AANP Board Certification Exam Questions and Complete Solutions Graded A+

  1. how long will a cough last for acute bronchitis? Answer: up to three weeks is com- pletely normal 2. how do you treat acute bronchitis? Answer: 95% cases are viral-- tessalon pearls to help with cough. ** prednisone is never the answer *** 3. explain the following views of chest xrays Answer: AP, PA, PA and lateral which one do you want for pneumonia patient? Answer: AP- shows the heart predomi- nantly because its from front to back PA- shows the lungs predominantly because its back to front lateral shows fluid line 4. what is the gold standard for diagnosing community acquired pneumonia- Answer: chest xray- PA/lateral, repeat post treatment in 6 weeks (repeat not really done anymore) 5. treatment guidelines for CAP- healthy adult no comorbidities Answer: MAD LUNG amoxicillin 1 gram TID (best choice) doxycycline 100 mg twice daily macrolide (mycin) in areas with low macrolide resistance so not the best choice 6. treatment guidelines for CAP- adult with comorbidities Answer: monotherapy Answer: respi- ratory quinolone (levofloxacin 750 mg daily) combination therapy Answer: augmentin or cephalosporin PLUS macrolide or doxy 7. what are common respiratory fluroquinolones? Answer: Think FLOXACIN-- moxi- floxacin, gemifloxacin, levofloxacin 8. what are common macrolides for CAP Answer: think "MYCIN" -- azithromycin, clar- ithromycin 9. what are common tetracyclines for CAP Answer: doxycycline 10. what are common beta lactams for CAP Answer: amoxicillin, augmentin (amox with clav), cefpodoxime, cefuroxime 11. how would you treat a pregnant 29 year old with pneumonia? Answer: Amoxicillin 1 g TID-- cant give levaquine (flouroquinolones no in pregnancy due to fetal ligament destruction, doxycycline no in pregnancy stains tooth bones in fetus) 12. how long do you give antibiotics to patient with pneumonia? Answer: 5-10 days, you always want to continue antibiotics for 3 more days after clinically stable (no fever) 13. When do you get a chest xray for pneumonia? Answer: it is the gold standard for diagnosis, you do not need to do resolution chest xray unless things are lingering or you suspect something else. 14. When do you give pneumococcal vaccine? Answer: adults > 65 years old you give PPSV23 or you can give both PCV 13 and PPSV23 but must be 1 year apart adults > 65 with immunocompromising condition give both pcv 13 and ppsv23 adults 19-64 at increased risk of pneumococcal disease (asthma, copd, smokers, cv dz) - give PPSV23 only adults 19-64 with asplenia, cochlear implants, csf leak-- give pCV13 NOW then PPSV23 in 8 weeks , then PPSV23 in 5 years. 15. What is the diagnostic criterion for COPD Answer: FEV1/FVC ratio of < 0.70 16. What are characteristics of COPD Answer: midlife onset, symptoms slowly progres- sive, exposure to lung irritant, DOE is progressive, chronic cough and chronic sputum production 17. what are characteristics of asthma Answer: onset early in life, symptoms vary widely from day to day, symptoms worse at nighttime/early AM, allergic rhinitis, eczema, family history, obesity 18. what are characteristics of heart failure (when evaluating diff dx of COPD)- Answer: chest xray with dilated heart, pulmonary edema 19. what are characteristics of tuberculosis when ruling out for COPD patient- Answer: onset all ages, chest xray with lung infiltrate, microbiologic confirmation 20. what are the characteristics of bronchiectasis Answer: LOTS OF PURULENT SPU- TUM, chest xray shows bronchial wall thickening and bronchial dilation 21. What intervention has the greatest influence on slowing progression of a COPD patient? Answer: smoking cessation!! 22. what are first line smoking cessation drugs? (3) Answer: varenicline (chantix), nico- tine patch, buproprion extended release (zyban) 23. what is second line smoking cessation drug? Answer: sertraline (zoloft) 24. what smoking cessation drug would you give to someone with a history of a suicide attempt? Answer: nicotine patch-- NOT CHANTIX OR ZYBAN 25. What are the short acting beta agonists Answer: albuterol, levalbuterol 26. what are the long acting beta agonists Answer: "terols" Salmeterol Formoterol 27. How do inhaled anticholinergic drugs work? Answer: used in COPD, prevent bron- choconstriction 28. how do beta agonists work? Answer: stimulate beta 1 (tachycardia) and beta 2 (bron- chodilation) 29. what is the suffix for inhaled anti-cholinergic drugs? Answer: "tropium" think iprat- ropium (atrovent) SHORT ACTING, tiotropium (spiriva) long acting 30. What is a SAMA? Answer: short acting antimuscarinic (anticholinergic) - Ipratropium 31. what is a LAMA? Answer: long acting muscarinic antagonist (anticholinergic) Tiotropi- um (spiriva) 32. what are the 4 steps of GOLD guidelines Answer: 1) SABA or SAMA prn 2) LABA or LAMA PLUS rescue med 3) ICS + LABA/LAMA plus rescue med 4) ICS+ LABA AND LAMA plus rescue med THEN REFER 33. How to manage COPD exacerbation? Answer: figure out the cause mild Answer: sabas with spacers / nebulizer moderate Answer: SABAs plus AB and or steroid Severe Answer: hospitalization 34. right supraventricular nodes signal what malignancies? Answer: lungs, medi- astinum, esophagus 35. left supraventricular nodes signal what malignancies? Answer: abnormal (stomach, GB, liver, pancreas, ovaries, prostate) 36. us preventive services task force routine lung cancer screening recom- mends what annual screening for current smokers aged 55-80 with 30 pack year history or have quit within the last 15 years? Answer: annual low dose CT (LDCT) 37. how do you diagnose asthma > 5 years of age Answer: Answer: presence of asthma features reversible airway obstruction on spirometry >12% improvement from baseline or FEV1 > 200 ml after SABA 38. How do you treat asthma? Answer: saba always as rescue inhaler Step wise approach (GINA) Low dose ICS then ICS + LABA increase dosage strength 39. acute bronchitis classic case symptoms Answer: cough that keeps awake at night dry cough but may be productive low grade fever or chest pain with cough wheezing and rhonchi median duration of cough is 18 days up to 3 weeks history of a cold before onset of symptoms 40. objective findings in acute bronchitis Answer: lungs Answer: clear to severe wheezing, rhonchi percussion Answer: resonant CXR Answer: normal afebrile to low grade fever 41. treatment plan for bronchitis Answer: symptomatic treatment- increas fluids and rest tessalon perles, expectorant / mucolytic (guaifenesin) ventolin (albuterol) for wheezing for severe wheezing consider short term oral steroid 42. complications of acute bronchitis Answer: exacerbation of asthma pneumonia from secondary bacterial infection 43. pertussis "whooping cough" Answer: caused by bordetella pertussis (gram negative) coughing illness at least 14 days paroxysmal coughing, inspiratory whooping neonates / infants at highest risk for death 44. three stages of pertussis Answer: catarrhal 1-2 weeks, if treated at this stage can shorten disease course paroxysmal Answer: lasts 2-4 weeks, treatment has little influence but is useful to decrease spread convalescent Answer: treatment goal is to eradicate carriage state / disease spread 45. how to diagnose pertussis Answer: nasopharyngeal swab for culture - collect at 0-2 weeks following cough PCR may provide accurate results up to 4 weeks Pertussis antibodies by ELISA CBC with elevated WBCs and marked lymphocytosis cxr should be negative 46. how to treat pertussis Answer: administer a course of antibiotics to close contacts iwthin 3 weeks of exposure first line Answer: macrolides - azithromycin z pack x 5 days alternative bactrim x 14 days antitussives, mucolytics, rest, hydration, frequent small meals 47. complications of pertussis Answer: sinusitis, otitis media, pneumonia, fainting, rib fractures from coughing 48. signs of pulmonary embolism Answer: new onset dyspnea, hemoptysis, pleuritic chest pain, vital signs with tachycardia, tachypnea, may have signs of DVT