AANP board certification exam 48 Questions with Answers,100% CORRECT

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AANP board certification exam 48 Questions with Answers how long will a cough last for acute bronchitis? - CORRECT ANSWER up to three weeks is completely normal how do you treat acute bronchit... is? - CORRECT ANSWER 95% cases are viral-- tessalon pearls to help with cough. ** prednisone is never the answer *** explain the following views of chest xrays: AP, PA, PA and lateral which one do you want for pneumonia patient? - CORRECT ANSWER AP- shows the heart predominantly because its from front to back PA- shows the lungs predominantly because its back to front lateral shows fluid line what is the gold standard for diagnosing community acquired pneumonia - CORRECT ANSWER chest xray- PA/lateral, repeat post treatment in 6 weeks (repeat not really done anymore) treatment guidelines for CAP- healthy adult no comorbidities - CORRECT ANSWER MAD LUNG amoxicillin 1 gram TID (best choice) doxycycline 100 mg twice daily macrolide (mycin) in areas with low macrolide resistance so not the best choice treatment guidelines for CAP- adult with comorbidities - CORRECT ANSWER monotherapy: respiratory quinolone (levofloxacin 750 mg daily) combination therapy: augmentin or cephalosporin PLUS macrolide or doxy what are common respiratory fluroquinolones? - CORRECT ANSWER Think FLOXACIN-- moxifloxacin, gemifloxacin, levofloxacin what are common macrolides for CAP - CORRECT ANSWER think "MYCIN" -- azithromycin, clarithromycin what are common tetracyclines for CAP - CORRECT ANSWER doxycycline what are common beta lactams for CAP - CORRECT ANSWER amoxicillin, augmentin (amox with clav), cefpodoxime, cefuroxime how would you treat a pregnant 29 year old with pneumonia? - CORRECT ANSWER Amoxicillin 1 g TID-- cant give levaquine (flouroquinolones no in pregnancy due to fetal ligament destruction, doxycycline no in pregnancy stains tooth bones in fetus) how long do you give antibiotics to patient with pneumonia? - CORRECT ANSWER 5-10 days, you always want to continue antibiotics for 3 more days after clinically stable (no fever) When do you get a chest xray for pneumonia? - CORRECT ANSWER it is the gold standard for diagnosis, you do not need to do resolution chest xray unless things are lingering or you suspect something else. When do you give pneumococcal vaccine? - CORRECT ANSWER adults > 65 years old you give PPSV23 or you can give both PCV 13 and PPSV23 but must be 1 year apart adults > 65 with immunocompromising condition give both pcv 13 and ppsv23 adults 19-64 at increased risk of pneumococcal disease (asthma, copd, smokers, cv dz) - give PPSV23 only adults 19-64 with asplenia, cochlear implants, csf leak-- give pCV13 NOW then PPSV23 in 8 weeks , then PPSV23 in 5 years. What is the diagnostic criterion for COPD - CORRECT ANSWER FEV1/FVC ratio of < 0.70 What are characteristics of COPD - CORRECT ANSWER midlife onset, symptoms slowly progressive, exposure to lung irritant, DOE is progressive, chronic cough and chronic sputum production what are characteristics of asthma - CORRECT ANSWER onset early in life, symptoms vary widely from day to day, symptoms worse at nighttime/early AM, allergic rhinitis, eczema, family history, obesity what are characteristics of heart failure (when evaluating diff dx of COPD) - CORRECT ANSWER chest xray with dilated heart, pulmonary edema what are characteristics of tuberculosis when ruling out for COPD patient - CORRECT ANSWER onset all ages, chest xray with lung infiltrate, microbiologic confirmation what are the characteristics of bronchiectasis - CORRECT ANSWER LOTS OF PURULENT SPUTUM, chest xray shows bronchial wall thickening and bronchial dilation What intervention has the greatest influence on slowing progression of a COPD patient? - CORRECT ANSWER smoking cessation!! what are first line smoking cessation drugs? (3) - CORRECT ANSWER varenicline (chantix), nicotine patch, buproprion extended release (zyban) what is second line smoking cessation drug? - CORRECT ANSWER sertraline (zoloft) what smoking cessation drug would you give to someone with a history of a suicide attempt? - CORRECT ANSWER nicotine patch-- NOT CHANTIX OR ZYBAN What are the short acting beta agonists - CORRECT ANSWER albuterol, levalbuterol what are the long acting beta agonists - CORRECT ANSWER "terols" Salmeterol Formoterol How do inhaled anticholinergic drugs work? - CORRECT ANSWER used in COPD, prevent bronchoconstriction how do beta agonists work? - CORRECT ANSWER stimulate beta 1 (tachycardia) and beta 2 (bronchodilation) what is the suffix for inhaled anti-cholinergic drugs? - CORRECT ANSWER "tropium" think ipratropium (atrovent) SHORT ACTING, tiotropium (spiriva) long acting What is a SAMA? - CORRECT ANSWER short acting antimuscarinic (anticholinergic) - Ipratropium what is a LAMA? - CORRECT ANSWER long acting muscarinic antagonist (anticholinergic) Tiotropium (spiriva) what are the 4 steps of GOLD guidelines - CORRECT ANSWER 1) SABA or SAMA prn 2) LABA or LAMA PLUS rescue med 3) ICS + LABA/LAMA plus rescue med 4) ICS+ LABA AND LAMA plus rescue med THEN REFER How to manage COPD exacerbation? - CORRECT ANSWER figure out the cause mild: sabas with spacers / nebulizer moderate: SABAs plus AB and or steroid Severe: hospitalization right supraventricular nodes signal what malignancies? - CORRECT ANSWER lungs, mediastinum, esophagus left supraventricular nodes signal what malignancies? - CORRECT ANSWER abnormal (stomach, GB, liver, pancreas, ovaries, prostate) us preventive services task force routine lung cancer screening recommends what annual screening for current smokers aged 55-80 with 30 pack year history or have quit within the last 15 years? - CORRECT ANSWER annual low dose CT (LDCT) how do you diagnose asthma > 5 years of age: - CORRECT ANSWER presence of asthma features reversible airway obstruction on spirometry >12% improvement from baseline or FEV1 > 200 ml after SABA How do you treat asthma? - CORRECT ANSWER saba always as rescue inhaler Step wise approach (GINA) Low dose ICS then ICS + LABA increase dosage strength acute bronchitis classic case symptoms - CORRECT ANSWER cough that keeps awake at night dry cough but may be productive low grade fever or chest pain with cough wheezing and rhonchi median duration of cough is 18 days up to 3 weeks history of a cold before onset of symptoms objective findings in acute bronchitis - CORRECT ANSWER lungs: clear to severe wheezing, rhonchi percussion: resonant CXR: normal afebrile to low grade fever treatment plan for bronchitis - CORRECT ANSWER symptomatic treatment- increas fluids and rest tessalon perles, expectorant / mucolytic (guaifenesin) ventolin (albuterol) for wheezing for severe wheezing consider short term oral steroid complications of acute bronchitis - CORRECT ANSWER exacerbation of asthma pneumonia from secondary bacterial infection pertussis "whooping cough" - CORRECT ANSWER caused by bordetella pertussis (gram negative) coughing illness at least 14 days paroxysmal coughing, inspiratory whooping neonates / infants at highest risk for death three stages of pertussis - CORRECT ANSWER catarrhal 1-2 weeks, if treated at this stage can shorten disease course paroxysmal: lasts 2-4 weeks, treatment has little influence but is useful to decrease spread convalescent: treatment goal is to eradicate carriage state / disease spread how to diagnose pertussis - CORRECT ANSWER nasopharyngeal swab for culture - collect at 0-2 weeks following cough PCR may provide accurate results up to 4 weeks Pertussis antibodies by ELISA CBC with elevated WBCs and marked lymphocytosis cxr should be negative how to treat pertussis - CORRECT ANSWER administer a course of antibiotics to close contacts iwthin 3 weeks of exposure first line: macrolides - azithromycin z pack x 5 days alternative bactrim x 14 days antitussives, mucolytics, rest, hydration, frequent small meals complications of pertussis - CORRECT ANSWER sinusitis, otitis media, pneumonia, fainting, rib fractures from coughing signs of pulmonary embolism - CORRECT ANSWER new onset dyspnea, hemoptysis, pleuritic chest pain, vital signs with tachycardia, tachypnea, may have signs of DVT [Show More]

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