AANP EXAM NOTES 7 Flashcards by joseph allen

Lab results will reflect increased in band forms (immature WBCs) d/t increased bacterial infection. What term is used to describe this?

“Shift to the left”

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This lab should be present in the greatest # in a healthy pt?

Total WBCs (leukocytes)

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This lab is increased with acute bleeding?

Reticulocyte count

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This psychiatric medication class has a black box warning for suicidal ideation in people < 24 years of age. Side effects include sexual dysfunction & serotonin syndrome

SSRIs
Ex: escitalopram (Lexapro)
sertraline (Zoloft)
paroxetine (Paxil)
citalopram (Celexa)

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This class of psychiatric medication requires BMI/weight monitoring q 3 months

Atypical antipsychotics
Ex: olanzapine (zyprexa); risperidone (risperadol), & quetiapine (seroquel)

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This psychiatric medication class requires monitoring for Steven Johnson syndrome.

Anticonvulsants
Ex: specifically lamotrigine (Lamicatal)
Others: Carbamazepine (Tegratol) & valproate (Depakote)

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This psychiatric medication class can worsen acute narrow angle glaucoma

SNRIs
Ex: Venlafaxine (Effexor) & duloxetine (Cymbalta)

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This hypnotic has a quick onset of 15 to 30 min

Zolpidem (Ambien)
Eszopiclone (Lunesta)

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How should the following benzodiazapines be managed & why? (versed, halcion, xanax, ativan restoril, valium, librium, & klonopin)?

Must discontinue slowly d/t increased risk for seizures

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This class of psychiatric medication are not to be combined with SSRIs & high tyramine or fermented foods (beer, wine, cheese, fava beans)

MAOIs
Ex: isocarboxazid (Marplan)
phenelzine (Nardil)
selegiline (Eldepryl, Zelapar)
tranylcypromine (Parnate)

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This psychiatric medication class should not be combined with SSRIs or MAOIs d/t increased risk for serotonin syndrome. it is on the beers list for “SADCUB” sedation in elderly. Category x

TCAs
Ex: amitriptyline (Eleval) “end in ine”

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2 examples of atypical antidepressants that are used to help pt. quit smoking. It is contraindicated in pt. with seizure disorder, anorexia, & bulimia.

Wellbutrin & Zyban

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This SSRI drug can cause sexual dysfunction in both men & women & causes wt. gain more frequently

Paroxetine (Paxil)

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This class of psychiatric medications may induce mania with bipolar patients & prolongs QT interval.

SSRIs

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This antipsychotic medication class has a black box warning that may cause death in frail elderly

Typical antipsychotics
Ex: Geodon, Haldol, Seroquel, or Thorazine

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Ranitidine (Zantac), Famotidine (Pepcid), & Nizatidine (Axid) are examples of what class GI med?

H2 antagonist

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Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Pravacid), & Pantoprazole (Protonix) are examples of what class GI med that is a/w increased risk of osteoporosis?

PPI

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Aluminum/magnesium/ simethicone (Mylanta, Maalox), calcium carbonate (Tumms, caltrate), & aluminum magnesium (Gaviscon) are all examples of what class GI medication?

Antacids

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What potency is group/class 1 steroids?

Super potent

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Hydrocortisone 0.5 to 1.5% is considered what group/level potency steroid?

Group/class 7

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What is the most likely cause of elevated liver enzymes with norm BP, lipids, & normal hepatitis panel in a pt. ?

Daily consumption of grapefruit juice for more than 10 days

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This potency steroid can be used on face, intertriginous areas, & genitals.

Group/class 7 (least potent) ex: Hydrocortisone 1%

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This class potency steroid can be used to tx severe dermatoses (psoriasis, severe eczema) on palms and soles of feet for up to 2 weeks

Group/class 1 (super potent) ex: temovate, ultrabate 0.5%

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2 herbs thought to help with insomnia

Chamomile tea & melatonin

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This herb is thought to improve blood sugar & cholesterol

Cinnamon

This herb is thought to shorten the duration of the common cold/flu

Echinachea (Purple coneflower)

This herb is thought to help with migraine, irregular mesus, & tinnitus

Feverfew (butterbur)

This herb is thought to help with high cholesterol & arthritis/ joint pain

Fish oil/ krill oil Omega 3 oil

This herb is thought to help with dementia, memory problems, tinnitus but affects blood clotting.

Ginko

This herb provides estrogen like effects

Isoflavones (from soybeans)

This herb is thought to relieve anxiety & help with insomnia, but causes elevation of LFT's.

Kava Kava (valerian root)

This natural cream is thought to help with premenstrual & menopausal (hot flashes) symptoms

Progesterone cream

This supplement is thought to help lower triglyceride cholesterol. It requires monitoring of Liver enzymes.

Red yeast rice

This herb is thought to treat mild depression, menopausal symptoms. It may decrease the efficiency of contraceptives

St. John's wart

This herb is thought to help with alzheimer's dz., arthritis, & cancer

Turmeric

This medication is used to promote wt. gain in HIV/cancer pt.s., but may take up to 3 months to work.

Megestrol (Megace)

3 strategies to help older adults gain weight.

1) increase calories with each meal 2) increase frequency of meals 3) Consider liquid supplements

This dietary liquid is an inhibitor of P450 enzyme

Grapefruit juice

This type burn causes destruction of all skin elements (epithelium, SQ layer, soft tissue facia, hair follicles, sweat glands, & nerve endings. )

Third degree full thickness burn

This type burn has local pain & is erythematous without blisters

Superficial thickness 1st degree burn

This type burn impacts the epidermis layer only (redness, no blistering/ open sores, appears dry & blanches with pressure. Ex: coffee burn, sunburn

Superficial partial thickness burn (2nd degree)

This type burn impacts the epidermis & part of the dermis appear wet, weeping with blisters. Does blanch with pressure

Partial thickness (stage 2)

When should pt.'s be referred to ED for a burn?

For facial/electrical burns, or burns involving the cartilage of the ear

What percent according to the rule of nines is it if chest & abd affected (anterior)

18% each

The head & arms are considered what % according to the rule of nines?

4.5% each

Each leg anterior & posterior are considered what % according to the rule of nines?

9% each

The genitals is what % according to the rule of nines?

This is caused by sharing needles, blood transfusion, or mother to infant transfer?

Hep C

If a pt. has a + anti HCV what does this mean? What test should be ordered?

They are infected with Hep C order RNA test

What is the HCV RNA used for?

To confirm if a pt. has Hep C

This is transmitted via blood, semen, or other body fluids

Hep B

The HBs AG (surface antigen) detects what?

Current Hep B infection

The anti HBs Ab (surface antibody) detects what?

Immunity/protected/previous recovery from Hep b

The HBc Ab (Core antibody) detects what?

History of past/ current infection

This is transmitted via international travel, stool, unwashed food, or contaminated water?

Hep A

The anti HAV IgM detects what?

Current infection

The anti HAV IgG detects what?

Immunity through past infection or vaccination

When ALT is grossly higher than AST what should the NP suspect?

Hepatitis

When AST is double the ALT what should the NP suspect?

Acetaminophen toxicity, alcohol/drug abuse (alcoholic hepatitis)

Cancer occurring on the bone (typically shoulders, elbows, knees, & hand) that are not well circumscribed & are fixed (not mobile) are called?

Osteosarcoma

This condition typically affects ages 15 to 19. It presents as enlarged, painless cervical/axillary/groin/ supraclavicular lymphadenopathy. May have fever, unexplained wt. loss, & night sweats.

Hodgkin's Lymphoma

Unopposed estrogen therapy is the most common cause of this type of cancer.

Endometrial

Women treated with unopposed estrogen therapy should receive?

Progesterone or progestin at least q 3 months to reduce the risk of endometrial hyperplasia & cancer

Condition that causes bleeding, low grade fever, lymphadenopathy, non blanchable redeness (petechiae) over bil. knees/ elbows (joints) that can cause nosebleeds, bleeding gums, mid-shaft femur pain, or pain with ambulation? Peak incidence is between ages 2 & 5 years of age.

Acute lymphoblastic leukemia

Treatment for women who do not want to have children or are menopausal with cervical cancer?

Total hysterectomy

Treatment for women who want to have children diagnosed with cervical cancer?

Cervical conization (Pronounced cone ah za shun)

This type of cancer is seen in Ashkenazi Jewish populations? How should it be diagnosed?

Ovarian cancer Transvaginal US & CA 125

This is a type of cancer that starts on the nipple & spreads to the areola causing chronic scaly erythematous itchy rash. The nipple may be inverted, bleeding (straw colored) with the sensation of burning, tingling pain.

Paget's Dz

This type of cancer occurs when abnormal cells have not moved out of the mammary ducts into the surrounding tissue?

Ductal (in situ) carcinoma

If breastfeeding mother experiences mastitis what should you instruct her to do in regards to breastfeeding?

Instruct her to continue nursing with both breasts

This form of cancer is aggressive, fast growing and presents with swelling, warmth, peau d' orange, retraction, & itching. Often no distinct mass/lump & more common in African Americans.

Inflammatory breast cancer

1st line diagnostic test in pregnancy or < 30 years of age for breast cancer is?

ULTRASOUND!!! (Note: 3D mammography in female/ men > 30 yrs)

The following risk factors including age (> 50), sex, obesity, lack of physical activity, alcoholism, high dose radiation therapy to chest at young age, family h/o BRCA 1or 2 genetic mutations, low parity, early menarch (<12 yrs), late menopause (> 55yrs), & estrogen meds are seen in what condition?

Breast cancer

The term for immature white blood cells produced by the bone marrow that leads to the diagnosis of leukemia?

Metamyelocytes

This is a neoplastic proliferation the bone marrow that results in skeletal destruction. It is more common in older pts (> 65, African Americans) & causes pain in the long bones in the trunk & back?

Multiple myeloma

How and what age range do you screen a pt. with smoking history for lung cancer?

Low dose CT of the chest in adults 55 to 80 years of age

This type of cancer is associated with Lynch syndrome, familial adenomatous polyposis, & Juvenile polyposis syndrome?

Small bowel cancer

This type of cancer may present with gradual pencil like/ ribbon shaped bloody/ dark tarry stool with wt. loss, N&V?

Colon cancer

Cancer in this pt. may present with sensation of fullness/heaviness swelling in one scrotum that radiates to lower abdomen. Mass does not transilluminate, it is non tender (painless), cremasteric reflex is abscent, & testicle may be high riding with a transverse lie?

Testicular cancer

Prostate cancer screening may begin at what age if high risk, but normally should start at what age?

High risk 40 Normally at 50 yrs

This is clinically insignificant in increasing the prostate specific antigen (PSA)?

Digital rectal exam (DRE)

If prostate cancer is suspected what should the NP order?

Transrectal US with guided needle biopsy

What is the most specific & sensitive imaging test for bone metastases?

MRI

Screening mammogram, annual breast MRI, & clinical breast exam q 6 to 12 months beginning 10 years prior to the age at diagnosis of the youngest family member should be done in pt.'s with?

BRCA 1 & 2 genes

What does ABCD stand for in assessing cancer?

Asymmetry, border, color, & diameter

This is a wart like raised cauliflower like lesion that is painless & commonly caused by HPV is known as what?

Condyloma Acuminata (Pronounced acuma na ta)

Podofilox (condylox) or Imiquimod (Aldara) is used to treat what condition?

Condyloma Acuminata

How is condyloma Acuminata treated in pregnant women?

Mechanical methods (cryotherapy, laser, excision)

What 2 strains of HPV are oncogenic/carcinogenic?

16 & 18

This is a viral skin infection of the fingers that is extremely painful with red bumps/ blisters on the sides of the fingers caused by herpes simplex 1 or 2 that results from direct contact with a sore? how is it treated?

Herpetic Whitlow Tx: acyclovir

When should a pregnant pt be treated if h/o or recent outbreak of herpes genitals (HSV 2)?

Viral therapy should start at 36 weeks or near term

How many days of coverage is required for breakouts of herpes genitals (HSV 2)? How many days for primary?

5 days 7 to 10 days

How long can asymptomatic herpes shedding last?

2 to 4 weeks

What test is used for herpes?

Viral culture, PCR assay for HSV 1&2 RNA is the diagnostic test

This "old test " showed multinucleated giant cells in herpes? It is also used to test for chlamydia & gonorrhea.

NAAT

How is latent syphilis (> 1yr) treated?

Penicillin G 2.4 units IM q week x 3

How is primary, secondary, or early syphilis (< 1yr) treated?

Penicillin G 2.4 units IM x 1

How should pt.'s with syphilis who are allergic to pcn be treated?

Doxycycline or tetracycline x 28 days

What are 2 screening tests for syphilis?

RPR & VDRL

If RPR or VDRL are + for syphilis what test should be ordered?

Fluorescent treponemal antibody absorption (FAT ABS)

What can happen to a fetus is the mother is infected with syphilis?

Can be born stillborn or die as a newborn from infection

Infants presenting at birth with skin rashes, yellowing of the skin or whites of the eyes, liver/spleen enlargement, severe anemia, developmental delay, or seizures may have been infected from what condition from the mother?

Syphilis

Lesions from this condition may persist up to 6 weeks & present with lesions/ rash on the palms of the hands, soles of feet or painless genital chancre typically resolving without tx in 6 to 9 weeks.

Syphillis

How is trichomonas treated?

Metronidazole (Flagyl) x 7 days

This is a small flat wart like or fleshy or grey/white lesion that is painless, typically grows on hands, feet, & genitals. it is a manifestation of syphilis, this is known as what?

Condylomata Lata

AST/ ALT scores > 2 are strongly suggestive of what dz?

Alcoholic liver diz

AANP EXAM NOTES 7 Flashcards

(106 cards)