Download AANP Review 89Questions and Answers, Latest Update Rated A+ [with certified solutions] and more Exams Health sciences in PDF only on Docsity!
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A 64 year old with HTN and DM presents with productive cough, fever, body aches. What diagnosis is most likely? a. Acute bronchitis b. Chronic bronchitis c. Pneumonia d. Pertussis Correct Answer - c. Pneumonia 1st clue: 64 year old 2nd clue: multiple comorbidities 3rd clue: cough, fever what was the stem of the question? Indications for a chest xray with acute cough Correct Answer - abnormal vital signs (increased RR or HR, temp >38c, 100.4F rales, consolidation
or equal 75 years of age with cough*** ***Pneumonia in older patient: tachypnea, decreased O2 sat, OR change in mental status or behavior A 75 year old patient wo smokes and has COPD presents with a worsening cough, weight loss, fatigue, and an enlarged right supraclavicular node. Which finding is most indicative of a right lung tumor?
- worsening cough
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- weight loss
- fatigue
- supraclavicular node Correct Answer - 4. supraclavicular node most important stem clue because this lymph node drains the chest and breast. It's a BIG deal! If the stem gives a unilateral finding, look for a unilateral diagnosis What symptoms most commonly accompany acute bronchitis?
- Fever, runny nose
- Cough, fever
- Cough and URI symptoms
- Cough, URI, and headache Correct Answer - 3. Cough and URI symptoms Remember that bronchitis is an inflammation of the bronchioles, bronchi, and trachea; usually follows an upper respiratory infection Starts above the shoulders and drops down into chest. A 35 year old patient with acute bronchitis has no underlying lung disease. He asks, "How long before my cough goes aways?" The NP responds:
- <1 week
- about 1 week
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When is it given again? Correct Answer - Who-Prevention: Pneumococcal polysaccharide vaccination (PPSV) given once in a lifetime to immunocompetent adults > or equal 65 years Who else-Adults 19-64 with --chronic CV, lung, liver disease --smokers, DM, ETOH, or asplenic --chronic care facilities --immunocompromising conditions When again-one time 5 years after for CRF, nephrotic syndrome, asplenia, sickle cell, immunocompromising conditions A 52 year old feale was recently diagnosed with RA. She is being treated with a DMARD. Should she receive PPSV? If so, should she receive another one, and if so when?
- Yes, in 5 years
- No, another is not needed
- Yes, at 65 years old
- Yes, at age 60 years Correct Answer - Yes, in 5 years What are some presentation symptoms for pneumonia? What is the classical presentation? Correct Answer - Cough (>90%) Sputum production, purulent Fever, malaise, fatigue SOB
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Chest pain >50%, especially with inspiration, or between shoulder blades (classical presentation) Increased RR and HR What are the common pathogens for CAP? Correct Answer - S. pneumoniae - rust colored sputum. Most common cause of death from PNA - Bad for business! or atypical organisms: M. pneumoniae - mycoplasma pneu. aka "Walking PNA" Chlamydophila pneumoniae What is the tx for CAP? Correct Answer - 1st line - Macrolide (azithromycin or clarithromycin) or Doxy these ABX treat atypicals If a patient with PNA has comorbidities or have had an ABX in the past days, what do you suspect the PNA is? Correct Answer - Drug Resistant Strep Pneumo - DRSP Risk factors: PCN, ceph, macrolide, or FQ in past 90 days ETOHism Comorbid Immunosuppress Exposure to child in daycare
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each scores 1 point If patient has PNA and scores 0 or 1, outpatient TX AANP exam categories Correct Answer - 1. Acute problems
- Chronic problems
- Emergency problems
- Safety Issues (drug-drug and drug-disease questions)
- Professional issues (more on ANCC) COPD Correct Answer - Irreversible, chronic airflow obstruction and inflammation of the airways with reduction in expiratory flow that worsens as the disease progresses Asthma not included in COPD Chronic Bronchitis Correct Answer - Sputum at least 3 months annually for 2 years with cough Emphysema Correct Answer - Lung disease by permanent enlargement of alvelor ducts. air trappiing Consider COPD in patients who have... Correct Answer - chronic cough with sputum dyspnea
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inhalation to tobacco smoke, dust, chemicals What imaging modality is usually used to diagnose COPD?
- CXR
- Pulmonary function tests
- Chest CT
- Spirometry Correct Answer - 2. Pulmonary function tests. If both are choices are present (PFT and Spirometry), choose PFT. Otherwise spirometry. What is the diagnostic criteria for COPD? Correct Answer - Airflow obstruction <70% (FEV1/FVC ratio) What are some meds for COPD? Correct Answer - Beta agonist - SABA (about 4 hrs duration) & LABA (12 hrs duration) BRONCHODILATION Anticholinergics - ipratropium. works great in combo with beta agonists PREVENT BRONCHOCONSTRICTION Theophylline - resp stimulant. causes nervousness, like caffiene, xanthines, need theo levels. watch out for TOXIC effects (drug-drug). metabolized in liver. if pt develops lower resp infections, erythro and clarithro metabolized in liver and can cause theo levels to rise.
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- pulmonary embolism Correct Answer - 1. a respiratory infection Respiratory infection (80%) Environmental pollution Others (MI, PE, HF) What meds are for management of acute exacerbations of COPD? Correct Answer
- SABA Glucocortocoids ABX depends on etiology Health promotion of COPD Correct Answer - Smoking cessation Regular exercise PPSV immunization Influenza immunization Education on SABA, LABA, etc. Asthma triad Correct Answer - Wheeze Cough SOB or chest tightness What is asthma? Correct Answer - A chronic, reversible (as opposed to COPD: irreversible), airway obstruction, inflammation and airway hyper-responsiveness.
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Triggers for asthma Correct Answer - Exercise Cold air Exposure to irritants, dust, molds, furry animals, etc Infection What choice below characterizes exercise induced asthma?
- Symptoms worsen with viral URI
- Symptoms develop within 5 minutes of exercise
- Symptoms develop 5-15 minutes after exercising
- Symptoms abate within 5 minutes of stopping exercise Correct Answer - 2. Symptoms develop within 5 minutes of exercising Classification of asthma severity Correct Answer - Intermittent: symptoms </= 2 days per week Persistent: mild: >/=2 days, but not daily mod: daily severe: thoughout day Stepwise approach to asthma mgmnt Correct Answer - SABA PRN (all asthma) low-dose ICS
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LABA's must have a steroid on board. If miss dose or late on LABA, can lead to bronchoconstriction and is a safety issue. Health Promotion for asthma Correct Answer - PNA Vaccine Influenza Vacc Exercise Asthma action plan A patient needs to be screen for TB prior to starting a new job. Which test would meet this requirement?
- Mantoux skin test
- CXR
- Sputum specimen
- Bronchoscopy Correct Answer - 1. Mantoux skin test CXR shows active disease. Diagnostic test is sputum specimen An otherwise healthy 35 year old male has been diagnosed with acute bronchitis. What medication might help eradicate his symptoms quickly?
- Albuterol
- Azithromycin
- Fluticasone inhaler
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- None Correct Answer - 4. None Only time will heal A patient describes his course of symptoms with acute bronchitis. Which description is inaccurate?
- The cough was last to go away
- It started with a runny nose
- I never had a fever
- It started with a cough Correct Answer - 4. It started with a cough A patient has been diagnosed with chronic bronchitis. He uses a SABA PRN and has never had to use a LABA daily. His likely stage of COPD is:
- Stage I
- Stage II
- Stage III
- Stage IV Correct Answer - 1. Stage I An ipratropium inhaler is most appropriately prescribed for a patient with which disease?
- Emphysema
- Acute bronchitis
- Pneumonia
- Asthma Correct Answer - 1. Emphysema
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This patient is high risk for DRSP LABA is no more than BID DOXY is not best coice for DRSP D/C home meds will kill patient. Don't stop symbicort Mr. Smith has Stage III COPD. Which finding would be LEAST likely in him?
- Normal sed rate
- Increased resonance
- Hgb=10, HCT=29.
- 65% FEV1/FVC ratio Correct Answer - 3. Hgb=10, HCT=29. COPD patients usually have high HCT An 82 y.o. patient is diagnosed with PNA. She takes tiotropium daily and is allergic to PCN. What is the most appropriate antibiotic for her treatment?
- Ciprofloxacin
- Amoxicillin-clavulanate
- Azithromycin
- Levofloxacin Correct Answer - 4. Levofloxacin Likely to have DRSP because of comorbidities
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A 40 y.o. patient just had bilateral cataract surgery. Which choice below likely contributed to premature cataract formation?
- Albuterol use
- Daily oral steroid use
- Moxifloxacin use
- Nebulized bronchodilators Correct Answer - 2. Daily oral steroid use Every anemia is characterized by what two things? Correct Answer - Size - cytic and Color - chromic Microcytic, normocytic, macrocytic Hypochromic, normochromic, hyperchromic - the greater the hgb content, the redder the cell On a CBC, the size of RBC's is described by the
- hemoglobin
- MCV (mean corpuscular volume)
- RDW (red cell distribution width)
- hematocrit Correct Answer - 2. MCV (mean corpuscular volume) On a CBC, the hemoglobin content of RBC's is described by the
- MCH (mean corpuscular hemoglobin)
- MCV (mean corpuscular volume)
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causes (female) occult malignancy menorrhagia poor iron absorption impaired RBC production A patient has HGB=9.1, HCT=27%. Which findings are consistent with iron deficiency anemia? Norms: MCV:80-100, MCH:28-
- MCV:72, MCH: 24
- MCV: 82, MCH: 28
- MCV: 120, MCH: 30
- MCV:65, MCH: 35 Correct Answer - 1. MCV:72, MCH: 24 Microcytic, hypochromic Management of IDA Correct Answer - Diet rich in foods containing iron Organ meats (especially liver) Red meat Beans - especially in vegetarians Dark leafy veggies whole grains
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A patient with IDA is taking Fe supplements three times daily. What could be used with the supplements to enhance the absorption of iron?
- Food
- Vitamin C (250 mg)
- Vitamin D (1000mg)
- Milk Correct Answer - 2. Vitamin C (250 mg) A 42 y.o. female with IDA has taken iron gluconate for 3 months and would like to stop. What lab parameter can help determine whether stopping iron is prudent at this time?
- Increased serum iron
- Inreased reticulocyte count
- Normal Hgb/Hct
- Normal serum ferritin Correct Answer - 4. Normal serum ferritin Normal H/H is the first to be correct. Iron stores must be completed before stopping therapy Anemia of Chronic Disease Correct Answer - Mild to moderate normocytic, normochromic anemia associated with chronic disease (eg DM, SLE, RA, hyper/hypo thyroid) Usually find low serum iron, normal TIBC, normal to increased serum ferritin A patient's Hgb=10, HCT=30.6%. Which findings are consistent with a normocytic normochromic anemia?
