NR 510 AANP Study
Cardiac
• Know S3 what does it mean
o Indicative of CHF. Occurs during early diastole, aka ventricular gallop or
S3 gallop. Sounds like Kentucky. Considered abnormal id occurs after the
age of 35. May be normal in children or young adults if there is no signs
or symptoms of heart disease.
• Know S4 it is a sign of what? They describe a patient.
o Sounds like Tennessee. Caused by increased resistance due to a stiff left
ventricle, usually indicates LVH. Considered a normal finding in some
elderly due to thickening. Occurs during late diastole, also called the atrial
gallop or atrial kick. Best heard at the apex or apical area, using the bell of
the stethoscope.
• A murmur that is loud and heard with your scope plus thrill is 4. A loud murmur
that you don’t need a scope for is 6
• They tell you a systolic murmur one that radiates to the neck ( aortic stenosis) and
one the radiates to the axilla (mitral regurgitation)
• How do you rule out AAA -US gold standard in 65 and older especially if they
smoke
o Order and abdominal ultrasound and CT
• You have a patient with HTN and osteoporosis what medication do you put them
on for HTN
o Thiazides diuretics. Has favorable effect with osteopenia/osteoporosis.
o Ex: hydrochlorothiazide, chlorothalidone, indapamide
• HTN drug for DM with neuropathy-
o ACE (end in pril) or ARB (end in sartan)
• You have a patient that on eye exam you notice copper and silver arterioles AV
nicking what else do you assess them for
o HTN
• You have an elderly patient with ISH BP log what medication do you start?
o CCB (end in pine)
• PAD:
o Smoking and hyperlipidemia with complaints of pain with ambulation, aka
intermittent claudication, that is relieved by rest instantly. Atrophic skin
changes may occur (shiny and hyperpigmentated ankles that are hairless
and cool to touch).
• PAD pt what is treatment?
o exercise
• PAD what test?
o brachial index
• Know chronic venous insufficiency
o -Edema, thick skin discolored
• Test you do for stable angina
o Stress test.
• Mitral area
,NR 510 AANP Study
o Aka apex or apical area of the heart
o 5h ICS =, midsternal line and slightly medial to the midclavicular line
• Aortic area
o 2nd ICS t the right side of the upper border of the sternum
o Also described as the second ICS by the right side of the sternum at the
base of the heart
• Know Systolic and Diastolic Murmur was asked about heart murmur with high
pitch holosystolic and the other one is mid systolic.
o MR
▪ Panasystolic (holosystolic murmur)
▪ Heard best at the apex of the heart or the apical area
▪ Radiates to the axilla
▪ Loud blowing high putched murmur
o AS
▪ Midsystolic ejection murmur
▪ Heard best at the second ICS at the right side of the sternum
▪ Radiates to the neck
▪ Harsh or noisy murmur
▪ Pts should avoid physical extertion, as there is an increased risk for
sudden death
o MS
▪ Low pitched diastolic rumbling murmur
▪ Heard best at the apex of the heart or the apical area
▪ Also called an opening snap
o AR
▪ High pitched diastolic murmur
• Best heard at the second ICS at the right side of the sternum
• High pitched blowing murmur
• Question about Grade III/VI Murmur: (Loud murmur easily heard)
o Grade III murmur: loud murmur that is easily heard once the stethoscope
is placed on the chest
o Grade VI murmur: murmur is so loud that it can be heard even with the
stethoscope off the chest, thrill is palpated.
• Know the difference between Peripheral Arterial Disease and Chronic Venous
Insufficiency.
o CVI affects the lower extremities, due to venous reflux or obstruction.
Symptoms include spider and varicose veins, leg pain and swelling, and
changes to the color of the skin. Affected areas may become inflamed and
irritated, with development of venous ulcers.
• Question about JVD causes?
o Right sided heart failure (abdominal fullness, dependent edema,
hepatomegaly), pulmonary hypertension, tricuspid valve stenosis,
constrictive pericarditis, cardiac tamponde
, NR 510 AANP Study
• Know Bacterial endocarditis (There was a pt. with gradual onset of fever,
hemorrhages on nail beds, painful raised red nodules) Osler’s nodes
o Fever, chills, and malaise that is associated with a new murmur and abrupt
onset of CHF. Present with skin finding on fingers/hands and toes/feet.
These are subungual hemorrhages (splinter hemorrhages on the nailbed),
petechiae on the palate, painful violet colored nodes on the fingers or feet
(osler nodes), and tender red spots on the palms/soles (janeway lesions).
• Questions about carotid bruit signs can signifies what?
o narrowing of the carotid
GI
• Review seriology sample questions to learn types of hepatitis.
o IgG-gone. Due to antibodies present, immune, due to vaccine. Not
infectious
o IgM-has infection. Pt is contagious. No immunity yet
o HBSAg-screening test for Hep B. If positive, patient is positive and is
infectious, wither an acute infection or chronic hep B.
o Anti-HBs- antibodies present and is immune. May be due to either past
infection of vaccination
o HbeAg-indicates active viral replication. May be highly infectious.
o Anti-HCV-screening test for hepatitis C. positive does not always mean
that the patient has recovered from the infectionand has developed
immunity. It instead indicate current infection. If positive order HCV RNA
or HCV PCR to rule out hronic infection. Ifi positive patient has hep C.
• High triglycerides increase the risk of
o pancreatitis
• You have a pt with chronic Hep C what will be high the AST or ALT or Both?
o Both are elevated due to chronic damage
• First line tx GERD
o H2 blocker (ranitidine)
• Hep serology you have to tell them what they have see Hollier notes
o See above
• You have a positive psoas maneuver and it is positive. What does this mean?
o Used for acute appendicitis or suspected retropertitoneal area acute
process (ie ruptured ectopic pregnancy). Flex hip at 90 degrees, ask patient
to push against resistance (examiners hand) and to straighten the leg.
Supine position
• Rovsing sign
o Deep palpation of the left lower quadrant of the abdomen results in
referred pain to the right lower quadrant
• Pt. with GERD and Barrett’s esophagus (white male greater than 50, with long
term GERD):
o Refer to Oncologist
• Question about Hepatitis B active Immunology.
Cardiac
• Know S3 what does it mean
o Indicative of CHF. Occurs during early diastole, aka ventricular gallop or
S3 gallop. Sounds like Kentucky. Considered abnormal id occurs after the
age of 35. May be normal in children or young adults if there is no signs
or symptoms of heart disease.
• Know S4 it is a sign of what? They describe a patient.
o Sounds like Tennessee. Caused by increased resistance due to a stiff left
ventricle, usually indicates LVH. Considered a normal finding in some
elderly due to thickening. Occurs during late diastole, also called the atrial
gallop or atrial kick. Best heard at the apex or apical area, using the bell of
the stethoscope.
• A murmur that is loud and heard with your scope plus thrill is 4. A loud murmur
that you don’t need a scope for is 6
• They tell you a systolic murmur one that radiates to the neck ( aortic stenosis) and
one the radiates to the axilla (mitral regurgitation)
• How do you rule out AAA -US gold standard in 65 and older especially if they
smoke
o Order and abdominal ultrasound and CT
• You have a patient with HTN and osteoporosis what medication do you put them
on for HTN
o Thiazides diuretics. Has favorable effect with osteopenia/osteoporosis.
o Ex: hydrochlorothiazide, chlorothalidone, indapamide
• HTN drug for DM with neuropathy-
o ACE (end in pril) or ARB (end in sartan)
• You have a patient that on eye exam you notice copper and silver arterioles AV
nicking what else do you assess them for
o HTN
• You have an elderly patient with ISH BP log what medication do you start?
o CCB (end in pine)
• PAD:
o Smoking and hyperlipidemia with complaints of pain with ambulation, aka
intermittent claudication, that is relieved by rest instantly. Atrophic skin
changes may occur (shiny and hyperpigmentated ankles that are hairless
and cool to touch).
• PAD pt what is treatment?
o exercise
• PAD what test?
o brachial index
• Know chronic venous insufficiency
o -Edema, thick skin discolored
• Test you do for stable angina
o Stress test.
• Mitral area
,NR 510 AANP Study
o Aka apex or apical area of the heart
o 5h ICS =, midsternal line and slightly medial to the midclavicular line
• Aortic area
o 2nd ICS t the right side of the upper border of the sternum
o Also described as the second ICS by the right side of the sternum at the
base of the heart
• Know Systolic and Diastolic Murmur was asked about heart murmur with high
pitch holosystolic and the other one is mid systolic.
o MR
▪ Panasystolic (holosystolic murmur)
▪ Heard best at the apex of the heart or the apical area
▪ Radiates to the axilla
▪ Loud blowing high putched murmur
o AS
▪ Midsystolic ejection murmur
▪ Heard best at the second ICS at the right side of the sternum
▪ Radiates to the neck
▪ Harsh or noisy murmur
▪ Pts should avoid physical extertion, as there is an increased risk for
sudden death
o MS
▪ Low pitched diastolic rumbling murmur
▪ Heard best at the apex of the heart or the apical area
▪ Also called an opening snap
o AR
▪ High pitched diastolic murmur
• Best heard at the second ICS at the right side of the sternum
• High pitched blowing murmur
• Question about Grade III/VI Murmur: (Loud murmur easily heard)
o Grade III murmur: loud murmur that is easily heard once the stethoscope
is placed on the chest
o Grade VI murmur: murmur is so loud that it can be heard even with the
stethoscope off the chest, thrill is palpated.
• Know the difference between Peripheral Arterial Disease and Chronic Venous
Insufficiency.
o CVI affects the lower extremities, due to venous reflux or obstruction.
Symptoms include spider and varicose veins, leg pain and swelling, and
changes to the color of the skin. Affected areas may become inflamed and
irritated, with development of venous ulcers.
• Question about JVD causes?
o Right sided heart failure (abdominal fullness, dependent edema,
hepatomegaly), pulmonary hypertension, tricuspid valve stenosis,
constrictive pericarditis, cardiac tamponde
, NR 510 AANP Study
• Know Bacterial endocarditis (There was a pt. with gradual onset of fever,
hemorrhages on nail beds, painful raised red nodules) Osler’s nodes
o Fever, chills, and malaise that is associated with a new murmur and abrupt
onset of CHF. Present with skin finding on fingers/hands and toes/feet.
These are subungual hemorrhages (splinter hemorrhages on the nailbed),
petechiae on the palate, painful violet colored nodes on the fingers or feet
(osler nodes), and tender red spots on the palms/soles (janeway lesions).
• Questions about carotid bruit signs can signifies what?
o narrowing of the carotid
GI
• Review seriology sample questions to learn types of hepatitis.
o IgG-gone. Due to antibodies present, immune, due to vaccine. Not
infectious
o IgM-has infection. Pt is contagious. No immunity yet
o HBSAg-screening test for Hep B. If positive, patient is positive and is
infectious, wither an acute infection or chronic hep B.
o Anti-HBs- antibodies present and is immune. May be due to either past
infection of vaccination
o HbeAg-indicates active viral replication. May be highly infectious.
o Anti-HCV-screening test for hepatitis C. positive does not always mean
that the patient has recovered from the infectionand has developed
immunity. It instead indicate current infection. If positive order HCV RNA
or HCV PCR to rule out hronic infection. Ifi positive patient has hep C.
• High triglycerides increase the risk of
o pancreatitis
• You have a pt with chronic Hep C what will be high the AST or ALT or Both?
o Both are elevated due to chronic damage
• First line tx GERD
o H2 blocker (ranitidine)
• Hep serology you have to tell them what they have see Hollier notes
o See above
• You have a positive psoas maneuver and it is positive. What does this mean?
o Used for acute appendicitis or suspected retropertitoneal area acute
process (ie ruptured ectopic pregnancy). Flex hip at 90 degrees, ask patient
to push against resistance (examiners hand) and to straighten the leg.
Supine position
• Rovsing sign
o Deep palpation of the left lower quadrant of the abdomen results in
referred pain to the right lower quadrant
• Pt. with GERD and Barrett’s esophagus (white male greater than 50, with long
term GERD):
o Refer to Oncologist
• Question about Hepatitis B active Immunology.
