NURS5434/ NURS 5434 Final Exam – Family III (FNP 3) 2026/ 2027 | UTA Latest Update | Practice Questions & Verified Answers

NURS5434/ NURS 5434 Final Exam – Family III (FNP 3) 2026/ 2027 | UTA Latest Update | Practice Questions & Verified Answers Q: In the USPSTF Grading system which of the following grades are Recommended to DO? SATA A. Grade A B. Grade B C. Grade C D. Grade D E. Grade I A. Grade A B. Grade B Q: Which of the following are NOT examples of USPSTF Grade A or B recommendations? SATA A. Routine AAA screening in women B. AAA Screening in Men age 65-75 who have never smoked C. Routine PSA for all men D. Teaching Breast Self Exam E. Routine Pap Smear F. Depression Screening A. Routine AAA screening in women C. Routine PSA for all men D. Teaching Breast Self Exam Q: Patient ages 21-29 should get a Pap Smear done: A. Every year B. Every 2 years C. Every 3 years D. Every 6 months C. Every 3 years Q: Patients age 30-65 years old should get Pap + HPV: A. Every 3 years B. Every 5 years C. Every 6 years D. Every 10 years B. Every 5 years Q: Breast cancer prevention counseling should be given to all women, True or False? False Only High risk women Q: A screening for colonoscopy should be done starting age? A. 35 B. 45 C. 50 D. 65 C. 50 years old Q: How often do you perform a colonoscopy screening starting at age 50 years old? A. Every 6 months B. Every year C. Every 3 years D. Every 5 years E. Every 10 years E. Every 10 years Q: How often do you get the Influenza vaccine? How early can you get it? Annually (staring at 6 months) Q: A 65 year old man comes to a primary care facility. He states that it has been 10 years since his last Tetanus shot and he is excited about seeing his newborn grandchild, he should be offered and immunization with: A. Tdap B. Prevnar 23 C. Hepatitis B D. HPV A. Tdap Q: Which of the following is Secondary prevention? SATA A. Influenza vaccine B. COVID-19 booster C. Mammogram D. Antibiotics for an STI E. Pap smear F. Colonoscopy C. Mammogram E. Pap smear F. Colonoscopy Q: Age range for HPV vaccine 9-45 years old Q: Polly is 66 years old. She smokes and enjoys going on walks to the park twice a week. Which of the following vaccines would you recommend for her? SATA A. HPV B. Meningococcal Vaccine C. Prevnar 13 (PCV13) D. Hepatitis B E. Pneumovax 23 (PPSV23) C. Prevnar 13 (PCV13) E. Pneumovax 23 (PPSV23) Q: Polly is 66 years old. She smokes and enjoys going on walks to the park twice a week. She tells you that she has never gotten the pneumococcal shot. Which of the following vaccines would you recommend for her TODAY? A. Prevnar 20 (PCV 20) B. Meningococcal Vaccine C. Prevnar 13 (PCV13) D. Hepatitis B E. Pneumovax 23 (PPSV23) A. Prevnar 20 (PCV 20) Q: Polly is 66 years old. She smokes and enjoys going on walks to the park twice a week. She tells you that she has never gotten the pneumococcal shot. You give PCV 20 today, what do you give 1 year from now? A. Prevnar 20 booster (PCV 20) B. Meningococcal Vaccine C. Prevnar 13 (PCV13) D. Hepatitis B E. Pneumovax 23 (PPSV23) E. Pneumovax 23 (PPSV23) Q: All of the following patients received the pneumococcal vaccine 5 years ago. Who's is the best candidate for the second dose AntiPneumococcal vaccination at this time. A. A 66 year old male on dialysis B. A 70 year old female with diabetes C. A 65 year old male who is sexually active and has multiple partners D. A 66 year old woman with COPD D. A 66 year old woman with COPD Q: Prevnar 13 (PCV13) and Pneumovax 23 (PPSV23) are indicated for which age group? A. Ages 35-50 years old B. Ages 50-55 years old C. Ages 55-65 years old D. Ages 65 and up D. Ages 65 and up Q: According to the USPSTF which of the following women should get a Pap Smear? A. 18 years old with 3 Sex Partners B. 21 years old C. 85 year old with no previous high risk D. 75 year old women who is not sexually active B. 21 years old Q: Betty is a 53 year old women who got the Zostavax vaccine 18 months ago, it is recommended for her to also get the Shingrix Vaccine at this time, True or False? True Q: Prostate Cancer Screening is which of the following recommendations? A. Grade A B. Grade B C. Grade C D. Grade D E. Grade I C. Grade C Motivational Interviewing (MI) helps patients explore their Ambivalence, Identify Barriers and discover Personal motivators, True or False? True USPSTF Recommendations Grade D are those that you should not do as the harm outweighs the risk except for which of the following? A. COPD Screening B. Asymptomatic Carotid Artery stenosis C. HIV Screening D. Colorectal Cancer screening 85 yer C. HIV Screening (Grade A) . An exercise RX Should include the intensity, type, and ____ of exercise? A. Risk B. Benefits C. Duration C. Duration What type of prevention is Vaccine? A. Not prevention B. Primary C. Secondary D. Tertiary B. Primary Name the 5 A's in smoking cessation Ask Advise Assess Assist Arrange Model Based on the 5 A's model, the most important comment you should make to your patient who is a smoker to Advise him is: A. Why do you feel the need to smoke? B. Stopping smoking is the single best thing you can do for your health C. Review the patients need for smoking D. What can I do to support you in your smoking cessation journey E. We will make a plan for you to stop smoking B. Stopping smoking is the single best thing you can do for your health Wanda has been smoking for 10 years. She has started making small changes to quit smoking like throwing away her cigarettes and wants your help to set a quit date. What stage of the Transtheoretical Model is she on? A. Pre contemplation B. Contemplation C. Preparation D. Action E. Maintenance C. Preparation Clarence has been smoking for 10 years and has COPD. You tell Clarence that one of the best ways to treatment COPD is to quit smoking. Clarence says that he is too stressed to quit and is not interested. He is not interested in quitting and wants to focus on getting his blood sugar under control. What stage of the Transtheoretical Model is he on when it comes to Tobacco cessation? A. Pre contemplation B. Contemplation C. Preparation D. Action E. Maintenance A. Pre contemplation Which stage of the Transtheoretical Model stage of change is when the patient says, "I'll be okay" despite the risk? A. Pre contemplation B. Contemplation C. Preparation D. Action E. Maintenance A. Pre contemplation In the pre contemplation stage the patient is not yet considering change and may dismiss or minimize the risk. The statement "I'll be okay" despite the risk reflects How soon should someone start Bupropion once they have quit smoking? A. You can start the same day B. You can start in 1-2 weeks C. You can start in one month D. Bupropion is not to be used for smoking cessation B. You can start in 1-2 weeks Which of the following smoking cessation tools are recommend for a patient with Schizophrenia? A. Counseling B. Bupropion 150mg BID for 10 weeks C. Varenicline 1 mg BID for 10 weeks D. Nicotine Gum 1 piece every 1-2 hours E. Nicotine Patch 21 mg for 4 weeks E. Nicotine Patch 21 mg for 4 weeks The FDA approved the used of pharmacological interventions in tobacco cessation to increase long term smoking abstinence rate, True or False? True Which of the following smoking cessation tools are recommend for a pregnant patient? A. Counseling B. Bupropion 150mg BID for 10 weeks C. Varenicline 1 mg BID for 10 weeks D. Nicotine Gum 1 piece every 1-2 hours E. Nicotine Patch 21 mg for 4 weeks A. Counseling Nicotine patch: Patients with Cardiovascular disease will have no increase in CV events even if the patient continues smoking, True or False? True Which of the following Tobacco Cessation combination is NOT recommended according to the lecture? A. Nicotine patch + Gum B. Nicotine patch + Spray C. Nicotine patch + Bupropion D. Nicotine patch + Varenicline E. Nicotine patch + Nortiptyline D. Nicotine patch + Varenicline A patient started taking Chantix (Varenicline) 4 weeks ago. Which of the following questions should you ask them? A. Have you experienced any sour taste in your mouth? B. Have you had any gas? C. Have you had any weird dreams? D. Have you had any changes in mood? D. Have you had any changes in mood? "How do you feel about your weight?" Is a great example of a question to pose to a person with obesity who is in Pre contemplation, True or False? True How many calories equal 1 pound? 3500 kcals In a 6 month period what is considered the maximum amount of weight loss to still be safe? A. 10% B. 15% C. 20% D. 25% A. 10% Which of the following is the guideline for long term activity? SATA A. 30 - 60 mins/wk of moderate intensity B. 150 - 300 mins/wk of moderate intensity C. 30 - 60 mins/wk of vigorous aerobic activity D. 75 - 150 mins/wk of vigorous B. 150 - 300 mins/wk of moderate intensity D. 75 - 150 mins/wk of vigorous Which of the following weigh loss medications are best for someone who has type 2 diabetes? SATA A. Qsymia (phentermine/topiramate) B. Contrace (naltrexone/bupropion) C. Saxenda (liraglutide) D. Wegovy (semiglutide) C. Saxenda (liraglutide) D. Wegovy (semiglutide) Paula has been diagnosed with depression. She has been a smoker for several years and often binge eats when she is sad. She wants to get started on a weight loss medication. Which of the following may be best suited for her? A. Qsymia (phentermine/topiramate) B. Contrace (naltrexone/bupropion) C. Saxenda (liraglutide) D. Wegovy (semiglutide) B. Contrace (naltrexone/bupropion) Which of the following patients is a good candidate for the weight loss medication Qsymia (phentermine/topiramate)? A. A patient with diabetics that is trying to get pregnant B. A patient that gets migraines one a week C. A patient with atrial fibrillation D. A patients on dialysis B. A patient that gets migraines one a week Which of the following patients is a good candidate for Bariatric Surgery? A. A patient with a BMI of 41 with schizophrenia B. A patient with a BMI of 35, type II DM, who smokes one pack of cigarettes a week C. A patient with a BMI of 40 and a family history of breast cancer D. A patient with a BMI of 36 that uses a Bipap to sleep every night E. A patient with a BMI of 35 that has been loosing weight on Ozempic successfully C. A patient with a BMI of 40 and a family history of breast cancer D. A patient with a BMI of 36 that uses a Bipap to sleep every night What important long term goal of hypertension treatment? Stop target organ damage Which of the following is the most common cause of Secondary Hypertension? A. Elevated blood sugar B. Polycystic kidney disease C. Alcohol and drug use D. Pheochromocytoma E. Obstructive sleep apnea E. Obstructive sleep apnea Which of the following would quality as a Hypertensive Emergency? A. Blood pressure of 200/100 B. Blood pressure of 170/80 C. Blood pressure of 182/121 with blurry vision D. Blood pressure of 166/65 with dizziness C. Blood pressure of 182/121 with blurry vision Hypertensive Emergency BP of greater than or equal to 180/120 WITH Target organ damage How many high readings do you need to diagnose someone with hypertension? Two or more High potassium is due to A. Renal disease B. Heart condition C. Asthma D. Aldosterone excess A. Renal disease Low potassium is due to A. Renal disease B. Heart condition C. Asthma D. Aldosterone excess D. Aldosterone excess A patient has come into the office. Her systolic BP has been between 158-162 for the last several weeks. The patient has been on Lisinopril and a CCB for 3 weeks now. What is the best course of action? A. Implement diet modifications B. Try yoga for 30 minutes a day C. Add HCTZ D. Stop the current medication C. Add HCTZ A patient comes into the office with a BP of 190/120. He admits that he has not been taking this blood pressure medication for several weeks. What is the FIRST thing you want to do with this patient? A. Call the emergency services to take the patient to the ER B. Assess the patient for target organ damage C. Send him home and tell him to take his meds D. Start Clonidine in the office B. Assess the patient for target organ damage What is the sodium limit for a hypertensive patient? 1,500 mg/day Alcohol recommendations for men? 2 drinks or less per day Alcohol recommendations for women? 1 drink or less per day A male patient comes into to the office with no past medical history. He has only taking Advil cold and sinus daily. He is having elevated blood pressure. What do you recommend? A. Stop the Advil cold and sinus for a week and log BP B. Start BP medication C. Send the patient home since it's White Coat HTN D. Replace the sinus medication with another A. Stop the Advil cold and sinus for a week and log BP You exam a 79 year old woman with along standing poorly controlled hypertension, when evaluating her for hypertensive target organ damage you look for evidence of: A. High blood glucose B. Increased energy C. Asthma or COPD D. Left Ventricular Hypertrophy D. Left Ventricular Hypertrophy Shortness of breath, chest pain, palpitations, dizziness or fainting, fatigue Which of the following are considered Stage I HTN? (ACC/AHA) A. SBP 120 DBP 80 B. SBP 120 - 129 DBP 80 C. SBP 130 - 139 DBP 80 - 89 D. SBP greater than or equal to 140 DBP greater than or equal to 90 C. SBP 130 - 139 DBP 80 - 89 Which of the following are considered Stage 2 HTN? (ACC/AHA) A. SBP 120 DBP 80 B. SBP 120 - 129 DBP 80 C. SBP 130 - 139 DBP 80 - 89 D. SBP greater than or equal to 140 DBP greater than or equal to 90 D. SBP greater than or equal to 140 DBP greater than or equal to 90 Caroline comes in. This is her third time coming in with an elevated blood pressure greater than 130/80. Today's BP is 136/84. Under what circumstances would you initiated anti HTN treatment? (ACC/AHA) A. If the patient had an additional 4th elevated BP reading B. If the patient has diabetes C. If the patient has Atrial Fibrillation D. Of the patient had ASCVD risk of 10% C. If the patient has Atrial Fibrillation Treatment should be initiated if the patient has clinical cardiovascular disease Bobby comes in. This is her third time coming in with an elevated blood pressure greater than 140/90. Today's BP is 146/94. Under what circumstances would you initiated anti HTN treatment? (ACC/AHA) A. If the patient had an additional 4th elevated BP reading B. If the patient has diabetes C. If the patient has Atrial Fibrillation D. Of the patient had ASCVD risk of 10% D. Of the patient had ASCVD risk of 10% A patient that's been off his meds for 2 to 4 months. The BP is currently 168/112. The patient has no signs of target organ damage. What should the NP do next? A. Have him come in for ambulatory monitoring B. Refer to Emergency Department C. Start patient on new BP meds D. Create a plan for patient to start the DASH diet C. Start patient on new BP meds A 69 year old male comes in as is diagnosed with HTN. According to the JNC 8 guidelines, which one of the following is his target BP? A. 120/80 B. 130/80 C. 140/90 D. 150/90 D. 150/90 A 58 year old male comes in as is diagnosed with HTN. According to the JNC 8 guidelines, which one of the following is his target BP? A. 120/80 B. 130/80 C. 140/90 D. 150/90 C. 140/90 A patient 21 years old has type II DM and HTN. According to the JNC 8 guidelines, which one of the following is his target BP? A. 120/80 B. 130/80 C. 140/90 D. 150/90 C. 140/90 A family history of premature heart disease should always be elicited and documented in the diagnosis list as its significant risk factor for heart disease. It's is defined as: Males __ years old Females __ years old Males 55 years old Females 65 years old What is the role of ABPM (Ambulatory Blood Pressure Monitoring)? ABPM plays a crucial role is diagnosing and managing HTN by providing a comprehensive 24 hour view of blood pressure fluctuations during a patients normal daily activities How long should a patient do ABPM out of the office? A. 12 hours B. 24 hours C. 36 hours D. 48 hours B. 24 hours Which of the following patients are suitable for HTN treatment with Hydrochlorothiazide? A. Patient on dialysis B. Patient with gout C. Patient with Hyperlipidemia D. Patient prone to getting kidney stones D. Patient prone to getting kidney stones Which of the following patients are suitable for HTN treatment with Loop Diuretics? A. Patient with Heart Failure B. Patient with osteoporosis C. Patient with gout A. Patient with Heart Failure Penny suffers from migraines once a week, she was recently diagnosed with hypertension is currently on HCTZ. The NP is choosing an additional medication for her to add. Which of the following medications would be best suited for her issues? A. Furosemide B. Spironolactone C. Verapamil D. Metoprolol C. Verapamil Good for migraine prophylaxis Which of the following medications are not recommended as first line medications? A. Losartan B. Verapamil C. HCTZ D. Atenolol D. Atenolol Beta blockers are not recommended as first line for HTN unless a compelling indication is present Special Considerations for medications selection (SATA): African Americans A. ACEi B. ARBS C. Beta Blockers D. CCB E. Thiazides D. CCB E. Thiazides Special Considerations for medications selection (SATA): Elderly with isolated systolic HTN A. ACEi B. ARBS C. Beta Blockers D. CCB (long acting) E. Thiazides (low dose) D. CCB E. Thiazides Special Considerations for medications selection (SATA): Patient with Left Ventricular Hypertrophy A. ACEi B. ARBS C. Beta Blockers D. CCB E. Thiazides A. ACEi B. ARBS Special Considerations for medications selection (SATA): patient with Diastolic Dysfunction A. ACEi B. ARBS C. Beta Blockers D. CCB E. Thiazides C. Beta Blockers D. CCB A 68 year old woman presents to the clinics with Hypertension and BP of 152-158/92-96 mmHg documented over two months on three different occasions. ECG and creatinine are normal, and she has no protein urea. Clinical findings included the following: BMI 26.4 kg/m^2: no S3, S4 or murmur and the point of maximal impulse is range. Which of the following resents the best interventions? A. DASH Diet and Lifestyle Mods B. Initiate Metoprolol C. Initiate HCTZ D. Clonidine C. Initiate HCTZ A colleague placed a patient on Valsartan and Lisinopril, which of the following outcomes would you expect to occur? A. Increase calcium loss B. Hypertension rebound effect C. Acute renal failure D. Constipation C. Acute renal failure Childhood secondary HTN is often cause by: A. Renal relation conditions B. Immunodeficiency conditions C. Unhealthy diet and exercise habits D. Obstructive sleep apnea A. Renal relation conditions Clara is 12 years old and has come in for her annual physical. Which of the following would be considered Stage I HTN? A. 90th percentile in age, sex, ht B. 90th - 95th percentile C. 95th percentile D. BP reading it 141/99 C. 95th percentile A 9 year old patient is diagnosed with HTN. The NP wants to complete further testing, they should do all of the following except: A. Fasting lipids, Fasting glucose B. EKG C. CBC D. BUN, Creatinine E. Renal Ultrasound B. EKG EKG are typically NOT recommended And Echocardiograms are only recommended if Meds are considered for the patient An NP can allow a child to participate in sports in all of the following cases except: A. A patient with BP readings between the 90th and 95th percentile B. Stage I HTN with Left Ventricular Hypertrophy C. Stage II HTN that's controlled with BP meds D. A patient multiple reasonings 90th percentile. B. Stage I HTN with Left Ventricular Hypertrophy Which of the following are not appropriate meds for Pediatric HTN patients? A. Doxazosin B. Metoprolol C. Losartan D. Lisinopril E. Amlodipine F. HCTZ A. Doxazosin You should refer your pediatric patient with Stage II HTN to a specialist, True or False? True You should refer your pediatric patient with Primary HTN to a specialist, True or False? False Secondary HTN Children at age 13 are ____ to adults with respect to Hypertension. A. Different B. The same B. The same Which of the following are considered high intensity Statins? A. Atorvastatin 10-20mg B. Atorvastatin 40-80mg C. Simvatstain 20-50mg D. Rosuvastatin 5-10mg E. Rosuvastatin 20-40mg F. Pravastation 40-80mg B. Atorvastatin 40-80mg E. Rosuvastatin 20-40mg Four Statin Benefit Group (2013 Guidelines) What are are Four things patients need in order to qualify for Statin therapy based on these guidelines? 1. Established Atherosclerotic cardiovascular Disease 2. LDL greater than or equal to 190 3. Diabetes 4. 10 year ASCVD Risk greater than or equal to 7.5 Four Statin Benefit Group (2013 Guidelines) Patient with an LDL of greater than 190 could indicated potential for which of the following? A. Diabetes diagnosis B. High blood pressure C. Immunodeficiency D. Familial Hypercholesterolemia D. Familial Hypercholesterolemia Four Statin Benefit Group (2013 Guidelines) All diabetic patients should be on a statin regardless of LDL, True or False? True Polly has been diagnosed with Type II Diabetes. Her 10 year ASCVD risk is 7.0%. Which is the following statins should she start? A. Atorvastatin 80mg B. Rosuvastatin 40mg C. Rosuvastatin 10mg D. Fluvastatin 40mg C. Rosuvastatin 10mg Amy has been diagnosed with Type II Diabetes. Her 10 year ASCVD risk is 8.0%. Which one the following statins could she start? SATA A. Atorvastatin 80mg B. Rosuvastatin 40mg C. Rosuvastatin 10mg D. Fluvastatin 40mg A. Atorvastatin 80mg B. Rosuvastatin 40mg For patients with an ASCVD risk of 5-7.5% what type of statin should they consider being on? A. Low intensity statin B. Moderate intensity statin C. High intensity statin B. Moderate intensity statin A 42 year old obese patient comes to the office. The patient has a Family Hx of DM and hypertension. The total cholesterol is 255, triglycerides are 150, HDL 45 and LDL 180. Which of the following options should be next for this patient? A. Lifestyle modifications B. Initiate Atorvastatin 40-80mg C. Initiate Rosuvastatin 20-40mg D. Initiate Simvastatin 20-40mg A. Lifestyle modifications Patient does not have DM type II. Patient does not meet any of the criteria Patient with Type 2 Diabetes only should start in which type of statin? A. Low intensity statin B. Moderate intensity statin C. High intensity statin B. Moderate intensity statin A 58 year old African American man comes into the clinic. He has HTN and diabetes. The patient does not consume tobacco products. He had a heart attack 3 years ago. Total cholesterol is 234, LDL is 140 and HDL is 38. The SBP is 138 and DBP is 90. Other than HTN meds he is taking nothing else. A. Control BP better B. His LDL is not very elevated so will only need high intensity statin. C. Very high risk, start high intensity statin assess after 3 mo. And may add Ezetimibe and PCSK9-1 prn C. Very high risk, start high intensity statin assess after 3 mo. And may add Ezetimibe and PCSK9-1 prn Which of the following is the number 1 modifiable risk factor that we can control in order to reduce risk of stroke? A. Smoking B. Hypertension C. Caffeine intake D. Race B. Hypertension Age 40-70 with LDL between 70-190 and no diabetes. ASCVD risk is 5%, what is the next step. A. Lifestyle B. Discuss statin if risk enhancer are present C. Recommend moderate intensity statin D. Recommend high intensity statin B. Discuss statin if risk enhancer are present How many weeks after the initiation of a statin should the lipid panel be repeated? 6-12 weeks When a patient is in statin therapy it is recommended to do a repeat CK or ALT even if the patient is not symptomatic, True or False? False Fibrates do not replace statins and should not be substituted for muscle pain, True or False? True In 2016 caring for patients who are candidates for statin therapy's most important goal is to: A. Control Blood pressure and Diabetes B. Decrease LDL levels C. Decrease body mass index D. Decreased global risk D. Decreased global risk When prescribing a Fibrate, the NP expects to see which of the filling changes in lipid profile? A. Decrease in Triglyceride levels B. Decrease in LDL levels C. Increase in HDL levels D. Decrease in Total cholesterol levels A. Decrease in Triglyceride levels Fibrates may be used for triglycerides ___ + statin (low/moderate intensity) A. 100 B. 350 C. 500 D. 1000 C. 500 Lilly has been on Atorvastatin 40mg for several months. She is now developing some muscle pain in her legs and needs help. What should the NP recommend she do First? A. Stop the statin for 2 weeks B. Lower the dose of the statin C. Switch to another statin D. Switch to a Fibrate A. Stop the statin for 2 weeks Stop the medication for 2 weeks and rechallenge with the same statin and dose Only if the symptoms approve at the break. A patient is on a moderate intensity statin. She started to experience statin induced muscle pain and told her NP. The NP had her pause the med for two week and restart with no improvement. Lowering the dose also did not help. Which of the following statins should the NP consider switching her to? (Choose the best answer) A. Lovastatin 40mg B. Pravastatin 40mg C. Pitavastatin 1mg D. Rosuvastatin 40mg B. Pravastatin Although Rosuvastatin is also a Hydrophilic statin that is typically used as a replacement. The patient was on a Moderate intensity statin and Pravastatin is the best Moderate intensity replacement. Which of the following can you pair with a low intensity statin to reduce risk for statin induced myalgias? A. Ezetimibe B. Bile acid sequestrants C. PCSK9 D. Vitamin C B. Bile acid sequestrants (resins) The 4 categories for which a statin is recommend includes all of the following EXCEPT: A. LDL ≥ 190 mg/dL B. Diabetes C. 10 year ASCVD risk ≥ 7.5% D. Comorbid Hypertension D. Comorbid Hypertension If a patient's risk score does not show a need for statin medication, you can assess the CAC score to determine if it's needed, True or False? True CAC is a Coronary Artery Calcium Score which is used to refine risk assessment in borderline/intermediate risk patients A patient on statin medication asks when they should recheck his CK and ALT. How often should this occur? A. Every 6-12 weeks B. Once a month C. Every 6 months D. Annually D. Annually When determining Pediatric Hyperlipidemia which of the following lab values are the most significant? A. Triglycerides B. LDL C. HDL D. Non HDL E. Total cholesterol D. Non HDL Caitlyn is 12 years old. She recently got her labs back and TC was 202 mg/dL and her HDL were 44 mg/dL. Which of the filling should the NP do First? A. Repeat Lipid Profile the following day B. Repeat Lipid Profile in 2 weeks C. Start patient on low intensity Statin D. Do nothing, these are normal values B. Repeat Lipid Profile in 2 weeks Patient has a Non-HDL of 158, any value greater than or equal to 145 is abnormal. If the patient has an abnormal screening, repeat test in 2 weeks to 3 months first. If a pediatric patient has an abnormal result in their lipid panel, once you repeat the test 2 weeks to 3 months later and get a second result, which result do you use to determine if tx is needed? A. Use initial values of the first lipid panel B. Use the values of the repeat lipid panel C. Use the average value of the two lipid panels C. Use the average value of the two lipid panels Which of the following medications is the preferred lipid medication for pediatric patients? A. Atorvastatin B. Pravastatin C. Pitavastatin D. Rosuvastatin B. Pravastatin Lipid soluable If a child under the age 12 is diagnosed with hyperlipidemia, what is the next step? A. Lifestyle modifications B. Initiate Pravastatin C. Repeat the testing for a third time D. Refer out to a specialist for management D. Refer out to a specialist for management Metabolic syndrome significantly increases risk for: A. Lung cancer B. Asthma C. Cardiovascular Disease D. Obesity C. Cardiovascular Disease How many obesity related comorbidities are need to qualify for Metabolic Syndrome? A. 1 B. 2 C. 3 D. 4 E. 5 C. 3 Which of the following waist circumference is needed for a man to qualify for Metabolic Syndrome? A. ≥ 28 B. ≥ 30 C. ≥ 35 D. ≥ 40 E. ≥ 45 D. ≥ 40 Which of the following waist circumference is needed for a woman to qualify for Metabolic Syndrome? A. ≥ 28 B. ≥ 30 C. ≥ 35 D. ≥ 40 E. ≥ 45 C. ≥ 35 What SBP and DBP is needed to qualify for metabolic syndrome? SBP ≥ 130 DBP ≥ 85 What is the triglyceride level needed to qualify for metabolic syndrome? A. ≥ 100 B. ≥ 150 C. ≥ 200 D. ≥ 250 B. ≥ 150 Which of the following HDL levels do you need as a man to qualify for metabolic syndrome? A. 40 B. 45 C. 50 D. 55 A. 40 Which of the following HDL levels do you need as a woman to qualify for metabolic syndrome? A. 40 B. 45 C. 50 D. 55 C. 50 Being on medication for low HDL is one item that can qualify you for Metabolic Syndrome, True or False? True What is the fasting glucose needed in order to qualify the patient for metabolic syndrome? ≥ 100 Can a prior diagnosis of Type 1 DM qualify a patient for potential metabolic syndrome? A. Yes B. No B. No Needs to be Type 2 DM Charlie comes in to the office for a check up. His waist circumference is 42 inches. His LDL are high at 190 mg/dL, his Triglyceride level is 160 mg/dL, and his HDL is 38 mg/dL. How many characteristics of Metabolic Syndrome does he have? A. 2 B. 3 C. 4 D. 1 B. 3 Name all qualifications for Metabolic Syndrome. 1. Waist circumference men ≥ 40 women ≥ 35 2. Triglycerides ≥ 150 3. High systolic BP of ≥ 130/85 4. Low HDL men 40 women 50 , or meds for HDL 5 Type II Diabetes diagnosis or fasting blood glucose ≥ 100 or diabetic medication Which of the following diagnostic criteria for Generalized Anxiety Disorder? A. Excessive anxiety every single day for a week B. Excessive anxiety and worry for ≥ 6 months C. One occasion of intense panic and hallucinations D. Excessive anxiety and worry for ≥ 6 months with OCD B. Excessive anxiety and worry for ≥ 6 months How many of the following symptoms does a child need to have in order to be diagnosed with Generalized Anxiety Disorder? Restlessness Fatigue Difficulty concentrating/blank mind Irritability Muscle tension Sleep disturbance 3 out of 6 Laura, a 35 year old woman, comes into the office. She has expressed that she has been feeling some symptoms of anxiety. She has a family history of depression. She drinks an energy drink every morning because she doesn't get much sleep. Which of the filling screening tools would be beneficial for you to use to screen for generalized anxiety disorder? A. Parent Health Questionnaire-9 B. The CRAFT C. Columbia-Suicide Severity Rating Scale (C-SSRS) D. Liebowitz Social Anxiety Scale E. GAD-7 E. GAD-7 (Generalized Anxiety Disorder 7) Which of the following Items can mimic Generalized anxiety disorder? SATA A. Corticosteroids B. Benzodiazepines C. Alcohol D. Sympathomimetics E. Caffeine F. Thyroid supplements G. Barbiturates A. Corticosteroids D. Sympathomimetics E. Caffeine F. Thyroid supplements Alcohol is a depressant but alcohol withdrawal can stimulate anxiety. Benzodiazepines are depressants Which of the following is the FIRST line treatment for Generalized Anxiety Disorder? A. Cognitive Behavioral Therapy B. SSRI/SNRI C. Benzodiazepines D. Antihistamines A. Cognitive Behavioral Therapy An adult male who is 40 years old has been placed on SSRI treatment (Paroxetine ) He comes back after some time and says that he has erectile dysfunction and has never experienced this before and now they have it? What medication would we consider? A. Wellbutrin B. Fluoxetine C. Lorazepam D. Venlafaxine A. Wellbutrin Which of the following is the FIRST line Pharmacological treatment for Generalized Anxiety Disorder? A. Beta Blockers B. SSRI/SNRI C. Benzodiazepines D. Antihistamines B. SSRI/SNRI Research shows that patient outcomes for those diagnosed with mental conditions are improved when counseling is combined with using medication, True or False? True Which of the following is the FIRST line treatment for Generalized Anxiety Disorder in a Pregnant Patient? A. Cognitive Behavioral Therapy/Psychotherapy B. SSRI/SNRI C. Benzodiazepines D. Antihistamines A. Cognitive Behavioral Therapy/Psychotherapy Earl, a 65 year old man, has been diagnosed with Generalized Anxiety Disorder ever since his wife passed away. The NP is considering pharmacological intervention in combination with Cognitive Behavioral Therapy, which of the following Meds should you NEVER give this patient? A. Sertraline B. Paroxetine C. Alprazolam D. Escitalopram C. Alprazolam Avoid benzodiazepines in elderly patients due to risk of fall and cognitive risks All of the filings patients have panic attacks. Which of the following patients have Panic Disorder? SATA A. A 20 year old man who has a fear of dying, he getting sweaty and his heart accelerates fast with occasional chest pain. B. A 70 year old woman with a fear of spiders, she gets sweaty and starts trembling. C.A 30 year old woman who gets nausea and "tummy aches". Sometimes life doesn't feel real and she is never able to gain control. She hates going to new places. A and C Which of the following medications would be the best First Line treatment for Panic Disorder? SATA A. Clonazepam B. Sertraline C. Diazepam D. Fluvoxamine E. Lithium B. Sertraline D. Fluvoxamine Best option for first line. Treatment of panic disorder is an SSRI. A patient was recently diagnosed with panic disorder. This patient also has a history of chronic back pain, which of the following medications can you give for BOTH? A. Fluoxetine B. Duloxetine C. Sertraline D. Venlafaxine B. Duloxetine Cymbalta or duloxetine is an SNRI that is often cited as the most effective antidepressant for various pain conditions, including fibromyalgia, neuropathic pain, and musculoskeletal skeletal pain It's not uncommon to use a sleep med short term when starting anti depressants to restore normal sleep pattern, True or False? True Which of the following screening tools are using for Depression and possible comorbid anxiety? SATA A. PHQ-9 B. GAD-7 C. CRAFT D. CSSRS E. SDQ F. PHQ-2 A. PHQ-9 F. PHQ-2 B. GAD-7 (to rule out anxiety or possible combined anxiety) After completing the GAD-7 questionnaire, the NP notices that the patient has a score of 10, which of the following does she have? A. Minimal anxiety B. Mild anxiety C. Moderate anxiety D. Severe anxiety C. Moderate anxiety Emily has been feeling sad and unmotivated. She has been having depressed mood, fatigue, and significant weight loss within a short period of time. Based on her PHQ-9 score of 7 which of the following treatments should we start with? A. Counseling B. Counseling and Meds (recommended) C. Counseling and Meds (required) A. Counseling A score of 7 is considered Mild anxiety and should start with counseling and added meds if needed Emily has agreed to start counseling for her anxiety, how long should she do counseling before being referred to a psychiatrist for meds? A. 2 weeks B. 4 weeks C. 6 weeks D. 8 weeks C. 6 weeks If no improvement in six weeks of counseling begin medication or refer to a psychiatrist Emily has agreed to start counseling for her anxiety, how often should you schedule a check in and reassess with PHQ-9? Every 2 weeks Mark wants to know how long it takes for antidepressants (SSRI) to take effect, what range would you give him? 4-6 weeks Depression is more common if there is a family history, True or False? True A combination of counseling and medication is often most successful in depression therapy, True or False? True Which patient presentation is most consistent with the diagnosis of depression? A. A patient that goes on a shopping spree and then gets very guilty and sad about it after B. A patient who consistently wakes up at 5am and has trouble sleeping. C. A patient who has trouble discarding possessions even trash D. A patient with rapid heart palpitations B. A patient who consistently wakes up at 5am Insomnia Which of the following side effects should your patient report upon starting antidepressant medication for the first time? A. GI upset B. Sexual dysfunction C. Suicide ideation D. Headache E. Insomnia C. Suicide ideation Clara has been on Paroxetine for two months now. She has been complaining of sexual dysfunction despite healthy eating and exercise. Which of the following medications would you consider for her? A. Vortioxetine B. Vilazodone C. Duloxetine D. Trazodone E. Bupropion E. Bupropion A patient is started on Escitalopram for depression. The pt starts and then reports back 48 hours later to the NP that they are not able to sleep, to work, they can't get anything done and they are uncomfortable. Which of the following do you say to this patient. A. Give the medication more time, you need to be on it for 6 weeks to see full effects B. This could be evidence of mania and you may need to be reassessed for bipolar C. Take 12.5mg Benadryl for anxiety and sleep B. This could be evident of mania and you may need to be reassessed for bipolar Which of the following disorder should you ALWAYS screen for before starting antidepressant treatment to avoid triggering mania? A. Obsessive Compulsive Disorder B. Panic Disorder C. Generalized Anxiety Disorder D. Bipolar disorder D. Bipolar disorder Continue treatment. For at least ___ months AFTER remission to prevent relapse for Anxiety. A. 1-2 months B. 3-4 months C. 5-8 months D. 6-12 months D. 6-12 months Pharmalogical intervention and anxiety disorder should be continued for at least six months after remission is achieved. Which of the following people are most at risk for Suicide? SATA A. Patient that lives with Family B. Patient in their mid 30s C. Patient with a previous suicide attempt D. Patient who smokes weed once a week C. Patient with a previous suicide attempt Which of the following are NOT Suicide risk assessment tools for adults ? A. SAFE-T B. CASSY C. SIDAS D. C-SSRS E. SAD PERSONS B. CASSY Computerized adaptive screen for suicidal youth is a universal screening tool designed for a large scale screening of youth in settings, like hospitals and emergency departments. This screening tool is specifically for pediatric patients. What does does SIDAS stand for? Suicidal ideation Attributes Scale Benzodiazepines in combination with ____ can enhance their effects. A. Alcohol B. Viagra C. Estrogen D. Nicotine A. Alcohol Your patient who is having a long term migraine noted that her headaches are worsening and she now vomits with every migraine. You A. Order labs to check inflammation B. Order CT of head C. Change her to a different migraine medication D. Evaluate for OSA B. Order CT of head A patient is going to be starting Almotriptan for her migraine headaches, which of the following labs should be monitored while in this med? SATA A. AST/ALT B. CBC C. TSH D. CrCl E. CMP A. AST/ALT D. CrCl Which of the filling patients are able to use Triptans for their migraines? A. Patient looking to get pregnant within the next month B. Patient with controlled HTN C. A patient Who had a stroke last month D. A patient on MAOI medication B. Patient with controlled HTN Which of the following medications can cause elevated Blood Pressure? SATA A. Sumatriptan B. Ergotamine C. Lasmiditan D. Ubrogepant E. Ibuprofen A. Sumatriptan B. Ergotamine Which of the following are typically contraindicated in a female with classic migraine with aura? A. Copper IUD B. Depo-Provera C. Nexplanon D. Progestin only oral contraceptive pill E. Ortho Erva Patch E. Ortho Erva Patch (estrogen) Copper IUD - non hormonal Depo-Provera - progesterone only Nexplanon - progesterone only Progestin only oral contraceptive pill - progesterone only A patient is using an analgesic medication for their migraine headaches. Which of the following would you NOT have to warn them about? A. GI Bleed B. CVD risk C. Issues with contraception D. Medication overuse headache C. Issues with contraception Which of the following is approved for menstrual migraine prevention? A. Candesartan B. Naratriptan C. Labetelol D. Ergotamine B. Naratriptan Triptans such as Naratriptan, Frovatriptan and Zolmitriptan are all good for menstrual migraines A patient is taking Zolmitriptan for her menstrual migraines. What instructions should you give her when it comes to initiating this medication? A. Take at the onset of a migraine B. Take a week before the start of menses for 4-5 days C. Take 2 days prior to menses for 6-7 days C. Take 2 days prior to menses for 6-7 days Which of the following migraine medication is approved in patients that are pregnant or breastfeeding? A. Divalproex B. Candesartan C. Atogepant D. Rimegepant D. Rimegepant NSAIDS like Naproxen, Ibuprofen Ketoprofen and Aspirin can cause rebound headache if taken for less than a week, True or False? False NSAIDS like Naproxen, Ibuprofen Ketoprofen and Aspirin can cause rebound headache if taken more than twice a week A 69 year old women comes in to the office. She is complaining for some pain and stiffness on her hips and shoulders for about an hour. She has been really tired and hasn't felt like cooking or eating. Which of the following labs should you consider? A. CrCl and BU B. PTT and INR C. ESR and CRP D. ALT and AST C. ESR and CRP Which of the following are associated with polymyalgia rheumatica? A. Giant cell arteritis B. Rheumatoid arthritis C. Osteoporosis D. Plantar fasciitis A. Giant cell arteritis What diagnostic working considered the Gold Standard for Polymyalgia Rheumatica? A. CT Scan of the Brain B. X-Ray of the joints C. Temporal Artery Biopsy D. DEXA Scan C. Temporal Artery Biopsy Which of the following are NOT First Line for Generalized Tonic/Clonic Seizures? A. Carbamazepine B. Lacodsmide C. Phenytoin D. Vaproic acid E. Ethosuximide E. Ethosuximide Which of the following side of effect of Phenytoin should be reported to the NP as soon as possible? A. Drowsiness B. Constipation C. GI upset D. Nausea E. Gingival hyperplasia E. Gingival hyperplasia A 4-year-old boy had a focal seizure. He is conscious and calm and is sitting on his mother's lap. Which of the following medications is safe for this patient? A. Eslicatbazepine B. Lacodsmide C. Phenytoin D. Vaproic acid E. Ethosuximide A. Eslicatbazepine Which of the following is the drug of choice for Absence Seizures? A. Eslicatbazepine B. Lacodsmide C. Phenytoin D. Vaproic acid E. Ethosuximide E. Ethosuximide Which of the following medication is recommended for Atypical, Absence, Myoclonic and Atomic Seizures? A. Eslicatbazepine B. Lacodsmide C. Phenytoin D. Vaproic acid E. Ethosuximide D. Vaproic acid A patient has more than one seizure within a 30 minute period. Which of the following medications is first line for this type of seizure? A. Eslicatbazepine B. Lorazepam C. Phenytoin D. Vaproic acid E. Brivaracetam B. Lorazepam Which of the following items are NOT typically an option for treating Essential tremors? A. Opioids B. Beta blockers C. Anticonvulsants D. Benzodiazepines E. Alcohol (1-2 drinks/day) A. Opioids A patient comes into the office that is diagnosed with Restless Leg Syndrome, which of the following advice could you give you patient to help them manage this? A. Drink 1-2 cups of green tea a day B. Having one glass of wine each night will not hurt C. Take 30 minutes to do some walking around the neighborhood each day D. You need to take an ice cold bath to decrease inflammation C. Take 30 minutes to do some walking around the neighborhood each day Regular exercise can be a great way to reduce the symptoms of restless leg syndrome What are signs of later stages if Parkinson's? A. Tremor B. Constipation C. Loss of smell D. Postural instability D. Postural instability Which of the following symptoms are consistent with MS? Choose all that apply A. Fatigue B. Visual changes C. Weakness D. Weight gain E. Trigeminal neuralgia A. Fatigue B. Visual changes C. Weakness E. Trigeminal neuralgia A patient comes in with facial droop in the right side and slurred speech. No extremity affected, no neurological deficits. What do you tell the patient? A. She is having a stroke B. She is having TIA C. She has Bells Palsy D. She had Multiple Sclerosis C. She has Bells Palsy Which of the following are symptoms of Bells Palsy? SATA A. Facial motions are not symmetrical B. Loss of taste on the front part of the tongue C. Left sided weakness of the arm and leg D. Hearing amplified in the affected ear A. Facial motions are not symmetrical B. Loss of taste on the front part of the tongue D. Hearing amplified in the affected ear Colorectal Cancer (CRC) Screening: Recommendation: Begin screening at age 45. Methods: Colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, or annual FIT (Fecal Immunochemical Test). Cervical Cancer Screening: Recommendation:Ages 21-29: Pap smear every 3 years.Ages 30-65: Pap plus HPV co-testing every 5 years or Pap alone every 3 years. Breast Cancer Screening Recommendation: Begin annual mammograms at age 40 (or 50, depending on guidelines) for women, continuing as long as the woman is in good health. Prostate Cancer Screening (PSA): Recommendation: Discuss potential benefits and harms of screening with men starting at age 50, or at 45 for those at higher risk (e.g., family history). Cardiovascular Disease (CVD) Screening: Recommendation: Regular blood pressure checks starting at age 20, lipid profile screening every 4-6 years starting at age 20, and diabetes screening as needed. D Recommendations: D Recommendations: Typically include recommendations against certain screenings or treatments where the harms outweigh the benefits. For example:Do not screen for cervical cancer in women under 21, regardless of sexual history.Do not screen for prostate cancer with PSA in men under 55 or over 69 unless there are specific risk factors. 2017 ACC/AHA HTN Guidelines Normal BP: 120/80 mmHg; Elevated: 120-129/80; Stage 1: 130-139/80-89; Stage 2: ≥140/90. Lifestyle recommendations for HTN o Exercise: At least 150 minutes of moderate aerobic activity per week. o Sodium Intake: Limit to 2,300 mg/day; ideally 1,500 mg/day for those with HTN. o Alcohol Intake: Limit to ≤1 drink/day for women and ≤2 drinks/day for men. Drug Categories for HTN Thiazide Diuretics: Side effects include electrolyte imbalances. ACE Inhibitors: May cause cough and angioedema. ARBs: Generally well-tolerated but may lead to hyperkalemia. Calcium Channel Blockers: Possible peripheral edema. Target BP Goals Start meds if BP ≥130/80; aim for 130/80. Target Organ Damage (TOD): Assess through history and physical exam, looking for signs of heart, kidney, and eye damage. step up drug therapy If BP remains high, consider adding a second agent, such as a thiazide or CCB, or increasing the dose. Resistant HTN definition Defined as BP ≥130/80 despite three or more medications. Evaluate for secondary causes and consider referral. ABPM (Ambulatory blood pressure monitoring) Useful for diagnosing HTN and assessing variability. Powerful Med Combo for HTN Common combinations include an ACE inhibitor with a thiazide or CCB. Hypertensive urgency vs emergency o Urgency: BP 180/120 without acute end-organ damage; treat with oral medications. o Emergency: BP 180/120 with evidence of TOD; treat with IV medications. Four Major Statin Treatment Categories Individuals with clinical ASCVD. Individuals with an LDL-C ≥190 mg/dL. Adults aged 40-75 with diabetes and LDL-C 70-189 mg/dL. Adults aged 40-75 without diabetes but with an estimated 10-year ASCVD risk of 20% or higher. Cholesterol guidelines 2013 AHA/ACC: Focus on statin therapy based on risk categories, emphasizing a more individualized approach. 2018: Emphasizes the importance of considering risk factors and shared decision-making. Enhanced Risk Factors for Statin Consideration Family history of premature ASCVD. Persistently elevated LDL-C despite lifestyle changes. Conditions like chronic kidney disease, metabolic syndrome, or inflammatory disorders. Global Risk Levels Assess using ASCVD risk calculators; higher risk warrants earlier intervention. Statin Intensities High-Intensity: Atorvastatin 40-80 mg, Rosuvastatin 20-40 mg. Moderate-Intensity: Atorvastatin 10-20 mg, Rosuvastatin 5-10 mg. Statin Side Effects: Common: Myalgias, liver enzyme elevation. Rare: Rhabdomyolysis; monitor liver enzymes periodically. Evaluating and Treating Myalgias Assess the timing and severity; consider switching to a different statin or lower dose, or try non statin alternatives. Universal Screening Criteria for Pediatric Lipid Levels Screen children ages 9-11 and 17-21; earlier screening for those with risk factors. Acceptable Drug Therapy for Pediatric Dyslipidemia: Lifestyle modifications first; consider statins in children aged ≥10 with severe dyslipidemia or high-risk situations. Metabolic syndrome definition cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. Components of METS characterized by the presence of at least three of the following five components: 1. Abdominal Obesity: o Waist circumference: 40 inches in men; 35 inches in women. 2. Hyperglycemia: o Fasting glucose: ≥100 mg/dL or diagnosed diabetes. 3. Hypertension: o Blood pressure: ≥130/85 mmHg or diagnosed hypertension. 4. Dyslipidemia: o Triglycerides: ≥150 mg/dL or on treatment for elevated triglycerides. o HDL-C: 40 mg/dL in men; 50 mg/dL in women. 5. Insulin Resistance: o Typically assessed through glucose levels and associated risk factors. Diagnostic criteria for METS presence of at least 3 out of the 5 abdominal obesity, hyperglycemia, hypertension, dyslipidemia, insulin resistance risk factors for METS Genetic Factors: Family history of metabolic syndrome, type 2 diabetes, or cardiovascular disease. Lifestyle Factors: Poor diet, physical inactivity, and sedentary behavior. Age: Risk increases with age. Ethnicity: Higher prevalence in certain populations (e.g., Hispanic, African American). implications of METS Individuals with metabolic syndrome are at a significantly increased risk of: Cardiovascular disease (CVD). Type 2 diabetes. Non-alcoholic fatty liver disease. Sleep apnea. Lifestyle modifications for METS 1. Lifestyle Modifications: o Diet: Emphasize a heart-healthy diet (Mediterranean or DASH diet). o Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity weekly. o Weight Management: Achieve and maintain a healthy weight. Pharmacologic treatment of METS o Hypertension: Use of antihypertensive medications if lifestyle changes are insufficient. o Dyslipidemia: Statins or other lipid-lowering agents as needed. o Hyperglycemia: Metformin or other agents for glucose control if indicated. 1. Regular Monitoring: o Routine follow-ups to monitor blood pressure, lipid levels, and glucose levels. 2017 AAP guidelines for pedi HTN Hypertension is defined as consistent BP readings ≥95th percentile for age, sex, and height. pediatric HTN assessment 1. Measurement: BP should be measured annually starting at age 3, using appropriate-sized cuffs. 2. Classification: o Stage 1 HTN: BP 95th to 99th percentile + 5 mmHg. o Stage 2 HTN: BP ≥99th percentile + 5 mmHg. Differences between pedi HTN and adolescent HTN Childhood: More often related to secondary causes (e.g., kidney disease). Adolescents: Often linked to obesity, lifestyle factors, and may resemble adult hypertension patterns. Causes of pedi HTN and adolescent HTN Childhood:Secondary causes: Renal disease, endocrine disorders (e.g., Cushing’s), coarctation of the aorta. Adolescents:Primary (essential) hypertension, obesity, poor diet, sedentary lifestyle. Treatment of pedi HTN 1. Lifestyle Modifications: o Diet (DASH), exercise, weight management. 2. Medication (if lifestyle changes are insufficient): o First-line options include: § ACE Inhibitors (e.g., lisinopril). § ARBs (e.g., losartan). § Calcium Channel Blockers (e.g., amlodipine). § Thiazide Diuretics (e.g., hydrochlorothiazide). when to refer pedi HTN Refer to a pediatric cardiologist or nephrologist if:Secondary hypertension is suspected.Resistant hypertension or severe hypertension (Stage 2).Symptoms of target organ damage (e.g., headaches, vision changes). Anxiety- diagnostic & 1st line treatment Diagnostic Criteria: Excessive anxiety and worry occurring more days than not for at least 6 months about various events or activities (Generalized Anxiety Disorder - GAD). Associated with three (or more) of the following symptoms: Restlessness or feeling keyed up or on edge. Being easily fatigued. Difficulty concentrating or mind going blank. Irritability. Muscle tension. Sleep disturbance. First-Line Treatment: SSRIs (e.g., escitalopram) or SNRIs (e.g., venlafaxine), along with **cognitive behavioral therapy (CBT). Expected Duration of Treatment: 6-12 months for acute treatment, potentially longer for chronic cases. Panic disorder- diagnostic & 1st line treatment Diagnostic Criteria: Recurrent unexpected panic attacks with persistent concern about future attacks or behavior changes (e.g., avoidance). First-Line Treatment: SSRIs or SNRIs; CBT is also effective. Expected Duration of Treatment: 6-12 months, with consideration for longer-term treatment in chronic cases. Major Depressive Disorder- diagnostic & 1st line treatment Diagnostic Criteria: Five or more symptoms present during the same 2-week period, including depressed mood or loss of interest/pleasure. First-Line Treatment: Cognitive behavior therapy or interpersonal therapy. SSRIs (e.g., fluoxetine, sertraline) or SNRIs. Expected Duration of Treatment: At least 6-12 months after remission; longer if recurrent episodes occur. Depression screening approaches PHQ-9 is a self-administered questionnaire consisting of 9 items that assess the presence and severity of depressive symptoms over the past two weeks.0-4: Minimal or none, 5-9: Mild, 10 14: Moderate, 15-19: Moderately severe, 20-27: Severe (BECK) BDI-II is a 21-item self-report inventory that measures the severity of depression in adolescents and adults.0-13: Minimal depression, 14-19: Mild depression, 20-28: Moderate depression 29-63: Severe depression Possible Hazards of SSRI Potential increased risk of suicidal thoughts or behavior, particularly in children, adolescents and young adults when using SSRI as mono therapy for new depression Suicide Risk Evaluation assess risk factors (previous attempts, family history, psychosocial stressors) protective factors (support systems), and current ideation. Use direct questioning about suicidal thoughts and plans. common drug choices for depression with specific patient issues Fatigue: consider activating antidepressants like bupropion Sexual dysfunction: options include bupropion or mirtazapine, which are less likely to cause sexual side effects Chronic pain: SNRI (duloxetine) are effective for both depression and chronic pain management restless leg syndrome (RLS) definition A neurological disorder characterized by an irresistible urge to move the legs, often accompanied by an uncomfortable sensations. restless leg syndrome (RLS) symptoms Tingling, burning, or itching sensations in the legs. symptoms typically worsen in the evening or at night and are relieved by movement restless leg syndrome (RLS) Diagnosis based on clinical history, no specific lab test. Use the international restless legs syndrome study group criteria (IRLSSG) restless leg syndrome (RLS) Treatment Lifestyle changes, iron supplements, and medications like dopamine agonists. first line- dopaminergic agents (pramipexole, ropinirole) other options: gabapentin or pregabalin for patients with significant pain or insomnia Migraine prevention/ prophylaxis Indications for Prophylaxis: Frequent migraines (≥4-6 per month), severe migraines, or those not responsive to acute treatments. First-Line Medications:Beta-Blockers: Propranolol.Antidepressants: Amitriptyline.Anticonvulsants: Topiramate, valproate. Non-Pharmacological Approaches: Lifestyle modifications, dietary changes, stress management, and regular sleep patterns. supplements- magnesium and riboflavin Parkinson's Disease: Motor symptoms like tremors, rigidity, bradykinesia. Treat with dopaminergic agents (e.g., levodopa). Multiple Sclerosis: Autoimmune condition affecting the central nervous system. Treatment may include disease modifying therapies (e.g., interferons). Alzheimer's Disease: Characterized by cognitive decline. Treat with acetylcholinesterase inhibitors (e.g., donepezil). OTC analgesics Acetaminophen: Safe for mild to moderate pain; liver toxicity risk at high doses. NSAIDs (e.g., ibuprofen, naproxen): Effective for pain and inflammation; GI and renal risks, especially with long-term use. Patient Considerations: Advise on proper dosing, potential side effects, and contraindications (e.g., history of GI ulcers for NSAIDs). Patient education- RLS encourage good sleep hygiene and regular physical activity. discuss the importance of avoiding stimulants in the evening patient education- migraines educate on triggers (certain foods, stress) and encourage a headache diary. Discuss medication adherence and proper use of acute treatments patient education- general neuro health stress importance of regular medical follow-ups, adherence to treatment plans and lifestyle modifications (diet, exercise) to improve the overall neurological health Learn More You can also click on terms or definitions to blur or reveal them