AANP EXAM, PRACTICE EXAM AND STUDY
GUIDE NEWEST 2024 ACTUAL EXAM 450
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
Erythropoetin - CORRECT ANSWER 90 % renal, 10% hepatic, need supplementation
when GFR is less than 49
Reticulocytes - CORRECT ANSWER In health, make up 1-2 % of total RBCs,
increased in response to anema. Absence of reticulocytosis or presence of
reticulocytopenia shows inadequate bone marrow response.
Hemoglobin - CORRECT ANSWER normal is 12 for females and 15 for males. Ratio
to hematocrit is 1:3
MCV - CORRECT ANSWER determines red blood cell size - normal is 80-96
MCH - CORRECT ANSWER reflects hgb content and color, normal is 31-37
RDW - CORRECT ANSWER variation of RBC size - normal is 11.5-15%
Normocytic, normochromic , normal RDW - CORRECT ANSWER acute blood loss,
anemia of chronic disease
Microcytic, hypochromic anemia, elevated RDW - CORRECT ANSWER Iron
deficiency anemia
Microcytic, hypochromic, normal RDW - CORRECT ANSWER alpha or beta
thalassemia minor
Macrocytic, normochromic, elevated RDW - CORRECT ANSWER Vitamin B12
deficiency, folate deficiency, pernicious anemia
Macrocytosis without anemia - CORRECT ANSWER use of medications like tegretol,
AZT, depakote, dilantin, alcohol
Heart murmur seen in b12 deficiency - CORRECT ANSWER Hemic murmur
Most common pathogen in CAP, ABRS, AOM - CORRECT ANSWER S. pneumoniae
, Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and
tobacco use - CORRECT ANSWER H. influenzae, more than 30% now pcn resistant
via beta lactamase production
First line treatment for Acute Bacterial Rhinosinusitis - CORRECT ANSWER
Augmentin 500/125 TID or 875/125 BID
Second line treatment for Acute Bacterial Rhinosinusitis - CORRECT ANSWER
Augmentin 2000/125 BID or doxy 100 mg BID or 200 mg QD
Treatment for ABRS if allergic to PCN, Cephalosporins - CORRECT ANSWER Doxy,
Levofloxacin, Moxifloxacin
Treatment for ABRS if antibiotic resistance of failed initial therapy - CORRECT
ANSWER Doxy, levofloxacin, moxifloxacin
Presbycusis - CORRECT ANSWER slowly progressive hearing loss that is symmetric
and high frequency
1st line controller therapy in allergic rhinitis - CORRECT ANSWER Intranasal
corticosteriods like Flonase, Nasonex, Nasacort, Omnaris. Side effects are that nasal
irritation and bleeding may occur. Optimal efficacy may take 1-2 weeks.
1st line rescue treatment in allergic rhinitis - CORRECT ANSWER Nasal
antihistamines, esp if there is nasal congestion. sedation could occur. Drugs like astelin,
Astepro, and patanase
1st generation oral antihistamines - CORRECT ANSWER significant potential to cause
sedation and anticholinergic effects so not a first line therapy. Ex. benadryl, chlor
trimeton, dimetapp, vistaril.
2nd generation oral antihistamines - CORRECT ANSWER These are preferred over
because no anticholinergic effects but not as helpful with nasal congestion. Ex. claritin,
clarinex, zyrtec, allergra
Oral decongestants - CORRECT ANSWER alpha adrenergic agonist so
vasoconstrictive. Take caution with the elderly, young children, HTN, bladder neck
obstruction, glaucoma, and hyperthyroidism. Ex. sudafed
Nasal decongestants - CORRECT ANSWER Alpha adrenergic agonist so
vasoconstrictive. Can cause rebound congestion/medicamentosa so limit use to 5-7
days.
Intranasal anticholinergics - CORRECT ANSWER reduce runny nose because of
drying action. No effect on other nasal symptoms. Dryness can occur. Ex.. Atrovent
, Found on fundoscopic exam of person with angle-closure glaucoma - CORRECT
ANSWER deeply cupped optic disc because of increase intraocular pressure than
pushes the optic disc backwards., acute, painful
Amsler grid - CORRECT ANSWER screening test for macular problems.
Tonometry - CORRECT ANSWER measurement of intraoccular pressure, screen for
glaucoma
Presbyopia - CORRECT ANSWER Hardening of the lens, close vision problems,
adults over 45
Senile cataracts - CORRECT ANSWER lens clouding, progressive vision dimming,
distance vision problems, close vision usually retained and often improves. Risk factors
are tobacco use, poor nutrition, sun exposure, systemic corticosteriod therapy.
Potentially correctable with surgery.
Open-angle glaucoma - CORRECT ANSWER Painless, gradual onset of increased
intraocular pressure leading to optic atrophy. Causes a loss of peripheral vision if not
treated. Avoidable with appropriate and ongoing intervention. more than 80% of all
glaucoma. Treat with topical miotics, beta blockers, or surgery
Angle closure glaucoma - CORRECT ANSWER sudden increases in intraocular
pressure. Usually unilateral, painful, red eye, halos around lights, eyeball firm when
compare to other. Immediate referral to opthmalogy
Macular degeneration - CORRECT ANSWER thickening sclerotic changes in retinal
basement membrane complex. Causes painless changes in vision including distortion of
central vision. On fundo exam will see drusen (soft yellow deposits in macular region).
Risk factors are tobacco use, sun exposure. No treatment available for dry form. Laser
treatment or intraviteal injection of antivascular growth factor for wet form
Treatment of suppurative (non gonococcal or chlamydial infection (s. aureas, s.
pneumo, H. influ) - CORRECT ANSWER Primary: opthalmic with FQ ocular solution.
Secondary: opthalmic treatment with polymixin B with trimetroprim solution or with
azithromycin 1%.
Treatment of otitis externa (pseudomonas sp, proteus sp). Acute infection often S.
aureus. - CORRECT ANSWER otic drops with ofloxacin or cipro with hydrocortisone or
polymixin B with neomycin and hydrocortisone. Cleaning of ear canal important. Use 1:2
mix of white vinegar and rubbing alcohol after swimming. Do not use neomycin if
eardrum punctured.
Exudative pharyngitis - CORRECT ANSWER Caused by A, C, G streptococcus, viral,
HHV-6, M. pneumo. 1st line therapy is PCN PO for 10 days or IM for 1 dose if problems
with adherence.
GUIDE NEWEST 2024 ACTUAL EXAM 450
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
Erythropoetin - CORRECT ANSWER 90 % renal, 10% hepatic, need supplementation
when GFR is less than 49
Reticulocytes - CORRECT ANSWER In health, make up 1-2 % of total RBCs,
increased in response to anema. Absence of reticulocytosis or presence of
reticulocytopenia shows inadequate bone marrow response.
Hemoglobin - CORRECT ANSWER normal is 12 for females and 15 for males. Ratio
to hematocrit is 1:3
MCV - CORRECT ANSWER determines red blood cell size - normal is 80-96
MCH - CORRECT ANSWER reflects hgb content and color, normal is 31-37
RDW - CORRECT ANSWER variation of RBC size - normal is 11.5-15%
Normocytic, normochromic , normal RDW - CORRECT ANSWER acute blood loss,
anemia of chronic disease
Microcytic, hypochromic anemia, elevated RDW - CORRECT ANSWER Iron
deficiency anemia
Microcytic, hypochromic, normal RDW - CORRECT ANSWER alpha or beta
thalassemia minor
Macrocytic, normochromic, elevated RDW - CORRECT ANSWER Vitamin B12
deficiency, folate deficiency, pernicious anemia
Macrocytosis without anemia - CORRECT ANSWER use of medications like tegretol,
AZT, depakote, dilantin, alcohol
Heart murmur seen in b12 deficiency - CORRECT ANSWER Hemic murmur
Most common pathogen in CAP, ABRS, AOM - CORRECT ANSWER S. pneumoniae
, Common pathogen in ABRS, AOM, CAP particularly with recurrent infections and
tobacco use - CORRECT ANSWER H. influenzae, more than 30% now pcn resistant
via beta lactamase production
First line treatment for Acute Bacterial Rhinosinusitis - CORRECT ANSWER
Augmentin 500/125 TID or 875/125 BID
Second line treatment for Acute Bacterial Rhinosinusitis - CORRECT ANSWER
Augmentin 2000/125 BID or doxy 100 mg BID or 200 mg QD
Treatment for ABRS if allergic to PCN, Cephalosporins - CORRECT ANSWER Doxy,
Levofloxacin, Moxifloxacin
Treatment for ABRS if antibiotic resistance of failed initial therapy - CORRECT
ANSWER Doxy, levofloxacin, moxifloxacin
Presbycusis - CORRECT ANSWER slowly progressive hearing loss that is symmetric
and high frequency
1st line controller therapy in allergic rhinitis - CORRECT ANSWER Intranasal
corticosteriods like Flonase, Nasonex, Nasacort, Omnaris. Side effects are that nasal
irritation and bleeding may occur. Optimal efficacy may take 1-2 weeks.
1st line rescue treatment in allergic rhinitis - CORRECT ANSWER Nasal
antihistamines, esp if there is nasal congestion. sedation could occur. Drugs like astelin,
Astepro, and patanase
1st generation oral antihistamines - CORRECT ANSWER significant potential to cause
sedation and anticholinergic effects so not a first line therapy. Ex. benadryl, chlor
trimeton, dimetapp, vistaril.
2nd generation oral antihistamines - CORRECT ANSWER These are preferred over
because no anticholinergic effects but not as helpful with nasal congestion. Ex. claritin,
clarinex, zyrtec, allergra
Oral decongestants - CORRECT ANSWER alpha adrenergic agonist so
vasoconstrictive. Take caution with the elderly, young children, HTN, bladder neck
obstruction, glaucoma, and hyperthyroidism. Ex. sudafed
Nasal decongestants - CORRECT ANSWER Alpha adrenergic agonist so
vasoconstrictive. Can cause rebound congestion/medicamentosa so limit use to 5-7
days.
Intranasal anticholinergics - CORRECT ANSWER reduce runny nose because of
drying action. No effect on other nasal symptoms. Dryness can occur. Ex.. Atrovent
, Found on fundoscopic exam of person with angle-closure glaucoma - CORRECT
ANSWER deeply cupped optic disc because of increase intraocular pressure than
pushes the optic disc backwards., acute, painful
Amsler grid - CORRECT ANSWER screening test for macular problems.
Tonometry - CORRECT ANSWER measurement of intraoccular pressure, screen for
glaucoma
Presbyopia - CORRECT ANSWER Hardening of the lens, close vision problems,
adults over 45
Senile cataracts - CORRECT ANSWER lens clouding, progressive vision dimming,
distance vision problems, close vision usually retained and often improves. Risk factors
are tobacco use, poor nutrition, sun exposure, systemic corticosteriod therapy.
Potentially correctable with surgery.
Open-angle glaucoma - CORRECT ANSWER Painless, gradual onset of increased
intraocular pressure leading to optic atrophy. Causes a loss of peripheral vision if not
treated. Avoidable with appropriate and ongoing intervention. more than 80% of all
glaucoma. Treat with topical miotics, beta blockers, or surgery
Angle closure glaucoma - CORRECT ANSWER sudden increases in intraocular
pressure. Usually unilateral, painful, red eye, halos around lights, eyeball firm when
compare to other. Immediate referral to opthmalogy
Macular degeneration - CORRECT ANSWER thickening sclerotic changes in retinal
basement membrane complex. Causes painless changes in vision including distortion of
central vision. On fundo exam will see drusen (soft yellow deposits in macular region).
Risk factors are tobacco use, sun exposure. No treatment available for dry form. Laser
treatment or intraviteal injection of antivascular growth factor for wet form
Treatment of suppurative (non gonococcal or chlamydial infection (s. aureas, s.
pneumo, H. influ) - CORRECT ANSWER Primary: opthalmic with FQ ocular solution.
Secondary: opthalmic treatment with polymixin B with trimetroprim solution or with
azithromycin 1%.
Treatment of otitis externa (pseudomonas sp, proteus sp). Acute infection often S.
aureus. - CORRECT ANSWER otic drops with ofloxacin or cipro with hydrocortisone or
polymixin B with neomycin and hydrocortisone. Cleaning of ear canal important. Use 1:2
mix of white vinegar and rubbing alcohol after swimming. Do not use neomycin if
eardrum punctured.
Exudative pharyngitis - CORRECT ANSWER Caused by A, C, G streptococcus, viral,
HHV-6, M. pneumo. 1st line therapy is PCN PO for 10 days or IM for 1 dose if problems
with adherence.
