AANP FNP FINAL EXAM ACTUAL QUESTIONS AND
ANSWERS GRADED A+
✔✔Peripheral Vertigo - ✔✔I. Findings: Suggestive of peripheral causes
A. Pathognomonic for peripheral cause
1. Sudden onset with brief episodes often on awakening
2. Rotary Illusion with Nausea, Vomiting
B. Nystagmus
1. Combined horizontal and torsional Nystagmus
2. Persists 5-20 seconds after Dix-Hallpike Maneuver
3. Fixation of eyes on object inhibits Nystagmus
C. Moderate imbalance
D. Nausea or Vomiting
E. Associated findings
1. Hearing Loss
2. Tinnitus
F. Tullio's Phenomenon
1. Nystagmus and Vertigo provoked by loud sounds
II. Causes: Common (Peripheral Vertigo)
A. Acute Vestibular Neuronitis
B. Benign Paroxysmal Positional Vertigo
C. Meniere's Disease
III. Causes: Other (Peripheral Vertigo)
A. Ear Infections
1. Serous Otitis Media
2. Chronic Otitis Media
3. Otitis Externa
4. Mastoiditis
B. Other infections
1. Herpes Zoster Oticus (Ramsay Hunt Syndrome)
2. Acute Labyrinthitis (uncommon)
a. Not synonymous with Vestibular Neuritis
i. Labyrinthitis is much less common than neuritis
ii. Labyrinthitis causes permanent Hearing Loss
b. Types
i. Viral Labyrinthitis
ii. Bacterial Labyrinthitis (Rare)
C. Structural disorder
1. Cholesteatoma
2. Perilymphatic Fistula
3. Otosclerosis
D. Trauma
1. Temporal Bone Fracture
2. Labyrinthine Concussion
,✔✔Reiter's Syndrome - ✔✔
✔✔Perihepatitis - ✔✔
✔✔Spontaneous Abortions - ✔✔When there is vaginal bleeding and cramping but the
cervix remains closed it is a threatened abortion. It is possible in this case that the
pregnancy can be salvaged. In an inevitable abortion the cervix is dilated. In a complete
abortion the placenta and fetus are expelled completely. In an incomplete abortion
placental products remain in the uterus and the cervix remains dilated.
✔✔Addison's Disease - ✔✔
✔✔Cushing's Disease - ✔✔
✔✔Myocardial Infarction - ✔✔
✔✔Fosamax - ✔✔Patients taking aledronate are instructed to take the medication when
they get up in the morning, 30 minutes before eating and with a full glass of water. They
should be instructed to remain upright to avoid esophageal irritation. If they take this
medication with food, it will reduce the bioavailability by 40%. Taking alendronate with
coffee or orange juice will reduce bioavailabiliy by 60%.
✔✔Hyperlipidemia Medications - ✔✔The expected outcomes of the preceding
medications are as follows: Lipitor: LDL: 20-60% decrease HDL: 5-15% increase
Triglyceride: 10-40% decrease Gemfibrozil: LDL: 5-15% decrease HDL: 14-20%
increase Triglyceride: 20-50% decrease Nicotinic acid: LDL: 10-25% decrease HDL: 15-
35% increase Triglyceride: 20-50% decrease Colestipol: LDL: 10-20% decrease HDL:
3-5% increase Triglyceride: May increase
✔✔Trochanteric Bursitis - ✔✔I. Definition
A. Inflammation of bursa overlying hip greater trochanter
II. Symptoms
A. Pain overlying greater trochanter
B. May radiate into knee or ankle or into buttock
C. Night pain occurs if lying on affected side
D. Palliative and provocative factors
1. Worse when standing from seated or lying position
2. Improves initially on walking
3. Worse again after walking for >30 minutes
III. Signs
A. Point tenderness over lateral greater trochanter of hip
B. Symptoms reproduced on hip adduction
,C. Adduction and internal rotation may also provoke
IV. Management
A. NSAIDs
B. Modify activity
C. Trochanteric Bursa Injection
✔✔Marfan Syndrome - ✔✔I. Etiology
A. Defect in gene coding for fibrillin structure
B. Connective tissue defect affecting multiple systems
1. Musculoskeletal disease
2. Ocular disease
3. Cardiac disease
II. Signs
A. Body habitus
1. *Tall (Height exceeds 95th percentile for age)*
2. *Extremely slender build*
B. Cardiovascular signs and conditions
1. Mitral Valve Prolapse
2. Aortic root dilatation
3. Myocardial Infarction
4. Aortic Insufficiency
5. Congestive Heart Failure
6. Subacute Bacterial Endocarditis
7. Aortic Dissection
C. Musculoskeletal signs and conditions
1. Arachnodactyly (Spider fingers)
2. *Pectus deformity (Pigeon Breast or Funnel Breast)*
3. High narrow Palate
4. Arm Span exceeds height
5. Leg length exceeds trunk length
6. Hyperextensible joints and ligaments
7. Pes planus
8. Hammer toes
9. Vertebral Column deformities (e.g. Kyphoscoliosis)
10. Inguinal Hernia
11. Striae Distensae
D. Ocular signs and conditions
1. Upward ectopia lentis
2. Myopia
3. Iridodonesis
4. Glaucoma
5. Retinal Detachment
III. Labs
, A. Homocystinuria
IV. Radiology
A. Echocardiogram
1. Enlarged aortic root
B. Chest XRay
1. Deformed aorta and pulmonary artery
✔✔Korsakoff's Syndrome - ✔✔I. Causes
A. Untreated Thiamine deficiency from Alcoholism
II. Pathophysiology
A. Follows Wernicke's Encephalopathy
B. Lesions develop in mammillary bodies and Thalamus
III. Signs
A. Severe Short Term Memory loss
B. Intact Immediate Memory
C. Confabulation
IV. Management
A. Thiamine (See Wernicke's Encephalopathy)
V. Prognosis
A. Life-long Impairment
B. Improvement in 75% of patients with treatment
✔✔Mallory Weiss Syndrome - ✔✔I. Pathophysiology
A. Severe Retching results in tear in esophageal mucosa
B. Lesion occurs near esophagogastric junction
II. Symptoms
A. Hematemesis (vomiting fresh blood) follows episode of Retching or Vomiting
III. Signs
A. Melena (black, tarry stool)
B. Shock
IV. Diagnosis
A. Endoscopy (EGD)
1. Mucosal tear directly visualized
V. Management
A. Generally heals spontaneously within several days
B. Endoscopy for cauterization if needed
C. Surgery rarely required
ANSWERS GRADED A+
✔✔Peripheral Vertigo - ✔✔I. Findings: Suggestive of peripheral causes
A. Pathognomonic for peripheral cause
1. Sudden onset with brief episodes often on awakening
2. Rotary Illusion with Nausea, Vomiting
B. Nystagmus
1. Combined horizontal and torsional Nystagmus
2. Persists 5-20 seconds after Dix-Hallpike Maneuver
3. Fixation of eyes on object inhibits Nystagmus
C. Moderate imbalance
D. Nausea or Vomiting
E. Associated findings
1. Hearing Loss
2. Tinnitus
F. Tullio's Phenomenon
1. Nystagmus and Vertigo provoked by loud sounds
II. Causes: Common (Peripheral Vertigo)
A. Acute Vestibular Neuronitis
B. Benign Paroxysmal Positional Vertigo
C. Meniere's Disease
III. Causes: Other (Peripheral Vertigo)
A. Ear Infections
1. Serous Otitis Media
2. Chronic Otitis Media
3. Otitis Externa
4. Mastoiditis
B. Other infections
1. Herpes Zoster Oticus (Ramsay Hunt Syndrome)
2. Acute Labyrinthitis (uncommon)
a. Not synonymous with Vestibular Neuritis
i. Labyrinthitis is much less common than neuritis
ii. Labyrinthitis causes permanent Hearing Loss
b. Types
i. Viral Labyrinthitis
ii. Bacterial Labyrinthitis (Rare)
C. Structural disorder
1. Cholesteatoma
2. Perilymphatic Fistula
3. Otosclerosis
D. Trauma
1. Temporal Bone Fracture
2. Labyrinthine Concussion
,✔✔Reiter's Syndrome - ✔✔
✔✔Perihepatitis - ✔✔
✔✔Spontaneous Abortions - ✔✔When there is vaginal bleeding and cramping but the
cervix remains closed it is a threatened abortion. It is possible in this case that the
pregnancy can be salvaged. In an inevitable abortion the cervix is dilated. In a complete
abortion the placenta and fetus are expelled completely. In an incomplete abortion
placental products remain in the uterus and the cervix remains dilated.
✔✔Addison's Disease - ✔✔
✔✔Cushing's Disease - ✔✔
✔✔Myocardial Infarction - ✔✔
✔✔Fosamax - ✔✔Patients taking aledronate are instructed to take the medication when
they get up in the morning, 30 minutes before eating and with a full glass of water. They
should be instructed to remain upright to avoid esophageal irritation. If they take this
medication with food, it will reduce the bioavailability by 40%. Taking alendronate with
coffee or orange juice will reduce bioavailabiliy by 60%.
✔✔Hyperlipidemia Medications - ✔✔The expected outcomes of the preceding
medications are as follows: Lipitor: LDL: 20-60% decrease HDL: 5-15% increase
Triglyceride: 10-40% decrease Gemfibrozil: LDL: 5-15% decrease HDL: 14-20%
increase Triglyceride: 20-50% decrease Nicotinic acid: LDL: 10-25% decrease HDL: 15-
35% increase Triglyceride: 20-50% decrease Colestipol: LDL: 10-20% decrease HDL:
3-5% increase Triglyceride: May increase
✔✔Trochanteric Bursitis - ✔✔I. Definition
A. Inflammation of bursa overlying hip greater trochanter
II. Symptoms
A. Pain overlying greater trochanter
B. May radiate into knee or ankle or into buttock
C. Night pain occurs if lying on affected side
D. Palliative and provocative factors
1. Worse when standing from seated or lying position
2. Improves initially on walking
3. Worse again after walking for >30 minutes
III. Signs
A. Point tenderness over lateral greater trochanter of hip
B. Symptoms reproduced on hip adduction
,C. Adduction and internal rotation may also provoke
IV. Management
A. NSAIDs
B. Modify activity
C. Trochanteric Bursa Injection
✔✔Marfan Syndrome - ✔✔I. Etiology
A. Defect in gene coding for fibrillin structure
B. Connective tissue defect affecting multiple systems
1. Musculoskeletal disease
2. Ocular disease
3. Cardiac disease
II. Signs
A. Body habitus
1. *Tall (Height exceeds 95th percentile for age)*
2. *Extremely slender build*
B. Cardiovascular signs and conditions
1. Mitral Valve Prolapse
2. Aortic root dilatation
3. Myocardial Infarction
4. Aortic Insufficiency
5. Congestive Heart Failure
6. Subacute Bacterial Endocarditis
7. Aortic Dissection
C. Musculoskeletal signs and conditions
1. Arachnodactyly (Spider fingers)
2. *Pectus deformity (Pigeon Breast or Funnel Breast)*
3. High narrow Palate
4. Arm Span exceeds height
5. Leg length exceeds trunk length
6. Hyperextensible joints and ligaments
7. Pes planus
8. Hammer toes
9. Vertebral Column deformities (e.g. Kyphoscoliosis)
10. Inguinal Hernia
11. Striae Distensae
D. Ocular signs and conditions
1. Upward ectopia lentis
2. Myopia
3. Iridodonesis
4. Glaucoma
5. Retinal Detachment
III. Labs
, A. Homocystinuria
IV. Radiology
A. Echocardiogram
1. Enlarged aortic root
B. Chest XRay
1. Deformed aorta and pulmonary artery
✔✔Korsakoff's Syndrome - ✔✔I. Causes
A. Untreated Thiamine deficiency from Alcoholism
II. Pathophysiology
A. Follows Wernicke's Encephalopathy
B. Lesions develop in mammillary bodies and Thalamus
III. Signs
A. Severe Short Term Memory loss
B. Intact Immediate Memory
C. Confabulation
IV. Management
A. Thiamine (See Wernicke's Encephalopathy)
V. Prognosis
A. Life-long Impairment
B. Improvement in 75% of patients with treatment
✔✔Mallory Weiss Syndrome - ✔✔I. Pathophysiology
A. Severe Retching results in tear in esophageal mucosa
B. Lesion occurs near esophagogastric junction
II. Symptoms
A. Hematemesis (vomiting fresh blood) follows episode of Retching or Vomiting
III. Signs
A. Melena (black, tarry stool)
B. Shock
IV. Diagnosis
A. Endoscopy (EGD)
1. Mucosal tear directly visualized
V. Management
A. Generally heals spontaneously within several days
B. Endoscopy for cauterization if needed
C. Surgery rarely required
