LEIK FNP System Review Exam With
100% Correct Answers 2023
Chapter 4 (Preventive Health) - Correct Answer-
Sensitivity - Correct Answer-(SNOUT) Negative results rules out the disease. Sensitivity
test are good at identifying the positive markers of disease. So good that it is more
prone to report false positives. So a negative result is more definitive
Specificity - Correct Answer-(SPIN) Positive results rules in the disease. Specificity tests
are good at identifying the negative marker of a disease. So good that is more prone to
report false negatives. So a positive result is more definitive.
Primary Prevention - Correct Answer-Prevent the disease in its entirety. Examples
include healthy diet, exercise, safety (helmets/seatbelts), immunizations, and job safety
Secondary Prevention - Correct Answer-Early detection of a disease. Examples include
screening tests
Tertiary Prevention - Correct Answer-Rehabilitation of a disease. Examples include
support groups, education for pts with pre-existing disease, drug side effect safety,
medical equipment safety, any type of rehab like PT or OT
Breast Cancer Screening Guidelines (USPSTF) - Correct Answer-Onset = 50yo.
Biannual. Stop at age 74yo. No SBE.
Breast Cancer Screening Guidelines (ACA) - Correct Answer-Onset = 40yo. Annual. No
stop age.
Cervical cancer screening guidelines - Correct Answer-Onset=21yo
(immunocompromised individuals start at onset of sexual activity). Every 3 years Pap w/
no HPV test until 30yo. Pap and HPV test after 30 yo and can begin screening every 5
years. Stop at age 65yo. Complete hysterectomy means no Pap unless pt has history of
cervical cancer or high grade lesion.
Colorectal cancer - Correct Answer-Onset 50yo. 1) colonoscopy q 10 years if wnl, 2)
sigmoidoscopy q 5 years if wnl, 3) annual FOBT with 3 stool samples. Stop age 75 yo.
Prostate cancer - Correct Answer-USPSTF does not recommend screening with PSA
but it based on individual pt.
Lipid screening - Correct Answer-Onset 18-35/45yo screen if at increased risk of heart
disease. Males >35yo and Females >45yo
,Flu vaccine - Correct Answer-LAIV - Live virus can only be given to healthy non-
pregnant 2 -49 yo w/o recent hx of asthma (Peds). Cautioned or C/I in pts with egg,
gentamicin or gelatin allergy and kids receiving aspirin therapy (Reye's syndrome). TIV
(trivalent inactivated vaccine) is approved for >6months.
Tetanus vaccine - Correct Answer-Q 10 years. Booster for dirty wounds if last TDAP/Td
is > 5 years old. >7yo receive Td/TDAP. Avoid in egg allergy and Gullian Barre. 5 doses
of DTAP aka Pediarix (2,4,6,15 months and 5 yo) First TDAP is at age 11-12yo. Td is
the booster every 10 years or if someone has never had TDAP (came out in 2005) then
they should have a one time dose of TDAP and then continue with Td boosters.
Pneumococcal vaccine - Correct Answer-PCV 23 given one time at age 65 yo in healthy
adults and for persons who are 2 years and older and at high risk for pneumococcal
disease (e.g., those with sickle cell disease, HIV infection, or other
immunocompromising conditions). PPSV23 is also recommended for use in adults 19
through 64 years of age who smoke cigarettes or who have asthma. One time booster
given 5 years after first dose (So non-healthy pts will receive 2 doses of PSV23 over
their lifetime). PCV 13 is for <5 yo. When both PCV13 and PPSV23 are indicated,
PCV13 should be administered first; PCV13 and PPSV23 should not be administered
during the same visit. When indicated, PCV13 and PPSV23 should be administered to
adults whose pneumococcal vaccination history is incomplete or unknown.
Varicella Vaccine - Correct Answer-60 yo. May be given to pts who have previously had
shingles. May be given earlier at age 50yo. Live virus so c/I include pregnancy and
immunocompromised.
Chapter 5 (EENT) - Correct Answer-
Herpes Keratitis - Correct Answer-Inflammation of the cornea. C/O abrupt severe eye
pain, photophobia and blurred vision. Diagnose with fluorescein dye and black lamp.
Look for fernlike lines (corneal abrasions appear more linear). Infection permanently
damages corneal epithelium which may result in blindness.
Acute angle closure - Correct Answer-Glaucoma (Increased ICP r/t blocked drainage
duct). Elderly pt c/o abrupt onset of severe eye pain, HA, N/V, halos around eyes, and
decreased vision. Exam reveals mid-dilated pupil that is oval shaped, cloudy cornea,
and fundoscopic exam shows cupping of the optic nerve. Tx = keep pt supine, trx to ED
for acetazolamide, B blockers, and topical steroids. Sx may be required
Cholesteatoma - Correct Answer-Cauliflower like growth in the middle ear. Pt c/o foul
smelling discharge and hearing loss. On exam, no TM or ossicles visible. PMhx of
chronic OM. The mass is not cancerous but it can erode in to the bones of the face and
damage CN7. Tx = ENT referral for sx, abx. Mass is usually made of epithelium and
cholesterol. AKA pearl tumor.
,Battle's sign - Correct Answer-Bruise behind the ear over the mastoid process. Hx of
trauma, and indicates a fracture of the basilar skull. Golden serous discharge from ear
or nose. Refer to ED for abx and imaging (CSF will be + for glucose. Mucous will be -
for glucose).
Cavernous sinus thrombosis - Correct Answer-Blood clot in w/I cavernous sinus. This
cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial
infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema,
photophobia, proptosis and inability to move eye appropriately.
Peritonsillar abcess - Correct Answer-Pt c/o severe sore throat, difficult and painful
swallowing (odonophagia) and LOCKJAW (trimus), and a hot potato voice. Unilateral
swelling peritonsillar area and soft palate with displaced uvula. Tx = I&D in ED or needle
aspiration
Diptheria - Correct Answer-Bull neck, dysphagia, and gray/yellow psuedomembrane
that is not to displace (stuff is like concrete) and may obstruct airway
Geographic tongue - Correct Answer-Benign finding
Torus Palatinus - Correct Answer-Painless bony protuberance on hard palate that is
benign
Fishtail uvula - Correct Answer-Split uvula is usually benign (rarely a sign of cleft palate)
Nystagmus - Correct Answer-Vertical nystagmus is always abnormal. Horizontal
nystagmus that occurs on prolonged lateral gaze and resolves when eye moves toward
midline is benign
Papilledema - Correct Answer-Optic disc swollen w blurred edges r/t increased ICP
(most commonly from bleeding, brain tumor, abscess or pseudo tumor cerebri).
HTN Retinopathy includes - Correct Answer-result from damage and adaptive changes
in the arterial and arteriolar circulation in response to the high blood pressure such as
Copper/silver arterioles, av nicking, blot/flame hemorrhages, cotton wool spots, hard
exudates and papilledema
Copper/silver arterioles - Correct Answer-Indicates sclerosis and hyalinization of the
arterioles. Silver is worse than copper.
Diabetic Retinopathy - Correct Answer-Microaneurysms caused by new fragile arteries
in the retina. Examples see cotton wool spots, flame hemorrhages and dot-blot
hemorrhages.
Cataracts - Correct Answer-Opacity of cornea
, Koplik's spots - Correct Answer-Small sized red papules w/ blue white centers inside the
cheeks by the lower molars. They are the prodromic viral enathem of measles
(Rubeola)
Hairy Leukoplakia - Correct Answer-Pathognomic for Epstein barr virus in
immunocompromised pts
Sjogren's syndrome - Correct Answer-Chronic autoimmune disorder characterized by
decreased function of lacrimal and salivary glands. Pt c/o dry eyes/mouth for > 3
months and/or gritty eyes. OTC eye drops and refer to ophthalmology and
rheumatologist
Blepharitis - Correct Answer-Chronic condition. Base of eyelids are inflamed.
Ithcy/irritation with some crusting. Tx is johnson's baby shampoo and may need
erythromycin optho ointment
Epitaxis - Correct Answer-Posterior nasal bleeds can result in severe hemorrhage. Tx
for anterior bleeds is tilt head forward and apply pressure over nasal bridge. Afrin nasal
spray can be helpful.
Strep throat - - Correct Answer-Beta hemolytic streptococcus group A. Classic triad is
no cough, sore throat, and enlarged cervical anterior lymph nodes. Possible fever,
petechiae on hard palate. Tx = C&S or rapid strep test. PCN x 10 days. PCN alternative
are Zpak or Levaquin (for pts >18yo). Sequalae includes scarlet fever, rheumatic fever
and peritonsillar abscess.
AOM - Correct Answer-Common organisms are streptococcus pneumoniae (gram +),
haemophilus influenza (gram - ), Moraxella catarrhalis (gram - ). Weber has
lateralization to affected ear. Decreased mobility (flat trace line on typanogram). Tx =
amoxicillin (80mcg/kg/day for peds and 500-875mg/day BID for adults). 2nd line agents
are Augmentin, Ceflin and Cefzil. PCN alternatives include Macrolides, Bactrim or
Levaquin.
Bullous myringitis - Correct Answer-AOM with blisters (bulla) on TM.
Hordeolum (aka stye) - Correct Answer-Acute bacterial infection of a hair follicle on the
eyelid. Pt c/o itching w painful pustule. Tx abx and warm compress (Remember Horders
live in a pig stye)
Chalazion - Correct Answer-Chronic inflammation of the meibomian gland (aka sweat
gland of the eyelid). Gradual onset of superficial nodule which is non tender. Tx if
nodule does not self resolves than refer for sx.
Pinguecula - Correct Answer-Yellow triangular thickening of the bulbar conjunctiva
caused by UV light damage (Penguins no volar far from the bulbar)
100% Correct Answers 2023
Chapter 4 (Preventive Health) - Correct Answer-
Sensitivity - Correct Answer-(SNOUT) Negative results rules out the disease. Sensitivity
test are good at identifying the positive markers of disease. So good that it is more
prone to report false positives. So a negative result is more definitive
Specificity - Correct Answer-(SPIN) Positive results rules in the disease. Specificity tests
are good at identifying the negative marker of a disease. So good that is more prone to
report false negatives. So a positive result is more definitive.
Primary Prevention - Correct Answer-Prevent the disease in its entirety. Examples
include healthy diet, exercise, safety (helmets/seatbelts), immunizations, and job safety
Secondary Prevention - Correct Answer-Early detection of a disease. Examples include
screening tests
Tertiary Prevention - Correct Answer-Rehabilitation of a disease. Examples include
support groups, education for pts with pre-existing disease, drug side effect safety,
medical equipment safety, any type of rehab like PT or OT
Breast Cancer Screening Guidelines (USPSTF) - Correct Answer-Onset = 50yo.
Biannual. Stop at age 74yo. No SBE.
Breast Cancer Screening Guidelines (ACA) - Correct Answer-Onset = 40yo. Annual. No
stop age.
Cervical cancer screening guidelines - Correct Answer-Onset=21yo
(immunocompromised individuals start at onset of sexual activity). Every 3 years Pap w/
no HPV test until 30yo. Pap and HPV test after 30 yo and can begin screening every 5
years. Stop at age 65yo. Complete hysterectomy means no Pap unless pt has history of
cervical cancer or high grade lesion.
Colorectal cancer - Correct Answer-Onset 50yo. 1) colonoscopy q 10 years if wnl, 2)
sigmoidoscopy q 5 years if wnl, 3) annual FOBT with 3 stool samples. Stop age 75 yo.
Prostate cancer - Correct Answer-USPSTF does not recommend screening with PSA
but it based on individual pt.
Lipid screening - Correct Answer-Onset 18-35/45yo screen if at increased risk of heart
disease. Males >35yo and Females >45yo
,Flu vaccine - Correct Answer-LAIV - Live virus can only be given to healthy non-
pregnant 2 -49 yo w/o recent hx of asthma (Peds). Cautioned or C/I in pts with egg,
gentamicin or gelatin allergy and kids receiving aspirin therapy (Reye's syndrome). TIV
(trivalent inactivated vaccine) is approved for >6months.
Tetanus vaccine - Correct Answer-Q 10 years. Booster for dirty wounds if last TDAP/Td
is > 5 years old. >7yo receive Td/TDAP. Avoid in egg allergy and Gullian Barre. 5 doses
of DTAP aka Pediarix (2,4,6,15 months and 5 yo) First TDAP is at age 11-12yo. Td is
the booster every 10 years or if someone has never had TDAP (came out in 2005) then
they should have a one time dose of TDAP and then continue with Td boosters.
Pneumococcal vaccine - Correct Answer-PCV 23 given one time at age 65 yo in healthy
adults and for persons who are 2 years and older and at high risk for pneumococcal
disease (e.g., those with sickle cell disease, HIV infection, or other
immunocompromising conditions). PPSV23 is also recommended for use in adults 19
through 64 years of age who smoke cigarettes or who have asthma. One time booster
given 5 years after first dose (So non-healthy pts will receive 2 doses of PSV23 over
their lifetime). PCV 13 is for <5 yo. When both PCV13 and PPSV23 are indicated,
PCV13 should be administered first; PCV13 and PPSV23 should not be administered
during the same visit. When indicated, PCV13 and PPSV23 should be administered to
adults whose pneumococcal vaccination history is incomplete or unknown.
Varicella Vaccine - Correct Answer-60 yo. May be given to pts who have previously had
shingles. May be given earlier at age 50yo. Live virus so c/I include pregnancy and
immunocompromised.
Chapter 5 (EENT) - Correct Answer-
Herpes Keratitis - Correct Answer-Inflammation of the cornea. C/O abrupt severe eye
pain, photophobia and blurred vision. Diagnose with fluorescein dye and black lamp.
Look for fernlike lines (corneal abrasions appear more linear). Infection permanently
damages corneal epithelium which may result in blindness.
Acute angle closure - Correct Answer-Glaucoma (Increased ICP r/t blocked drainage
duct). Elderly pt c/o abrupt onset of severe eye pain, HA, N/V, halos around eyes, and
decreased vision. Exam reveals mid-dilated pupil that is oval shaped, cloudy cornea,
and fundoscopic exam shows cupping of the optic nerve. Tx = keep pt supine, trx to ED
for acetazolamide, B blockers, and topical steroids. Sx may be required
Cholesteatoma - Correct Answer-Cauliflower like growth in the middle ear. Pt c/o foul
smelling discharge and hearing loss. On exam, no TM or ossicles visible. PMhx of
chronic OM. The mass is not cancerous but it can erode in to the bones of the face and
damage CN7. Tx = ENT referral for sx, abx. Mass is usually made of epithelium and
cholesterol. AKA pearl tumor.
,Battle's sign - Correct Answer-Bruise behind the ear over the mastoid process. Hx of
trauma, and indicates a fracture of the basilar skull. Golden serous discharge from ear
or nose. Refer to ED for abx and imaging (CSF will be + for glucose. Mucous will be -
for glucose).
Cavernous sinus thrombosis - Correct Answer-Blood clot in w/I cavernous sinus. This
cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial
infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema,
photophobia, proptosis and inability to move eye appropriately.
Peritonsillar abcess - Correct Answer-Pt c/o severe sore throat, difficult and painful
swallowing (odonophagia) and LOCKJAW (trimus), and a hot potato voice. Unilateral
swelling peritonsillar area and soft palate with displaced uvula. Tx = I&D in ED or needle
aspiration
Diptheria - Correct Answer-Bull neck, dysphagia, and gray/yellow psuedomembrane
that is not to displace (stuff is like concrete) and may obstruct airway
Geographic tongue - Correct Answer-Benign finding
Torus Palatinus - Correct Answer-Painless bony protuberance on hard palate that is
benign
Fishtail uvula - Correct Answer-Split uvula is usually benign (rarely a sign of cleft palate)
Nystagmus - Correct Answer-Vertical nystagmus is always abnormal. Horizontal
nystagmus that occurs on prolonged lateral gaze and resolves when eye moves toward
midline is benign
Papilledema - Correct Answer-Optic disc swollen w blurred edges r/t increased ICP
(most commonly from bleeding, brain tumor, abscess or pseudo tumor cerebri).
HTN Retinopathy includes - Correct Answer-result from damage and adaptive changes
in the arterial and arteriolar circulation in response to the high blood pressure such as
Copper/silver arterioles, av nicking, blot/flame hemorrhages, cotton wool spots, hard
exudates and papilledema
Copper/silver arterioles - Correct Answer-Indicates sclerosis and hyalinization of the
arterioles. Silver is worse than copper.
Diabetic Retinopathy - Correct Answer-Microaneurysms caused by new fragile arteries
in the retina. Examples see cotton wool spots, flame hemorrhages and dot-blot
hemorrhages.
Cataracts - Correct Answer-Opacity of cornea
, Koplik's spots - Correct Answer-Small sized red papules w/ blue white centers inside the
cheeks by the lower molars. They are the prodromic viral enathem of measles
(Rubeola)
Hairy Leukoplakia - Correct Answer-Pathognomic for Epstein barr virus in
immunocompromised pts
Sjogren's syndrome - Correct Answer-Chronic autoimmune disorder characterized by
decreased function of lacrimal and salivary glands. Pt c/o dry eyes/mouth for > 3
months and/or gritty eyes. OTC eye drops and refer to ophthalmology and
rheumatologist
Blepharitis - Correct Answer-Chronic condition. Base of eyelids are inflamed.
Ithcy/irritation with some crusting. Tx is johnson's baby shampoo and may need
erythromycin optho ointment
Epitaxis - Correct Answer-Posterior nasal bleeds can result in severe hemorrhage. Tx
for anterior bleeds is tilt head forward and apply pressure over nasal bridge. Afrin nasal
spray can be helpful.
Strep throat - - Correct Answer-Beta hemolytic streptococcus group A. Classic triad is
no cough, sore throat, and enlarged cervical anterior lymph nodes. Possible fever,
petechiae on hard palate. Tx = C&S or rapid strep test. PCN x 10 days. PCN alternative
are Zpak or Levaquin (for pts >18yo). Sequalae includes scarlet fever, rheumatic fever
and peritonsillar abscess.
AOM - Correct Answer-Common organisms are streptococcus pneumoniae (gram +),
haemophilus influenza (gram - ), Moraxella catarrhalis (gram - ). Weber has
lateralization to affected ear. Decreased mobility (flat trace line on typanogram). Tx =
amoxicillin (80mcg/kg/day for peds and 500-875mg/day BID for adults). 2nd line agents
are Augmentin, Ceflin and Cefzil. PCN alternatives include Macrolides, Bactrim or
Levaquin.
Bullous myringitis - Correct Answer-AOM with blisters (bulla) on TM.
Hordeolum (aka stye) - Correct Answer-Acute bacterial infection of a hair follicle on the
eyelid. Pt c/o itching w painful pustule. Tx abx and warm compress (Remember Horders
live in a pig stye)
Chalazion - Correct Answer-Chronic inflammation of the meibomian gland (aka sweat
gland of the eyelid). Gradual onset of superficial nodule which is non tender. Tx if
nodule does not self resolves than refer for sx.
Pinguecula - Correct Answer-Yellow triangular thickening of the bulbar conjunctiva
caused by UV light damage (Penguins no volar far from the bulbar)
