AANP STUDY QUESTIONS AND ANSWERS LATEST EXAM 2023/2024

AANP STUDY QUESTIONS AND ANSWERS LATEST EXAM 2023/2024 what OTC medication class should be avoided in patients with HF, and HTN - CORRECT ANSWER-NSAIDS (ASA, Naproxen, IBU, Diclofenac, Indomethacin, Advil, Motrin, Aleve, Naprosyn) differential for protein in urine - CORRECT ANSWER-R/O infection, pyelonephritis-order C&S What back problem is worse with standing, better with sitting - CORRECT ANSWERHerniated disc What HTN medication will a patient be on permanently after an MI - CORRECT ANSWER-Beta Blocker-cardio-selective Most common cause of Dementia - CORRECT ANSWER-Alzheimer's disease 2nd most common cause of Dementia in elderly - CORRECT ANSWER-Dementia with Lewy body (DLB) S/S Lewy Body Dementia - CORRECT ANSWER-1. Causes sleep disturbance 2. Visual Hallucinations 3. Impaired executive fx (self-regulation skills, attention, planning, multitasking, selfcontrol, motivation and decision making skills 4. parkinsonism (muscle rigidity, tremors) 5.Fluctuations of alertness and cognition Alzheimer's Disease (AAA) - CORRECT ANSWER-Early signs are short term memory difficulty remembering names and recent events( Agnosia), plus wandering, apathy, apraxia (trouble speaking), aphasia, (loss of ability to understand/comprehend or formulate/express speech). Vascular Dementia - CORRECT ANSWER-Ischemic damage d/t atherosclerotic plaques, bleeding, blood clots S/S vascular dementia - CORRECT ANSWER-sx of stroke with cognitive symptoms such as memory loss, impaired executive fx, impaired judgement, and apathy (lack of interest). Delerium - CORRECT ANSWER-reversible temporary acute onset Tx cause (ie... medication, substance abuse, benzo withdrawal, preexisting medical problem, infection/sepsis, electrolyte imbalance, heart failure renal failure Wernicke-Korsakoff syndrome - CORRECT ANSWER-D/T chronic thiamine (B1) deficiency secondary to chronic alcohol intake S/S Wernicke-Korsakoff - CORRECT ANSWER-confusion disorientation indifference horizontal movement nystagmus(both eyes) Tx high dose thiamine S/S of Delirium - CORRECT ANSWER-excitable, irritable, and combative, with short attention span, memory loss and disorientation. How to screen for Dementia - CORRECT ANSWER-elicit a thorough Hx from friends/family Cognitive testing via MME Diagnostic test needed to R/O secondary causes - CORRECT ANSWER-syphilis, VB12 deficiency, TSH, CBC, heavy metals, Best brain imaging = MRI Feverfew - CORRECT ANSWER-Migraine HA glucosamine - CORRECT ANSWER-osteoarthritis Cinnamon - CORRECT ANSWER-Improves Blood sugar Isoflavones (from soy beans) - CORRECT ANSWER-estrogen-like effects saw palmetto - CORRECT ANSWER-Urinary sx of BPH Kava Kava - CORRECT ANSWER-Anxiety; insomnia St Johns wort - CORRECT ANSWER-Mild depression, do not use with SSRI, sumatriptans, HIV protease inhibitors, Tumeric - CORRECT ANSWER-Alzheimers disease, arthritis, CA ginko boloba - CORRECT ANSWER-memory Black co-hosh - CORRECT ANSWER-menopause sx/hot flashes Leg-calve-Perthese Disease - CORRECT ANSWER-Hip disorder in children. Ball shaped head of thigh bone (femoral head) loses its blood supply casing aseptic necrosis (ER) Osgood-Schlatter Disease - CORRECT ANSWER-common cause of knee pain in young athletes. Caused by overuse of knee. stress on patellar tendon by quadriceps muscles. pain, tenderness and swelling at the tendon insertion site (tibial tuberosity). Usually effects one knee, can be bilateral. Example: 14 y/o boy c/o tender bony mass over anterior tubercle of one knee. R/O avulsion fracture (tibial tubercle) if acute onset of pain post trauma. Tx of Osgood Schlatter disease - CORRECT ANSWER-R.I.C.E; avoid aggravating activities. Tylenol or NSAIDs Quadriceps strengthening/hamstring strengthening S/S of leg-calve-perthes - CORRECT ANSWER-pain in hip aggravated by activity, pain in thigh or knee area, walks with limp, rest alleviates pain, muscle loss noticed over time. Slipped Capital Femoral epiphysis (SCFE) - CORRECT ANSWER-posterior and inferior slippage of the proximal femoral epiphysis on the metaphysis (femoral neck) during early adolescent growth spurt. most common hip disorder S/S of SCFE - CORRECT ANSWER-groin, thigh, or knee pain, rather then hip pain. what anti-HTN drugs d you avoid in GERD - CORRECT ANSWER-CCB also avoid grapefruit What topical estrogen cream can be used for atrophic vaginitis - CORRECT ANSWERPremarin cream Causes of sinus tachycardia - CORRECT ANSWER-Hypothyroidism drug use anemia Hypotension Fever If an HIV patient has a CD4 count of <200 what do they have - CORRECT ANSWERAIDS what induration is a (+) PPD test in an HIV patient - CORRECT ANSWER->5mm milia - CORRECT ANSWER-multiple white 1-2 mm papules located mainly of forehead, cheeks and nose. resolves spontaneously d/t retention of sebaceous material and keratin Seborrheic dermatitis (cradle cap) - CORRECT ANSWER-excessive thick scaling on scalp Tx softening and removal of scales-use mineral or vegetable oil Mongolian spots - CORRECT ANSWER-Blue to black colored patches or stains. common in NA, Hispanic, black neonates Erythema Toxicum Neonatorum - CORRECT ANSWER-Small pustules (whitish yellow color) that are 1-3mm in size and surrounded by a red base erupts during 2nd-3rd day of life. Located on face, chest, back, extremities. last 1-2 weeks, then resolves. Addisons disease - CORRECT ANSWER-Disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and non-exposed parts of the body. adrenal glands do not produce enough of the hormone cortisol and in some cases, the hormone aldosterone Faun Tail Nevus - CORRECT ANSWER-Tufts of hair overlying spinal column usually at the lumbosacral area May be a sign of neural tube defect. PE to perform if Faun Tail Nevus is noted - CORRECT ANSWER-Perform neurological exam focusing on lumbosacral nerves (fecal/urinary incontinence, problems with gait) Dx test to order if suspected Faun Tail Nevus - CORRECT ANSWER-US to r/o occult spina bifida Pt presentation with Addison disease - CORRECT ANSWER-Chronic, worsening fatigue and muscle weakness, loss of appetite, and weight loss are characteristic of the disease. Nausea, vomiting, and diarrhea occur in about 50 percent of cases. Blood pressure is low and falls further when standing, causing dizziness or fainting. Skin changes also are common in Addisons disease, with areas of hyperpigmentation, or dark tanning, covering exposed and nonexposed parts of the body. This darkening of the skin is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes. Addisons disease can cause irritability and depression. Because of salt loss, craving of salty foods also is common. Hypoglycemia, or low blood sugar, is more severe in children than in adults. In women, menstrual periods may become irregular or stop. what test would you order to confirm Addison Disease - CORRECT ANSWER-morning cortisol test Eye changes in Hypertensive retinopathy - CORRECT ANSWER-AV nicking, silver &/or copperwire arterioles, flame shaped hemorrhage Abnormal eye findings in Diabetic Retinopathy - CORRECT ANSWER-Cotton wool spots, microaneurysm, hard exudate, neovascularization Beta Andrenergic Blockers - CORRECT ANSWER-"olols" decrease HR and SV Cardioselective. Avoid non cardio selective (propranolol, Nadolol) in lower airway disease Aldosterone - CORRECT ANSWER-e.g. aldosterone, spironolactone S/E Gynecomastia, Hyperkalemia risk Decreases PVR ARBS "sartans" - CORRECT ANSWER-Meds: Losartan, Telmisartan Effects: Decrease PVR S/E K+ sparing/Hyperkalemia Contra: Preg category D ACEI "prils" - CORRECT ANSWER-Med: Lisinopril Effects: Decreases PVR S/E: K+ sparing/hyperkalemia risk with inadequate fluid intake Induces cough Contra: Preg Categ D Q: patient presents with amenorrhea and galactorrhea (spontaneous flow of milk). what lab would you order - CORRECT ANSWER-A: check prolactin Q: what does pencil like/ribbon-like stool represent - CORRECT ANSWER-Colon CA Reactive arthritis "Ode" - CORRECT ANSWER-Cant see (conjunctivitis) Cant pee (urethritis) Cant climb a tree (Ankle/knee involvement) Reactive arthritis/Reiter syndrome - CORRECT ANSWER-is an inflammatory arthritis effects intestines, genitals or urinary tract. Reactive arthritis usually targets your knees and the joints of your ankles and feet. Inflammation also can affect your eyes, skin and urethra