AGPCNP Board Review Questions plus Answers

AGPCNP Board Review Questions plus Answers Lesions often begin as small, firm, dome-shaped growths on genitals or other parts of the body (armpits, neck, face, hands); have a surface that feels smooth, waxy, or pearly; are flesh-colored or pink; have a dimple in the center (may be filled with a thick, white substance that is cheesy or waxy); and are painless but itch. Scratching or picking can spread the virus. Molluscum contagiosum Thayer-Martin Selective Agar is an enriched medium for the selective isolation of Neisseria species. N. gonorrhoeae Trauma to Kiesselbach's plexus will result in an anterior nosebleed The diagnostic or gold-standard test for sickle cell anemia glucose- 6-phosphate dehydrogenase (G6PD) anemia the test is positive in De Quervain's tenosynovitis Finkelstein's test—positive in De Quervain's tenosynovitis Anterior drawer maneuver and Lachman maneuvers are positive when: anterior cruciate ligament (ACL) of the knee is damaged positive in meniscus injuries of the knee McMurray's sign neovascularization, cotton wool spots, and microaneurysms are suggestive off diabetic retinopathy atrioventricular [AV] nicking, silver and/or copper wire arterioles on fundal exam are suggestive of hypertensive retinopathy A S4 heart sound is auscultated in an elderly patients, suggesting: S4 heart sounds absent other symptoms in the elderly are often a benign finding For pain relief during pregnancy use: For pain relief, pick acetaminophen (Tylenol) instead of NSAIDs such as ibuprofen (Advil) or naproxen (Aleve, Anaprox) which hand should the ophthalmoscope be held in to examine a patient's eye should be held in the same hand as the eye being examined the cut to disc ratio of a normal fundal exam should not exceed 1:2, e.g. the cup should not be more than half the size of the disc diameter if the provider is having trouble visualizing the macula on fundoscopic exam, the patient should be asked to look: directly into the light of the ophthalmoscope clinical term used to described patient who have trouble seeing items that are far away (nearsightedness) myopia clinical term for farsightedness hyperopia difficulty in maintaining a clear focus at a new distance due to lessening of flexibility of the crystalline lens and weakening of ciliary muscles - common after 40 years presbyopia raised, wedge-shaped growth of noncancerous tissue over the conjunctiva exacerbated by sun, wind and dust pterygium acute inflammatory process affecting the eyelid usually caused by staphylococcus aureus hordeolum (stye) hordeolum (stye) is most commonly caused by what organism staphylococcus aureus hordeolum is commonly managed with: 1. warm compresses 2. topical bacitracin or erythromycin ointment 3. refer to an ophthalmologist if not resolved in ~ 2 days beady nodule on the eye lid that is usually painless apart from the tenderness caused by swelling chalazion seborrheic dermatitis of the LID EDGE, often presents with red, scaly, greasy flakes blepharitis tends to be the most irritating clinical symptoms of blepharitis itching TX for blepharitis 1. hot compress 2. topical abx: bacitracin or erythromycin 3. Vigorously scrub lashes and lid margins with eyes closed and follow with thorough rinsing organism most commonly responsible for blepharitis staphylococcus most common inflammatory eye disorder with itching, burning, increases tearing, blurred vision (possible), sensation of foreign body in the eye which may be caused by allergies, chemical irritation, bacterial, viral or gonococcal/chlamydial infection conjunctivitis (pink-eye) results from an increased intraocular pressure glaucoma acute increase in IOP, opthalmic emergency closed-angle glaucoma a patient who presents with extreme eye pain, blurred vision, pupils that are dilated or fixed and HALOS AROUND LIGHTS should be: referred to opthlamology for emergent suspicion of closed-angel glaucoma screening for glaucoma should begin at age 40 results from clouding and opacification of the normally clear lens of the eye cataracts highest cause of treatable blindness is: cataracts most common surgical procedure in patients 65+ cataract surgery a patient presents with painless, clouded or dim vision with halos around lights, no red reflex and DIPLOPIA IN A SINGLE EYE would be suspected of cataract floaters in the eye is the most concerning symptom for: retinal detachment the most important diagnostic indicator in the evaluation of headache is: chronology patient describes a "vise-like", generalized headache that is more intense about his neck and back of head. The most probable diagnosis is: tension headache duration of tension headaches are usually: no more than a few hours management of tension headache include: OTC analgesics and relaxation the pathophysiology of most migraines is: a result of dilation and excessive pulsation of the external carotid artery migraine's typically last: at least 2 but no more than 72 hours migraines without aura are classified as: common migraine migraines with aura are classified as: classic migraine migraine headaches, which affect females males can commonly be triggered by this inciting event in women: hormonal changes seen with onset of the menstrual cycle patient reports a unilateral throbbing headache that occurs episodically. she states reports "seeing stars" and some weakness. she has no history of migraines. the appropriate first step is: all patients with new migraines must be worked up to R/O organic causes of disease. the provider should order: CBC CMP VDRL ESR CT scan the priority management of chronic migraine includes: 1. avoidance of triggers 2. relaxation / stress avoidance 3. prophylactic daily therapy if attacks occur more than 2-3 times per month if amitriptyline (Elavil) is being used for migraine prophylaxis, the provider knows to monitor for: prolongation of the QT interval which is a BLACK BOX warning on all tricyclics abortive therapy for migraines include: sumatriptan 6mg sub-q, repeated every other to max of 3 doses OR sumatriptan 25 mg PO an onset a patient presents with unilateral periorbital pain with no prior history of migraine. the most likely diagnosis is: cluster headache abortive therapy for cluster headache usually includes sumatriptan and 100% O2 for which two headache types is sumitriptan indicated: cluster and migraine patient presents with hx of diagnosed parkinson's and onset of tremors that had previously been controlled. which medication should the NP add: an anticholinergic to help alleviate the tremor, e.g. trihexyphenidyl (Artane) on physical exam a patient who has a positive glabellar reflex when repetitively tapped over the bridge of the nose is illiciting what sign? name the sign and the commonly associated clinical condition myerson's sign (blinks in response to tap on the nose) which is suggestive of parkinsons the classic triad of parkinson's is represented by what clinical symptoms: tremor rigidity bradykinesia contraction of the facial muscles when the facial nerve (VII) is tapped briskly in front of the ear is termed: what does the condition result from chvostek's sign usually resulting from low calcium the group with the highest prevalence of cluster headaches are: middle-aged men name the two most common types of dementia in order of prevalence: Alzheimer's disease Vascular Dementia first line agents for migraine prophylaxis include: propranolol (Inderal) amitriptyline (Elavil) sodium valproate topiramate the gag reflex is a function of which cranial nerve X - the vagus nerve. the gag reflex evaluates nasopharyngeal sensation acute onset of headaches behind one eye with eye pain, autonomic s/sx with hazy cornea or partial dilation of the affected pupil: acute/narrow angle-close glaucoma requiring referral to ED a patient who demonstrates resistance to a flex hip (or back pain) that is attempted to be straightened while keeping the hip flexed shows: positive kernig's sign indicative of inflammation on lumbar nerve roots which may indicate menigeal irritation patient reflexes the hips and knee to relieve pressure when the provider flexes the patients head toward the chest positive brudzinski's sign indicative of menigeal irritation two physical exam tests for meningeal irritation are: kernig's sign and brudzinski's sign a patient has been diagnosed with chronic migraine and is being started on sumitriptan for abortive therapy. Counseling should include: R/O hx of cardiovascular disease, HPTN, CVA, TIA - warn patients that flushing, tingling, chest/neck/sinus/jaw discomfort can occur SUPERVISE 1st dose if patient has any risk factor for cardiovascular disease, diabetics, obesity, males40 etc. as there is increased risk of MI Name the V cranial nerves and its major divisions: the trigeminal nerve has three branches: - ophthalmic - maxillary - mandibular shock like facial pain, lasting from seconds to minutes per episode that follows a branch of CN V is most likely: trigeminal neuralgia (Tic Douloureux) patient responds that it feels like pins and needles sensation when the provider tap on the anterior wrist briskly. What test has been performed and what does the finding indicate tinel's sign indicative of carpel tunnel T=Tinel=Tingling patient reports tingling sensation when asked to place her wrists together in full flexion. What test has been performed and what does the finding indicate: Phalen's Sign indicative of carpel tunnel primary abortive treatment for cluster headache should always include: High dose oxygen at 12L/m for 15 minutes A triptan or intranasal lidocaine may also be added first line a patient asked for an herbal alternative for headache treatment, the provider may suggest: butterburr a patient presents with a bilateral headaches which feels "band-like head pain". The most likely diagnosis is: muscle tension headache complications of metformin include: lactic acidosis renal dysfunction, patients with renal disease and alcoholics are at increased risk metabolic syndrome is defined as: elevated BP + waist circumference 35:40 F:M FPG 100 Triglycerides 150 HDL 40M or 50F a diabetic patient is hypoglycemic is the morning but not during the not. the provider recognizes this as _______ and makes what adjustment to the insulin regimen dawn phenomenon, increase the coverage in the evening who is recommended to receive thyroid screening and at what age women should begin screening at age of 50 the primary pathology of addison's disease is a lack of: cortisol and aldosterone by the adrenal gland a patient with a TSH 5.0 mU/L with normal T3 and T4 levels would be classified as: subclinical hypothyroidism the initial lab screening for hypothyroidism would show: High TSH 5 with low T4 and T3 the gold standard for dx confirmation of hypothyroidism is: order a TPO, thyroid peroxidase antibody which confirms hasimoto's hypothyroidism the appropriate next step following diagnosis of hyperthyroidism is: referral to an endocrinologist koilonychia is the clinical term for? What condition is it often associated with? spoon shaped nails that is often seen in patients with iron deficient anemia most prevalence gyn cancer uterine second most prevalence gyn cancer ovarian most prevalent cancer in females breast highest morality cancer in females lung highest overall mortality from cancer related to lung most prevalent cancer in men prostate most prevalent cancer overall (males and females) skin 1st line TX for AOM is: Amoxicillin 500mg PO BID X 7 days first line management of acne includes: non-pharmacologic therapies: - washing several times / day with mild soap - avoid topical oil-based products - use oil free cleansers and moisturizers second line therapy for acne includes: benzoyl peroxide is first line and/or salicyclic acid (Neutrogen 2% wash) then Retina A then combination antibiotics + erythromycin (Benzamycin) when prescribing retina A the NP councils on the risk of: - increase risk of sunburn - pregnancy category C - adverse effects have been shown in animal studies; only use when the benefits clearly outweigh the risk the most frequently use ABX for acne is: clindamycine the most common cause of inflamed hair follices, including: folliculitis, furuncle's and carbuncles is: staphylococcus aureus treatment of choice for CA-MRSA trimethoprim-sulfamethoxazole treatment of choice for group A strep: trimethoprim-sulfamethoxazole