AANP EXAM NOTES 6

Question 1

Transient ischemic attack (TIA) is an episode of dysfuntion of what system?

Answer 1

Neurologic

Question 2

A PT who had a TIA is at high/low risk for severe stroke in the future

Answer 2

HIGH

Question 3

TX for TIA?

Answer 3

Refer to ED, Schedule CT/MRI within 24 hrs

Question 4

TIA ABCD2 Score is a tool to help predict who is at high risk for subsequent stroke after a TIA within next 7 days. What is next step if PT has ABCD2 score of 3 or greater?

Answer 4

Refer to ED for hospitalization

Question 5

What does ABCD represent for a PT with a possible TIA?

Answer 5

Age (greater than 65)
BP (140/90 or higher)
Clinical features of TIA (unilateral weakness)
Duration (> 60 mins)
Diabetes

Question 6

72-year-old patient with a hx of coronary artery disease and hypertension reports an episode of slurred speech and right sided facial droop that started yesterday while at home. It lasted for about an hour. She denies pain or headache. What is likely cause?

Answer 6

TIA

Question 7

An 80-year-old pt. comes with c/o ataxic gait, new onset headache & slurred speech that began 2 hours ago. What is likely Etiology?

Answer 7

Stroke/TIA

Question 8

Name 2 risk factors of CVA (stroke)

Answer 8

A fib, prolonged immobilization.

Question 9

Name 1 risk factor for Homorrhagic CVA

Answer 9

1. Poorly controlled HTN

Question 10

Name 3 s/s the describes how hemorrhagic CVA presents

Answer 10

1. abrupt onset severe HA
2. N&V
3. Photophobia
4. Nuchal rigidity

Question 11

Intracerebral/ Sub arachnoid hemorrhage presents with sudden onset of severe “thunderclap”/ “the worst HA of my life” or “sentinel HA. T/F

Answer 11

TRUE

Question 12

CVA has high prevalence in blacks, hispanics, american indians, and women of what age?

Answer 12

25-34

Question 13

PTs preparing to undergo heart catheterization should/should not stop Losartan

Answer 13

Should not stop Losartan

Question 14

Naproxen should be stopped for 24 hours prior to heart cath due to the impact on renal prostaglandin production. T/F

Answer 14

TRUE

Question 15

The TIMI score evaluates patients for what 2 condx?

Answer 15

angina & possible MI

Question 16

Splinter hemorrhages on nail, new onset murmur fever, chills, tender violet-colored (red to purple) nodules on fingers & toes are some symptoms presented by what bacterial condition?

Answer 16

bacterial endocarditis

Question 17

Osler Nodes are what color?

Answer 17

purple/pink

Question 18

What part of body do you find Osler Nodes?

Answer 18

These nodules are found on distal fingers/ toes

Question 19

Lesions that are irregular, non-tender, erythematous macules/papules on the hands and soles are called?

Answer 19

Janeway lesions

Question 20

What condx includes a color change in hands from white, blue, and red in a symmetric pattern.

Answer 20

Raynaud’s Phenomenon

Question 21

What is TX for Raynaud’s Phenomenon

Answer 21

CCB (nifedipine, amlodipine)

Question 22

Insulin resistance syndrome is AKA

Answer 22

Metabolic Syndrome, Syndrome X

Question 23

What labs would you order for Metabolic Syndrome?

Answer 23

Labs: Fasting (9 to 12 hrs) lipid profile (esp. triglycerides & HDL), Fasting blood glucose

Question 24

What type of HTN Medication should be avoided when treating a PT with Metabolic syndrome?

Question 25

A butterfly rash is associated with what dz?

Answer 25

lupus

Question 26

When may children with chickenpox return to school?

Answer 26

After lesions have crusted.

Question 27

What OTC medication should be avoided in children with chickenpox? why?

Answer 27

ASPRIN - May cause Reye's syndrome

Question 28

What condx presents with Lip/ oral cavity symptoms that may present as painful vesicles on the soft palate & mouth

Answer 28

Herpangina

Question 29

What condx presents with honey colored crusts, fragile bullae (that easily ruptures), pruritic.

Answer 29

Impetigo

Question 30

What labs are drawn for PT with Impetigo?

Answer 30

C&S of crusts/wound

Question 31

What is the TX for PT with severe case of Impetigo but NKDA?

Answer 31

Cephalexin (Keflex) QID, dicloxacillin QID x 10 days.

Question 32

What is the TX for PT with severe case of Impetigo who has penicillin allergy?

Answer 32

Azithromycin 250mg x 5 days (Macrolide), Clindamycin x 10 days.

Question 33

What is the TX for PT with Impetigo with few lesions and no bullae (NDKA)?

Answer 33

Topical 2% mupirocin ointment (Bactroban)

Question 34

What acute bacterial infection is caused by Staph/Strep that ruptures easily and becomes superficial, bright red, weeping with honey crusted exudate on face, arms or legs.

Answer 34

Bullous Impetigo

Question 35

What medication is used to treat Bullous Impetigo

Answer 35

Mupirocin

Question 36

What highly contagious virus presents small spots with White centers (Koplik's spots), round spots on a red base of the buccal mucosa by the rear lower molars & appears 2-3 days before onset of symptoms?

Answer 36

Measles

Question 37

Measles is AKA

Answer 37

Rubeola

Question 38

What infectious dz of the skin is caused by poxvirus?

Answer 38

Molluscum contagiosum

Question 39

What infection dz of the skin presents smooth papules that arfe dome shaped with central umbiligation (belly button white plug)?

Answer 39

Molluscum contagiosum

Question 40

What condition presents with a Christmas Tree pattern rash (on cleavage lines); Herald patch lesion appears initially

Answer 40

Pityriasis rosacea

Question 41

Roseola typically occurs in children of what age?

Answer 41

6 mos to 3 years

Question 42

Roseola typically presents a fever lasting how long?

Answer 42

2-3 days

Question 43

Interdigital webs are associated with what skin infestation?

Answer 43

scabies

Question 44

What infectious dz presents with Sandpaper rash with sore throat (strep throat), fever.

Answer 44

Scarlet fever

Question 45

Compared to PTs with strep throat, PTs with scarlet fever are at higher risk for developing postglomerular nephritis. T/F

Answer 45

TRUE

Question 46

What is the 1st approved drug for smallpox?

Answer 46

TPOXX

Question 47

Smallpox vaccine can lessen severity if given within ..... days post exposure.

Answer 47

3

Question 48

What inflammatory condition is characterized by Multiple painful, reddened nodules on anterior surface of both legs seen in pt. with ulcerative colitis?

Answer 48

Erythema Nodosum

Question 49

What is prescribed to treat nodulocystic acne?

Answer 49

Isotretinoin

Question 50

If pt. with Nodulocystic acne has been Rx’d Isotretinoin & oral contraceptives but presents with sinus infection, who should be consulted?

Answer 50

call the dermatologist to report the BP and discuss the risk of stroke.

Question 51

What condx presents an extravasation of blood under the skin that is not present with Scarlet Fever?

Answer 51

Petechiae

Question 52

What is a Pruritic rash located on hands, flexural folds, and neck?

Answer 52

Eczema

Question 53

What can cause Urticaria?

Answer 53

Medications (e.g., Penicillin allergy rash), viral/bacterial infections, insect bites, latex allergies)

Question 54

Urticaria is AKA

Answer 54

Hives

Question 55

What is the best clue to differentiate between contact and atopic dermatitis?

Answer 55

Unilateral location and shape

Question 56

Dermatitis symptoms include a NON-Pruritic rash located on hands, flexural folds (antecubital, popliteal space), neck, cheeks, entire trunk, knees, & elbows. T/F

Answer 56

FALSE. Dermatitis symptoms include an EXTREMELY PRURITIC RASH on hands, flexural folds (antecubital, popliteal space), neck, cheeks, entire trunk, knees, & elbows.

Question 57

What is 1st line tx for dermatitis?

Answer 57

Topical steroids and emollients (hydrocortisone)

Question 58

Dermatitis may be treated with Hydrating baths (warm water) then applying skin lubricants (Eucerin, Keri Lotion, Crisco, Mineral oil) while skin is wet. T/F

Answer 58

TRUE

Question 59

What inflammatory skin reaction may present with just red skin or red skin with painful/ burning or stinging blisters. The blisters may be located anywhere, may/may not have a belt like pattern (linear).

Answer 59

Contact dermatitis

Question 60

Rashes caused by contact dermatitis may become crusted, very pruritic, & lichenified from chronic itching when they dry. T/F

Answer 60

True

Question 61

Cutaneous Lichen planus may present with purple plaques of what shape?

Answer 61

Polygonal

Question 62

Actinic Keratosis is a precancerous precursor to squamous cell carcinoma. T/F

Answer 62

TRUE

Question 63

What is the gold standard test for Actinic Keratosis?

Answer 63

Biopsy

Question 64

What is TX for actinic Keratosis?

Answer 64

Refer to dermatologist for surgery, cryotherapy, topical medications such as fluorouracil cream 5% or imiquimod.

Question 65

What condx may present soft, painless, wartlike, fleshy growths in the trunk that are located mostly on the back. They can look like they are “pasted” on the skin.

Answer 65

Seborrheic Keratosis

Question 66

The most appropriate tx for a steroid responsive condition includes: Gel, cream, ointment but NOT lotion. T/F

Answer 66

TRUE

Question 67

Autoimmune dz (Grave’s dz, Hashimoto’s thyroiditis, RA, psoriasis, pernicious anemia) are risk factors for what chronic autoimmune skin disorder?

Answer 67

Vitiligo

Question 68

Cherry Angioma presents benign small, smooth round papules that are bright cherry red. They may bleed if ruptured. T/F

Answer 68

TRUE

Question 69

What is an Inherited/ chronic skin disorder in which squamous epithelial cells undergo rapid mitotic division & abnormal maturation?

Answer 69

Psoriasis

Question 70

Methotrexate absolute contraindications includes Chronic alcohol use, acute renal failure, & breastfeeding. T/F

Answer 70

TRUE

Question 71

Symptoms of this condx may be a/w inflammatory bowel disease (IBD) or psoriatic arthritis.

Answer 71

Psoriasis

Question 72

Superficial candidiasis in the vagina presents with vaginal irritation and a non-malodorous discharge of what color.

Answer 72

White-ish

Question 73

What is the tx for superficial candidiases in the vagina?

Answer 73

Miconazole cream (Monistat)

Question 74

What condx presents an acute skin infection of the deep dermis & underlying tissue?

Answer 74

Cellulitis

Question 75

Cellulitis is caused by what bacteria?

Answer 75

Staph aureus (Gram + bacteria)

Question 76

What is a virulent strain of cellulitis?

Answer 76

MRSA

Question 77

PT in office with diffused pink colored skin that is poorly demarcated with advancing margins and warm to the touch. PT has temp, fever, chills, and c/o malaise. What is a possible diagnosis?

Answer 77

Cellulitis

Question 78

MRSA is a strain of cellulitis that presents with/without abscess?

Answer 78

WITH

Question 79

What antibiotics are used to TX MRSA?

Answer 79

Note: Vancomycin or daptomycin are the agents of choice for treatment of MRSA (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5204005/)

Question 80

Is orbital cellulitis more common in adults or younger children?

Answer 80

younger children

Question 81

What type of cellulitis is more common in younger children

Answer 81

orbital cellulitis

Question 82

What type of cellulitis involving upper dermis & superficial lymphatics is usually caused by group A Streptococcus?

Answer 82

Erysipelas

Question 83

PTs with clenched fist injury is at high/low risk for infection to joints (knuckles), fascia, nerves, & bones (osteomyelitis) esp. if punched in mouth or bitten by a human.

Answer 83

HIGH

Question 84

Pt presents to office after being in a fight. He was punched in mouth and bitten. What is next step?

Answer 84

Refer to ED for xray to r/o foreign body or fracture

Question 85

Furuncles are AKA

Answer 85

BOILS

Question 86

How are furuncles usually treated?

Answer 86

antibiotic ointment

Question 87

PT presents with painful nodules, abscesses, & pustules in groin and axilla areas. A ruptured lesion is draining purulent green colored discharge. What is DX?

Answer 87

HIDRADENITIS SUPPURATIVA

Question 88

How is HIDRADENITIS SUPPURATIVA treated?

Answer 88

Antibiotics: Clindamycin, cholorhexidine (Hibiclens) 4% sol Oral antibiotics: Tetracycline

Question 89

PT presents with broken hair shafts that leave a dot like pattern on scalp. What is likely Dx?

Answer 89

Tinea Capitis

Question 90

What antifungal medication considered to be the gold standard TX for tinea capitis?

Answer 90

Griseofulvin

Question 91

Tinea pedis is AKA

Answer 91

Athlete's foot

Question 92

PT presents with itchy, scaly rash on foot. Microscopic exam shows hyphae (skin lesion that fluoresces under wood's lamp). What is likely dx?

Answer 92

Tinea Pedis

Question 93

What is common TX for athlete's foot?

Answer 93

antifungal cream (clotrimazole (Lotrisone), econazole (Ecoza, Spectazole) or ciclopirox (Loprox, Penlac).

Question 94

Tinea unguium, is a fungal infection of the ...

Answer 94

fingernail

Question 95

Tinea unguium, is treated with

Answer 95

Terbinafine (Lamisil)

Question 96

PT presents with unguium. What should you require prior to initiation of Lamisil? Why?

Answer 96

LFT. Lamisil is an inhibitor of CYP 2D6 enzyme can lead to liver failure

Question 97

Why does FDA recommend avoiding prescribing oral ketoconazole (Nizoral) for fungal skin & nail infections?

Answer 97

May cause serious harm (liver damage)

Question 98

What fungal skin infection presents hypopigmented or hyperpigmented (reddish, brown hue) round to oval macular rash/ patch? most lesions on upper shoulders/back

Answer 98

Tinea Versicolor

Question 99

Where do most Tinea Versicolor lesions appear on the body?

Answer 99

upper shoulders/back

Question 100

KOH test reveals “spaghetti & meatballs” hyphae & spore pattern on PT's back. What is likely DX?

Answer 100

Tinea Versicolor