Mixed Deck — All AANP Topics Flashcards

Which SSRI has the longest half-life and is least likely to cause discontinuation syndrome?

Answer: Fluoxetine

Fluoxetine has a half-life of 2–6 days (with active metabolite norfluoxetine at 4–16 days), which effectively tapers itself and minimizes discontinuation symptoms.

What is the first-line treatment for mild-to-moderate acne vulgaris characterized by comedones and a few inflammatory papules?

Answer: Topical retinoids and/or benzoyl peroxide

Topical retinoids normalize follicular keratinization and benzoyl peroxide has antimicrobial properties; both are recommended as first-line agents for mild-to-moderate acne.

A patient with darkening, velvety, hyperpigmented skin in the axillae and neck creases most likely has which underlying condition?

Answer: Insulin resistance or type 2 diabetes

Acanthosis nigricans is strongly associated with insulin resistance and hyperinsulinemia, which stimulate keratinocyte and fibroblast proliferation via IGF-1 receptors.

A patient presents with a target-like skin lesion with central blistering after starting a new antibiotic. What condition should be suspected?

Answer: Erythema multiforme

Erythema multiforme is characterized by target lesions (three concentric zones) and is commonly triggered by HSV infection or medications such as sulfonamides and penicillins.

A pregnant woman at 28 weeks with no blood type antibodies has Rh-negative blood. What intervention is indicated?

Answer: Rh immunoglobulin (RhoGAM) injection now and after delivery

Rh-negative women receive RhoGAM at 28 weeks and again within 72 hours of delivery to prevent sensitization that could cause hemolytic disease in future Rh-positive fetuses.

Which medication used for gout prevention requires monitoring for ocular toxicity, including retinal damage?

Answer: Hydroxychloroquine

Hydroxychloroquine (used for RA and lupus, sometimes related to inflammatory arthritis) can deposit in the retina, causing irreversible retinopathy with prolonged use.

A patient with hypothyroidism has been stable on levothyroxine 100 mcg for 2 years. A repeat TSH returns at 6.8 mIU/L (reference 0.4–4.0). She reports fatigue and cold intolerance. What is the most appropriate action?

Answer: Increase levothyroxine dose by 12.5–25 mcg

A mildly elevated TSH with symptoms consistent with hypothyroidism indicates under-replacement; the standard approach is a small incremental increase in levothyroxine dose.

A patient on an SSRI for depression develops agitation, hyperthermia, diaphoresis, clonus, and hyperreflexia after starting tramadol for pain. What is the most likely diagnosis?

Answer: Serotonin syndrome

Serotonin syndrome results from excess serotonergic activity; tramadol inhibits serotonin reuptake and when combined with an SSRI can trigger the syndrome.

Which medication is the recommended pharmacological treatment for postmenopausal osteoporosis prevention as first-line therapy?

Answer: Bisphosphonates (e.g., alendronate)

Bisphosphonates such as alendronate are the first-line pharmacological treatment for postmenopausal osteoporosis due to their proven efficacy in reducing fracture risk.

Which drug interaction can occur when combining an MAOI with meperidine (pethidine)?

Answer: Serotonin syndrome, potentially fatal

MAOIs inhibit monoamine oxidase, and meperidine blocks serotonin reuptake, causing dangerous serotonin accumulation that can lead to fatal serotonin syndrome.

A patient with rheumatoid arthritis has inadequate response after 3 months of methotrexate monotherapy. She has no comorbidities. What is the most appropriate next step per current guidelines?

Answer: Add a TNF inhibitor or other biologic DMARD

ACR guidelines recommend adding a biologic or targeted synthetic DMARD (such as a TNF inhibitor) after 3 months of inadequate response to methotrexate monotherapy.

The AUDIT-C questionnaire is used to screen for which behavioral health condition?

Answer: Hazardous or harmful alcohol use

The AUDIT-C (Alcohol Use Disorders Identification Test-Concise) is a validated 3-question screen for hazardous or harmful alcohol consumption in primary care.

A patient with inflammatory bowel disease (Crohn's disease) on long-term corticosteroids presents for a routine visit. Which monitoring intervention is most important?

Answer: Bone density scan (DEXA)

Long-term corticosteroid use significantly increases osteoporosis risk; DEXA scan is recommended for patients on chronic steroid therapy to assess bone density and guide preventive treatment.

A patient presents with acute urinary retention. After placement of a Foley catheter, which complication should the NP monitor for?

Answer: Post-obstructive diuresis with electrolyte imbalances

Rapid decompression of a chronically obstructed bladder can cause post-obstructive diuresis with large urine output, leading to dehydration and electrolyte disturbances requiring careful monitoring.

What finding on skin examination is most suggestive of scabies infestation?

Answer: Burrows in finger web spaces with intense nocturnal pruritus

Sarcoptes scabiei mites create linear burrows in thin-skinned areas like finger webs, with intense itching that worsens at night due to mite activity.

How does an ACNP contribute to patient care during a medical emergency?

Answer: By taking the lead in assessing the situation, performing necessary procedures, and coordinating care

During a medical emergency, ACNPs are highly skilled in quickly assessing patient status, implementing immediate life-saving interventions, and coordinating the efforts of the healthcare team. Their advanced clinical judgment and procedural skills are vital for stabilizing patients and optimizing outcomes in critical situations. They often take a leadership role in managing the emergency response.

What is the treatment of choice for uncomplicated vulvovaginal candidiasis?

Answer: Topical azole antifungals (e.g., clotrimazole) or single-dose oral fluconazole

Uncomplicated vulvovaginal candidiasis is effectively treated with topical azole antifungals applied intravaginally or a single oral dose of fluconazole 150 mg.

A patient presents with a 2-week history of depressed mood, anhedonia, hypersomnia, psychomotor retardation, and suicidal ideation. What is the minimum duration criterion for major depressive disorder?

Answer: 2 weeks

DSM-5 requires symptoms of major depressive disorder to be present for at least 2 weeks and represent a change from previous functioning for the diagnosis.

A 72-year-old patient with hypertension and stage 3a CKD has a blood pressure of 148/88 mmHg on amlodipine 10 mg. Which antihypertensive class should be added first?

Answer: ACE inhibitor or ARB

ACE inhibitors and ARBs are preferred add-on agents in CKD with hypertension because they reduce proteinuria and slow progression of kidney disease.

Which USPSTF-recommended screening is appropriate for a 40-year-old average-risk woman with no family history of breast cancer?

Answer: Biennial mammogram starting at age 40

The 2024 USPSTF guidelines recommend that average-risk women begin biennial mammography screening at age 40, updated from the prior recommendation of age 50.