AANP board certification exam 48 Questions with Answers
how long will a cough last for acute bronchitis? - CORRECT ANSWER up to three weeks is
... [Show More] completely normal
how do you treat acute bronchitis? - CORRECT ANSWER 95% cases are viral-- tessalon pearls to help with cough. ** prednisone is never the answer ***
explain the following views of chest xrays: AP, PA, PA and lateral
which one do you want for pneumonia patient? - CORRECT ANSWER AP- shows the heart predominantly because its from front to back
PA- shows the lungs predominantly because its back to front
lateral shows fluid line
what is the gold standard for diagnosing community acquired pneumonia - CORRECT ANSWER chest xray- PA/lateral, repeat post treatment in 6 weeks (repeat not really done anymore)
treatment guidelines for CAP- healthy adult no comorbidities - CORRECT 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
treatment guidelines for CAP- adult with comorbidities - CORRECT ANSWER monotherapy: respiratory quinolone (levofloxacin 750 mg daily)
combination therapy: augmentin or cephalosporin PLUS macrolide or doxy
what are common respiratory fluroquinolones? - CORRECT ANSWER Think FLOXACIN-- moxifloxacin, gemifloxacin, levofloxacin
what are common macrolides for CAP - CORRECT ANSWER think "MYCIN" -- azithromycin, clarithromycin
what are common tetracyclines for CAP - CORRECT ANSWER doxycycline
what are common beta lactams for CAP - CORRECT ANSWER amoxicillin, augmentin (amox with clav), cefpodoxime, cefuroxime
how would you treat a pregnant 29 year old with pneumonia? - CORRECT 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)
how long do you give antibiotics to patient with pneumonia? - CORRECT ANSWER 5-10 days, you always want to continue antibiotics for 3 more days after clinically stable (no fever)
When do you get a chest xray for pneumonia? - CORRECT 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.
When do you give pneumococcal vaccine? - CORRECT 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.
What is the diagnostic criterion for COPD - CORRECT ANSWER FEV1/FVC ratio of < 0.70
What are characteristics of COPD - CORRECT ANSWER midlife onset, symptoms slowly progressive, exposure to lung irritant, DOE is progressive, chronic cough and chronic sputum production
what are characteristics of asthma - CORRECT ANSWER onset early in life, symptoms vary widely from day to day, symptoms worse at nighttime/early AM, allergic rhinitis, eczema, family history, obesity
what are characteristics of heart failure (when evaluating diff dx of COPD) - CORRECT ANSWER chest xray with dilated heart, pulmonary edema
what are characteristics of tuberculosis when ruling out for COPD patient - CORRECT ANSWER onset all ages, chest xray with lung infiltrate, microbiologic confirmation
what are the characteristics of bronchiectasis - CORRECT ANSWER LOTS OF PURULENT SPUTUM, chest xray shows bronchial wall thickening and bronchial dilation
What intervention has the greatest influence on slowing progression of a COPD patient? - CORRECT ANSWER smoking cessation!!
what are first line smoking cessation drugs? (3) - CORRECT ANSWER varenicline (chantix), nicotine patch, buproprion extended release (zyban)
what is second line smoking cessation drug? - CORRECT ANSWER sertraline (zoloft)
what smoking cessation drug would you give to someone with a history of a suicide attempt? - CORRECT ANSWER nicotine patch-- NOT CHANTIX OR ZYBAN
What are the short acting beta agonists - CORRECT ANSWER albuterol, levalbuterol
what are the long acting beta agonists - CORRECT ANSWER "terols"
Salmeterol
Formoterol
How do inhaled anticholinergic drugs work? - CORRECT ANSWER used in COPD, prevent bronchoconstriction
how do beta agonists work? - CORRECT ANSWER stimulate beta 1 (tachycardia) and beta 2 (bronchodilation)
what is the suffix for inhaled anti-cholinergic drugs? - CORRECT ANSWER "tropium" think ipratropium (atrovent) SHORT ACTING, tiotropium (spiriva) long acting
What is a SAMA? - CORRECT ANSWER short acting antimuscarinic (anticholinergic) - Ipratropium
what is a LAMA? - CORRECT ANSWER long acting muscarinic antagonist (anticholinergic) Tiotropium (spiriva)
what are the 4 steps of GOLD guidelines - CORRECT 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
How to manage COPD exacerbation? - CORRECT ANSWER figure out the cause
mild: sabas with spacers / nebulizer
moderate: SABAs plus AB and or steroid
Severe: hospitalization
right supraventricular nodes signal what malignancies? - CORRECT ANSWER lungs, mediastinum, esophagus
left supraventricular nodes signal what malignancies? - CORRECT ANSWER abnormal (stomach, GB, liver, pancreas, ovaries, prostate)
us preventive services task force routine lung cancer screening recommends what annual screening for current smokers aged 55-80 with 30 pack year history or have quit within the last 15 years? - CORRECT ANSWER annual low dose CT (LDCT)
how do you diagnose asthma > 5 years of age: - CORRECT ANSWER presence of asthma features
reversible airway obstruction on spirometry
>12% improvement from baseline or FEV1 > 200 ml after SABA
How do you treat asthma? - CORRECT ANSWER saba always as rescue inhaler
Step wise approach (GINA)
Low dose ICS
then ICS + LABA
increase dosage strength
acute bronchitis classic case symptoms - CORRECT 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
objective findings in acute bronchitis - CORRECT ANSWER lungs: clear to severe wheezing, rhonchi
percussion: resonant
CXR: normal
afebrile to low grade fever
treatment plan for bronchitis - CORRECT ANSWER symptomatic treatment- increas fluids and rest
tessalon perles, expectorant / mucolytic (guaifenesin)
ventolin (albuterol) for wheezing
for severe wheezing consider short term oral steroid
complications of acute bronchitis - CORRECT ANSWER exacerbation of asthma
pneumonia from secondary bacterial infection
pertussis "whooping cough" - CORRECT ANSWER caused by bordetella pertussis (gram negative)
coughing illness at least 14 days
paroxysmal coughing, inspiratory whooping
neonates / infants at highest risk for death
three stages of pertussis - CORRECT ANSWER catarrhal 1-2 weeks, if treated at this stage can shorten disease course
paroxysmal: lasts 2-4 weeks, treatment has little influence but is useful to decrease spread
convalescent: treatment goal is to eradicate carriage state / disease spread
how to diagnose pertussis - CORRECT 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
how to treat pertussis - CORRECT ANSWER administer a course of antibiotics to close contacts iwthin 3 weeks of exposure
first line: macrolides - azithromycin z pack x 5 days
alternative bactrim x 14 days
antitussives, mucolytics, rest, hydration, frequent small meals
complications of pertussis - CORRECT ANSWER sinusitis, otitis media, pneumonia, fainting, rib fractures from coughing
signs of pulmonary embolism - CORRECT ANSWER new onset dyspnea, hemoptysis, pleuritic chest pain, vital signs with tachycardia, tachypnea, may have signs of DVT [Show Less]