FNP Boards review for the boards powerpoint

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1. ZADAKA FNP BOARDS PREP Leor Zadaka, FNP-C

2. Overview TEST TOPICS AND BREAKDOWN Neurology HEENT Endocrine Musculoskeletal Cardiology Hematology Sexual health psychiatric 43 questions (32%) reflecting Domain 01, Assess 36 questions (26.5%) reflecting Domain 02, Diagnose 36 questions (26.5%) reflecting Domain 03, Plan 20 questions (15%) reflecting Domain 04, Evaluate. Dermatology Respiratory Gastroenterology Urology Men’s health Pregnancy women's health

3. What To Expect AANP questions 150 questions, only graded on 135 3.5 hours for the exam AANP Cost $240 for members $315 for non-members AANP Test Sites Prometric testing centers

4. Neurology Conditions Covered TIA Stroke Temporal arteritis Bell’s palsy Headaches ( migraines , tension, cluster) Dementia Multiple sclerosis Essential tremor Parkinson’s Disease Benign paroxysmal vertigo Vestibular neuritis Myasthenia gravis FNP Board Review: Neurological Disorders Flashcards | Quizlet

5. HEENT Conditions Eyes: Ears: Nose: Throat:

6. Cardiology Conditions Covered Abdominal aortic aneurysm Heart failure Hypertension Coronary artery disease Myocardial infarction Aortic stenosis Mitral regurgitation Hypertrophic cardiomyopathy Pericarditis Infective endocarditis Common ECG abnormalities Peripheral arterial disease AANP-Cardiac Flashcards | Quizlet

7. What To Expect Quizzes & Exams 1 quiz each week XX% of total grade 5 exams during the school year XX% of total grade

8. What To Expect In-Class Participation X% of total grade Homework Assignments X% of total grade Quizzes & Exams 1 quiz each week XX% of total grade 5 exams during the school year XX% of total grade

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14. Let’s Have A Great Year!

15. Abdominal Aortic Aneurysm Patho: Progressive, permanent, localized dilation of the abdominal aorta with aortic diameter >3.0 cm or 50% increase in diameter compared to previous findings Signs and symptoms: hypotension, pulsatile abdominal mass, abdominal pain or back pain. Position them lying supine with knees flexed. Risk factors: Smoking #1, HTN, HLD Diagnosis: US, CT for repair Treatment: >4 cm: Refer to vascular physician >5.5 cm or 0.6 cm - 0.8 cm grown in one year: Refer to surgery Screen: 65 years old male who has ever smoked

16. Coronary Artery Disease Patho: Signs and symptoms: Amaurosis fugax ( ipsilateral blindness) and Hollenhorst plaque on fundoscopic exam Risk factor: Diagnosis: Carotid duplex US, Lipid panel (HDL, LDL, Triglycerides), Exercise Tolerance Test Treatment: Plavix + aspirin for four weeks and then only plavix afterwards > 75%: requires surgery Cornerstone: smoking cessation, statin therapy, antihypertensive, and antiplatelet Statin goal LDL <100 or <70 ATORVASTATIN 80 MG Thiazide, calcium channel blockers , and ACE/ARB for goal <130/80 Aspirin and clopidogrel - symptomatic CS Low intensity: Moderate-high: DM, CAD, LDL >190, stroke Recheck: 6-8 weeks not at goal: increase statin dose or add ezitimibe

17. Deep Vein Thrombosis Patho: Clinical presentation: +Homan sign, pain at rest, redness, tender, edema Diagnosis: US, Well’s Score Treatment: Distal: Serial imaging if asymptomatic (once weekly for two weeks) and then anticoagulants. Symptomatic start on anticoagulants. Provoked (shorter treatment) and unprovoked (longer treatment) Proximal: Eliquis or warfarin for three months Early ambulation is safe Cancer hx, pregnant, hepatic impairment: Low weight molecular heparin Renal impairment: Warfarin

18. Heart Failure 2 main types of HF HFeF HFpF Clinical Manifestation: Left sided HF: Nocturnal non productive cough, orthopnea, SOB, frothy sputum, wheezing Right sided HF: Edema, JVD, Weight gain, hepatomegaly Diagnosis: First: ECG and chest X-ray (Kerly B lines, pleural effusions, and cardiomegly) Second: BNP > 100, Pro BNP >300 Third or hemodynamically unstable: Echo (Echo cannot detect the cause of HF) S3: CHF, normal in athletes , preg, and children, “Kentucky” S4: LVH, normal in elderly, “ Tennessee ”

19. Heart failure Main: ACE/ARB, Beta blocker (carvedilol, metoprolol succinate), Diuretic ( spironolactone ) Symptom management: DIURETICS (Lasix) Reduce preload or fluid overload Treatment: Reduced sodium 2-3 g per day, smoking cessation, immunization, fluid restriction , weight monitoring ICD: < 35% ejection fraction

20. Peripheral Artery Diseases Clinical Manifestation: Intermittent claudication, shiny legs, weak pulses in lower extremities, No drainage, sores on the toes and feet, pain with elevating legs, no hairs on the lower extremities Diagnosis: Normal: 1.0-1.4 <0.9: PAD Treatment: Walking helps PAD (5 mins, rest, 5 mins) Refer to vascular specialist Compression socks

21. Ventricular Septal Defect Pathology: Diagnosis: EKG, chest X-ray, 2D echo with color doppler (location, size of defect, and shunt direction) Cardiac catheterization: confirm dx Follow up test: Weight, hematocrit check, and serial Echocardiogram Treatment: Small VSD- resolves spontaneously in childhood Large VSD- persist in adulthood and have complications Pediatric: Medications aim to control pulmonary edema, decrease work of breathing, and allow for growth- DIURETICS

22. Murmurs Systolic Aortic Stenosis: R 2nd intercostal space, common in elderly, radiates to the neck Pulmonic Stenosis: Mitral Regurgitation Tricuspid Regurgitation Diastolic Aortic Regurgitation : radiates to L 2nd intercostal space Pulmonic Regurgitation: Mitral Stenosis: Tricuspid Stenosis:

23. Hypertension Stage 1: > 130 or >80 Stage 2: > 140 or >90 Treatment: DM or Renal insufficiency: ACE/ARBs African American or Elderly: Thiazides and CCBs Osteoporosis: Thiazides Sulfa allergies: No thiazides Non-pharm: Sodium reduction < 1.5 mg per day, increase potassium, daily BP monitoring Reassess: Need 2 office readings to initially dx: 1-4 weeks Lifestyle changes with prehypertension: 3-6 months Adding or changing medications: 1 month

24. Thiazide: Increase glucose, uric acid, triglycerides. Low potassium, low sodium. ACE/ARB: High potassium, cough with ACE Spironolactone: High potassium CCB: contraindicated for HF BB: contraindicated for second degree- and third degree blocks and respiratory dx like asthma/COPD, (pediatric: cause cough with mucus), common s/s fatigue NSAID: decrease efficacy of ACE/ARBs, raise BP within 4 hours

25. Hyperlipidemia Treatment: Low intensity; Moderate-high intensity: High intensity: Reassess: 6-8 weeks Muscle pain: CK levels Darkened urine , fatigue, muscle pain: LFT, CK levels, stop medication (Medication induced hepatitis and Rhabdomyolysis )

26. Angina At rest: Unstable New onset or worsening, serial EKG (NSTEMI- T wave inversion and elevated cardiac enzymes), send to the ED Only with activity, relieved with rest, last 1-3 minutes, or better after one nitro: Stable EKG, exercise stress test, aspirin, statin, and nitro Women, older adults, DM: Atypical symptoms. Retrosternal, lower jaw/teeth

27. Dermatology

28. Acne Vulgaris Treatment: First: Second:

29. Actinic Keratosis Clinical Manifestations: thick and scaly, precursor to squamous cell carcinoma, does not easily bleed, sun exposed areas (ears, scalp, face), blue/green eyes RF

30. Atopic Dermatitis Clinical manifestation : Treatment:

31. Callous

32. Dermatophytosis AKA “ Ringworm ”

33. Impetigo

34. Melanoma

35. Onychomycosis Terbinafine: 250 mg/day PO for 6 weeks for fingernails and 12 weeks for toenails Labs: baseline, and as needed, LFTs and CBC Debridement of the nail

36. Lentigo Dark flat spots on sun exposed areas Treatment: Most lentigos are left alone SPF 50, retinoids, Vit C, hydroquinone bleaching cream

37. Topical Steroids

38. Rules of Nine

39. Endocrine

40. Addison’s Disease

41. Crohn's Disease

42. Diabetes Mellitus Type 1

43. Diabetes Mellitus 2 Patho: insulin resistance Clinical Manifestations: Diagnosis:

44. Hirsutism Treatment: First line: Birth control like COC

45. Hypothyroidism Clinical manifestations: fatigue, weight gain, constipation, skin skin, thinning of hair, cold- intolerance, hoarseness, bradycardia Dx: TSH (elevated), Free T4, TPO titers (Autoimmune) Treatment: Synthroid: elder start on a low dose 12.5 mcg Subclinical and symptoms: treat TSH >10: treat regardeless Reassess: 4-6 weeks Euthyroid in 4-6 weeks Complication: Myxedema Coma, hyperthyroidism (from medication)

46. Hyperthyroidism Clinical Manifestations: palpitations, proptosisi Dia Disease) Dx: iodine uptake scan (1 pill 1 time po) Homogeneous uptake- graves Nodular: single area: toxic adenoma. Multiple areas: toxic multinodular goiter Tx: PTU in first trimester, Methimazole in 2nd and 3rd. For nonpregnant- Methimazole BB for symptom management (atenolol, propranolol ) >1 cm

47. HEENT

48. Cataracts Patho: opacity of lens S/S: Flashes of light, photophobia, blurry vision, glares at night. Educate: No driving at night, encourage pt with cataracts to wear sunglasses Dx: clinical- no corneal reflex. Tx: surgical correction

49. Down syndrome

50. Glaucoma

51. Ophthalmic Exam Retinal Hemorrhages:

52. Epiglottitis Caused by Hib, get the hib vaccine Clinical Manifestation: Children: stridor, tripod positioning, dyspnea, drooling Adult: dysphagia, odynophagia, and voice changes Dx: airway stabilization before further dx, no tongue depressor Treatment: ED

53. Otitis media Signs and symptoms: ear drainage

54. Myopia

55. Hearing Loss

56. Gastroenterology

57. Health Promotion

58. Primary: Secondary: Tertiary:

59. Immunizations:

60. Hematology

61. Iron Deficiency Anemia

62. Thalassemia Anemia

63. Polycythemia Vera

64. Sickle Cell Disease

65. Men’s Health

66. Benign Prostatic Hyperplasia

67. Prostate Cancer

68. Prostatitis

69. Spermatocele

70. Tanner Stages

71. Testicular Exam

72. Urethritis

73. Neurology

74. Essential Tremors

75. Febrile Seizures

76. Meningitis

77. Mental Status

78. Spasticity

79. TIA

80. Orthopedics

81. Ankylosing Spondylitis

82. De Quervain's Tenosynovitis

83. Sciatica

84. Scoliosis

85. Tenosynovitis

86. Pediatrics

87. Teeth Fully erupt at 3 years old No tetracyclines <7 years old

88. Pregnancy

89. Professional Issues

90. Psychiatry

91. Respiratory

92. Sexually Transmitting Infections

93. Urology

94. Women’s Health