Ultimate NP Certification Review
Primary & Secondary Prevention
● Primary prevention
○ Definition: preventing the health problem, the most cost-effective form of healthcare
○ Examples: immunizations, counseling on injury/disease prevention, education
● Secondary prevention
○ Definition: detecting disease in early, asymptomatic, or preclinical state to minimize
its impact
○ Examples: screening tests (BP check, mammogram, colonoscopy, skin survey, lab tests)
● Tertiary prevention
○ Definition: minimizing negative disease-induced outcomes
○ Examples: In established disease, adjusting therapy to avoid further target organ
damage (adjusting therapy to enhance glycemic control)
Immunizations
● Immunizations should only be deferred in the presence of a moderate-to-severe illness with
or without fever
● Active Immunization
○ Resistance developed in response to a vaccine and usually characterized by the
presence of an antibody produced by the host.
○ Protection on board in anticipation of possible exposure
● Passive Immunization
○ Immunityconferred by an antibody produced in another host by administration of an
antibody-containing preparation (immune globulin)
○ Given post exposure toselectinfectingagents,patientsneedtopresentwithriskor
report of exposure
● Tetanus
○ When to administer tetanus vaccine
■ All wounds if history of tetanus vaccination is unknown or <3 doses
■ Clean, minor wounds if >10 years since last booster dose
■ All other wounds if >5 years since last booster dose
● This includes wounds >6 hours old, contaminated, puncture/crush
wounds, burns, frostbite
○ DTaP should be used for children age <7 years
○ Tdap is recommended for adolescents and adults
, ○ Adose of Tdap is recommended during each pregnancy regardless of Prior history of
taking Tdap
Suicide
● Malesrepresent nearly 80% of all completed suicides
○ Men use more lethal action, which leads to more completed suicides, but women
attempt more often
● When compared with male suicide attempts, female attempts at suicide are approximately 2
to 3 times more common
● The highest rate of completed suicide is found in the elderly population >75 years
Leading Causes of Death
● All ages = CVD, followed by malignant neoplasms
● 10-44 = unintentional injury
● Estimated new cancer cases in the US
○ Males
■ Prostate - 27%
■ Lung & bronchus - 12%
■ Colon & rectum - 8%
○ Females
■ Breast - 31%
■ Lung & bronchus - 8%
■ Colon & rectum - 7%
● Estimated cancer deaths in the US
○ Males
■ Lung & bronchus - 21%
■ Prostate - 11%
■ Colon & rectum - 9%
○ Females
■ Lung & bronchus - 21%
■ Breast - 15%
■ Colon & rectum - 8%
Screening Tests
● Sensitivity - A sensitive test is very good at identifying/detecting those people who have the
disease (true positive).
○ An easy way to remember is to think of “sensitivity—rule in” or “SIN.”
● Specificity - A specific screening test is very good at identifying/detecting those people
without the disease (true negative).
○ An easy way to remember is to think of “specificity—rule out” or “SPOUT.”
● USPSTF Recommendations: Breast Cancer (January 2016)
○ Baseline mammogram: Start at age 50 years and repeat every 2 years until age 74 years
○ Aged ≥75 years: Insufficient evidence for routine mammogram
○ Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial
breast cancer, or a history of chest radiation at a young age or women previously
, diagnosed with high-risk breast lesion who may benefit from starting screening in their
40s
● USPSTF Recommendations: Cervical Cancer (August 2018)
● USPSTF Recommendations: Colorectal Cancer (May 2021)
● USPSTF Recommendations: Lung Cancer (March 2021)
○ The USPSTF recommends annual screening for lung cancer with low-dose computed
tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking
history and currently smoke or have quit within the past 15 years.
○ Screening should be discontinued once a person has not smoked for 15 years or
develops a health problem that substantially limits life expectancy or the ability or
willingness to have curative lung surgery.
, ● USPSTF Recommendations: Prostate Cancer (May 2018)
○ Aged55 to69 years:Individualizethedecisionto undergo periodic prostate-specific
antigen (PSA) screening. Discuss potential harms (erectile dysfunction, urinary
incontinence, prostate biopsy, false-positive results) versus the benefits. Do not screen
men who do not express preference for screening.
○ Aged 70 years or older: Do not screen.
Hematology
● Lab values
○ Normal MCV (size) = 80-96
○ Normal MCHC (color) = 31-37
○ Normal RDW (RBC distribution width) = 11-15%
● *Test success tip: small RBCs are always pale RBCs, large RBCs are always normochromic
● Anemia
○ Normocytic (MCV = 80-96) normochromic anemia with normal RDW
■ Most common causes
● Anemia of chronic disease
● CKD
● Acute blood loss (GI bleed)
■ Next step: find underlying cause
○ Microcytic (MCV <80) hypochromic anemia with elevated RDW
■ Most common causes
● Iron deficiency
● Plumbism (lead toxicity)
■ Next step: draw ferritin, lead if young child or suspected case
○ Microcytic (MCV <80) hypochromic anemia with normal RDW
■ Most common causes
● Alpha or beta thalassemia minor
■ Next step: hgb electrophoresis
○ Macrocytic (MCV >96) normochromic anemia with elevated RDW
■ Most common causes
● Vit B12 deficiency
● Folate deficiency
■ Next step: draw serum B12 and RBC folate
○ *Test success tip: Vit B12 is hard to find in a plant based diet (vegans)
○ *Test success tip: Vit B12 deficiency is associated with peripheral neuropathy,
dementia, cognitive impairment, and depression
○ *Test success tip: 3 G’s (Ginseng, Gingko, Garlic) are associated with increased
bleeding risk and should be discontinued at least 7 to 10 days prior to elective surgical
procedures and used with caution with drugs such as aspirin, direct oral
anticoagulants, and warfarin
● Evaluation of WBC and Differential
○ Normal WBC count = 6,000-10,000
○ Leukocytosis = WBC > 10,000
Primary & Secondary Prevention
● Primary prevention
○ Definition: preventing the health problem, the most cost-effective form of healthcare
○ Examples: immunizations, counseling on injury/disease prevention, education
● Secondary prevention
○ Definition: detecting disease in early, asymptomatic, or preclinical state to minimize
its impact
○ Examples: screening tests (BP check, mammogram, colonoscopy, skin survey, lab tests)
● Tertiary prevention
○ Definition: minimizing negative disease-induced outcomes
○ Examples: In established disease, adjusting therapy to avoid further target organ
damage (adjusting therapy to enhance glycemic control)
Immunizations
● Immunizations should only be deferred in the presence of a moderate-to-severe illness with
or without fever
● Active Immunization
○ Resistance developed in response to a vaccine and usually characterized by the
presence of an antibody produced by the host.
○ Protection on board in anticipation of possible exposure
● Passive Immunization
○ Immunityconferred by an antibody produced in another host by administration of an
antibody-containing preparation (immune globulin)
○ Given post exposure toselectinfectingagents,patientsneedtopresentwithriskor
report of exposure
● Tetanus
○ When to administer tetanus vaccine
■ All wounds if history of tetanus vaccination is unknown or <3 doses
■ Clean, minor wounds if >10 years since last booster dose
■ All other wounds if >5 years since last booster dose
● This includes wounds >6 hours old, contaminated, puncture/crush
wounds, burns, frostbite
○ DTaP should be used for children age <7 years
○ Tdap is recommended for adolescents and adults
, ○ Adose of Tdap is recommended during each pregnancy regardless of Prior history of
taking Tdap
Suicide
● Malesrepresent nearly 80% of all completed suicides
○ Men use more lethal action, which leads to more completed suicides, but women
attempt more often
● When compared with male suicide attempts, female attempts at suicide are approximately 2
to 3 times more common
● The highest rate of completed suicide is found in the elderly population >75 years
Leading Causes of Death
● All ages = CVD, followed by malignant neoplasms
● 10-44 = unintentional injury
● Estimated new cancer cases in the US
○ Males
■ Prostate - 27%
■ Lung & bronchus - 12%
■ Colon & rectum - 8%
○ Females
■ Breast - 31%
■ Lung & bronchus - 8%
■ Colon & rectum - 7%
● Estimated cancer deaths in the US
○ Males
■ Lung & bronchus - 21%
■ Prostate - 11%
■ Colon & rectum - 9%
○ Females
■ Lung & bronchus - 21%
■ Breast - 15%
■ Colon & rectum - 8%
Screening Tests
● Sensitivity - A sensitive test is very good at identifying/detecting those people who have the
disease (true positive).
○ An easy way to remember is to think of “sensitivity—rule in” or “SIN.”
● Specificity - A specific screening test is very good at identifying/detecting those people
without the disease (true negative).
○ An easy way to remember is to think of “specificity—rule out” or “SPOUT.”
● USPSTF Recommendations: Breast Cancer (January 2016)
○ Baseline mammogram: Start at age 50 years and repeat every 2 years until age 74 years
○ Aged ≥75 years: Insufficient evidence for routine mammogram
○ Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial
breast cancer, or a history of chest radiation at a young age or women previously
, diagnosed with high-risk breast lesion who may benefit from starting screening in their
40s
● USPSTF Recommendations: Cervical Cancer (August 2018)
● USPSTF Recommendations: Colorectal Cancer (May 2021)
● USPSTF Recommendations: Lung Cancer (March 2021)
○ The USPSTF recommends annual screening for lung cancer with low-dose computed
tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking
history and currently smoke or have quit within the past 15 years.
○ Screening should be discontinued once a person has not smoked for 15 years or
develops a health problem that substantially limits life expectancy or the ability or
willingness to have curative lung surgery.
, ● USPSTF Recommendations: Prostate Cancer (May 2018)
○ Aged55 to69 years:Individualizethedecisionto undergo periodic prostate-specific
antigen (PSA) screening. Discuss potential harms (erectile dysfunction, urinary
incontinence, prostate biopsy, false-positive results) versus the benefits. Do not screen
men who do not express preference for screening.
○ Aged 70 years or older: Do not screen.
Hematology
● Lab values
○ Normal MCV (size) = 80-96
○ Normal MCHC (color) = 31-37
○ Normal RDW (RBC distribution width) = 11-15%
● *Test success tip: small RBCs are always pale RBCs, large RBCs are always normochromic
● Anemia
○ Normocytic (MCV = 80-96) normochromic anemia with normal RDW
■ Most common causes
● Anemia of chronic disease
● CKD
● Acute blood loss (GI bleed)
■ Next step: find underlying cause
○ Microcytic (MCV <80) hypochromic anemia with elevated RDW
■ Most common causes
● Iron deficiency
● Plumbism (lead toxicity)
■ Next step: draw ferritin, lead if young child or suspected case
○ Microcytic (MCV <80) hypochromic anemia with normal RDW
■ Most common causes
● Alpha or beta thalassemia minor
■ Next step: hgb electrophoresis
○ Macrocytic (MCV >96) normochromic anemia with elevated RDW
■ Most common causes
● Vit B12 deficiency
● Folate deficiency
■ Next step: draw serum B12 and RBC folate
○ *Test success tip: Vit B12 is hard to find in a plant based diet (vegans)
○ *Test success tip: Vit B12 deficiency is associated with peripheral neuropathy,
dementia, cognitive impairment, and depression
○ *Test success tip: 3 G’s (Ginseng, Gingko, Garlic) are associated with increased
bleeding risk and should be discontinued at least 7 to 10 days prior to elective surgical
procedures and used with caution with drugs such as aspirin, direct oral
anticoagulants, and warfarin
● Evaluation of WBC and Differential
○ Normal WBC count = 6,000-10,000
○ Leukocytosis = WBC > 10,000
