AANP Board Questions with complete solutions

INR values below ____ increase stroke risk sixfold. - ANSWER-2 What allergy contradicts the use of thiazide diuretics? - ANSWER-Sulfa Why should ACE-Is be avoided with renal stenosis? - ANSWER-Leads to ARF Adver ...

INR values below ____ increase stroke risk sixfold. - ANSWER-2 What allergy contradicts the use of thiazide diuretics? - ANSWER-Sulfa Why should ACE-Is be avoided with renal stenosis? - ANSWER-Leads to ARF Adverse effects of aldosterone antagonists (Aldactone) - ANSWER-Galactorrhea and hyperkalemia What are beta blocker indications? - ANSWER-HTN, post-MI< angina, arrhythmias, migraine prophylaxis, hyperthyroidism 1st line BP med for DM? - ANSWER-ACE or ARB Grapefruit juice should be avoided in what 1st line antihypertensive medication? - ANSWER-CCB Alternative antibiotic treatment for patients with gram positive baterial infections that are allergic to PCN: - ANSWER-macrolides Initial treatment of COPD - ANSWER-Ipratropium bromide (anticholinergic) 1st line treatment for gonorrheal infections - ANSWER-Rocephin IM Treatment of anthrax - ANSWER-Cipro 500mg BID 7-10 days Treatment of traveler's diarrhea - ANSWER-Cipro 500mg BID 3 days What can increase the risk of tendon rupture when on a quinolone? - ANSWER-age and steroids How long does ASA suppress platelet function? - ANSWER-up to 7 days What is the FDA category and dose of finasteride? - ANSWER-5mg PO QD and category X What drug category should not be given with warfarin? - ANSWER-sulfa drugs When should routine screening for breast cancer start? - ANSWER-40 If a patient had only one dose of the hep B vaccine what is recommended? - ANSWER-Do not restart series; Start with 2nd dose What is done if a patient has a tetanus-prone wound and an unknown vaccination status? - ANSWER-Administer immediate dose of Td and the teatnus immunoglobulin injection If a person is vaccinated with pneumovax prior to 65 what is recommended? - ANSWER-Give a booster dose of pneumovax 5 years after initial dose When should Zostavax be given? - ANSWER-age 60 How far apart should the varicella vaccines be given? - ANSWER-4 weeks Treatment for otitis externa - ANSWER-Cortisporin otic drops Common bacterial pathogen of otitis externa - ANSWER-Pseudomonas What is cholesteatoma a complication of? - ANSWER-periorbital sinusitis What indicates an abnormal Rinne test? - ANSWER-BC>AC What kind of hearing loss is found with an abnormal Rinne if BC>AC? - ANSWER-conductive What kind of hearing loss is associated with lateralization to affected ear when Weber test is performed - ANSWER-Conductive What kind of hearing loss is associated with lateralization to unaffected ear when Weber test is performed - ANSWER-sensorurial What does 20/40 vision mean? - ANSWER-A person can see 20 ft whereas normal vision can see 40 Common treatment of cerumenosis - ANSWER-Carbamide peroxide What route should HIV esophageal candida infections - ANSWER-Oral systemic Where is a scabies rash located? - ANSWER-Interdigital webs and/or penis Antibiotic treatment for human, dog, or cat bite - ANSWER-Augmentin A herald patch or "Christmas tree" pattern is associated with what disease? - ANSWER-PItyriasis rosea What class of meds are used to treat PHN? - ANSWER-TCAs What is the treatment for rosacea? - ANSWER-Metronidazole gel What areas of the body have thicker skin and call for higher potency steroids? - ANSWER-scalp, back, soles How do you check for pulsus paradoxus? - ANSWER-BP cuff and stethoscope and the apical pulse What findings are associated with hypertensive retinopathy? - ANSWER-copper and silver wire arterioles, AV nicking What findings are associated with diabetic retinopathy? - ANSWER-Neovascularization, microaneurysms, hard exudates, cotton wool spots What class of anti-hypertensives are used for isolated HTN in the elderly? - ANSWER-CCB What are some "hyper" side effects of thiazide diretics - ANSWER-hyperglycemia, hyperuricemia, hypertriglyceremia At what age is a high cholesterol no longer considered a risk factor heart disease? - ANSWER-75 If a patient has an INR between 3-5, how should this be managed? - ANSWER-Skip 1 dose; decrease maintenance dose, check INR in 1-2 days until normal If a patient has an INR between 5-9 how should this be managed? - ANSWER-Omit a dose and give a small dose of oral vitamin K or omit the next 2 doses. Daily INR monitoring; decrease maintenance dose Class I NYHA heart disease classification - ANSWER-No limitation of physical activity Class II NYHA heart disease classification - ANSWER-Ordinary physical activity results in fatigue, exertional dyspnea Class III NYHA heart disease classification - ANSWER-Marked limitation in physical activity Class IV NYHA heart disease classification - ANSWER-Symptoms are present at rest Treatment class for Raynaud's - ANSWER-CCBs What class of med lower triglycerides? - ANSWER-Niacin and fibrates Should you lower a markedly high triglyceride level or cholesterol first? - ANSWER-Triglycerides Criteria for metabolic syndrome: - ANSWER-Abdominal obesity, HTN, hyperlipidemia, high triglycerides, high fasting glucose What are characteristics of fatty liver disease? - ANSWER-Mild elevation of ALT & AST not associated with alocohol, meds, or viral hep in overweight patients What is used to calculate PEF? - ANSWER-Height, age, gender (HAG) When treating a COPD patient with antibiotics what organism (s) must the antibiotic cover? - ANSWER-H. influenzae (gram negative) No. 1 bacterium in CAP - ANSWER-Strep pneumo No. 1 atypical pneumonia - ANSWER-Mycoplasma pneumoniae At what mm is a PPD considered positive with no risk factors? - ANSWER-15mm At what mm is a PPD considered positive in HIV? - ANSWER-5mm What class of medications is 1st line treatment for asthma prevention? - ANSWER-Inhaled corticosteroids 1st line treatment for severe asthmatic exacerbation - ANSWER-adrenaline injection Why should patients have annual eye exams when on long-term steroids - ANSWER-increases the risk of cataracts and glaucoma What is the definition of subclinical hypothyroidism - ANSWER-Elevated TSH and normal serum free T4 Which antidiabetic drugs are contraindicated in heart failure or severe heart disease and why? - ANSWER-Glitizones because they can cause water retention How is the psoas maneuver performed? - ANSWER- Which hepatitis is associated with the highest risk of cirrhosis and liver cancer? - ANSWER-Hep C When is nitr