621

Question 1

A 26-year-old male has two new recent sexual partners and presents with urethral discharge. Which one of the following tests is preferred for detecting Chlamydia trachomatis?

A. First catch urine culture

B. Urethral swab Gram’s stain

C. First catch urine nucleic acid amplification test

D. Urethral swab culture

Answer 1

C. First catch urine nucleic acid amplification test

Question 2

Which one of the following most accurately describes recommendations from the National STD Curriculum for chlamydia screening in asymptomatic females?

a. Perform annual screening in sexually active females 15 to 21 years of age and in older women who have a prior history of a sexually transmitted disease
b. Perform annual screening in sexually active females 25 years or younger and in older women who are at increased risk for infection
c. Perform one time screening in all women aged 21 to 25 years
d. Perform one time screening in all women aged 25 to 30 years

Answer 2

b. Perform annual screening in sexually active females 25 years or younger and in older women who are at increased risk for infection

Question 3

A 19-year-old sexually active Hispanic woman living in Florida attends a health fair that offers STD testing. She is not sure if she should undergo screening for gonorrhea. Which of the following statements is TRUE regarding gonorrhea epidemiology in the United States?

a. The rate of gonococcal infections among Hispanics is the highest of all ethnic groups
b. The gonorrhea rate is highest among women aged 15 to 19
c. The rate of gonorrhea infections is higher in persons living in the South than in other regions of the country
d. The rate of gonorrhea infections is approximately 5 times higher than the rate of chlamydia infections in women younger than 25 years of age

Answer 3

c. The rate of gonorrhea infections is higher in persons living in the South than in other regions of the country

Question 4

A 24-year-old male patient presents to the clinic requesting STD testing. He has a new female partner and he is interested in making sure he does not have any STDs. Currently, he has no genitourinary symptoms. Which one of the following diagnostic tests is the most sensitive for the detection of urethral Neisseria gonorrhoeae infection in an asymptomatic male patient?

a. Nucleic acid amplification test (NAAT)
b. Gram’s stain of a urethral swab specimen
c. Culture
d. Methylene blue-gentian violet stain microscopy

Answer 4

a. Nucleic acid amplification test (NAAT)

Question 5

A 24-year-old female presents to establish care in your clinic. She has no current complaints and no prior medical problems. She has had 2 lifetime sexual partners, and is in a monogamous relationship with her husband who is also healthy. She has no history of genital ulcers or symptoms. She asks if she should be screened for genital HSV infection.

According to the National STD Curriculum, which of the following is recommended for screening for HSV-1 and HSV-2 in the general population?

a. Routine screening with type-specific serologies for all patients aged 13 to 64 years as a normal part of medical care.
b. Routine screening with plasma HSV PCR for all patients aged 13 to 64 years as a normal part of medical care
c. Routine screening with type-specific serologies for all patients aged 21 years and older as a normal part of medical care.
d. No indication for routine screening for HSV-1 and HSV-2 for asymptomatic persons in the general population

Answer 5

d. No indication for routine screening for HSV-1 and HSV-2 for asymptomatic persons in the general population

Question 6

A 21-year-old female college student presents to your clinic complaining of a 3-day history of a painful genital lesion on her left labial region. She has been sexually active throughout college and thinks she may have had a similar lesion about 6 months ago but is unsure. You suspect she has genital herpes. She has never had any testing for herpes. Which one of the following tests is preferred to yield a specific diagnosis of genital HSV infection?

a. Serum antibody for HSV 1 and 2
b. HSV PCR on a sample taken from the base of the genital lesion
c. Tzanck smear of a swab obtained from the genital lesion
d. Direct fluorescent antibody (DFA) testing

Answer 6

b. HSV PCR on a sample taken from the base of the genital lesion

Question 7

Which one of the following statements most accurately describes the natural history of human papillomavirus (HPV) infection?

a. More than 90% of individuals with genital HPV infections are asymptomatic and more than 90% clear the infection within 2 years
b. Approximately 60% of individuals with genital HPV infections are symptomatic and 50% clear the infection within 3 years
c. Approximately 60% of individuals with genital HPV infections are asymptomatic and 60% clear the infection within 2 years
d. Approximately 90% of individuals with genital HPV infections are symptomatic and 20% clear the infection within 5 years

Answer 7

a. More than 90% of individuals with genital HPV infections are asymptomatic and more than 90% clear the infection within 2 years

Question 8

What are the indications for the 9-valent human papillomavirus (HPV) vaccine?

a. Administer for girls and boys anytime after age 16 when they become sexually active
b. Administer routinely for girls and boys beginning at age 15
c. Administer for girls and boys anytime after age 18 when they become sexually active
d. Administer routinely for girls and boys at ages 11-12 and it can be administered as early as 9 years of age

Answer 8

d. Administer routinely for girls and boys at ages 11-12 and it can be administered as early as 9 years of age

Question 9

24-year-old man presents with a diffuse macular and papular rash on his chest, back, hands and feet. He had 2 new male sexual exposures approximately 6 weeks ago. He now has a positive Venereal Diseases Research Laboratory (VDRL) test with a titer of 1:256. He had a negative syphilis test about 3 months ago. He has no other symptoms and his neurologic examination is normal. He has no known antibiotic allergies. What treatment is indicated?

a. Benzathine penicillin G 2.4 million units IM in a single dose
b. Benzathine penicillin G 2.4 million units IM weekly for 3 total doses
c. Doxycycline 200 mg twice a day for 3 days
d. Ceftriaxone 250 mg IM in a single dose plus Azithromycin 1 g orally in a single dose

Answer 9

a. Benzathine penicillin G 2.4 million units IM in a single dose

Question 10

Which one of the following best describes a primary syphilis (chancre) lesion?

a. A painful soft ulcer that persists for 2 to 4 days
b. A large serpiginous ulcer that has a soft, beefy edge and persists for 2 to 4 days
c. Multiple painful shallow ulcers that have an erythematous base and persist for 3 to 4 days
d. A painless, well-circumscribed ulcer that has a clean base and persists for 1 to 6 weeks

Answer 10

d. A painless, well-circumscribed ulcer that has a clean base and persists for 1 to 6 weeks

Question 11

Your patient tells you she has a positive home urine pregnancy test, and wants to repeat one in the clinic where it is a ‘real’ test. She is 2 weeks late for her menses. What is best educational information for patient

a. Urine tests specific for Beta-hCG have accuracy rates of 99% with very few false positives. With Urine testing, early gestational age and decreased specimen concentration may yield false negatives. We can repeat this if you like, but our urine tests are the same.
b. Urine tests specific for Beta-hCG have accuracy rates of 50% with very few false positives, so we can do a blood test to confirm.
c. Only serum Beta-hCG tests are 99% accurate for diagnosis of pregnancy, so we will do that now.
d. The only “real” test is an ultrasound, so lets get one scheduled today.

Answer 11

a. Urine tests specific for Beta-hCG have accuracy rates of 99% with very few false positives. With Urine testing, early gestational age and decreased specimen concentration may yield false negatives. We can repeat this if you like, but our urine tests are the same.

Question 12

The highest risk for a miscarriage is in the second trimester.

True or False

Answer 12

False

Question 13

What is the recommended daily Folic Acid intake recommended prior and during pregnancy?

a. 1000 mcg
b. 400 mcg
c. 5000 mcg
d. 100 mcg

Answer 13

b. 400 mcg

Question 14

Bleeding during Pregnancy: Check all that apply

1) Is common
2) Can be life threatening
3) Could be a spontaneous abortion
4) Could indicate Eptopic pregnancy
5) Is not considered a complaint to follow up

Answer 14

1-4 is correct, 5 is not.

Question 15

The most common signs and symptoms of pregnancy? Check all that apply

1) Amenorrhea
2) Fatigue
3) Nausea with or without vomiting
4) Abdominal Pain
5) Hot Flashes
6) Breast tenderness and enlargement

Answer 15

1, 2, 3, 6.

4 & 5 are not.

Question 16

Red flag causes of pelvic pain include (select all that apply)

1) Ectopic pregnancy
2) Urinary tract infection
3) Appendicitis
4) Pelvic Inflammatory Disease

Answer 16

1, 2, 4.

NOT 3

Question 17

All of the following are common symptoms of urinary tract infections except

a. Dysuria
b. Flank pain
c. Urinary urgency
d. Suprapubic pain

Answer 17

b. Flank pain

Question 18

Structural causes of abnormal uterine bleeding include (select all that apply):

1) Endometrial polyps
2) Adenomyosis
3) Ovulatory dysfunction
4) Uterine fibroids (leiomyomas)

Answer 18

1, 2, & 4 are correct.

3 is not.

Question 19

In the vaginal ecosystem, it is normal to find squamous epithelial cells, lactobacilli, and an acidic pH.

True or False

Answer 19

True

Question 20

In the vaginal ecosystem, it is normal to find squamous epithelial cells, lactobacilli, and an acidic pH

True or False?

Answer 20

True

Question 21

The three most common causes of vaginitis include (select 3)

1) Yeast infections
2) Chlamydia
3) Trichomoniasis
4) Bacterial vaginosis

Answer 21

All except chlamydia

Question 22

Mr. N is a 28 year old male who comes to see you today having noted a small “lump” in his scrotum. On physical exam, you feel a 1cm mass and in a darkened room you use a penlight and note that the mass transilluminates light well. You suspect testicular cancer because a solid mass like a cancerous tumor will transilluminate light.

True or False?

Answer 22

False

Question 23

You are a nurse practitioner in a busy family practice clinic. The triage nurse comes to you at 1pm and shares that she just got a call from the mom of Noah. Noah is a 17 year old young man who was playing soccer earlier in the day. At noon he had acute onset of testicular severe right sided testicular pain. In the past half hour the pain has started radiated to the right inguinal area and right abdominal wall. the triage nurse tells you there you have an opening at 4:45 pm and is wondering if she should put Noah in that appointment. Given the information presented, the best answer to the triage nurse is:

a. What you have described could be testicular torsion. If it is not treated in four hours, permanent damage may occur, Noah and his parent should go to the ER for evaluation.
b. Yes, please put him in for the 4:45 appointment.
c. Noah should rest, use ice, and only needs to worry about the problem if it gets worse or does not gradually get better.
d. Have him put ice on the testicle, elevate it, and come for the 4:45 appointment.

Answer 23

a. What you have described could be testicular torsion. If it is not treated in four hours, permanent damage may occur, Noah and his parent should go to the ER for evaluation.

Question 24

According to Goroll and Mulley (2014), the ABSENCE of the cremasteric reflex is the most sensitive physical finding for testicular torsion.

True or False?

Answer 24

True

Question 25

The most likley causative pathogens in a 26-year old man with acute epididymitis include: a. Pseudomonas species b. C. trachomatis c. Escherichia coli d. Enterobacteriaceae

Answer 25

b. C. trachomatis

Question 26

Concerning BPH, which of the following statements is true? a. Digital rectal examination is accurate in diagnosis the condition. b. Prostate size directly correlates with symptoms and bladder emptying. c. Bladder distention is usually present in early disease. d. The use of a validated patient symptom tool is an important part of diagnosing and monitoring the condition.

Answer 26

d. The use of a validated patient symptom tool is an important part of diagnosing and monitoring the condition.

Question 27

When assessing a 78-year old man with suspected BPH, the FNP considers that: a. BPH affects less than 50% of men this age. b. the presence of BPH increases the risk for development of prostate cancer. c. limiting fluids is a helpful method of relieving severe symptoms. d. prostate size does not correlate well with severity of symptoms

Answer 27

d. prostate size does not correlate well with severity of symptoms

Question 28

Risk factors for acute bacterial prostatitis include all of the following except: a. use of urinary catheter. b. prior bladder infection. c. having unprotected sex. d. age > 70 years.

Answer 28

d. age > 70 years.

Question 29

A 23-year old man has a non tender "bag of worms" mass within the left scrotum that disappears when he is in the supine position. He is diagnosed with a varicocele. What is a risk factor that may have contributed to this condition? a. younger age b. current cigarette smoker c. multiple sexual partners d. None of the above

Answer 29

d. None of the above

Question 30

Which of the following is not a COMMON risk factor for erectile dysfunction (ED)? a. diabetes mellitus b. hypertension c. cigarette smoking d. testosterone deficiency

Answer 30

d. testosterone deficiency

Question 31

Patient education about the use of sildenafil (Viagra) includes the following: a. this medication helps regain erectile function in nearly all men who use it. b. With the use of the medication, sexual stimulation also is needed to achieve an erection. c. A spontaneous erection occurs about 1 hour after taking the medication. d. treatment options for younger men are seldom effective in older men.

Answer 31

b. With the use of the medication, sexual stimulation also is needed to achieve an erection.

Question 32

A 24 year old female presents with vaginal discharge that she describes as milky and fishy smelling. A wet prep is completed results include Vaginal PH of 5, positive for clue cells, negative for yeast, negative for trichomonas. Positive Wiff test. Choose below the most consistent diagnosis with 1st line treatment. 1) Candida Vaginitis: Treat with Metronidazole 500mg orally 2 times day for 10 days 2) Does not meet diagnostic criteria, needs additional work-up 3) Bacterial Vaginosis, Treat with Metronidazole 250 mg orally 2 times day for 10 days 4) Bacterial Vaginosis, Treat with Metronidazole 500 mg orally 2 times day for 7 days

Answer 32

4) Bacterial Vaginosis, Treat with Metronidazole 500 mg orally 2 times day for 7 days

Question 33

MM comes in today for her preventative health care. While completing her exam she asks you when her adolescent daughter should begin cervical screening? According to ASCCP and ACOG guidelines, your response is: a. When they initiate oral contraceptives. b. When they initiate sexual activity. c. At age 21. d. Any time they come in and request it.

Answer 33

c. At age 21.

Question 34

Contraindications and high risk of adverse events to use of combined hormonal contraceptives include all of the following except: a. Diabetes Mellitus b. Thromboembolic Disorders c. Migraines with Aura d. Breast Cancer

Answer 34

a. Diabetes mellitus

Question 35

Oral contraceptives can be used by females who have migraine headaches with all of the following symptoms except: a. Phonophobia b. Throbbing Pain c. Nausea d. Visual Aura

Answer 35

d. Visual Aura

Question 36

BB is a 38 year old female, with an elevated BMI, who you are seeing in the office today for chief complaint of period problems. She tells you that over the last several months she is having 2 periods per month, light and spotty. Your initial workup (at clinic appointment) of this would include: a. an endometrial biopsy b. ordering an ultrasound c. starting oral contraceptives to help regulate her cycle d. obtaining a BHCG blood test to rule out if patient is pregnant

Answer 36

d. obtaining a BHCG blood test to rule out if patient is pregnant

Question 37

You are reviewing lab results for Jim, a 24 year old male patient who presented to clinic for STI testing a week ago. Tests are as follows; Rapid plasma reagin (RPR) test: Reactive at 1:2 Fluorescent treponemal antibody absorption (FTA-ABS) test: Negative When calling the patient to review the results, what would you recommend? a. Syphilis positive, order Benzathine Penicillin G 2.4 million units IM in a single dose. b. Syphilis negative, no further testing required, encourage condom use. c. Syphilis positive, order Benzathine Penicillin G 2.4 million units IM, 3 doses each 1 week apart. d. Inconsistent findings, screening test positive but confirmatory test negative, consider potential for autoimmune disorder or previously treated Syphilis infection.

Answer 37

d. Inconsistent findings, screening test positive but confirmatory test negative, consider potential for autoimmune disorder or previously treated Syphilis infection.

Question 38

You are working up a patient with amenorrhea who stopped her OCP's seven months ago for a planned pregnancy. She has not restarted her menses. Pregnancy test is negative and you find that her prolactin level is 65 ng/ml with a normal FHS/LH. What Diagnostic test would you order to evaluate this further? a. MRI b. FSH/LH again c. LFTs d. Ultrasound

Answer 38

a. MRI

Question 39

AA is an 18-year-old who presents with a 5-day history of very painful vulvar ulcers that began as small "blisters". She is now complaining of a low-grade fever, headache, and bilateral groin swelling. Large, painful vulvar and perineal ulcers and inguinal adenopathy are found on exam. The most likely diagnosis is: a. disseminated gonococcal infection b. primary herpes vulvitis c. secondary syphilis c. lymphogranuloma venereum

Answer 39

b. primary herpes vulvitis

Question 40

Emergency contraception includes all of the following except: a. Insertion of an IUD b. Combined oral contraceptive pills c. Vaginal contraceptive ring. d. Progesterone contraceptive pills

Answer 40

c. Vaginal contraceptive ring.

Question 41

Gonorrhea infections are frequently associated with co-infections by: a. trichomonas b. chlamydia trachomatis c. human papilloma virus (HPV) d. treponema pallidum

Answer 41

b. chlamydia trachomatis

Question 42

A 20-year old client is seeing you for her preventative services and to get started on birth control pills. Which question is most important to ask her? a. Can you remember to take a pill everyday? b. Does your partner use condoms? c. Have you ever had a blood clot? d. When was your last pap?

Answer 42

c. Have you ever had a blood clot?

Question 43

For which client would an intrauterine device be contraindicated today? a. A 20 year old, married, nulliparous woman who plans on having a family someday b. A 23 year old, G1 P1001, Type I diabetic on Humulin pump, mutually monogamous c. A 29 year old, G2 P1102 with five lifetime partners, diagnosed and treated today with chlamydia d. A 35 year old female who is not currently sexually active

Answer 43

c. A 29 year old, G2 P1102 with five lifetime partners, diagnosed and treated today with chlamydia

Question 44

A client is concerned about her risk for breast cancer. Following the initial history, you identify which of the following as a high risk factor for breast cancer? a. History of late menarche and early menopause b. Sister with premenopausal breast cancer c. Mother with fibrocystic breast disease d. Smoking 1 PPD x 10 years

Answer 44

b. Sister with premenopausal breast cancer

Question 45

A 22-year-old female patient has a single, smooth, non-tender, well-delineated, freely movable lump in her right breast. She denies any nipple discharge. Which of the following is the most likely diagnosis? a. Fibrocystic breast changes b. Breast cancer c. Fat necrosis d. Fibroadenoma

Answer 45

d. Fibroadenoma

Question 46

What is the USPSTF recommendation for lung cancer screening? 1. Annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. 2. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. 3. Annual screening for lung cancer with low-dose computed tomography (LDCT) in all adults over 50 years of age with a history of past or current tobacco abuse. 4. 1 & 2

Answer 46

4. 1 & 2

Question 47

Candace, a 28 year old patient complains of vaginal discharge that is heavier than usual and occurs intermittently and started a few months ago. She denies odor or irritation or any pain or cramping and denies urinary symptoms or fever. She has regular periods with a LMP of 2 weeks ago. She is in a monogamous relationship x 2 years and uses the vaginal ring for birth control x 3 months. PMHx: depression; PSHx: negative; STIHx: Chlamydia in her teens with treatment. Your physical exam shows no lesions and you collect a sample of discharge and perform a saline and KOH wet smear with the following results: pH 4.2; whiff/amine odor negative; many epithelial cells; many lactobacilli; negative clue cells; negative trichomonads; few WBCs; negative hyphae What is the most likely diagnosis? a. Bacterial vaginosis b. Vulvovaginal candidiasis c. Chlamydia trachomatis d. Leukorrhea

Answer 47

d. Leukorrhea

Question 48

A 35 year old patient presents to the clinic and wonders if she needs a colonoscopy, she states her mom at age 45 had colon polyps removed. You advise the following; a. Given your family history you will need a routine colonoscopy at age 40 b. You will need a routine colonoscopy at age 45 c. Given your family history you should get a colonoscopy this year, at age 35 d. You will need a routine colonoscopy at age 50

Answer 48

c. Given your family history you should get a colonoscopy this year, at age 35

Question 49

TD is a 22 year old female who presents for physical exam. She has no symptoms, is sexually active with males and females with 4 partners in the last year but no new partners in the last 3 months. She denies IV drug use. What STI testing would you recommend at today's visit? a. Chlamydia, gonorrhea, trichomonas, HIV, Syphilis, and asses for Hepatitis B vaccine completion b. Chlamydia, gonorrhea, trichomonas, HIV, and Syphilis c. Chlamydia, gonorrhea, HIV, and Hepatitis B d. Chlamydia, gonorrhea and HIV

Answer 49

a. Chlamydia, gonorrhea, trichomonas, HIV, Syphilis, and asses for Hepatitis B vaccine completion

Question 50

An 19 year old, nulliparous female complains of cyclic, sharp, cramp, lower abdominal pain that begins on Day 1 of her cycle and lasts for 2-3 days. Menarche at age 13, cycles q 28 days x 5 days with moderate flow. Denies sexual activity. Pelvic exam is normal. Which of the following is the most likely diagnosis? a. Primary dysmenorrhea b. Adenomyosis c. Uterine myomas d. Endometriosis

Answer 50

a. Primary dysmenorrhea

Question 51

A patient presents with complaints of fatigue, aches and chills along with pain in her right breast. She is 12 weeks postpartum with a healthy baby and is breastfeeding. She went back to work a few days ago and has been trying to pump at work. On exam, you note a hard, full, tender right breast with redness and warmth over the outer aspect of the breast. Patient is normotensive with a temperature of 102 degrees F. You diagnose mastitis and your treatment plan will include all of the following except: a. Initiate antibiotic therapy and antipyretics. b. Apply warm compresses frequently and massage the breast while breast feeding or pumping to c. Advise to stop breast feeding or pumping. d. Contact the clinic if symptoms do not improve.

Answer 51

c. Advise to stop breast feeding or pumping.

Question 52

A 27-year-old G1T1P0A0L1 presents to your office for a preconception care visit. She is asymptomatic and has no major past medical history or family history. This visit is likely to include all of the following EXCEPT: a. Reproductive life plan discussion b. Immunization update c. A pelvic ultrasound d. A CAGE questionnaire

Answer 52

c. A pelvic ultrasound

Question 53

You are seeing a 58- year-old female patient for a pre-op evaluation prior to a left carpal tunnel release to be done under block anesthesia. PMH includes breast cancer, HTN, ovarian cancer, and right carpal tunnel release 3 months ago. The patient' exam is negative except for a BP of 150/90. Her BP has been in this range for the past couple of visits over the last year. The patient is on Toprol XL 50 mg qd, but the patient has been having problems adhering to this medication regimen. Which of the following do you recommend in regards to this patient's surgery? a. Order a stress test. b. Cancel the surgery and tell the patient that she can not undergo the procedure until her BP is down to < 120/80. c. Cancel the surgery because she is at increased risk for cardiovascular event during surgery. d. Send the patient to surgery as her current blood pressure does not add to cardiovascular surgical risk.

Answer 53

d. Send the patient to surgery as her current blood pressure does not add to cardiovascular surgical risk.

Question 54

A 45 year old patient presents for a wellness exam and asks about when should he get a colonoscopy? He has no family history of polyps or colon cancer. a. You will need a colonoscopy at age 50, unless you have any change in bowel pattern or alarm findings. b. You are overdue for colonoscopy c. You will need a colonoscopy this year, at age 45 based on the new guidelines and recommendations d. You will start colon cancer screenings at age 50, this can be done with a fit stool test or a colonoscopy.

Answer 54

c. You will need a colonoscopy this year, at age 45 based on the new guidelines and recommendations

Question 55

A 38-year-old G2 P1001 presents for prenatal care at 10 weeks of gestational age. She is feeling well with no c/o problems. Review of her medications show use of a diuretic prior to pregnancy. She reports that her BP typically is 140/90. On physical exam, the patient weighs 280 pounds and her BP, taken with a large cuff is 135/85 supine and 140/95 sitting. She has a mild arteriolar narrowing on fundoscopic exam, a normal cardiovascular exam, a 10-week size uterus, and 1+ lower extremity peripheral edema. Her urine sample dipstick shows neg protein and trace glucose. Based on this information, your initial diagnosis is: a. Pregnancy induced hypertension b. mild preeclampsia c. severe preeclampsia d. Chronic hypertension

Answer 55

d. Chronic hypertension

Question 56

Which of the following is a known risk of unopposed estrogen therapy used in postmenopausal women: a. Endometrial hyperplasia b. Uterine fibroids c. Cervical Cancer d. Lung Cancer

Answer 56

a. Endometrial hyperplasia

Question 57

Gestational diabetes is diagnosed when: a. The Hemoglobin A1C is >8.0% b. The fasting blood sugar is > 90 c. There is sugar in the urine on 2 successive visits 1 week apart d. There are at least 2 abnormal findings on a 3 hour 100 gram glucose tolerance test

Answer 57

d. There are at least 2 abnormal findings on a 3 hour 100 gram glucose tolerance test

Question 58

MB is a 28 year old nulliparous female you are seeing for her annual women's health visit. She has a new male sexual partner (her only sexual partner) and they have been having sex with one another for about one month. MB tell you that her partner has told her that he has had HSV II for about 5 years. MB had an IUD placed for birth control last year. She otherwise is a healthy woman with no ongoing chronic health problems. To her knowledge, she has never been tested for HSV. MB tells you that her boyfriend told her that she only has to worry about HSV acquisition when he has sores, but she says she heard HSV can come from skin "even when there is no sore". You know that HSV transmission can occur even from intact skin. Correct Answer True or False

Answer 58

True

Question 59

Even though she has not had any symptoms, MB would like to know if she has ever been exposed to HSV II. You correctly tell her: a. There is no testing that can be done when you don't have a sore. If you get a sore, then we will culture it for Herpes. b. I can offer you a blood test that will tell you if you have ever been exposed to HSV I or II and help guide if and what your partner needs to consider for potential HSV transmission. You then order a HSV Type Specific IgG antibody test. c. Since your boyfriend has HSV and you have been sexually active for one month. It is likely that you are already exposed, and no testing is necessary.

Answer 59

b. I can offer you a blood test that will tell you if you have ever been exposed to HSV I or II and help guide if and what your partner needs to consider for potential HSV transmission. You then order a HSV Type Specific IgG antibody test.

Question 60

MB finds out that she is HSV negative and wants to reduce the likelihood of acquiring HSV from her partner. You correctly tell her that: a. You should take valacyclovir 500mg daily to reduce the risk that you acquire HSV from your partner. You still want to avoid sexual contanct when he has an outbreak and condoms, used correctly may further reduce risk of HSV transmission. b. Just be sure to avoid sex when your partner has an outbreak, and you are unlikely to get HSV c. If your partner is willing, he can take a daily dose of valacyclovir 500mg once daily if he has less than 9 outbreaks per year. You still want to avoid sexual contact when he has an outbreak and condoms, used correctly may further reduce risk of HSV transmission d. If your partner is willing, he can take a daily dose of valacyclovir 1500mg once daily if he has less than 9 outbreaks per year. You still want to avoid sexual contact when he has an outbreak and condoms, used correctly may further reduce risk of HSV transmission.

Answer 60

c. If your partner is willing, he can take a daily dose of valacyclovir 500mg once daily if he has less than 9 outbreaks per year. You still want to avoid sexual contact when he has an outbreak and condoms, used correctly may further reduce risk of HSV transmission

Question 61

NCEP III guidelines recommend screening everyone for hyperlipidemia at what age? a. Initial screening of all adults at age 35 b. Men age > 35 and Women age > 45 c. Initial screening of all adults at age 20 d. Initial screening of all adults at age 40

Answer 61

c. Initial screening of all adults at age 20

Question 62

B.B. was diagnosed with late latent syphilis by you and treated in your office. His baseline RPR was 1:64. He is HIV negative. He asks you when and if he needs to follow-up with you. According to CDC 2015 guidelines, you correctly tell him that you need to recheck his titer (RPR) in: a. 1 month b. 3 months c. 6 months d. 9 months

Answer 62

c. 6 months

Question 63

Which of the following statements concerning ectopic gestation is correct: a. Abdominal pain, amenorrhea, and vaginal bleeding are noted in all cases of ectopic pregnancies b. Patients feel pain on the side of the ectopic pregnancy in all cases c. Patients are more likely to be symptomatic if implantation is in the proximal portion of the tube d. Ectopic pregnancies are symptomatic from the earliest stages without exceptions.

Answer 63

c. Patients are more likely to be symptomatic if implantation is in the proximal portion of the tube

Question 64

The best time to obtain an ultrasound for dating the pregnancy is: a. 14-16 weeks b. 22-24 weeks c. <14 weeks d. 28 week

Answer 64

c. <14 weeks

Question 65

Which on of the following statements most accurately describes the natural history of human papillomavirus (HPV)? a. Approximately 60% of individuals with genital HPV infections are symptomatic and 50% clear the infection within 3 years. b. Approximately 90% of individuals with genital HPV infections are symptomatic and 20% clear the infection within 5 years. c. Approximately 60% of individuals with genital HPV infections are asymptomatic and 60% clear the infection within 2 years. d. More than 90% of individuals with genital HPV infections are asymptomatic and more than 90% clear the infection within 2 years.

Answer 65

d. More than 90% of individuals with genital HPV infections are asymptomatic and more than 90% clear the infection within 2 years.

Question 66

You recently had a well visit with a 22 year old female who C&G testing was positive for chlamydia, you treat the patient and advise her regarding partner treatment a. Partner treatment should be offered to your last sexual partner b. Partner treatment should include any sexual contacts in the last 30 days c. Partner treatment should include anyone you have had sexual contact with in the last 60 days, if you have not had any partner in the last 60 days, just the last known partner d. Partner treatment is not necessary

Answer 66

c. Partner treatment should include anyone you have had sexual contact with in the last 60 days, if you have not had any partner in the last 60 days, just the last known partner

Question 67

Which one of the following best describes a primary syphilis (chancre) lesion? 1) A large serpiginous ulcer that has a soft, beefy edge and persists for 2-4 days. 2) A painless well-circumscribed ulcer that has a clean base and persists for 1 to 6 weeks. 3) Multiple painful shallow ulcers that have an erythematous base and persist for 3 to 4 days. 4) A painful soft ulcer that persists for 2 to 4 days.

Answer 67

2) A painless well-circumscribed ulcer that has a clean base and persists for 1 to 6 weeks.

Question 68

The presence of which of the following symptoms would make the diagnosis of streptococcal pharyngitis less likely? 1) dysphagia 2) sore throat 3) fever 4) cough

Answer 68

4) cough

Question 69

Patient is a young 18 year old female with left lower quadrant abdominal pain. She is sexually active without use of contraceptives. What is a diagnosis you do not want to miss? A. Ectopic pregnancy B. Ovarian Torsion C. Bacterial Vaginosis D. A & B

Answer 69

D. A & B

Question 70

The CDC and USPSTF recommends HIV one time screening between ages 18-64 years of age. True or False

Answer 70

True

Question 71

A 14 year-old female presents to your clinic with severe right ear pain for the past 3 days. Review of Systems is positive for redness and purulent discharge from her right eye X 1 day. She can swallow small tablets without difficulty, no recent antibiotic use, and no allergies. Vital signs confirm a fever of 101.5R On exam you confirm AOM in the right ear and bacterial conjunctivitis in her right eye. According to the CDC Guidelines, What will your treatment plan include? a. For AOM and bacterial conjunctivitis, treat with Amoxicillin 500mg. Take 1 tab TID for 10 days b. For AOM treat with Amoxicillin 1000mg 1 tab TID for 10 days c. "Wait-and-see" strategy for management of the AOM and for conjunctivitis treat with polytrim eye gtts to left eye QID for 7 days d. "Wait-and-see" strategy for AOM and conjunctivitis

Answer 71

a. For AOM and bacterial conjunctivitis, treat with Amoxicillin 500mg. Take 1 tab TID for 10 days

Question 72

A 7 year-old male presents to your clinic with a sore throat with an exposure to strep at school. No recent antibiotic use, and no allergies. His rapid strep test is positive. VS: Wt 65lb, temp 100.8F, HR 90. What is NOT a first-line antibiotic treatment? a. PCN V 250mg PO BID X 10 days b. Azithromycin 360mg daily for 5 days c. Benzathine PCN G600,000 units IM X 1 d. Amoxicillin 750mg PO BID X 10 days.

Answer 72

b. Azithromycin 360mg daily for 5 days

Question 73

Mrs. Mussorsky is a 45 -year -old woman who presents to you with three days of severe sinus pain that is worsening in the past two days. She is having a fever up to 102.5 degrees F. She is feeling general malaise and decreased appetite. She denies ear pain, but does feel some tenderness and pressure on the upper teeth bilaterally. She denies visual changes or discharge, and does have a minor sore throat. She has stayed away from work for the past two days. Her physical exam is positive for a temp of 102 F and significant tenderness to palpation of the frontal and maxillary sinuses bilaterally. You note a large amount of green/yellow discharge in her nasal passages with erythematous nasal mucosa. Her posterior oropharynx is slightly erythematous but no lesions or discharge noted. She denies cough or SOB. No chest pain. Given her symptoms, her likely diagnosis is: a. Viral upper respiratory infection b. Acute bacterial rhinosinusitis (ABRS) c. Acute strep pharyngitis d. Acute viral rhinosinusitis

Answer 73

b. Acute bacterial rhinosinusitis (ABRS)

Question 74

For Acute bacterial rhinosinusitis (ABRS), what would be the recommended treatment? a. No medications, just self-care and symptom relief measures. b. Augmentin 875 mg BID X 10 days c. Amoxicillin 500mg TID X 7 days d. Azithromycin 600mg daily X 10 day

Answer 74

b. Augmentin 875 mg BID X 10 days

Question 75

Mr. Picasso, an 88-year-old nursing home resident is seen emergently in your clinic for visual loss and severe right eye pain. ON exam you note vesicular lesions on his scalp, eyelids and tip of the nose that have a dermatomal pattern of distribution on the same side as the painful eye. What do you suspect is the diagnosis? a. Uveitis b. Ramsey Hunt Syndrome c. Erysipelas d. Herpes zoster ophthalmicus

Answer 75

d. Herpes zoster ophthalmicus

Question 76

What is your immediate plan for this patient? a. Oral Prednisone 60 mg TID x 10 days b. Send to ER, needs Emergent Ophthalmology exam c. Burrow's solution washes TID until clear d. Oral valacyclovir for 14 days BID

Answer 76

b. Send to ER, needs Emergent Ophthalmology exam

Question 77

Which of the following is NOT part of a laboratory evaluation to further evaluate preeclampsia in a pregnant woman? a. Hemoglobin b. Total Bilirubin c. Alanine transaminase (ALT) & Aspartate transaminase (AST) d. Platelets

Answer 77

b. Total Bilirubin

Question 78

Climbing a flight of stairs without stopping to rest would be considered: a. 1 MET (metabolic equivalent) b. 2 METs (metabolic equivalents) c. 3 METs (metabolic equivalents) d. 4 METs (metabolic equivalents)

Answer 78

d. 4 METs (metabolic equivalents

Question 79

MaryJane is a 68 yr old FM who is in your office for a preoperative H & P for a cataract removal surgery. PMHX: atrial fibrillation - HR is controlled, osteoporosis, dyslipidemia, hx of skin ca; removed s/p TKA in 2004. She is able to walk circles around her husband and continues to do all the housework and food preparation without difficulty. In regards to her surgery follow the ACC/AHA guidelines and determine: a. This is an emergent non-cardiac surgery; no further evaluation is needed and she should proceed to the OR b. This is a low risk surgery and she can continue with plans for elective surgery; no further testing is needed. c. This is not a low risk surgery but her functional capacity is good so she can proceed to surgery with no furter evaluation d. This is not a low risk surgery and her functional capacity is poor so you should manage her based on her clinical risk factors

Answer 79

b. This is a low risk surgery and she can continue with plans for elective surgery; no further testing is needed.

Question 80

ill is a 70 yr old M who recently cardiac stenting X 2 for 90% occluded vessels (6 weeks ago). He also has a h/o diabetes with some mild renal insufficiency. He is hoping to undergo elective abdominal hernia repair and you are doing an H & P. functional status: 2-3 METs The best next step according to the ACC/AHA guidelines is to a. Advise patient since this is emergent, he needs to be sent to the OR! b. Advise patient this is a low risk procedure and no further testing is needed, he can go ahead with surgery as planned. c. Advise patient he is too high risk and will need to wait 3 month and then you will be able to clear the patient. d. Advise patient since he has had a recent cardiac procedure and other comorbidities, it is best to consult with his collaborating cardiologist to determine clearance prior to procedure.

Answer 80

d. Advise patient since he has had a recent cardiac procedure and other comorbidities, it is best to consult with his collaborating cardiologist to determine clearance prior to procedure.

Question 81

A 30 year old male who is otherwise healthy presents with chief complaint of sinus pain and congestion for the past 3 days, he states he has history of reoccurring sinus infections. He states it usually clears with a zpak (azithromycin). What is the best next step? a. Advise patient that you will treat his sinus infection and refer patient to ENT given his reoccurring sinus infections b. Advise patient that sinusitis is diagnosis made clinically and with his sinus pain/pressure and history of reoccurring sinusitis you will prescribe azithromycin c. Advise patient to monitor symptoms for the next week, and if new or worsening symptoms of sinus pain and or fevers to return to clinic for consideration of starting Augmentin d. Advise patient to monitor symptoms for the next week and if new or worsening symptoms of sinus pain and or fevers to return to clinic for consideration of starting azithromycin

Answer 81

c. Advise patient to monitor symptoms for the next week, and if new or worsening symptoms of sinus pain and or fevers to return to clinic for consideration of starting Augmentin

Question 82

According to the ICSI, the four principles to healthier lifestyles include all of the following EXCEPT: a. Adequate physical activity b. Avoidance of multiple sexual partners and sexually transmitted diseases c. Diet that emphasizes fruits and vegetables d. Abstinence from tobacco and avoidance of tobacco smoke e. Avoidance of hazardous and harmful drinking

Answer 82

b. Avoidance of multiple sexual partners and sexually transmitted diseases

Question 83

You are seeing Mr. N, a 34 year old male who reports to you he has two beers every weekday and on weekends will have four beers per day. You know that according to ICS's health lifestyle guidelines, Mr. N is engaging in hazardous drinking behavior. True or False

Answer 83

True

Question 84

Your best response to Mr. N's reported alcohol intake is: a. No response required, Mr. N.'s alcohol intake is not concerning b. "Mr. N, you have got to stop this drinking." c. "Why do you think you are drinking so much?" d. "Mr. N, I'm concerned about your alcohol intake. For a man your age, more than 14 drinks in one week is called hazardous drinking and puts you at risk for health issues and injury. I'd like to ask you a few more questions about your alcohol intake."

Answer 84

d. "Mr. N, I'm concerned about your alcohol intake. For a man your age, more than 14 drinks in one week is called hazardous drinking and puts you at risk for health issues and injury. I'd like to ask you a few more questions about your alcohol intake."

Question 85

Ms. W is a 55 year old woman currently taking atorvastatin (Lipitor) 20mg daily for cholesterol control. She is seeing you today for a preoperative exam for an elective laparoscopic cholecystectomy for recurrent biliary colic. As part of her perioperative medication instructions, you tell her that, "According to ICSI guidelines for perioperative stating therapy you should..." a. "Keep taking the atorvastatin as the usual dose. You can take it in the morning of surgery with sips of water" b. "Stop taking the atorvastatin at least 7 days prior to surgery" c. "Stop taking the atorvastatin when you are NPO at midnight before surgery and restart the day after surgery" d. "Keep taking the atrovastatin but decrease the dose to 10mg per day seven days prior to surgery and return to your usual dose seven days after surgery"

Answer 85

a. "Keep taking the atorvastatin as the usual dose. You can take it in the morning of surgery with sips of water"

Question 86

Ms. L is a 34 year old woman with a BMI of 31%. She is talking with you today about advice for starting an exercise program with a goal of better fitness and weight loss. Currently, she has no regular activity in her life. She states that she does not have time for an aerobics class during her day. The best response to her is: a. Exercise works best when it is completed in at least 30 minute increments so that your heart rate can be sustained at an aerobic rate. You should really try to work out a schedule to accommodate a 30 minute elevated heart rate period. b. Aerobic exercise is best for weight loss. If you can't get that in, it will be difficult to lose weight. c. You can break up the recommended exercise into smaller increments to fit better into your schedule. The best method is to try for at least 10 long period of exercise, but first just getting any activity in is a good accomplishment. d. Can you fit in 30 minutes of swimming a day?

Answer 86

c. You can break up the recommended exercise into smaller increments to fit better into your schedule. The best method is to try for at least 10 long period of exercise, but first just getting any activity in is a good accomplishment.

Question 87

According to Minnesota law, the only reason to opt out of state required childhood or adult vaccines is medical reasons? True or False

Answer 87

False

Question 88

You are seeing a child for regular vaccines today and the schedule includes the 12-15 month MMR vaccine. The child's mother states that she is not sure she wants her child to receive the MMR vaccine as she heard it might be related to autism. The response that indicates use of the "S" aspect of the CASE model for talking with vaccine hesitate individuals is: a. I understand your fear as you want what is best for your child. b. I too want what is best for all my patients, especially your child today. I have studied this issue extensively so I could provide the best information possible. c. Since this connection was first suggested, there have been many studies with well over 500,000 individuals and not one connection between the MMR vaccine and autism has been found. d. I really recommend your child get the MMR vaccine today to help him/her stay healthy.

Answer 88

c. Since this connection was first suggested, there have been many studies with well over 500,000 individuals and not one connection between the MMR vaccine and autism has been found.

Question 89

Mr. L is seeing you today for a complete physical. He received the first and second of the Hepatitis B shots as per the schedule about 3 years ago. He would like to complete the series. According to the CDC, Mr. L. needs to start the series over again and complete three more shots as per the recommended schedule. True or False

Answer 89

False