AANP Exam tips
AANP Exam tips
3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? Iron, TIBC
3 months of synthroid, TSH increased, T4 normal, what do you do? Increase Medication
3 ways to assess cognitive function in patient with signs/symptoms of memory loss…. Mini mental exam
4 month old with strabismus, mom is worried…… tell her it is normal.
4 month old wont keep anything down, what is the main thing you look at? Growth chart
6 month old closed anterior fontanel. XRAY
Abnormal cells on PAP, what do you do next? Refer for Colposcopy
Causes of tachycardia
Cranial nerves responsible for extraocular eye movements… 3,4,6
Definition of metabolic syndrome- cluster of conditions that increase risk of heart disease, stroke, diabetes.
Definitive diagnosis of acute bacterial prostatitis: urinalysis and culture!
Diagnose Trich: wet prep
Elederly presents with atrophic vaginitis, small uterus, palpable 4×5 ovary, what do you do next? Pelvic US
Elder presents with atrophic vaginitis-add estrogen cream
Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? Anterior septum
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Fingernail hematoma treatment… drill hole, drain blood
GERD treatment: H2 is first line
Grade 3 cells on pap, treatment? Excision
Growth Plate fracture/Salter Harris Fx
Increased risk of ectopic pregnancy…. Salpingitis
Koplick Spots… Measles
Legg-Calve Perthes disease: avascular necrosis of the proximal femoral head
Lipid level of 1500, increased risk for? Pancreatitis
Low HGB, Low HCT, High MCV indicates what? Macrocytic anemia, B12 Def
Man with high BPH, prostate feels on digital exam? Enlarged, symmetrical, smooth
Man with HTN, CAD, present femoral pulses but absent pedal…. Arterial Insufficiency
McMurrays Sign- Meniscus tears
Know heart murmors!!!! MrPASS MVP MsARD
Newborn with foot turned in, what do you do? Refer to orthopedist
Osgood Schlatter disease- Knee pain
Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? Alzheimers
Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? Refer to oncologist
Know labs for diagnosing Hepatitis
Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? Tinea Corporis
Pt presents with “bag of worms:, indicates? Varicocele
Pt with atopic dermatitis, look for what other diseases? Asthma
Pt with bleeding after menopause- endometrial biopsy
Pt with hx of PID, increased rick for? Infertility
Bacterial vaginosis does not cause PID- trich, gonorrhea, and chlamidia can cause it
Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? This is good. Want higher than 350
Pt with hx of htn and stroke, now having memory loss. What does this indicate? Vascular dementia
Pregnant teacher with exposure to 5ths disease, what risk is there to the fetus? Fetal death and birth defects
Quick assessment of patients fall risk? Timed Get up and Go
Red beefy tongue? Pernicious anemia
Rotator cuff injury presentation: disturbs sleep, arm weakness, dull ache
Shingles near eye- immediate referral to ophthalmology
Signs and symptoms of Roseola? High fever, pink flat or raised rash
Treatment for chronic alcoholism: 12 step program
Treatment for Gonorrhea? Rocpehin IM and Zithromax PO
Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: IUD
few questions about T2DM and appropriate treatment, including insulin.
Know the reason for doing a PSA
When to give a pregnant woman with negative rubella titer the rubella vaccine
Treatment for gonorrhea, and syphilis, including during pregnancy
What meds you can’t take while ingesting grapefruit juice
Bells palsy s/S
S/s of serotonin syndrome
Kawasaki disease presentation
Lab test for “slapped face”
Treatment for shin splints
What to do with thyroid meds based on lab values
What heart sound would be expected in CHF
What antihypertensive meds to avoid in GERD
Who gets hep C screening
Definition of AIDS
No hepatitis a or b on mine
The cheapest treatment of shingles -acyclovir
T2DM has foot laceration, what would u monitor them for- osteomylitis
Acute GAD treatment-ssri
Know which murmurs are diastolic and where they’re located
What pts would need to go to ED with pneumonia… CURB65
Presentation of allergic conjunctivitis- bilateral eye symptoms
Treatment of mild persistent asthma
Parents have heterozygous disorder, what % of children are homozygous-25%
Weber and Rinne
No CN questions for me
Cotton wool on fundoscopic exam means??
Chronic use of afrin causes…medicamentosa
Vascular dementia most commonly occurs with people who had stroke and htn
S/s of strep a pharyngitis
Some of the questions I still remember from this morning exam:
Signs and symptoms of definitive HF
Description of Molluscum contagiosum
Management of fall with extended arm but no fracture seen on the xray
2 questions about Hepatitis
Evaluation of fall for the elderly
Know your labs for anemia, hypo & hyperthyroidism, hyperparathyroidism
Drugs for OM and alternatives
Drugs for gono and chlamydia and alternatives
Autosomal recessive and dominant
Pediatric asthma management
Infant dehydration assessment
Grades of HF, bruits and thrills
A lot of questions about Weber and Rinnes test
12 weeks just above SP
Antipsychotic drug that causes hyperglycemia
Management of TG if niacin does not work
When to prescribe insulin… that’s all I remember. And I’m sure all of you know these stuff?
but some variations like titration of levothyxine based on labs as well as coumadi at least 4 or 5 questions . Grapefruit affects what meds? On the review class from Barkley, some comments about the least expensive treatment for severe shingles. His questions are not the same format as AANP. TB diagnosis and PPD readings. No cranial nerves. Xray interpretation of knee fx. No pictures. What kind of pain on MI, ekg interpretation. Read in detail about the 3 recent posts about the new test, they helped me a lot . Good luck
genetics, a few on sexually transmitted disease and the medications (mostly gonorrhea), I had several questions about the elderly and medications that were safe and meds that were not. I had several questions on Derm, Basal cell carcinoma and seborrheic keratosis, I had a lot of questions of what labs to order, and they gave the situation of the patient. I had several questions on monon, anemia ,and sinusitis. I had PNA when to send to ER, Glaucoma, Hep B, 2 murmurs, one asthma, One on Marijuana s/s, 2 on BV, one on Alzheimer’s, one on hypothyroidism, one on symptoms of a person with Myasthenia Gravis, menopause, woman had bleeding what to do, Glaucoma, also shingles around the eyes, treatment of Bells Palsy, also how to diagnose Temperal arthritis, OA and RA.
anemias and RA vs OA, two murmurs, 2-3 Hepatitis serological, picking which Abx is appropriate for a named infection, PTSD, lots of frail elderly, STIs, PUD, GERD, Adolescents, who’s at risk for suicide, Myesthenia Gravis, Parkinson’s, appropriate tests for poss diagnoses, HTN meds, proteinuria, gastroenteritis dx, tests for appendicitis, expected labs changes in cholecystitis, dx hepatitis from pt symptoms.
hep b and C, hypercalcemia, fibromyalgia, Alzheimer’s, fifth disease, MCL, Pagets.
I had a couple of questions on genetics, a few on sexually transmitted disease and the medications (mostly gonorrhea), I had several questions about the elderly and medications that were safe and meds that were not. I had several questions on Rocky Mountain spotted fever. I had a lot of questions of what labs to order, and they gave the situation of the patient. I had several questions on mononucleosis, anemia ,and sinusitis. I want to thank everyone for all the questions that were posted, they helped a lot.
Here’s some additional details on my AANP FNP exam from Jan 12, 2018. I suspect my exam was the “new version” (it was expected to be updated this January).
[Edit: I have no idea if/when the test is updated – lots of people posted conflicting information about it; you can search the group for posts on the subject to see the whole gamut.]
NOTE: I will not give out any questions or any specifics. This is just a vague description of some of the topics covered. ?
I feel like I had multiple musculoskeletal questions – from RA to pediatric conditions to tendonitis to grade 3 muscle strains.
I had a lot of endocrine on my exam too – particularly hypothyroid, hyperthyroid, Hypoparathyroidism vs hyperparathyroidism – the type of questions ranged from from s/s, to meds, to scan, test and lab results.
Quite a few derm questions, from lichen planus to tinea to BCC to shingles. One question about what in-office procedure is best for a specified derm finding.
Only 1-2 questions were right off the PSI predictor. Only a few were like the questions from this group or from Leik. Difficulty level of the AANP exam felt more in line with the difficulty of the APEA practice exam.
2 murmurs. One hepatitis serology. 2 asthma. 1 or 2 anemia questions.
EKG finding description for bradyarrythmia
Otitis externa and media
Varus vs. valgus in knee exam
Presentation of HTN 2* to renal dx
Tendonitis progressing into tear s/s
Palpable ovary in elderly female
Palpable abdominal mass in a child
Meds that may worsen GERD s/s
Acute renal conditions
Pain meds for geriatric pt
Venous and arterial insufficiency
Top cause of mortality in a specific population group
Post menopausal abnormal gyne findings and how to respond
Newborn/infant GI disorders
Fair amount of derm and Peds derm dx and treatment, Peds ortho dx and reg ortho dx and tests, elderly women’s health issues, some pregnancy. 2 murmurs, one asthma, one asked about prolonged PR on EKG strip what kind of block!!, UAs, thyroid and parathyroid, one anemia, one hep serology, one asthma tx, infant emergent conditions.
passed AANP yesterday!! yayy! This group was so much help! Thank you for everyone posting tips and questions! I strongly recommend going through the tips that people have been giving in the past few weeks. My test had many of the topics they gave! Some of the questions I had no clue at all, but most of them I could come down to two answers and choose from there. It was very nerve wracking and I am so happy to be done! One thing that really helped me every day for a couple weeks for my test was I reread this bible verse over and over and told myself it was okay if I failed! It put less pressure on me Here are some of the topics I specifically remember! (also read the old psi test because I had a couple from there on the test)
I started studying hard about 3-4 weeks before the test and I studied most week days at least 5-8 hrs because I felt very behind and like I needed it. I went to a fitzgerald live review a couple of months ago, I watched and took notes on all of the hollier videos (which really helped me get an initial knowledge for the topics) then I read the leik book (which had almost every topic that was on my exam!) then I made note cards and spent the last week reviewing those and the topics that were given by the people in this group. Probably overkill but I’m glad I did it! On my scratch paper I wrote: Deuteronomy 31:6, heart murmurs, cranial nerve picture, S/S of anticholinergics (SAD CUB) and SSRI (BAD SSRI), weber and Rinne and hepatitis panel.
-ruptured tympanic membrane
-thyroid and parathyroid
-Treatment for gonorrhea and chlamydia while pregnant
-I had about 3 cranial nerves which I wasn’t expecting
-2-3 Rinne and Weber
-know what fundoscopic exam will look like from HTN and DM-I got one about AV nicking
-Fundal height at 12 weeks
-Apthous stomatitis- a little kid with sores in his mouth
-Hypertension medications – like which one you would give or not give for specific patient- which one causes GERD CCB.
-Gold standard for temporal lobe arthritis- biopsy, give sterids, associated with Temporal arteritis
-I had one hepatitis question- IGm was positive
-Cause for ectopic pregnancy
That’s all I can remember specifically! Good luck everyone!
Question that I was able to remember
• Basal Cell Cancer: Question description and the fact that it doesn’t have any tx (Hints: Waxy, pearly, telangiectasia, ulcer center lesion
• Actinic Keratosis: Question about description (Scaly red to yellow located in sun exposed area
• Melanoma question: Know ABCDE
• Subungal Hematoma tx: Make a hole and drain the blood
• Tx for moderate acne- I got one about Retin A
• Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS question was asked about heart murmur with high pitch holosystolic and the other one is mid systolic. Got one about a low rumbling diastolic murmur
• Question about Grade III/VI Murmur: (Loud murmur easily heard)
• Coarctation of Aorta: Know that systolic BP on lower extremities is supposed to be higher compare to upper extremities. In COA case its vise versa. Look for weak radial and bounding femoral pulse
• Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency. There was question about PAD and the answer was exercise by walking (Tx)- chronic venous insufficiency you elevate it
• Question about JVD causes? HF right side to be specific
• Know Bacterial endocarditis (There was a pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules) Osler’s nodes
• RML CXR
• Chronic bronchitis description and treatment
• Hiv pt. PPD + (5mm)
• Croup/Epiglottitis: Question about what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck.
• Hyper and Hypothyroidism
• Question about AV nicking (Arterioles pressing on vein of the eye): Its HTN retinopathy
• Question causes of IOP-Papilledema
• Rovsing sign
• Pt. with GERD and Barrett’s esophagus: Refer to Oncologist
• Question about pencil like stool: Options include problem with ascending colon, descending colon. Descending colon
Question about a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy
• Question about Hepatitis B active Immunology.
• Know your urinalysis result
• Question about Pt. complaining of headache after trauma: (Options include post concussion headache, subarachnoid hemorrhage and Subdural hemorrhage). I think the answer is subdural hemorrhage
• Question about Migraine headache: Know the description and duration of headaches as well- nausea vomitting
• Question about CN 3,4,6 (EOM)
• Anemia question, Vitamin B12 deficiency-beefy red tongue, tingling
• A lot of Musculoskeletal questions: (Anteriorly ligament which is for ACL; Apprehension test positive, lateral epicondylitis Tx, Morton’s Neuroma description as someone with high heels and has a mass or nodule on the 4th/5th toe)
• Osgood Schlatter Disease: Hint tibia tuberosity
• Question about an 88/yr. old patient in for follow up secondary. She’s been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. (Do nothing, Increase Tylenol, change to NSAID, and pt. is expected to have a high SED rate due to age). I think it should be changed to NSAID cuz SED rate is a sign of inflammation,
• Question about medial Tibia Stress
• ADHD is a behavior disease
• Which medication causes low sperm count for a patient (SSRI)
• Question about grandiosity (Bipolar)
• Question about contraceptive pills
• Question about, Trichomonas test wet mount was mentioned on the exam
• Question about a pt. pap’s smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? (Options are referring for colposcopy, repeat in 12 month and can’t remember other options. My review book stated to order HPV test if not done. Refer for colposcopy.
• Question about NP palpating right ovaries on a 1-year postmenopausal woman. Options include (To refer for endocerviacal test, for ovarian cancer something, couldn’t remember other options). Answer is to r/o ovarian cancer
• Another question about who is at high risk for ovarian cancer (Options include Family history, previous abortion and cant remember the rest)
• High risk for ectopic pregnancy: (Options include: Infertile, and cant remember the rest of the options)
• Question about chlamydia
• Question about CURBS: Which of the options does not require hospitalization for pneumonia (Options are all except 1; all include one that’s not part of it) Review CURBS: It’s a criteria for pneumonia hospital admission
• Question about genital wart tx
• Question about treating HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. (Different option but the best option is to tell the pt. that he is qualified to be diagnosed with AIDS according to CDC
• Most common cause of death in children (Options are poisoning, Motor vehicle accident, drowning, and cant remember the fourth one)
• Tanner stage questions
• Sensorineural (Presbyacus)
• Know types of Alzheimer’s: Question about a pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. Options include (Dementia with lewy bodies, Vascular dementia, frontotemporal dementia). I think the answer is vascular dementia.
• Question about Romberg test and how its done
• Question about sensitivity
• Question about Coombs test r/o bilirubin
• Hyperbiliribubin question risk
Preeclampsia tx (bed rest, laying on her side and
• Question about a pregnant female at slightly above symphysis pubic and Fundal height is 32cm (above the umbilical. What should be done (I picked to have Ultrasound done to)
• Question about molloscum contagiosum- umbilicated,
• Question about pyloric stenosis (Hint is non bilious vomiting, olive like firm mass palpated on right upper quadrant)
• Review your skin issues for adult and kids.
Question about Rubeola (Koplick)- measles
• Question about horizontal nystagmus that stops when eye is close to midline in a college student (options include messinere, BBPV, normal and cant remember the forth one)
• Question about someone eating, painful lump noted on the jaw that comes and go. Options include (Cancer of Wharton, sialolithiasis). The answer is sialolithiasis
• Question about ADHD (options include are solely a behavior disorder, panic, personality disorder)
• Question about a pt. complaining about upper arm tremor that seems to be hereditary. What’s the treatment? options include (Xanax, lorazepam, metoprolol and cant rember the last one)
• Which among the list can cause increase in respiration. Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)
• Question about osteoporosis risk factors. Options include (low estrogen level, obesity, sedimentary lifestyle, cant remember the last one)
Osteoporosis exercise- walking (weight bearing exercise)
• Tx to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct (Option include Calcium carbonate 600mg, vitamin d 800 IU, cant remember the remaining 2 options)
• Questions about carotid bruit signs can signifies what. Options include (Pulmonary HTN, carotid problem, cant remember the remaining two options0
• Ovarian CA risk. options are (multipara, family history and cant remember the rest).
• Question about ectopic risk factor. Options include (abnormality, exposure to some chemicals, previous abortion)
• Common causes of GERD. Options are (Histamine blocker, BB, CCB, cant remember the last one)
• Zeprexa (What lab and intervention to put in place) such as weigh check, DM,)
• Question about what’s the common bug in children with diarrhea.
• What test needed to differentiate lesion/cyst found on a breast (Options include Screening mammogram, Ultrasound, Need aspiration)
• Increase in triglyceride can cause pancreatitis
• Weber/Rinne Test know this by heart multiple questions about it –WUS and WAC
Lung sound on a pt with emphysema- I put hyperresonance?
Things I remembered that I marked:
– Assessment for dullness on patient with ascites
-INR goal on patient with DVT less than a month ago 2-3
If INR not therapeutic increase the dose
-know pneumoconiosis (so you know which one you can eliminate)
-know the difference of measles (Rubeola)vs german measles(Rubella)
-patient with IOP of 32mmHg, what do you expect during fundoscopic exam-Cupping
-1st line tx for Chronic bronchitis
-significant risk factor for ovarian CA
-meds for patient with BPH and urge incontinence-flomax
-causes of hyperbilirubinemia in newborn
-treatment for genital herpes-cheapest option acyclovir oral
-mild persitent asthma meds
-CN responsible for EOM (3,4&6)
-metabolic syndrome criteria
-seasonal disorder definition
-fundal heights and what to do if there is discrepancy with the expected measurement
-glucagon counteracts hypoglycemia
-Janeway lesions and Osler’s nodes for bacterial endocarditis
-causes of carotid bruit
-III/VI murmur presentation
-organism responsible for IBS
-otitis externa treatment
-meds for patients with osteoporosis (know your Ca and Vit D dosage)
-Psych med that causes high glucose
-Meds for GAD-ssri
Know presentation of PTSD
-hallmark finding in retinoblastoma
-molloscum contagiosum description
-signs of dehydration in infants (post fontanel)
-meds for staph aureus infection (skin) with pus
-hyperparathyroidism=high calcium level
-tx for hyperthyroidism
-breast changes in elderly
-antihypertensive med that causes GERD
-difference of RA vs OA based on symptoms
-systolic vs diastolic murmurs
-recent guidelines on screening mammography
-symptoms of serotonin syndrome
-causes of arrhythmia in elderly-hyperthyroidism
-How to diagnose fibromyalgia
-lab test for fifth disease-B19
-one anemia screening question
-pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give? (Process of elimination..) azithromycin
-treatment for chylamdia in pregnant women
-know CURB 65criteria.
-sensorineural hearing loss what is it called in elderly-presbycusus
– basal cell description
– squamous cell description
-Signs in strep throat
-when do you see av nicking
– what does IOP look like of fundascope
-treatment for allergic rhinitis
-treatment for pt who comes in with “something in my eye”. What would NP do first? Check visual acuity
-papilledema what it looks like on fundascope .
-TB in duration for Immuno compromised pt.
-what does melanoma look like
-what would np do when pt. comes in with rash on palms .
-what test would you order to evaluate breast cyst
-know treatment for COPD
-know tx. For mild persistent asthma
-what is first approach for pt. With high lipids
-causes of GERD
-know how to treat thyroid disease. They give you labs and you decide what to do with meds
-jvd what does it indicate
-treatment for subungal hematoma
-causes of Peptic ulcer disease and presentation
-when you give pregnant woman MMR- postpartum
-H/A. Know signs, duration I had 2 questions on different type and 1 question of treatment
-tx for gonorrhea
-anemia’s. Know s/s and labs – ex what would pt present w/ an elevated MCV MCH
-know test you perform for knee injuries. Lachman Test and anterior drawer.
-neuro:Romberg tear, post concussion
-breast changed in elderly
-know thx for calcium and vit. D
-Know murmurs where they Are located, radiate ,
-know murmur grades
-labs you would consider for pt w/5th disease
-tx. for GAD
-contraindications for taking ACEI
Ace inhibitor can cause renal stenosis- stop the ACE
-when you administer live vaccines-12months
-tx for mild acne
-when would you see Kolpik
-s/s of otitis externa
– cataracts – how would pt describe s/s
– Kawasaki disease. How does pt present desquamation
– Know ABCDE of melanoma
– Lyme disease
– RMSF-presentations in hands and feet
– Coaction of aorta. What would pt exam look like
– JVD when do you see it and what does it mean
– Description of MI how would patient describe feeling-persistnat does let up
– Addison’s. What would pt. presentation look like – needs steroids, HINT pt craving salt
– Romberg Test. How do you do it
– Dx of essential tremors. What would you prescribe for pt to relieve or decrease tremors
– HIV know DC4 count
– Tx of pt with urge incontinence what med would you prescribe
– Tx for allergic rhinitis-flonase
– Osteoarthritis how joints present (on hand) bochard and herberden
– Exercise that would help osteoporosis-walking
– Dx of fibromyalgia
– serotonin syndrome what are s/s
– Tx for veriocele
– Coombs Test
– Know Fundus Checks
– Morton’s. Neuroma
– Korsakoff wernicke
I had breast-feeding, Child growth stages, STD, hyper and hypo thyroidism, skin types and treatments, screening for breast cancer, colon cancer, birth control, hepatitis, heart murmur, several questions on medications for BP and DM type 1 and 2, temporal arteritis, anemia, and skin treatments for adolescents.
lot of geriatrics- HF, COPD meds, kidney issues & meds to avoid, DM- the question about DM pt with foot laceration – what is he at risk for was on there. Thyroid & parathyroid question, HTN, hyperlipidemia, neuro – Parkinson’s , LUTS, (bph, prostatitis) women/pregnancy- AFP testing, fundus height, mastitis treatment- obvious answer of dicloxacillin was not listed as an option, so I used Hollier’s trick- which bug are you treating then the answer became obvious- more than 5. One eye thing. Lots of pedi – resp, msk, rash – viral exanthems, one murmur question. Lots of adolescents- Early & late adolescents questions. STD male & female – HIV/AIDS, gonorrhea, syphillis. One anemia- pernicious, cluster & migraine h/a. Reason for JVDistention.
heart murmurs, cranial nerve picture, S/S of anticholinergics (SAD CUB) and SSRI (BAD SSRI), weber and Rinne and hepatitis panel.
-ruptured tympanic membrane
-thyroid and parathyroid
-Treatment for gonorrhea and chlamydia while pregnant
-I had about 3 cranial nerves which I wasn’t expecting
-2-3 Rinne and Weber
-know what fundoscopic exam will look like from HTN and DM
-Fundal height at 12 weeks
-Hypertension medications – like which one you would give or not give for specific patient
-Gold standard for temporal lobe arthritis
-I had one hepatitis question
-Cause for ectopic pregnancy
GOOD LUCK EVERYONE!!! HAPPY STUDYING!!!
Board Review Combined
RMSF- Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. EXAM
Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST being bitten by a deer tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, then confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM
Melanoma- Dark Moles, uneven texture, different colors, irregular, >6mm, could be itchy. EXAM
Stevens Johnson Syndrome- Classic is target or bulls-eye. Abruptly, hives, blisters, petechiae, purpura, necrosis, sloughing of tissues. Extensive mucosal involvement. Prodrome of fevers with flu like symptoms. Triggers: Allopurinol, anticonvulsants, pcn, sulfonamides, NSAIDS. HIV ppl have higher risk for this syndrome.
Psoriasis– Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.
(Koebner phenomenon- new psoriatic plaques form over skin trauma)
(Auspitz sign- pinpoint bleeding when plaques are removed).
TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic.
Acanthros Nigricans- velvet hyperpigmented patches most common on back of neck or skin folds- DM resistance.
Scabies- itching bedtime. Primethrin cream treat everyone wash sheets and everything else in hot water.
Atopic Dermatitis (eczema)- Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. “small vesicles that rupture leaving painful, bright-red, weepy lesions” they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM
Tinea Corporis- “ring like itchy rash, slowly enlarge central clearing”-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending
Actinic Keratosis- Precursor to squamous cell carcinoma. “numerous dry round and pink to red lesions” with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness. EXAM
Seborrheic Keratosis- soft round wart light tan to black pasted on. Asymptomatic and benign.
Cellulitis- Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS.
Erysipelas- Group A strep, Upper dermis, clear demarcated, cheeks, shins.
TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d.
MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.
Basal Cell Carcinoma- pearly, waxy, skin lesions, atrophic, ulcerated center that does not heal.
Molloscum Contagiosum- white plug, dome shaped. Highly contagious. EXAM
Varicella Zoster Virus- “contagious 48 h. before, until all lesions crusted over” low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. “initially on trunk, then scalp and face” TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. EXAM
Acne Vulgaris (common acne)- ON EXAM
mild (topicals only) *open/closed comedone w/ or w/o sm. papules. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide.
Moderate (topicals plus antibiotics)- papules, pustules w/ comedones. Continue with topicals combined with topical antibiotics. Then add ORAL antibiotics tetra, mino, doxy.
Severe- with painful indurated nodule, cysts, abscesses, pustules. Accutane- check LFTs, 2 forms of contraceptives, monthly prego testing, only prescribe 1 month supply.
Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM
Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM
Scarlet fever (Scarlantina)- “sandpaper textured-pink rash with sore throat” strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM
LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM
Spider bite: fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam
Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM AANP Exam tips
Herpes keratitis- fluorescein dye “fern like” CN V. Abrupt onset of pain.
Corneal Abrasions- Round/Irregular. Was on EXAM.
Acute Angle-closure glaucoma– acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM
Primary Open Angle Glaucoma- CN2 gradual changes in peripheral vision LOST FIRST, then second central vision.
Cataracts is on EXAM in elderly night vision issues. Opaque EXAM
Age-Related Macular Degeneration – Painless loss of “central vision” reports straight lines appear curved. Periphery is preserved. Give asmler grid.
Retinal Detachment- Floaters, curtain, flashes of light. Painless. EXAM
Cholesteatoma- cauliflower, foul-smell, hearing loss. If erodes bones in face affects CN VII. SURGERY
Canker sores- Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash.
Papilledema- optic disc swollen w/ blurred edges due to increased ICP. EXAM
Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM
Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED
Koplik Spots- “clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars”. Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM
Sensorineural: Lateralization to good ear. Rinne- AC > BC.
Conductive: Lateralization to bad ear. Rinne- BC > AC.
Rinne (1st mastoid, 2 front of ear, time each area).
Weber: Tunning fork midline. CN 8 (acoustic). EXAM
Hordeolum- painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin.
Acute Otitis Media- middle ear. Usually S. pneumo. (others: h influ, mor catarrhalis). Popping, muffled, afebrile or low-grade, TM can rupture blood and pus on pillow on awakening with relief of ear pain. “erythematous TM” bulging or retracting. Decreased mobility. TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. Weber- Lateralization to bad ear. Rhinne- BC>AC. If your patient is only PCN allergic do azithromycin or clarithromycin. EXAM MULTIPLE QUESTIONS AANP Exam tips
Otitis Media with Effusion– Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. THIS ONE U CAN DO SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM
Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM
Presbycusis- sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM
Allergic Conjunctivitis- “stringy; increased tearing” PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner.
Anthrax- animals/hides/hair/wool. Lesions begin as papule that enlarges quick 24-48h develops necrosis and ulceration (sort of like a spider bite recluse)- Treatment: Doxy, Cipro, Levaquin. If you suspect BIOTERRORISM treat 60 d. Prophylaxis – Cipro, doxy. If BIOTERRORISM 60 d.
Sialolithiaisis- painful lump hurts more with eating (by jaw) aka calculi or salvary stones. Usually in sub mandibular gland aka whartons; duct.
Meinier’s disease- VERTIGO TINNITUS, HEARING LOSS.
BBPV DIX HALLPIKE MANEUVAR EXAM
SINUSITIS ON EXAM: TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE
MONO know the name of test. Its heterophile antibody test. ON EXAM
MI- atypical SOB, dyspnea, weakness, n/v, fatigue, syncope. Back pain. EXAM or typical signs
Medication causing heart burn- BB, CCB, alpha agonists. (HTN meds). EXAM
ASS (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam.
Mitral Regurg (Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL.
Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb.
MS ARD (Diastolic Murmur)
Mitral Stenosis – soft low rumbling best apex / mitral 5ics mcl. Opening snap. Use bell. (MID/LATE DIASTOLIC)
Aortic regurgitation- loud high pitched, blowing murmur. (EARLY DIASTOLIC)
All diastolic murmurs are pathological. Murmurs I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM AANP Exam tips
Benign split s2- pulmonic best. Normal during inspiration disappears with expiration.
MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC.
S3- HF, Kentucky, early diastole. Abn >35. Bell EXAM
S4-LVH stiffening, Tennesse, late diastole. “Atrial kick/gallop” EXAM
S1- Closure of AV
S2- Closure of SL
EXAM: 1ST DEGREE OR A 2ND DEGREE DESCRIPTION OF HEART BLOCK
BBS AFTER MI IS ON EXAM
Isolated systolic hypertension- do CCB. EXAM
Stable Angina? – do stress test.
PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM
CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM
BP – ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM. Thiazides- no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM Infective Endocarditis- Fever, chills, malaise, new onset murmur. Oslers nodes- painful petechiae, violet colored nodes on the fingers or feet. Janeway lesions- non tender red spots on the palms/soles. Fundoscopic exam may show roth spots or retinal hemorrhages. Blood culture x3 (first 24 hours). Antibiotic prophylaxis is NOT recommended. Except if there is existing infection. 1 h. b4 Amoxicillin 2g po or 50mg/kg. Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM COA ON EXAM ORDER A PLAGIARISM-FREE PAPER HERE PULM COPD- Gold 1-2- SABA or SAMA ON EXAM.. BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN Asthma Intermittent ON EXAM. BASCIALLY IF LOW DOSE ICS, NEXT IS MEDIUM DOSE ICS ON EXAM (<2d, <2)- SABA Mild persistent (>2d, 3-4N)- SABA, Low dose ICS *Altern. Cromolyn, leukotriene, theophylline.
(DAILY, NOT NIGHTLY)- SABA, Low dose ICS plus LABA or Medium dose ICS.
Severe- (Throughout the day, nightly)- SABA, Med ICS plus LABA.
Always think first line treatment for asthma is some type of SABA, and ICS.
CURB-65 (criteria for hospital admission) If >1pt. hospitalize. Confusion, Blood urea >19.6, Respiration >30, BP <90/60, 65 years of age or older. ON EXAM Hypercapnia- causes greatest INC in respiration. Emphysema Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM Acute Bacterial Pneumonia- CXR middle lobe. ON EXAM OSA-does not include Microglossia which is an absent tongue congenital. EXAM Tuberculosis- fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three "consecutive days". TB is usually upper lobes. AANP Exam tips >5mm-think immunocompromised or person in close contacts. EXAM
>10 think Immigrants, working status, drug users, home life.
>15 Think no risks
CXR- shows big black holes
Anything with hyper/hypo SUBCLINICAL-always think of their TSH being off but their Free T4/T3 are normal. Could recheck in 1 year if not having symptoms.
TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM
Normal TSH 0.5-5
Complications of Cellulitis with a diabetic patient = OSTEOMYLITIS. EXAM
Hyperthyroid- Low TSH, high “FREE” T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY
RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.
Hypoglycemia- Pancrease releases glucagon which stimulates ur liver to convert stored glycogen to glucose. EXAM or if asks what pancreas secretes besides this its digestive enzymes
Hypothyroidism- High TSH LOW Free T4/T3, However, Free T4 is much more specific to this disease. Hashimotos (autoimmune) think of everything in ur body is slowing down. Synthroid.
Parathyroid gland- PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM
If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM
Cushings syndrome-Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. “INC BS, SODIUM” Dec K. You must draw cortisol levels in the morning. AANP Exam tips
Addison’s- deficient in cortisol (think low sodium, bloodsugar, but INC K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and shit and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM Fructosesamine test- checks sugar for past 2-4 weeks. MAYBE EXAM Gastrointestinal High Triglycerides- causes pancreatitis >500. If >500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM
Pancreatitis- diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback “boring” epigastric pain. Fever, n/v. EXAM TOPICS
Gerd- Barrotts “pre ca” chronic cough, acid sour breath, sore throat, thinning tooth enamel. First line for mild/intermittent lifestyle. BB, CCB, HTN meds increase GERD. FIRST LINE: H2, only 6-8 weeks, if not effective do a PPI. Never d/c PPI abruptly. If you still got cho GERD post 6-8 weeks of treatment just PUNT this shit to GI. (PPI-prilosec, protonix, prevacid) (H2-Zantac, Pepcid). Barretts tx- PPI daily and H2 bedtime. ALWAYS GIVE h2 at BEDTIME. EXAM
Pyloric stenosis- 4-6 weeks, nonbilious vomiting olive like mass immediately after vomiting. Diagnosis by ultrasound will see a string. Differential include: GERD, milk protein intol. Intestinal
obstruction. PUNT for surgical correction. ON EXAM
Intussecption- sausage shaped mass in upper right quad. Currant jelly stool. Ur bowels prolapse into another part of ur intestine. Barium enema can help to reduce this. Previously healthy then they get sick. Usually before 2 years. PROB ON EXAM
Pencil like stool think colon cancer: Descending colon- tenesmus incomplete sensation of defecation. ON EXAM
Encopresis-involuntary soiling of stool in kids <4 y. Caused by constipation. Treat behavior cuz they don't want to shit in public and laxatives to relieve the current constipation. ON EXAM Hep A: IgG Anti-HAV (GONE = G). IgM Anti-HAV (M= MEOW). Hep B: HBsAg = (HAS the word in it). Anti-HBs- (Anti= not now) IM GUESSING ONE ON EXAM HbeAg(E=Everyday/chronic). Hep C: Anti-HCV- order HCV RNA. Biopsy of liver to check stage. HEP D: Gotta have boobs before you can get dick. B before D. Chronic hep C: just elevations in ALT. Positive psoas/obturator/rvosing– acute appendix. EXAM Zolinger-Ellison Syndrome- gastrioma causes multiple ulcers. First line is PPI. Screening done by serum fasting gastrin level. Pancrease secretes enzymes lipase, amylase, proteases. Digest protein, fat, and carbs. EXAM Hpylori negative ulcers: h2 first bedtime, may combine them with PPI. Do 6-8 weeks. PUNT after. PROB ON EXAM Positive H. Pylori: (Always do ABX for 14 days). Triple therapy: Biaxin, Flagyl OR Amoxicillin. With a PPI. Quad: Pepto Bism, PPI, tetra, Flagyl Genitourinary Diagnosis of a kidney stone- Ultrasound. Old lady with new onset of incontinence – UA/CULTURE UA results: >10 WBC NitrItes=Ecoli WBC casts (infection UTI, pyelonephritis)
RBC case (glomerulonephritis). EXAM TOPICS
Any baby 2-24 months with UTI- do renal and bladder ultrasound for first febrile UTI. EXAM
Signs of dehydration in baby: sunken fontanels, decreased urine, no tears when crying (normal in babies), dry/sticky mucous membranes, lethargy, irritability.
A sample with large amounts of epithelial cells and multiple bacteria = contaminated sample.
3+ protein in urine- do 24 hour urine for protein and creat clear. EXAM Cholesterol, serum creatin and albumin, blood sugar.
Stress incontinence- do kegals 100x day. So 10x a day and 10 each time.
KNOW THAT UTI IS 100,000 CFU’S TO BE DIAGNOSED. EXAM
PSA WHAT DOES IT MEAN TO PATIENT EXAM
CN V- Trigeminal Herpes. CORNEAL ABRASION. EXAM
EOM- CN III, IV, VI. EXAM
IV- superior oblique muscles
VI- lateral muscles.
CN I- Nose
CN IX- Shoulder shrug/ ROMBERG test EXAM
CN VIII –ears 8 EXAM
CN VII- Facial BELLS EXAM
Old lady taking digoxin- if her creatinine level increases you have to decrease digoxin dose.
Migraine- Triptains for abortive. Prophylaxis (propranolol) TCA (Amitriptyline) Anticonvulsants (gabapentin, topiramate). EXAM TOPIC
Cluster headaches- High dose O2 via Mask 12L 100%, imitrex (abort) and a CCB for prophylaxis. VERAPAMIL EXAM TOPIC
BPPH- Dix Hallpike maneuver- Primidone, or propranolol. AANP Exam tips
Fibro- 11/18 points. Widespread pain for at least three months. EXAM
Worst headache of my life- SAH- may experience sentinel headache few weeks prior. S/sx of meningitis. Falls in elderly or MVA younger.
SDH- skateboarding concussion. Diagnosed with CT (Never do Contrast if you suspect a bleed). EXAM
MMSE- <24 dimentia. The lower your score the more retarded you are. EXAM Trigeminal Neuralgia- compression of nerve root possibly. Unliateral facial pain close to nose/cheeks. Sharp shooting pains by eating etc. TREATMENT: high doses of anticonvulsants. MRI / CT. AKA TIC DOULOUREUX Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids. POLY- bilateral joint stiffness aching, shoulders neck hips and torso problems with dressing. 50 or older females. Carpal- MEDIAN NERVE, tinnels sign t=tapping. Phalens sign- putting phingers together. ABSENCE SEIZURE AKA PETIT MAL SEIZURE: SUDDEN BRIEF LAPSES OF IN ATTENTION. SEEN ON EXAM FEVER DECREASES SEIZURE THRESHOLD..SEEN ON EXAM HEMATOLOGY ONE OF THESE IS ON EXAM AT LEAST FOR EACH MACRO OR MICRO TYPE. ALSO LEAD APPEARED ON AN EXAM. USUALLY IRON DEF..ABNORMAL LEAD LEVELS ARE >80 POISONING, TX >40 WITH SYMPTOMS TX. OVER 5 IS ELEVATED BUT PREVIOUS LABS MENTIONED ARE WHEN TO TREAT IT.
s/s n/v, fatigue, loss of appetite, abdomen and joint pain, slowed growth, mental disability.
Thalassemia- gold standard for sickle cell also. Only BETA THALASSEMIA will be abnormal with this NOT alpha. (Alpha-asians, BETA- by sea). MICROCYTIC HYPOCHROMIC. Check Ferritin this will be either normal or slightly elevated. HEMOGLOBIN ELECTROPHORESIS GOLD STANDARD TO DX. AANP Exam tips
Iron deficient- microcytic hypochromic. TIBC Inc. Ferritin/iron Dec. Angular cheilitis, glossitis, spoon-shaped nails, pica. Check reticulocyte wk post starting iron to make sure u don’t have bone marrow suppression. Must do 3-6 months. 150-250 elementary iron. Ferrous sulfate 325 mg po TID. Take with calcium helps to absorb. SE constipation black colored stools.
Macrocytic normochromic anemias (Folate/B12 CHECK THEM BOTH). B12 will be the ONLY one with neuro findings or pernicious. Pernicious (autoimmune destruction of parietal cells in fundus) think ppl that get their stomach taken out w/ pernicious must do b12 injections life long. With b12 only temporary.
PERNICIOUS- ANTI IF Antibody or 24 h urine test for MMA increase.
B12 foods- ALL MEAT PRODUCTS OF ANIMAL ORIGIN
Think of a BIG BEEFY TONGUE.
Folate- doesn’t cause neuro s/sx. Folic acid 1-5 mg/d. Prego need 400 mcg 1 mo. Prior to prego. Dec. neuro deficits. Eat things green.
Sickle cell- CBC is SCREENING, HGB electro is GOLD STAND diagnosis (don’t get a screening test and a gold standard test mixed up on the boards). Could do 8-10 prego a CVS or Amnio to check to sickle. Give sickle cell patients their vaccines to protect from illnesses such as pneumonia/flu. EXAM
Bicep Tendon Rupture- HOOK TEST (description of the test and say what it is trying to diagnose) bicep will roll into a giant ball EXAM
Rotator cuff description- apprehension test rules it in or out. Positive means pain is reduce on relocation test and positive use. Rotator cuff injury-disturbed sleep, arm weakness, dull ache. EXAM
Navicular fracture- falling with outstretched arm hyperextension. Thumb spica splint and PUNT 2 weeks to see on xray.
Drawers sign- “knee stability” Anterior checks ACL, posterior checks PCL. EXAM
McMurrays test- “CLICK” medial meniscus (valgus) EXAM. LateRal meniscus (vaRus). (BOTH HAVE R’S)
Lachman’s- “LAXITY” VERY SENSITIVE for ACL. EXAM
OA- Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM
OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM
RA- Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM
Medial Tibial Stress Syndrome of Fracture: OVERUSE, “inner border” painful on palpation. DO bone scan or MRI cuz a plain X-ray wont show a stress fracture. FOLLOW RICE. EXAM
Lateral epicondylitis- (TENNIS) pain in outside elbow, worse with twisting or grasping.
Medial Epicondylitis- (GOLFER) inner elbow pain by funny bone. Baseball, bowlers.
Morton’s Neuroma- do mulder test. “pebble, burning, numbness” ¾ metatarsals. PUNT TO pod. EXAM
Scoliosis- Adams Forward Bend Test= both arms hanging freely, knees straight, look for asymmetry of spine, scapular, thoracic, lumbar curvature, inspect shoulders and hip for asymmetry.
Treatment to prevent fracture in patient with low vitamin D high TSH low HCT- VITAMIN D 600-800, CALCIUM 1000-1200. EXAM
Low back pain- MRI (herniated disk) So sciatica is a form of radiculopathy and one of the most common causes is a herniated disc. So both are aggravated by long periods of sitting. And feel better with WALKING. Lumbar stenosis is aggravated by long periods of standing and walking. Releived by sitting and rest. EXAM
ELDERLY CANT SLEEP INSOMNIA ETC. SCREEN FOR DEPRESSION
Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM
Anorexia- lanugo, osteoporosis, BMI <18.5, peripheral edema, heart problems. Atypical Antipsych- Zyprexa, Seroquel, Risperdal- OBESITY, DM2, check BMI Q3M. CAUSES WEIGHT GAIN. EXAM SSRI- Paxil (sex dysfunc causes this). Zoloft, Celexa (Good for older few drug interactions) Lexapro. Gradually wean paxil. SSRI are ALWAYS first choice FOR MAJOR AND MINOR DEPRESSION AND PTSD. Causes low sperm count also. EXAM Kava Kava- used for anxiety and insomnia, don't mix with other sedating medications, such as benzos. Bipolar- Type I- class manic- severe anxiety, rage, chronic relationship difficulties, euphoria, talkativeness, flight of ideas. Type II- Hypomanic. TREATMENT: Lithium salts (affect TSH, Kidney), anticonvulsants, Antipsychotic. MMSE- Used to evaluate confusion and dementia. Orientation, Immediate recall, Attention and Calculation, Writing and copying. 0 bad 30 good. <24 dimentia highly suggestive. Anxiety Attack- Treat Benzo SHORT PERIOD OF TIME EXAM Zyprexa- (atypical antipsychotic) TCA- easy to overdose on don't give to patients with suicidal. Seasonal affective disorder- depression occurring during winter months, causative factors include circadian rhythm, drop in serotonin syndrome, change in melatonin level. Treatment light therapy, antidepressants, psychotherapy/talk therapy. Generalized Anxiety Disorder- SSRI, SNIR, Wellbutrin. May do benzo for short time. EXAM WEAN BENZOS EXAM Wellbutrin can help with sexual dysfunction from SSRI/Paxil. Do not give it to people with seizures or anorexics. Alcoholics- CAGE questionnaire, 12 step program. Al-Alonon for family, Al-teen for teenagers and shit. ADHD BEHAVIORAL, SO THERAPY FIRST THEN MEDS. ADDERAL, RITALI, VYVANSE, SETERRA. EXAM MENS HEALTH REVIEW Acute Bacterial prostatitis- UA/ Culture is definitive. CBC shift to left (band cells) UA, pyuria, hematuria. High fever, chills, suprapubic, perineal pain, radiates to back or rectum, s/sx of uti. Prostate is warm and boggy. Older than 35= cipro, levaquin 4-6 wk. other Bactrim. AANP Exam tips <35-Rocephin 250mg IM and doxy 100 mg BIDx10d. EXAM BPH- Symmetrical rubbery and enlarged. Proscar must times PSA X2. All of BPH meds, take at bedtime. Hytrin is good for ppl with HTN and BPH. EXAM Testicular Torsion- extremely painful, swollen red scrotum, affected teste is higher/closer to the body, cremasteric reflex is missing. Dx- Doppler ultrasound with color flow study. Women's Health Review Ectopic Pregnancy- Light to scant bleeding in 6-7 weeks/lower abd pain/pelvic pain. Intermittent cramping, if radiating to right shoulder think rupture. Pain is worsen with SUPINE or with JARRING. Previous ectopic pregnancy, tubal ligation, PID. Anything that is causing scaring. EXAM Natural estrogen- Isoflavones. SOY BEANS EXAM Ovarian CA- Family history. Should not ever be able to palpate an ovary, r/o US ovarian CA. Risks: >50, early menarche, late menopause, obesity, family history, 1st prego after 35, or not ever prego. EXAM
Breast cancer- Do Ultrasound to differentiate between lesion vs cyst. EXAM OR AT LEAST MASS AND WHAT IS NEXT STEP MAMMO OR US.
LSIL- 21-24y.o. (Repeat in 12 mo) 25-29 (refer for colpososcopy/biopsy). >30 if HPV (-) repeat in 12 mo. If HPV (+) then refer to colp / biopsy. EXAM
HSIL- 21-24y.o (colp), >25y.o surgical excision.
Bacterial Vaginosis- Wet smear. Squamous epithelial cells with a large amount of bacterial coating, just milky and fishy, no redness or irritation. KOH to cotton swab for whiff test. TREATMENT: FLAGYL BID x7d. Altern- Cleocin or flagyl cream. EXAM TOPICS
Candidia Vaginitis- wet smear= pseudohyphae / spores w/ lrg wbc. Cheese curd like pruritis, itching, swelling, redness. TREAT: Diflucan 100 mgx1. Or OTC= Monistat, clotrimazole. Exam
Trich- Microscopic – mobile unicellular organisms with flagella and large amount of wbc. TREAT : FLAGYL 2 g PO x1, or 500 mg BID x7d. “strawberry cervic, red, itchy, grayish-green bubbly vaginal dc. Burning with urination. Wet prep. EXAM TOPICS
WET PREP : BV, YEAST, TRICH. Exam
Atrophic vaginitis- lack a estrogen, apply topical estrogens. exam
Pap smear- Begin 21 q 3y until 29. Age 30 pap / HPV repeat q 5 y. May stop at 65, if negative x10 y. Must have squamous epithelial cells and endocervical cells are present.
Mammogram- baseline 50 then q 2y. age 75 older =don’t do. Begin at 40 for high risk patients.
Postmenopausal bleeding- ENDOMETRIAL BX. EXAM. US to rule out OV CA
AIDS <200. CD4. EXAM You want higher than 350 Gonorrhea Tx: Rocephin 250 mg IM and Azithromycin 1 gm po x1, or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Chlamydia- Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM If not prego do the Azithro 1 mg PO x1 or Doxy 100 mg BID x7d. AANP Exam tips Clap is usually asymptomatic. Untreated Gonorrhea: leads to PID, abscess, ectopic prego, infertility, can pass to baby during delivery. In men: epidydimitis, infertility. Both people: can lead to disseminated, petechial pustule lesions, lesions of hands/soles, swollen, red, tender joints in one large joint. Green throat. Occasionally Fitz-Hugh-Curtis syndrome. Liver PID- Infertility, cervical motion tenderness indicates PID. Treat symptomatic PID even if GC and Clap are negative. Follow up with bimanual exam in 2-3 days. EXAM topic PID Syphillis- PAINLESS GENITAL CHANCRE- Condyloma lata. First test do RPR, VDRL SCREENING if reactive then confirm with FTA ABS. EXAM… Condyloma Acuminata (genital warts)- types 16/18 HPV. Treatment: trichloracetic acid….Condylox, aldara, veregne. EXAM Genital herpes on exam: Dx RPR assay for 1 &2. Itching, burning, and tingling. Primary more severe lasts 2-4 weeks etc. recurrent outbreaks. First outbreak Acyclovir 400mg 3x/d for 7-10days. CHEAPEST medication Episodic, try to start within 1 day of lesion (pt may fee start of prodromal sx) Acyclovir BID or TID x 5 days. WOMENS HEALTH PREGNANCY / CHILDBIRTH Pregnant (5th disease)- Teratogenic on baby. Positive signs of pregnancy: things done by health care provider, FHR HEARD, US SEE BABY. Probable: Signs, enlargement of uterus, prego test. Presumptive: She is just PRESUMING that she is prego. EXAM TOPICS Goodell's sign: cervical softening. Chadwicks sign Blue cervix and vagina. Hegars sign- softening uterine isthmus. 1st 1-12 weeks. 2nd 13-26 weeks. 3rd 27-end. Appointment schedule: 0-28 q4w. 28-36 q2w. 36 till end q1w. Naegele's Rule- add 9 months and 7 days! BOOM OR SUBTRACT 3 MONTHS ADD 7 DAYS. Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US. Placental Previa- 2nd-3rd trimester new PAINLESS vaginal bleeding worsened by interCourse. Blood is bright red. Uterus soft non-tender. If cervix is not dilated, treatment is strict bed rest. Administer IV MAG IF THERE IS UTERINE CRAMPING. Do not insert anything into the vag/rectal. If dilated cervix then deliver via c- section (according to leik). Placental Abruption- Late third trimester, sudden vaginal bleeding PAINFUL. Uterus feels hard. Dark red bleeding. In severe cases deliver. Can always do an ABD ultrasound with vaginal bleeding but NOT A VAGINAL ULTRASOUND. Preeclampsia- late third trimester >34 wk. sudden onset of h/e, visual abnormalities, pitting edema. Edema easily seen on face eyes fingers, sudden rapid weight gain within 1-2d (>2-4lb/wk). RUQ pain. BP >140/90. Protein 1+, dec. urine. IF SEIZURES THEN ECLAMPSIA. Earliest is at 20 weeks that they can have this. Lay on left side.
1300 for calcium and pregnancy.
AT 16 WEEKS TEST FOR AFP (EXAM) – Low- Downs
High-Neural tube deficits.
TRIPLE SCREEN- AFP, BETA HCG, ESTRIOL.
QUAD SCREEN- The triple screen PLUS INHIBIN A
GBS- 35-37 weeks swab.
GiVe rhogam at 28 weeks. The coombs test detects rh antibodies in the mother (indirect) and the infant (direct). 2nd dose is 72 hours or sooner post delivery. IF RH NEG MOM.
UTI- 10 (3) wbc is considered positive in prego with symptoms. Normal people its 10 (5). MEDS: Macrobid (not for 3 trimester) Augmentin, Amoxicillin, Cephalexin, Fosfomycin. EXAM
Mastitis- red firm tender area fever chills, flu like symptoms. Basically this is cellulitis on ur tit. Dicloxacillin, or Keflex. If you suspect MRSA, do Bactrim or clinda. EXAM AANP Exam tips
ADHD- hyperactive, impulsive, inattentive. Present prior to 12 years. Symptoms last > 6 months, should be evident in at least 2 different settings. Treated with schedule II – Ritalin, Adderal, vyvanse, streterra etc. EXAM
Anterior fontanel- closes 15-18 mo. Posterior 2-3 mo.
Erythema infectiosum (5th disease)- “slapped cheeks” 5-14 y.o. LACY, spreads to upper arms lgs trunks dorsum of hands and feet. Rash can last up to 40 days. Fever, rash, runny nose, headache. EXAM humanparovirus19, no labs for it.
Milia 1-2mm papules. Resolves spontaneously. EXAM
RETINOBLASTOMA- leukocoria: Hallmark sign white spots in eye. Cancer. Red light reflex. EXAM
Cephalohematoma- swelling does not cross midline.
Caput succedaneum- crosses midline. Cone shaped head. HAHA.
Fragile X- Large head, mental retard. Delayed milestones, crawling, walking. Autism is common. Long face with prominent forehead, jaw, and large ears, large body.
Do not give varicella/MMR <12 mo. EXAM QUESTION Tdap, HPV, MCV4 (11-12y). HPV youngest age 9 years. Do not give TDAP <7years Influenza youngest 6 month. HBsAG + mom give baby Hep B and immunoglobulin. Neuroblastoma- painful abd mass fixed first irregular, crosses midline. Most common side is adrenal glands. Weight loss fever horners syndrome. Raccoon eyes, bone pain, hypertension. 1-4 year olds. Dx ultrasound PUNT to nephro. NEURO think brain in middle crosses midline. **Urine catecholamines and anemia. EXAM Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM Epiglottis- Acute/rapid onset of high fever, chills, toxicity. Severe sore throat, drooling saliva. Will not eat or drink muffled hot potato voice, anxiety, tachycardia, tachypnea. 2-6 y. old. Prophylaxis w/ rifampin. Report this disease. EXAM Autism- may be as early as 18 mo. 18-24 mo do screening. Most apparent in 2-6 y. old. "extremely sensitive to noises, touch smells, textures" poor language, repeated body movements. Five behaviors to look for: doesn't point/wave/grasp by 12 mo. No babbling or cooing (by 12 mo) dose not say single words (by 16 mo) Does not say two – word phrases on his own ( by 24 months) Any loss of language or social skills ( by 24 months) Does not gesture by 24 months. Think about kids who do not act normal especially with interactions. Kawasaki disease- acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM Hand-foot-mouth disease: Viral, acute fever, sore throat, headache, multiple blisters on hands, feet, diapher area. Ulcers are in the mouth throat tonsils and the tongue. Treat SYMPTOMS. Encoporesis- Kid doesn't like to poop. Do plain X-ray. Bronchiolitis: Don't give abx, cool mist breathing txs. Basically bronchitis in kids. EXAM topics Croup: No antibiotics. Stridor barking cough. Dexamethasone x1 dose. Darcryotosis lacrimal sac, rub down towards mouth. If think secondary AANP Exam tips infection abx. EXAM how it presents. OLDER KIDS Teste torsion- Doppler, unilateral teste pain, absent cremaster reflex. Scrotal edema, redness. Precocious puberty before 8 / delayed if no breast development by 12 y. (FEMALES) Precocious puberty before 9/ delayed if no testicular/scrotal growth by 14 years (MALES) Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics. Osgood-Schlatter: knee pain in young adults, overuse. Repetitive stress pain, tenderness, swelling at the tendon's insertion site. The tibial tuberosity. Rule out avulsion fracture if there is an acute onset and order a lateral xray. RICE. Usually stops when the growth stops. EXAM Legg-calve perthes disease: aseptic/avascular necrosis of the femoral head. Could be due to vascular disruption. Insidious onset of KNEE PAIN that migrates up to the groin. AFEBRILE. Positive Trendelenburg's test. Slipped capital femoral epiphysis – spontaneous dislocation of femoral head. Pain in groin that is referred to the knee. Unable to properly flex. No ambulation is permitted cuz this will cause irreversible damage. Could be due to puberty or hormonal changes. U will have a shortening of the leg with this. Klinefelter syndrome- More female traits in males cuz they got an xtra X. Turners Syndrome- Females with ONLY ONE X. Webbed neck, lymphedema. Short stature. AANP Exam tips
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