AANP-FNP exam 2023 with 100% correct questions and answers

Hegar's sign Softening of lower uterine segment Chadwick's sign Bluish color of cervix and vagina at 6-8 weeks Goodell's sign Softening of cervix at 4+ weeks Lipids in chronic inactivity Low HDL Lipids in under- or untreated hypothyroidism Elevated total cholesterol, TG, and LDL Lipids in chronic renal insufficiency Elevated total cholesterol and TG Lipids in alcohol abuse Elevated TG, HDL, and LDL Vaccines with live attenuated viruses MMR, varicella, flu-mist(intranasal), Zostavax Drugs of choice for abdominal infection Beta lactams + metronidazole (most common); fluoroquinolones Drugs of choice for urinary tract infection Fluoroquinolones (except moxi), TMP-SMX, fluconazole, b-lactams, nitrofurantoin, fosfomycin if pt has many allergies Drugs of choice for pulmonary infections Macrolides, resp fluoroquinolones, b-lactams, doxycycline (MRSA, atypical coverage) Drugs of choice for skin and soft tissue infections MRSA: TMP-SMZ, doxycycline, clindamycin; b-lactams Drugs of choice for MRSA Vancomycin, daptomycin , linezolid, TMP-SMZ, doxycycline, ceftaroline Macrolide drugs Erythromycin, clarithromycin, azithromycin Macrolide AEs GI, QT prolongation Tetracycline uses MRSA, rocky mtn spotted fever, atypicals (mycoplasma pneumonia, chlamydia), spirochetes (Lyme), i Tetracycline AEs GI, teeth, hepatic dysfunction, photosensitivity Fluoroquinolone drugs Ciprofloxacin, levofloxacin, moxifloxacin Fluoroquinolone uses UTI (cipro or levo), atypicals (mycoplasma, legionella) Fluoroquinolones and dairy or vitamins Take 2 hrs before or 4 hours after (decrease concentrations) Metronidazole (Flagyl) uses C. Diff, vaginitis Metronidazole AEs GI, peripheral neuropathy, disulfiram reaction Nitrofurantoin uses UTI -not pyelonephritis due to no systemic absorption Nitrofurantoin AEs, contraindications Pulmonary fibrosis, contraindicated in CrCl 60 (excludes many elderly) Aminoglycoside drugs Gentamycin, tobramycin Aminoglycoside uses Atypical coverage, resistant infections, tobramycin for CF only Aminoglycoside AEs Ototoxicity (irreversible), nephrotoxicity (reversible) Aminoglycoside monitoring Renal dose adjust, hearing test, drug level monitoring Antifungals (azoles) Fluconazole, itraconazole Itraconazole interactions Acid suppressive therapies Fluconazole dose adjust Renal Antifungal AEs GI, QTc prolongation (fluconazole) Antifungal drug interactions QT prolongation meds, warfarin Anti-infectives not for pregnant Tetracyclines, TMP-SMZ TMP-SMZ coverage G+, G-, MRSA, Protozoa (toxoplasma gondii), fungus (pneumocystis jirovecii), poor anaerobic activity TMP-SMZ AEs Sulfa allergy, photosensitivity, hematologic (anemia, leukopenia, thrombocytopenia) TMP-SMZ on renal function Dose adjust in renal impairment, false elevation in serum Cr TMP-SMZ drug interactions Warfarin Gram + only coverage Clindamycin, linezolid, vancomycin, daptomycin Gram - only Monobactams (aztreonam), penicillin VK Gram +/- PCN (aminopcn, ext. spectrum), carbapenams, aminoglycosides, TMP-SMZ, fluoroquinolones, fosfomycin Head growth in first year of life Total 12cm Head growth 0-3mo 6cm Head growth 4-6mo 3cm Head growth 6-12mo 3cm Head growth 2-7yo 0.5cm/yr Head growth 8-12yo 0.3cm/yr Tumor grading: T0 No evidence of primary tumor Tumor grading: T1 2 cm or less in greatest dimension Tumor grading: T2 2-5cm Tumor grading: T3 5cm Chvostek sign Hypocalcemia, spasm when tap facial nerve Trousseau sign Hypocalcemia, spasm when compress brachial artery w/ BP cuff Myocardial ischemia EKG changes Inverted T wave, T wave depression Myocardial injury EKG changes, ST segment elevation, tall peaked t wave Myocardial infarction EKG changes Q wave 1st gen antihistamines Diphenhydramine, chlorpheniramine 2nd gen antihistamines Loratadine, desloratadine, cetirizine, fexofenadine, levocetirazine Ishihara chart Test for color blindness Scarlet fever presentation Sandpaper-like rash, exudative pharyngitis, localized anterior cervical lymphadenopathy, rash 2 days after pharyngitis then peels later Roseola (HHV-6) presentation Rash lasts hours to 3 days, follows 3-7 day high fever, sometimes febrile seizures, tx supportive Rubella (German measles, rubella virus) Mild sx, posterior and postauricular cervical lymphadenopathy, arthralgia 5-10 days before rash, teratogenic, contagious 1 week before and 2 weeks after rash Measles (rubeola) Acute presentation, generalized lymphadenopathy, photophobia, koplik spots, pharyngitis mild w/o exudate, rash 3-4 days after sx, contagious 1 wk before and 2-3 weeks after rash, permanent neuro impairment and/or death possible, tx supportive Hand foot mouth dz (coxsackievirus a16) Fever, malaise, sore mouth, anorexia, lesions, fecal-oral or droplet, highly contagious 2-6 wks, tx supportive Fifth disease (human parvovirus b19) Rash starts on face (slapped cheek) spreads to trunk, extremities, contagious before rash but not during or after. Droplet. Leukopenia. Hydrops fetalis in pregnant. Tx supportive. Infectious mononucleosis (Epstein-Barr) Diffuse lymphadenopathy, hepatic and splenic tenderness/ enlargement, incubation 20-50 days, systemic corticosteroids if resp distress from swollen airway, monospot/leukopenia w/ atypical lymphocytes diagnostic. Avoid contact sports at least one month. Kawasaki disease Acute phase: fever = 104 = 5 days, polymorphous exanthem on trunk/flexor region/perineum, erythema of oral cavity (strawberry tongue), chapped lips, bilateral conjunctivitis w/o discharge, edema/erythema of hands and feet w peeling skin. Children 1-8yr. Tx IV immunoglobulin, pop aspirin, consult Lyme stage 1 (early localized disease) Mild flu-like illness, singular annular lesion (erythema migrans), sx resolve 3-4 wks w/o tx Lyme stage 2 (early disseminated) Months after initial infx, classic rash may reappear w/ multiple lesions. Arthralgias, myalgia, HA, fatigue. Less common: heart block, neuro findings (Bell's palsy) Lyme stage 3 (late persistent) 1 year after initial infection, msk s/s persist w/ joint pain, frank arthritis, joint damage. Neuropsychiatric findings - memory problems, depression, neuropathy. Lyme organism B. burgdorferri (tick-transmitted spirochete) Lyme testing ELISA confirmed with western blot Lyme tx Doxycycline (children 8yo), amoxicillin, cefuroxime - adults and children Chancroid tx Azithromycin or ceftriaxone, alt. ciprofloxacin or erythromycin Genital herpes (HSV 2) tx Acyclovir Lymphogranuloma vereneum (c. trachomatis) tx Doxycycline, or erythromycin Nongonococcal urethritis/cervicitis (c. Trachomatis) tx Azithromycin or doxycycline Gonococcal urethritis/cervicitis tx Cefixime or ceftriaxone, add azithromycin or doxy if chlamydia not ruled out Bacterial vaginosis tx Metronidazole Pelvic inflammatory disease tx Ceftriaxone+doxycycline +/- metronidazole Trichomoniasis tx Metronidazole