AANP FNP Board Exam Questions and Answers

AANP FNP Board Exam Questions and Answers USPSTF breast cancer screening recommendations (2024) Baseline mammo at 40 years old Screen q2 years until 74 years old USPSTF cervical cancer screening recommendations (2018) Baseline pap at 21 years old Screen q3 years until 65 years old Alternative screen for age 30 - 65 high risk HPV testing q5 years Do not screen if hysterectomy and no hx of precancer or cervical cancer If hx of ca, screen for 20 years after surgery USPSTF lung cancer screening recommendations (2021) Only for Age 50 - 80 years old W/ 20 pack year smoking hx OR quit 15 years ago -Annual screening w/ LDCT (low dose computed tomography) USPSTF prostate cancer screening recommendations (2018) PSA screening ages 55 - 69 years old screening should be individualized USPSTF testicular cancer screening recommendations (2011) Routine screening not recommended USPSTF colorectal cancer screening recommendations (2021) Baseline screening age 45 years - 75 years old w/ high-sensitivity fecal occult blood test annually OR Cologuard every 3 years OR sigmoidoscopy every 5 years OR colonoscopy every 10 years USPSTF skin cancer screening recommendations (2016) Educate fair-skinned persons to avoid sunlight (10 am - 3 pm) and use sunblock SPF 15 *insufficient evidence for visual skin exam USPSTF tobacco smoking recommendations (2020) Ask ALL adults about tobacco use, advise to stop smoking, provide smoking cessation USPSTF fall prevention in community-dwelling older adults (2018) Exercise interventions to prevent falls in adults at increased risk 65 years old USPSTF ovarian cancer screening recommendations (2018) Routine screening not recommended High-risk are screened by specialist (BRCA mutation, family hx breast/ovarian ca) refer to genetic counseling USPSTF abdominal aortic aneurysm screening recommendations (2019) Age 65- 75 years old for men who have ever smoked One time screening (US abd) USPSTF statin use for primary prevention of CVD in adults Prescribe statin for primary prevention of CVD for adults Age 40 - 75 yrs old w/ 1 or more risk factors -dyslipidemia -DM II -HTN -smoking -10 year ASCVD risk score 10% USPSTF prevention of HIV (2023) Prescribe PEP to persons at increased risk of HIV acquisition USPSTF prediabetes and DM II (2021) Screen for prediabetes and DM II in adults age 35 - 70 years old w/ overweight or obesity USPSTF osteoporosis screening recommendations (2018) Screen for osteoporosis w/ bone measurement testing in -postmenopausal women 65 at increased risk -all women 65 EBM Levels of Evidence 1. meta-analysis and/or systematic reviews 2. randomized controlled trials 3. Experimental studies (control group, intervention group, randomization) 4. cohort studies and case-control studies 5. Retrospective chart reviews 6. Expert/specialty society opinions Developmental milestones neonate Normal vs abnormal Strong reflexes 6-8 bm per day urinates x8 day Abnormal - jaundice, high-pitched cry, irritable, hypotonic, poor reflexes Developmental milestones 3 mo Smiles Coos Gurgling sounds Holds head up when prone Starts to recognize parents Abnormal - avoids eye contact, hypotonic, inability to hold head up Developmental milestones 6 mo Sits without support Rolls in both directions Single syllable sounds (ba, da, ma) "Raking" - using palms to get things out of reach Developmental milestones 9 mo Pincer grasp Plays peek a boo Stranger anxiety Can stand holding on to furniture Crawls Abnormal - Does not bear weight w/ support, unable to sit with help, persistence of primitive reflexes Developmental milestones 12 mo Supports own weight Walks with hands held Parallel play Separation anxiety Can crawl up or down stairs Starts to cruise (moves from one furniture to other) Abnormal - Unable to support own weight, lack of babbling, No response to smiles, poor eye contact, loss of previously learned skills Developmental milestones 2 years Walks Runs Climbs up and down stairs with rails Speech mostly understood Follows 2-3 step directions Copies a line *two word phrases understood by family members Abnormal - unable to speak meaningful 2 word sentences. Does not understand simple commands. Developmental milestones 3 years Speaks 3-5 word sentences Copies a circle *Rides tricycle Builds towers of more than six blocks Runs and climbs easily *3-5 word sentences understood by strangers Abnormal - unclear hard to understand speech. unable to understand simple commands. Falls down often, No eye contact. Developmental milestones 4 years Copies a cross Draws person with 3 body parts Plays mom and dad Hops and stands on one foot up to 2 seconds *Cooperates with other children Names some colors and numbers Can dress self Abnormal - unable to speak in full sentences, inability to skip, run, hop. Cannot put on clothes without help. Unable to play with other kids Developmental milestones 5 years Can draw a person with 6 body parts Counts 10 or more things Is aware of gender speaks clearly Abnormal - unusually withdrawn, not active, touble focusing on one activity for 5 minutes car safety, toddlers Toddlers placed in back seat in a forward facing safety seat with harness until height and weight limits outgrown Children 12 years should be restrained in the back seat Early signs of autism and when to begin screening Begin screening at age 18 months -Des not point/wave/grasp/reach by 12 mo -No babbling by 12 mo -Does not say single words by 16 mo -Does not say 2 word phrases on their own by 24 mo -Loss of language or social skills at any age Neuroblastoma presentation and diagnosis presentation - abdominal mass that is fixed, firm, irregular, and frequently crosses the midline usually adrenal medulla May be accompanied by weight loss, fever, subcutaneous nodules Ultrasound is initial imaging choice Refer to pediatric surgeon Wilms Tumor (nephroblastoma) presentation and diagnosis Asympomatic abdominal mass rarely crosses midline Sometimes accompanied by abdominal pain, hematuria, hypertension. High incidence in black female children. Palpate the abdomen gently to avoid rupturing renal capsule. Use abdominal ultrasound and refer to nephrologist Epiglottitis *Medical emergency Acute, rapid onset of fever, chills, toxicity c/o severe sore throat, drooling saliva, will not eat or drink; Muffled voice and anxiety (hot potato voice) Tripod sitting with hyperextended neck and open mouth breathing Stridor, tachycardia, and tachypnea on exam Most cases were due to Hib. (importance of Hib vaccine) Rifampin for prophylaxis in close contacts (4 days) Osteomyelitis in children more common in boys Exquisitely tender metaphyses, febrile and toxic appearing. Will not bear weight Emergent hospitalization - IV abx, OR debridement Septic arthritis in children Most commonly from S. aureus Abrupt onset of unilateral hip or knee pain, with swelling, warmth. Antalgic limp or inability to bear weight. Emergent joint aspiration and IV abx Orbital cellulitis Young child c/o abrupt onset of deep eye pain aggravated by eye movements, w/ high fever, chills. Eye will appear bulging, EOM exam abnormal CT scan or MRI in the ED Periorbital cellulitis More common than orbital cellulitis. Infection of anterior portion of eyelid that does not involve the orbit or eyes. Young child c/o red, swollen, eyelids and eye pain. eye movements do not cause pain, EOM exam normal. Refer to ED Red flags for child abuse Posteriomedial rib fractures Metaphyseal avulsion fractures bruises or fractures in various stages of healing delay in seeking care Injuries inconsistent with explanation Toilet training usually begins 2-3 years of age most master by age 3-4 *children btw 5-6 years of age w/ primary nocturnal enuresis should be evaluated and interventions started Features of down syndrome round face that appears flat (decreased anterior-posterior diameter), palpebral fissures, low-set ears, macroglossia, short neck, short fingers, small palms, braod hand with simian crease Down syndrome risks intellectual disability, congenital heart defects, feeding difficulties, congenital hearing loss, thyroid disease, cataracts, sleep apnea, early onset alzheimers Avoid contact sports, trampoline d/t cervical spine instability Features of fetal alcohol syndrome microcephaly, short palpebral fissures, epicanthal folds, flat nasal bridge, thin upper lip, smooth philtrum, ears undeveloped Risks for fetal alcohol syndrome neurocognitive and behavioral problems Cryptorchidism undescended testicles Exam - warm room, massage inguinal canal Increased risk of testicular ca if testicles not removed from abdomen Surgical correction necessary w/in 1st year of life Gonococcal ophtlamia neonatorum s/s 2- 5 days after birth, with infection spreading rapidly leading to blindness. injected red conjunctiva w/ profuse purulent discharge and swllen eyelids Also test for chlamydia, gonorrhea, herpes simplex Tx - high dose IV or IM cefotaxime Prophylaxis - 0.5% erythromycin ointment Chlamydial ophthalmia neonatorum s/s 4-10 days after birth. red eyelids, profuse watery discharge that becomes purulent. R/o chlamydial pneumonia Tx w/ oral erythromycin *0.5% erythromycin ointment does not prevent chlamydial conjunctivitis Chlamydial PNA Infant with frequent cough, bibasilar rales, tachypnea, hyperinflation and diffused infiltrates on cxr Tx - erythromycin QID x 2 weeks Prevention of SIDS Position infants on backs; use firm sleep surface, encourage breastfeeding and immunizations, room share w/o bedsharing, offer pacifier, avoid soft objects and loose bedding in sleep area, smoke exposure, and overheating What is considered excessive newborn weight loss Beyond 10% Most lose 5-7% and should be regained within 10 - 14 days. Dehydration in an infant weak, rapid pulse, tachypnea, parched mucous membranes, anterior fontanelle markedly sunken, skin tenting, cool skin, acrocyanosis, anuria, change in LOC Refer to ED for IV hydration Failure to thrive in infants Weight for age below 3-5th percentile for gestation corrected age and gender. Most commonly caused by inadequate intake, diarrhea, malabsorption (celiac, cystic fibrosis, food allergy), poor maternal bonding, frequent infections Mongolian spots bluish purple spots of pigmentation usually lumbosacral area usually fades by 2-3 years Milia Multiple white 1-3 mm papules located on forehead, cheeks and nose. resolves spontaneously Erythema toxicum neonatorum small 1-3 mm white pustules surrounded by red base, usually on face, chest, back, extremities. Lasts 1-2 weeks and resoles spontaneously seborrheic dermatitis (cradle cap) in newborns excessive thick scaling on scalp treat with vegetable oil or mineral oil soak Prevent with frequent shampooing and removing scales with soft brush or comb. resolves spontaneously within a few months Faun tail nevus tufts of hair overlying spinal column. May be a sign of neural tube defects. perform neuro exam on lumbosacral nerves Order US of lesion to r/o occult spina bifida Cafe au Lait spots Flat light brown to dark brown spots 5 mm. R/o neurofibromatosis or von recklinghausen's if six or more spots 5 mm Nevus simplex (salmon patches) Flat pink patches found on forehead, eyelids, and nape of neck. Blancheable but can change color. Typically fades within 18 mo Nevus Flammeus (Port wine stain) pink to red flat stain like lesion on upper and lower eyelids. Refer to pediatric ophthalmologist to r/o congenital glaucoma. newborn laboratory tests TSH, PKU, sickle cell, anema (9-12 mo) Lead (age (12 and 24 mo) Birth weight 6 mo and 12 mo Birth weight doubles 6 mo and triples at 12 mo caput succedaneum vs cephalohematoma Caput Succedaneum- soft tissue swelling, that can cross suture lines Cephalohematoma- subperiosteal hemorrhage that does NOT cross suture lines. Avoid cows milk for first ___ mo of life 12 mo can cause GI bleeding and iron deficiency anemia Exclusively breastfeeding should supplement with vitamin D Newborn Reflexes Plantar reflex, palmar reflex, moro reflex, step reflex, blink reflex, tonic neck reflex, rooting reflex primitive reflexes usually disappear by 3-4 mo Vaccines pediatrics tips Do not give Varicella and MMR vaccine 12 mo Youngest age for flu is 6 mo Only vaccine at birth is hep B If HBsAg positive mother, give neonate hep B immunoglobulin and hep B vaccine Do not use DTap if 7 years or older Give Tdap at 11 -12 years as booster Meningococcal vaccine (MenACWY) at 11-12 infant can be vaccinated even with mild illness - low grade fever, cold, runny nose, cough, otitis media or mild diarrhea pathologic jaundice jaundice within first 24 hours -evaluate for sepsis, TORCH infection, occult hemorrhage If jaundice in infant after 2 weeks - requires eval -r/o sepsis, hemolytic disease, metabolic d/o, intestinal obstruction Physiologic jaundice starts after 24 hours and usually clears up within 2-3 weeks. other nonpathologic jaundice - breast milk jaundice (3 weeks, clears in 1 mo or more) treatment of neonatal jaundice check bilirubin if suspected pathologic, order serum fractionated bilirubin level, Coombs test, cbc, reticulocyte, periperal smear keep baby well hydrated with breast milk or formula first line treatment - phototherapy infant colic rule of 3s The goal when evaluating an infant with colic is to rule out conditions causing pain and/or discomfort, infections, environment, and formula "allergy." ■ Crying and irritability lasting a total of 3 hours a day in an infant younger than 3 months. ■ Occurs more than 3 days in a week and crying lasts more than 3 hours a day. ■ Crying usually occurs at the same time each day. Usually resolves by 3 to 4 months. Coarctation of the aorta neonate is pale, irritable, dyspneic, diaphoretic. Absence or delay of femoral pulse compared with brachial pulse Order echo EKG, cxr Developmental dysplasia of the hip asymmetry of thigh/gluteal folds positive barlow and ortolani test order hip ultrasound and refer to orthopedic specialist Kawasaki Disease High fever up to 104.0 for 5 or more days At least four of following: -enlarged lymph nodes on neck -Bright red rash -Bilateral conjuncitivits -Oral mucosal changes -Swollen hands and feet Treat w/ high dose aspirin and IV gamma globulin Resolves w/in 1-3 weeks - requires close followup with pediatric cardiologist d/t risk of coronary artery aneurysms, aortic dissection Leukemia c/o extreme fatigue, weakness, pale skin, easy bruising. may have petechial bleeding; bleeding gums and nosebleeds; bone or joint pain, lymphadenopathy, abdominal swelling. Most common in children is ALL (acute lymphocytic leukemia) CBC - high WBC 50,000