New Update 2023 !! AANP FNP
certification exam/ AANP Certification
FNP Updated 2023-2024 Latest Version
Pt presents with rash on shoulder, erythematous maculopapular rash with center
clearing and scaling? -------- Answer --------- Tinea Corporis
Pt presents with "bag of worms:, indicates? -------- Answer --------- Varicocele
Pt with atopic dermatitis, look for what other diseases? -------- Answer --------- Asthma
Pt with bleeding after menopause -------- Answer --------- endometrial biopsy, need to
screen for cancer
Pt with hx of PID, increased rick for? -------- Answer --------- Infertility
Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this
indicate? -------- Answer --------- This is good. Want higher than 350
Pt with hx of htn and stroke, now having memory loss. What does this indicate? --------
Answer --------- Vascular dementia
PAD/ PVD -------- Answer --------- PAD/ PVD (same)- Nocturnal pain relieved by
lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny,
hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the
most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal.
EXAM
CVI -------- Answer --------- CVI- Impaired venous return. Achy legs relieved by
elevation, edema after prolonged standing, night cramps, brownish discoloration, cold,
ulcers. Etc. do support stockings. EXAM
blood pressure -------- Answer --------- BP - ST 1 (140-159/ 90-99), if you know this you
will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL
INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.
Thiazide diuretics -------- Answer --------- no sulfa allergies, hyperuricemia, hypokalemia,
hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM
Statin -------- Answer --------- Must check LFT before starting Statin. Know when to start
statins and what to check for to decide mod-high dose statins. ON EXAM
Pulses paradoxus -------- Answer --------- Pulsus paradox Apical pulse can still be heard
even though the radial pulse is no longer palpable. Certain issues cause impairment
,with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient
had asthma and their pressure dropped by 10 etc. ON EXAM
Emphysema -------- Answer --------- Emphysema Lungs- Percussion-
HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with
hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss.
ON EXAM
Acute Bacterial Pneumonia- CXR -------- Answer --------- middle lobe. ON EXAM
OSA -------- Answer --------- does not include Microglossia which is an absent tongue
congenital. EXAM
TB -------- Answer --------- fatigue, fever, cough. Never do fewer than 3-4 drugs initially if
positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect
ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if
gold standard. Deep morning cough collected for three "consecutive days". TB is
usually upper lobes.
TPO -------- Answer --------- TPO- this lab is off MEANING ELEVATED in BOTH
hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you
always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself.
Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long
these meds take to work. TOPIC ON EXAM
hyperthyroid -------- Answer --------- Hyperthyroid- Low TSH, high "FREE" T4/T3.
ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything
is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY
RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.
A1C > 9 -------- Answer --------- If you are already on TWO oral drugs for diabetes and
A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is
9 or higher start BASAL insulin. ON EXAM
Parathyroid -------- Answer --------- For parathyroid- dx blood test. You will have
elevated calcium because your parathyroid is releasing too much from bones and this
will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR
SECONDARY HYPERPARATHY. EXAM
cushings -------- Answer --------- Central obesity, moon face, purple striae, hairy,
hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must
draw cortisol levels in the morning.
Fructosamine test -------- Answer --------- checks sugar for past 2-4 weeks.
, triglycerides -------- Answer --------- causes pancreatitis >500. If >500 treat with Niacin
or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like
(LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM
Pancreatitis -------- Answer --------- diagnosed with amylase / lipase draw. Amylase
beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to
alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback
"boring" epigastric pain. Fever, n/v. EXAM TOPICS
Metformin -------- Answer --------- Metformin - monitor BUN, Creatinine.
contraindicated renal and liver disease
ARF creatinine up and GFR down.
affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea
flatulence
CT: hold 24 hr before and 48hr after
Polycythemia vera -------- Answer --------- slow growing blood cancer. blood too thick,
clots. bone marrow to many RBC. risk bleed , anemia, CBC
All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly
audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM -------- Answer --------- III
first time audible, IV first time thrill
Fundal height 12 weeks -------- Answer --------- Fundal Height 12 weeks above
symphysis pubis. EXAM
Fundus 16 weeks between symphysis pubis and umbilicus.
Fundus at 20 weeks is at umbilicus.
2 cm more of less from # of wk gestation is normal if more or less order US
3 month old infant with down syndrome, due to milk intolerance, mom started on goats
milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test
would you order? -------- Answer --------- Iron, TIBC
3 months of synthroid, TSH increased, T4 normal, what do you do? -------- Answer ------
--- Increase Medication
3 ways to assess cognitive function in patient with signs/symptoms of memory loss ------
-- Answer --------- Mini mental exam
4 month old with strabismus, mom is worried...... -------- Answer --------- tell her it is
normal.
4 month old wont keep anything down, what is the main thing you look at? --------
Answer --------- Growth chart
certification exam/ AANP Certification
FNP Updated 2023-2024 Latest Version
Pt presents with rash on shoulder, erythematous maculopapular rash with center
clearing and scaling? -------- Answer --------- Tinea Corporis
Pt presents with "bag of worms:, indicates? -------- Answer --------- Varicocele
Pt with atopic dermatitis, look for what other diseases? -------- Answer --------- Asthma
Pt with bleeding after menopause -------- Answer --------- endometrial biopsy, need to
screen for cancer
Pt with hx of PID, increased rick for? -------- Answer --------- Infertility
Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this
indicate? -------- Answer --------- This is good. Want higher than 350
Pt with hx of htn and stroke, now having memory loss. What does this indicate? --------
Answer --------- Vascular dementia
PAD/ PVD -------- Answer --------- PAD/ PVD (same)- Nocturnal pain relieved by
lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny,
hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the
most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal.
EXAM
CVI -------- Answer --------- CVI- Impaired venous return. Achy legs relieved by
elevation, edema after prolonged standing, night cramps, brownish discoloration, cold,
ulcers. Etc. do support stockings. EXAM
blood pressure -------- Answer --------- BP - ST 1 (140-159/ 90-99), if you know this you
will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL
INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.
Thiazide diuretics -------- Answer --------- no sulfa allergies, hyperuricemia, hypokalemia,
hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM
Statin -------- Answer --------- Must check LFT before starting Statin. Know when to start
statins and what to check for to decide mod-high dose statins. ON EXAM
Pulses paradoxus -------- Answer --------- Pulsus paradox Apical pulse can still be heard
even though the radial pulse is no longer palpable. Certain issues cause impairment
,with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient
had asthma and their pressure dropped by 10 etc. ON EXAM
Emphysema -------- Answer --------- Emphysema Lungs- Percussion-
HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with
hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss.
ON EXAM
Acute Bacterial Pneumonia- CXR -------- Answer --------- middle lobe. ON EXAM
OSA -------- Answer --------- does not include Microglossia which is an absent tongue
congenital. EXAM
TB -------- Answer --------- fatigue, fever, cough. Never do fewer than 3-4 drugs initially if
positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect
ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if
gold standard. Deep morning cough collected for three "consecutive days". TB is
usually upper lobes.
TPO -------- Answer --------- TPO- this lab is off MEANING ELEVATED in BOTH
hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you
always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself.
Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long
these meds take to work. TOPIC ON EXAM
hyperthyroid -------- Answer --------- Hyperthyroid- Low TSH, high "FREE" T4/T3.
ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything
is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY
RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.
A1C > 9 -------- Answer --------- If you are already on TWO oral drugs for diabetes and
A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is
9 or higher start BASAL insulin. ON EXAM
Parathyroid -------- Answer --------- For parathyroid- dx blood test. You will have
elevated calcium because your parathyroid is releasing too much from bones and this
will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR
SECONDARY HYPERPARATHY. EXAM
cushings -------- Answer --------- Central obesity, moon face, purple striae, hairy,
hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must
draw cortisol levels in the morning.
Fructosamine test -------- Answer --------- checks sugar for past 2-4 weeks.
, triglycerides -------- Answer --------- causes pancreatitis >500. If >500 treat with Niacin
or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like
(LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM
Pancreatitis -------- Answer --------- diagnosed with amylase / lipase draw. Amylase
beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to
alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback
"boring" epigastric pain. Fever, n/v. EXAM TOPICS
Metformin -------- Answer --------- Metformin - monitor BUN, Creatinine.
contraindicated renal and liver disease
ARF creatinine up and GFR down.
affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea
flatulence
CT: hold 24 hr before and 48hr after
Polycythemia vera -------- Answer --------- slow growing blood cancer. blood too thick,
clots. bone marrow to many RBC. risk bleed , anemia, CBC
All diastolic murmurs are pathological. Murmurs Grades I-barely II-audible III- clearly
audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM -------- Answer --------- III
first time audible, IV first time thrill
Fundal height 12 weeks -------- Answer --------- Fundal Height 12 weeks above
symphysis pubis. EXAM
Fundus 16 weeks between symphysis pubis and umbilicus.
Fundus at 20 weeks is at umbilicus.
2 cm more of less from # of wk gestation is normal if more or less order US
3 month old infant with down syndrome, due to milk intolerance, mom started on goats
milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test
would you order? -------- Answer --------- Iron, TIBC
3 months of synthroid, TSH increased, T4 normal, what do you do? -------- Answer ------
--- Increase Medication
3 ways to assess cognitive function in patient with signs/symptoms of memory loss ------
-- Answer --------- Mini mental exam
4 month old with strabismus, mom is worried...... -------- Answer --------- tell her it is
normal.
4 month old wont keep anything down, what is the main thing you look at? --------
Answer --------- Growth chart
