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APEA PEARLS TO HELP PASS FNP
BOARDS TITLE 2025 REVISED GRADED
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oxacin - EXACT ANSWER fluoroquinolones terol - EXACT ANSWER beta agonist tropium - EXACT ANSWER inhaled anticholinergic "prevents bronchospasm" ipratropium (atrovent) one or ide - EXACT ANSWER inhaled steriods -lol - EXACT ANSWER beta blocker triptan - EXACT ANSWER migraine (constricts cerebral arteries--to not overuse) mycin - EXACT ANSWER macrolide -pam - EXACT ANSWER benzo -dine - EXACT ANSWER h2 blockers (famotidine) prazole - EXACT ANSWER proton pump inhibitor -ide - EXACT ANSWER thiazide diuretic -pril - EXACT ANSWER ace inhibitor -sartan - EXACT ANSWER ARB -lol - EXACT ANSWER Beta Blocker -pine - EXACT ANSWER calcium channel blocker---first line for ISH -gliptan - EXACT ANSWER diabetic med--no hypoglycemia
-sin - EXACT ANSWER alpha adrenergic blockers (tx BPH) 4 indications for cxr with acute cough - EXACT ANSWER abnormal VS rales, consolidation
75 years old fever Who gets PPSV23 vaccine?? - EXACT ANSWER -single dose 65 or older -single dose 19-64 if chronic illness, smoker, group home -Immunocompromised receive another dose at 5 YEAR interval -ALWAYS get dose at 65 even if received earlier doses as long as 5 Years has passed!! Bacteria responsible for most pneumonia deaths - EXACT ANSWER Strep pneumonae (Gram -)
Three most common bacteria - CAP - EXACT ANSWER S. Pneumoniae Mycoplasma pneumoniae (walking pneumonia) Chlamydophila pneumoniae Best initial antibiotics for pneumonia if no antibiotic exposure in last 3 months - EXACT ANSWER Doxycycine or Macrolide (Azithromycin or Clarithromycin) ----because they cover for atypicals Best initial antibiotics for pneumonia if comorbidities or antibiotics in 90 days - EXACT ANSWER -Resp quinolone (levofloxacin, gemifloxacin, moxifloxacin) or IF ALLERGY -Beta-lactam (PCN or cephalosporin) PLUS macrolide How long course of antibiotics for pneumonia - EXACT ANSWER 3 days longer than s/s of infection. Pneumonia severity index??? - EXACT ANSWER CRB- -Confusion -RR > -BP low -Age > What confirms COPD on PFTs??? - EXACT ANSWER FEV1/FVC <70%
96 Macrocytic on a cbc, the size of rbc is described by the - EXACT ANSWER MCV On a cbc, the hemoglobin content of RBCs is decribed by the - EXACT ANSWER MCH (mean corpucular hgb) hypo/hyperchromic?? Normal Hgb - EXACT ANSWER 11-15g/dl normal Hct - EXACT ANSWER 33-45% RDW - what is it? What is normal? - EXACT ANSWER indicates degree of variation in RBC size (<15 is normal) ...do not want large variation in rbc sizes! serum iron measures? - EXACT ANSWER measure of iron in circulation (reciprocal with TIBC) egg carton serum ferritin measures? - EXACT ANSWER iron in storage TIBC (transferrin) - EXACT ANSWER total Iron binding capacity-reciprocal with iron level Microcytic , hypochromic anemia - EXACT ANSWER Iron deficiency anemia Most common causes of iron deficiency anemia - EXACT ANSWER hemolysis impaired rbc production blood loss poor iron absorption (celiac disease) What do the TIBC and RDW look like in Iron deficiency anemia - EXACT ANSWER TIBC and RDW increased (spitting out small pale cells) Hgb 8/1%; Hct 24%; MCV 74; MCH 26 - EXACT ANSWER Iron deficiency anemia Foods other than meat rich in iron - EXACT ANSWER dried peas and beans; dark green leafy veggies
When will iron deficient patient start to feel better after placed on supplement - EXACT ANSWER in a few days Replacement dose of Fe for anemia - EXACT ANSWER 150-200 mg/d of elemental iron What lab value represents adequate iron supplementation has occurred (supplements can stop?) - EXACT ANSWER serum ferritin (normal iron stores) How do labs for anemia of chronic disease differ from IDA? - EXACT ANSWER Normocytic, normochromic...but can be also Microcytic/ Hypochromic. Serum iron is decreased, but TIBC and Serum Ferritin are normal...Fe will not HELP!!! Thalassemia - EXACT ANSWER hereditary; microcytic, hypochromic...premature hemolysis. Will have normal Fe, TIBC, Ferritin, and RDW!!! DO NOT GIVE FE!!!! Pernicious anemia - EXACT ANSWER B12 deficiency often ABSORPTION problem..not dietary deficiency! Macrocytic What other nutrient should you check with a B12? - EXACT ANSWER Folate!! Elevated levels of MMA and homocystiene indicate what ???? - EXACT ANSWER Sensitive measures of B12 deficiency...B12 needed for metabolism of these MCV>100 - EXACT ANSWER Pernicious anemia s/s of pernicious anemia - EXACT ANSWER dementia, neuopathy, weakness, elderly, vegans, alcholics, bariatric patients B12 supplementation - EXACT ANSWER Vit B12 IM every day for one week----then weekly x4----than monthly for life when do monocytes elevate? - EXACT ANSWER after 24 hours of illness
Treatment for bell's palsy? - EXACT ANSWER High dose steroids! 60 mg x5days prevents future sequelae What maneuver provokes BPV ---benign positional vertigo? - EXACT ANSWER Dix Hallpike Treatment for vertigo? - EXACT ANSWER Antihistamines: meclizine, dimenhydrinate Benzos--alprazolam...for vertigo from hell!! what neurotransmitter is part of the underlying patho in Parkinsons?? - EXACT ANSWER Dopamine how is parkinson's diagnosed? - EXACT ANSWER response to dopaminergic therapy Treatment for Parkinsons... - EXACT ANSWER levodopa...carbodopa What drug may help with physiologic tremors? - EXACT ANSWER beta blocker dementia?? - EXACT ANSWER memory impairment PLUS at defecit of at least 1 of aphasia, apraxia, agnosia, executive function important w/u in assessment for dementia - EXACT ANSWER TSH, B12, Folate, RPR, HIV, CBC, CMP..imaging to r/o injury or bleed how would you manage a migraine in a hypertensive patient? - EXACT ANSWER Toradol. No tryptan!!! What cranial nerve might cause hearing loss and vertigo? - EXACT ANSWER VIII-vestibulocochlear pneumonic for cranial nerves (dirty) - EXACT ANSWER oh, oh, oh, to touch and feel vaginas get vinny all hot CNI - EXACT ANSWER olfactory You have one nose, so the olfactory nerve is CN I CNII - EXACT ANSWER Optic ---checked with snellen chart
You have two eyes, so the optic nerve is CN II, which functions to produce vision. what does 20/200 vision mean? - EXACT ANSWER at 20 ft...the person can see what a normal person can see at 200 feet. CNIII - EXACT ANSWER oculomotor---eye movements, pupillary constriction, accommodation CNIV - EXACT ANSWER Trochlear ---movemnt of superior oblique muscle CNV - EXACT ANSWER Trigeminal-sensation to face, cheek, and teeth. Motor---mastication CNVI - EXACT ANSWER Abducens--lateral rectus muscle movement CN VII - EXACT ANSWER Facial: facial muscles and taste---think Bells palsy CN VIII - EXACT ANSWER Vestibulocochlear---hearing balance awareness of position The number 8 resembles an ear, so CN VIII, the vestibulocochlear/acoustic nerve is a sensory nerve for hearing. CN IX - EXACT ANSWER Glossopharyngeal--sensation to tongue, pharynx and tympanic membrane CN X - EXACT ANSWER Vagus---parasympathetic CN XI - EXACT ANSWER Spinal accessory ---sternocleidomastoid/trapezius 11 looks like pair of arms /shoulders... test...shoulder shrug... CN XII - EXACT ANSWER Hypoglossal motor fibers of tongue...stick out tongue
1st gen Cephalosporin - EXACT ANSWER Keflex---Gram + 2nd gen Cephalosporin - EXACT ANSWER Cefuroxime, Gram + and Gram
Should you use cefuroxime to treat infection in pt. who has received antbx in last few months?? - EXACT ANSWER NO...probably betalactamase producer.. 3rd generation cefalosporin - EXACT ANSWER Cefixime (suprax), Ceftibuten ...weak gram -, gram +...beta lactamase!!! should you use ceftibuten to treat infection in pt. who has received antbx in last few months?? - EXACT ANSWER YES! Beta lactamase cover Extended spectrum 3rd gen Cephalosporins - EXACT ANSWER Rocephin (ceftriaxone), cefdinir Gram +, Gram -, B-lactamases!!! Macrolides (Later gen) - EXACT ANSWER Azithromycin, Clarithromycin Atypical pathogens! NOT STREP! Fluoroquinolones 2nd gen - EXACT ANSWER Cipro---gram - ; atypical pathogens why is cipro a poor choice to treat CAP? - EXACT ANSWER strep pneumo Gram+....doesn't cover for DRSP Respiratory Fluoroquinolones --3rd gen - EXACT ANSWER Levofloxacin--- the idiot's antibiotic! Kill everything except MRSA. SAVE AS LAST RESORT Resp Fluoroquinolones--4th gen. - EXACT ANSWER moxifloxacin, gemifloxacin, gatifloxacin Gram+, Gram-, Atypicals, Beta lactamase, DRSP DO NOT USE BELOW THE BELT!! What is the most effective fasting time for lipid panel?? - EXACT ANSWER Most accurate after 12 hour fast.
What are the CHD equivalents when deciding whether or not to treat hyperlipidemia? - EXACT ANSWER Diabetes symptomatic CAD PAD AAA What cardiac class may cause exercise intolerance - EXACT ANSWER Beta Blockers -lol slows heart rate. What diuretic bp med should not be given to a patient with hx of severe reaction to bactrim - EXACT ANSWER HCTZ...has a sulfonamide ring!!! Where would the PMI be felt in a pt. with hert failure? - EXACT ANSWER 5th intercostal space to LEFT of midclavicular line. The most common arrhythmia from valvular heart disease is... - EXACT ANSWER Atrial fibrillation Microscopic exam of tinea would show? - EXACT ANSWER hyphae what is the process of screening for Lyme disease?? - EXACT ANSWER H&P first! ELISA then confirm with Western blot if positive. skin lesion which is a solid mass up to 1 cm is described as a - EXACT ANSWER papule. lesion flat and small like a freckle - EXACT ANSWER macule fluid filled lesion less than 1 cm - EXACT ANSWER vesicle fluid filled lesion >1cm - EXACT ANSWER bullae What is koilondychia - EXACT ANSWER spooning of the nails.. common with chronic anemia...always screen with a cbc What area of the body has the greatest percutaneous absorption??? - EXACT ANSWER genitals
What type of anemias are most likely in an elderly patient with history of chronic illnesses and poor health for over a decade?? - EXACT ANSWER folic acid and pernicious----malabsorbption!!! Hallmark finding with B12 and folate deficiencies??? - EXACT ANSWER macrocytosis 35 yo with normal paps since 18. Normal pap and hpv..when should she be tested again??? - EXACT ANSWER 5 YEARS....ACOG says testing no more than every 5 years in women over 30 if BOTH tests are negative and adequate screening has taken place. If PAP ONLY ---rec is every 3 YEARS. HPV testing in combo with pap is more sensitive. HPV testing is more SPECIFIC in women over 30. HPV testing ALONE is NOT recommended. A localized tumor in the prostate gland associated with early stage prostate CA is likely to produce... a. urinary hesitancy b. low back pain c. urinary frequency d. an absence of symptoms - EXACT ANSWER D! these produce no symptoms or clinical manifestations. Thus PSA screening. hematuria is not a common clinical manifestation in ... a. early prostate CA b. BPH c. bladder CA d. Renal CA - EXACT ANSWER A. localized tumors in prostate are not associated with hematuria. often have no s/s. How soon after a diagnosis of acute prostatitis can a PSA be accurate? - EXACT ANSWER 4 weeks....infection or inflammation can cause a shharp rise in PSA values. Elective PSA should be deferred for four weeks. Earlier checks will result in elevated levels not associated with cancer...causing unnecessary patient anxiety. What is the recommendation of the American Cancer Society for initial screening of an AA male for prostate CA? - EXACT ANSWER Discussions
starting at 40-45 years....AA males and those with first degree relative with prostate CA before age 65 are HIGH RISK. What is the PSA threshold? - EXACT ANSWER 4.0 ng/mL A carotid bruit in an elderly patient indicates what? - EXACT ANSWER Indicates artery disease in other places. Those with carotid bruit have double stroke risk. Other vessels should be evaluated. MORE LIKELY TO DIE OF CARDIOVASCULAR DISEASE THAN CEREBROVASCULAR DISEASE How long will it take to evaluate the effectiveness on acetylcholinesterase inhibitor drugs like donezepil used in Alzheimer's? - EXACT ANSWER 6- months. Eval includes family report. MMSE, ADL assessment, and side effects. What are the presenting symptoms, treatment for temporal arteritis? - EXACT ANSWER Dx with biopsy. Chronic vasculitis...new onset HA, abrupt visual disturbance, jaw claudication, unexplained fever or anemia, elveated sed rate. Avg. age of onset 72 yo. Which fingers are not affected by carpal tunnel? - EXACT ANSWER Fifth finger (pinky) Anosmia...what cranial nerve should be evaluated. - EXACT ANSWER I- olfactory (1 nose!) Elderly pt. at increased risk for stroke..Daily ASA is an example of what kind of prevention? - EXACT ANSWER PRIMARY....would be secondary if history of stroke. When should you consider imaging for low back pain in a pt without red flags or hx or cancer, advanced age, or hx of trauma? - EXACT ANSWER 4 weeks at earliest In what part of the hip does osteoarthritis cause pain? - EXACT ANSWER The anterior hip. Finkelstein test - EXACT ANSWER DeQuervians tenosynovitis
AST and ALT are usually elevated. AST is usually double ALT. GGT is often elevated when ALT and AST are still normal. 4 criteria diagnostic of anorexia nervosa - EXACT ANSWER Weight below 85% of ideal body weight Intense fear of weight gain Severe body image disturbance Absence of menses What characterizes bulimia? - EXACT ANSWER Binge eating...followed by either purging or periods of excessive exercise or starvation What are side effects of tricyclic antidepressants? - EXACT ANSWER anticholinergic effects; sleepiness, weight gain, in ELDERLY---hypotension, bradycardia, and prolonged QT interval! Always get baseline EKG in elderly prior to starting TCA. What does the peak flow meter measure? - EXACT ANSWER peak expiratory flow good for asthma...little to no benefit for CoPD and pneumonia How does Ipratropium work? - EXACT ANSWER decreases parasympathetic tone and produces bronchodilation rust colored sputum - EXACT ANSWER strep pneumo....most deadly cause of pneumonia What antibiotic should be used to treat uncomplicated pneumonia in an otherwise healthy patient without recent antibiotic exposure? - EXACT ANSWER a macrolide (azithromycin/clarithromycin) or a tetracycline (doxy). They cover atypical pathogens and provide coverage for non- DRSP. What risk factor has the greatest impact on HIV transmission. - EXACT ANSWER viral load! When do the majority of patients exposed to HIV seroconvert if they are going to do so? - EXACT ANSWER within 3 months
How long should a female patient with an uncomplicated UTI be treated with antibiotics - EXACT ANSWER 3 days What should be done in the case of a pregnant woman with hypothyroidism? - EXACT ANSWER Low T4 can affect fetal growth TSH levels should be monitored frequently. Needs can increase as much as 50% How should you treat a patient diagnosed with Gonorrhea? - EXACT ANSWER Treat both gonorrhea and chlamydia. They are so often found together. What class of drugs should be avoided in CHF? - EXACT ANSWER ca channel blockers (verapamil) can cause bradycardia...reduce contractility...worsen heart failure Where do direct and indirect inguinal hernias occur??? - EXACT ANSWER direct-hesselbach's triangle indirect-internal inguinal ring What is Medicare Part A? - EXACT ANSWER hospital insurance; also covers some skilled nursing facilities
. No enrollment fee for most and they are charged montlhly premium based on number of eligible quarters they contributed. What cranial nerve allows you to stick tongue out and move side to side - EXACT ANSWER XII-Hypoglossal What cranial nerve allows you to close eyes tightly, wrinkle forehead, and smile? - EXACT ANSWER VII-Facial CN partly responsible for speaking and tongue movement? - EXACT ANSWER X-Vagus Which mitral valve disorder results from redundancy of the mitral valve's leaflets?? - EXACT ANSWER MVP What is kava kava? - EXACT ANSWER herb used to treat anxiety, fibro, hyperactivity and ADD. HEPATOTOXICITY possible ...monitor liver function.
What is the diff between major and minor depression?? - EXACT ANSWER number of symptoms >5/9 MAJOR <4 Minor How would a pt. with acute cholecystitis present?? - EXACT ANSWER URQ or epigastric pain; nausea; very still b/c peritoneal inflammation causes increased pain with movement; + murphy's sign----ELDERLY likely to not have this or classic sx!! What does leukocytosis indicate?? - EXACT ANSWER infection of unknown origin (bacterial or viral) Niacin. USE, ADVERSE AFFECTS - EXACT ANSWER Increases HDL; DECREASES GLUCOSE TOLERANCE, flushing, hypotension, gout flares. Take at night with ASA to reduce sx. Tolerance improves over time. What is the correlation with hyperlipidemia and TSH? - EXACT ANSWER If lipids elevated, check TSH. ..may be secondary to hypothyroidism. It is safe to NOT treat hyperlipidemia until TSH is less than 10...if they are still elevated start a statin. Pre-HTN? - EXACT ANSWER 120-139 OR 80- Stage 1 HTN? - EXACT ANSWER 140-159 OR 90- Stage 2 HTN - EXACT ANSWER >or=160 OR > or = 100 diastolic "2 drugs today" What are HTN treatment goals for most patients?? - EXACT ANSWER <140/ HTN treatment goal for pt. with diabetes or chronic kidney disease - EXACT ANSWER <130/ How should you treat a patient newly diagnosed with Stage 1 HTN? - EXACT ANSWER Lifestyle modifications What antiHTN classes are contraindicated in pregnancy - EXACT ANSWER ARB, ACEI
ATPIII recommendations for diabetics? - EXACT ANSWER TC-NO REC LDL < HDL >40 Males; >50 females Trigs < ATPIII recs for general population? - EXACT ANSWER TC < LDL < HDL 30- Trigs < Rubeola - EXACT ANSWER Measles; Fever, malaise...3 Cs (conjunctivitis, coryza, and cough) Koplick spots ---1-3mm whitish, bluish, or gray "grains of sand" appear on buccal mucosa, hard and soft palate BEFORE RASH. Rash starts on head and spreads down. Fifth disease - EXACT ANSWER slapped cheek...lacy macular rash Rubella - EXACT ANSWER marked lymphadenopathy, maculopapular rash like measles rash. macules on soft palate Chicken pox - EXACT ANSWER vesicular lesions on erythematous base appearing in crops...no school until lesions all crusted over Ho do you manage CAP in kids? - EXACT ANSWER suspect DRSP! Gram
HIGH dose Amox 90-100mg/kg/day OR 2nd or 3rd gen cephalosporin IF PCN allergy....clarithromycin dont give Hep B vaccine if anaphalaxis with .... - EXACT ANSWER baker's yeast Dont give what vaccines if anaphalaxis with neomycin? - EXACT ANSWER IPV, mmr, varicella dont give what vaccines of anaphalaxis with gelatin? - EXACT ANSWER varicella zoster, MMR Kernig sign - EXACT ANSWER Pt lying supine , hip flexed at 90 degrees-- +when extension of knee from this position elicits resistance or pain in lower back or posterior thigh (meningitis)
