Oswego Outbreak Investigation Paper

NOTE: The following resource was prepared for class use by replicating portions of the Centers for Disease Control and Prevention’s (CDC), “Oswego – An Outbreak of Gastrointestinal Illness Following a Church Supper: Student Guide” (CDC, n.d.), except for the “Questions” section, with the understanding that the CDC document is in the public domain and available for educational use.

Background:

On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse. Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation. When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper held on the previous evening, April 18. Family members who did not attend the church supper did not become ill. Accordingly, Dr. Rubin focused the investigation on the supper. He completed interviews with 75 of the 80 persons known to have attended, collecting information about the occurrence and time of onset of symptoms, and foods consumed. Of the 75 persons interviewed, 46 persons reported gastrointestinal illness Oswego Outbreak Investigation.

Clinical Description:

The onset of illness in all cases was acute, characterized chiefly by nausea, vomiting, diarrhea, and abdominal pain. None of the ill persons reported having an elevated temperature; all recovered within 24 to 30 hours. Approximately 20% of the ill persons visited physicians. Oswego Outbreak Investigation. No fecal specimens were obtained for bacteriologic examination.

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Description of the Supper:

The supper was held in the basement of the village church. Foods were contributed by numerous members of the congregation. The supper began at 6:00 p.m. and continued until 11:00 p.m. Food was spread out on a table and consumed over a period of several hours Oswego Outbreak Investigation. Data regarding onset of illness and food eaten or water drunk by each of the 75 persons interviewed [are provided in the Excel “Oswego Line Listing Workbook” (CDC, n.d.)]. The approximate time of eating supper was collected for only about half the persons who had gastrointestinal illness. Oswego Outbreak Investigation Paper

Conclusion:

The following is quoted verbatim from the report prepared by Dr. Rubin:

The ice cream was prepared by the Petrie sisters as follows:

On the afternoon of April 17 raw milk from the Petrie farm at Lycoming was brought to boil over a water bath, sugar and eggs were then added and a little flour to add body to the mix. The chocolate and vanilla ice cream were prepared separately. Hershey’s chocolate was necessarily added to the chocolate mix. At 6 p.m. the two mixes were taken in covered containers to the church basement and allowed to stand overnight. They were presumably not touched by anyone during this period. Oswego Outbreak Investigation

On the morning of April 18, Mr. Coe added five ounces of vanilla and two cans of condensed milk to the vanilla mix, and three ounces of vanilla and one can of condensed milk to the chocolate mix. Then the vanilla ice cream was transferred to a freezing can and placed in an electrical freezer for 20 minutes, after which the vanilla ice cream was removed from the freezer can and packed into another can which had been previously washed with boiling water. Then the chocolate mix was put into the freezer can which had been rinsed out with tap water and allowed to freeze for 20 minutes. At the conclusion of this both cans were covered and placed in large wooden receptacles which were packed with ice Oswego Outbreak Investigation. As noted, the chocolate ice cream remained in the one freezer can.

All handlers of the ice cream were examined. No external lesions or upper respiratory infections were noted. Nose and throat cultures were taken from two individuals who prepared the ice cream. Oswego Outbreak Investigation Paper

Bacteriological examinations were made by the Division of Laboratories and Research, Albany, on both ice creams. Their report is as follows: “Large numbers of Staphylococcus aureus and albus were found in the specimen of vanilla ice cream. Only a few staphylococci were demonstrated in the chocolate ice cream.”

Report of the nose and throat cultures of the Petries who prepared the ice cream read as follows: “Staphylococcus aureus and hemolytic streptococci were isolated from nose culture and Staphylococcus albus from throat culture of Grace Petrie. Staphylococcus albus was isolated from the nose culture of Marian Petrie. The hemolytic streptococci were not of the type usually associated with infections in man Oswego Outbreak Investigation.”

Discussion as to Source: The source of bacterial contamination of the vanilla ice cream is not clear. Whatever the method of the introduction of the staphylococci, it appears reasonable to assume it must have occurred between the evening of April 17 and the morning of April 18. No reason for contamination peculiar to the vanilla ice cream is known. Oswego Outbreak Investigation Paper

 

In dispensing the ice creams, the same scooper was used. It is therefore not unlikely to assume that some contamination to the chocolate ice cream occurred in this way. This would appear to be the most plausible explanation for the illness in the three individuals who did not eat the vanilla ice cream.

Control Measures: On May 19, all remaining ice cream was condemned. All other food at the church supper had been consumed. Oswego Outbreak Investigation.

Conclusions: An attack of gastroenteritis occurred following a church supper at Lycoming. The cause of the outbreak was contaminated vanilla ice cream. The method of contamination of ice cream is not clearly understood. Whether the positive Staphylococcus nose and throat cultures occurring in the Petrie family had anything to do with the contamination is a matter of conjecture.

Note: Patient #52 was a child who while watching the freezing procedure was given a dish of vanilla ice cream at 11:00 a.m. on April 18.

Addendum:

Certain laboratory techniques not available at the time of this investigation might prove very useful in the analysis of a similar epidemic today. These are phage typing, which can be done at CDC, and identification of staphylococcal enterotoxin in food by immunodiffusion or by enzyme-linked immunosorbent assay (ELISA), which is available through the Food and Drug Administration (FDA). Oswego Outbreak Investigation.

One would expect the phage types of staphylococci isolated from Grace Petrie’s nose and the vanilla ice cream and vomitus or stool samples from ill persons associated with the church supper to be identical had she been the source of contamination. Distinctly different phage types would mitigate against her as the source (although differences might be observed as a chance phenomenon of sampling error) and suggest the need for further investigation, such as cultures of others who might have been in contact with the ice cream in preparation or consideration of the possibility that contamination occurred from using a cow with mastitis and that the only milk boiled was that used to prepare chocolate ice cream Oswego Outbreak Investigation. If the contaminated food had been heated sufficiently to destroy staphylococcal organisms but not toxin, analysis for toxin (with the addition of urea) would still permit detection of the cause of the epidemic. A Gram stain might also detect the presence of nonviable staphylococci in contaminated food.

Reference

Centers for Disease Control and Prevention. (n.d.). Oswego – An outbreak of gastrointestinal illness following a church supper: Student guide (Case No. 401-303). Retrieved from https://www.cdc.gov/eis/casestudies/xoswego.401-303.student.pdf Oswego Outbreak Investigation

Review the Ten Great Public Health Achievements

HLT 605 Public Health Administration Entire Course
HLT605 FULL COURSE
GC HLT605 WEEK 1 DQ 1 & DQ 2 NEW
DQ 1
Public health practice was initially concerned with infectious and environmentally related diseases, but in recent years has evolved to focus more on injury
prevention, substance abuse, violence, tobacco-related, and other chronic diseases. Present at least one pivotal legal and historical occurrence that resulted in this shift of public health effort. Justify your rationale with supportive evidence.
DQ 2
Review the Ten Great Public Health Achievements (Exhibit 2.3) of your textbook. Select one of the 10 achievements. What is the importance of your chosen achievement to society? In your own words, defend its right to be considered a “Great Public Health Achievement.” Select three other peers’ postings and debate their analysis. Keep in mind all postings should be substantive and well supported with examples, details, and evidence. Brief responses are not appropriate. Review the Ten Great Public Health Achievements
GC HLT605 WEEK 2 DQ 1 & DQ 2 NEW
DQ 1
Focus on a “current event” ethical dilemma in public health. Apply the principles of the ethical practices of public health to resolve the issue (see page 125 of the textbook). You may integrate recommendations based on conclusions from public health acts and principles to support your position. Select three other peers’ postings and provide feedback on the presented resolution. Offer further suggestions, details, or examples.
DQ 2
State agencies typically follow one of two general structure models: the free-standing agency model or the super agency model. What are the pros and cons of each model? Which model do you think is “ideal” for a state agency and why?
GC HLT605 WEEK 3 DQ 1 & DQ 2 NEW
DQ 1
Within a budget there are two categories: mandatory and discretionary. In which categories do most public health programs fall? Provide an example of an expenditure that is considered mandatory. Justify your rationale. Provide an example of an expenditure that is discretionary. Justify your rationale.
DQ 2
What are the responsibilities and role of the Appropriations Committee? What is the importance of this committee to public health spending as it relates to Medicaid and Medicare?
GC HLT605 WEEK 4 DQ 1 & DQ 2 NEW Review the Ten Great Public Health Achievements
DQ 1
The public health workforce is found in both population-based and institutional services that stem from the official public health agencies. What are the most frequent employment sites for health care workers? Present an example of an organization, institution, or agency that would be categorized under each service, population-based and institutional. Provide an example of a job title and an associated job description at each level of service. Select three other peers’ postings to peer review. Provide appropriate feedback.
DQ 2
Review the Root Cause Analysis Topic Materials to learn more about conducting a root cause analysis. Using the “Root Cause Analysis Template,” conduct a root cause analysis of the “Root Cause Analysis Scenario.” Post a description of the problem and a summary of your root cause analysis, including recommendations for proposed action to eliminate the problem from reoccurring. Select other peers’ postings to peer review. Provide appropriate feedback.
GC HLT605 WEEK 5 DQ 1 & DQ 2 NEW
DQ 1
Identify five sources of data available at the federal level. What is the importance of each data source in public health funding and surveillance? Describe the information/content that can be found in these data sources. Present an example of an industry that might find each of these data sources useful.
DQ 2
What is the difference between service-based and population-based applications for information systems in public health organizations? Present an example of each application and justify your rationale. Select three other peers’ postings to peer review. Provide appropriate feedback.
GC HLT605 WEEK 6 DQ 1 & DQ 2 NEW
DQ 1
As it relates to the development and management of public health assessment activities, what is your response to the following statement?
It is suggested that the assessment process is driven by decisions made by the community members themselves, rather than by influences from the outside community.
Select three other peers’ postings and debate their response. Keep in mind all postings should be substantive and well supported with examples, details, and evidence. Brief responses are not appropriate.
DQ 2
What are the four organizational strategy types? Describe how an organization chooses which strategy to implement.
GC HLT605 WEEK 7 DQ 1 & DQ 2 NEW
DQ 1
Provide an example of the three prevention strategies: primary, secondary, and tertiary prevention as they relate to disaster epidemiology. Justify your rationale. Select three other peers’ postings and debate their responses.
DQ 2
How are surveillance systems used in post-disaster situations? Support your answer with examples and evidence.
GC HLT605 WEEK 8 DQ 1 & DQ 2 NEW
DQ 1
Explain the life cycle of public health partnerships. Why are collaborative partnerships important? What reasons or issues lead to the termination of partnerships?
DQ 2
What is the difference between intervention research and systems research? Provide an example of a public health advancement or accomplishment that represents each type of research. In addition, explain the role of systems research and the integration of systems theory for public health programs implemented within community-based organizations. Justify your rationale.
GC HLT605 WEEK 1 ASSIGNMENT NEW
Design a PowerPoint presentation (6-8 slides) that includes the following components:
1.Your definition of public health.
2.An overview of Healthy People 2020 and your perspectives regarding at least one of the leading health concerns posed by Healthy People 2020.
While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. Review the Ten Great Public Health Achievements
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to Turnitin.
GC HLT605 WEEK 2 ASSIGNMENT NEW
Details:
Submit a paper (1,250-1,500 words) focusing on public health reform. Provide an overview of the current status of public health in the United States.

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Review a portion of the Affordable Care Act and present the strengths and weaknesses of the plan, as well as make suggestions for plan improvement.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
GC HLT605 WEEK 3 ASSIGNMENT NEW
Details:
Create a small budget for a hypothetical state program based on priority health concerns from Healthy People 2020.
In addition, create a narrative (2-4 sentences) that identifies the most appropriate federal funding source for your proposed program.
APA format is not required, but solid academic writing is expected.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are not required to submit this assignment to Turnitin.
GC HLT605 WEEK 5 ASSIGNMENT NEW
Details:
Select a database from NCHS or complete a query using CDC WISQARS.
Select a specific health concern or injury using the population of your choice. Be sure not to limit your query so you have enough data to evaluate, and include a substantial time frame so you are able to identify trends.
Submit a 750-1,000 word report that provides an overview the database or query results. The report should consist of a demographic description of the chosen population including a review of noticeable trends in morbidity and/or mortality by race, gender, and geographic location where specified.
Based on the results and possible trends, present the implications for public health intervention or involvement.
In your report, include considerations of basic ethical and legal principles pertaining to the collection, maintenance, use, and dissemination of epidemiologic data. As Chapter 13 of the text describes, focus on privacy and security issues surrounding protected health information and how HIPAA protects the confidentiality of the patient. Consider the ethical implications of whether public health organizations have too much latitude in the use and dissemination of epidemiologic data.
Use examples and evidence to support your report.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
GC HLT605 WEEK 7 ASSIGNMENT NEW
Details:
This is a Collaborative Learning Community (CLC) assignment.
The instructor will assign each student to a CLC group.
Each CLC group will be assigned one of the following public health emergencies to analyze: swine flu, shortages of influenza vaccine, anthrax, severe acute respiratory syndrome (SARS), Gulf of Mexico oil spill, Hurricane Katrina, California wildfires, syphilis outbreak, salmonella outbreak, and mass trauma (such as that associated with terrorists/bombings).
In a report format of 500-750 words, address the following:
1.Describe the chain of command and the method of public health response that was conducted in this situation.
2.Determine the important public health issues related to medical care in this situation.
3.Describe the possible public health risks as well as the pros and cons of communicating the situation to the public and the media.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
One member of the CLC group will post the assignment on Day 1 of the Topic 8 discussion forum for peer review. Individually, provide constructive feedback and commentary and ask specific questions to all posted public health emergencies. In particular, focus on the chain of command as it relates to addressing the specific emergency, the benefits of effective communication, and the risks associated with miscommunication of emergency-related events and statistics. It is the CLC group’s responsibility to decide who will respond to the postings provided by peers. This will account for part of your participation grade for the week.
GC HLT605 WEEK 8 ASSIGNMENT NEW
Details:
Review your state public health department and environmental quality departments online to identify vector-related diseases affecting your community.
In a report format of 1,250-1,500 words, address the following:
1.Describe the health concerns of the community.
2.Identify current environmental risk assessment methods which apply to public health issues.
3.Suggest a modifier or new prevention or intervention program based on your research.
4.Create a sample program budget.
5.Complete a SWOT analysis of the proposed program.
APA format is not required, but solid academic writing is expected.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success CenterView less » Review the Ten Great Public Health Achievements

AANP Exam tips Paper

• AANP Exam tips
• 3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? Iron, TIBC
• 3 months of synthroid, TSH increased, T4 normal, what do you do? Increase Medication
• 3 ways to assess cognitive function in patient with signs/symptoms of memory loss…. Mini mental exam
• 4 month old with strabismus, mom is worried…… tell her it is normal. AANP Exam tips Paper
• 4 month old wont keep anything down, what is the main thing you look at? Growth chart
• 6 month old closed anterior fontanel. XRAY
• Abnormal cells on PAP, what do you do next? Refer for Colposcopy
• CAGE ACRONYM
• Causes of tachycardia
• Cranial nerves responsible for extraocular eye movements… 3,4,6
• Definition of metabolic syndrome- cluster of conditions that increase risk of heart disease, stroke, diabetes.
• Definitive diagnosis of acute bacterial prostatitis: urinalysis and culture!
• Diagnose Trich: wet prep
• Elederly presents with atrophic vaginitis, small uterus, palpable 4×5 ovary, what do you do next? Pelvic US
• Elder presents with atrophic vaginitis-add estrogen cream
• Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? Anterior septum

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• Fingernail hematoma treatment… drill hole, drain blood
• GERD treatment: H2 is first line
• Grade 3 cells on pap, treatment? Excision
• Growth Plate fracture/Salter Harris Fx
• Increased risk of ectopic pregnancy…. Salpingitis
• Koplick Spots… Measles
• Legg-Calve Perthes disease: avascular necrosis of the proximal femoral head
• Lipid level of 1500, increased risk for? Pancreatitis
• Low HGB, Low HCT, High MCV indicates what? Macrocytic anemia, B12 Def
• Man with high BPH, prostate feels on digital exam? Enlarged, symmetrical, smooth
• Man with HTN, CAD, present femoral pulses but absent pedal…. Arterial Insufficiency
• McMurrays Sign- Meniscus tears
• Lachmans- ACL
• Know heart murmors!!!! MrPASS MVP MsARD
• Newborn with foot turned in, what do you do? Refer to orthopedist
• Osgood Schlatter disease- Knee pain
• Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? Alzheimers
• Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? Refer to oncologist
• Know labs for diagnosing Hepatitis
• Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? Tinea Corporis
• Pt presents with “bag of worms:, indicates? Varicocele
• Pt with atopic dermatitis, look for what other diseases? Asthma
• Pt with bleeding after menopause- endometrial biopsy
• Pt with hx of PID, increased rick for? Infertility
• Bacterial vaginosis does not cause PID- trich, gonorrhea, and chlamidia can cause it
• Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? This is good. Want higher than 350
• Pt with hx of htn and stroke, now having memory loss. What does this indicate? Vascular dementia
• Pregnant teacher with exposure to 5ths disease, what risk is there to the fetus? Fetal death and birth defects
• Quick assessment of patients fall risk? Timed Get up and Go
• Red beefy tongue? Pernicious anemia
• Rotator cuff injury presentation: disturbs sleep, arm weakness, dull ache
• Shingles near eye- immediate referral to ophthalmology
• Signs and symptoms of Roseola? High fever, pink flat or raised rash
• Treatment for chronic alcoholism: 12 step program
• Treatment for Gonorrhea? Rocpehin IM and Zithromax PO
• Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: IUD

Questions:

few questions about T2DM and appropriate treatment, including insulin.
Know the reason for doing a PSA
When to give a pregnant woman with negative rubella titer the rubella vaccine
Treatment for gonorrhea, and syphilis, including during pregnancy
What meds you can’t take while ingesting grapefruit juice
Bells palsy s/S
S/s of serotonin syndrome
Kawasaki disease presentation
Lab test for “slapped face”
Treatment for shin splints
What to do with thyroid meds based on lab values
What heart sound would be expected in CHF
What antihypertensive meds to avoid in GERD
Who gets hep C screening
Definition of AIDS
No hepatitis a or b on mine
The cheapest treatment of shingles -acyclovir
T2DM has foot laceration, what would u monitor them for- osteomylitis
Acute GAD treatment-ssri
Know which murmurs are diastolic and where they’re located
What pts would need to go to ED with pneumonia… CURB65
Presentation of allergic conjunctivitis- bilateral eye symptoms
Treatment of mild persistent asthma
Parents have heterozygous disorder, what % of children are homozygous-25%
Weber and Rinne
No CN questions for me
Darcosytosis s/s
Cotton wool on fundoscopic exam means?? AANP Exam tips Paper
Chronic use of afrin causes…medicamentosa
Vascular dementia most commonly occurs with people who had stroke and htn
S/s of strep a pharyngitis

Questions:

Some of the questions I still remember from this morning exam:
Signs and symptoms of definitive HF
Description of Molluscum contagiosum
Management of fall with extended arm but no fracture seen on the xray
2 questions about Hepatitis
Dacryocystitis
Evaluation of fall for the elderly
Know your labs for anemia, hypo & hyperthyroidism, hyperparathyroidism
Systolic murmurs
Carotid bruits
Primary amenorrhea
Acquired hypothyroidism
Drugs for OM and alternatives
Drugs for gono and chlamydia and alternatives
Autosomal recessive and dominant
AV nicking
Pediatric asthma management
Infant dehydration assessment
Trichomonas
Grades of HF, bruits and thrills
A lot of questions about Weber and Rinnes test
Erysipelas
12 weeks just above SP
Intussuception
Wilms tumor
Antipsychotic drug that causes hyperglycemia
Management of TG if niacin does not work
When to prescribe insulin… that’s all I remember. And I’m sure all of you know these stuff? AANP Exam tips Paper

but some variations like titration of levothyxine based on labs as well as coumadi at least 4 or 5 questions . Grapefruit affects what meds? On the review class from Barkley, some comments about the least expensive treatment for severe shingles. His questions are not the same format as AANP. TB diagnosis and PPD readings. No cranial nerves. Xray interpretation of knee fx. No pictures. What kind of pain on MI, ekg interpretation. Read in detail about the 3 recent posts about the new test, they helped me a lot . Good luck

 

Questions:

genetics, a few on sexually transmitted disease and the medications (mostly gonorrhea), I had several questions about the elderly and medications that were safe and meds that were not. I had several questions on Derm, Basal cell carcinoma and seborrheic keratosis, I had a lot of questions of what labs to order, and they gave the situation of the patient. I had several questions on monon, anemia ,and sinusitis. I had PNA when to send to ER, Glaucoma, Hep B, 2 murmurs, one asthma, One on Marijuana s/s, 2 on BV, one on Alzheimer’s, one on hypothyroidism, one on symptoms of a person with Myasthenia Gravis, menopause, woman had bleeding what to do, Glaucoma, also shingles around the eyes, treatment of Bells Palsy, also how to diagnose Temperal arthritis, OA and RA.

 

Questions:

anemias and RA vs OA, two murmurs, 2-3 Hepatitis serological, picking which Abx is appropriate for a named infection, PTSD, lots of frail elderly, STIs, PUD, GERD, Adolescents, who’s at risk for suicide, Myesthenia Gravis, Parkinson’s, appropriate tests for poss diagnoses, HTN meds, proteinuria, gastroenteritis dx, tests for appendicitis, expected labs changes in cholecystitis, dx hepatitis from pt symptoms.

Questions:

hep b and C, hypercalcemia, fibromyalgia, Alzheimer’s, fifth disease, MCL, Pagets.

Questions:

I had a couple of questions on genetics, a few on sexually transmitted disease and the medications (mostly gonorrhea), I had several questions about the elderly and medications that were safe and meds that were not. I had several questions on Rocky Mountain spotted fever. I had a lot of questions of what labs to order, and they gave the situation of the patient. I had several questions on mononucleosis, anemia ,and sinusitis. I want to thank everyone for all the questions that were posted, they helped a lot. AANP Exam tips Paper

Questions:

Here’s some additional details on my AANP FNP exam from Jan 12, 2018. I suspect my exam was the “new version” (it was expected to be updated this January).
[Edit: I have no idea if/when the test is updated – lots of people posted conflicting information about it; you can search the group for posts on the subject to see the whole gamut.]

NOTE: I will not give out any questions or any specifics. This is just a vague description of some of the topics covered. ?

I feel like I had multiple musculoskeletal questions – from RA to pediatric conditions to tendonitis to grade 3 muscle strains.

I had a lot of endocrine on my exam too – particularly hypothyroid, hyperthyroid, Hypoparathyroidism vs hyperparathyroidism – the type of questions ranged from from s/s, to meds, to scan, test and lab results.

Quite a few derm questions, from lichen planus to tinea to BCC to shingles. One question about what in-office procedure is best for a specified derm finding.

Only 1-2 questions were right off the PSI predictor. Only a few were like the questions from this group or from Leik. Difficulty level of the AANP exam felt more in line with the difficulty of the APEA practice exam.

2 murmurs. One hepatitis serology. 2 asthma. 1 or 2 anemia questions.

Also:
EKG finding description for bradyarrythmia
Otitis externa and media
Varus vs. valgus in knee exam
Presentation of HTN 2* to renal dx
Tendonitis progressing into tear s/s
Palpable ovary in elderly female
Palpable abdominal mass in a child
Headaches
Hyperlipidemia
Calcium dosage
Meds that may worsen GERD s/s
Diltiazem
Acute renal conditions
Concussion
Pain meds for geriatric pt
Venous and arterial insufficiency
Top cause of mortality in a specific population group
Post menopausal abnormal gyne findings and how to respond
Antibiotics
Newborn/infant GI disorders

 

Questions:

Fair amount of derm and Peds derm dx and treatment, Peds ortho dx and reg ortho dx and tests, elderly women’s health issues, some pregnancy. 2 murmurs, one asthma, one asked about prolonged PR on EKG strip what kind of block!!, UAs, thyroid and parathyroid, one anemia, one hep serology, one asthma tx, infant emergent conditions.

passed AANP yesterday!! yayy! This group was so much help! Thank you for everyone posting tips and questions! I strongly recommend going through the tips that people have been giving in the past few weeks. My test had many of the topics they gave! Some of the questions I had no clue at all, but most of them I could come down to two answers and choose from there. It was very nerve wracking and I am so happy to be done! One thing that really helped me every day for a couple weeks for my test was I reread this bible verse over and over and told myself it was okay if I failed! It put less pressure on me 🙂 Here are some of the topics I specifically remember! (also read the old psi test because I had a couple from there on the test) AANP Exam tips Paper
I started studying hard about 3-4 weeks before the test and I studied most week days at least 5-8 hrs because I felt very behind and like I needed it. I went to a fitzgerald live review a couple of months ago, I watched and took notes on all of the hollier videos (which really helped me get an initial knowledge for the topics) then I read the leik book (which had almost every topic that was on my exam!) then I made note cards and spent the last week reviewing those and the topics that were given by the people in this group. Probably overkill but I’m glad I did it! On my scratch paper I wrote: Deuteronomy 31:6, heart murmurs, cranial nerve picture, S/S of anticholinergics (SAD CUB) and SSRI (BAD SSRI), weber and Rinne and hepatitis panel.
– Dacrocytsis
-ruptured tympanic membrane
-Rosacea
-thyroid and parathyroid
-Treatment for gonorrhea and chlamydia while pregnant
-I had about 3 cranial nerves which I wasn’t expecting
-2-3 Rinne and Weber
-aquired hypothyroidism
-know what fundoscopic exam will look like from HTN and DM-I got one about AV nicking
-Fundal height at 12 weeks
-Wilms tumor
-Carotid bruits
-Primary amenorrhea
-Apthous stomatitis- a little kid with sores in his mouth
-Hypertension medications – like which one you would give or not give for specific patient- which one causes GERD CCB.
-Fibromyalgia diagnosis-11/18
-Gold standard for temporal lobe arthritis- biopsy, give sterids, associated with Temporal arteritis
-I had one hepatitis question- IGm was positive
-Cause for ectopic pregnancy
That’s all I can remember specifically! Good luck everyone!

Question that I  was able to remember
•       Basal Cell Cancer: Question description and the fact that it doesn’t have any tx  (Hints: Waxy, pearly, telangiectasia, ulcer center lesion
•       Actinic Keratosis: Question about description (Scaly red to yellow located in sun exposed area
•       Melanoma question: Know ABCDE
•       Subungal Hematoma tx: Make a hole and drain the blood
•       Tx for moderate acne- I got one about Retin A
•       Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS question was asked about heart murmur with high pitch holosystolic and the other one is mid systolic.  Got one about a low rumbling diastolic murmur
•       Question about Grade III/VI Murmur: (Loud murmur easily heard)
•       Coarctation of Aorta: Know that systolic BP on lower extremities is supposed to be higher compare to upper extremities. In COA case its vise versa. AANP Exam tips Paper.  Look for weak radial and bounding femoral pulse
•       Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency. There was question about PAD and the answer was exercise by walking (Tx)- chronic venous insufficiency you elevate it
•       Question about JVD causes? HF right side to be specific
•       Know Bacterial endocarditis (There was a pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules) Osler’s nodes
•       RML CXR
•       Chronic bronchitis description and treatment
•       Hiv pt. PPD + (5mm)
•       Croup/Epiglottitis: Question about what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck.
•       Hyper and Hypothyroidism
•       Question about AV nicking (Arterioles pressing on vein of the eye): Its HTN retinopathy
•       Question causes of IOP-Papilledema
•       Rovsing sign

Mcmurray sign
•       Pt. with GERD and Barrett’s esophagus: Refer to Oncologist
•       Question about pencil like stool: Options include problem with ascending colon, descending colon. Descending colon

Question about  a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy
•       Question about Hepatitis B active Immunology.
•       Know your urinalysis result
•       Question about Pt. complaining of headache after trauma: (Options include post concussion headache, subarachnoid hemorrhage and Subdural hemorrhage). I think the answer is subdural hemorrhage
•       Question about Migraine headache: Know the description and duration of headaches as well- nausea vomitting
•       Question about CN 3,4,6 (EOM)
•       Anemia question, Vitamin B12 deficiency-beefy red tongue, tingling
•       A lot of Musculoskeletal questions: (Anteriorly ligament which is for ACL; Apprehension test positive, lateral epicondylitis Tx, Morton’s Neuroma description as someone with high heels and has a mass or nodule on the 4th/5th toe)
•       Osgood Schlatter Disease: Hint tibia tuberosity
•       Question about an 88/yr. old patient in for follow up secondary. She’s been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. (Do nothing, Increase Tylenol, change to NSAID, and pt. is expected to have a high SED rate due to age). I think it should be changed to NSAID cuz SED rate is a sign of inflammation,
•       Question about medial Tibia Stress
•       ADHD is a behavior disease
•       Which medication causes low sperm count for a patient (SSRI)
•       Question about grandiosity (Bipolar)
•       Question about contraceptive pills
•       Question about, Trichomonas test wet mount was mentioned on the exam
•       Question about a pt. pap’s smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? (Options are referring for colposcopy, repeat in 12 month and can’t remember other options. My review book stated to order HPV test if not done. Refer for colposcopy.
•       Question about NP palpating right ovaries on a 1-year postmenopausal woman. Options include (To refer for endocerviacal test, for ovarian cancer something, couldn’t remember other options). Answer is to r/o ovarian cancer
•       Another question about who is at high risk for ovarian cancer (Options include Family history, previous abortion and cant remember the rest)
•       High risk for ectopic pregnancy: (Options include: Infertile, and cant remember the rest of the options)
•       Question about chlamydia
•       Question about CURBS: Which of the options does not require hospitalization for pneumonia (Options are all except 1; all include one that’s not part of it) Review CURBS: It’s a criteria for pneumonia hospital admission
•       Question about genital wart tx
•       Question about treating HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. (Different option but the best option is to tell the pt. that he is qualified to be diagnosed with AIDS according to CDC
•       Most common cause of death in children (Options are poisoning, Motor vehicle accident, drowning, and cant remember the fourth one)
•       Tanner stage questions
•       Sensorineural (Presbyacus) AANP Exam tips Paper
•       Know types of Alzheimer’s: Question about a pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. Options include (Dementia with lewy bodies, Vascular dementia, frontotemporal dementia). I think the answer is vascular dementia.
•       Question about Romberg test and how its done
•       Question about sensitivity
•       Question about Coombs test r/o bilirubin
•       Hyperbiliribubin question risk

•      Preeclampsia tx  (bed rest, laying on her side and
  •       Question about a pregnant female at slightly above symphysis pubic   and Fundal height is 32cm (above the umbilical. What should be done (I picked to have Ultrasound done to)
  •       Question about molloscum contagiosum- umbilicated,
  •       Question about pyloric stenosis (Hint is non bilious vomiting, olive like firm mass palpated on right upper quadrant)
  •       Review your skin issues for adult and kids.

Question about Rubeola (Koplick)- measles
•       Question about horizontal nystagmus that stops when eye is close to midline in a college student (options include messinere, BBPV, normal and cant remember the forth one)
•       Question about someone eating, painful lump noted on the jaw that comes and go. Options include (Cancer of Wharton, sialolithiasis). The answer is sialolithiasis
•       Question about ADHD (options include are solely a behavior disorder, panic, personality disorder)
•       Question about a pt. complaining about upper arm tremor that seems to be hereditary. What’s the treatment? options include (Xanax, lorazepam, metoprolol and cant rember the last one)
•       Which among the list can cause increase in respiration. Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)
•       Question about osteoporosis risk factors. Options include (low estrogen level, obesity, sedimentary lifestyle, cant remember the last one)

Osteoporosis exercise- walking (weight bearing exercise)
•       Tx to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct (Option include Calcium carbonate 600mg, vitamin d 800 IU, cant remember the remaining 2 options)
•       Questions about carotid bruit signs can signifies what. Options include (Pulmonary HTN, carotid problem, cant remember the remaining two options0
•       Ovarian CA risk. options are (multipara, family history and cant remember the rest).
•       Question about ectopic risk factor. Options include (abnormality, exposure to some chemicals, previous abortion)
•       Common causes of GERD. Options are (Histamine blocker, BB, CCB, cant remember the last one)
•       Zeprexa (What lab and intervention to put in place) such as weigh check, DM,)
•       Question about what’s the common bug in children with diarrhea.
•       What test needed to differentiate lesion/cyst found on a breast (Options include Screening mammogram, Ultrasound, Need aspiration)
•       Increase in triglyceride can cause pancreatitis
•       Weber/Rinne Test know this by heart multiple questions about it –WUS and WAC

Lung sound on a pt with emphysema- I put hyperresonance?

 

2/15/18:

Things I remembered that I marked:
– Assessment for dullness on patient with ascites
-INR goal on patient with DVT less than a month ago 2-3

If INR not therapeutic increase the dose
-know pneumoconiosis (so you know which one you can eliminate)
-Varus/Valgus test
-know the difference of measles (Rubeola)vs german measles(Rubella) AANP Exam tips Paper
-patient with IOP of 32mmHg, what do you expect during fundoscopic exam-Cupping
-1st line tx for Chronic bronchitis
-significant risk factor for ovarian CA
-meds for patient with BPH and urge incontinence-flomax
-causes of hyperbilirubinemia in newborn
-treatment for genital herpes-cheapest option acyclovir oral
-mild persitent asthma meds
-CN responsible for EOM (3,4&6)
-metabolic syndrome criteria
-seasonal disorder definition
-intussusception symptoms
-fundal heights and what to do if there is discrepancy with the expected measurement
-glucagon counteracts hypoglycemia
-Janeway lesions and Osler’s nodes for bacterial endocarditis
-causes of carotid bruit
-III/VI murmur presentation
-organism responsible for IBS
-otitis externa treatment
-meds for patients with osteoporosis (know your Ca and Vit D dosage)
-Psych med that causes high glucose
-Meds for GAD-ssri

Know presentation of PTSD
-hallmark finding in retinoblastoma
-molloscum contagiosum description
-signs of dehydration in infants (post fontanel)
-meds for staph aureus infection (skin) with pus
-hyperparathyroidism=high calcium level
-tx for hyperthyroidism
-breast changes in elderly
-antihypertensive med that causes GERD
-difference of RA vs OA based on symptoms
-systolic vs diastolic murmurs
-recent guidelines on screening mammography
-symptoms of serotonin syndrome
-causes of arrhythmia in elderly-hyperthyroidism
-Weber/Rinne test
-How to diagnose fibromyalgia
-lab test for fifth disease-B19
-one anemia screening question
-pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give? (Process of elimination..) azithromycin

 

2/14/18:

-treatment for chylamdia in pregnant women
-know CURB 65criteria.
-sensorineural hearing loss  what is it called in elderly-presbycusus
– basal cell description
– squamous cell description
-Signs in strep throat
-when do you see av nicking
– what does IOP look like of fundascope
-treatment for allergic rhinitis
-treatment for pt who comes in with “something in my eye”. What would NP do first? Check visual acuity
-papilledema what it looks like on fundascope .
-TB in duration for Immuno compromised pt.
-what does melanoma look like
-what would np do when pt. comes in with rash on palms .
-what test would you order to evaluate breast cyst
-know treatment for COPD
-know tx. For mild persistent asthma
-what is first approach for pt. With high lipids
-causes of GERD
-know how to treat thyroid  disease. They give you labs and you decide what to do  with meds
-jvd what does it indicate
-treatment for subungal  hematoma
-pyloric stenosis
-causes of Peptic ulcer disease and presentation
-when you give pregnant woman MMR- postpartum
-H/A. Know signs, duration I had 2 questions on  different type and 1 question  of treatment
-sensitivity def.
-tx for gonorrhea
-anemia’s. Know s/s and labs – ex what would pt present w/ an elevated MCV MCH
-know test you perform for knee injuries. Lachman Test and anterior drawer.

-neuro:Romberg tear, post  concussion
-breast changed in elderly
-know thx for calcium and vit. D
-Know murmurs where they Are located, radiate ,
-know murmur grades
-labs you would consider for pt w/5th disease
-tx. for GAD
-contraindications for taking ACEI

Ace inhibitor can cause renal stenosis- stop the ACE

-when you administer live vaccines-12months
-tx for mild acne
-when would you see Kolpik
-s/s of otitis externa
– cataracts – how would pt describe s/s
– Kawasaki disease.  How does pt present desquamation
– Know ABCDE of melanoma
– Lyme disease
– RMSF-presentations in hands and feet
– Coaction of  aorta. What would pt exam look like
– JVD when do you see it and what does it mean
– Description of MI  how would patient describe feeling-persistnat does let up
– Addison’s. What would pt.    presentation look like – needs steroids, HINT pt craving salt
– Romberg  Test. How do you do it
– Dx of essential tremors.  What would you prescribe for pt to relieve or decrease tremors
– HIV know DC4 count
– Tx of pt with urge incontinence what med would you prescribe
– Tx for allergic rhinitis-flonase
– Osteoarthritis how joints present (on hand) bochard and herberden
– Exercise that would help osteoporosis-walking
– Dx of fibromyalgia
– serotonin syndrome what are s/s
– Tx for veriocele
– Coombs Test
– Know Fundus Checks
– Morton’s. Neuroma
– Korsakoff wernicke

-Mastitis tx

2/11/18:

I had breast-feeding, Child growth stages, STD, hyper and hypo thyroidism, skin types and treatments, screening for breast cancer, colon cancer, birth control, hepatitis, heart murmur, several questions on medications for BP and DM type 1 and 2, temporal arteritis, anemia, and skin treatments for adolescents.

2/6/18

lot of geriatrics- HF, COPD meds, kidney issues & meds to avoid, DM- the question about DM pt with foot laceration – what is he at risk for was on there. Thyroid & parathyroid question, HTN, hyperlipidemia, neuro – Parkinson’s , LUTS, (bph, prostatitis) women/pregnancy- AFP testing, fundus height, mastitis treatment- obvious answer of dicloxacillin was not listed as an option, so I used Hollier’s trick- which bug are you treating then the answer became obvious- more than 5. One eye thing.  Lots of pedi – resp, msk, rash – viral exanthems, one murmur question.  Lots of adolescents- Early & late adolescents questions. STD male & female – HIV/AIDS, gonorrhea, syphillis. One anemia- pernicious, cluster & migraine h/a.  Reason for JVDistention. AANP Exam tips Paper

 

2/2/18:

heart murmurs, cranial nerve picture, S/S of anticholinergics (SAD CUB) and SSRI (BAD SSRI), weber and Rinne and hepatitis panel.
– Dacrocytsis
-ruptured tympanic membrane
-Rosacea
-thyroid and parathyroid
-Treatment for gonorrhea and chlamydia while pregnant
-I had about 3 cranial nerves which I wasn’t expecting
-2-3 Rinne and Weber
-aquired hypothyroidism
-know what fundoscopic exam will look like from HTN and DM
-Fundal height at 12 weeks
-Wilms tumor
-Carotid bruits
-Primary amenorrhea
-Apthous stomatitis
-Hypertension medications – like which one you would give or not give for specific patient
-Fibromyalgia diagnosis
-Gold standard for temporal lobe arthritis
-I had one hepatitis question
-Cause for ectopic pregnancy

GOOD LUCK EVERYONE!!! HAPPY STUDYING!!!

 Board Review Combined

Skin:

 

RMSF- Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline.  EXAM

 

Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST being bitten by a deer tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, then confirm with western blot. Increased ESR. TREATMENT: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline. EXAM

 

Melanoma- Dark Moles, uneven texture, different colors, irregular, >6mm, could be itchy. EXAM

 

Stevens Johnson Syndrome- Classic is target or bulls-eye. Abruptly, hives, blisters, petechiae, purpura, necrosis, sloughing of tissues. Extensive mucosal involvement. Prodrome of fevers with flu like symptoms. Triggers: Allopurinol, anticonvulsants, pcn, sulfonamides, NSAIDS. HIV ppl have higher risk for this syndrome.

 

Psoriasis– Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.

(Koebner phenomenon- new psoriatic plaques form over skin trauma)

(Auspitz sign- pinpoint bleeding when plaques are removed).

TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic.

 

Acanthros Nigricans- velvet hyperpigmented patches most common on back of neck or skin folds- DM resistance.

 

Scabies- itching bedtime. Primethrin cream treat everyone wash sheets and everything else in hot water.  AANP Exam tips Paper.

 

Atopic Dermatitis (eczema)- Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. “small vesicles that rupture leaving painful, bright-red, weepy lesions” they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM

 

Tinea Corporis- “ring like itchy rash, slowly enlarge central clearing”-Treatment: most respond to topical antifungals, if severe do oral Lamisil.  EXAM AZOLE ending

 

Actinic Keratosis- Precursor to squamous cell carcinoma. “numerous dry round and pink to red lesions” with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness. EXAM

 

Seborrheic Keratosis- soft round wart light tan to black pasted on. Asymptomatic and benign.

 

Cellulitis- Deep dermis poor demarcated low legs.  EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS.

Erysipelas- Group A strep, Upper dermis, clear demarcated, cheeks, shins.

TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d.

MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.

 

Basal Cell Carcinoma- pearly, waxy, skin lesions, atrophic, ulcerated center that does not heal.

 

Molloscum Contagiosum- white plug, dome shaped. Highly contagious. EXAM

 

Varicella Zoster Virus- “contagious 48 h. before, until all lesions crusted over” low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. “initially on trunk, then scalp and face” TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best.  EXAM

 

Acne Vulgaris (common acne)- ON EXAM

mild (topicals only) *open/closed comedone w/ or w/o sm. papules. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide.

Moderate (topicals plus antibiotics)- papules, pustules w/ comedones. Continue with topicals combined with topical antibiotics. Then add ORAL antibiotics tetra, mino, doxy.

Severe- with painful indurated nodule, cysts, abscesses, pustules. Accutane- check LFTs, 2 forms of contraceptives, monthly prego testing, only prescribe 1 month supply.

 

Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM

 

Impetigo-Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM

 

Scarlet fever (Scarlantina)- “sandpaper textured-pink rash with sore throat” strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates. EXAM

 

LICHEN PLANUS: SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals. EXAM

 

Spider bite: fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc. Exam

Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM AANP Exam tips

HEAD/EARS/EYES/NOSE/THROAT

 

Herpes keratitis- fluorescein dye “fern like” CN V.  Abrupt onset of pain.

 

Corneal Abrasions- Round/Irregular. Was on EXAM.

 

Acute Angle-closure glaucoma– acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT. EXAM

 

Primary Open Angle Glaucoma- CN2 gradual changes in peripheral vision LOST FIRST, then second central vision.

 

Cataracts is on EXAM in elderly night vision issues. Opaque EXAM

 

Age-Related Macular Degeneration – Painless loss of “central vision” reports straight lines appear curved. Periphery is preserved. Give asmler grid. AANP Exam tips Paper

 

Retinal Detachment- Floaters, curtain, flashes of light. Painless. EXAM

 

Cholesteatoma- cauliflower, foul-smell, hearing loss. If erodes bones in face affects CN VII. SURGERY

 

Canker sores- Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash.

 

Papilledema- optic disc swollen w/ blurred edges due to increased ICP. EXAM

 

Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM

 

Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED

 

Koplik Spots- “clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars”. Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM

 

Sensorineural:  Lateralization to good ear.  Rinne- AC > BC.

Conductive: Lateralization to bad ear. Rinne- BC > AC.

Rinne (1^st mastoid, 2 front of ear, time each area).

Weber: Tunning fork midline. CN 8 (acoustic). EXAM

 

Hordeolum- painful swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin.

 

Acute Otitis Media- middle ear. Usually S. pneumo. (others: h influ, mor catarrhalis).  Popping, muffled, afebrile or low-grade, TM can rupture blood and pus on pillow on awakening with relief of ear pain. “erythematous TM” bulging or retracting. Decreased mobility. TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. Weber- Lateralization to bad ear. Rhinne- BC>AC. If your patient is only PCN allergic do azithromycin or clarithromycin.  EXAM MULTIPLE QUESTIONS AANP Exam tips

 

Otitis Media with Effusion– Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. THIS ONE U CAN DO SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM

 

Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin,  Cipro EXAM

 

Presbycusis- sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM

 

Allergic Conjunctivitis- “stringy; increased tearing” PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner.

 

Anthrax- animals/hides/hair/wool. Lesions begin as papule that enlarges quick 24-48h develops necrosis and ulceration (sort of like a spider bite recluse)- Treatment: Doxy, Cipro, Levaquin. If you suspect BIOTERRORISM treat 60 d. Prophylaxis – Cipro, doxy. If BIOTERRORISM 60 d.

 

Sialolithiaisis- painful lump hurts more with eating (by jaw) aka calculi or salvary stones. Usually in sub mandibular gland aka whartons; duct.

 

Meinier’s disease- VERTIGO TINNITUS, HEARING LOSS.

 

BBPV DIX HALLPIKE MANEUVAR EXAM

SINUSITIS ON EXAM: TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE

MONO know the name of test. Its heterophile antibody test. ON EXAM

 

CARDIOVASCULAR

MI- atypical SOB, dyspnea, weakness, n/v, fatigue, syncope. Back pain. EXAM or typical signs

Medication causing heart burn- BB, CCB, alpha agonists. (HTN meds). EXAM

 

1. ASS (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam.

Mitral Regurg (Holo/pansystolic)- radiates to axilla. Think Mitral area 5^th ics MCL.

Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb.

MS ARD (Diastolic Murmur)

Mitral Stenosis – soft low rumbling best apex / mitral 5ics mcl. Opening snap. Use bell. (MID/LATE DIASTOLIC)

Aortic regurgitation- loud high pitched, blowing murmur. (EARLY DIASTOLIC)

 

All diastolic murmurs are pathological. Murmurs I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM AANP Exam tips

 

Benign split s2- pulmonic best. Normal during inspiration disappears with expiration.

 

MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC.

 

S3- HF, Kentucky, early diastole. Abn >35. Bell EXAM

S4-LVH stiffening, Tennesse, late diastole. “Atrial kick/gallop” EXAM

S1- Closure of AV

S2- Closure of SL

 

EXAM: 1^ST DEGREE OR A 2^ND DEGREE DESCRIPTION OF HEART BLOCK

 

BBS AFTER MI IS ON EXAM

 

Isolated systolic hypertension- do CCB. EXAM

Stable Angina? – do stress test.

PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM

 

CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings.  EXAM

 

BP – ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80.  ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.

 

Thiazides- no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM

 

Infective Endocarditis- Fever, chills, malaise, new onset murmur. Oslers nodes- painful petechiae, violet colored nodes on the fingers or feet. Janeway lesions- non tender red spots on the palms/soles. Fundoscopic exam may show roth spots or retinal hemorrhages. Blood culture x3 (first 24 hours). Antibiotic prophylaxis is NOT recommended. Except if there is existing infection. 1 h. b4 Amoxicillin 2g po or 50mg/kg. AANP Exam tips Paper

Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM

Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM

COA ON EXAM

PULM

COPD- Gold 1-2- SABA or SAMA ON EXAM.. BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM

Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue.

Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS.

Gold 3-4- refer

SABA- Albuterol, levoalbuterol (terol)

LABA- Formeterol, salmeterol (Terol)

SAMA- Atrovent Ipatropium (tropium)

LAMA- Spiriva Tiotroium (tropium)

COPD long term is OXYGEN

 

Asthma Intermittent  ON EXAM. BASCIALLY IF LOW DOSE ICS, NEXT IS MEDIUM DOSE ICS ON EXAM

(<2d, <2)- SABA

Mild persistent

(>2d, 3-4N)- SABA, Low dose ICS *Altern. Cromolyn, leukotriene, theophylline.

Mod Persistent

(DAILY, NOT NIGHTLY)- SABA,  Low dose ICS plus LABA or Medium dose ICS.

Severe- (Throughout the day, nightly)- SABA, Med ICS plus LABA. AANP Exam tips Paper

 

Always think first line treatment for asthma is some type of SABA, and ICS.

 

CURB-65 (criteria for hospital admission) If >1pt. hospitalize. Confusion, Blood urea >19.6, Respiration >30, BP <90/60, 65 years of age or older. ON EXAM

 

Hypercapnia- causes greatest INC in respiration.

 

Emphysema Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM

 

Acute Bacterial Pneumonia- CXR middle lobe. ON EXAM

 

OSA-does not include Microglossia which is an absent tongue congenital. EXAM

 

Tuberculosis- fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three “consecutive days”. TB is usually upper lobes. AANP Exam tips

>5mm-think immunocompromised or person in close contacts. EXAM

>10 think Immigrants, working status, drug users, home life.

>15 Think no risks

CXR- shows big black holes

 

Endocrine

Anything with hyper/hypo SUBCLINICAL-always think of their TSH being off but their Free T4/T3 are normal. Could recheck in 1 year if not having symptoms.

 

TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work. TOPIC ON EXAM

 

Normal TSH 0.5-5

 

Complications of Cellulitis with a diabetic patient = OSTEOMYLITIS. EXAM

 

Hyperthyroid- Low TSH, high “FREE” T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY

RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.

 

Hypoglycemia- Pancrease releases glucagon which stimulates ur liver to convert stored glycogen to glucose. EXAM or if asks what pancreas secretes besides this its digestive enzymes

 

Hypothyroidism- High TSH LOW Free T4/T3, However, Free T4 is much more specific to this disease. Hashimotos (autoimmune) think of everything in ur body is slowing down. Synthroid.

 

Parathyroid gland- PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM

 

If you are already on TWO oral drugs for diabetes and A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM

 

Cushings syndrome-Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. “INC BS, SODIUM” Dec K. You must draw cortisol levels in the morning. AANP Exam tips

 

Addison’s- deficient in cortisol (think low sodium, bloodsugar, but INC K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM

 

For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and shit and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM

 

Fructosesamine test- checks sugar for past 2-4 weeks. MAYBE EXAM

 

Gastrointestinal

 

High Triglycerides- causes pancreatitis >500. If >500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM

 

Pancreatitis-  diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback “boring” epigastric pain. Fever, n/v. EXAM TOPICS

 

Gerd- Barrotts “pre ca” chronic cough, acid sour breath, sore throat, thinning tooth enamel. First line for mild/intermittent lifestyle. BB, CCB, HTN meds increase GERD. FIRST LINE: H2, only 6-8 weeks, if not effective do a PPI. Never d/c PPI abruptly. If you still got cho GERD post 6-8 weeks of treatment just PUNT this shit to GI. (PPI-prilosec, protonix, prevacid) (H2-Zantac, Pepcid). Barretts tx- PPI daily and H2 bedtime. ALWAYS GIVE h2 at BEDTIME. EXAM

 

Pyloric stenosis- 4-6 weeks, nonbilious vomiting olive like mass immediately after vomiting. Diagnosis by ultrasound will see a string. Differential include: GERD, milk protein intol. Intestinal

obstruction. PUNT for surgical correction. ON EXAM

 

Intussecption- sausage shaped mass in upper right quad. Currant jelly stool. Ur bowels prolapse into another part of ur intestine. Barium enema can help to reduce this. Previously healthy then they get sick. Usually before 2 years. PROB ON EXAM

 

Pencil like stool think colon cancer: Descending colon- tenesmus incomplete sensation of defecation. ON EXAM

 

Encopresis-involuntary soiling of stool in kids <4 y. Caused by constipation. Treat behavior cuz they don’t want to shit in public and laxatives to relieve the current constipation. ON EXAM

 

Hep A:

IgG Anti-HAV (GONE = G). IgM Anti-HAV (M= MEOW).

Hep B:

HBsAg = (HAS the word in it).

Anti-HBs- (Anti= not now)                    IM GUESSING ONE ON EXAM

HbeAg(E=Everyday/chronic).

Hep C:

Anti-HCV- order HCV RNA. Biopsy of liver to check stage.

HEP D:

Gotta have boobs before you can get dick. B before D.

 

Chronic hep C: just elevations in ALT.

 

Positive psoas/obturator/rvosing– acute appendix. EXAM

 

Zolinger-Ellison Syndrome- gastrioma causes multiple ulcers. First line is PPI. Screening done by serum fasting gastrin level.

Pancrease secretes enzymes lipase, amylase, proteases. Digest protein, fat, and carbs. EXAM

 

Hpylori negative ulcers: h2 first bedtime, may combine them with PPI. Do 6-8 weeks. PUNT after. PROB ON EXAM

 

Positive H. Pylori: (Always do ABX for 14 days).

Triple therapy: Biaxin, Flagyl OR Amoxicillin. With a PPI.

Quad: Pepto Bism, PPI, tetra, Flagyl

 

Genitourinary

Diagnosis of a kidney stone- Ultrasound.

Old lady with new onset of incontinence – UA/CULTURE

UA results: >10 WBC NitrItes=Ecoli WBC casts (infection UTI, pyelonephritis)

RBC case (glomerulonephritis). EXAM TOPICS

 

Any baby 2-24 months with UTI- do renal and bladder ultrasound for first febrile UTI. EXAM

 

Signs of dehydration in baby: sunken fontanels, decreased urine, no tears when crying (normal in babies), dry/sticky mucous membranes, lethargy, irritability.

 

A sample with large amounts of epithelial cells and multiple bacteria = contaminated sample.

 

3+ protein in urine- do 24 hour urine for protein and creat clear. EXAM Cholesterol, serum creatin and albumin, blood sugar.

 

Stress incontinence- do kegals 100x day. So 10x a day and 10 each time.

 

KNOW THAT UTI IS 100,000 CFU’S TO BE DIAGNOSED. EXAM

PSA WHAT DOES IT MEAN TO PATIENT EXAM

 

Neurological

CN V- Trigeminal Herpes. CORNEAL ABRASION. EXAM

EOM- CN III, IV, VI. EXAM

IV- superior oblique muscles

VI- lateral muscles.

CN I- Nose

CN IX- Shoulder shrug/ ROMBERG test EXAM

CN VIII –ears 8 EXAM

CN VII- Facial BELLS EXAM

Old lady taking digoxin- if her creatinine level increases you have to decrease digoxin dose.

 

Migraine- Triptains for abortive. Prophylaxis (propranolol) TCA (Amitriptyline) Anticonvulsants (gabapentin, topiramate). EXAM TOPIC

Cluster headaches- High dose O2 via Mask 12L 100%, imitrex (abort) and a CCB for prophylaxis. VERAPAMIL  EXAM TOPIC

 

BPPH- Dix Hallpike maneuver- Primidone, or propranolol. AANP Exam tips

 

Fibro- 11/18 points. Widespread pain for at least three months. EXAM

 

Worst headache of my life- SAH- may experience sentinel headache few weeks prior. S/sx of meningitis. Falls in elderly or MVA younger.

 

SDH- skateboarding concussion. Diagnosed with CT (Never do Contrast if you suspect a bleed). EXAM

 

MMSE- <24 dimentia. The lower your score the more retarded you are. EXAM

 

Trigeminal Neuralgia- compression of nerve root possibly. Unliateral facial pain close to nose/cheeks. Sharp shooting pains by eating etc. TREATMENT: high doses of anticonvulsants. MRI / CT.  AKA TIC DOULOUREUX

 

Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids.

POLY- bilateral joint stiffness aching, shoulders neck hips and torso problems with dressing. 50 or older females.

ORDER   A PLAGIARISM FREE PAPER   NOW

Carpal- MEDIAN NERVE, tinnels sign t=tapping. Phalens sign- putting phingers together.

 

ABSENCE SEIZURE AKA PETIT MAL SEIZURE: SUDDEN BRIEF LAPSES OF IN ATTENTION. SEEN ON EXAM

FEVER DECREASES SEIZURE THRESHOLD..SEEN ON EXAM

HEMATOLOGY

ONE OF THESE IS ON EXAM AT LEAST FOR EACH MACRO OR MICRO TYPE.

ALSO LEAD APPEARED ON AN EXAM. USUALLY IRON DEF..ABNORMAL LEAD LEVELS ARE >80 POISONING, TX >40 WITH SYMPTOMS TX. OVER 5 IS ELEVATED BUT PREVIOUS LABS MENTIONED ARE WHEN TO TREAT IT.

s/s n/v, fatigue, loss of appetite, abdomen and joint pain, slowed growth, mental disability.

Thalassemia- gold standard for sickle cell also. Only BETA THALASSEMIA will be abnormal with this NOT alpha. (Alpha-asians, BETA- by sea). MICROCYTIC HYPOCHROMIC. Check Ferritin this will be either normal or slightly elevated. HEMOGLOBIN ELECTROPHORESIS GOLD STANDARD TO DX. AANP Exam tips

 

Iron deficient- microcytic hypochromic. TIBC Inc. Ferritin/iron Dec. Angular cheilitis, glossitis, spoon-shaped nails, pica. Check reticulocyte wk post starting iron to make sure u don’t have bone marrow suppression. Must do 3-6 months. 150-250 elementary iron. Ferrous sulfate 325 mg po TID. Take with calcium helps to absorb. SE constipation black colored stools.

 

Macrocytic normochromic anemias (Folate/B12 CHECK THEM BOTH). B12 will be the ONLY one with neuro findings or pernicious. Pernicious (autoimmune destruction of parietal cells in fundus) think ppl that get their stomach taken out w/ pernicious must do b12 injections life long. With b12 only temporary.

PERNICIOUS- ANTI IF Antibody or 24 h urine test for MMA increase.

 

B12 foods- ALL MEAT PRODUCTS OF ANIMAL ORIGIN

Think of a BIG BEEFY TONGUE.

Folate- doesn’t cause neuro s/sx. Folic acid 1-5 mg/d. Prego need 400 mcg 1 mo. Prior to prego. Dec. neuro deficits. Eat things green.

Sickle cell- CBC is SCREENING, HGB electro is GOLD STAND diagnosis (don’t get a screening test and a gold standard test mixed up on the boards). Could do 8-10 prego a CVS or Amnio to check to sickle. Give sickle cell patients their vaccines to protect from illnesses such as pneumonia/flu. EXAM

 

Musculoskeletal

 

Bicep Tendon Rupture- HOOK TEST (description of the test and say what it is trying to diagnose) bicep will roll into a giant ball EXAM

 

Rotator cuff description- apprehension test rules it in or out. Positive means pain is reduce on relocation test and positive use. Rotator cuff injury-disturbed sleep, arm weakness, dull ache. EXAM

 

Navicular fracture- falling with outstretched arm hyperextension. Thumb spica splint and PUNT 2 weeks to see on xray.

 

Drawers sign- “knee stability” Anterior checks ACL, posterior checks PCL. EXAM

McMurrays test- “CLICK” medial meniscus (valgus) EXAM. LateRal meniscus (vaRus). (BOTH HAVE R’S)

Lachman’s- “LAXITY” VERY SENSITIVE for ACL. EXAM

 

OA- Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike. EXAM

 

OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity. EXAM

 

RA- Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has BOUCHARDS, SWAN NECK IS DESCRIPTION ON EXAM

 

Medial Tibial Stress Syndrome of Fracture: OVERUSE, “inner border” painful on palpation. DO bone scan or MRI cuz a plain X-ray wont show a stress fracture. FOLLOW RICE. EXAM

 

Lateral epicondylitis- (TENNIS) pain in outside elbow, worse with twisting or grasping.

Medial Epicondylitis- (GOLFER) inner elbow pain by funny bone. Baseball, bowlers.

 

Morton’s Neuroma- do mulder test. “pebble, burning, numbness” ¾ metatarsals. PUNT TO pod. EXAM

 

Scoliosis- Adams Forward Bend Test= both arms hanging freely, knees straight, look for asymmetry of spine, scapular, thoracic, lumbar curvature, inspect shoulders and hip for asymmetry.

 

Treatment to prevent fracture in patient with low vitamin D high TSH low HCT- VITAMIN D 600-800, CALCIUM 1000-1200. EXAM

 

Low back pain- MRI (herniated disk) So sciatica is a form of radiculopathy and one of the most common causes is a herniated disc. So both are aggravated by long periods of sitting.  And feel better with WALKING. Lumbar stenosis is aggravated by long periods of standing and walking. Releived by sitting and rest. EXAM

 

PSYCHIATRIC

ELDERLY CANT SLEEP INSOMNIA ETC. SCREEN FOR DEPRESSION

Acute Serotonin Syndrome- Dilated pupils, high fever, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening. EXAM

 

Anorexia- lanugo, osteoporosis, BMI <18.5, peripheral edema, heart problems.

 

Atypical Antipsych- Zyprexa, Seroquel, Risperdal- OBESITY, DM2, check BMI Q3M. CAUSES WEIGHT GAIN. EXAM

SSRI- Paxil (sex dysfunc causes this). Zoloft, Celexa (Good for older few drug interactions) Lexapro. Gradually wean paxil.

SSRI are ALWAYS first choice FOR MAJOR AND MINOR DEPRESSION AND PTSD. Causes low sperm count also. EXAM

 

Kava Kava- used for anxiety and insomnia, don’t mix with other sedating medications, such as benzos.

 

Bipolar- Type I- class manic- severe anxiety, rage, chronic relationship difficulties, euphoria, talkativeness, flight of ideas. Type II- Hypomanic. TREATMENT: Lithium salts (affect TSH, Kidney), anticonvulsants, Antipsychotic.

 

MMSE- Used to evaluate confusion and dementia. Orientation, Immediate recall, Attention and Calculation, Writing and copying. 0 bad 30 good. <24 dimentia highly suggestive. AANP Exam tips Paper

 

Anxiety Attack- Treat Benzo SHORT PERIOD OF TIME EXAM

 

Zyprexa- (atypical antipsychotic)

 

TCA- easy to overdose on don’t give to patients with suicidal.

 

Seasonal affective disorder- depression occurring during winter months, causative factors include circadian rhythm, drop in serotonin syndrome, change in melatonin level. Treatment light therapy, antidepressants, psychotherapy/talk therapy.

 

Generalized Anxiety Disorder- SSRI, SNIR, Wellbutrin. May do benzo for short time.  EXAM

 

WEAN BENZOS EXAM

 

Wellbutrin can help with sexual dysfunction from SSRI/Paxil. Do not give it to people with seizures or anorexics.

 

Alcoholics- CAGE questionnaire, 12 step program. Al-Alonon for family, Al-teen for teenagers and shit.

 

ADHD BEHAVIORAL, SO THERAPY FIRST THEN MEDS. ADDERAL, RITALI, VYVANSE, SETERRA.  EXAM

 

MENS HEALTH REVIEW

 

Acute Bacterial prostatitis- UA/ Culture is definitive. CBC shift to left (band cells) UA, pyuria, hematuria. High fever, chills, suprapubic, perineal pain, radiates to back or rectum, s/sx of uti. Prostate is warm and boggy.

Older than 35= cipro, levaquin 4-6 wk. other Bactrim. AANP Exam tips

<35-Rocephin 250mg IM and doxy 100 mg BIDx10d. EXAM

 

BPH- Symmetrical rubbery and enlarged. Proscar must times PSA X2. All of BPH meds, take at bedtime. Hytrin is good for ppl with HTN and BPH. EXAM

 

Testicular Torsion- extremely painful, swollen red scrotum, affected teste is higher/closer to the body, cremasteric reflex is missing. Dx- Doppler ultrasound with color flow study.

 

Women’s Health Review

 

Ectopic Pregnancy- Light to scant bleeding in 6-7 weeks/lower abd pain/pelvic pain. Intermittent cramping, if radiating to right shoulder think rupture. Pain is worsen with SUPINE or with JARRING. Previous ectopic pregnancy, tubal ligation, PID. Anything that is causing scaring. EXAM

 

Natural estrogen- Isoflavones. SOY BEANS EXAM

 

Ovarian CA- Family history. Should not ever be able to palpate an ovary, r/o US ovarian CA. Risks: >50, early menarche, late menopause, obesity, family history, 1^st prego after 35, or not ever prego.  EXAM

 

Breast cancer- Do Ultrasound to differentiate between lesion vs cyst. EXAM OR AT LEAST MASS AND WHAT IS NEXT STEP MAMMO OR US.

 

LSIL- 21-24y.o. (Repeat in 12 mo) 25-29 (refer for colpososcopy/biopsy). >30 if HPV (-) repeat in 12 mo. If HPV (+) then refer to colp / biopsy. EXAM

 

HSIL-  21-24y.o (colp), >25y.o surgical excision.

 

Bacterial Vaginosis- Wet smear. Squamous epithelial cells with a large amount of bacterial coating, just milky and fishy, no redness or irritation. KOH to cotton swab for whiff test. TREATMENT: FLAGYL BID x7d. Altern- Cleocin or flagyl cream. EXAM TOPICS

 

Candidia Vaginitis- wet smear= pseudohyphae / spores w/ lrg wbc. Cheese curd like pruritis, itching, swelling, redness. TREAT: Diflucan 100 mgx1. Or OTC= Monistat, clotrimazole. Exam

 

Trich- Microscopic – mobile unicellular organisms with flagella and large amount of wbc. TREAT : FLAGYL 2 g PO x1, or 500 mg BID x7d. “strawberry cervic, red, itchy, grayish-green bubbly vaginal dc. Burning with urination. Wet prep. EXAM TOPICS

 

WET PREP : BV, YEAST, TRICH. Exam

 

Atrophic vaginitis- lack a estrogen, apply topical estrogens. exam

 

Pap smear- Begin 21 q 3y until 29. Age 30 pap / HPV repeat q 5 y. May stop at 65, if negative x10 y. Must have squamous epithelial cells and endocervical cells are present.

 

Mammogram- baseline 50 then q 2y. age 75 older =don’t do. Begin at 40 for high risk patients.

 

Postmenopausal bleeding- ENDOMETRIAL BX. EXAM. US to rule out OV CA

 

STD

AIDS <200. CD4. EXAM

You want higher than 350

 

Gonorrhea Tx: Rocephin 250 mg IM and Azithromycin 1 gm po x1, or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM

 

Chlamydia- Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM

If not prego do the Azithro 1 mg PO x1 or Doxy 100 mg BID x7d. AANP Exam tips

Clap is usually asymptomatic.

 

Untreated Gonorrhea: leads to PID, abscess, ectopic prego, infertility, can pass to baby during delivery.

In men: epidydimitis, infertility.

Both people: can lead to disseminated, petechial pustule lesions, lesions of hands/soles, swollen, red, tender joints in one large joint. Green throat. Occasionally Fitz-Hugh-Curtis syndrome. Liver

PID- Infertility, cervical motion tenderness indicates PID. Treat symptomatic PID even if GC and Clap are negative. Follow up with bimanual exam in 2-3 days. EXAM topic PID

 

Syphillis- PAINLESS GENITAL CHANCRE- Condyloma lata. First test do RPR, VDRL SCREENING if reactive then confirm with FTA ABS. EXAM…

 

Condyloma Acuminata (genital warts)- types 16/18 HPV. Treatment: trichloracetic acid….Condylox, aldara, veregne. EXAM

 

Genital herpes on exam: Dx RPR assay for 1 &2. Itching, burning, and tingling. Primary more severe lasts 2-4 weeks etc. recurrent outbreaks.

First outbreak Acyclovir 400mg 3x/d for 7-10days. CHEAPEST medication

Episodic, try to start within 1 day of lesion (pt may fee start of prodromal sx)

Acyclovir BID or TID x 5 days.

WOMENS HEALTH PREGNANCY / CHILDBIRTH

 

Pregnant (5^th disease)- Teratogenic on baby.

 

Positive signs of pregnancy: things done by health care provider, FHR HEARD, US SEE BABY.

Probable: Signs, enlargement of uterus, prego test.

Presumptive: She is just PRESUMING that she is prego.        EXAM TOPICS

 

Goodell’s sign: cervical softening. Chadwicks sign Blue cervix and vagina. Hegars sign- softening uterine isthmus.

 

1^st 1-12 weeks.

2^nd 13-26 weeks.

3^rd 27-end.

 

Appointment schedule: 0-28 q4w. 28-36 q2w. 36 till end q1w.

 

Naegele’s Rule- add 9 months and 7 days! BOOM OR SUBTRACT 3 MONTHS ADD 7 DAYS.

 

Fundal Height 12 weeks above symphysis pubis.      EXAM TOPICS

Fundus 16 weeks between symphysis pubis and umbilicus.

Fundus at 20 weeks is at umbilicus.

2 cm more of less from # of wk gestation is normal if more or less order US.

 

Placental Previa- 2^nd-3^rd trimester new PAINLESS vaginal bleeding worsened by interCourse. Blood is bright red. Uterus soft non-tender. If cervix is not dilated, treatment is strict bed rest. Administer IV MAG IF THERE IS UTERINE CRAMPING. Do not insert anything into the vag/rectal. If dilated cervix then deliver via c- section (according to leik).

 

Placental Abruption- Late third trimester, sudden vaginal bleeding PAINFUL. Uterus feels hard. Dark red bleeding. In severe cases deliver.

 

Can always do an ABD ultrasound with vaginal bleeding but NOT A VAGINAL ULTRASOUND.

 

Preeclampsia- late third trimester >34 wk. sudden onset of h/e, visual abnormalities, pitting edema. Edema easily seen on face eyes fingers, sudden rapid weight gain within 1-2d (>2-4lb/wk). RUQ pain. BP >140/90. Protein 1+, dec. urine. IF SEIZURES THEN ECLAMPSIA. Earliest is at 20 weeks that they can have this. Lay on left side.

 

1300 for calcium and pregnancy.

 

AT 16 WEEKS TEST FOR AFP (EXAM) – Low- Downs

High-Neural tube deficits.

 

TRIPLE SCREEN- AFP, BETA HCG, ESTRIOL.

QUAD SCREEN- The triple screen PLUS INHIBIN A

 

GBS- 35-37 weeks swab.

 

GiVe rhogam at 28 weeks. The coombs test detects rh antibodies in the mother (indirect) and the infant (direct). 2^nd dose is 72 hours or sooner post delivery. IF RH NEG MOM.

 

UTI- 10 (3) wbc is considered positive in prego with symptoms. Normal people its 10 (5). MEDS: Macrobid (not for 3 trimester) Augmentin, Amoxicillin, Cephalexin, Fosfomycin. EXAM

 

Mastitis- red firm tender area fever chills, flu like symptoms. Basically this is cellulitis on ur tit. Dicloxacillin, or Keflex. If you suspect MRSA, do Bactrim or clinda. EXAM AANP Exam tips

 

CHILDREN

ADHD- hyperactive, impulsive, inattentive. Present prior to 12 years. Symptoms last > 6 months, should be evident in at least 2 different settings. Treated with schedule II – Ritalin, Adderal, vyvanse, streterra etc. EXAM

 

Anterior fontanel- closes 15-18 mo. Posterior 2-3 mo.

 

Erythema infectiosum (5^th disease)- “slapped cheeks” 5-14 y.o. LACY, spreads to upper arms lgs trunks dorsum of hands and feet. Rash can last up to 40 days. Fever, rash, runny nose, headache. EXAM humanparovirus19, no labs for it.

 

Milia 1-2mm papules. Resolves spontaneously. EXAM

 

RETINOBLASTOMA- leukocoria: Hallmark sign white spots in eye. Cancer. Red light reflex. EXAM

 

Cephalohematoma- swelling does not cross midline.

Caput succedaneum- crosses midline. Cone shaped head. HAHA.

 

Fragile X- Large head, mental retard. Delayed milestones, crawling, walking. Autism is common. Long face with prominent forehead, jaw, and large ears, large body.

 

Do not give varicella/MMR <12 mo. EXAM QUESTION

Tdap, HPV, MCV4 (11-12y).

HPV youngest age 9 years.

Do not give TDAP <7years

 

Influenza youngest 6 month.

 

HBsAG + mom give baby Hep B and immunoglobulin.

 

Neuroblastoma- painful abd mass fixed first irregular, crosses midline. Most common side is adrenal glands. Weight loss fever horners syndrome. Raccoon eyes, bone pain, hypertension. 1-4 year olds. Dx ultrasound PUNT to nephro. NEURO think brain in middle crosses midline. **Urine catecholamines and anemia. EXAM

 

Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn’t cross. Stays where kidney is. EXAM

 

Epiglottis- Acute/rapid onset of high fever, chills, toxicity. Severe sore throat, drooling saliva. Will not eat or drink muffled hot potato voice, anxiety, tachycardia, tachypnea. 2-6 y. old. Prophylaxis w/ rifampin. Report this disease.  EXAM

 

Autism- may be as early as 18 mo. 18-24 mo do screening. Most apparent in 2-6 y. old.

“extremely sensitive to noises, touch smells, textures” poor language, repeated body movements.

Five behaviors to look for:

doesn’t point/wave/grasp by 12 mo.

No babbling or cooing (by 12 mo) dose not say single words (by 16 mo)

Does not say two – word phrases on his own ( by 24 months)

Any loss of language or social skills ( by 24 months)

Does not gesture by 24 months. Think about kids who do not act normal especially with interactions.

 

Kawasaki disease- acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM

 

Hand-foot-mouth disease: Viral, acute fever, sore throat, headache, multiple blisters on hands, feet, diapher area. Ulcers are in the mouth throat tonsils and the tongue. Treat SYMPTOMS.

 

Encoporesis- Kid doesn’t like to poop. Do plain X-ray.

 

Bronchiolitis: Don’t give abx, cool mist breathing txs. Basically bronchitis in kids. EXAM topics

 

Croup: No antibiotics. Stridor barking cough. Dexamethasone x1 dose.

Darcryotosis  lacrimal sac, rub down towards mouth. If think secondary AANP Exam tips

 

infection abx. EXAM how it presents.

OLDER KIDS

 

Teste torsion- Doppler, unilateral teste pain, absent cremaster reflex. Scrotal edema, redness.

 

Precocious puberty before 8 / delayed if no breast development by 12 y. (FEMALES)

Precocious puberty before 9/ delayed if no testicular/scrotal growth by 14 years (MALES)

 

Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics.

 

Osgood-Schlatter: knee pain in young adults, overuse. Repetitive stress pain, tenderness, swelling at the tendon’s insertion site. The tibial tuberosity. Rule out avulsion fracture if there is an acute onset and order a lateral xray. RICE. Usually stops when the growth stops. EXAM

 

Legg-calve perthes disease: aseptic/avascular necrosis of the femoral head. Could be due to vascular disruption. Insidious onset of KNEE PAIN that migrates up to the groin. AFEBRILE. Positive Trendelenburg’s test.

 

Slipped capital femoral epiphysis – spontaneous dislocation of femoral head. Pain in groin that is referred to the knee. Unable to properly flex. No ambulation is permitted cuz this will cause irreversible damage. Could be due to puberty or hormonal changes. U will have a shortening of the leg with this.

 

Klinefelter syndrome- More female traits in males cuz they got an xtra X. AANP Exam tips Paper

 

Turners Syndrome- Females with ONLY ONE X. Webbed neck, lymphedema. Short stature. AANP Exam tips 

Identify people who are considered most at risk of suicide and briefly explain your answer

HLTEN510B: Implement and monitor nursing care for consumers with mental health conditions – Nursing Assignment

Q1: In your own words, describe the difference between a voluntary client and one detained under the Mental Health Act 2000.

Q2: In your own words reflect on your understanding of how Australian society’s perception of mental illness has changed over time. Issues to address should include social, political and economic contexts of mental health (max 200 words).

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Q3: When admitted to a mental health unit, every client provides a urine sample for testing of illicit drugs. Explain why this happens and your responsibility as an Enrolled Nurse. Identify people who are considered most at risk of suicide and briefly explain your answer

Q4: Using the Code of Professional Conduct for Nurses Outline the role of the enrolled nurse in incorporating the cultural values and beliefs of an individual diagnosed with a mental health disorder.

Q5: What are some of the issues you would consider when admitting a client from another culture to a mental health facility?

Q6: Explain the term ‘case management’ and define the differences and characteristics of this type of management from other patterns of nursing care

Q7: Describe the impact of stigma and discrimination on consumers and significant others and indicate the role of the enrolled / division 2 nurse in reducing its impact on individuals affected by mental illness.

Q8: Explain the development of a therapeutic relationship.

Q9: Identify people who are considered most at risk of suicide and briefly explain your answer. Consider what is meant by resilience and vulnerability in your answer.

Q10: Research and explain why extra-pyramidal side-effects occur with the use of antipsychotic medication. Identify people who are considered most at risk of suicide and briefly explain your answer