AANP Board 2023 with verified questions and answers

INR values below ____ increase stroke risk sixfold. 2 What allergy contradicts the use of thiazide diuretics? Sulfa Why should ACE-Is be avoided with renal stenosis? Leads to ARF Adverse effects of aldosterone antagonists (Aldactone) Galactorrhea and hyperkalemia What are beta blocker indications? HTN, post-MI angina, arrhythmias, migraine prophylaxis, hyperthyroidism 1st line BP med for DM? ACE or ARB Grapefruit juice should be avoided in what 1st line antihypertensive medication? CCB Alternative antibiotic treatment for patients with gram positive baterial infections that are allergic to PCN: macrolides Initial treatment of COPD Ipratropium bromide (anticholinergic) 1st line treatment for gonorrheal infections Rocephin IM Treatment of anthrax Cipro 500mg BID 7-10 days Treatment of traveler's diarrhea Cipro 500mg BID 3 days What can increase the risk of tendon rupture when on a quinolone? age and steroids How long does ASA suppress platelet function? up to 7 days What is the FDA category and dose of finasteride? 5mg PO QD and category X What drug category should not be given with warfarin? sulfa drugs When should routine screening for breast cancer start? 40 If a patient had only one dose of the hep B vaccine what is recommended? Do not restart series; Start with 2nd dose What is done if a patient has a tetanus-prone wound and an unknown vaccination status? Administer immediate dose of Td and the teatnus immunoglobulin injection If a person is vaccinated with pneumovax prior to 65 what is recommended? Give a booster dose of pneumovax 5 years after initial dose When should Zostavax be given? age 60 How far apart should the varicella vaccines be given? 4 weeks Treatment for otitis externa Cortisporin otic drops Common bacterial pathogen of otitis externa Pseudomonas What is cholesteatoma a complication of? periorbital sinusitis What indicates an abnormal Rinne test? BCAC What kind of hearing loss is found with an abnormal Rinne if BCAC? conductive What kind of hearing loss is associated with lateralization to affected ear when Weber test is performed Conductive What kind of hearing loss is associated with lateralization to unaffected ear when Weber test is performed sensorurial What does 20/40 vision mean? A person can see 20 ft whereas normal vision can see 40 Common treatment of cerumenosis Carbamide peroxide What route should HIV esophageal candida infections Oral systemic Where is a scabies rash located? Interdigital webs and/or penis Antibiotic treatment for human, dog, or cat bite Augmentin A herald patch or "Christmas tree" pattern is associated with what disease? PItyriasis rosea What class of meds are used to treat PHN? TCAs What is the treatment for rosacea? Metronidazole gel What areas of the body have thicker skin and call for higher potency steroids? scalp, back, soles How do you check for pulsus paradoxus? BP cuff and stethoscope and the apical pulse What findings are associated with hypertensive retinopathy? copper and silver wire arterioles, AV nicking What findings are associated with diabetic retinopathy? Neovascularization, microaneurysms, hard exudates, cotton wool spots What class of anti-hypertensives are used for isolated HTN in the elderly? CCB What are some "hyper" side effects of thiazide diretics hyperglycemia, hyperuricemia, hypertriglyceremia At what age is a high cholesterol no longer considered a risk factor heart disease? 75 If a patient has an INR between 3-5, how should this be managed? Skip 1 dose; decrease maintenance dose, check INR in 1-2 days until normal If a patient has an INR between 5-9 how should this be managed? Omit a dose and give a small dose of oral vitamin K or omit the next 2 doses. Daily INR monitoring; decrease maintenance dose Class I NYHA heart disease classification No limitation of physical activity Class II NYHA heart disease classification Ordinary physical activity results in fatigue, exertional dyspnea Class III NYHA heart disease classification Marked limitation in physical activity Class IV NYHA heart disease classification Symptoms are present at rest Treatment class for Raynaud's CCBs What class of med lower triglycerides? Niacin and fibrates Should you lower a markedly high triglyceride level or cholesterol first? Triglycerides Criteria for metabolic syndrome: Abdominal obesity, HTN, hyperlipidemia, high triglycerides, high fasting glucose What are characteristics of fatty liver disease? Mild elevation of ALT & AST not associated with alocohol, meds, or viral hep in overweight patients What is used to calculate PEF? Height, age, gender (HAG) When treating a COPD patient with antibiotics what organism (s) must the antibiotic cover? H. influenzae (gram negative) No. 1 bacterium in CAP Strep pneumo No. 1 atypical pneumonia Mycoplasma pneumoniae At what mm is a PPD considered positive with no risk factors? 15mm At what mm is a PPD considered positive in HIV? 5mm What class of medications is 1st line treatment for asthma prevention? Inhaled corticosteroids 1st line treatment for severe asthmatic exacerbation adrenaline injection Why should patients have annual eye exams when on long-term steroids increases the risk of cataracts and glaucoma What is the definition of subclinical hypothyroidism Elevated TSH and normal serum free T4 Which antidiabetic drugs are contraindicated in heart failure or severe heart disease and why? Glitizones because they can cause water retention How is the psoas maneuver performed? ... Which hepatitis is associated with the highest risk of cirrhosis and liver cancer? Hep C When is nitrofurantoin contraindicated? renal insufficiency What indicates pyelonephritis on a u/a microscopic? WBC casts with proteinuria What is the best indicator of renal function? eGFR Treatment for temporal arteritis: high-dosed prednisone for several weeks Screening test for temporal arteritis Sed rate What HA is treated with high dosed oxygen Cluster What HA is treated with high-dosed anticonvulsants? Trigeminal neuralgia What HA is accompanied by tearing and nasal congestion? Cluster What is the diagnostic test of thalassemia and sickle cell anemia? Hemoglobin electrophoresis What two tests indicate that a patient has pernicious anemia if they are elevated? parietal antibody test and/or intrinsic factor antibody test What lab value indicates RBC size? MCV What anemia manifests with neurologic symptoms? B12 Where are Heberden's nodes located? Distal interphalangeal joint (DIP) How is uveitis treated? High-dose steroids; refer to opthalmology How does a Baker's cyst present? Located behind the knee (popliteal fossa) as a ball-like mass 1st line treatment for ankolysing spondilytis? NSAIDS What medical conditions do antipsychotics increase the risk of (5)? obesity, DMII, hyperlipidemia, metabolic syndrome, and hypothyroidism What foods are high in tyramine? fermented-beer, wine, aged cheese, fava beans What is the FDA black box warning for SSRIs? May increase the risk of suicidal thoughts/behaviors in children, adolescents, and young adults What causes Korsakoff's syndrome? Chronic thiamine deficiency Can a patient smoke while on Zyban? yes What SSRI should be weaned? Paroxetine How is the effectiveness of Proscar determined? Obtain a PSA value and multiply it by 2. Should be below baseline What BC pills are indicated for acne rx? Ortho-Tri-Cyclin, Yaz, and Desogen Characteristics of clue cells squamous epithelial cells that have blurred edges due to a large number of bacteria (increased WBC count) What is Fitz-Hugh-Curtis syndrome? Chlamydial and/or gonoccal infection of the liver capsule resulting in scarring What is Jarisch-Herxheimer reaction? Acute febrile reaction that can occur 24 hrs after rx of an STI such as chlamydia, gonorrhea, or syphillis What is the treatment for genital warts? Imiquimod How long should a reproductive age female wait to get pregnant after receiving the varicella vaccine? 3 months Which ethnic group should be screened for Tay-Sach's disease during pregnancy? Askenazi (european) Jews Cryptorchidism increases the risk of: testicular cancer Which of these crosses the midline? Caput succedaneum or cephalohematoma caput succedaneum What does a strong Moro relfex in an infant 6 months indicate? brain damage What are the screening tests for degenerative hip dysplasia? Ortolani and Barlow How do you assess for coartication of the aorta? compare radial and femoral pulses How many doses of HPV vaccine are there? 3 What is the youngest age a child can receive Gardasil? 9 Physical presentation of fragile X syndrome: long face with prominent forehead, jaw, and large ears. Large body with flat feet How does an anorexic patient present? lanugo, peripheral edema, amonorrhea, weight loss 10 % body weight Most common cause of blindness in the US macular degeneration 1st line treatment for essential tremors beta blockers What occurs at Kiesselbach's plexus? Anterior nosebleed What ligament is damaged in a positive anterior drawer test? anterior cruciate ligament What is tonus palatinus? A chronic bony growth located midline in hard palate Which drugs increase hyperbilirubinemia in the 3rd trimester? Nitrofurantoin and sulfa drugs Most common gynecological cancer Uterine Examples of gluten wheat, rye, barley, oats Examples of plant sterols and steols wheat germ, sesame oil, corn oil, peanuts Examples of monounsaturated fats olive oil, canola oil, almonds, walnuts, sunflowers Examples of foods with magnesium almonds, peanuts, cashews, some beans, whole wheat Example of foods with iron liver, beef, black beans Signs and symptoms of RMSF petechiae rash on hands/feet, headache, myalgia, conjunctival injection, nausea/vomiting, arthralgia Diagnostic screening for herpes keratitis Fluorescein lamp Signs of acute angle-closure glaucoma Sudden onset of severe eye pain with headache, n/v, halos, decreased vision, cupping of the optic nerve A maculopapular rash that is oval-shaped with herald patch (disease) pityriosis rosea Where is the best location to auscultate the S3 heart sound? pulmonic area Drugs that have a narrow therapeutic index Warfarin, digoxin, lithium, levothyroxine, theophylline, tegretol, dilatin What is the black box wearing of aldosterone antagonists? increases benign and malignant tumors When are beta blockers contraindicated? asthma, COPD, chronic bronchitis, emphysema, bradycardia, and AV-block What bacteria do 1st generation cephalosporins act on? gram positive What bacteria do 2nd generation cephalosporins act on? gram negative and gram positive What bacteria do 3rd generation cephalosporins act on? Both gram positive and negative, however, poor gram positive coverage What is 1st line treatment of MRSA? Bactrim DS or clindamycin Which abx should not be used with mono? ampicillin or amoxicillin What bacteria do sulfonamides act on? gram negative When is LAIV contraindicated? Pregnancy, asthma, COPD, renal failure, DM, immunosuppression, What is larger in the eyes-veins or arteries? veins What diagnostic tool is used to assess for fluid in the middle ear? Tympanogram Appearance of nasal turbinates in allergic rhinitis Bluish, pale, boggy Description of Koplik spots small sized papules with blue-white center inside the cheek What is a pinguecula? A yellow-triangular thickening of the bulbar conjunctiva What disease is a sandpaper-textured pink rash found in: Scarlet fever Description of basal cell carcinoma pearly or waxy skin lesion with atrophic or ulcerated center that does not heal What drug classes are higher risk for Steven Johnson's syndrome dilantin, PCN, sulfas, barbituates Is a thyroid cancer nodule hot or cold? Cold What is pheochromocytoma? Random episodes of severe HTN assc with abrupt onset of severe headache, tachycardia, and anxiety What hormone stimulates the ovaries to ovulate? LH Treatment of hyperthyroidism Prophylthiouracil (PTU) or Methimazole (Tapazole)