Exam (elaborations)
ACNP BOARDS- QUESTIONS & ANSWERS
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ACNP BOARDS- QUESTIONS & ANSWERS
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ACNP BOARDS- QUESTIONS & ANSWERSmetabolic Alkalosis Labs: Correct Ans-pH >7.45
HCO3 >26
pCO2 >45
Serum K and Cl decreased
Maybe increased AGAP
Management of Metabolic Alkalosis Correct Ans-Correct volume deficit w/ NS (NaCl) or
KCl, D/C diuretics, H2blockes for GI loss, Acetazolamide 250-500 mg IV if fluids
contraindicated.
R-O-M-E Correct Ans-Respiratory opposite, Metabolic Equal.
First degree burns Correct Ans-Dry, Red, NO BLISTERS, epidermis ONLY.
Second degree burns Correct Ans-Moist, BLISTERS, beyond epidermis.
Third degree burns Correct Ans-Dry, leathery, black, pearly, waxy, extends to fat, muscle, and
bone.
Rule of nine Correct Ans-Each arm 9%,
Each leg 18%,
,Thorax 18%
front & 18%
back, Head 9%,
Perineum/genitals 1%.
Fluid resuscitation for burns (Parkland formula) Correct Ans-4 ml/kg X TBSA for 1st 24H:
Give have in 1st 8H, then 1⁄4 Q8 for 16H.
When do fluid resuscitation for burn pt begin? Correct Ans-At time of burn, not when pt
reaches hospital
Patient comes in with 60% burns, weighing 220lbs. What is his 24H fluid requirement? First 8
H? Correct Ans-60 x (220/2.2) x 4 = 24,000 ml or 24 L;
1st 8 hrs = 12L
Monitor burn patients for what metabolic or electrolyte complications? Correct Ans-
Metabolic Acidosis during early resuscitation & Hyperkalemia for 24-48 then hypokalemia for 3
days post-burn.
For burn patient when is prophylactic intubation indicated? Correct Ans-Burns to face,
Singed nares/eyebrows, dark soot/mucous from nares/mouth.
Emergent Burn management in field includes: Correct Ans-Wrap in clean, wet towel and
transport to nearest hospital.
,Emergent burn management in hospital: Correct Ans-Use NS and wrap with sterile towels,
maintain
temp at (37-37.5 C),
pain management (Fentanyl#1 or Morphine)
Silver sulfadiazine for 2nd or 3rd degree burns.
How to manage a Tar burn: Correct Ans-Use petroleum based product (or Bacitracin or
mayonnaise) to remove burning tar.
When to refer to burn center per American Burn Association. Correct Ans-A. Partial
thickness burns > 10% TBSA
B. All 3rd degree/electrical/chemical/inhalation burns
C. Pt with preexisting medical disorders that could complicate management, prolong recovery or
affect mortality.
D. Pt with Concomitant trauma
E. Burn children if no qualified equip/personnel
F. Pt who require special social/emotional/rehab services.
Management for Dog, Cat, or Human Bites: Correct Ans-Irrigate ASP w/ NS or LR, Rabies
status?, Hand/BLE wound leave open,
wound > 6 H leave open.
Prophylactic ABX for 3-7 days (Augmentin).
, Most common causes of outpatient cellulitis: Correct Ans-Strep pyogenes (Group A) #1,
Staph aureus #2
Most common causes of inpatient cellulitis: Correct Ans-S. Aureus (MRSA), Strep & Gram (-
) organisms (E. coli, Klebsiella, Pseudomonas, Enterobacter)
Treatment for MRSA cellulitis: Correct Ans-Bactrim #1, Doxy/minocycline, Clindamycin.
Treatment for Group A Strep cellulitis: Correct Ans-Bactrim + Beta lactam (PCN, Amox,
Keflex) Doxy/minocycline + Beta lactam Clindamycin.
Patient has a sore on his foot w/o systemic symptoms. What would the treatment be? With
systemic syptoms (i.e., fever), tx would be? Correct Ans-Non-systemic: I & D, Cultures, no
ABX;
Systemic: Bactrim.
What is the first and most important step in poison or drug OD treatment? Correct Ans-
History
Treatment for poison/drug OD? Correct Ans-Charcoal, Gastric lavage (if < 30 min), Diuresis,
dialysis, hemoperfusion and plasmapheresis.
Ipecac can be used for "at home" remedy but delays charcoal use and never should be used for
corrosive or detergents (bleach, liq plumber, soap, fabric softener, etc).
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