to opthlamology to rule out congeital glaucoma. Can be a sign of Sturge-Weber syndrome. Hirschberg Test - CORRECT ANSWER-Corneal light reflex, tests for strabismus. Anal wink - CORRECT ANSWER-Absence is indicitave of spina bifida Tonic neck - CORRECT ANSWER-Fencing When do you get MMR? - CORRECT ANSWER-12 months and 4-6 years ol.d 2 month development - CORRECT ANSWER-Follows objects past midline, coos, lifts head, smiles 6 month development - CORRECT ANSWER-Palmar grasp, reaches, bring things to mouth, pass things from one hand to another, sits up on own, turns belly-back-belly 9 month development - CORRECT ANSWER-pincer grasp, pulls to stand, peek a boo, report absence of babble or inabilty to sit alone. Follows simple one-step command (9- 11mo) 12 month development - CORRECT ANSWER-Bye bye, walks, mama, dada, check for anemia, lead poisoning. Report inability to transfer, or weight bearing. 15 month development - CORRECT ANSWER-Spoon, cup, walk, follows 2-step commands, knows 4-6 words, up stairs w/help 18 month development - CORRECT ANSWER-Walk up steps, turns pages, body parts. Pathologic jaundice - CORRECT ANSWER-At birth or within first day,soles of feet bright yello. Caused by ABO incompatibility. R/o kernicterus Coarctation of aorta signs - CORRECT ANSWER-Compare brachial and femoral pulse. Normal finding BP higher in legs than arms. Wilm's Tumor - CORRECT ANSWER-Abdominal mass that extends from flank to midline. Rarely crosses midline. Abdominal pain, hematuria, HTN. Epiglottitis signs - CORRECT ANSWER-Rapid onset of fever, chills, severe sore throat, "hot potato voice", drooling. Usu. between age 2-6. 2 year development - CORRECT ANSWER-2-3 word setences. Simple commands. Knows first name. Copy straight line. Jumps w/ both feet, runs 3 year development - CORRECT ANSWER-Copies circle. Knows 3 numbers and 3 colors. Speech understood by strangers. Phallic stage. Group play. Walks backward, hops on 1 foot. Gives 1st and last name 5 year development - CORRECT ANSWER-Copies square. Dresses self. Skipping, hopping. 6 year development - CORRECT ANSWER-Copies trinagle, diamond (7). Ties shoes. Preschool vaccines - CORRECT ANSWER-MMR, varicella, IPV, dtap Middle School Vaccines - CORRECT ANSWER-Tdap, MCV4, HPV. (3 total doses of HPV). Fragile X Syndrome - CORRECT ANSWER-Large head circumference, mental retardation, autism, avoids eye contact. Prominent long face, forehead, large ears, flat face. Hodgkin's Lymphoma - CORRECT ANSWER-Enlarged, painless cervical and supraclavicular adenopathy, fever a nd night sweats. Common 15-19. ALK phos - CORRECT ANSWER-normally elevated in puberty due to growth spurts. Primary amenorrhea - CORRECT ANSWER-Lack of menarche before age 15. Secondary amenorrhea - CORRECT ANSWER-Most common cause pregnancy, anorexia, PCOS. CRAFFT questions - CORRECT ANSWER-Screening for adolescent substance abuse. Car, relax, alone, forget, friends, trouble When to screen for type 2 diabetes in children? - CORRECT ANSWER-Overweight (BMI >85th percentile), plus 2 risk factors. Family hx, race, signs of diabetes, maternal history of DM or gestational Diagnosing ADD - CORRECT ANSWER-Symptoms present before age 12, impairment present in 2 settings, functional interference Peritonsillar abscess - CORRECT ANSWER-Bacterial, hot potato voice, lock jaw (trismus) ICS for children 0-4 - CORRECT ANSWER-Budesonide, fluticasone ICS 5-11 - CORRECT ANSWER-budeonide, beclomethasone, fluticasone When to tx AOM? - CORRECT ANSWER-Children younger than 6 months, severe with unilateral or bilateral, non severe with bilateral in children 6-23 months Abx for AOM - CORRECT ANSWER-Amoxicillin or if PCN allergic, cefdinir/cefuroxine Moderate dehydration Oral rehydration therapy - CORRECT ANSWER-50-100 ml/kg over 3-4 hours, frequent small volumes CAP in children less than 5 - CORRECT ANSWER-Common: Amoxillin or augmentin, atypical: azithromycin CAP in children older than 5 - CORRECT ANSWER-Amoxicillin, atypical" azithromycin/clarithyromycin. Doxy for children over 7 UTI treatment in children 2-24 months - CORRECT ANSWER-7-14 days. Amoxicillin, bactrim, ceficime, cephalexin, cefpodoxine Ectopic pregnancy - CORRECT ANSWER-Abdominal pain, dark, tarry bleeding. Get HCG. Tender adnexa, positive CMT Goodell's sign - CORRECT ANSWER-softening of cervix Chadwick's sign - CORRECT ANSWER-blue color to cervix Hager's sign - CORRECT ANSWER-Softening of cervical uterine junction Alpha Fetal Protein - CORRECT ANSWER-Should not be elevated in single uterine pregnancy When is viability? - CORRECT ANSWER-24 weeks Treatment for PIH - CORRECT ANSWER-Rest, fetal surveillance, kick counts, left lateral position Signs of preeclampsia - CORRECT ANSWER-sudden weight gain, hands/feet swelling, protein in urine, htn Signs of placental previa - CORRECT ANSWER-late 2nd-3rd trimester, bleeding preciptated by intercourse, painless, no tenderness. Nothing in vagina. Signs of placental abruptio - CORRECT ANSWER-Severe pain, bleeding, cocaine use,smoking, alcohol Absolute contraindications of combination BC - CORRECT ANSWER-DVt, bleeding disorder, major surgery, smoker over 35, migraines with focal neuro changes, CAD or CVA, undiagnosed bleeding, pregnancy, liver tumor, estrogen depednet tumor. MYCUPLETS Relative contraindications for BC - CORRECT ANSWER-Migraines, smoke >15 cigarettes under 35, fracture on lower extremities, severe depression, hyperlipidemia Advantages of BC pill - CORRECT ANSWER-Decreased risk of ovarian and endometrial cancer, cramps, PID, IDA< acne, cysts, heavy periods What do you do if you miss the pill? - CORRECT ANSWER-Missed 1 day: Take 2 now and continue. Missed 2 days: Take 2 the next 2 days and finish pack. Morning after pill - CORRECT ANSWER-72 hours. 89% effective. Treatment for fibrocystic breast - CORRECT ANSWER-Decrease caffeine. Vitamin E and primrose capsules. Paget's disease - CORRECT ANSWER-Older female, scaly, red-colored rash. Scaly nipples PAP smear: Atypical squamous cells of undetermined significance - CORRECT ANSWER-20 or younger: repeat in 1 year 21 and older: order with HPV DNA testing. HPV: colposcopy PAP smear: atypical glandular cells - CORRECT ANSWER-Endometrial biopsy PAP smear: endometrial cells - CORRECT ANSWER-endometrial biopsy PAP: Low grade squamous intraepithelial lesions, high grade squamous - CORRECT ANSWER-HPV testing, colposcopy, biopsy Biphosphonates - CORRECT ANSWER-Aldendronate, risedronate. Take in morning with full glass of water, wait at least 30 minutes before laying down. Do no take with other meds. Low Alpha fetal protein - CORRECT ANSWER-Down's syndrome; order triple screen or quadruple screen High Alpha fetal protein - CORRECT ANSWER-R/o neural tube defect or multiple gestation. order triple or quad screen. Positive signs of pregnancy - CORRECT ANSWER-Palpation of fetus, US, heart tones Probable signs of pregnancy - CORRECT ANSWER-HCG, quickening, all of the "signs" Presumptive signs of pregnancy - CORRECT ANSWER-N/V, fatigue, amenorrhea What does rhogam do? - CORRECT ANSWER-Destroys fetal Rh-positive RBCs that have crossed the placenta Tx for asymptomatic bacteruria in pregnancy - CORRECT ANSWER-Always treat. Nitrofurantoin, Amoxicillin. Abx to avoid late in pregnancy - CORRECT ANSWER-tetracyclines, nitrofurantoin (very end/also do not use in G^PD anemia)), sulfa drugs. How to treat mastitis? - CORRECT ANSWER-Non-MRSA: Dicloxacillin MRSA: Bactrim, clinda Normal cup to disc ratio in eye - CORRECT ANSWER-Cup should not be more than 1/2 the size of diameter of disc. If it is, glaucoma. Arcus stenosis - CORRECT ANSWER-Order lipid panel. Ptergyum - CORRECT ANSWER-Wedge shaped growth of non cancerous skin Hordeoleum - CORRECT ANSWER-Staph infection, stye. Warm compresses. Chalazion - CORRECT ANSWER-Beady nodule, painless. Blepharitis - CORRECT ANSWER-Staph. Sebhorreic dermatitis of lid edge. Hot compresses, topical, scrub. Signs of glaucoma - CORRECT ANSWER-Increased ICP. Cupping of disc Open angle glaucoma - CORRECT ANSWER-Peripheral vision loss. Alpha 2 adrenergic. Tinolol, pilocarpine. Closed angle glaucoma - CORRECT ANSWER-Immediate referral. Eye pain when closed, halos around lights. Mannitol, xolimide. What is leading cause of treatable blindness? - CORRECT ANSWER-Cataracts. Painless, clouded, blurred vision. Diplopia, opacity of lens