FNP BOARD REVIEW QUESTIONS AND ANSWERS WITH COMPLETE RATIONALE

A 24-year old, otherwise healthy college student presents with c/o cough x 6 weeks. She has tried several OTC cough meds with no improvement. What is the most important information to consider when building your differential diagnoses? A) Her age B) Family hx C) Ineffectiveness of OTC cough medicines D) Length of time she has been coughing - D) Length of time she has been coughing Why? This information helps you build your ddx Acute cough 3 weeks: bronchitis, sinusitis, PND, exacerbation of COPD/asthma, pneumonia, pulmonary embolism Chronic cough (8 weeks) GERD and Asthma are most common causes, also consider infection (e.g. pertussis, atypical pneumonia), ACE inhibitors, chronic bronchitis, bronchiectasis, lung ca) According to the CDC, what drug class is considered first-line treatment for pertussis? A) Sulfonamide B) Tetracycline C) Macrolide D) Beta-lactam - C) Macrolide antiobitic (e.g. Azithromycin, clarithromycin Sulfonamides are second-line Match the antibiotics with the correct drug class: 1. Sulfonamide 2. Tetracycline 3. Macrolide 4. Beta-lactam A. Doxycyline B. Azithromycin C. Penicillins D.Trimethoprim-Sulfamethoxazole E. Cephalosporin F. Clarithromycin - 1. Sulfonamide - D.Trimethoprim-Sulfamethoxazole (Bactrim) 2. Tetracycline - A. Doxycycline 3. Macrolide - B & F, Azithromycin and Clarithromycin 4. Beta-lactam - C & E, PCN and cephalosporins What are the three most common bugs in community-acquired pneumonia? - Streptococcus pneumoniae Mycoplasma pneuomiae (atypical pathogen) Chlamydophila pneumoniae (atypical pathogen) What is the treatment for CAP caused by Strep pneumo? - Respiratory quinolone (e.g. Levofloxacin, moxifloxacin, gemifloxacin) OR high-dose amoxicillin OR amoxicillin with clavulanate What antibiotics are avoided in CAP caused by Strep pneumo due to high rates of resistance? - Macrolides What is the treatment for CAP caused by Mycoplasma pneumoniae? - Macrolide OR doxycycline What antibiotics are avoided in CAP caused by atypical pathogens? - Beta-lactams (ineffective) A 38-year old mother of two teenagers recently recovered from Mycoplasma pneumonia a couple of weeks ago. She asks if she should get the "pneumonia shot." She takes levothyroxine 88 mcg daily for hypothyroidism, but is otherwise healthy. How do you respond? A) No, it's too soon after your infection B) No, it's not indicated C) Yes, you can get it in about a month D) Yes you can get it today - B) No, it's not indicated An otherwise healthy adult without immunocompromise or multiple comorbid conditions is not a "vulnerable population" The pneumonia vaccine does not prevent mycoplasma pneumonia According to GOLD, what is required to establish the diagnosis of COPD? - Spirometry (FEV1/FVC ratio 70%) A 70-year old house painter reports a 4-week history of exertional dyspnea, chest tightness, and cough for the past 3 months. He has never smoked. What diagnoses are included in your differential? Select 4. A) Asthma B) Angina C) COPD D) GERD E) Pneumonia F) Tuberculosis G) Heart Failure - B) Angina C) COPD F) Tuberculosis G) Heart failure How do inhaled anticholinergics work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - Tiotropium (Spiriva) How do inhaled betá-agonists work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - A) They cause bronchodilation in the lungs What are the only 2 inhaled short-acting beta agonists (SABAs): - Albuterol and levalbuterol