AGACNP EXAM- Risk Assessment, Herbal Agents Questions and Answers

AGACNP EXAM- Risk Assessment, Herbal Agents Questions and Answers When should a self breast exam start? Clinical breast exam? Age 21 Mammography- 40 years old When should adolescents have visits? 11-14, 15-17, 18- 21 What is done during an adolescent check up? Height, weight check, eating disorders, skin exam, abuse, depression, oral cavity, hearing, neglect. Which vaccines are indicated for female adolescents for HPV and associated ages? Gardasil 11-26 Cerverix 10-25 What is the most common cancer killer for boys in adolescent period? 2nd most common? Testicular cancer HIV depending on drug use/sexual activity When is the last meningiococcal vaccine given? When is revaccination indicated? Late adolescent period Person who will go to college and live in a dorm. Meningioccal vaccine is not a routine vaccine in the adult. At what age is the influenza vaccine given? Every year for persons 6 months of age and older. Should PPD screening be done in adolescents? Yes, one time. 20-39 age, when should a complete physical be done? When should it start? Start at 20, repeat complete physical every 5-6 years. PAP smears should begin at what age? 21 years old. Conventional/liquid based cytology is recommended. Repeated every 3 years. At age 30. HPV Co-test, repeated every 5 years. Full fasting lipid panel? Start at age 20 unless significant family history. If pt. not fasting, total and HDL are reasonable. Self skin exam? Dental cleaning and checkups? - every 6 to 12 months. TD vs. TDAP How often should a woman have mammography? Every 1 to 2 years until woman is 50 years old to 74 years old. Digital rectal exam? PSA? Age 40 Age 50 African-Americans or prostate CA hx- PSA done 40 years old or earlier. HIV, BP, cholesterol, ECG ? Colorectal cancer screening? Done by 40 years old. Starts by age 50 years old. Top killers of adults 1. Heart Disease (CAD, HF, cardiomyopathy) 2. Colorectal cancer 3. Lower respiratory disease (PNA, asthma, COPD) 4. CVA (stroke) Cancers responsible for highest mortality? 1. Lung 2. Colorectal Leading GYN associated killer cancer? Highest incidence of cancer in women? Ovarian Breast Highest incidence of cancer in men? 1. Lung 2. Prostate Leading killer of African Americans in US? Heart Disease Tinometry (glaucoma screening) Have a baseline by age 40. Herpes zoster vaccine (Zosyvax), what age should it be given? 50 years old. Discontinue PAP smear at what age? D/c mammography at what age? 65-70 with consecutive negative cytology. 50-74 Continue DRE and PSA to when? Indefinitely. TDAP not for what ages? 65 and older. Pneumococcal vaccine? Recommended 65 and older. 19 to 64 years old who smoke or have asthma, diabetes, sickle, cell, immunocompromised. The degree to which those who have a disease screen or test positive is? Sensitivity Is when the negatives show negative, those who do not have a disease screen negative. Specificity. Can you infer specificity statistics from sensitivity data? No. ELISA is 99% sensitive, 99% of the time positives show positive, you cannot infer that 1% shows negative- this would infer specificity. The frequency with which a disease or disorder appears in population at a given time. Incidence What is the rate in which disease occurs in a given period? Incidence 20 cases of botulism/ 500,000 people What is the proportion of a population affected by disease or disorder at a particular time? Prevalence Lupus prevalence of women in Illinois is 1%. What are adolescent killers? MVC, suicide, homicide, congenital illnesses. What are killers of young adults, 20-39? Suicide, heart disease, AIDS What is the leading killer of AA in US less than 40 year of age? In AA less than 35 years of age, leading killer? AIDS Homocide Middle aged adult killers? Heart disease, accidents, Breast colorectal cancer, Lung cancer, CVA, COPD Elderly year killers? PNA and Flu with all preceding killers. What prevention promotes measures to promote health prior to onset of any recognizable problems? Diet, exercise, vaccinations, immunizations. Secondary prevention? Screening Early detection and treatment of existing problems- PAP smear, cholesterol check and the like. Tertiary Prevention? Rehabilitation, restoration of health, Cardiac rehab after MI, physical therapy after car accident. Food plate divisions? 55-60% of daily intake should be carbs, 0.8-1 g/kg/day protein intake half of plate should be fruits and vegetables. Exercise and health promotion, what does it do? How long/day Increases LDL, increases basal metabolic rate, reduces stress, helps to decrease signs of aging, improves cardiovascular health. 30 minutes per day For patients 35 who never exercised but want to start? They should have a physical exam, exercise stress test. What is the substance that the bad guy? Antigen What is made by the body to fight antigens? Antibodies This immunity comes from say receiving a tetanus toxoid? Active Immunity Conferred by antibody formation that is stimulated with a specific antigen- like toxoids. Conferred by introduction of antibody protein such as gammaglobuin injections or maternal immunity that is transferred to fetus? Passive immunity Gammaglobulin injection- HBIG - given for known exposure to hep B in a patient that is not previously vaccinated. Pneumococcal vaccine indications. 65+ 19 to 64 who smoke or have asthma People with lung, heart, liver, or kidney disease. People with weakened immune systems. People with chronic term condition. Hep A vaccine? Hep B vaccine? Military, men who have sex with men, travelers to endemic areas All health care workers and high risk patients including sexually active adults. Mumps vaccine? Born before 1957, take one dose of vaccine After 1957- take 2 doses of vaccine. Meningiococcal vaccine age? 2-55 years old. Military, immunocompromised, travelers to Africa, college students. Expensive, not that effective. Which herb is used to increase overall physical and mental well being, lowers cholesterol, reduces fatigue, and enhances libido? Ginseng The side effects of this herb are insomnia, nausea, diarrhea, headaches, nervousness, and nose bleeds. Ginseng What is used for nausea, dyspepsia, constipation, colic? Ginger This herb can cause blood pressure changes (high or low), mania in depressed patients taking MAOIs, may inhibit the effects of opioids. Ginseng This herb is used to treat depression, anxiety, sleep disorders, improve BPH symptoms St. John's wort The side effects of this herb are increased sensitivity to sunlight, anxiety, dry mouth, dizziness, GI symptoms, fatigue, HA, sexual dysfunction. St. John's Wort Which herb causes an increased risk of clotting? St. John's Wort Which herb has many drug interactions namely serotonin syndrome when combined with SSRIs, decreased effectiveness of oral contraceptives, digoxin, alprazolam, amitryptiline, an increased effects of narcotics. St. John's Wort Which herb reacts with light, leading to cataract formation? St. John's wort Which herb reduces symptoms of the common cold? Echinea Which herb has the side effects of allergic reactions, nausea, abd pain, dysuria, myalgias? Echinea Which herb can result in anaphylaxis, hepatotoxicity, nephrotoxicity, and may potentially cause increased sedation during anesthesia? Echinacea Which herb is a memory and concentration enhancer, improves symptoms of Alzheimer's disease, intermittent claudication and glaucoma. Ginko Bilboa Which herb has the side effects of n/v/d, HA, dizziness, palps, restlessness? Ginko Bilboa Which herb may increase blood pressure? Ginko Bilboa Which herb improves premenstrual and menopausal discomfort? Black Cohosh Which herb has the side effects of n/v, dizziness, matalgia, weight gain? Black Cohosh Which herb may cause seizures, visual disturbances, bradycardia? Black Cohosh This herb mimics estrogen effects. It should not be taken by women taking hormone replacements. Black Cohosh This herb improves premenstrual and menopausal discomfort. Black Cohosh The side effects of this herb are n/v dizziness, mastalgia, weight gain. Black Cohosh This herb may cause seizures, visual disturbances, bradycardia, may increase the risk of bleeding, and should not be taken by women taking hormone replacement. Black Cohosh This herb improves premenstrual and menopausal discomfort Evening Primrose The side effects of this herb are nausea, soft stools, HA, allergy. Evening primrose This herb may elevate blood glucose, increase the risk of epilepsy in patients taking antipsychotics, may increase the incidence of seizures in patients with seizure disorder requiring anesthesia for sx. Evening Primrose