AANP AGPCNP Exam Practice Questions And Answers
2024/2025 Update Completely Solved 100% Correct
Myasthenia Gravis Symptoms/Patho - ANSWER-autoimmune- decreased Ach
receptor and antibodies against sites
-weakness and rapid fatigue of muscles under voluntary control
-dropping eyelid, impaired voice, difficulty swallowing, arm/leg weakness
-worsening throughout day as Ach drops- more symptomatic at dinner
Myasthenia Gravis Tests - ANSWER-Tensilon Test (anticholinesterase allowing for
Ach) looking for improved muscle responses in 5 minutes*
- also check RA and ANA for coexisting autoimmune disease
-EMGs
Myasthenia Gravis Complications - ANSWER-slowly progressive- can lead to fatal
aspiration
Myasthenia Gravis Treatment - ANSWER-Anticholinesterase drugs: Neostigmine
QID*
-Prednisone high dose then taper
-Thymectomy (thymus may be abnormal)
-Plasmapheresis (get rid of antibodites against Ach receptors)
Never give this class of meds in Myasthenia Gravis - ANSWER-Aminoglycosides
(gentomycin, tobramycin, neomycin)- they exacerbate disease leading to difficulty
swallowing and aspiration
What Hz tuning fork to use for Weber Test - ANSWER512
Disease caused by Pituitary Adenoma - ANSWER-Acromeagly-excess growth
hormone
-Cushings- stim adrenal to increase cortisol
-Diabetes Insipidous- decreased antidiuretic hormone (vasopressin)
(caution: in pts being treated for hypothyroid with no response to high synthroid
doses order CT to r/o pituitary adenoma)
Anasacoria - ANSWEROne pupil bigger then other
-can occur with M.S. and other coniditions-needs investigated
#1 symptom presentation in MS - ANSWER-ocular symptoms*
-bursts of light and dark, anasacoria
-pallor of optic disc on microscopic exam
Diagnostics for MS - ANSWERMRI- progressive demylinization of white matter*;
Autoimmune
,Symptoms of MS - ANSWER-remission and attacks- symptoms aggravated by physical
and emotional stress
-sensory and vision abnormalities (anasacoria)
-symptoms on opposite side of body then brain demylinzation
-intention tremor
-onset 20-30years
-balance and speech affected
-hyperreflexia +4
-babinski may be present on one foot (stroke lateral foot upward and watch big toe)
-Lhermitte's sign
-incontinence- may have frequent UTI (>3 a year)
Lhermitte's sign* - ANSWER-diagnostic of MS
-lay supine and flex neck- this causes electric shock down both arms
MS Treatments - ANSWERAcute (both cause weight gain):
-Glucocorticoids
-Baclofen for spasticity
Reduce relapses:
-SQ Betaseron (Interferon beta 1b) QOD
-IM Avonex (Interferon beta 1a) Qweek
Guillian Barre Polyneuropathy - ANSWERAcute prob involving PROXIMAL limb
SYMMETRICAL weakness that often begins in the legs and ASCENDs quickly;
unknown cause; Areflexia and facial paralysis and respiratory paralysis may results;
Maximum deficit BY 7 days; Tx: plasmapharesis or IgG
MONO IS A RISK FOR GB so watch for it in pt's you are treating for mono- MUST
document achilles reflex when you make the diagnosis of mono to get baseline; GB
will have ascending loss of reflexes
-can start as tingling in the feet
Achilles DTR* - ANSWERS1, L5
Patellar DTR* - ANSWERL3, L4
Brachioradialis* - ANSWERC5, C6
Biceps* - ANSWERC5, C6
Triceps* - ANSWERC7, C8
Prolonged recovery of the achilles reflex supports the diagnosis of* -
ANSWERHypothyroid
Acromeagly - ANSWER-Nose, hands, bones getting larger d/t pituitary adenoma-
excessive growth hormone
-provider could be mistreating for hypothyroid
, Babinski reflex - ANSWERpositive- upward extension of big tow with fanning of toes
-should go away by time they are walking
-can be positive in MS on affected side
Amyotropic Lateral Scelorsis - ANSWERaka Lou Gehrigs disease
-progressive neuromuscular disease
-remain cognitively intact
-50-70 years old, men>female
-prognosis 3-5 years after respiratory failure
S/Sx Amyotropic lateral sceloris - ANSWER-trips over feet **
-fasculations of toungue
-pooling of secretions (wake with wet pillow, wiping mouth)
Cilary Flush/blush* - ANSWER-when redness touches the limbal boarder of the eye
-always worry about this!
-could be: uveitis, acute glaucoma
-pt will be very symptomatic
-always check pupils next- true ciliary blush pupil will be irregular in size and shape
Eye Anatomy from outermost to intermost - ANSWER(CAIL)
cornea, anterior chamber, iris, lens
Eye Exam Steps with opthalmoscope* - ANSWER1. Start with wheel at '0' with clear
glass (initial setting of opthalmoscope**) start 12 inches from patient
2. Instruct patient to look at far wall to make pupil dilate
3. Obtain red reflex
4. Aim nasally (medially) to optic disk, then superiorly, inferiorly, and temporally
ending at the macula and fovea
*if difficulty visualizing macula have patient look directly into the light
-the optic disc is always located towards the nose**
-the macula is always towards the temples**
The diameter of the cup should be _______ of the opic disc?** - ANSWER-1/2 the
size (or 50%)**
-cupping of the disk (large cup) is BAD and occurs in glaucoma***
(to decide acute vs chronic glaucoma is whether or not patient is having
pain/symptoms)
corneal light reflex - ANSWERsparkle of light on the corneas; should be at same
oclock position in both eyes
Consensual light reflex - ANSWERshine light in right eye and watch for left to
constrict
2024/2025 Update Completely Solved 100% Correct
Myasthenia Gravis Symptoms/Patho - ANSWER-autoimmune- decreased Ach
receptor and antibodies against sites
-weakness and rapid fatigue of muscles under voluntary control
-dropping eyelid, impaired voice, difficulty swallowing, arm/leg weakness
-worsening throughout day as Ach drops- more symptomatic at dinner
Myasthenia Gravis Tests - ANSWER-Tensilon Test (anticholinesterase allowing for
Ach) looking for improved muscle responses in 5 minutes*
- also check RA and ANA for coexisting autoimmune disease
-EMGs
Myasthenia Gravis Complications - ANSWER-slowly progressive- can lead to fatal
aspiration
Myasthenia Gravis Treatment - ANSWER-Anticholinesterase drugs: Neostigmine
QID*
-Prednisone high dose then taper
-Thymectomy (thymus may be abnormal)
-Plasmapheresis (get rid of antibodites against Ach receptors)
Never give this class of meds in Myasthenia Gravis - ANSWER-Aminoglycosides
(gentomycin, tobramycin, neomycin)- they exacerbate disease leading to difficulty
swallowing and aspiration
What Hz tuning fork to use for Weber Test - ANSWER512
Disease caused by Pituitary Adenoma - ANSWER-Acromeagly-excess growth
hormone
-Cushings- stim adrenal to increase cortisol
-Diabetes Insipidous- decreased antidiuretic hormone (vasopressin)
(caution: in pts being treated for hypothyroid with no response to high synthroid
doses order CT to r/o pituitary adenoma)
Anasacoria - ANSWEROne pupil bigger then other
-can occur with M.S. and other coniditions-needs investigated
#1 symptom presentation in MS - ANSWER-ocular symptoms*
-bursts of light and dark, anasacoria
-pallor of optic disc on microscopic exam
Diagnostics for MS - ANSWERMRI- progressive demylinization of white matter*;
Autoimmune
,Symptoms of MS - ANSWER-remission and attacks- symptoms aggravated by physical
and emotional stress
-sensory and vision abnormalities (anasacoria)
-symptoms on opposite side of body then brain demylinzation
-intention tremor
-onset 20-30years
-balance and speech affected
-hyperreflexia +4
-babinski may be present on one foot (stroke lateral foot upward and watch big toe)
-Lhermitte's sign
-incontinence- may have frequent UTI (>3 a year)
Lhermitte's sign* - ANSWER-diagnostic of MS
-lay supine and flex neck- this causes electric shock down both arms
MS Treatments - ANSWERAcute (both cause weight gain):
-Glucocorticoids
-Baclofen for spasticity
Reduce relapses:
-SQ Betaseron (Interferon beta 1b) QOD
-IM Avonex (Interferon beta 1a) Qweek
Guillian Barre Polyneuropathy - ANSWERAcute prob involving PROXIMAL limb
SYMMETRICAL weakness that often begins in the legs and ASCENDs quickly;
unknown cause; Areflexia and facial paralysis and respiratory paralysis may results;
Maximum deficit BY 7 days; Tx: plasmapharesis or IgG
MONO IS A RISK FOR GB so watch for it in pt's you are treating for mono- MUST
document achilles reflex when you make the diagnosis of mono to get baseline; GB
will have ascending loss of reflexes
-can start as tingling in the feet
Achilles DTR* - ANSWERS1, L5
Patellar DTR* - ANSWERL3, L4
Brachioradialis* - ANSWERC5, C6
Biceps* - ANSWERC5, C6
Triceps* - ANSWERC7, C8
Prolonged recovery of the achilles reflex supports the diagnosis of* -
ANSWERHypothyroid
Acromeagly - ANSWER-Nose, hands, bones getting larger d/t pituitary adenoma-
excessive growth hormone
-provider could be mistreating for hypothyroid
, Babinski reflex - ANSWERpositive- upward extension of big tow with fanning of toes
-should go away by time they are walking
-can be positive in MS on affected side
Amyotropic Lateral Scelorsis - ANSWERaka Lou Gehrigs disease
-progressive neuromuscular disease
-remain cognitively intact
-50-70 years old, men>female
-prognosis 3-5 years after respiratory failure
S/Sx Amyotropic lateral sceloris - ANSWER-trips over feet **
-fasculations of toungue
-pooling of secretions (wake with wet pillow, wiping mouth)
Cilary Flush/blush* - ANSWER-when redness touches the limbal boarder of the eye
-always worry about this!
-could be: uveitis, acute glaucoma
-pt will be very symptomatic
-always check pupils next- true ciliary blush pupil will be irregular in size and shape
Eye Anatomy from outermost to intermost - ANSWER(CAIL)
cornea, anterior chamber, iris, lens
Eye Exam Steps with opthalmoscope* - ANSWER1. Start with wheel at '0' with clear
glass (initial setting of opthalmoscope**) start 12 inches from patient
2. Instruct patient to look at far wall to make pupil dilate
3. Obtain red reflex
4. Aim nasally (medially) to optic disk, then superiorly, inferiorly, and temporally
ending at the macula and fovea
*if difficulty visualizing macula have patient look directly into the light
-the optic disc is always located towards the nose**
-the macula is always towards the temples**
The diameter of the cup should be _______ of the opic disc?** - ANSWER-1/2 the
size (or 50%)**
-cupping of the disk (large cup) is BAD and occurs in glaucoma***
(to decide acute vs chronic glaucoma is whether or not patient is having
pain/symptoms)
corneal light reflex - ANSWERsparkle of light on the corneas; should be at same
oclock position in both eyes
Consensual light reflex - ANSWERshine light in right eye and watch for left to
constrict
