AANP STUDY GUIDE EXAM TEST 2023/2024 QUESTIONS AND ANSWERS

AANP STUDY GUIDE EXAM TEST 2023/2024 QUESTIONS AND ANSWERS normal heart anatomy - CORRECT ANSWER-- base at top, apex at bottom - aortic, pulmonic, tricuspid, mitral - S1 heart sound = closure of AV valves, mitral & tricuspid - S2 heart sound = closure of SL valves, aortic & pulmonic - S3 = extra fluid, HF, preg - S4 = uncontrolled HTN, LV hypertrophy Split S2 - CORRECT ANSWER-- during inspiration and expiration is bad - normal = only during inspiration where do you hear heart sounds - CORRECT ANSWER-- S2 at base - S1, S3, S4 at apex Diastolic murmurs - CORRECT ANSWER-- DOOM! - refer! - MS. ARD 1. mitral senosis 2. aortic regurgitation systolic murmurs - CORRECT ANSWER-- only systolic murmurs radiate MR. ASS MVP mitral regurg aortic stenosis mitral valve prolapse aortic stenosis - CORRECT ANSWER-- closest to neck - radiates to neck - systolic Mitral regurgitation - CORRECT ANSWER-- radiates to armpit - systolic Mitral valve prolapse - CORRECT ANSWER-- systolic murmur - normally hear a click - commonly seen with marfan syndrome palpable thrill murmur - CORRECT ANSWER-= grade 4 or higher peripheral arterial disease - CORRECT ANSWER-- purple and shiny - intermittent claudication: pain relieved with rest and dangling, pain with activity - ulcer on toes - DX: Ankle Brachial Index (ABI) < 0.9 = PAD - ABI calculated for each leg by dividing BP in artery of ankle by BP in artery of arm - risks: smoking - tx: keep walking and take breaks as needed chronic venous insufficiency - CORRECT ANSWER-- red, brown skin - edema - vericose veins - high risk for DVTs: no good venous return to heart so it starts to pool - refer to vascular DVTs - CORRECT ANSWER-- s/s = localized swelling, redness, calf pain - DX: venous doppler, D-dimer, homan's sign (no longer specific enough) Raynaud's phenomenon - CORRECT ANSWER-- decreased blood flow to fingers - caused by exposure to cold, stress - Tx = CCBs, avoid triggers asthma severity - CORRECT ANSWER-- predominant symptom = cough - intermittent, mild, moderate, severe asthma tx - CORRECT ANSWER-- peak flow readings at home - NOT determined on how often they use rescue inhaler - NEVER prescribe long acting beta agonist by itself (formoterol, salmeterol), always with ICS. Increases risk of asthma related death - all pts need low dose ICS (decrease overall mortality in pts) Peak flow readings - CORRECT ANSWER-height age gender HAG ASthma meds - CORRECT ANSWER-- ICS-LABA PRN: intermittent - ICS-LABA daily: mild - ICS-LABA daily OR low dose ICS with LRTA (singulair): moderate - REFER to pulm: severe *budesonide-formoterol = preferred ICS-LABA combo bronchodilators - CORRECT ANSWER-- "terol" steroids - CORRECT ANSWER-- "ide" - "zone" COPD Dx - CORRECT ANSWER-- FEV1/FVC ratio < 0.70 - s/s: barrel chest, clubbing of fingers, chronic caugh - exam: percussion hyperresonance - chronic bronchitis and emphysema chronic bronchitis or emphysema BEFORE COPD - CORRECT ANSWER-= bronchodilator COPD Tx - CORRECT ANSWER-- Group A: SABA or LABA - Group B: LABA or LAMA - Group C: LAMA - Group D: LAMA or LAMA-ICS *albuterol - formoterol - tiotropium - combo LAMA-ICS (trelegy) Pneumonia - CORRECT ANSWER-- infiltrates and consolidation in lower lobes - exam: increased tactile fremitis - s/s: cough, fever, chills, rhonchi, wheezes pneumonia tx - CORRECT ANSWER-- MAD: macrolide, amoxicillin, doxycycline = healthy outpt adults - comorbidities or abx in last 90 days = levaquin or augmentin AND macrolide CURB-65 criteria - CORRECT ANSWER-- hospital admission criteria for elderly - confusion, BUN > 19, RR > 20/30, BP < 90/60, > 65 yrs - 1pt for criteria. 2 pts might be admission. 3 or greater is admission tuberculosis - CORRECT ANSWER-- upper lobes - tx: usually requires tx up to a year and 3 drug tx - dx: confirmed with sputum culture TB skin test - CORRECT ANSWER-- HIV/immunocompromised: > 5mm - gen public: > 15 mm - immigrants: > 10 mm HIV - CORRECT ANSWER-- turns into AIDS with CD4 < 200 - prophylactic abx < 200 = bactrim strep throat - CORRECT ANSWER-- s/s = sore swollen throat, exudates on tonsils - KEY: palentine petichiae - amoxicillin, PCN mononucleosis - CORRECT ANSWER-- s/s = sore swollen throat, exudates on tonsils - KEY: splenomegaly - tx: no abx, viral, tx s/s - return to sports after spleen ultrasound scarlantina - CORRECT ANSWER-- s/s: sandpaper rash, terrible looking throat - results from untx strep throat - can lead to rheumatic fever, glomerulonephritis tx for strep and mono at same time - CORRECT ANSWER-- must tx with abx due to risks - do not give PCN, can lead to morbillaform rash - tx = macrolide, cephalosporin, PCN VK acute bronchitis - CORRECT ANSWER-- s/s: nagging cough, some sputum or not - 95% of cases are viral - tx: only tx with abx if due to pertusis (doesn't decrease s/s but does decrease transmission) - azithromycin - vax: TDAP, DTAP - fever after vax usually due to pertusis component sinusitis - CORRECT ANSWER-- s/s: recent URI, 7-10 days later roccurance of symptoms, pain bending over, unilateral toothache - tx: augmentin allergic rhinitis - CORRECT ANSWER-- avoid triggers - tx: intra-nasal corticosteroids (flonase), antihistamine (benadryl) - dx: IGE anticholinergic side effects - CORRECT ANSWER-- cant see, cant pee, cant spit, cant poop Thyroid function - CORRECT ANSWER-- check TSH first - TSH: 0.5-5.0 hypothyroidism - CORRECT ANSWER-- high TSH, low T3/T4 - tx: Synthroid -- monitor cardiac affects, start at low dose in elderly - check TSH every 4-6 wks hyperthyroidism - CORRECT ANSWER-- low TSH, high T3/T4 - tx: propanolol, tapazole, PTU - PTU preferred in 1st trimester of preg then move to tapazole - PTU: frequent lab levels, mult doses per day parathyroid - CORRECT ANSWER-- located behind thyroid - release PTH: calcium and phosphorus hyperparathyroidism - CORRECT ANSWER-- calcium is high - phos is low - calcium high is concern for underlying malignancy subclinical hypo or hyperthyroidism - CORRECT ANSWER-abn TSH and normal ts/t4 - monitor in 6 months, tx once actually hyper or hypo DM 2 - CORRECT ANSWER-- dx: A1C at or > 6.5% - fasting BG, oral glucose tolerance test