AANP Certification Exam 393 Questions with Answers
diverticulum can be an infection of - CORRECT ANSWERS both gram - and + bacteria
Which
... [Show More] diuretic should be used for osteoporosis? - CORRECT ANSWERS Thiazide diuretics:
slows the kidneys excretion of calcium and increases reabsorption
Lachman maneuver - CORRECT ANSWERS knee instability
tear of ACL
Infections of labia and vagina - CORRECT ANSWERS bacterial vaginosis, candidiasis, and trichomoniasis
Chlamydia affects - CORRECT ANSWERS cervix, endometrial lining, fallopian tubes, pelvic cavity
Acute abdomen symptoms - CORRECT ANSWERS involuntary guarding, rebound tenderness, board-like abdomen, +obturator and psoas sign
Care of preecplampsia - CORRECT ANSWERS bed rest, weight and blood pressure monitoring
Preeclampsia labs - CORRECT ANSWERS urine protein, serum protein, creatinine, platelet count
Preeclampsia symptoms - CORRECT ANSWERS hypertension, proteinuria, edema (weight gain)
Preeclampsia complications - CORRECT ANSWERS placental abruption, coagulopathy (DIC), renal failure, uteroplacental insufficiency, liver failure, hypertensive encephalopathy, retinal detachment, pulmonary edema, seizure, death
community acquired pneumonia
Most common bacteria
least common bacteria
Population
treatment - CORRECT ANSWERS mycolpasma pneumoniae (atypical)
h. influenza, strep pneumoniae
atypical: psuedomonas aeruginosa
college student, school children, military
macrolides: azithromycin, clarithromycin
Mantoux test - CORRECT ANSWERS Positive: 5mm
Positive for recent immigrants: 10mm
Murphy's sign - CORRECT ANSWERS biliary disorders
deep inspiration by patient and deep palpation RUQ below costovertebral angle
placenta previa - CORRECT ANSWERS implantation of the placenta over the cervical opening or in the lower region of the uterus
painless bright red blood in the second or third trimester
Order abdominal US
Hashimoto's is most common in which population - CORRECT ANSWERS middle age to older women
Hypertension Retinopathy - CORRECT ANSWERS AV nicking and copper or silver wire arterioles
flame-shaped hemorrhages
threatened abortion - CORRECT ANSWERS vaginal bleeding and cramping, soft uterus, cervix closed
bacterial vaginosis - CORRECT ANSWERS fishy odor, milky white or dull gray discharge
pH > 4.5
> 20% clue cells
KOH whiff test
squamous cells dotted with lots of bacteria that obscure borders - CORRECT ANSWERS clue cells
Lichen sclerosis - CORRECT ANSWERS skin disease, white spots appear over time, most common genital and rectal
most common in older woman
itching, discomfort, bleeding
order biopsy
AV valves - CORRECT ANSWERS mitral and tricuspid
semilunar valves - CORRECT ANSWERS pulmonary and aortic
S1 - CORRECT ANSWERS systole
closure of AV valves
mitral regurgitation
aortic stenosis
S2 - CORRECT ANSWERS diastole
closure of semilunar valves
mitral stenosis
aortic regurgitation
S3 - CORRECT ANSWERS normal variant in children, healthy young adults, and athletes
heart failure
early diastole
S4 - CORRECT ANSWERS left ventricle hypertrophy
late diastole
Tanner Stages Males: II - CORRECT ANSWERS no changes to penis, testes enlarge
Pubic hair is sparse and straight
Tanner Stages Males: III - CORRECT ANSWERS penis lengthens
hair darker and starts to curl
Tanner Stages Males: IV - CORRECT ANSWERS penis increases in length and width
hair coarse, not yet on medial thigh
Tanner Stages Females: II - CORRECT ANSWERS breast buds
pubic hair sparse and straight
Tanner Stages Females: III - CORRECT ANSWERS breast tissue and areola in one mound
hair darker, starts to curl
Tanner Stages Females: IV - CORRECT ANSWERS areola separates and forms a secondary mound
hair coarse, not on medial thigh yet
TORCH infections - CORRECT ANSWERS Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
osteoarthritis vs rheomatoid arthritis - CORRECT ANSWERS OA: stiffness, heberden's nodes, increase age, overuse, family history
RA: relies more on labs, increased ESR, Bouchard's nodes, fatigue, fever, body aches
drawer test - CORRECT ANSWERS instability of the knee
mediolateral and anteroposterior plane
torn or ruptured ligament
fundal height 12 weeks - CORRECT ANSWERS just above pubic bone
fundal height 20 weeks - CORRECT ANSWERS level of umbilicus
fundal height 20-35 weeks - CORRECT ANSWERS number of weeks gestation +/- 2 cm
apraxia - CORRECT ANSWERS loss of ability to perform purposeful movements in the absence of sensory or motor damage
ectopic pregnancy - CORRECT ANSWERS amenorrhea, new onset of vaginal spotting, left adnexal tenderness, and cervical motion tenderness
G6PD anemia - CORRECT ANSWERS hereditary, RBC break down, hemolysis
Meds that can trigger: antimalarial drugs, aspirin, nitrofurantoin, NSAIDs, quinidine, quinine, sulfa
Pheochromocytoma - CORRECT ANSWERS a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine and norepinephrine
these hormones control heart rate, metabolism, and blood pressure
Fitz-Hugh-Curtis - CORRECT ANSWERS Perihepatic inflammation & fibrosis;
Complication of Chlamydia and pelvic inflammatory disease
Sharp pain in RUQ
subconjunctival hemorrhage
risk factors - CORRECT ANSWERS Bright red patches in conjunctiva of eyes due to ruptured blood vessels
Risk factors: DM, HTN, coughing, sneezing, blood thinners, aspirin, ginkgo
Benign, will spontaneously resolve
atopic dermatitis - CORRECT ANSWERS Excess inflammation; dry skin, redness, and itching from allergies and irritants.
linear
Koplik spots - CORRECT ANSWERS Rubeola (measles)
small white papules inside the cheeks by rear molars
treponema pallidum
symptoms - CORRECT ANSWERS syphilis
painless chancre, maculopapular rash on palms and soles, lymphadenopathy, condyloma acata
hCG is produced by - CORRECT ANSWERS placenta after implantation
majority of AFP is produced by - CORRECT ANSWERS fetal liver
Inevitable abortion - CORRECT ANSWERS bleeding and cramping/pain with cervical dilation but no passage of tissue
incomplete abortion - CORRECT ANSWERS moderate to diffuse vaginal bleeding, passage of tissue, painful uterine cramping or contractions
MMR and pregnancy - CORRECT ANSWERS contraindicated
wait 4 weeks before becoming pregnant
Positive signs of pregnancy - CORRECT ANSWERS ultrasound, auscultation of fetal HR with doppler
Probable signs of pregnancy - CORRECT ANSWERS detected by examiner
blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign, enlarged uterus
Presumptive signs of pregnancy - CORRECT ANSWERS felt by woman
amenorrhea, nausea, breast tenderness, deepening pigmentation, urinary frequency, quickening, fatigue
testing HPV - CORRECT ANSWERS lesions will turn white with application of acetic acid
OCD treatment - CORRECT ANSWERS SSRI
first step for dementia assessment - CORRECT ANSWERS history from family and friends
Phalen maneuver - CORRECT ANSWERS Tests carpel tunnel syndrome, pinches median nerve
chronic cough causes - CORRECT ANSWERS postnasal drip, asthma, GERD, chronic bronchitis, bronchiectasis, allergic rhinitis
Aspirin effect on platelets - CORRECT ANSWERS irreversible, can last 15-20 days
Chromolyn sodium inhaler - CORRECT ANSWERS prevent symptoms of asthma
Rovsign's sign - CORRECT ANSWERS acute abdomen
palpate deep LLQ, referred pain to RLQ
cauda equina - CORRECT ANSWERS caused by compression of lumbar, sacral, or coccygeal nerve roots
loss of bladder and bowel control
paralysis/numbness of legs
cause: disc herniation. abscess, tumor, inflammation
order MRI
placenta abruptio - CORRECT ANSWERS premature separation of the placenta from the wall of the uterus
bright red vaginal bleeding, board-like uterus on palpation, pain
Jarisch-Herxheimer reaction - CORRECT ANSWERS Flu-like syndrome (fever, chills, headache, myalgia) after antibiotics are started; due to killed bacteria (usually spirochetes) releasing endotoxins.
Treatment of syphilis, first 24 hours
headache, myalgias, rigors, sweating, hypotension, worsening of rash
spontaneously resolves in 12-24 hours
coarctation of the aorta - CORRECT ANSWERS congenital cardiac condition characterized by a narrowing of the aorta
blood pressure higher in arms than legs
mitral valve prolapse - CORRECT ANSWERS improper closure of the mitral valve
late systolic murmur in the apical area
mid-systolic click
pterygium - CORRECT ANSWERS triangular opaque tissue on the nasal side of the conjunctiva that grows toward the center of the cornea
cause by long-term sun exposure
corneal arcus senilis - CORRECT ANSWERS Lipid deposits in the periphery of the eye
white to grey colored ring around the edge of the cornea in both eyes
pingeucula - CORRECT ANSWERS benign growth on the conjunctiva caused by degeneration of collagen fibers
cause by long-term sun exposure
Lyme disease - CORRECT ANSWERS Tick-borne disease caused by the spirochete Borrelia burgdorferi.
erythema migrans
treat with doxycycline
Epstein-Barr virus labs - CORRECT ANSWERS infectious mononucleosis
triad: fever, pharyngitis, lymphadenopathy
normal to moderate WBCs, increased lymphocytes, >10% atypical lymphocytes
Cafe au lait spots - CORRECT ANSWERS Smooth edged tan-to-brown pigmentations on the skin seen in neurofibromatosis or von Recklinghausen's
papilledema - CORRECT ANSWERS swelling of the optic disc caused by increased ICP
usually bilateral
enlarged blind spot on visual field test
Fundoscopic exam - CORRECT ANSWERS The use of an ophthalmoscope to look through the pupil and examine the interior surface of the posterior eye
visualizes vessels and assess intracranial tension
recommended for new onset headache - CORRECT ANSWERS fundoscopic exam
red reflex exam - CORRECT ANSWERS used to assess for cataracts
Leukoplakia - CORRECT ANSWERS thickened, white, leathery-looking spots on the inside of the mouth from chronic tobacco use
retinoblastoma fundoscopic exam - CORRECT ANSWERS white reflection on pupil
high vitamin K levels effect with coumadin - CORRECT ANSWERS decrease INR
HELLP syndrome - CORRECT ANSWERS hemolysis, elevated liver enzymes, low platelets
complication of preeclampsia
multipara, >25, 3rd trimester
RUQ pain, n/v, malaise
low H/H
low AFP - CORRECT ANSWERS Down syndrome
order triple screen
high AFP - CORRECT ANSWERS indicates neural tube defects, multiple gestation
order triple screen or sonogram
HCG doubles every - CORRECT ANSWERS 48 hours during the first 12 weeks
ectopic pregnancy HCG level - CORRECT ANSWERS lower levels
inevitable abortion HCG level - CORRECT ANSWERS starts decreasing rapidly
drawer sign - CORRECT ANSWERS knee instability, torn/ruptured ligament
anterior: ACL
posterior: PCL
Finklestein's test - CORRECT ANSWERS Test for de Quervain's syndrome
McMurray Test - CORRECT ANSWERS medial meniscus
hear a click
acute angle closure glaucoma - CORRECT ANSWERS sudden unilateral eye pain, redness, dilated oval shaped pupil with poor light response
headache, n/v, halos around lights
cloudy cornea
fundoscope: cupping of optic nerve
optic neuritis - CORRECT ANSWERS new-intermittent loss of vision in 1 eye
nystagmus
multiple sclerosis
orbital cellulitis - CORRECT ANSWERS Redness, swelling, impaired motility, painful, proptosis
retinal detachment - CORRECT ANSWERS floaters and flashes of light, curtain vision
diabetic retinopathy - CORRECT ANSWERS Microaneurysms caused by new fragile arteries in the retina.
cotton wool spots
cataracts - CORRECT ANSWERS opacity of lens, halos around lights, develop slowly over time, causing symptoms such as blurry vision
Fibromyalgia - CORRECT ANSWERS symptoms last more than 3 months
diffuse pain, sleep abnormalities, fatigue
Alzheimer's symptoms - CORRECT ANSWERS aphasia, apraxia, agnosia
Mini-Mental State Examination (MMSE) mid-moderate score - CORRECT ANSWERS 10-26
Mini-Mental State Examination (MMSE) moderate-advanced score - CORRECT ANSWERS <17
Mini-Mental State Examination (MMSE) severe score - CORRECT ANSWERS <10
Diabetes screening tests - CORRECT ANSWERS fasting plasma glucose >/= 126
A1C > 6.5
random blood sugar > 200 with symptoms
Most common risk factor for developing hyperbilirubinemia in newborn - CORRECT ANSWERS blood incompatibility with the mother
Sports physical: limitations for participation - CORRECT ANSWERS hypertyrophic cardiomyopathy
down syndrome
juvenile RA
marfan syndrome
ehers-danlos
infections
rheumatic fever
mitral valve prolapse
Mono vs group a strep pharyngitis - CORRECT ANSWERS Mono: gradual, fatigue, LUQ pain
Strep: sudden, white patches, red throat
Grade I heart murmur - CORRECT ANSWERS only heard in optimal conditions
Grade II heart murmur - CORRECT ANSWERS clearly audible but faint
Grade III heart murmur - CORRECT ANSWERS loud, easily heard with stethoscope
Grade IV heart murmur - CORRECT ANSWERS loud, associated with thrill
Grade V heart murmur - CORRECT ANSWERS very loud, thrill easily palpable
heard with edge of stethoscope off chest
Grade VI heart murmur - CORRECT ANSWERS very loud, audible even with stethoscope not on chest, thrill palpable and visible
BPH symptoms
clinical findings - CORRECT ANSWERS weak urinary stream, post-void dribbling, feeling of incomplete emptying, urinary retention, nocturia
prostate feels boggy and uniformly enlarged
Initial assessment of depression in geriatric patients - CORRECT ANSWERS mental status exam
Risk factors for post menopausal osteoporosis - CORRECT ANSWERS history of tobacco or alcohol use
family history
thin, bony
chronic steroid use
anorexia, bulimia
PPI use
decreased intake of calcium and vitamin D
sedentary lifestyle
gastric bypass
celiac disease
hyperthyroidism
ankylosing spondylitis
RA
causes of CKD - CORRECT ANSWERS DM, HTN, ischemia, infection, obstruction, toxins, autoimmune diseases (SLE, amyloidosis)
exacerbations of urinary incontinence - CORRECT ANSWERS impacted stool
atrophic vaginitis
UTI
positive IgG Anti-HAV - CORRECT ANSWERS history of hepatitis A infection or vaccination
positive IgM Anti-HAV - CORRECT ANSWERS acute hepatitis A infection
HbsAg - CORRECT ANSWERS screening test for Hepatitis B
+: current infection
positive HbeAg - CORRECT ANSWERS persistent chronic Hepatitis B infection
positive Anti-Hbs - CORRECT ANSWERS antibodies
past Hepatitis B infection or vaccination
positive Anti HCV - CORRECT ANSWERS current infection
Order HCV RNA or PCR to rule out chronic infection
enlarged parotid gland - CORRECT ANSWERS mumps
vulvar cancer symptoms - CORRECT ANSWERS bump on vulva, pruritus, malodorous drainage, ulcerate lesion
syphilis symptoms - CORRECT ANSWERS one painless ulcer, enlarged groin lymph nodes
genital herpes - CORRECT ANSWERS shallow, small ulcers with red base, painful, swollen lymph nodes
Osgood-Schlatter disease - CORRECT ANSWERS pain relieved with rest, swelling of the tibial tubercle
Multiple myeloma symptoms - CORRECT ANSWERS anemia, back pain, osteoporosis, increased ESR
lab frequency when changing synthroid dose - CORRECT ANSWERS 6 weeks
labs with stable synthroid dose - CORRECT ANSWERS 6-12 months
best medication for hypertension with diabetic patients - CORRECT ANSWERS ACE inhibitor
treatment of retentive encopresis - CORRECT ANSWERS laxative protocol
if no improvement: refer to GI
rhogam administration after spontaneous abortion - CORRECT ANSWERS 72 hours
when can infants have solid foods? - CORRECT ANSWERS 6 months
first line treatment of parkinson's - CORRECT ANSWERS sinemet
treatment of otitis media - CORRECT ANSWERS Amoxicillin
PCN allergy: cefidinir
Treatment of cat bites - CORRECT ANSWERS Augmentin
treatment of anthrax - CORRECT ANSWERS Ciprofloxacin and doxycycline
Asthma Step 1 - CORRECT ANSWERS intermittent
FEV1>80%
daytime symptoms <2 days/week
nighttime awakenings <2/month
SABA PRN
Asthma Step 2 - CORRECT ANSWERS mild persistent
FEV1>80%
daytime symptoms >2 days/week, not daily
nighttime awakenings 3-4/month
SABA PRN
Asthma Step 3 - CORRECT ANSWERS moderate persistent
FEV1: 60-80%
daytime symptoms
nighttime awakenings >1/week, not nightly
SABA PRN
PLUS
low dose ICS + LABA or medium dose ICS
Advair, symbicort combo
Steroids: budesonide (pulmicort) or fluticasone (flovent)
Asthma Step 4 - CORRECT ANSWERS sever persistent
FEV1 <60%
symptoms throughout the day
nighttime awakenings nightly
SABA PRN
PLUS
medium dose ICS + LABA
Advair, symbicort combo
OR medium dose ICS + montelukast
optic disc normal exam - CORRECT ANSWERS has sharp margins, yellow-orange to creamy pink color and round or oval in shape
veins to arteries ratio- 3:2
veins are darker and larger
Snellen test results - CORRECT ANSWERS Numerator: the test distance, 20 ft
denominator: the distance at which average eye can see letters on line
Symogi effect - CORRECT ANSWERS also called the rebound effect
caused by too much insulin (or missing a meal) in the evening, resulting in hypoglycemia in the early morning (2-3 am)
body secretes glucagon and epinephrine, resulting in high blood sugars in the morning
Dawn phenomenon - CORRECT ANSWERS high blood glucose levels occur between 2 a.m. and 8 a.m
treat: avoid high carb snacks before bed, adjust night time insulin dose
intermittent claudication evaluation - CORRECT ANSWERS ankle and brachial blood pressure before and after exercise
interactions with theophylline - CORRECT ANSWERS erythromycin, phenytoin, cimetidine
Theophylline - CORRECT ANSWERS used to control inflammation of the lungs and for maintenance as a bronchodilator
cover/uncover test - CORRECT ANSWERS screening for strabismus
Ishihara test - CORRECT ANSWERS test for color blindness
Peak expiratory flow is determined by - CORRECT ANSWERS height, gender, age
pap smear sample must contain - CORRECT ANSWERS squamous cells: sample from transition area
endocervical cells: upper limit of transformation zone
physiological jaundice - CORRECT ANSWERS caused by build up of unconjugated bilirubin because the infant's immature live cannot metabolize and excrete it quickly enough
starts 2nd-4th day
phototherapy is usually not indicated
pathological jaundice - CORRECT ANSWERS occurs before 24 hours and may indicate early hemolysis
most common type of jaundice - CORRECT ANSWERS physiological [Show Less]