AANP EXAM, PRACTICE EXAM AND STUDY GUIDE NEWEST 2024 ACTUAL EXAM 450 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES

Erythropoetin - CORRECT ANSWER 90 % renal, 10% hepatic, need supplementation when GFR is less than 49 Reticulocytes - CORRECT ANSWER In health, make up 1-2 % of total RBCs, increased in response to anema. Absence of reticulocytosis or presence of reticulocytopenia shows inadequate bone marrow response. Hemoglobin - CORRECT ANSWER normal is 12 for females and 15 for males. Ratio to hematocrit is 1:3 MCV - CORRECT ANSWER determines red blood cell size - normal is 80-96 MCH - CORRECT ANSWER reflects hgb content and color, normal is 31-37 RDW - CORRECT ANSWER variation of RBC size - normal is 11.5-15% Normocytic, normochromic , normal RDW - CORRECT ANSWER acute blood loss, anemia of chronic disease Microcytic, hypochromic anemia, elevated RDW - CORRECT ANSWER Iron deficiency anemia Microcytic, hypochromic, normal RDW - CORRECT ANSWER alpha or beta thalassemia minor Macrocytic, normochromic, elevated RDW - CORRECT ANSWER Vitamin B12 deficiency, folate deficiency, pernicious anemia Macrocytosis without anemia - CORRECT ANSWER use of medications like tegretol, AZT, depakote, dilantin, alcohol Heart murmur seen in b12 deficiency - CORRECT ANSWER Hemic murmur Most common pathogen in CAP, ABRS, AOM - CORRECT ANSWER S. pneumoniae Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and tobacco use - CORRECT ANSWER H. influenzae, more than 30% now pcn resistant via beta lactamase production First line treatment for Acute Bacterial Rhinosinusitis - CORRECT ANSWER Augmentin 500/125 TID or 875/125 BID Second line treatment for Acute Bacterial Rhinosinusitis - CORRECT ANSWER Augmentin 2000/125 BID or doxy 100 mg BID or 200 mg QD Treatment for ABRS if allergic to PCN, Cephalosporins - CORRECT ANSWER Doxy, Levofloxacin, Moxifloxacin Treatment for ABRS if antibiotic resistance of failed initial therapy - CORRECT ANSWER Doxy, levofloxacin, moxifloxacin Presbycusis - CORRECT ANSWER slowly progressive hearing loss that is symmetric and high frequency 1st line controller therapy in allergic rhinitis - CORRECT ANSWER Intranasal corticosteriods like Flonase, Nasonex, Nasacort, Omnaris. Side effects are that nasal irritation and bleeding may occur. Optimal efficacy may take 1-2 weeks. 1st line rescue treatment in allergic rhinitis - CORRECT ANSWER Nasal antihistamines, esp if there is nasal congestion. sedation could occur. Drugs like astelin, Astepro, and patanase 1st generation oral antihistamines - CORRECT ANSWER significant potential to cause sedation and anticholinergic effects so not a first line therapy. Ex. benadryl, chlor trimeton, dimetapp, vistaril. 2nd generation oral antihistamines - CORRECT ANSWER These are preferred over because no anticholinergic effects but not as helpful with nasal congestion. Ex. claritin, clarinex, zyrtec, allergra Oral decongestants - CORRECT ANSWER alpha adrenergic agonist so vasoconstrictive. Take caution with the elderly, young children, HTN, bladder neck obstruction, glaucoma, and hyperthyroidism. Ex. sudafed Nasal decongestants - CORRECT ANSWER Alpha adrenergic agonist so vasoconstrictive. Can cause rebound congestion/medicamentosa so limit use to 5-7 days. Intranasal anticholinergics - CORRECT ANSWER reduce runny nose because of drying action. No effect on other nasal symptoms. Dryness can occur. Ex.. Atrovent Found on fundoscopic exam of person with angle-closure glaucoma - CORRECT ANSWER deeply cupped optic disc because of increase intraocular pressure than pushes the optic disc backwards., acute, painful Amsler grid - CORRECT ANSWER screening test for macular problems. Tonometry - CORRECT ANSWER measurement of intraoccular pressure, screen for glaucoma Presbyopia - CORRECT ANSWER Hardening of the lens, close vision problems, adults over 45 Senile cataracts - CORRECT ANSWER lens clouding, progressive vision dimming, distance vision problems, close vision usually retained and often improves. Risk factors are tobacco use, poor nutrition, sun exposure, systemic corticosteriod therapy. Potentially correctable with surgery. Open-angle glaucoma - CORRECT ANSWER Painless, gradual onset of increased intraocular pressure leading to optic atrophy. Causes a loss of peripheral vision if not treated. Avoidable with appropriate and ongoing intervention. more than 80% of all glaucoma. Treat with topical miotics, beta blockers, or surgery Angle closure glaucoma - CORRECT ANSWER sudden increases in intraocular pressure. Usually unilateral, painful, red eye, halos around lights, eyeball firm when compare to other. Immediate referral to opthmalogy Macular degeneration - CORRECT ANSWER thickening sclerotic changes in retinal basement membrane complex. Causes painless changes in vision including distortion of central vision. On fundo exam will see drusen (soft yellow deposits in macular region). Risk factors are tobacco use, sun exposure. No treatment available for dry form. Laser treatment or intraviteal injection of antivascular growth factor for wet form Treatment of suppurative (non gonococcal or chlamydial infection (s. aureas, s. pneumo, H. influ) - CORRECT ANSWER Primary: opthalmic with FQ ocular solution. Secondary: opthalmic treatment with polymixin B with trimetroprim solution or with azithromycin 1%. Treatment of otitis externa (pseudomonas sp, proteus sp). Acute infection often S. aureus. - CORRECT ANSWER otic drops with ofloxacin or cipro with hydrocortisone or polymixin B with neomycin and hydrocortisone. Cleaning of ear canal important. Use 1:2 mix of white vinegar and rubbing alcohol after swimming. Do not use neomycin if eardrum punctured. Exudative pharyngitis - CORRECT ANSWER Caused by A, C, G streptococcus, viral, HHV-6, M. pneumo. 1st line therapy is PCN PO for 10 days or IM for 1 dose if problems with adherence.